Showing posts with label Radiology. Show all posts
Showing posts with label Radiology. Show all posts

30 May 2012

Radiation Injury



Basics of Treatment of Victims of Radiation Terrorism or Accidents
Preparing for an Unplanned Radiation Event
Niel Wald, M.D.
Basics of Treatment.ppt
Preparing for an Unplanned Radiation.ppt


Follow-up of Persons Exposed to Radiation and Radioactivity
Niel Wald, M.D. and Michael Kuniak, D.O.
Follow-up.ppt

The Radiobiology of Radiation Therapy
The Radiobiology of Radiation Therapy.ppt

Tissue Radiation Biology
Tissue Radiation Biology.ppt

Tumor Radiation Effects
Radiation Effects.ppt

Physician and Hospital Responses to Radiological Incidents
Robert E Henkin, MD, FACNP, FACR
Physician and Hospital Responses to Radiological Incidents.ppt

Radiation Biology and Radiation Risk
Prof. Higley
Interactions.ppt

Injury by Physical Agents
Nancy L. Jones, M.D.
Jones-physical_injury.ppt

Laser Safety
Lasersafety.ppt

Trauma and Pregnancy
William Schecter, MD
Trauma and Pregnancy.ppt

Applications of Proton Beam Radiation
Jean Paul Font, MD, Vicente Resto, MD, Ph.D.
Applications of Proton Beam Radiation.ppt

Skin Care of Breast Cancer Patients Undergoing Standard External Beam Radiation
Donna M. Braunreiter RN BSN OCN
Skin Care of Breast Cancer Patients.ppt

Radiation and Catheterization Lab Safety
Joan E. Homan, M.D.
Radiation and Catheterization Lab Safety.ppt

Nuclear and Radiological Events
Nuclear and Radiological Events.ppt

Radioactive Materials II -Radiation Protection
Radioactive Materials.ppt

Radiation And Radioactive Materials Safety Training for non-user employees
Radioactive Materials Safety Training.ppt

Ionizing Radiation
Ionizing Radiation.ppt

Biological Effects of Ionizing Radiations
Ionizing Radiations.ppt

Radiation Safety - Annual Refresher Training
UMD_XRD.ppt

Radiologic Events: Attack on a Nuclear Power Plant
Rad_pub.ppt

Basic Radiation Safety Awareness Training
Radiation Safety Program
Awareness.ppt

Radiation Safety Basics
Janet M Gutiérrez, CHP, MS, RRPT
Radiation Safety Manager
Radiation Safety Basics.ppt

Relevant Dates in Radiation Protection
History_of_radiation_protection.ppt
122 free full text articles

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21 May 2012

Magnetic Resonance Imaging - MRI



MRI scans and medical implants
Brent Hoffmeister
MRI scans and medical implants.ppt

Compensating for Motion Artifacts in Magnetic Resonance Imaging
Amy Buerkle, Keith Chung, Anthony Nuval, & Farhan Shamsi
mri_presentation.ppt

M R I Physics
Jerry Allison Ph.D., Chris Wright B.S., Tom Lavin B.S., Nathan Yanasak Ph.D.
MRI.ppt

Magnetic Resonance Imaging - Basic principles of MRI
Magnetic Resonance Imaging.ppt

Magnetic Resonance Imaging
Magnetic Resonance Imaging.ppt

Introduction to MRI
Introduction to MRI.ppt

Magnetic Resonance Imaging
David Ramsay
Magnetic Resonance Imaging.ppt

Magnetic Resonance Imagining (MRI) Magnetic Fields
Magnetic Resonance Imagining (MRI).ppt

Functional Magnetic Resonance Imaging
Carol A. Seger
Functional MRI.ppt

Principles of MRI: Image Formation
Allen W. Song
Brain Imaging and Analysis Center, Duke University
ImageFormation.ppt

Medical Imaging Applications
James D. Christensen, Ph.D.
Medical Imaging Applications.ppt

Magnetic Resonance Imaging
Dennis M. Marchiori
Magnetic Resonance Imaging.ppt

Functional Magnetic Resonance Imaging
Albert Parker
fMRI.ppt

Magnetic Resonance Imaging (MRI)
Naomi Kim
MRI-Magnetic_Resonance_Imaging1.ppt

Diffusion Tensor MRI And Fiber Tacking
Eng. Inas Yassine.
DT-MRI.ppt

Magnetic Resonance Imaging
2003 Noble Prize Laureates in Physiology or Medicine
Paul C. Lauterbur and Peter Mansfield
Magnetic Resonance Imaging.ppt

Principles of Magnetic Resonance Imaging
David J. Michalak
Michalak_MRI.ppt

13C-NMR, 2D-NMR, and MRI Lecture Supplement
NMR/14C_CNMR.ppt

Magnetic Resonance Imaging
MRI_1.ppt


Latest 500 published articles free access

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21 July 2011

Chest Radiology Presentations



Diagnostic Imaging of Blunt Chest Trauma by Phil Goebel, Oregon Health Sciences University
http://www.ohsu.edu/radiology/med/chest/bcti.ppt

Thoracic Radiographic Anatomy by Einav Shochat
http://www.ohsu.edu/radiology/med/chest/tra.ppt

Tubes & Lines, Radiographic Evaluation of the Placement of Monitoring and Support Devices
by Tula Top
http://www.ohsu.edu/radiology/med/chest/tl.ppt

Soft Tissue Radiographic Findings in Blunt Chest Trauma by Jonathan Yarris
http://www.ohsu.edu/radiology/med/chest/bct.ppt

Acute Eosinophilic Pneumonia by Annie Weinsoft
http://www.ohsu.edu/radiology/med/chest/aep.ppt

Radiologic Manifestations of Pulmonary Aspergillus Infections by Joe M Chan
http://www.ohsu.edu/radiology/med/chest/pai.ppt

Aortic Dissection by Beverly Mielke
http://www.ohsu.edu/radiology/med/chest/aodis.ppt

Pneumocystis Carinii Pneumonia by Elizabeth Wozniak
http://www.ohsu.edu/radiology/med/chest/pcp.ppt

What is Idiopathic Pulmonary Fibrosis? Classification, Diagnosis and Prognosis
http://www.ohsu.edu/radiology/med/chest/ipf.ppt

ICU Radiography, Diseases that Develop Within 24 hrs and Longer in Critical Care Patients
by Tyler Andrews
http://www.ohsu.edu/radiology/med/chest/icu.ppt

CTA and Acute Pulmonary Embolism: Too much of a good thing? by Kathleen O’Brien
http://www.ohsu.edu/radiology/med/chest/ctape.ppt

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05 April 2011

Posterolateral Lumbar Fusion Presentations



Electromagnetic Image Guidance in Posterior Spinal Fusion By David Strauss, MD
ISIS Research Center/Georgetown University Department of Radiology

http://www.isis.georgetown.edu/CAIMR/DesktopModules/ViewDocument.aspx?DocumentID=128

Lumbar Degenerative Disc Disease by Chris Williams, MSIII
http://pages.slu.edu/org/mclenngp/LDDD.ppt

Lumbar Disc Herniation by Jennifer Holliday, MS4
http://www.ohsu.edu/radiology/med/neuro/lbps.ppt

Thoracic and Lumbar Spine Special Tests and Pathologies
Orthopedic Assessment III – Head, Spine, and Trunk with Lab
http://www2.fiu.edu/~dohertyj/FIU%20-%20Thoracic%20and%20Lumbar%20Spine%20Special%20Tests%20and%20Pathologies.ppt

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06 April 2010

Magnetic Resonance CholangioPancreatography



Magnetic Resonance CholangioPancreatography
By:Falguny Bhavan MS4
Oregon Health & Sciences University
Radiology Clerkship


Objectives
* Introduction
* Technique
* Advantages
* Limitations
* Clinical applications

Introduction
Anatomy of the Hepato-Biliary and Pancreatic system

Technique
* Basic principle: body fluids (bile and pancreatic secretions) have high signal intensity on heavily T2-weighted MR sequences therefore, appear white
o Background tissues generate little signal appear dark
* Stationary or slow-flowing fluid within the bile and pancreatic ducts appears bright relative to low signal intensity produced by adjacent solid tissues
* New MR advancements allow faster imaging in which imaging is performed during single breath-holding session to reduce motion artifact due to respiration
* New variants such as rapid acquisition with relaxation enhancement (RARE) and half-Fourier acquisition single-shot turbo spin-echo (HASTE) can be performed in a breath-hold period with a scan time of <20 seconds provide superior images Advantages * Does not require intravenous or oral contrast material to be administered into the ductal system * Avoids complications of ERCP such as pancreatitis (3-5%), sepsis, perforation, hemorrhage, sedation * Can be completed in 10 minutes, easily performed as outpatient examination * Passive procedure; displays the ducts in the resting state and more accurately displays native caliber of the duct than ERCP. o In ERCP, segments may be overdistended because of attempt to visualize the duct upstream from a stricture, or segments may be underdistended because of the operator's fear of inducing cholangitis or pancreatitis. Limitations * Purely diagnostic, does not provide access for therapeutic intervention (e.g. stone extraction, stent insertion, or biopsy) * Image artifact due to other structures in abdomen with high fluid content * Lack of patient compliance; claustrophobia, inability to breath-hold * Dropout of signal can be caused by metallic clips, crossing defects induced by the right hepatic artery, or from severely narrowed ducts, such as occurs with primary sclerosing cholangitis * Lower resolution than direct cholangiography o Can miss small stones (<4 mm), small ampullary lesions, primary sclerosing cholangitis, and strictures of the ducts Clinical applications: Diseases Diagnosed by MRCP Biliary Disease * Screening examination in patients with low or intermediate probability of choledocholithiasis * Cholangiocarcinoma * Anatomic variants (low or medial duct insertion, aberrant right hepatic duct) * Failed or incomplete ERCP * Post-operative anatomy or screening for biliary complications * Primary sclerosing cholangitis * Cystic disease of bile duct (choledochal cyst, choledochocele, Caroli’s disease) Pancreatic Disease * Anatomic variants (pancreas divisum) * Chronic pancreatitis * Pancreatic cancer Clinical Applications: General guidelines for selection of MRCP or ERCP Obstruction of the Common Bile Duct * MRCP can visualize the normal or dilated common bile duct in 96 to 100 percent of patients. * Strictures typically appear as focal areas of ductal narrowing or signal void with proximal dilatation. * Cause of biliary strictures may be more difficult to determine on the basis of MRCP alone. o lacks specificity o differentiation between benign and malignant causes is based on a combination of clinical, radiographic, and pathological data * Obstruction 2° to calculi, pancreatic adenocarcinoma, or pancreatitis is usually obvious with MRCP, and with aid of conventional MRI or CT Obstruction Combined Biliary-Duct Obstruction and Pancreatic-Duct Obstruction Due to a Small Mass in the Pancreatic Head. The biliary-duct obstruction is indicated by the curved arrow, and the pancreatic-duct obstruction by the straight arrow. The mass was identified on axial, contrast-enhanced, T1-weighted images (not shown) obtained by routine MRI during the same examination. Arrowheads indicate the pancreatic duct. * ERCP is more beneficial in pts with dilatation of the common bile duct who have obstruction at the ampulla, since it permits direct visualization of the ampulla, biopsy of lesions, manometry, or endoscopic sonography. * MRCP Study of 79 cases of biliary obstruction found 14 due to malignant cause; 6 cases due to ampullary carcinoma. o 2 of 6 cases were misdiagnosed as benign obstructions, and 2 cases of benign obstruction were thought to be ampullary cancers. (This study used an early form of the technique, and results may be more accurate with the currently available technology.) * MRCP performed after pharmacologic stimulation with secretin has been shown to be helpful in evaluating ampullary obstruction Secretin-enhanced MRCP * Visualization of the pancreatic duct can be improved with imaging after administration of IV secretin * Secretin frequently used when pancreatic duct is not apparent on MRCP * Reduces the incidence of false positive findings of strictures Secretin-enhanced MRCP Dynamic MRCP with Intravenous Injection of Secretin in Patient with Abdominal Pain after a Whipple Procedure. (ERCP was not attempted because the patient had a pancreaticoenteric anastomosis.) In Panel A, the pancreatic duct (arrowheads) is incompletely visualized on MRCP before the administration of secretin. In Panel B, an MRCP obtained 15 minutes after the administration of secretin shows prominent and prolonged dilatation of the pancreatic duct upstream of a stricture (arrow) at the pancreaticoenteric anastomosis. Common duct stones * Displayed by MRCP as a signal void within bright signal arising from bile * MRCP is a useful means of determining presence or absence of CBD stones, as well as number, size, and location * MRCP is as accurate as ERCP for detecting choledocholithiasis o Sensitivity = 95-100% o Specificity = 85-100% * Increased sensitivity in pts with suspected gallstone pancreatitis, and pts with non-specific abdominal pain and normal LFTs * Stones larger than 4 mm are readily seen but difficult to differentiate from filling defects such as blood clots, tumor, sludge, or parasites o Other mimickers include flow artifacts, biliary air, and a pseudostone at the ampulla * In the presence of a dilated CBD, MRCP has a 90 to 95 percent concordance with ERCP in diagnosing CBD stones over 4 mm in diameter * ERCP is preferred in pts with cholangitis because it allows therapeutic drainage Cholangiocarcinoma * Role of MRCP in the diagnosis and management of bile duct malignancy is not yet defined * Useful noninvasive adjunct * Capability to evaluate the bile ducts both above and below a stricture while also identifying any intrahepatic mass lesions * Study of 126 patients with suspected bile duct obstruction showed that MRCP alone has limited specificity in the diagnosis of malignant strictures o Malignant obstruction dx by MRCP in 12 out of 14 pts o Positive predictive value = 86% o Negative predictive value = 98% Pancreatitis * Acute pancreatitis o MRCP is useful for evaluating bile ducts and cystic duct remnants for stones, for evaluating the pancreatic ducts, and for documenting the presence of cysts in or around the pancreas. o ERCP is often preferred in patients with gallstone pancreatitis since endoscopic papillotomy can be performed in pts with obstructive jaundice or biliary sepsis. * Chronic pancreatitis o MRCP is useful in demonstrating complications such as, ductal dilatation, strictures, intraductal calculi, fistulas, and pseudocysts o Defines ductal anatomy and extent of ductal disease prior to surgical drainage * MRCP is as accurate as ERCP for distinguishing pancreatic cancer from chronic pancreatitis. o In study of 124 patients who were suspected of having pancreatic cancer, pts underwent a number of diagnostic studies, including ERCP and MRCP. The correct diagnosis was confirmed histologically and clinically. 37 patients (30 percent) dx with pancreatic cancer; others had chronic pancreatitis (46 percent) or other causes. o MRCP sensitivity (84%) and specificity (97%) for diagnosis of pancreatic cancer o ERCP sensitivity (70%) and specificity (94%) * Secretin-enhanced MRCP is being increasingly studied for evaluation of pancreatic exocrine function and in the early diagnosis of chronic pancreatitis Variant ductal anatomy * MRCP is also useful in demonstrating variant anatomy and congenital anomalies of the biliary tract and pancreatic duct o Pancreas divisum o Choledochal cyst o Annular pancreas o Abnormal pancreaticobiliary junctions o Aberrant bile ducts * And in evaluation of pts prior to laparoscopic cholecystectomy Normal Extrahepatic Bile Duct and Incidental Pancreas Divisum. Magnetic resonance cholangio-pancreatography is an accurate method of diagnosing pancreas divisum because it shows the dominant dorsal pancreatic duct (arrowheads) continuously from the tail to the head of the pancreas, crossing the common bile duct (curved arrows) and draining at the minor papilla (straight arrow) superiorly and separately from the common bile duct. GB denotes gallbladder. Failed or incomplete ERCP * ERCP is technically challenging o Associated with 10-20% failed cannulation rate o Anatomic variants can contribute to failed ERCP attempts * MRCP is useful in demonstrating variant anatomy o MRCP may have advantages compared to ERCP in specific settings such as pts who have gastric outlet or duodenal stenosis or who have had surgical rearrangement (eg, Billroth II) or ductal disruption, resulting in ducts that can’t be assessed by ERCP * MRCP also allows evaluation of ducts in pts with contraindications for ERCP: o Cervical spine fractures, head and neck tumors, sleep apnea, other diseases/ injuries that preclude placement of endoscope or positioning Post-surgical anatomy Normal Results of Magnetic Resonance Cholangiopancreatograpy in a Patient after Cholecystectomy. Imaging was performed in two seconds with the thick, single-slice technique. The normal common bile duct (arrow) and pancreatic duct (arrowheads) are clearly visible. Du denotes duodenal bulb. References Magnetic Resonance CholangioPancreatography.ppt

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29 March 2010

MRI Safety and Policies & Procedures



MRI Safety and Policies & Procedures

Magnet Safety at ALL TIMES
Outline
Understanding Magnets
o Your role in MR Safety
o Metallic Screening
o Screening Patients / Colleagues
o Other Safety Considerations

What to do in Emergencies
MRI Department Policies and Procedures
Preview MRI Safety Videotape

Magnetism / Magnets
* All substances possess some form of magnetism.
* The degree of magnetism exhibited depends on the atoms that make-up the substance.
* Magnetic susceptibility is the ability of a substance to become magnetized.
* Ferromagnetic substances, such as iron have a large magnetic susceptibility, it is easily magnetized permanently and becomes a magnet itself.
* All magnets have a North and a South pole.
* All magnets have a “fringe” magnetic field which exists in the vicinity surrounding the magnet.

Magnetic Fringe Fields
* The fringe magnetic field is the magnetic field which exists in the vicinity surrounding the magnet.
* This field may extend many meters from the magnet itself.
* These imaginary lines of force demonstrate the pattern of the magnetic field.
* Safety and operational concerns make it necessary to contain the fringe field to a small area.
* Magnetic fields are measured in units of Gauss or Tesla.

MRI Safety at ALL TIMES
A STATIC MAGNETIC FIELD IS ALWAYS PRESENT 24hrs/day, 365 days/yr. EVEN WHEN NOT IN USE.
ANY PERSON USING THE MAGNET MUST BE CERTIFIED AFTER ATTENDING THE MRI SAFETY TRAINING CLASS.
ONE MUST BE TRAINED ON THE SCANNER INTERFACE BEFORE SCANNING.

What is your role in MR Safety?
The greatest risk of injury and damage to the system results from:
o Misuse or abuse of the MR equipment
o Failure to comply with recommended safety procedures
o Lack of proper inspection and maintenance of the MR equipment

Who should know MR Safety?
All in-house personnel that have reason to enter the MR suite area should be trained in MR safety procedures:
o MR technologists, students, researchers, transporters and other medical personnel
o Maintenance and janitorial personnel
All personnel must be thoroughly briefed about the potential risks involved and reminded not to bring any ferromagnetic items into the magnetic field.

Examples of items in-house personnel may have that can become projectiles if brought into the magnetic field

Tool Kits
Clipboards, Metal Pens
Tools
Gurneys, Wheelchairs
Vacuum Cleaners
Oxygen Cylinders
Buffers
Stethoscopes
Buckets
Scalpels, Syringes, Needles
Dustpans
Scissors, Hemostats
Maintenance & Janitorial personnel
MR technologists, students, researchers, transporters & other medical personnel

Who should know MR Safety?
Public safety forces that may respond to the MR suite for an emergency must also know the potential hazards of the MR equipment.
o Law enforcement personnel
o Fire department personnel

A person from the MR site should discuss the possible hazards with these people and provide them with handouts that will reinforce the information.

Examples of items public safety forces may have that can become projectiles if brought into the magnetic field
Breathing apparatus
Fire Extinguishers
Flashlights
Pike poles
Clipboards
Nozzles
Handcuffs
Hose couplings
Knives
Axes
Guns
Fire Department personnel
Law enforcement personnel

MRI Safety - Projectiles
* Projectile effects of metal objects seriously compromise safety. The potential harm cannot be over emphasized.
* Many types of clinical equipment are ferromagnetic and should never be brought into the scan room.
* Items may be tested for magnetic susceptibility with a hand-held magnet located at each MR station.

Metal Objects Becoming Projectiles
Fatal Accidents CAN Happen!
Patient Emergencies
Should a condition exist where the patient is having a medical emergency, all efforts must be made to quickly and safely remove the patient from the scan room.
Once the patient is removed from the MR scan room, close the door to prevent re-entry.
Under no circumstances should a “code team” be allowed to enter the scan room without proper screening!
Controlled Access Area
Although not detectable by the human senses, a magnetic field can be dangerous to equipment and to people.
Since a magnet is always “at field,” safety procedures must be followed to prevent accidents.
For the safety of patients and personnel, controlled access areas are established.

Controlled Access Area
* These areas are established for the safety of patients and personnel.
* The area is labeled with the use of warning signs and markings to prevent the entry of ferromagnetic objects into the controlled access area and to limit the access of individuals with medical implants near high magnetic fields.
* Public access begins at the 5 gauss line (0.5mT).

Equipment / Personal Items
The magnetic field can seriously damage or impair the operation of equipment or personal items such as:
o Oscilloscopes (slow moving electron beams)
o Camera
o Watches
o Credit / Bank cards
o Hearing Aids
o Hair Accessories, Belt Buckles, Shoes

Screening Procedures
* At least one MR operator must screen the patient for possible contraindications that could affect the MR scan. See Patient History and Safety Screening form.
* Check implanted devices in the Reference Manual for Magnetic Resonance Safety by Frank Shellock, Ph.D. or by using MRIsafety.com
Example of MRI Metal Screening Sheet
Screening Procedures
Static magnetic fields can alter the operation of electrically and mechanically operated implants and must remain outside the 5 gauss line.
Pregnant medical personnel should take precautions and remain outside of the magnet room during scanning.
Questions about implants not found in reference material should be discussed with a licensed, MRI technologist or a radiologist before allowing the patient to be scanned.
Absolute Contraindications
* Cardiac Pacemakers (except in rare, controlled environments)
* Cochlear (inner ear) implants
* Swan-Ganz catheters with thermodilution tips
* Ferromagnetic or unidentifiable aneurysm clips of the brain
* Implanted neuro stimulators
* Metal or unidentifiable foreign bodies in the eyes
* Shrapnel near a vital organ
Bioeffects
There is no conclusive evidence for irreversible or harmful bioeffects in humans below 3.0T.
Reversible abnormalities may include but are not limited to:
o Localized tissue and core body temperature heating
o Cutaneous sensations (tingling)
o Peripheral nerve stimulation (involuntary muscle contractions)
o Burn hazards
* Burn Hazards are caused by damaged hardware or by electrical currents produced in conductive loops of material.
* Localized heating is caused by RF irradiation energy absorption to a volume of tissue.
* Dissipation of the absorbed RF energy is described in terms of Specific Absorption Rate (SAR), measured in watts/kg.
* SAR is calculated by the patient’s weight and the expected increase in body temperature for each imaging pulse sequence.
* Patients with poor thermo-regulatory systems must be carefully monitored.
Acoustic Noise
The MR scanner can produce very high acoustic noise levels.
Some patients may experience discomfort from the associated noise of the scanner.
Prior to scanning, it is strongly recommended that earplugs be provided to the patient to reduce the noise level by at least 25dB.

Operating Safely
When operating the MR equipment, be attentive to the following abnormal conditions:
* Louder-than-normal motor noises
* Sparks
* Components overheating
* Smoke or odors coming from the electronic equipment or from within the scan room.
Do not operate equipment with protective panels opened or removed, there is risk of electric shock and can cause image artifacts.

Magnetic Field / Scan Room Emergencies
If an emergency situation arises, you may need to quickly bring down the patient systems and remove power from the MR system.
The nature of the emergency will dictate which procedure you follow. Each procedure has a distinct and specific purpose.
Each magnet is equipped with two emergency buttons:
* Emergency Stop / Shut Off
o Turns off all incoming electrical power to the magnet Power Distribution Unit (PDU)
* Quench or Emergency Run Down
o Causes immediate collapse of the superconductive magnetic field within minutes

FAMILIARIZE YOURSELF WITH THESE BUTTONS. KNOW THE DIFFERENCE!
Emergency Stop / Shut Off Button
Shutting power to the PDU may be required for life threatening situations such as:
* Fire in the computer room
* Fire, sparks, loud noises emanating from the scan room
* Flooding or sprinkling system goes off
* Catastrophic equipment failure
***Keep in mind that when this button is pushed, it does not initiate a quench, the magnet remains “at field.” Exercise caution, make sure that all ferromagnetic materials remain outside of the scan room***
Quench / Emergency Run Down Button
The following situation is THE ONLY TIME that may require quenching of the magnet:
* Large magnetic object pins or impales a person against the magnet and no other method can prevent further injury or free the person.
Do not attempt to pull large magnetic objects (oxygen tanks) from a magnet field. The object may change its magnetic polarity and re-align itself on the magnet and become a projectile, causing a serious or fatal injury.
Do not touch a quenched magnet. Under certain conditions, an electrical potential of >1,000 volts could exist on the surface of the magnet.

Quenching
Definition: a loss of superconductivity of the magnet coil due to a local temperature increase in the magnet as it becomes resistive, resulting in rapid evaporation of liquid helium in the cryostat and quickly reducing the magnetic field strength.
* A quench may happen spontaneously or can be manually instigated in case of an emergency.
* Quenching may cause severe and irreparable damage to the superconducting coils (magnet).
* A magnet quench will result in several days’ downtime, so do not press the button except in a true emergency.
* Do not attempt to test this button!

Emergency Buttons @ MR1 Univ. of Utah Hospital
* QUENCH BUTTON
o Button is located on the east wall (with window).
* E-STOP BUTTON
o Button is located behind the door as you enter the scan room (on the right).
QUENCH
OXYGEN
SENSOR
QUENCH
University of Utah Hospital and Clinics
MRI Department Policies and Procedures
This manual is available at all sites having a MRI scanner. Detail of all departmental situations can be reviewed. The following safety considerations are further highlighted:

Cryogen Safety Oxygen Monitors
Metallic Screening Pregnancy / Nursing
Magnet Quench Medical Emergencies
Magnetic Field / Scan Room Emergencies
Summary
* MRI scanners are powerful magnets with the ability to attract ferromagnetic objects.
* Any personnel around the MRI suite must be adequately screened for metallic implants and personal items before entering the scan room.
* Patients in the scanner must be carefully monitored for reversible bioeffects caused by the magnet’s hardware.
* Become familiarized with E-Stop vs. Quench buttons at each scanner.
* Review Policies and Procedures Manual

Congratulations!
You have completed the University of Utah Hospital and Clinics MRI Safety Training course!
Please review a safety video that demonstrates the powerful forces of MRI magnets.
Following written certification, you will be authorized to aid or assist an MRI technologist with patient examination procedures.

MRI Safety and Policies & Procedures.ppt

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Radiation Safety Oversight of Surgical Procedures



Radiation Safety Oversight of Surgical Procedures Involving the Use of RAM
By: René Michel, M.S., RSO
VA San Diego Healthcare System, San Diego, CA

Introduction
* The objective of this presentation is to review the various Radiation Safety aspects of a typical medical procedure that involves the use of radiological agents.
* Lymphoscintigraphy (LS) is a medical procedure for the treatment of malignant melanoma and mamma-carcinoma.
* The goal is to identify which sentinel lymph nodes (SLN) have been infiltrated by tumor cells
* The objective of this presentation is to determine what basic radiation safety controls are needed.
* ALARA, dosimetry, contamination control, radioactive waste, etc.

Outline
* Radioactive Drugs Used
* Overview of the Procedure
* Radiation Exposure
* Contamination Control
* Recommendations

Radioactive Drugs
* Many radiopharmaceuticals have been evaluated for and used in LS studies
* The ideal drug, must have the following characteristics:
* Small and uniform particle size
* Short half-life
* Low LET
* Appropriate energy for gamma imaging
* 198Au colloid was one of the first widely used drugs in LS
198Au Characteristics
Particle size: 3-5 nm
Half-life: 2.7 d
Emissions: 412 keV photons plus beta particles
* 198Au was replaced by other agents with the increased availability of 99mTc
* Antimony trisulfide, albumin, human serum albumin, sulfur colloid and nano-colloid
99mTc Characteristics
Particle size: 3-90,000 nm
Half-life: 6 h
Emissions: 140 keV photons

Procedure Overview
* There are three stages in Sentinel Node LS
1) Lymphatic Mapping
2) Intradermal Blue Dye Injection
3) SLN Biopsy
Lymphatic Mapping
* The surgeon injects about 1 mCi of 99mTc unfiltered sulfur colloid intradermally near the lesion.
* The colloid is taken up by the lymphatic system and the patient is imaged with a conventional gamma camera.
* About 20 min from injection dynamic scanning is performed
* A late phase scanning done 90 min after injection shows the location of the SLNs.
* The location of the node is marked on the skin of the patient

Blue Dye Injection
* The patient is moved to the OR to perform biopsy
* To assist in identifying the nodes draining the site of interest, a blue dye is injected

SLN Biopsy

* A surgeon uses the skin mark and a scintillation probe to relocalize the highest area of uptake
* A dissection is performed through soft tissue to remove “hot” nodes located by the gamma probe
* All excised nodes are sent to the pathology lab for histological examination to asses for invasion by tumor cells

Radiation Exposure
* Nuclear Medicine personnel are excluded from this evaluation, they are already closely monitored.
* Radiation exposure to OR and Pathology personnel and the potential for spread of contamination are considered the main radiation safety concerns.

Hazards Control-Radiation Exposure
* The expected radiation exposure to personnel from handling SLN radioactive specimens is very small
* 10-15 SLN procedures/year are performed in most large medical centers
* Several studies have documented dosimetry data
Average whole-body radiation dose equivalent/procedure for hospital personnel from malignant melanoma and mamma-carcinoma SLN surgery with typical activities.
* A surgeon's hand dose has been reported to be 10 mrem (Miner et al. 1999)
* The pathologist’s hand dose is even smaller, ~ 4-6 mrem (Veronesi et al.1999)

Hazards Control- Contamination
* The residual activities a day post surgery are <0.3 mCi for tumor-specimens and <50 nCi for SNLE (Kopp and Wengenmair 2002). * These activities are relatively fixed to the tissue, they do not produce contamination that exceeds the allowed levels. * Standard universal precautions used to prevent infections are sufficient to avoid any kind of incorporation in the bodies of those handling specimens. Specimen Control * Under 10 CFR 20.1905 (NRC 2002), labeling is not required for containers holding less than 1.0 mCi of Tc-99m * Labeling is also exempted if only authorized personnel have access to containers, provided a written record identifies the contents. * Specimen quarantine before gross examination is unnecessary since the level of exposure to personnel is not a safety concern. * Despite the simplicity of the guidelines, each institution is expected to develop and implement procedures for handling radioactive specimens. * Awareness training documentation for all individuals handling these specimens is also necessary. Recommended Guidelines 1. Follow standard universal precautions (e.g., wear hospital gown, surgical gloves, etc.). 2. Using forceps, place all radioactive specimens removed from the patient in a sealed container. 3. In addition to the patient’s name and specimen number, label all resected primary site specimens with the name of the isotope (e.g., 99mTc), date and time when it was collected 4. Maintain security of specimens at all times 1. Upon completion of the surgical procedure, all instruments (e.g., forceps, scalpels, etc.) having had direct contact with the radioactive specimens should be cleaned following standard procedures. 2. All specimens should follow the normal biomedical waste stream and be surveyed before disposal to ensure that radiation levels are not distinguished from background References Radiation Safety Oversight of Surgical Procedures.ppt

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07 January 2010

Management of Radiation Accident victim



Physician and Hospital Responses to Radiological Incidents
By: Robert E Henkin, MD, FACNP, FACR
Professor of Radiology
Director, Nuclear Medicine

Robert H. Wagner, MD, MSMIS
Associate Professor of Radiology
Section on Nuclear Medicine/Department of Radiology
Loyola University
Maywood, IL

Experience of Authors

* Dr Wagner trained at Loyola and the DOE in Oak Ridge - Radiation Emergency Assistance Center/Training Site (REAC/TS)
* Drs Wagner and Henkin co-wrote the original manual for hospital management that was used by the State of Illinois
* Dr Wagner is has been consultant for Radiation Management Consultants since 1990 and trains and drills approximately 5 hospitals/year until 1998. Developed the plan for radiation accidents at Loyola

* Dr Henkin is a member of the Radiation Information Network of the American College of Nuclear Physicians
* Drs Wagner and Henkin are Board Certified by ABNM

Radiation and Terrorism
* Public perceptions of radiation
* The good news and the bad news
* Terrorism scenarios
* Types of radiation injuries
* Hospital response to radiation incidents

The Public Perceptions
The Bad News
* Almost nothing creates more terror than radiation
o It’s invisible to touch, taste, and smell
o Most people have unrealistic ideas about radiation
o Most physicians don’t even understand it
* The objective of the terrorist is as much or more panic than it is physical harm

The Good News

* Nuclear Medicine and Radiation Therapy professionals are well trained in the fundamentals of radiation
* Respect radiation, but do not fear it
* Understand what radiation can and cannot do
* There have been industrial radiation accidents that we have learned much from
* It is easily detected in contrast to biological and chemical agents

What Can We Expect?
* Radiological/Nuclear Terrorism
o A true nuclear detonation
o A failed nuclear detonation
o Radiation dispersal device
* Power Plant attacks

A Nuclear Detonation
* Least likely scenario (fortunately)
* Most likely from a stolen nuclear weapon
* Results would be devastating, both psychologically and in terms of damage

The Unthinkable
* Effects of a 1 megaton detonation in Chicago
o 30% of all hospitals destroyed in 50 mile radius
o Transportation and infrastructure compromised
o Emergency vehicles and professionals unable to respond
o Walking wounded with burns may have been fatally irradiated – unknown effects for days to weeks

Radiological Devices
* Not a “nuclear explosion”
* Consists of a bomb designed to disperse radioactive materials in air and water
o Designed to create panic
o Difficult to clean up, material spreads
o Biological effects may take years to appear
* “A Dirty War” HBO/BBC Films 2005

Failed Nuclear Detonation
* Most likely from an improvised nuclear device (IND)
* Beyond the scope of an individual terrorist – would need 10-15 people
* Greatest barrier is availability of weapons grade material
* Would create a critical mass or explosion, but not the same degree as a true nuclear detonation.
* Nuclear material needs to stay in contact for a longer period of time to allow flux to form

Radiological Dispersal Device
* The most likely scenario
* Simply a bomb loaded with radioactive materials
* Uses stolen hospital or industrial materials
* Acute effects are limited to psychological and traumatic injury
* Long term effects would be on contamination of large areas
* Huge expense for cleanup

Chernobyl Comparison
Co-60 food irradiation pencil in a RDD
Radiation Levels
* Inner ring – same as permanently closed around Chernobyl
* Middle ring – same as permanently controlled area around Chernobyl
* Outer ring – same as periodically controlled zone around Chernobyl

Cancer Deaths
Co-60 food irradiation pencil in a RDD

Increase risk of cancer
* Inner ring – 1 per 100 people
* Middle ring – 1 per 1,000 people
* Outer ring – 1 per 10,000 people

What do I Need to Know?
* Fundamental Radiobiology
o Radiation effects are delayed
o Burns if you see them are chemical or thermal in origin.
o Dose limits
* Key personnel
* Contamination control
* Focus on the medical problems

1. Radiation - Fundamentals
* Types of Radiation
* All radiation is part of the electromagnetic spectrum
* This spectrum ranges from infrared through radio/TV transmission and beyond
* Ranges of common exposures

Radiation - Definition
* Energy that is transferred through space
* Examples
o Microwaves
o Radio waves
o Visible Light
o Nuclear radiation (Alpha, Beta, Gamma)
o X-Radiation

Effectiveness of a Lead Apron
Isotope
Percent Stopped
Don’t wear one during an accident!
Measurement Units
* Roentgen – radiation dose measured in air
* Radiation Absorbed Dose (RAD) – a pseudo biologic unit
* Gray – 100 RADS
* Radiation Effective Dose Man (REM) – a biologically corrected dose
* Millrem - .001 REM

We Live in Radioactive World
* Naturally occurring radioactive elements abound
* Cosmic radiation
* Man-made radiation accounts for less than 1% of total radiation
* Average human dose 150 to 170 mR/year
* Dose varies by geographic location

Low Level Radiation 500 - 5,000 mR
High Level Radiation 5- 50 R
Decrease In Sperm Count (transient)
High Level Radiation 500- 5,000 R
LD 50/60 (Estimated With Intensive Support - Possible BMT)
Neurological syndromes
Typical Therapy for Cancer (Divided Doses)
Contamination In Perspective

Radiation Injuries
* Dependent on dose
o Non-Stochastic effects (Dose related)
+ Decrease in sperm count – 15 R
+ Hematological effects – 150 R
+ Gastrointestinal effects, epilation – 300 R
+ CNS effects – 1000 R
o Stochastic Effects (Non-dose related)
+ Increase in cancer risk
+ Genetic abnormalities
Burns From Radiation
* Generally do not appear immediately
* Healing is extremely poor
* Not likely to be seen in the acute setting

2. Introduction to Radiobiology
* Mechanism of Cellular Injury
* Comparison of Tissue Sensitivities
* Dose Effect Relationships
* Genetic Effects
* Carcinogenic Effects
* Embryonic and Fetal Effects
* How to Limit Exposure
Mechanism of Cellular Injury
DNA STRAND
Biological Effects of Radiation Depend on:
* Total Dose Received
* Rate of Exposure
* Total or Partial Body
Radiation In Perspective
Genetic Effects
Radiation In Perspective
Carcinogenic Effects
Embryonic and Fetal Effects
Methods of Decreasing Exposure to Staff

* Time – linear relationship
* Distance – geometric relationship
* Shielding – half value layers.....

What’s My Role?

* Learn the institutional protocols
* Do not wait for the disaster to train
* Know who and where your resources are
* Do not contribute to panic with uninformed statements
* Refer questions to the scene commanders

Management of Radiation Accident victim

Read more...

25 December 2009

NEW IMAGING TECHNIQUES IN THE EVALUATION OF CROHNS DISEASE



NEW IMAGING TECHNIQUES IN THE EVALUATION OF CROHNS DISEASE
By: Barry Daly, M.D.
Department of Radiology
University of Maryland School of Medicine

Imaging for Crohn Disease

Traditional Techniques
Newer Techniques
Imaging for Crohn Disease

Traditional Techniques
* Abdominal Radiographs
* Barium UGI
* Barium small bowel follow through
* Barium Enteroclysis
* Barium Enema

Imaging for Crohn Disease Newer Techniques

* CT
* CT Enteroclysis
* CT Enterography
* Magnetic Resonance
* Ultrasound
* Nuclear Medicine

Imaging for Crohn Disease Traditional Techniques

* Abdominal Radiographs
o Use for initial evaluation of acute pain
o Bowel obstruction
o Perforation
o Limited value

Imaging for Crohn Disease Traditional Techniques


* Barium UGI
o limited in the evaluation of milder cases of mucosal and transluminal inflammation in EGD region

Imaging for Crohn Disease Traditional Techniques

* Barium small bowel follow through
o Distention of small bowel with contrast material is essential for proper evaluation - poor distension of the lumen causes subtle lesions to be overlooked
o Must use intermittent compression to find lesions
o Role in 2005: pre capsule endoscopy evaluation for strictures ?

SIFT Crohn Disease

Ileo-vesical Fistula

SIFT still useful on occasion…

“Hunt the Capsule”

Imaging for Crohn Disease Traditional Techniques

* Enteroclysis
o Enteroclysis can improve small bowel distension by infusing barium contrast rapidly via a duodenal tube

o Unfortunately, the passing of the enteroclysis catheter into the distal duodenum is often difficult and unpleasant for the patient


o Time consuming procedure, difficult technique

Imaging for Crohn Disease Enteroclysis

Imaging for Crohn Disease
Traditional Techniques

* Barium Enema
o Used less frequently in recent years
o helpful in patients who have strictures that preclude endoscopy
+ Asymmetric colonic wall involvement
+ Punched-out ulcers (aphthous, rose thorn, collar stud)
+ Discontinuous bowel inflammation
+ Terminal ileum often involved

Crohn’s Disease Imaging for Crohn Disease Newer Techniques

* CT
* CT Enteroclysis
* CT Enterography
* Magnetic Resonance
* Ultrasound
* Nuclear Medicine

Imaging for Crohn Disease Newer Techniques

* CT
* CT Enteroclysis
* CT Enterography
* Magnetic Resonance
* Ultrasound
* Nuclear Medicine

Imaging for Crohn Disease Newer Techniques


* CT
o Widely used to evaluate for abscess
o Mesenteric fatty proliferation
o May show strictures but wall thickening difficult to assess due to variable distension
o not as sensitive in delineating fissure or fistula as barium studies
o superior to barium in showing the extraluminal sequelae of Crohns

SBO – Crohn Disease

Enteropathic Arthropathy

SacroIliitis – see in 10-20% of Crohns

Imaging for Crohn Disease Newer Techniques

* CT Enteroclysis
o High volume positive contrast infused rapidly via tube
o improves small bowel distension – sensitive for small lesions
o Time consuming procedure to pass Enteroclysis tube
o Need to use Fluoro room & CT scanner
o Unpopular with patients (and radiologists !)

CT Enteroclysis

Active Crohns disease, not seen on SIFT done previously Imaging for Crohn Disease Newer Techniques


* CT Enterography
o High volume (1200ml) negative oral contrast (VoLumen) over 1 hour
o improves small bowel distension c/w regular CT or SIFT
o Give IV contrast to evaluate bowel wall
o Use thin section multislice CT cuts to generate 3D coronal and sagital views also
o Well tolerated by patients, no need for jejunal tube

NORMAL SMALL BOWEL WITH VOLUMEN

View as stack of thin 4 mm images through entire abdomen
Coronal cuts simulate traditional SIFT view



* CT Enterography
o Enhanced wall seen better with negative lumen contrast
o Early studies show superiority to barium studies and conventional CT for detection of mucosal disease activity and strictures (Lee et al, AJR 03)
o May be problematic in cases of suspected infection or perforation
+ Fluid collections/abscesses may appear similar to bowel
+ May avoid post operatively or when abscess suspected


Crohn’s Disease Inflammatory Hyperemia and Reactive adenopathy
Evaluate all abdomen organs as well as bowel

* Crohn’s With Neo-TI & Colonic Disease
* Better evaluation of colon than with SIFT
ILEO-SIGMOID FISTULA
Coronals Show Definite Ileo-vesicular Fistula

* Chronic Crohns in TI
* Fat in bowel wall

CT Enterography

CT Enterography Post Op.
* Magnetic Resonance
Anorectal Crohns
MR of Ano-rectal disease
Bilateral severe complex trans-sphincteric fistulae
Liver Disease associated with Crohns/UC
Primary Sclerosing Cholangitis
PSC & Cholangiocarcinoma

* Ultrasound
o difficult to do, inconsistent results
o May be used to monitor therapy in kids

* Nuclear Medicine
o Indium scan
o Not often used
o May be incidental finding of increased activity in bowel

CT Colography (Virtual Colonoscopy)

Long sigmoid stricture: Adenocarcinoma

Imaging for Crohn Disease Conclusions
Traditional Techniques
Newer Techniques
Imaging for Crohn Disease Traditional Techniques

* Abdominal Radiographs
* Barium UGI
* Barium small bowel follow through
* Barium Enteroclysis
* Barium Enema

Imaging for Crohn Disease Newer Techniques

* CT
* CT Enteroclysis
* CT Enterography
* Magnetic Resonance
* Ultrasound
* Nuclear Medicine

Imaging for Crohns Disease Conclusion

* Useful Newer Techniques evolving
o CT Enterography
+ Comprehensive evaluation of all bowel & solid organs
o Magnetic Resonance
+ Useful for ano-rectal disease
+ Real-time MR has potential for detection of strictures

* Traditional imaging techniques still of value in selected cases


NEW IMAGING TECHNIQUES IN THE EVALUATION OF CROHNS DISEASE.ppt

Read more...

16 July 2009

Radiographic Findings in Blunt Chest Trauma



Soft Tissue Radiographic Findings in Blunt Chest Trauma
By:Jonathan Yarris MSIV

Trauma
* Trauma is the leading cause of death in patients < 40 years
* 4th leading COD overall
* 80% of trauma is due to blunt mechanisms

Blunt Chest Trauma (BCT)
* Seen in about ½ of blunt trauma cases
* ~20% of trauma deaths attributable to BCT
* Etiology: typically deceleration injury
* Radiographic evaluation should begin immediately after initial trauma team assessment

Approach to Trauma Radiographs
* Initial exclusion of life threatening injuries
* Followed by search for less critical injuries
* Life threatening Injuries:
Pneumothorax
Deep Sulcus Sign
Tension Pneumothorax
Tension PTX
Pulmonary Contusion
Laceration
Laceration with Pneumatocele
Hematoma
Pulmonary hematoma
Pneumatocele
Pulmonary Contusion with pneumatocele
Blunt Cardiac Injury (BCI)
Hemopericardium
Great Vessel Injury
Thoracic Aorta Injury
Intimal Flap with double lumen
Airway Injury
* Tracheobronchial tears are uncommon
* Leads to persistent PTX
* Specific Symptom: persistent PTX after chest tube placement
* Finding: “Fallen Lung Sign”, pneumomediastinum, pneumopericardium, sub cut. Emphysema
* ET Tube balloon inflation >2.8cm implies tracheal rupture
Pneumomediastinum
* Etiology: alveolar, tracheobronchial or esophageal rupture
* Most common cause: alveolar rupture due to sudden increased intra-alveolar pressure (Macklin Effect) with air tracking centrally
* Findings:
o Air outlining mediastinal soft tissues and parietal pleura.
o Continuous diaphragm sign
Pneumomediastinum
Pneumopericardium with tamponade
Esophageal Injury
Other
* Skeletal injuries:
* Diaphragm injuries:

Radiographic Findings in Blunt Chest Trauma.ppt

Read more...

16 June 2009

Obstetrical Ultrasound Cases



Obstetrical Ultrasound Cases
By:Douglas Richards, M.D.
Maternal Fetal Medicine
University of Florida

40 case studies were discussed in this presentation.

http://www.obgyn.ufl.edu/ultrasound/RichardsFinalHotSeatsAnswers2009.ppt
http://obgyn.ufl.edu/ultrasound/RichardsFinalHotSeatsPodium2009.ppt

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29 May 2009

Uterine Fibroid Embolism Video-2



Uterine Fibroid Embolism and Interventional Radiology (Part 2)

Radiologists are known for looking inside the body to diagnose health problems. And now, many of these same doctors now use advanced

imaging equipment, not just to diagnose, but also to treat a wide range of problems. In this program, you'll learn how interventional

radiologists use minimally invasive techniques to help people with many conditions, including uterine fibroids and cancer.

Part Two:
Uterine fibroids - what are they?
Uterine fibroid symptoms
Uterine fibroid embolization
Treating pelvic pain

Guest:
Dr. Howard Richard, an interventional radiologist at the University of Maryland Medical Center. Dr. Richard is also an assistant professor of diagnostic radiology at the University of Maryland School of Medicine

Read more...

Uterine Fibroid Embolism Video-1



Uterine Fibroid Embolism and Interventional Radiology (Part 1)

Radiologists are known for looking inside the body to diagnose health problems. And now, many of these same doctors now use advanced

imaging equipment, not just to diagnose, but also to treat a wide range of problems. In this program, you'll learn how interventional

radiologists use minimally invasive techniques to help people with many conditions, including uterine fibroids and cancer.

Part One:
What is interventional radiology (IR)?
Technological advances to see inside the body
Overview of conditions that can be treated with IR
SIR-Spheres treatment for liver cancer
Radio frequency ablation for tumors

Guest:
Dr. Howard Richard, an interventional radiologist at the University of Maryland Medical Center. Dr. Richard is also an assistant professor of diagnostic radiology at the University of Maryland School of Medicine

Read more...

28 May 2009

MusculoSkeletal Imaging Teaching Files Part2



Musculoskeletal Case Forty One - Aneurysmal Bone Cyst


Musculoskeletal Case Forty Two - Pulmonary Osteoarthropathy


Musculoskeletal Case Forty Three - Melorheostosis


Musculoskeletal Case Forty Four - Brown Tumors Secondary to Hyperparathyroidism


Musculoskeletal Case Forty Five - Frostbite


Musculoskeletal Case Forty Six - Erosive Osteoarthritis


Musculoskeletal Case Forty Seven - Disuse Osteoporosis


Musculoskeletal Case Forty Eight - Scleroderma


Musculoskeletal Case Forty Nine - Articular Muscle of the Knee


Musculoskeletal Case Fifty - Sacral Stress Fracture


Musculoskeletal Case Fifty One - Condensing Osteitis


Musculoskeletal Case Fifty Two - Bucket Handle Tear of Lateral Meniscus


Musculoskeletal Case Fifty Three - Scleroderma with acroosteolysis


Musculoskeletal Case Fifty Four - Fluid in the Medial Collateral Ligament Bursa


Musculoskeletal Case Fifty Five - Partial Rupture of Tendon on Radial Tuberosity


Musculoskeletal Case Fifty Six - Synovial Osteochondramatosis


Musculoskeletal Case Fifty Seven - Unilateral Locked Facet


Musculoskeletal Case Fifty Eight - Ankylosing Spondylitis


Musculoskeletal Case Fifty Nine - Supracondylar Process of the Humerus


Musculoskeletal Case Sixty - Linear & Non displaced Fracture of Radial Head


Musculoskeletal Case Sixty One - Neurofibroma


Musculoskeletal Case Sixty Two - Lunatriquetral Coalition


Musculoskeletal Case Sixty Three - Dorsal Trans-radial Styloid Perilunate Dislocation


Musculoskeletal Case Sixty Four - Fibroxanthoma


Musculoskeletal Case Sixty Five - Secondary Hyperparathyroidism


Musculoskeletal Case Sixty Six - Transient Lateral Patellar Dislocation


Musculoskeletal Case Sixty Seven - Volar Intercalated Segmental Instability (VISI)


Musculoskeletal Case Sixty Eight - Calcaneal Cyst


Musculoskeletal Case Sixty Nine - Infection of Intervertebral Disc Cages


Musculoskeletal Case Seventy - Pelligrini - Stieda Disease


Musculoskeletal Case Seventy One - Bone Infarct


Musculoskeletal Case Seventy Two - Lymphoma


Musculoskeletal Case Seventy Three - Lisfranc Fracture / Dislocation of Foot


Musculoskeletal Case Seventy Four - Fracture through Solitary Bone Cyst


Musculoskeletal Case Seventy Five - Chondrosarcoma


Musculoskeletal Case Seventy Six - Posterior Dislocation with Impaction Fracture of the Humeral Head


Musculoskeletal Case Seventy Seven - Complete Rupture of the Hamstring Tendons


Musculoskeletal Case Seventy Eight - Aneurysmal Bone Cyst


Musculoskeletal Case Seventy Nine - Bilateral Subcapital Femoral Epiphyses


Musculoskeletal Case Eighty - Meniscal Ossicle


Musculoskeletal Case Eighty One - Lateral Patellar Dislocation


Musculoskeletal Case Eighty Two- Tear of Anterior Cruciate Ligament


Musculoskeletal Case Eighty Three- Soft Tissue Hemangioma


Musculoskeletal Case Eighty Four - Osteoid Osteoma


Musculoskeletal Case Eighty Five - Bucket Handle Tear of Medial Meniscus


Read more...

MusculoSkeletal Imaging Teaching Files Part1



Musculo Skeletal Imaging Teaching Files

Musculoskeletal Case One - Insufficiency Fractures

Musculoskeletal Case Two - Subacute Hematoma


Musculoskeletal Case Three - Blount's Disease


Musculoskeletal Case Four - Ankylosing Spondylitis


Musculoskeletal Case Five - Quadriceps Tendon Rupture


Musculoskeletal Case Six - Tarsal Coalition


Musculoskeletal Case Seven - Bilateral Glenoid Hypoplasia


Musculoskeletal Case Eight - Disruption of the Anterior Cruciate Mechanism


Musculoskeletal Case Nine - Bucket Handle Tear


Musculoskeletal Case Ten - Insufficiency Stress Fractures


Musculoskeletal Case Eleven - Infectious Tenosynovitis/Palmar Abscess


Musculoskeletal Case Twelve - Discoid Lateral Meniscus With a Tear


Musculoskeletal Case Thirteen - Melorheostosis of Phalanges


Musculoskeletal Case Fourteen - Melorheostosis


Musculoskeletal Case Fifteen - Talocalcaneal Subtalar Coalition


Musculoskeletal Case Sixteen - Uncorrected Developmental Dysplasia of the Left Hip


Musculoskeletal Case Seventeen - Infectious Spondylitis


Musculoskeletal Case Eighteen - Tillaux Fracture


Musculoskeletal Case Nineteen - Sarcoidosis of Hands


Musculoskeletal Case Twenty - Synovial Osteochondromatosis


Musculoskeletal Case Twenty One - Necrotizing Fasciitis


Musculoskeletal Case Twenty Two - Benign Giant Cell Tumor With a Pathological Fracture


Musculoskeletal Case Twenty Tree - SLAP Lesion


Musculoskeletal Case Twenty Four - Dracunculiasis (Guinea Worm Disease)


Musculoskeletal Case Twenty Five - Multiple Hereditary Exostoses


Musculoskeletal Case Twenty Six - Monteggia Fracture-Dislocation (Type 1)


Musculoskeletal Case Twenty Seven - Ruptured Baker’s Cyst


Musculoskeletal Case Twenty Eight - Myositis Ossificans


Musculoskeletal Case Twenty Nine - Flexion-Distraction Fracture at L1 Vertebral Body


Musculoskeletal Case Thirty - Calcium Pyrophosphate Dihydrate (CPPD) Arthropathy


Musculoskeletal Case Thirty One - Neuromuscular Arthropathy Secondary to Poliomyelitis


Musculoskeletal Case Thirty Two - Giant Cell Tumor With Pathologic Fracture


Musculoskeletal Case Thirty Three - Type IV SLAP Lesion of the Glenoid Labrum


Musculoskeletal Case Thirty Four - Melorheostosis


Musculoskeletal Case Thirty Five - Fractured Talar Lateral Process


Musculoskeletal Case Thirty Six - Osteopetrosis


Musculoskeletal Case Thirty Seven - Discitis / Osteomyelitis


Musculoskeletal Case Thirty Eight - Insufficiency Fracture of the Femoral Neck


Musculoskeletal Case Thirty Nine - Osgood Schlatter's Disease


Musculoskeletal Case Forty - Osteochondroma of L3 Spinous Process


Read more...

14 May 2009

Radiology Cases of the Month 2008-2009



Radiology Cases of the Month 2008-2009

Presented by Loyola Radiology Residents -Two cases will generally be posted at the beginning of the month as an unknown with researchable answers or responses.Answers will be posted the following month after posting date with discussion totake place in a designated conference time.

Click on the link below to open the power point presentation of the case.

April 2009 Case 1 - - Namit Mahajan, M.D. posted April 6, 2009 - Faculty Mentor: Dr. Sheikh

April 2009 Case 2 - - Sabir Taj, M.D. posted April 6, 2009 - Faculty Mentor: Dr. Sheikh

March 2009 Case 1 - - Damon Shearer, D.O. posted March 4, 2009 - Faculty Mentor: Dr. Lomasney

March 2009 Case 2 - - Sadaf Chaudhry, M.D. posted March 4, 2009 - Faculty Mentor: Dr. Lomasney

February 2009 Case 1 - - Heather Wichman, M.D. posted February 6, 2009 - Faculty Mentor: Dr. Lin

February 2009 Case 2 - - Monette Castillo, M.D. posted February 6, 2009 - Faculty Mentor: Dr. Lin

January 2009 Case 1 - - Laura Ross, M.D. posted January 5, 2009 - Faculty Mentor: Dr. Lim-Dunham

January 2009 Case 2 - - Anita Oza, M.D. posted January 5, 2009 - Faculty Mentor: Dr. Lim-Dunham

November 2008 Case 1 - Breast - Justin Spackey, M.D. posted October 12, 2008 - Faculty Mentor: Dr. Kral

November 2008 Case 2 - Breast - Joseph Park, M.D. posted October 12, 2008 - Faculty Mentor: Dr. Kral

October 2008 Case 1 - Small Bowel - Nathan Fedors, M.D. posted October 10, 2008 - Faculty Mentor: Dr. Dudiak

October 2008 Case 2 - - Nicholas Kennedy, M.D. posted October 10, 2008 - Faculty Mentor: Dr. Dudiak

September 2008 Case 1 - Breast - Kristen Wrigley, M.D. posted September 5, 2008 - Faculty Mentor: Dr. Cooper

September 2008 Case 2 - MSK - Enzo Cento, M.D. posted September 5, 2008 - Faculty Mentor: Dr. Cooper

August 2008 Case 1 - GU - Doug Brylka, M.D. posted August 11, 2008 - Faculty Mentor: Dr. Demos

August 2008 Case 2 - GU- Rekha Mody, M.D. posted August 11, 2008 - Faculty Mentor: Dr. Demos

May 2008 - - Joseph Park, M.D. posted May 26, 2008 (for eval dates 5/26-6/8/08) Faculty Mentor: Dr. Posniak

May 2008 - GI - Heather Wichman, M.D. posted May 12, 2008 (for eval dates 5/12-5/25/08) Faculty Mentor: Dr. Posniak

April 2008 - Thoracic Imaging - Anita Oza, M.D. posted April 28, 2008 (for eval dates 4/28-5/11/08) Faculty Mentor: Dr. Ward

April 2008 - Pediatric - Pia Dionisio, M.D. posted April 14, 2008 (for eval dates 4/14-4/27/08) Faculty Mentor: Dr. Ward

March 2008 - Ultrasound - Gary Turkel, D.O. posted March 17, 2008 (for eval dates 3/17-3/30/08) Faculty Mentor: Dr. Vade

March 2008 - Pediatric - Nicholas Kennedy, M.D. posted March 3, 2008 {for eval dates 3/3-3/16/08} Faculty Mentor: Dr. Vade

Feb 08 - Neuroradiology - Monette Castillo, M.D. posted February 18, 2008 (for eval dates 2/18-3/2/08) Faculty mentor: Dr. Woods

Feb 08 - Neuroradiology - Laura Ross, M.D. posted February 4, 2008 (for eval dates 2/4-2/17/08) Faculty Mentor: Dr. Woods ***Three cases are given - please diagnose each and give finding

Jan 08 - Nuclear Medicine - Kristen Wrigley, M.D. posted January 21, 2008 (for eval dates 1/21/08-2/3/08) Faculty Mentor: Dr. Wagner

Jan 08 - Nuclear Medicine - Douglas Brylka, M.D. posted January 7, 2008 (for eval dates 1/7-1/20/08) Faculty Mentor: Dr. Wagner

Read more...

10 May 2009

Radiologic Evaluation of Intracranial Tumors



Radiologic Evaluation of Intracranial Tumors
Presentation by:Todd Gourdin M-IV

Available Modalities

1)X-ray
2)CT
3)MRI
4)Nuclear Medicine


X-ray
* Primarily of historical interest since the onset of CT in 1974.
* Was useful for detecting increased intracranial pressure and intracranial calcifications.

Craniopharnygioma

CT
* Most intracranial neoplasms are visible on CT
* Tumors may be hypodense, isodense, or hyperdense on a noncontrast CT depending on tumor histology and location
Pilocytic Cerebellar Astrocytoma
Metastatic Lesion
Why not MRI them all???

* MRI is generally preferable to CT for evaluating intracranial neoplasms
* CT is preferred for visualizing tumor calcification or intratumor hemorrhage.

Commonly Calcified and Hemorrhagic Lesions
Glioblastoma Multiforme
MRI
Noncontrast MRI of Meningioma
Advanced MRI Techniques
Proton Magnetic Resonance Spectroscopy
Perfusion weighted MRI
MRI-guided Surgery
MRI guided stereotactic biopsy
Brain surface imaging
Interventional MRI
Brain Surface Imaging
Nuclear Medicine
SPECT(Single Photon Emission Computed Tomography)
Diagnosed by SPECT as a high-grade glioma and confirmed post-resection
PET(Positron Emission Tomography)
Radionuclides useful for PET analysis of intracranial tumors include:
Fluorodeoxyglucose
C methionine
F a-methyl tyrosine
Advantages of PET over SPECT:
Disadvantages of PET:
PET scan of Language Center
Classification of Intracranial Neoplasms
GBM
* Hallmark finding is tumor necrosis
* Often cross the midline
* Extremely poor prognosis
Tumors of Nerve Sheath – Schwannoma, Neurofibroma
Bilateral schwannomas in NF type 2
Meningeal tumors – meningioma
Meningioma
Lymphoma
Lymphoma on noncontrast/contrast CT
Metastasis
Metastases
References

Radiologic Evaluation of Intracranial Tumors.ppt

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07 May 2009

Rapid CT Diagnosis of Acute Appendicitis



Rapid CT Diagnosis of Acute Appendicitis with IV Contrast Material
Presentation by:
S Mun, K Chen, S Shah, A Oto,W Mileski, L Swischuk, R Ernst
Dept. of Radiology* and Surgery
The University of Texas Medical Branch

Background
* Controversy exists regarding the optimal use of IV, oral and rectal contrast in CT evaluation of suspected acute appendicitis

* Some studies advocate non-oral contrast CT Lane et al; Malone et al; Peck et al; Stacher et al; Yuksekkaya et al

* UTMB ED CT protocol was designed to accommodate high volume of patients requiring CT evaluation. Only IV contrast enhanced CT is utilized to aid in the diagnosis of suspected appendicitis

Purpose
* To determine retrospectively the sensitivity and specificity of IV contrast enhanced CT without oral contrast in confirming suspected acute appendicitis

Materials and Methods
* Patients studies were retrieved over an 8 month period (after institution of ED CT protocol) by a computer-generated search for “appendicitis” in the radiology reports
* Studies with oral contrast, and without IV contrast were excluded
* Patients age 17 and older with CT scans performed with IV contrast only were included in the study population
* Reports of all patients were reviewed retrospectively
* Pathology reports and medical records were reviewed
* Patients without a histopathologic diagnosis of appendicitis who had no documented clinical follow-up of 1 week were excluded
* Patients with indeterminate reports excluded
* Results of CT reports were compared with clinical/pathology reports
* Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated

Results

* 271 patients were initially retrieved from the radiology report database
* 59 patients were excluded
o Unenhanced or oral contrast studies (n=54)
o Pediatric patients (n=5)
* 212 patients were included
o Lost to follow-up (n=35) (16.5%)
o Indeterminate cases, rescanned (n=4) (2.2%)
* N= 173 Final study population

Results

* Appendicitis was confirmed in 56 patients (32.4%)
* Alternative diagnoses n=34 (19.6%)
o Enteritis/colitis (n=9)
o Acute gynecologic disorder (n=9)
o Diverticulitis (n=5)
o Urinary tract infection (n=4)
o Cholecystitis (n=4)
o Malignant neoplastic disease (n=3)
* Pain subsided without specific diagnosis (n=80) (46.2%)

CT
Appendicitis negative
Appendicitis positive
Clinical or histopathologic outcome
Results

* Sensitivity 100%
* Specificity 97%
* Positive predictive value 95%
* Negative predictive value 100%
* Time savings are approximately 1 hour

Images
Inflamed appendix
Diverticulitis
Cholecystitis
Pyelonephritis

Limitations
* Some patients were lost to follow up, so excluded from the study
* Computer-generated search for the word “appendicitis” may not have retrieved all patients presenting with RLQ pain
* Acute appendicitis may have resolved with non-surgical treatment

Conclusions

* IV contrast-enhanced helical CT without oral contrast material is a highly sensitive and specific technique for confirmation of suspected acute appendicitis
* E D waiting time and patient delay to diagnosis may be improved

Rapid CT Diagnosis of Acute Appendicitis.ppt

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01 May 2009

Esophageal Rupture



Esophageal Rupture
Presentation by: Erin M. Will
Overview

* Esophageal rupture is rare
o Roughly 300 cases reported per year
o The diagnosis is commonly missed/delayed
* Mortality is high
o Most lethal GI perforation
o Mortality falls with early dx/intervention
* Survival depends on rapid dx and surgery
o Within 24 hours of rupture: 70-75% survival
o Within 25-48 hours: 35-50% survival
o Beyond 48 hours: 10% survival

Etiology of Esophageal Rupture

* Traumatic Causes (MORE COMMON)1,2:
o Endoscopy or dilation procedures
+ Stent placement most common cause (up to 25% cases)
o Vomiting or severe straining
o Stab wounds / penetrating trauma
o Blunt chest trauma (rarely)
* Non-Traumatic Causes (LESS COMMON)1,2:
o Neoplasm / Ulceration of esophageal wall
o Ingestion of caustic materials

Demographics
* Spontaneous rupture:
o Middle-aged men
o Alcoholics
* Hx of recent esophageal instrumentation
* Chest Trauma
o Penetrating > Blunt

Anatomy

* Esophagus lacks serosa
o More likely to rupture
* Site of rupture:
o More commonly on left side
o Due to instrumentation: distal esophagus
o Spontaneous: posterolateral esophagus
* Tears are usually longitudinal

Pathophysiology

* Air, Saliva, and Gastric contents released
o mediastinitis
o pneumomediastinum
o empyema
o can progress to sepsis, shock, resp failure
Presentation

* Pain
o lower anterior chest / upper abdomen
o may radiate to left shoulder / back
* Vomiting >> Hematemesis
o hematemesis: think Mallory-Weiss/varices
* Dyspnea
* Cough (precipitated by swallowing)

On Exam

* Subcutaneous Emphysema
* Fever
* Tachycardia
* Tachypnea
* Cyanosis
* Upper Abdominal Rigidity
* Pneumothorax/Hydrothorax
* Respiratory Failure
* Sepsis
* Shock

Initial Imaging: X-ray

* PA and Lateral chest films
o Look for:
+ Hydrothorax (L side > R side)
+ Pneumothorax
+ Hydropneumothorax
+ Pneumomediastinum
+ SubQ emphysema
+ Mediastinal widening
+ Pleural Effusion (L side > R side)
Hydrothorax
Initial Imaging: X-ray
Subdiaphragmatic Air
Interventional Imaging
Gastrografin extravasation
CT scan
Pneumomediastinum
What to do next
Indications for conservative mgmt
What to do next

* Early surgical intervention reduces mortality rate: 1st 24 hours!
Indications for surgery

* Sepsis
* Respiratory Failure
* Shock
* Contamination of mediastinum
* Associated pneumothorax
Resources

Esophageal Rupture.ppt

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27 April 2009

Gastrointestinal Imaging



Gastrointestinal Imaging
Presentation by:Rajneesh Mathur D.O.

Basic Imaging Techniques

* Plain Film Radiography
o Quick, Easy, Inexpensive
o “Snapshot” of a dynamic system
o Technique
+ Bones
+ Upper quadrants
+ Flanks
+ Mid-Abdomen
+ Lower Abdomen

Plain Film Radiography Continued

* Acute Abdominal Series
o Supine
+ Detects fluid/blood in peritonuem
+ Detects gas in bowel
o Upright
+ Air Fluid Levels
o Left Lateral Decubitus
o Upright CXR
+ Best for free air

Contrast Radiography

* Barium Sulfate
o Standard for contrast GI studies
o Insoluble, High viscosity
o Not absorbed by the GI tract
* Gastrograffin
o Soluble, Low viscosity
o Not absorbed by the GI tract
o Laxative Effect
+ Not recommended in Peds

Computed Tomography

* Imaging of SOLID organs
* View of RETROPERITONEUM
* Oral Contrast
o Identify bowel
* IV Contrast
o Blood Vessels
* 2 Phases


Radionuclide Scanning

* Replaced by Ultrasound in ED secondary to time

Ultrasonography

* Inexpensive
* Non-Invasive
* Air is a poor conductor
* Solid structures conduct well

Specific Gastrointestinal Conditions

* Plain Film Radiography
* Abdominal CT
* Ultrasound
* Air Contrast or Barium Enema
* Angiography
* Radionuclide Scanning
* MRI

Plain Film Radiography

* In past, every belly pain got plain films
o 10 to 40% of the time it does not change clinical management
o Get it for
+ SBO
+ Free Air
+ Ileus
+ Bowel Ischemia
+ Foreign Bodies

Abdominal Computed Tomography

* Diagnostic Tool of Choice for:
o Diverticulitis
o Pancreatitis
o Pancreatic Pseudocysts
o Aortic Aneurysm
o Blunt Trauma
o Appendicitis
* Can pinpoint a diagnosis in 95% of cases where clinical judgment fails to narrow a wide range of potential diagnoses

Ultrasonography

* Initial study for patients with
o RUQ pain
o Pelvic Pain
o Acute Appendicitis



Air Contrast or Barium Enema

* Used for
o Intussusception
o Has been replaced by CT for suspected abdominal aortic aneurysm
o May be helpful in evaluation of patients with lower GI bleed

Angiography
Radionuclide Scanning

* Can be useful as an adjunct to Ultrasound when suspicion of
o Cholecystitis
o Cystic Duct obstruction
o No Role in the imaging of the GI tract in the ED

MRI
Gastrointestinal Imaging.ppt

Read more...
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