Dr' Jay Shahed

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By Dr. Jay Shahed
Radiology
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Definitions

• Radiology
• Is the study of disease using radiant energy.
• X-ray
• Radioactive substances
• Gamma rays
• U.V rays
• Alpha Beta particles
• Sound waves.
• Magnetic waves.

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• Cassette
• A light proof aluminum folder that holds the
  x-ray film.
• Density
• The quality of permeability to rays
• Dark or light
• Ionization
• energy given off by radioactive atoms and
  molecules.

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• Irridiation
• Exposure to radiation.
• Lead screens
• Shields that are used to separate x-ray personnel
  operating the controls of the machine from the
  patient receiving the radiation.
• Radiolucent
• Ability to absorb radiation
• Bone - Dense - White.

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• Radiopaque
• Material that blocks the passage of the radiation
  beam
• Radiogram
• Is a picture of internal body structures produced
  by the action of gamma rays or x-rays on a
  special film.
• Radiography
• Is the process of taking of radiograms.
• X-RAYS

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• Roentgen rays
• The radiological unites
• Also referred to as RAD or REM

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Radiological procedures

• Diagnostic Radiology
• Radiation Therapy
• (Radiation Oncology)
• Nuclear Medicine

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• DIAGNOSTIC RADIOLOGY

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• PREPARATION
• OF PATIENT
• AND
• ASSISTING WITH
• RADIOGRAPHS

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PROCEDURE

• Identify the patient
• Check if the special preparation was followed
  (when applicable), and explain the following
• The value of the examination
• How the machine operates
• Whether it will hurt
• What clothing and other articles must be removed
• How to put on the patient gown (that is, with the
  opening in the front or back)
• What position will be required
• The importance of remaining still during the
  examination

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• Drape the patient as necessary.
• Shield the abdominal regions with a lead apron,
  especially for patients who are pregnant,
  patients of childbearing age, or children.
• Reassure the patient as required.
• Offer assistance to the patient when getting on
  and off the x-ray table.
• Remain calm and quietly cheerful.

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• Be empathetic and courteous
• The patient will be lying on or standing against
  a cold, hard plate. In an empathetic and
  courteous manner, emphasize the importance of
  remaining still in the proper position.
• When the examination has been completed by the
  physician or x-ray technician or radiographer,
  ask the patient to wait in the dressing room
  while the films are developed.
• If it is necessary to obtain another film,
  explain to the patient that the physician
  requires another film for study.

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• Dismiss the patient after it has been determined
  that the films are satisfactory.
• If the x-ray film showed the presence of a
  fracture, make arrangements for immediate
  treatment.
• The physician will read the films later and
  notify the patient.
• Schedule a future appointment for a time when the
  physician can review the results with the
  patient.
• Record the procedure on the patients chart.

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Hazards of X-rays

• The direct x-ray beam itself from the x-ray
  machine, which travels through an opening in the
  x-ray tube.
• Scattered radiation.
• The abdomen and reproductive organs should be
  shielded with a lead apron or cover when a
  patient is having a x-ray examination.

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The Medical Assistants responsibilities

• Prepare the patient
• Provide reassurance when needed
• Employ safety measures relevant to x-ray
  equipment.
• When the physician employs a x-ray technician,
  the assistant may not do any of these functions.
• Call the radiologists office or hospital x-ray
  department to schedule the examination.

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• Furnish the patients name, the referring
  physicians name, and the type of examination(s).
• Inform the patient of the approximate amount of
  time the examination(s) should take.
• Give the patient any special directions required
  for the examination.

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Terms to know

• Radiological views
• The view that you are seeing the film.
• Radiological positions
• The position that you place the patient body part
  closest to the film.
• Radiological projections
• The side of the body that the beam is projected
  on to.

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Views with the prefix representing the beam
projection.

• Anteroposterior
• Position the back closest to the film
• KUB ( Kidney, Ureter, Bladder)
• Posteroanterior
• Position the front closest to the film
• CHEST X-RAY

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• Left lateral
• position the left side closest to the film
• CHEST X-RAY
• Right lateral
• Position the right side closest to the film
• CHEST X-RAY

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Views with the prefix representing the body part
touching the film.

• Right posterior oblique
• The right posterior angled side of the back is on
  the film
• Right kidney
• Left posterior oblique
• The left posterior angled side of the back is on
  the film
• Left kidney

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• Right Anterior Oblique
• The right anterior angled side of the back is on
  the film
• Ascending Colon
• Left Posterior Oblique
• The left posterior angled side of the back is on
  the film
• Descending Colon.

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• PROCEDURES
• USING
• RADIOPAQUE CONTRAST MEDIA

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CONTRAST MEDIA

• A contrast medium is a radiopaque substance that
  is used in diagnostic radiology to permit a more
  accurate visualization of internal body parts and
  tissues in contrast to their adjacent structures.

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Types of Media

• Positive contrast media
• Include
• Barium sulfate
• Iodine
• It absorbs radiation.
• Appears white on x-ray images.
• Negative contrast media
• Include
• Air, gas, and carbon dioxide.
• Appears black on x-ray images.

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Note

• X-ray examination not using a contrast medium are
  done before examination that do use a contrast
  medium.

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ANGIOGRAM

• Angio vessel gram recording
• X-ray record of blood vessels
• Contrast medium is injected through a catheter
  that is inserted into the appropriate vessel
• Arteriogram
• Lymphangiogram
• Phlebogram
• Time required 1-3 hours.

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ANGIOCARDIOGRAM

• X-ray record of the heart and great vessels
• Contrast medium is injected through a catheter
  into a large peripheral vein or a chamber of the
  heart by direct heart
• Time required 2 hours.

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ARTERIOGRAM

• X-ray record of an artery or arterial system
• Contrast medium is injected through a catheter
  which is inserted into an artery.
• Time required 1-3 hours.

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ARTHROGRAM

• X-ray record of a joint.
• A contrast medium, air or other gas is injected
  into a joint.
• Air can be combined with an iodine compound for
  double contrast studies.
• Time required 1 1/2hours.

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BRONCHOGRAM

• X-ray record of the bronchial tree and lungs
• Instillation of a contrast medium into the
  bronchi via the trachea with a special
  instrument.
• This procedure is almost extinct since the
  introduction of the new more sophisticated
  modalities.
• Time required 1 hour.

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CEREBRAL ANGIOGRAM

• X-ray record of the cerebral vessels
• To check the arteries of the brain
• a contrast medium is injected into the common
  carotid artery, the dye will travel into the
  vessels of the posterior fossa of the occipital
  lobes,
• To check the veins
• The medium could be injected into the vertebral
  artery in the neck .
• Time required 2-3 hours.

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CHOLECYSTOGRAM

• X-ray record of the Gallbladder
• An oral ingestion of radiopaque granules or
  tablets taken the evening before the examination.
• Time required 1-2 hours.

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DISKOGRAM

• X-ray record of the vertebral column
• The contrast medium is injected into an
  Intervertebral disk.
• Time required 1 hour.

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HYSTEROSALPINGOGRAM

• X-ray record of the uterus
• The contrast medium is injected into the
  fallopian tubes after injecting it through the
  vagina first into the uterus.
• Time required 1 hour.

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INTRAVENOUS CHOLANGIOGRAM

• X-ray record of the bile ducts
• Inject the contrast medium intravenously.
• The contrast medium is excreted by the liver into
  the bile ducts
• X-ray films are taken at intervals as the
  contrast medium is excreted through the hepatic,
  cystic and common bile duct into the duodenum.
• Time required 3 hours.

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INTRAVENOUS PYELOGRAM (IVP)

• X-ray record taken at intervals after intravenous
  injection of a contrast medium at intervals to
  observe the excretion rate and the concentration
  of the dye in the Renal Pelvis and the outline of
  the Ureters and Urinary Bladder.
• Time required 1 1/2 hours.

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LOWER GI

• Outlines the colon for study after the
  instillation of the barium mixture through an
  enema.
• Take 4 tablets of caster oil at 400 PM.
• No solid food since after
• NPO after mid-night
• Rectal suppository in the morning
• Time required 1/2 - 1 hour.

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LYMPHANGIOGRAM

• X-ray record of the
• After the injection of a contrast medium into the
  lymphatic system.
• Time required 1 hour.

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MYELOGRAM

• X-ray record of the spinal cord after injection
  of a water-soluble or an oily contrast medium,
  air, or gas (carbon dioxide) into the
  Subarachnoid space through a lumbar puncture
  needle.
• Time required 1 hour.

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RETROGRADE PYELOGRAM

• X-ray record of the urinary tract after
  introduction of a contrast medium through a
  urinary catheter into the ureters and pelvis of
  the kidneys.
• Time required 1-1 1/2 hours.

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UPPER GI ( Barium meal, Barium Swallow)

• Is the oral ingestion of the barium mixture to
  outline the esophagus, stomach, and if ordered,
  the small intestine depending on the physicians
  request.
• NPO
• No cigarettes
• No fluids
• Empty stomach
• Time required 1/2 - 1 hour.

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UROGRAM

• X-ray record of any part of the urinary tract
• An intravenous injection of a contrast medium.
• Time required 1 hour.

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• PROCEDURES
• NOT USING
• RADIOPAQUE CONTRAST MEDIA

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Bone x-ray films.

• X-ray records are made of bones suspected of
  disease or trauma such as tumors and fractures or
  displacement.
• Spinal X-ray
• studies of the Vertebral Column.
• Radiographs of the neck are referred to as
  Cervical x-ray films
• Middle back are referred to as Thoracic x-ray
  films
• Lower back are referred to as Lumbosacral x-ray
  films.

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Plain Chest

• Routine chest x-ray film.
• An x-ray of the chest is obtained with the
  patient in the Posteroanterior erect position.
• PA Lateral Views
• Time required 20 minutes.

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FLAT ABDOMEN

• Plain X-Ray of the abdomen
• Positions taken
• Erect, supine, prone, or lateral decubitus
  position
• Abnormal conditions of the abdomen
• Fluid levels (Ascitis), intestinal obstruction
  tumors, abscesses, enlarged or perforated organs,
  or Hematomas
• Time required 20 minutes.

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KIDNEY URETER AND BLADDER ( KUB )

• A film of the abdomen is used to study
• Kidneys, Ureter and Bladder
• Flank area
• Abdominal gas patterns
• Abdominal wall
• Bones of the pelvis
• Unusual abdominal masses.
• Time required 45 minutes.

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Mammography

• An x-ray examination of the breast
• To identify breast lesions or tumors
• Involves detection of the radio-dense tissue or
  calcification.
• It is the most effective method for detecting
  early and curable breast cancer.
• The patient should be asked not to wear any
  powder or deodorant on the day of the
  examination, because these products sometimes
  show up as artifacts on the x-ray images.
• ACS recommendation once/year after 40y/o
• Time required 1/2 - 3/4 hour.

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Skull series

• Skull series.
• A series of radiographs of the skull is used to
  determine
• Cranial injuries
• Effects of trauma to the head and neck.
• Skull fractures
• Time required 20 - 30 minutes.

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Paranasal sinuses

• Paranasal sinus series.
• X-ray records are made of the sinuses
• Frontal
• Ethmoid
• Sphenoid
• Maxillary
• Sinus congestion polyps
• Time required 20 - 30 minutes.

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FLUOROSCOPY

• Is used during x-ray examinations for visual
  observation of the internal body structures.
• The body part to be viewed is placed between the
  x-ray tube and a fluorescent screen.
• As x-rays pass through the body, shadowy images
  of the internal organs are projected onto the
  screen.
• Usually a contrast medium is used.

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• Fluoroscopy is the visual examination by means of
  an image intensifier.
• The major advantage of the fluoroscope over the
  usual type of x-ray film is that the action of
  organs, joints or entire body systems can be
  observed in motion.

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COMPUTERIZED TOMOGRAPHY ( CT-scan )

• Most effective in areas of high contrast
• Lungs and bones.
• Could be an out patient procedure.
• NPO for 4 hours
• Time required 1-2 hours.

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MAGNETIC RESONANCE IMAGING (MRI)

• It is a computer-based, cross-sectional imaging
  modality that examines the interactions of
  magnetism and radio waves with tissue to obtain
  its images.
• One advantages of MRI is that
• X-RAY are not used
• This lowers the risk of genetic mutations.

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• MRI is a painless and noninvasive procedure.
• MRI is used to detect tumors in soft tissue.
• MRI can detect Septal heart defects.
• MRI cannot see the hard parts of bones.
• Time required 1 hour.

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ULTRASOUND

• Diagnostic procedure that uses very high
  frequency inaudible sound waves
• The waves bounce off the body structure of
  internal organs.
• The procedure produces a record that is called an
  echogram or sonogram.
• Safe to use on a pregnant woman
• Painless.
• Oscilloscope
• A microphone that is used for visualizing the
  shape or waveform of sound waves
• Time required 1 hour.

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HAZZARDS OF RADIATION

• Radiation detector tag
• Controls overexposure of radiation.
• Overexposure results
• Tissues may begin to break down.
• Blood cells, skin, eyes, and reproductive cells
  are some of the tissues most sensitive to
  radiation.
• Lowered RBC and WBC count
• Burns on the skin
• Cancer, damage to the germinal cells in the
  ovaries and testes

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• Damage to a fetus
• especially in the first 3 months of pregnancy.
• Radiation also apparently predisposes individuals
  to the development of cataracts.
• Studies have shown that massive prolonged
  exposure to radiation can result in a higher
  incidence of cancer
• Especially of the lymph glands, and the various
  type of leukemia.

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Iodinated contrast media

• Interfere with thyroid studies performed by the
  nuclear medicine department, therefore procedures
  using the iodinated contrast media should not be
  performed when the patient is having thyroid
  function tests.

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• NUCLEAR MEDICINE

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Definition

• N.M. deals with the diagnosis and the treatment
  of disease processes with the use of radioactive
  substances.

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Procedure

• A radioactive Isotopes are administered or
  inhaled into the patient and the Scintillation
  probe .
• Hot or cold spots
• Areas that absorbs the isotopes
• Depends on the cell activity

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• RADIATION THERAPY
• (Radiotherapy)

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• Radium emits
• Alpha, Beta, Gamma and X-Rays and other
  radioactive substances.
• Applied for the treatment of cancer by destroying
  the DNA of the abnormal cells.
• The amount of radiation applied is dependent on
• The number of poorly differentiated cells
• The degree of Mitotic activity

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Types of treatments

• Interstitial treatment
• Radium could be implanted directly into the
  tumor.
• Teletherapy
• Radioactive Isotopes ( Cobalt-60 or Cesium- 137)
  emitting high energy Gamma rays through a beam.
• Liquid Isoptopes
• Irradiation the pleural and peritoneal cavities.

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Complications

• R.T. could affect the normal and abnormal cells.
• Must limit and precise the amount of radiation to
  the affected cells only.

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Complications Of R.T and N.M

• Loss of hair
• Shedding of skin
• Hemopoietic dysfunction
• Diarrhea/Nausea
• Chromosomal changes.