MEDI3100 - Medical Imaging PDF

lOMoARcPSD|23684851 MEDI3100 – Medical Imaging Clinical Anatomy and Medical Imaging (Macquarie University) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university...

lOMoARcPSD|23684851 MEDI3100 – Medical Imaging Clinical Anatomy and Medical Imaging (Macquarie University) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by Deva Sharma ([email protected])  lOMoARcPSD|23684851 MEDI3100 – Medical Imaging Thorax imaging X ray 1. Recognise AP, PA and lateral chest X ray images 2. Identify numbered ribs 3. Locate the lung hilum and distinguish lung fields from pneumothorax 4. Identify the borders of the heart, the aorta and vena cava and the aortopulmonary window 5. Trace the border of the diaphragm and identify the lateral and posterior costophrenic angles and cardiophrenic angles 6. Identify rib shadows, lung, pleura and pleural effusion by ultrasound AP or PA projection? How to distinguish: Does it say so on the radiograph? Are the medial borders of the scapulae in the lung fields? - AP Is the cardiothoracic ratio ≥ 50%? >50% = PA Does it look a bit fuzzy? Main features of a PA Chest X ray Downloaded by Deva Sharma ([email protected])  lOMoARcPSD|23684851 Aortopulmonary window Study focussing questions Is the heart is magnified most in AP or PA projections? AP Up to what % of the thoracic diameter should be occupied by the heart? Up to 50% Identify: A - Right main bronchus B - costophrenic angle C - cardio phrenic angle D - thoracic part of ascending aorta Lateral view Chest x ray applied anatomy Downloaded by Deva Sharma ([email protected])  lOMoARcPSD|23684851 Thoracic ultrasound  Ribs cast shadows  Pleura & diaphragm are seen as hyperechoic lines  Can often see several pleural lines due to echo  Anechoic fluid is readily detected Ultrasound to detect pleural effusion  Liver (& lungs) are hypoechoic  Fluid is anechoic Study focussing questions Is A the left- or right- hemidiaphragm? A is left hemidiaphragm Is B the left or right posterior costophrenic angle? B is right posterior costophrenic angle Identify heart chamber C Posterior - so left atrium Identify the 2 lines indicated by D Scapulae Which one is anechoic on ultrasound? Rib Diaphragm Pleura Lung Pleural effusion - fluid CT 1. Recognise coronal, sagittal and axial thorax CT images 2. Define the terms ‘CT window’ and ‘Hounsfield unit’ 3. Identify major anatomical structures from the lists provided Downloaded by Deva Sharma ([email protected])  lOMoARcPSD|23684851 CT windows  Radiodensity is measured in Hounsfield units (HU)  The range between black and white (Window) can be adjusted to better see different tissues Soft tissue, lung and bone windows Coronal CT thorax (lung window) 1. Sternum & ribs 2. Lung 3. Heart 4. Sternopericardial ligaments 5. Pulmonary trunk 6. Costophrenic angles 7. Cardiophrenic angles 8. Ascending aorta 9. IVC 10. SCV 11. Brachiocephalic veins 12. Pulmonary artery and veins 13. Trachea 14. Lobar bronchus 15. Thoracic aorta Study-focussing questions What type of image is this? Coronal Lung window CT Identify: A - ascending aorta B - pulmonary trunk C - right atrium Downloaded by Deva Sharma ([email protected])  lOMoARcPSD|23684851 Identify: A - left brachiocephalic vein B - SVC C - Costodiaphragmatic recess Identify: A - aorta B - right lower lobe bronchus C - Left pulmonary artery Sagittal CT thorax 1. Left and right lungs 2. Branch of left pulmonary artery 3. Pericardium 4. Hilum of lung 5. Left main bronchus 6. Trachea 7. Ribs 8. Scapula 9. Vertebrae 10. Stomach 11. Liver Study-focussing questions What type of image is this? Sagittal thorax lung window CT If you can see spleen and stomach = left side Identify A - stomach - has air and contents Identify B - spleen Identify lung lobe C - left upper Identify lung lobe D - left lower Identify A - descending aorta Identify B - pulmonary artery Identify C - bronchus Identify D- pulmonary vein Downloaded by Deva Sharma ([email protected])  lOMoARcPSD|23684851 Axial CT thorax 1. Trachea 2. Lung apices 3. Aortic arch and branches 4. Left brachiocephalic vein 5. SVC 6. Ascending and descending aorta 7. Pulmonary trunk and arteries 8. Left and right main bronchi 9. Left atrium and pulmonary veins 10. IVC 11. Gas in stomach 12. Liver Study focussing questions Identify A - Ascending aorta Identify B - Pulmonary trunk Identify C - SVC Identify D - left pulmonary artery Identify E - descending aorta Identify F - azygous vein Downloaded by Deva Sharma ([email protected])  lOMoARcPSD|23684851 Ventricles as there is a partition between them Identify A - right ventricle Identify B - left ventricle Identify C - interventricular septum Identify A - left atrium Identify B - right pul. vein Identify C - left lobar bronchus MRI 1. Recognise coronal, sagittal and axial thorax MRI images 2. Identify structures from the lists 3. Explain how intensity terms are used for MRI abnormalities and contrast these with the density terms used for CT abnormalities 4. Outline the benefits and disadvantages of MRI vs CT MRI (and CT) imaging convention Costs, procedure complexity and equipment availability Coronal MRI Downloaded by Deva Sharma ([email protected])  lOMoARcPSD|23684851 Study focussing questions Identify A - interventricular septum Identify B - Pulmonary trunk Identify C - Left brachiocephalic vein Identify D - brachiocephalic trunk - gives rise to RCCa and RSa Identify A - aorta Identify B - left pulmonary vein Identify C - right pulmonary artery Identify D - right pulmonary vein Identify E - IVC Identify A - aorta Identify B - pulmonary trunk / left pulmonary artery Identify C - left pulmonary vein Identify D - azygous vein Identify A - aorta Identify B - posterior intercostal arteries Cardiac MRI Identify A - pulmonary trunk Identify B - aorta Identify C - left coronary artery Identify D - left atrium Downloaded by Deva Sharma ([email protected])  lOMoARcPSD|23684851 Intensity (MRI) vs Density (CT) for abnormalities Which term best describes this lesion ? A. Hyperdense B. Isodense C. Hypodense D. Hyperintense E. Isodense F. Hypointense Abdomen and pelvis Imaging X ray Able to identify:  Vertebrae and pelvis  Psoas muscle  Bladder  Liver  Kidney  Air-filled regions of the gastrointestinal tract Standing or supine AP  Usually taken AP  Standing is most common  Viscera (and air-fluid levels) move with supine vs. standing X ray General features  Alignment  Bones and muscles  Soft tissues in quadrants  Air in soft tissues aids visualisation Downloaded by Deva Sharma ([email protected])  lOMoARcPSD|23684851 Bones and muscles 1. 12th rib 2. Spinous p. 3. Transverse p. 4. Pedicle 5. Psoas 6. Disc space 7. (a,b,c) Ilium, pubis, ischium 8. Sacrum 9. Femur Soft tissues 1. Liver 2. Spleen 3. Stomach 4. Colon 5. Kidney 6. Bladder Lateral abdominal x ray  Less common than AP  Reasonable view of lumbosacral spine  Poor view of intestine Study focussing questions 1. What is responsible for the horizontal lines? STANDING XRAY - fluid air interface 2. Identify A - transverse process B - left kidney C - lateral boarder of psoas D - ascending colon E - bone = coccyx soft tissue = bladder CT Able to identify:  Liver and gall bladder  Spleen and vessels  Kidneys and vessels, plus bladder Downloaded by Deva Sharma ([email protected])  lOMoARcPSD|23684851  Aorta and branches  Inferior vena cava  Small and large intestine  Psoas, iliacus, gluteal muscles Coronal CT Liver Stomach Superior mesenteric artery Portal vein Superior mesenteric vein Pancreas Duodenum Jejunum Ileum Colon Aorta IVC External iliac vessels Psoas, iliacus gluteal m. Kidney, adrenal, ureter Axial CT Liver Gall bladder Spleen and vessels Kidney and renal vessels SMA Aorta Crura of diaphragm Iliac bifurcation IVC Stomach Pancreas Portal vein Jejunum Ileum Colon Rectum Bladder Psoas, iliacus gluteal m. Downloaded by Deva Sharma ([email protected])  lOMoARcPSD|23684851 Study focussing questions Identify: A - pancreas B - stomach C - kidney D - sphenic vein E - abdominal aorta F - right crus of diaphragm Identify: A - gallbladder B - stomach C - Left renal vein D - jejunum E - SMA Identify: A - ileum B - descending colon C - psoas D - iliacus E - rectus abdominus F - transverse abdominus MRI Able to identify the following:  Coronal, axial and sagittal MRIs of the abdomen and pelvis  Liver, aorta, IVC, diaphragmatic crura, spleen, pancreas, duodenum, kidney and vessels  Viscera of the male and female pelvis Axial MRI 1. Liver 2. Aorta 3. IVC 4. Crura 5. Spleen 6. Pancreas 7. Duodenum 8. Kidney and vessels Downloaded by Deva Sharma ([email protected])  lOMoARcPSD|23684851 Study focussing question Identify this vessel Hepatic Vein Identify: A - right lobe of liver B - left renal vein C - aorta Sagittal MRI: male pelvis 1. Pubis 2. Bladder 3. Prostate 4. Seminal vesicle 5. Urethra 6. Rectum 7. Rectovesical pouch 8. S1 Sagittal MRI: female pelvis 1. Uterus 2. Vagina 3. Bladder 4. Pubis 5. S1 6. Rectum 7. Nucleus pulposus Study focussing questions Identify this peritoneal pouch (arrow) Vesicle uterine pouch Identify these regions of the uterus (*, **) *Cervix **Uterus Downloaded by Deva Sharma ([email protected])  lOMoARcPSD|23684851 What is the most likely reason the uterus is not anteflexed? Most likely taken in supine position A Identify this peritoneal pouch Rectovesical pouch Identify B Prostate C Is this corpus spongiosum or corpus cavernosum? Corpus spongiosum Spine Imaging Able to identify: Major features of the spine (Vertebral bodies, pedicles, laminae, facet joint and disc spaces, dens, uncinate processes, atlantooccipital and atlantoaxial joints, rib angles and shafts, sacrum and foramina, coccyx, sacroiliac joint) XRAY Full spine  Rarely done to avoid overexposure to radiation  A radiologically normal appearance calls into question the justification for imaging in the first place Cervical spine AP  Vertebral bodies  Disc spaces  Spinous processes  Tracheal shadow  Pedicles  Uncinate processes Cervical spine: open mouth (odontoid) view Cervical spine: Lateral  Vertebral bodies  Spinous process  Intervertebral foramina  Disc spaces  Facet joints  Transverse processes  C1  C2 and odontoid Downloaded by Deva Sharma ([email protected])  lOMoARcPSD|23684851 Cervical spine alignment: longitudinal lines Displacement of cervical vertebrae can cause narrowing (stenosis) of the vertebral canal putting the cervical spinal cord at risk. Ant and post longitudinal line Spinolaminar line Thoracic spine  Vertebral bodies  Disc spaces  Intervertebral foramina  Facet joints  Angles and shafts of ribs  Spinous processes  Pedicles  Head of humerus Lumbosacral spine Vertebral bodies Spinous processes Pedicles Transverse processes Sacrum, promentary & foramina Coccyx Sacroiliac joint Intervertebral foramina Facet joints Spinous processes Sacral disc lines Study focussing questions A. Identify this small projection from the vertebral body Uncinate process B. Identify this white circle Pedicle C. Identify this white circle and state which vertebra it belongs to C7 spinous process Identify A Posterior tubercle of C1 Identify line B Spinolaminar line What type of joint is C Secondary cartilaginous joints What type of joint is D? Facet joints are Synovial Downloaded by Deva Sharma ([email protected])  lOMoARcPSD|23684851 A Identify this part of the upper limb skeleton Head of humorous B Identify this part of the rib Shaft of rib C Identify this part of the rib Angle of rib Identify D Disc space Identify E Liver A Identify the white circular region of this vertebra Cortical bone - pedicle B Identify the white oval region of this vertebra Spinous process Which spinal nerve is found at C? S1 - ventral ramus (as it is a the front - dorsal at the back) Identify joint D Sacroiliac joint CT Cervical CT: Sagittal bone window 1. Foramen magnum 2. Odontoid process 3. Atlanto Dental interval 4. Spinous processes 5. Facet joints 6. Intervertebral discs 7. Atlantoaxial joint 8. Atlantooccipital joints Lumbar CT: Sagittal bone window Lumbosacral disc Pedicle Articular processes Intervertebral foramen Pars interarticularis Facet joints Downloaded by Deva Sharma ([email protected])  lOMoARcPSD|23684851 A Which skull bone is this? Study focussing questions Occipital bone Identify B Anterior arch of atlas Identify C Dens of C2 Identify D Posterior tubercle of atlas Identify E Hyoid bone Identify these synovial joints A: atlantooccipital joint B: facet joint Where (A-D) does the spinal cord end? Spinal cords ends at 1st and 2nd lumbar vertebrae - B What do the faint line E represent? Point of fusion of 1st and 2nd sacral segments Identify process A Superior articular process Identify process B Inferior articular process Identify region C Pars interarticularis Downloaded by Deva Sharma ([email protected])  lOMoARcPSD|23684851 MRI Cervical MRI Sagittal T2 Foramen magnum Medulla oblongata Cerebellomedullary cistern Spinal cord and CSF Odontoid process Anterior and posterior longitudinal ligaments Spinous processes Facet joints Annulus fibrosus and nucleus pulposus Atlantoaxial joint Lumbar MRI: Sagittal T2 Nucleus pulposus and anulus fibrosus Cauda equina CSF Anterior and posterior longitudinal ligaments Interspinous ligaments Sacralsegments Aorta and IVC Lumbar MRI: Axial T2 Sacroiliac joint Iliacus, psoas major, gluteus medius Multifidus Aorta, IVC and bifurcations Cauda equina Downloaded by Deva Sharma ([email protected])  lOMoARcPSD|23684851 Study focussing questions Identify: A medulla B Cerebellomedullary cistern C Dens D Spinal cord E Anterior longitudinal ligaments Identify: A Interspinous ligament B CSF (lumbar cistern) C Nucleus pulpous D Cauda equina E Posterior longitudinal ligaments F 2nd sacral segmant Identify: A IVC B Aorta C Psoas D quadratus lumorum E cauda equina Downloaded by Deva Sharma ([email protected])