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Head and Soft Tissues of Face and Neck

Skull and Brain The appropriate initial imaging studies for various clinical problems are shown in Table 2.1 . TABLE 2.1 Imaging Modalities for Cranial Problems Suspected Cranial Problem Initial Imaging Study Skull fracture CT scan including bone windows Major head trauma a CT (neurologically unstable); MRI (neurologically stable) Mild head trauma a Observe; CT (if persistent headache) Acute hemorrhage Noncontrast CT Intracerebral aneurysm or arteriovenous malformation…

The Ionising Radiation (Medical Exposure) Regulations 2000 with the Ionising Radiation (Medical Exposure) (Amendment) Regulations 2006 and the Ionising Radiation (Medical Exposure) (Amendment) Regulations 2011

These Regulations, together with the Ionising Radiations Regulations 1999 (S.I. 1999/3232) partially implement, as respects Great Britain, Council Directive 97/43/Euratom (OJ No. L180, 9.7.97, p. 22) laying down basic measures for the health protection of individuals against dangers of ionizing radiation in relation to medical exposure. The regulations impose duties on those responsible for administering ionizing radiation to protect persons undergoing medical exposure whether as part…

Patient consent

Introduction It is a legal requirement that consent be obtained from a patient before any medical care can be provided, with the exception of emergencies where consent cannot be obtained. Consent can take two forms: implied or express. When patients attend for low-risk procedures consent is often implied and has been taken by the referring clinician prior to the patient arriving in the radiology department on…

Medical emergencies

Medical emergencies occurring in the radiology department may be due to: 1. Medication or radiographic contrast given 2. Procedure-related complications 3. Deterioration of pre-existing morbidities. Patients may develop cardiac arrhythmias, hypotension, inadequate ventilation or adverse drug/radiographic contrast reactions. Complications arise from sedative drug administration, invasive procedures and human error; poor monitoring and organizational failings may contribute. If a complication occurs, rapid recognition of the problem and…

Sedation and monitoring

Sedation Sedation is the use of a drug or drugs to produce a state of depression of the central nervous system that enables interventional procedures or treatment to be carried out. Sedative drugs may be combined with drugs used for pain relief (analgesia). Sedation is only part of a ‘package’ of care comprising pre-assessment, properly informed consent, adequate facilities, good techniques and risk avoidance. Over recent…

Breast

Methods of imaging the breast 1. Mammography 2. Ultrasound (US) 3. Magnetic resonance imaging (MRI) 4. Radionuclide imaging 5. Imaging-guided biopsy/pre-operative localization. Mammography Indications 1. Focal signs in women aged >40 years in the context of triple (i.e. clinical, radiological and pathological) assessment at a specialist, multidisciplinary diagnostic breast clinic 2. Following diagnosis of breast cancer, to exclude multifocal/multicentric/bilateral disease 3. Breast cancer follow-up, no more…

Thyroid and parathyroids

Methods of imaging the thyroid and parathyroid glands 1. Plain film (limited to crude assessment of superior mediastinal extension of thyroid goitre and any secondary tracheal displacement and narrowing) 2. Ultrasound (US) 3. Computed tomography (CT) 4. Magnetic resonance imaging (MRI) 5. Radionuclide imaging, including positron emission tomography (PET). Ultrasound of thyroid Indications 1. Palpable thyroid mass 2. Screening high-risk patients 3. Suspected thyroid tumour 4.…

Lacrimal system and salivary glands

Methods of imaging the nasolacrimal drainage apparatus 1. Conventional/digital subtraction dacryocystography 2. CT dacryocystography 3. Magnetic resonance dacryocystography. Further Reading Ansari SA, Pak J, Shields M: Pathology and imaging of the lacrimal drainage system. Neuroimaging Clin N Am 2005; 15: pp. 221-237. Digital subtraction and CT dacryocystography Dacryocystography allows visualization of the lacrimal system by direct injection of contrast into the canaliculus of the eyelid. It…

Spine

Methods of imaging the spine Many of the earlier imaging methods are now only of historical interest (e.g. conventional tomography, epidurography, epidural venography): 1. Plain films . These are widely available, but with low sensitivity. They are of questionable value in chronic back pain because of the prevalence of degenerative changes in both symptomatic and asymptomatic individuals of all ages beyond the second decade. They are,…

Brain

Methods of imaging the brain Imaging the brain's structure and examining its physiology, both in the acute and elective setting, are now the domain of multiplanar, computer-assisted imaging. The imaging modalities in use today include the following: 1. Computed tomography (CT) . This is the technique of choice for the investigation of serious head injury; for suspected intracranial haemorrhage, stroke, infection and other acute neurological emergencies.…

Bones and joints

Imaging modalities 1. Plain films . These are cheap, widely available and valuable screening tools in the preliminary assessment of osteoarticular symptoms. Standard views require a minimum of two views perpendicular to each other, e.g. antero-posterior and lateral projections. The pathological processes underlying osteolysis and osteosclerosis, e.g. infection, tumours, articular erosions, etc., are well advanced before they become radiographically visible and radiographs may appear normal despite…

Radionuclide imaging in oncology and infection

Positron emission tomography imaging Positron emission tomography (PET) imaging is a technique used to detect and accurately stage malignant disease, to differentiate benign and malignant tissue, and to assess response to treatment. Until recently, PET imaging availability was restricted due to high capital cost and logistics of radiopharmaceutical supply. It uses short-lived cyclotron-produced radionuclides such as 18 Fluorine, 11 Carbon, 13 Nitrogen and 15 Oxygen with…

Venous system

Methods of imaging the venous system 1. Contrast venography 2. Ultrasound (US) 3. Impedance plethysmography 4. Radionuclide imaging 5. Computed tomography (CT) 6. Magnetic resonance imaging (MRI). Further Reading Kaufman JALee MJVascular and Interventional Radiology: The Requisites.2004.Elsevier-MosbyPhiladelphia: Scarvelis D, Wells PS: Diagnosis and treatment of deep-vein thrombosis. Can Med Assoc J 2006; 175: pp. 1087-1092. Peripheral venography Intravenous (i.v.) peripheral venography is an invasive procedure requiring…

Arterial system

Methods of imaging the arterial system 1. Catheter angiography 2. Ultrasound (US) 3. Computed tomography (CT) 4. Magnetic resonance imaging (MRI). Further Reading Collins R, Cranny G, Burch J, et. al.: A systematic review of duplex ultrasound, magnetic resonance angiography and computed tomography angiography for the diagnosis and assessment of symptomatic, lower limb peripheral arterial disease. Health Technol Assess 2007; 11: pp. iii-iv. Kaufman JALee MJVascular…

Heart

Methods of imaging the heart 1. Chest radiography 2. Fluoroscopy and angiocardiography 3. Echocardiography – transthoracic and transoesophageal techniques 4. Computed tomography (CT) 5. Magnetic resonance imaging (MRI). 6. Radionuclide imaging: (a) Ventriculography (b) Myocardial perfusion imaging. Angiocardiography Diagnostic catheterization has largely been replaced by echocardiography (including transoesophageal echocardiography), radionuclide ventriculography and MR imaging. Angiocardiography is usually used as part of an interventional therapeutic procedure and…

Respiratory system

Methods of imaging the respiratory system 1. Plain films 2. Computed tomography (CT) 3. Radionuclide imaging (V/Q scans) 4. Ultrasound (US) – for pleural and chest wall disease 5. Magnetic resonance imaging (MRI) 6. Positron emission tomography (PET). Further Reading Hansell DM, Lynch DA, Page H, et. al.: Technical considerations.Imaging of Diseases of the Chest.2009.ElsevierLondon:pp. 1-37. Computed tomography of the thorax Indications 1. In the assessment…

Reproductive system

Methods of imaging the female reproductive system 1. Plain abdominal film 2. Hysterosalpingography 3. Ultrasound (US) – transabdominal/transvaginal 4. Computerized tomography (CT) 5. Magnetic resonance imaging (MRI) 6. Minimally invasive procedures including biopsies, cyst drainage, angiography, fibroid embolization 7. PET-CT. Methods of imaging the male reproductive system (scrotum and testes) 1. US 2. MRI 3. Radionuclide imaging 4. Venography (including embolization of varices) and angiography. Further…

Urinary tract

Methods of imaging the urinary tract 1. Plain film radiography 2. Excretion urography (IVU) 3. Ultrasound (US) 4. Computed tomography (CT): (a) CT for urological diagnosis and urological cancer staging (b) CT for characterization of renal lesion (c) CT adrenals (d) CT KUB (kidneys, ureters, bladder) (e) CT urography (CTU) (f) CT angiography. 5. Magnetic resonance imaging (MRI): (a) MR for characterization of renal lesion (b)…