Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Thyroid, Parathyroid, and Salivary Gland Scintigraphy

1 What patient preparation is required before thyroid scintigraphy? Patients should fast after midnight or, at a minimum, for 4 hours before receiving the radioactive iodine-123 ( 123 I) pill to maximize absorption through the gut. Patients should also avoid ingesting foods containing high amounts of iodine because they would saturate the iodine stores in the body and thyroid gland and diminish the uptake of the…

Pulmonary Scintigraphy

1 How would you describe and prepare a patient for a ventilation-perfusion (V/Q) scan? A V/Q scan takes approximately 20 to 30 minutes and consists of two parts. During the ventilation part, the patient will have a face mask placed over his or her mouth and nose and will be asked to inhale oxygen and a radioactive gas that has no smell. The mask will be…

Bone Scintigraphy

1 What should patients know about a bone scan? A bone scan (i.e., bone scintigraphy) requires the intravenous injection of a small amount of a radioactive tracer (e.g., technetium-99m [ 99m Tc] methylene diphosphonate [MDP]) that is adsorbed into the hydroxyapatite structure of bone. Areas of increased radiotracer uptake relate to bone that is actively being remodeled such as with infection or tumor. The radiotracer carries…

Pet of Nononcological Disorders

1 What are some applications of 18 F-fluoro-2-deoxy-2-D-glucose positron emission tomography/computed tomography (FDG PET/CT) in the nononcological setting? For the answer, see Box 77-1 . The applications in nononcological cardiac and brain disorders will be discussed separately in Chapters 82 and 83 , respectively. Box 77-1 Applications of FDG PET/CT in the Nononcological Setting Assessment of patients with brain disorders Refractory seizures Neurocognitive disorders Assessment of…

Pet of Oncological Disorders

1 What is 18 F-fluoro-2-deoxy-2-D-glucose (FDG)? FDG is the most widely used radiotracer for positron emission tomography (PET) imaging and was first tested in humans in 1976. Its utility is based on the Warburg effect (described in the late 1920s by Otto Warburg), in which malignant cancer cells preferentially use glucose compared to other substrates. However, this radiotracer can be used to assess any organ or…

Musculoskeletal Interventional Radiology

1 What are some common image-guided musculoskeletal interventional procedures? Musculoskeletal radiology is a subspecialty that encompasses many diagnostic and therapeutic procedures using image guidance. Some common ultrasonography-guided (US-guided) procedures in musculoskeletal radiology include: joint injections, tendon sheath injections, calcific tendinosis lavage, bursal injections, tendon fenestration, and soft tissue biopsy. Fluoroscopy is often used to guide joint injections as well as joint aspiration and arthrography. Computed tomography…

Neurointerventional Radiology

1 What is the basic normal vascular anatomy of the brain? Arterial The cerebral vasculature is supplied by 4 arterial vessels—the paired internal carotid arteries (ICA) and the vertebral arteries (VA)—and can be divided into anterior and posterior circulations. The anterior circulation consists of the bilateral internal carotid arteries, which bifurcate into the anterior cerebral arteries (ACA) and the middle cerebral arteries (MCA) ( Figure 74-1,…

Genitourinary and Gastrointestinal Interventional Radiology

1 List the indications for percutaneous nephrostomy (PCN) ( Figure 73-1 ). To relieve obstruction in the setting of infection or to preserve renal function. To assist in the removal of a calculus or foreign body. To divert urine to permit healing of a leak or fistula. To provide access for ureteral intervention. 2 What is the indication for emergent PCN? Pyonephrosis (infected urinary obstruction) may…

Biliary and Portal Venous Interventions

1 What are the indications for percutaneous transhepatic biliary drainage? Percutaneous biliary drainage is indicated for the treatment of cholangitis or pruritus related to hyperbilirubinemia in the setting of benign or malignant obstructive biliary disease. Biliary drainage may also be performed in the setting of a traumatic bile leak to help divert bile and promote healing of the injured duct. Generally, percutaneous drainage is indicated only…

Embolization Techniques and Applications

1 Describe embolotherapy and some of its indications. Embolotherapy is temporary or permanent vascular occlusion induced by the intravascular administration of materials via a percutaneous route. Embolization has various clinical applications, including control of bleeding; treatment of vascular malformations; and tumor or organ ablation for curative, palliative, or preoperative purposes. 2 What materials are most commonly used for embolization? Various embolic materials are commercially available. The…

Peripheral Arterial Disease Diagnosis and Intervention

1 What is the appropriate landmark for a femoral artery puncture? Some risks of arteriography can be minimized by properly selecting the puncture site. Above the inguinal canal, the common femoral artery becomes the external iliac artery and dives posteriorly. Punctures above the inguinal canal may be problematic for several reasons. Because the artery is deep in relation to the puncture site, manual compression may be…

Advanced Procedures in Interventional Radiology

Endovascular Aneurysm Repair (EVAR) 1 What is the basic composition of a stent graft? A stent graft is composed of a metallic stent structure covered by a medical-grade fabric. The stents are typically made from stainless steel or nitinol (nickel titanium alloy), and the fabric is either Dacron (polyester) or expanded polytetrafluoroethylene (ePTFE). A stent graft comes compressed and loaded in a delivery catheter. Stent graft…

Image-Guided Percutaneous Needle Biopsy

1 What are the major indications for image-guided percutaneous needle biopsy? Image-guided percutaneous needle biopsy (IPNB) is an established, effective nonsurgical procedure that is performed in selected patients to obtain a pathologic diagnosis or to guide appropriate patient management. Indications for percutaneous needle biopsy include: To determine if a lesion is benign or malignant. To obtain material for microbiological analysis in suspected infection. To stage disease…

Inferior Vena Cava Filters

1 What is an inferior vena cava (IVC) filter? An IVC filter is a device inserted percutaneously into the IVC designed to prevent pulmonary emboli (PE) originating from lower extremity deep vein thrombosis (DVT) and to maintain caval patency. 2 What are some common indications for IVC filter placement? For patients with lower extremity DVT, accepted indications include: A contraindication to anticoagulation. Recurrent thromboembolic disease despite…

Equipment, Terms, and Techniques in Interventional Radiology

1 What are the characteristics of a diagnostic catheter? Catheters may be selected for a specific application based on many characteristics ( Figure 66-1 ). Although there are numerous catheters, experience and personal preference play a large role in the selection process. Length: Catheters are available in various lengths, the most common being 65 cm and 100 cm. The appropriate length is based on the access…

Patient Sedation and Pain Management

1 What is the purpose of sedation and pain management during an interventional radiology procedure? The purpose is to enable a patient to tolerate a potentially painful procedure yet still maintain satisfactory cardiopulmonary function and the ability to cooperate with verbal commands and tactile stimuli. 2 What is the difference between analgesia and anesthesia? Analgesia is the relief of pain without alteration of a patient's state…

Vascular Ultrasonography

1 List some of the most common indications for vascular ultrasonography (US). Vascular ultrasound is commonly used to evaluate the following: Extremity deep venous thrombosis. Carotid artery stenosis. Abdominal aortic aneurysm. Renal artery stenosis. Hepatic vasculature in the setting of cirrhosis and after transjugular intrahepatic portosystemic shunt (TIPS) placement. Pseudoaneurysm and arteriovenous fistula. 2 How is vascular flow assessed with US? Flow within vessels is detected…

Musculoskeletal Ultrasonography

1 What are some benefits of ultrasonography (US) for musculoskeletal applications? There are multiple benefits and unique advantages that US offers in musculoskeletal imaging. US does not involve the use of ionizing radiation, which is especially attractive when imaging pediatric and pregnant patients, and there are no absolute contraindications to diagnostic US. In addition, US has a higher spatial tissue resolution than magnetic resonance imaging (MRI)…

Abdominal Ultrasonography

1 List some of the most common indications for abdominal ultrasonography (US). Abdominal, flank, and/or back pain. Abnormal laboratory values (e.g., abnormal liver function tests). Palpable abdominal mass. Signs or symptoms referred from abdomen (e.g., jaundice or hematuria). 2 What is the sonographic appearance of the liver? The liver is normally homogeneous in echotexture, equal to or slightly more echogenic than the renal cortex, and hypoechoic…

Neck Ultrasonography

1 What is the basic normal anatomy and sonographic imaging appearance of the thyroid gland? The thyroid gland is a butterfly-shaped organ located in the anterior neck, just below the thyroid cartilage and anterior to the trachea. It extends posteriorly to the esophagus and laterally to the carotid sheath, and consists of two lateral conically shaped lobes and the isthmus, a narrow band of midline tissue…