MFDS Anatomical Aspects of Radiology

(Anatomy, Differential Diagnosis and the Basis of Pathology and Radiology)

Professor Peter Abrahams23 November 2004

Anatomy Seminars 2004/2005

Clinical Dental Sciences

AIMS

• REDUCE RADIATION• INTRODUCE “GOLD STANDARD”• STRUCTURES –MODERN TECHNIQUE• “BEST VALUE” – SOCIETY AT LARGE• STIMULATE DISCUSSION • INTRODUCE RCR GUIDELINES

IMAGES

• DO I NEED IT ?• DO I NEED IT NOW ?• DID SOMEONE DO IT BEFORE ?• HAVE I EXPLAINED THE PROBLEM ?• BEST TECHNIQUE / VIEW ?

MEDICO - LEGAL

• CLINICAL GROUNDS ONLY ?• ALTER MANAGEMENT ?• NOTE KEEPING- JUSTIFICATION ?• RCR GUIDELINE ADVICE• “DO SOMETHING” –PROTECTION

RADIATION EXPOSURE

4.5 yrs500CT. ABD/PEL3.2 yrs350BA ENEMA

16 months150BA MEAL7 months65LUMBAR

31CXR1 day0.5limbs

Natural radiation

CXR. equivalent

Examination

H

Fish-bone

LUMP

Barium swallow, Phanrygeal pouch due to Killian’s Dehiscence, Known also as Zenker’sDiverticulum. NB.HIGH Tone in Cricopharygeus muscle-This spasm causes the Pouch

Cricopharygeus Pouch

**

Parotid sialogram with strictures-*

Stone

Submandibular- Wharton’s Duct stone

Plain Xray- stone

Kick-boxfracture

Oedema

f

f

f

A

Normal sinuses with AIR “A” Blocked sinuses with Fluid “f”

A

T

SubmandibularCarcinoma –axial CT

T

Coronal CT nasal cavitycarcinomaNB Bone

T

Axial CT Lymphoma of Maxillary Sinus

Bony erosions in bilateral Glomus Jugulare Tumours

Coronal T1 wt + Gadolinium

T

T

CC= Common CarotidIC= Internal CarotidEC= Ext. Carotid

IC

CC CC CC

IC IC

DSA-Tumour DSA- post embolisation

EC

Carotid DSA, Arterial phase NB IC / ECdisplacement

IC

EC

Late arterial pathologicalVasculature= highlyvascular tumour

Saturday night knife -fight in St. Vincent W.I.- two days later patient complains of lump in root of neck, just above clavicle and an “orange “under his arm.What does this angiogram show?

Lymphadenopathy (Bilateral)Posterior Triangles

** =?

*

*= ?

Presented with lump inneck above clavicle and Typical facial appearance

Parotid PleomorphicAdenoma Axial T2 wt

Normal Parotids

*

*

*

Radionuclide thyroid scan- Multinodular Goitre

Sinogram

Thyroid Arteriogram

Thyroid MRI & DSA

Radionuclide Parathyroid Thallium

- 201 Scan

PARATHYROID Adenoma

Iodine-123 SubtractionScan NB. No Iodineuptake by Parathyroid

ULTRASOUNDULTRASOUND• REGIONAL ANATOMY-

eg. abdominal pain• NO RADIATION ? harm• CHEAP & MOBILE• BUT OPERATOR • POOR HARD COPY

• REGIONAL ANATOMY-eg. abdominal pain

• NO RADIATION ? harm• CHEAP & MOBILE• BUT OPERATOR • POOR HARD COPY

D.S.A.D.S.A.• VENOUS (IV DSA)• CAPILLARIES• ARTERIAL via venous (IA DSA)MANUAL SUBTRACTION• ? MRI for FUTURE ANGIO

• VENOUS (IV DSA)• CAPILLARIES• ARTERIAL via venous (IA DSA)MANUAL SUBTRACTION• ? MRI for FUTURE ANGIO

C.T. SCANSC.T. SCANS

• BONE DEFINITION 1mm. slice• SPEED• 3D POTENTIAL• SPIRAL CT

• BUT RADIATION 400 CXR• AXIAL ONLY-usually cf. ENT

• BONE DEFINITION 1mm. slice• SPEED• 3D POTENTIAL• SPIRAL CT

• BUT RADIATION 400 CXR• AXIAL ONLY-usually cf. ENT

M.R.I. SCANSM.R.I. SCANS

• REGIONAL ANATOMY• ALL PLANES• SOFT TISSUES • 1.Brain 2.Muscles 3. IVD• TISSUE PLANES• NO RADIATION ? harm.• BUT......COST

• REGIONAL ANATOMY• ALL PLANES• SOFT TISSUES • 1.Brain 2.Muscles 3. IVD• TISSUE PLANES• NO RADIATION ? harm.• BUT......COST

DOCTOR’S Guide to Radiology

Making the best use of Department of Clinical Radiology"Royal College of Radiologists , UK “Guidelines for Doctors” 5th Ed. 2003