[23-24] Y1 CVR Radiology.pdf

Dr Joshua Lauder Consultant Radiologist ELHT INTRODUCTION TO CARDIORESPIRATORY RADIOLOGY Case examples are from radiopaedia Learning Objectives  Understand the modalities used in Chest imaging  Che...

Dr Joshua Lauder Consultant Radiologist ELHT INTRODUCTION TO CARDIORESPIRATORY RADIOLOGY Case examples are from radiopaedia Learning Objectives  Understand the modalities used in Chest imaging  Chest Radiograph (CXR)  Computed Tomography (CT)  CTPA  VQ  PET/CT  Echocardiogram  Coronary angiogram  Identify common pathology Basic principles of Xray PA - The right way PA AP - The wrong way AP PA AP How to be good at radiology 1. Anatomy 2. Understand how X-rays make an image CXR acquisition  Rotation CXR acquisition  Should be taken in Expiration / Inspiration ? CXR acquisition  Inspiration CXR acquisition  Expansion CXR acquisition  Expansion CXR acquisition  Penetration Systematic approach  ABCDE Airway Breathing Circulation Disability Everything else  Airway ▪ Is the trachea straight and midline? ▪ Is there narrowing? ▪ Is the? carina wide (more than 100°)? ▪ Is there a foreign body Airway Breathing Case courtesy of Dr Phillip Marsh, Radiopaedia.org, rID: 58938 Both lungs are expanded and similar in volume Apices, upper, middle and lower zones are symmetrical Case courtesy of Dr Jeremy Jones, Radiopaedia.org, rID: 32556 Normal lung periphery Normal costophrenic angles Case courtesy of Dr Jeremy Jones, Radiopaedia.org, rID: 32556 Normal hemidiaphragms Normal cardiac borders Case courtesy of Dr Jeremy Jones, Radiopaedia.org, rID: 32556  Normal lung behind the heart Case courtesy of Dr Jeremy Jones, Radiopaedia.org, rID: 32556  Breathing (lungs) Nodule vs Airspace vs Interstital Blood Pus Water Fluid Protein Fibrosis Cells Nodule vs Airspace vs Interstital (Consolidation) (septal thickening) Nodule vs Airspace vs Interstital (Consolidation) (septal thickening) Consolidation Circulation 1. Superior vena cava 2. Right atrium 3. Inferior vena cava Case courtesy of Dr Vincent Tatco, Radiopaedia.org, rID: 46331 4. Aortic arch 5. Main pulmonary artery 6. Left atrial appendage 7. Left ventricle Circulation Cardiac position Cardiac size Case courtesy of Dr Jeremy Jones, Radiopaedia.org, rID: 32664 Circulation Aortopulmonary window Circulation Hilar vessels Case courtesy of Dr Jeremy Jones, Radiopaedia.org, rID: 32664 Dextrocardia Cardiomegaly Disability (bones) Case courtesy of Dr Jeremy Jones, Radiopaedia.org, rID: 26867 Disability (bones) Case courtesy of Dr Henry Knipe, Radiopaedia.org, rID: 31240 Case courtesy of Dr Ian Bickle, Radiopaedia.org, rID: 50381 Everything else Everything Else Look at things that do not fit into the A-D categories and review areas Lines and tubes Apices Behind the heart Below the diaphragm Soft tissues abnormalities (e.g. absent breast shadow) Everything else - lines Everything else - diaphragm Everything else – Hiatus hernia The weakness of CXR The weakness of CXR CT basic principles CT basic principles 3D view of the patient Multiplanar Pulmonary embolism  CTPA – CT pulmonary Non contrast angiogram CTPA – CT pulmonary angiogram Normal PE Nuclear medicine Xray Nuclear medicine Gamma camera  VQ scan (ventilation/perfusion) https://www.cteph-info.com/en/healthcare-professionals/?WHGRedir=1  VQ scan (ventilation/perfusion) https://www.cteph-info.com/en/healthcare-professionals/?WHGRedir=1 PET/CT Cardiac investigations  Echocardiogram  Coronary angiogram  CT coronary angiogram  Cardiac MRI Echocardiogram Coronary angiogram Coronary angiogram RAO 20 Caudal 20 (for LCA) 1. Left (main) coronary artery 2. Left anterior descending 5. Circumflex artery (LCx, Cx) Case courtesy of Assoc Prof Craig Hacking, Radiopaedia.org, rID: 63081 Coronary angiogram RAO 30 (for RCA) 7. Right coronary artery (RCA) 9. Posterior descending artery (PDA) Case courtesy of Assoc Prof Craig Hacking, Radiopaedia.org, rID: 63081 CT coronary angiogram  Full name Acronym Use Chest x-ray CXR Good screening test for respiratory problems Computed tomography CT Better sensitivity and specificity than CXR. Used if cancer suspected CT pulmonary angiogram CTPA Pulmonary embolism Ventilation/perfusion V/Q Pulmonary embolism Nuclear medicine In young patients Positron emission tomography PET/CT Cancer staging scan Echocardiogram Echo Excellent initial investigation Heart failure Pericardial effusion Coronary angiogram Coronary artery disease (myocardial infarction). Can deploy stents CT coronary angiogram Less invasive way of diagnosing coronary artery disease. End Images courtesy of: Dr Amanda Law Radiopaedia.org RadiologyMasterclass.com CXR survival guide, DeLacey