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Questions and Answers
What is the primary use of a chest x-ray (CXR)?
What is the primary use of a chest x-ray (CXR)?
Which imaging technique is used primarily for diagnosing pulmonary embolism?
Which imaging technique is used primarily for diagnosing pulmonary embolism?
What is the benefit of a CT coronary angiogram compared to a traditional coronary angiogram?
What is the benefit of a CT coronary angiogram compared to a traditional coronary angiogram?
Which imaging method is considered excellent for the initial investigation of heart failure?
Which imaging method is considered excellent for the initial investigation of heart failure?
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For what purpose is a nuclear medicine scan typically used in young patients?
For what purpose is a nuclear medicine scan typically used in young patients?
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What condition is a CT pulmonary angiogram (CTPA) primarily used to diagnose?
What condition is a CT pulmonary angiogram (CTPA) primarily used to diagnose?
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Which imaging study can deploy stents and is focused on coronary artery disease?
Which imaging study can deploy stents and is focused on coronary artery disease?
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What is the primary function of the left ventricle in circulation?
What is the primary function of the left ventricle in circulation?
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What is a distinguishing factor of a CT scan compared to a chest x-ray?
What is a distinguishing factor of a CT scan compared to a chest x-ray?
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Which imaging technique is used specifically to visualize pulmonary embolism?
Which imaging technique is used specifically to visualize pulmonary embolism?
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Which imaging technique is primarily used if cancer is suspected?
Which imaging technique is primarily used if cancer is suspected?
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In the context of cardiac investigations, which of the following focuses specifically on the coronary arteries?
In the context of cardiac investigations, which of the following focuses specifically on the coronary arteries?
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What is the primary use of an echocardiogram?
What is the primary use of an echocardiogram?
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Which of the following is NOT typically examined when assessing 'Everything else' in chest X-ray evaluations?
Which of the following is NOT typically examined when assessing 'Everything else' in chest X-ray evaluations?
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Which of the following does NOT relate to cardiomegaly?
Which of the following does NOT relate to cardiomegaly?
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What advantage does a CT scan provide over conventional X-rays for cardiac evaluation?
What advantage does a CT scan provide over conventional X-rays for cardiac evaluation?
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What is the primary limitation of chest X-rays?
What is the primary limitation of chest X-rays?
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Which of the following is NOT typically part of a cardiac investigation?
Which of the following is NOT typically part of a cardiac investigation?
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What does a nuclear medicine gamma camera primarily visualize?
What does a nuclear medicine gamma camera primarily visualize?
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Which structure is examined during an echocardiogram?
Which structure is examined during an echocardiogram?
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What is the primary imaging modality that should be performed during inspiration in chest imaging?
What is the primary imaging modality that should be performed during inspiration in chest imaging?
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Which of the following is NOT part of the ABCDE systematic approach to chest X-ray evaluation?
Which of the following is NOT part of the ABCDE systematic approach to chest X-ray evaluation?
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In the evaluation of lung pathology on a CXR, what is indicated by 'airspace disease'?
In the evaluation of lung pathology on a CXR, what is indicated by 'airspace disease'?
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What characteristic defines an ideal CXR image in terms of expansion?
What characteristic defines an ideal CXR image in terms of expansion?
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During a CXR analysis, what is the significance of evaluating the trachea's position?
During a CXR analysis, what is the significance of evaluating the trachea's position?
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What is one of the key aspects to be recognized under the 'circulation' evaluation in CXR?
What is one of the key aspects to be recognized under the 'circulation' evaluation in CXR?
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What type of imaging modality is VQ scan primarily used for?
What type of imaging modality is VQ scan primarily used for?
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Which of the following represents a mistake in the CXR acquisition technique?
Which of the following represents a mistake in the CXR acquisition technique?
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What must be true about the hemidiaphragms in a normal CXR?
What must be true about the hemidiaphragms in a normal CXR?
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Which of the following is a key learning objective in cardiopulmonary radiology?
Which of the following is a key learning objective in cardiopulmonary radiology?
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Study Notes
Introduction to CardioRespiratory Radiology
- Presented by Dr. Joshua Lauder, Consultant Radiologist, ELHT
- Case examples sourced from radiopaedia.org
Learning Objectives
- Understanding modalities used in chest imaging
- Chest Radiograph (CXR): Most common chest investigation (94%)
- Computed Tomography (CT): Detailed 3D images
- V/Q scan: Ventilation/perfusion scan
- PET/CT: Positron emission tomography combined with CT
- Echocardiogram: Ultrasound for heart
- Coronary angiogram: Visualizes coronary arteries
- Identifying common pathology
Basic Principles of X-Ray
- X-rays generated by bombarding a metal target with electrons from a cathode
- X-rays pass through the body, absorbed depending on density
- Dense materials like bone absorb more X-rays, appearing white
- Less dense materials like air show up black
- The image shows a 2D representation of the 3D subject.
PA Chest X-Ray (The Right Way)
- Patient stands facing the X-ray machine, chest facing the detector.
- Crucial for accurate cardiac size assessment.
AP Chest X-Ray (The Wrong Way)
- Patient lies flat while the x-ray machine is above the chest
- Used for patients unable to stand, but distorts the size of heart or other organs.
AP Projection vs. PA Projection
- AP projection: X-ray source in front, detector behind. Heart appears magnified on the image, and distorting other organs.
- PA projection: X-ray source behind, detector in front. Heart is not distorted, and other organs appears at their correct size.
Cardiothoracic Ratio
- Measured by dividing the diameter of the heart by the width of the chest cavity between the lines at the edges of the scapulae, commonly measured as 50%.
- An abnormally large ratio often indicates cardiomegaly.
How to be good at Radiology
- Understanding anatomy is key.
- Understanding how X-rays create images: Different densities appear differently on an X-ray (air, fat, soft tissue, bone, metal).
CXR Acquisition
- Rotation: Spinous processes should be aligned with the midline and the medial clavicles should centrally positioned.
- Inspiration/Expiration: Ideally, taken during inspiration to ensure full lung expansion.
- Expansion: Diaphragm should be identified with well-defined shape and edges. Pathologically flattened or elevated diaphragm can be observed in certain conditions.
- Penetration: Optimal penetration to see structures clearly without overexposure to radiation.
Systematic Approach (ABCDE)
- Airway (Airways): Trachea; carina; is there a foreign body?
- Breathing (Lungs): Are the lungs symmetrical? Is there any consolidation?
- Circulation (Mediastinum): Cardiac position; size; aortopulmonary window; hilar vessels.
- Disability (Bones): Look for any bone problems that may indicate a disability issue.
- Everything else: Look for anything that isn't in the other categories.
Breathing (Lungs)
- Normal Lung: symmetrical expansion, volume, pleura and costophrenic angles
- Nodules: Small, rounded density within the lung
- Interstitial: Infiltration in the pulmonary interstitium
- Airspace: filling of the alveoli with fluid, pus, blood
Circulation (Mediastinum)
- Superior and Inferior Vena Cava
- Right Atrium
- Left Atrium
- Aortic Arch
- Main Pulmonary Artery
- Left Atrial Appendage
- Left Ventricle
- Cardiac size and position
- Aortopulmonary window
- Hilar vessels
- Dextrocardia
- Cardiomegaly
Disability (Bones)
- Assessing for abnormalities.
Everything Else
- Lines and tubes
- Apices (uppermost portion of lungs)
- Behind the heart
- Below the diaphragm
- Soft tissue abnormalities
CT Basic Principles
- Gantry rotates while making a series of projections, enabling volumetric image acquisition
- 2, 4, 8, 16, 64+ projections creating a 3D image.
- 3D view of the subject.
3D View of the Patient
- A 3D view of the body from a CT scan; it shows all the structures in 3D view
Multiplanar (CT)
- Coronal, saggital, and transverse views of the the body using CT scan data
Pulmonary Embolism
- Clots traveling through the circulation, obstructing the pulmonary vasculature
- CTPA aids in detection
CT Pulmonary Angiogram (CTPA)
- Non-contrast and contrast-enhanced variants
- Detects pulmonary emboli
Nuclear Medicine
- Involving radioactive tracers to evaluate physiological activity
- Uses gamma cameras for imaging
V/Q scan (Ventilation/Perfusion)
- Assess lung ventilation and blood flow (perfusion)
- Normal scans show uniform distribution
- Indicates perfusion defects in abnormalities.
PET/CT
- Combines PET (positron emission tomography) with CT for anatomical context
- Detects cancer, tumor staging scans
Cardiac Investigations
- Echocardiogram
- Coronary angiogram
- CT coronary angiogram
- Cardiac MRI
Coronary Angiogram
- Diagnoses coronary artery disease (CAD)
- Catheter-based procedure using contrast dye
- Different views, including RAO 20 and 30
CT coronary angiogram
- 3D reconstruction of heart structure
- CT coronary angiography provides detailed look inside the coronary arteries.
Echo (Echocardiogram)
- Ultrasound modality to evaluate heart structures and function.
- Provides various views of the heart.
Subcostal View (Echocardiogram)
- Access to the heart from the lower ribs
- Allows visualization of the heart's position related to surrounding structures
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Description
Explore the essential modalities used in chest imaging through this quiz. Test your knowledge on various imaging techniques such as CXR, CT, and echocardiograms, and understand the basic principles of X-ray. Delve into case examples and identify common pathologies in cardio-respiratory radiology.
