residents review session slides
TRANSCRIPT
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De artment of Radiolo ,
Vancouver General Hospital
..
Director of ER/Trauma RadiologyDirector of ER/Trauma Radiology
[email protected]@vch.ca
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Note: NO NEW SLIDES! All Review
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Lecture 1- Introduction to Imaging Modalities
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Overview of imaging modalities
X-ray systems
Radiography (plain films, fluoroscopy, angiography)
ompu e omograp y
Nuclear Medicine NM / Positron Emission Tomo ra h PET
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Radiography
5 major densities are found on
radiographs, and aredemonstrated on this ima e
Air - fat - water - bone - metal Soft t issue
Lower Higher fat
Note that THICK structuresattenuate more radiation thanTHIN structures of the same bone
ai r
metal
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Fluoroscopy
Continuous low dose radiography used to monitorpart of the body in real-time
Often used in conjunction with contrast, can behelpful to evaluate motion such as
Used less commonly in
NB: Contrast is anexogenous agent used to
structure
Barium Swallow
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CT Views
x a
Coronal
CT Sagittal
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Hounsfield Unit (HU)
ColonGall bladder
-1000 HU6 HU
LiverFat -120
Air -1000; fat -100; water 0; blood 30 ; bone 500+ HU
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MRI Images
T1 weighted T2 Weighted
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Ultrasound (US)
1 2Anechoic
3Echogenic
Shadow
Hypo-echoic
Longitudinal cross section of the gall bladder. Fluid in bladder shows noreflections (1) whereas calcified stones (2) show strong reflections withdecrease of signal beyond (3)
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Nuclear Medicine - Bone Scan
show higher retention of radio-
labelled bone seekin a ent
Hot spot
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Nuclear Medicine Positron Emission Topography (PET)
Positron Emission Tomo ra hPET uses fluorine-18 which is a
positron emitter. Positron emissionproduce photons that can beimaged. CT
Fluorine-18 can be incorporatedinto biologically active moleculessuch as fluoro-18-deoxyglucose
PET
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Lecture 2- Imaging of the Spine
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Radiograph Views of the Spine
Anterior-Posterior (AP) Lateral
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Lateral View of Cervical Spine
Dens
Anterior arch of CI
Posterior arch of CI
CII Vertebral Body Pedicle(best seen on oblique image)
Superior Articular ProcessCIII
CIVCIII-IV Vertebral Disc
CVIIntervertebral Foramen
Transverse Process
Spinous Processes
CVII
TI
(best seen on oblique image)
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AP View
From the AP view, thoracic and lumbar vertebrae create an owl appearance:
Eyes are pedicles
Beak is spinous process
Face is vertebral body
Ears are transverse processes
CVII Vertebral Body
Right Pediclesof CVII & TI
Spinous Processes
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Ri ht IntervertebralPedicle
Foramen (CIII nerve)
CIV Vertebral Body
Spinous ProcessesInferior Articular Process
Superior Articular Process
Oblique
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Radiographical Views: X-ray
Odontoid
Dens and body of CII centre
Lateral masses of CI right and left
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CT Images
DensAnterior archDensAnterior arch
Foramentransversarium
Right lateralmass Left lateral mass
Right lateralmass
Left lateralmass
Posterior arch
This is CI (Atlas)
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Anteriorarch CI
Dens
ver e rabody
S inalcanal
SpinousProcesses
Intervertebraldisc space
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S inous
S inal Cord
Process
(dark on MR)
CSF surrounding thecord li ht on MR
Vertebral Body
Intervertebral Disc
(cannot differentiateannulus from nucleusdue to age related
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Thoracic Lateral
Vertebral Bodies
Intervertebral disc spaces
Intervertebral foramen
Inferior Articular Process
Superior Articular Process
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CT Sagittal
Vertebral bodies
Inferior articular
foramen
Intervertebral disc spaces
Pedicles Superior
process
Pars
interarticularis
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X-ray Lumbar AP
12th rib
TransverseProcessesSpinous
rocesses
Intervertebral
Sacrum
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Lecture 3- Imaging of the Shoulder
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AP View 1. Clavicle acromial end2. Clavicle- sternal end
3. Acromion4. Coracoid process
34
2
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5. Glenoid cavity6. Humerus greater
tuberosit
AP View
7. Humerus lessertuberosity
8. Head of humerus
67
85
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9. Surgical neck ofhumerus
AP View
.humerus
11. Supraglenoidtubercle
. n rag eno tu erc e11
10
9
12
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1 borders of thescapula indicated
by the yellow
3
arrows
1. Lateral border2. Superior border
3 B) What are the
.
scapula indicatedby the green
arrows?
1 1. Superior angle2. Inferior angle3. Lateral angle
2
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Lateral View 1
23
7
4.
2. Acromion
3. Coracoid process
5
4. Spine of scapula
5. Head of humerus
6
6. Humerus
7. Superior angle of scapula
.
8
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Axillary View
1. Humerus
2. Coracoid Process3. Clavicle
5. Greater tuberosity6. Lesser tuberosity7. Intertubercular sulcus
9. Anatomical neck10. Surgical neck11. Acromion
. eno cav y 8. Head of humerus
5
1
3
8
6
9 4
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Radiograph Views of the Elbow
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Radiograph Views of the Elbow
AP View Lateral View
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Lateral View of Elbow
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Lateral View of Elbow1. Shaft of Humerus2. Trochlea
. ecranon4. Coronoid Process5. Head of Radius6. Radial Tuberosit7. Tuberosity of Ulna
1
25
46
Trochlear Notch
37
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Lecture 5- Cross Sectional Imaging of the Chest
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Full size axial CT with contrast
7
8
1
23 4
5
6
.
2. Trachea
3. Brachiocephalic Artery
.
6. Right Subclavian Vein
7. Right Internal Jugular Vein
Artery and Right Subclavian Artery)
4. Left Common Carotid Artery
.
9. Left Subclavian Vein
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Full size axial CT with contrast
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Full size axial CT with contrast
3
1
2
(4)
1. Esophagus
2. Descending Thoracic Aorta
3. Inferior Vena Cava
(4. Liver)
Full size coronal CT with contrast
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Full size coronal CT with contrast
1
5
6
7 8
4
3
(9)
(10)
1. Trachea
2. Pulmonary Trunk
6. Superior Vena Cava
7. Right Brachiocephalic Vein
.
4. Aortic Sinus
5. Brachiocephalic Artery
.
(9. Right Atrium)
(10. Left Ventricle)
Full size coronal CT with contrast
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Full size coronal CT with contrast
1
4
5
3
6 7
8
1. Trachea2. Pulmonary Trunk
6. Right Brachiocephalic Vein7. Left Brachiocephalic Vein
.
4. Brachiocephalic Artery
5. Left Common Carotid Artery
.
9. Inferior Vena Cava
Full size coronal CT with contrast
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Full size coronal CT with contrast
12
3
4
5
6
1. Esophagus 5. Right Pulmonary Artery
.
3. Aortic Arch
4. Left Subclavian Artery
.
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Full size coronal CT with contrast
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Full size coronal CT with contrast
1
2
1. Esophagus 2. Descending Thoracic Aorta
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Lecture 6- Imaging of The Cardiac Anatomy
Heart borders (anterior)
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Superior vena cava
ort c root u monary artery
Right atrium
Right ventricle
Heart borders (right lateral)
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Aortic root
Right atrium
Right atrial appendage
Right ventricle
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Radiology Anatomy of the ThoraxAxial View
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Right Atrium
pulmonary vein
Descending Aorta
Radiology Anatomy of the ThoraxAxial View
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Ri ht ventricle
Tricuspid Valve
coronary sinus
Radiology Anatomy of the ThoraxAxial View
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ModeratorBand
LeftVentricle
Valvular Anatomy: Pulmonary Valve
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Tricuspid + Mitral valves
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Radiology Anatomy of the ThoraxCoronal View
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Aorta
Pulmonary ArteryAscending
Aorta
Left Ventricle
Right Ventricle
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Volume rendered heart (anterior)
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ort c root
Left anterior descending
coronar arter
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Volume rendered - Left lateral
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Left Circumflex
LAD coronary artery
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Left coronary artery branches
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Circumflex artery
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Lecture 7- Imaging of CXR
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SternumSternum
bodiesbodies
abuttingabuttingretrosternal spaceretrosternal space
Left AtriumLeft Atrium
Posterior margin ofPosterior margin of
LT ventricleLT ventricle
Normal Lateral Chest
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Pneumothorax - Air in Pleural Space
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pleura
pleura
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Right Upper, Middle and Lower Lobes
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RUL
RUL
RLL
RML
RML
RLL
Left Lower and Upper Lobes
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LUL
LLL
LLL
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Lecture 8 Imaging of Abdominal X-Ray
GASTROINTESTINAL SYSTEMInterpreting the Abdominal Radiograph
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Routine 3 Views:
Supine AP abdomen Erect AP abdomen Erect chest x-ray
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LiverSpleen
Stomach
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Left kidneypedicle
Hepatic
flexure
Left psoas
margin
p nous process
Left sacroiliacjoint
Left hi oint
Symphisis pubis
Soft Tissue
LiverSpleen
Stomach
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Left kidne
Hepaticflexure
Left psoas
Bone
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Spinous
Pedicle
Right iliaccrest
Left
Right
acetabulum sacroiliac
joint
Right femoral
head
Bowel Gas
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Bowel Gas
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Lecture 9 Cross Sectional Imaging of the Abdomen
Upper abdomen axial viewlevel of the pancreas and L1
1212
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1212
4
2
4
5
5
2
13
7
89
9
10
61
11 11
1. Liver
2. Stomach3. Pancreas
8. Abdominal aorta
9. Inferior vena cava10.Right crus
.5. Large intestine6. Intra-abdominal fat
7. Spleen
.12. Rectus abdominus
Mid-abdomen axial viewlevel of kidneys and L3
10
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10103 2 3
78
6 99
8
7 454 1
51
1. Liver2. Ascending colon3. Transverse colon
7. Abdominal aorta8. Inferior vena cava9. Psoas muscle
4. Descending colon5. Small intestine6. Left kidney
10.Rectus Abdominus
Lower abdomen - axial viewlevel of L5
4
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4
10
19
8
8 233
10
55766
7
1. Transversus abdominusmuscle 6. Quadratus lumborum muscle7. Lumbar vertebral body.
3. External oblique muscle
4. Rectus abdominus
5. Psoas muscle
.9. Descending Colon
10.Small Intestine
Mid-Sagittal view
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21. Abdominal aorta2. Liver
2
13. Small intestine1
3
3
Right Para-Sagittal view
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64. R Kidney5. Quadratus
46
5
lumborum muscle6. Liver
5
Left Para-Sagittal view
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7 64. L Kidney5. Quadratus
7
44
lumborum muscle6. Stomach
7. Spleen
5
Vascular Review
.
2. Left CommonIliac Artery
3 Ri ht C
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3. Right CommonIliac Artery
4. Left External
Iliac Artery.
Iliac Artery6. Inferior Vena
Cava
1
6
2
3
4
5
Coronal view
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31 3
42
2
4
57
5
7
6 6
1. Liver2. Gallbladder
5. Descending colon6. Rectum
. omac
4. Small intestine
. scen ng co on
Coronal view
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2
55
6
. un us o s omac2. Body of stomach
3. Pyloric antrum of stomach
. ar a no c5. Psoas muscles
6. Iliacus muscle
Coronal view
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1
3
4
3
55
66
1. Liver2. Spleen
3. Left kidne
5. Gluteal muscles6. Rectum
4. Psoas muscle