VIVA IMAGING APPS

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98 Terms

1
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What is FLAIR and what is it used for?

Fluid attenuated inversion recovery

Fluid is suppressed

Thus high areas of signal indicate pathology

`

2
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What MRI fields can cause harm to a patient and how?

Static: biological fields, Can move metal objects and affect implants.

Gradient: heating, acoustic noise, and nerve stimulation

RF (radiofrequency waves): heating, burns, interference with implants

<p>Static: biological fields, Can move metal objects and affect implants.</p><p>Gradient: heating, acoustic noise, and nerve stimulation</p><p>RF (radiofrequency waves): heating, burns, interference with implants</p>
3
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<p>What is the pathology?</p>

What is the pathology?

Skull fracture along lambdoid suture line.

Sits along the suture and the regular suture pattern is abnormal.

Best seen on non-contrast brain bone window.

4
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<p>What is the pathology?</p>

What is the pathology?

Saccular aneurysm: abnormal swelling of brain blood vessel

Rounded shape

Best seen on COW and carotid CT especially post contrast as vessel will enhance.

5
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What is the planning protocol for C+ A/P

Pt position: supine, feet first, hands above head

Scan range: diaphragms to pubic symph

Phase: Post contrast

For viewing bowels oral contrast is given and opacification should be seen in bowels

For other abdominal related pathology IV contrast is given with and arterial and PV phases.

6
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What are the abnormal effects of IV contrast?

Hot flush

Metallic taste in mouth

Feeling that they are wetting themselves

7
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How does IV contrast effect allergies and how can you minimise this risk?

Increases the risk of hypersensitivity reaction if patient has other allergies.

Medications can be taken prior such as antihistamines

8
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How does IV contrast affect beta blockers and how can you minimise this risk?

Taking beta blockers increases the risk of the patient having a moderate to severe reaction to IV contrast.

Intravenous glucagon can be used instead of iodinated contrast

9
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How does IV contrast affect renal function and how can you minimise the risk?

IV contrast is nephrotoxic therefore can cause further renal damage to the already existing condition.

Consult radiologist and identify EGFR

IV hydration is recommended prior to CT scan.

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How does IV contrast affect diabetic patients on metformin and how can you minimise the risk?

Consult radiologist on pt eGFR
lactic acidosis

eGFR>30 low risk of developing lactic acidosis therefore pt can take metformin as normal.

eGFR <30 cease taking metformin 48 hrs prior to CT scan.

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How does IV contrast affect thyroid disease and how can you minimise the risk?

IV contrast can cause thyroxicosis

Need to outweigh risk v benefits

Pt needs to be monitored and an emergency crash kit needs to be located close by.

12
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What is the pathology?

  • Diverticulosis: pockets of air

    branching from the bowel

  • Thickening of the lumen wall

  • Leaking of gas into Abdo cavity

13
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What are the sequences and what is the pathology?

  • T1, STIR, T1FS C+

  • Tissue lipoma- benign tumour made of fat tissue

14
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label each

2- lateral and medial condyles of femur

4- vastus lateralis muscle

5-posterior cruciate ligament

6- anterior cruciate ligament

7- medial meniscus of knee

8- lateral meniscus of knee

9-tibia

10-fibula

15
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What is the protocol planning for a CT thoracic angiogram?

  • Pt position: supine, feet 1st, arms above head

  • Scan range: skin margins above shoulder to iliac crests (aorta bifurcation)

  • Phases: non contrast and arterial phase – we will know we are in arterial phase when the aorta has maximum opacification

  • Recons: axial, sagittal and coronal in angio, soft tissue and lung windows

  • MIPs

  • Rotational VR

16
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Why are the advantages of using MRI for MSK imaging?

  • Non-invasive

  • Non ionising

  • High level of soft tissue detail

  • 3D imaging

  • Low cost compared to diagnostic surgery.

17
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What is the pathology?

  • Ascites: abnormal

    collection of

    intraperitoneal fluid

  • Evidenced by the fluid within the recesses of

    peritoneal cavity

18
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What is T2 Fat Sat and what is it used for?

  • Shows T2 however, fat will now be supressed thus, appear dark.

  • It enhances contrast between pathological changes associated with fluid.

19
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  1. What MRI plane best shows carpal tunnel?

  • Axial plane

  • It can show flattening or oedema of muscles and nerves sitting within the carpal tunnel.

20
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  1. What is T2 weighting and what is it useful for?

  • T2 relies on long time to repetition and long time to echo.

  • Fat and fluid appear bright.

  • It is useful for identifying fluid related pathologies such as oedema.

21
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Phase + pathology?

  • In PVP as there is opacification of

    the portal vein and the liver is also

    opacified

  • Path = small bowel obstruction

  • Small bowel as its characterised by

    the ridged lines

  • Bowels are dilated and we can’t see

    any gas patterns distal to the obstruction.

22
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Label:

23
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What is DWI and what is it used for?

  • Diffusion weighted imaging

  • Areas that have high signal intensity indicates there is restricted diffusion within that area and therefore, a pathological process.

  • Used in tumour characterisation and cerebral ischemia

24
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  1. What MRI imaging plane best demonstrates the glenoid labrum?

  1. • Axial (expand? or)

25
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  1. What are the advantages of scanning brain in MRI?

  • No ionising radiation

  • 3D imaging

  • High level of soft tissue contrast and detail

  • More sensitive and specific for abnormalities within the brain

  • Allows evaluation of structures that may be obscured by artefacts from bone in

    CT images.

  • Gadolinium based contrast is less likely to cause adverse reactions than

    iodinated contrast

26
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What sequences are useful in identifying brain tumours and what does each identify?

27
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What is the phase and pathology?

  • Appendicitis: inflammation of

    the appendix

  • Appendiceal wall thickening

  • This is a A/P C+ scan. Oral

    contrast has been given as there is max opacification seen in the bowels.

28
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What is the pathology?

  • Ischaemic stroke: blood flow to

    the brain has been blocked.

  • Hypodense areas = infarct (dead

    brain tissue)

29
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What is the sequence + pathology?

  • T1 – fat is bright fluid is dark

  • Path = avascular necrosis of the

    femoral head

  • Lost blood supply to the femoral

    head. = bone death

  • Decreased signal = oedema

30
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What is the protocol + pathology?

  • CTPA

  • There is max opacification within the pulmonary arteries therefore contrast was used and it’s in an EARLY arterial phase.

  • Path = pulmonary embolism with an occlusion in the left pulmonary artery

  • Filling defect characterised by hypodense streak within the left pulmonary artery.

  • Coronal MIP = highest attenuation values within the voxel selected

31
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What is the protocol + pathology?

  • Non contrast A/P CT

  • Path = hypodense renal cyst

  • Well defined margins

  • Best seen on Quad Phase Renal

    CT

  • No enhancement therefore,

    composed of water

32
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What is the protocol + pathology?

  • CT non con brain

  • Intraparenchymal

    haemorrhage: brain bleed within the brain parenchyma

  • Hyperattenuating mass posteriorly in the occipital lobe

  • Midline shift

  • Adjacent oedema.

33
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What are the sequences used in MRI MSK and what does each provide?

34
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What is the CT + Pathology?

Abdomen CT C+
- In arterial phase as the abdominal

aorta has maximum opacification • Path = renal cell carcinoma
- Heterogenous mass on the kidney

with poorly defined margins

35
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What is the planning for CT pulmonary angiography?

  • Pt position: supine, feet 1st hands, hands above head

  • Scan range: lung apices to base of lung

  • Phase: minimal scan delay to achieve max opacification in the pulmonary

    arteries only

  • Recons – axial, coronal sag, MIPs in angio, soft tissue and lung windows.

36
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Scan + pathology?

  • Non con CT

  • Path = primary brain tumour

  • Adjacent oedema

  • Double ring sign

  • Contrast phase should be

    done to see if tumour is vascular

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What is the protocol planning for a non con brain CT?

  • Pt position: supine, head 1st , chin tucked in (reduce dose to orbits)

  • Scan range: C2 lamina to skull vertex

  • Phase: non contrast therefore, no vessel enhancement should be seen.

  • Recons: axial, sagittal and coronal soft tissue and bone windows.

38
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What is CT and pathology?

  • Abdomen C-

  • Path = pneumoperitoneum

  • Gas seen anteriorly

  • It has pushed the liver

    posteriorly.

39
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What is the post contrast brain planning protocol?

  • Pt position: supine, head 1st, chin tucked (reduce dose to orbits)

  • Scan range: C2 lamina to skull vertex.

• Phase: delayed phase involves a 5-minute scan delay post contrast injection
- Good opacification in cerebral vessel indicates enough time has passed for the

contrast to pass the blood brain barrier.
• Recons: axial, sagittal and coronal in bone and soft tissue window

40
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What is the planning protocol for a Quad phase liver?

  • Pt position: supine, feet 1st, hands above head (reduce dose to arms and assist

    with dose modulation)

  • Scan range: diaphragm to iliac crests

  • Phases:

  • -  Non contrast: no vessel enhancement

  • -  Arterial: 15-30s delay– arteries should be enhanced

  • -  Portal venous: 50-70s delay – portal vein should be enhanced.

  • -  Delayed: 2-5min delay – portal vein will still be enhanced but not at its maximum

    opacification as in PVP

• Recons: axial, coronal and sagittal in soft tissue and lung windows.

41
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CT + pathology?

  • KUB CT – image presents non-con

  • Path = renal calculi evidenced by the

    hyperattenuating stones seen within the kidney

42
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What appears dark on every MRI scan?

• Tendons and ligaments

43
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On a T1 weighted image oedema appears dark because it has a ---- relaxation time?

Long relaxation time therefore,

protons in (fluid-rich) tissue take longer to realign with the magnetic field, resulting in low signal (dark appearance) on T1 images.

44
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What is the CT + Pathology?

  • Brain CT C-

  • Path = haemorrhagic stroke

  • Hyperattenuating mass

  • Adjacent oedema to the bleed

45
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What is the CT + Pathology?

  • Chest CT C-

  • Path = left sided pleural e`usion

  • Hazy areas of consolidation

46
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What is the most common rotator cuff tendon tear?

• Supraspinatus tendon

47
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What is the CT + Pathology?

  • Brain CT C-

  • Path = subdural haemorrhage:

    blood between the dura and

    subarachnoid matter

  • Characterised by its convex shape.

  • Hyperattenuating spot seen

    laterally and posteriorly.

48
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What is the CT + Pathology?

  • HRCT

  • Path = bronchiectasis: dilation of the bronchial wall due to chronic inflammation

  • Ground glass appearance: hazy areas of increased attenuation through the lung.

  • Bronchial wall thickening

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What is a T1 weighting and what is it most useful for?

  • T1 weighting has a short time to repetition and a short time to echo

  • This is characterised by the appearance of fat as bright on images and fluid as

    dark

  • It is useful in highlighting anatomical detail and useful for pre and post contrast

    studies

50
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51
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Pathology

  • Medial collateral ligament tear

  • High signal intensity within the

    medial aspect of the knee indicative of fluid presence as a result of a pathological process in this case the tear.

52
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CT protocol + Pathology?

  • Brain C-

  • Subarachnoid haemorrhage: brain bleed within the subarachnoid space and pia mater

  • Hyper attenuation within the basal cistern

  • Located around the circle of Willis

53
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CT protocol + Pathology?

  • Brain C-

  • Glioma: tumour that arises within the brain and spinal cord

  • Mass extends across the

54
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CT protocol + Pathology?

  • Brain C-

  • Extradural haemorrhage: bleed between the skull and the dura

  • Convex shape

  • Hyperattenuating

  • Midline shift

55
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CT protocol + Pathology?

  • Brain C-

  • Abscess: fluid filled pockets of infection within the brain parenchyma

  • Ring like structure where the hypodense inner ring is pus and the hyperattenuating outer ring is other fluid.

  • Adjacent phasogenic oedema.

56
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CT protocol + Pathology?

  • C- brain

  • Depressed skull fracture: parts of the skull have sunken into the cranium.

  • There is steps within the cortical margins of the frontal and temporal bones

57
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label

58
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What is the sequence and why?

• T1 – fluid is dark but fat is bright

59
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Label

60
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Sequence + Pathology?

T1,T2

  • Cauda Equina syndrome

  • L5/S1 disk space herniation compressing the cauda equina.

  • Signal intensity is lost in T2 sag as you get to L5/S1 disk space.

61
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Sequences + pathology?

  • Axial=T2,1st sag=T1,2nd sag=T2

  • Anterior disk bulge of L3/4 and L4/5 disks

  • Anterior longitudinal ligament has lost its normal shape as it is being pushed

    anteriorly by the disk bulges.

62
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Label

63
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Sequences + pathology?

  • T1, STIR, T1FS C+

  • Sarcoma within the muscle of the right thigh

  • T1 – lacking symmetry between the left and right thigh

  • STIR – fluid sensitive scan that has picked up fluid involvement hence,

    suggestive of a pathological process.

  • T1FS C+ - vascular involvement has there is high signal from contrast

    situated inside the sarcoma.

64
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Sequences + pathology?

T1

• Syrinx: fluid filled cyst that sits within the spinal cord • Areas of increased signal present

65
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Sequences + why?

T2FS

• Spots of high signal fluid around the humeral head

• Fat is dark hence has been supressed.

66
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Label

67
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Pathology?

• Vertebral tumour that has invaded the spinal cord

68
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Sequence + Why?

T2 – fat is bright and fluid

is bright

69
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Label

70
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Label

71
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Sequence + Why?

  • 1st – T1FS: fluid is dark and

    fat has been supressed

  • 2nd T1FS C+: vessel

    enhancement however T1 characteristics still remain

72
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<p>Label</p><p>\</p><p></p>

Label

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Label

74
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Sequences + Pathology?

  • 1st = T1: the white matter is brighter than the grey matter

  • 2nd = T2: the white matter is darker than the grey matter

  • 3rd = T1 C+: still has T1 characteristics but there is vascular involvement as there is

    increased signal from the lesion

  • Path = intra-axial lesions

75
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Sequence + Why?

PD- proton density

• Fat is bright, fluid is bright, intermediate signal from muscle.

76
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What is the planning protocol for a post contrast CT Chest?

  • Pt position: supine, feet 1st, hands above head (reduce dose to arms and allows for

    accurate dose modulation)

  • Scan range: skin margins above shoulder to diaphragm.

  • Phase: arterial phase (30s delay) should have max opacification in the thoracic aorta

    and its branching vessels.

  • Recons: axial, coronal and sagittal in bone, lung and soft tissue windows.

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Label

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Sequences + Pathology

  • T2, T2FS, T1C+

  • Path = multiple sclerosis

  • Increased signal within the spinal cord confirming the presence of lesions

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Label

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<p>Label</p>

Label

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Label

82
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What is the proton density MRI sequence and what is it used for?

  • Receives signal from areas that have the highest proton density, and these appear

    bright on an image.

  • Fat usually has the highest signal and appears bright.

  • Used for brain imaging as there is good grey and white matter contrast.

  • Also used for MSK imaging.

83
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What is the T1 FS sequence and what is it used for?

  • Adipose tissue appears dark.

  • This allows for tissue characterisation and better visualisation of contrast material.

84
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CT protocol + pathology?

  • Brain C-

  • Path = intraventricular haemorrhage

  • Abnormal hyper attenuation in lateral ventricles indicating the presence of blood.

85
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CT protocol + pathology?

  • Brain C-

  • Path = metastases: spread of cancer from its primary site

  • Ring sign where there is a hyperattenuating capsule

86
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CT protocol + pathology?

  • Chest C-

  • Path = pneumonia: infection of the lungs where pus sits within the alveoli

  • Hazy appearances in lung consistent with consolidation

  • Pulmonary consolidation

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What is patient prep in CT?

  • Positive patient ID

  • Pregnancy status

  • Contrast safety risk.

  • -  Previous allergic reaction to contrast and any known allergies?

  • -  Thyroid issues?

  • -  Kidney disease?

  • -  Diabetes and taking metformin?

  • Removal of radiopaque objects in ROI

  • Practice Breathing instructions prior to the commencement of examination if required.

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CT protocol + pathology?

  • CT thoracic angiogram – delayed arterial

    phase.

  • Path = dissection of the ascending aorta:

    there is a tear in the intima causing

    blood to leak into the media

  • intimal flap

  • dilated ascending aorta.

  • density di`erences within the aorta

89
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What is pathway of IV contrast from the right anti-cubital fossa?

Rt basilic v – Rt axillary v – Rt subclavian v – SVC – Rt atrium – Rt ventricle – Pulmonary a –

pulmonary V – Lt atrium – Lt ventricle – ascending aorta

90
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Label

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What are the disadvantages of using MRI for MSK imaging?

  • Poor bony detail compared to CT

  • Decreased availability

  • Decreased pt compliance – claustrophobia as well as pt movement due to long scan times

  • More expensive

  • Increased safety considerations

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What are IV contrast side e`ects and what can be done to minimise these from occurring?

Side effects:

  • -  Allergic reaction

  • -  Nauseous

  • -  Vomiting, coughing, choking.

• Preventative methods:

  • -  Safety screening prior to giving contrast.

  • -  Having an anaphylactic or emergency kit close by

93
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Label

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Sequence + pathology?

  • 1st = PD: intermediate signal from muscle and fat is bright, image quality is much better

  • 2nd = PD FS: fat has been supressed appearing much darker

  • Path = complete ACL tear: in a normal knee you would see a black band which is the acl sitting

    across the anterior aspect of the tibia and extending to the posterior aspect on the femur. This is not present at all hence, a tear.

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Sequence + pathology?

  • PD, PDFS

  • Path = supraspinatus tendon tear

  • -  You can follow the tendon and see that it stops just above the humeral head rather than

    attaching to the lateral aspect of the head.

  • -  More prominent of the PDFS you can see high signal around the lateral aspect of the humerus

    indicative of a pathological process occurring because of the tear.

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CT protocol + pathology

  • Quad Phase Renal CT

  • Path = hydronephrosis: swelling of the

    kidney and ureters caused by a blockage

    in the path of urine.

  • Significant dilation of kidneys

  • Hyperattenuating calculi causing the

    occlusion of the path of urine from the kidney to bladder.

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What is the planning protocol for a post contrast A/P CT?

  • Pt position: supine, feet 1st, hands above head (reduce dose to arms and allows for appropriate

    dose modulation)

  • Scan range: diaphragms to pubic symphysis.

  • Phases: portal venous phase (50-70s post injection scan delay) – should see max opacification

    in the portal vein

  • Recons: axial, sagittal and coronal in soft tissue and lung windows.

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What is the planning protocol for a high-resolution CT (HRCT)

Pt position: supine, feet 1st, hands above head (reduce dose to arms and allows for appropriate dose modulation)
Scan range: skin edge above shoulders to diaphragms.
Phase: non contrast

Recons:
INSPIRATION – axial in mediastinal, bone and lung window

EXPIRATION – axial in lung window only.