Radiology and Diagnostic Imaging

CHAPTER 20

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Radiology and Diagnostic Imaging Overview• X-rays

– High-energy electromagnetic waves – Travel in straight lines– Shorter wave length than visible light– Able to penetrate solid materials of varying

densities– Capable of exposing a photographic plate

(X-ray film) • Much the same way as a camera exposes film

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• X-rays – Used to visualize internal organs and

structures of body– Provide valuable means for verifying

presence of illness or disease

• Radiology– Study of the diagnostic and therapeutic uses

of X-rays

Radiology and Diagnostic Imaging Overview

PROCEDURES AND TECHNIQUES

Radiology and Diagnostic Imaging

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• Pronounced– (an-jee-oh-kar-dee-OG-rah-fee)– (CAR-dee-ak kath-eh-ter-ih-ZAY-shun)

• Defined– Specialized diagnostic procedure in which a

catheter is introduced into a large vein or artery

– Usually of an arm or a leg, and is then threaded through circulatory system to the heart

Angiocardiography(Cardiac Catheterization)

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Angiography

• Pronounced– (an-jee-OG-rah-fee)

• Defined– Series of X-ray films allowing visualization of

internal structures after the introduction of a radiopaque substance

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Cerebral Angiography

• Pronounced– (seh-REE-bral an-jee-OG-rah-fee)– (SER-eh-bral an-jee-OG-rah-fee)

• Defined– Injection of a radiopaque contrast medium

into an arterial blood vessel (carotid, femoral, or brachial) to make visualization of the cerebral vascular system via X-ray possible

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Renal Angiography

• Pronounced– (REE-nal an-jee-OG-rah-fee)

• Defined– X-ray visualization of internal anatomy of the

renal blood vessels (blood vessels of the kidney) after injection of a contrast medium

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Arteriography

• Pronounced– (ar-tee-ree-OG-rah-fee)

• Defined– X-ray visualization of arteries following the

introduction of a radiopaque contrast medium into the bloodstream through a specific vessel by way of a catheter

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Arthrography

• Pronounced– (ar-THROG-rah-fee)

• Defined– Process of taking X-rays of the inside of a

joint, after a contrast medium has been injected into the joint

• Contrast medium makes the inside of the joint visible

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Barium Enema (BE)

• Pronounced– (BAH-ree-um EN-eh-mah)

• Defined– Infusion of a radiopaque contrast medium,

barium sulfate, into the rectum– Contrast medium is retained in lower

intestinal tract while X-ray films are obtained of the lower GI tract

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Barium Swallow(Upper GI Series)

• Pronounced– (BAH-ree-um SWALL-oh)

• Defined– Oral administration of a radiopaque contrast

medium, barium sulfate, which flows into the esophagus as the person swallows

• X-rays are taken as barium sulfate flows into the upper GI tract

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Bronchography

• Pronounced– (brong-KOG-rah-fee)

• Defined– Bronchial examination via X-ray following the

coating of the bronchi with a radiopaque substance

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Cholangiography(Intravenous)

• Pronounced– (koh-lan-jee-OG-rah-fee) – (in-trah-VEE-nus)

• Defined– Visualizing and outlining of the major bile

ducts following an intravenous injection of a contrast medium

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Cholangiography(Percutaneous Transhepatic)

• Pronounced– (koh-lan-jee-OG-rah-fee) – (per-kyoo-TAY-nee-us trans-heh-PAT-ik)

• Defined– Examination of bile duct structure using a

needle to pass directly into an intrahepatic bile duct to inject a contrast medium

• Also known as PTC or PTHC

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• Pronounced– (koh-lan-jee-oh-pan-kree-ah-TOG-rah-fee)– (en-doh-SKOP-ic RET-roh-grayd)

• Defined– Procedure that examines the size of and the

filling of the pancreatic and biliary ducts through direct radiographic visualization with a fiberoptic endoscope

Cholangiopancreatography(Endoscopic Retrograde)

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Cholecystography(Oral)

• Pronounced– (koh-lee-sis-TOG-rah-fee)

• Defined– Visualization of the gallbladder through X-ray

following the oral ingestion of pills containing a radiopaque iodinated dye

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• Pronounced– (sin-eh-ray-dee-OG-rah-fee)

• Defined– Diagnostic technique combining the

techniques of fluoroscopy, radiography, and cinematography by filming the images that develop on a fluorescent screen with a movie camera

Cineradiography

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• Pronounced– (kom-PEW-ted AK-see-al toh-MOG-rah-

fee)

• Defined– Painless, noninvasive diagnostic X-ray

procedure using ionizing radiation that produces a cross-sectional image of the body

Computed Axial Tomography (CT, CAT)

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Computed Axial Tomography

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Voiding Cystourethrography

• Pronounced– (VOYD-ing sis-toh-yoo-ree-THROG-rah-

fee)

• Defined– X-ray visualization of the bladder and

urethra during the voiding process, after the bladder has been filled with a contrast material

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Digital Subtraction Angiography (DSA)

• Pronounced– (DIJ-ih-tal sub-TRAK-shun an-jee-OG-rah-

fee)

• Defined– X-ray images of blood vessels only, appearing

without any background, due to the use of a computerized digital video subtraction process

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Echocardiography

• Pronounced– (ek-oh-kar-dee-OG-rah-fee)

• Defined– Diagnostic procedure for studying the

structure and motion of the heart via ultrasound

• Useful in evaluating structural and functional changes in a variety of heart disorders

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Fluoroscopy

• Pronounced– (floor-or-OSS-koh-pee)

• Defined– Radiological technique used to examine the

function of an organ or a body part using a fluoroscope

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• Pronounced– (his-ter-oh-sal-ping-OG-rah-fee)

• Defined– X-ray assessment of uterus and fallopian

tubes by injecting a contrast material into these structures

Hysterosalpingography

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Lymphangiography

• Pronounced– (lim-fan-jee-OG-rah-fee)

• Defined– X-ray assessment of lymphatic system

following injection of a contrast medium into lymph vessels in the hand or foot

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Magnetic Resonance Imaging (MRI)

• Pronounced– (mag-NET-ik REZ-oh-nans IM-ij-ing)

• Defined– Noninvasive scanning procedure that

provides visualization of fluid, soft tissue, and bony structures without the use of radiation

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Mammography

• Pronounced– (mam-OG-rah-fee)

• Defined– Process of taking X-rays of the soft tissue of

the breast to detect various benign and/or malignant growths before they can be felt

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Myelography

• Pronounced– (my-eh-LOG-rah-fee)

• Defined– Introduction of contrast medium into the

lumbar subarachnoid space through a lumbar puncture to visualize the spinal cord and vertebral canal through X-ray examination

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Positron Emission Tomography Scan (PET)

• Pronounced– (POZ-ih-tron ee-MISH-un toh-MOG-rah-fee)

• Defined– Noninvasive diagnostic imaging method that

demonstrates the biological function of the body before anatomical changes take place

• Scan produces computerized radiographic images of the body structures when radioactive substances are administered to the patient

– Substances are inhaled or injected

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• Pronounced– (pye-eh-LOG-rah-fee)– (in-trah-VEE-nus)

• Defined– Radiographic procedure that provides

visualization of the entire urinary tract: kidneys, ureters, bladder, and urethra

• Also known as intravenous pyelogram or excretory urogram

Pyelography(Intravenous) (IVP)

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Radiation Therapy

• Pronounced– (ray-dee-AY-shun THAIR-ah-pee)

• Defined– Delivery of ionizing radiation to accomplish

one or more of the following:• Destruction of tumor cells• Reduction of tumor size• Decrease in pain• Relief of obstruction• To slow or stop the spread of cancer cells

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Radiation Therapy• Radiation therapy

– Destroys rapidly multiplying cells regardless of whether they are cancerous

– Goal is to reach maximum tumor control with no, or minimal, normal tissue damage

– May be delivered by teletherapy (external)– May be delivered by brachytherapy (internal)

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Radioactive Iodine Uptake• Pronounced

– (ray-dee-oh-AK-tiv EYE-oh-dine UP-tayk)

• Defined– Examination that determines the position,

size, shape, and physiological function of the thyroid gland through the use of radionuclear scanning

• Image of the thyroid is recorded and visualized after a radioactive substance is given

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• Pronounced– (SCAN-ing)

• Defined– Scanning is the process of recording emission

of radioactive waves, using a gamma camera (scanner)

• After an intravenous injection of a radionuclide material into the particular part of the body being studied

Scanning (Bone, Brain, Liver, Lungs)

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• Defined

– Image of the area being studied is displayed by recording concentration or collection of a radioactive substance specifically drawn to that area

Scanning (Bone, Brain, Liver, Lungs)

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Scanning

• Bone – Involves intravenous injection of a

radionuclide material absorbed by bone tissue• Used to detect spread of cancer to the bones,

osteomyelitis, and other destructive changes in the bones

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Scanning

• Brain – Nuclear scanning of cranial contents two

hours after an intravenous injection of radioisotopes

• Useful in diagnosing abnormal findings such as an acute cerebral infarction, cerebral neoplasm, cerebral hemorrhage, brain abscess, aneurysms, cerebral thrombosis, hematomas, hydrocephalus, cancer metastasis to the brain, and bleeds

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Scanning

• Liver – Noninvasive scanning technique that enables

the visualization of the shape, size, and consistency of the liver after the IV injection of a radioactive compound

• Useful in detecting cysts, abscesses, tumors, granulomas, or diffuse infiltrative processes affecting the liver

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Scanning

• Lung – Visual imaging of the distribution of ventilation

or blood flow in the lungs by scanning the lungs after the patient has been injected with or has inhaled radioactive material

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Scanning

• Spleen – Noninvasive scanning technique that enables

the visualization of the shape, size, and consistency of the spleen after injection of radioactive red blood cells

• Useful in detecting damage, tumors, and other problems

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Single-Photon Emission Computed Tomography (SPECT)• Pronounced

– (single FOH-ton ee-MISH-un

kom-PEW-ted toh-MOG-rah-fee)

• Defined– Nuclear imaging procedure that shows how

blood flows to tissues and organs• Tracking of radioactive material allows physician to

see perfusion of blood to tissues and organs

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Small Bowel Follow-Through• Pronounced

– (Small Bowel Follow-Through)

• Defined– Oral administration of a radiopaque contrast

medium, barium sulfate, which flows through the GI system

• X-ray films are obtained at timed intervals to observe progression of barium through small intestines

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Tomography

• Pronounced– (toh-MOG-rah-fee)

• Defined– X-ray technique used to construct a detailed

cross-section, at a predetermined depth, of a tissue structure

• Useful in identifying space-occupying lesions in the liver, brain, pancreas, and gallbladder

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• Pronounced– (ull-trah-son-OG-rah-fee)

• Defined– Procedure in which sound waves are

transmitted into body structures as a small transducer is passed over the patient’s skin

• Sound waves are reflected back into the transducer and are interpreted by a computer that converts waves to a composite picture form

Ultrasonography(Ultrasound)

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Ultrasonography

• Abdominal ultrasound– Use of reflected sound waves to provide

reliable visualization of the liver, gallbladder, bile ducts, pancreas, kidneys, bladder, and ureters

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Ultrasonography

• Pelvic ultrasound– Noninvasive procedure that uses high-

frequency sound waves to examine the abdomen and pelvis

– Can be used to locate a pelvic mass, an ectopic pregnancy, or an intrauterine device, and to inspect and assess the uterus, ovaries, and fallopian tubes

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• Renal ultrasound– Noninvasive ultrasound of the kidneys that is

useful in distinguishing between fluid-filled cysts and solid masses, detecting renal calculi, identifying obstructions, and evaluating transplanted kidneys

• Thyroid Echogram (ultrasound)– Ultrasound examination important in

distinguishing solid thyroid nodules from cystic nodules

Ultrasonography

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Venography

• Pronounced– (vee-NOG-rah-fee)

• Defined– Technique used to prepare an X-ray image of

veins– Veins are injected with a radiopaque contrast

medium – Phlebography

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X-rays• Pronounced

– (ECKS-rays)

• Defined– Use of high-energy electromagnetic waves,

passing through the body onto a photographic film, to produce a picture of the internal structures of the body for diagnosis and therapy

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X-rays

• Chest X-ray– Visualization of interior of chest– Provides diagnostic information about:

• Tumors, inflammation, accumulation of fluid, accumulation of air, bone fractures, diaphragmatic hernia, size of heart, calcification, placement of centrally located intravenous access devices

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• Chest X-ray views– Posteroanterior (PA)

• X-rays pass through the posterior (back) to the anterior (front)

– Lateral• X-rays pass through the person’s side

– Oblique• X-rays are taken from different angles

– Decubitus• X-rays are taken with person in recumbent lateral

position – aids in localizing fluid

X-rays