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Introduction to Terminology

▪ Introduction The focus of this chapter is to define terms used in cardiovascular and thoracic imaging and provide a basic framework for pattern recognition for problem solving in the clinical practice. The thoracic terms used in this book incorporate the recommendations of the Nomenclature Committee of the Fleischner Society published in 1984, 1996, and 2008 for thoracic radiography and computed tomography (CT). A few terms…

Thoracic Nuclear Imaging

Introduction Historically, radionuclide lung imaging was used mainly for the diagnosis of pulmonary embolism (PE) and lung function. The advent of fluorodeoxyglucose (FDG) positron emission tomography (PET) computed tomography (CT) scanning, with its integration of both functional and anatomic information into coregistered datasets, has heralded a new age of radionuclide imaging for lung cancer evaluation and staging. Expanded applications of FDG PET/CT now also include non-neoplasm…

Problem-Oriented Radionuclide Myocardial Perfusion Imaging

Introduction Radionuclide myocardial perfusion imaging (MPI) plays a key role in the diagnosis and management of individuals with known or suspected coronary artery disease (CAD). Recent breakthroughs in single-photon emission computed tomography (SPECT) technology and software, along with the increasing availability of positron emission tomography (PET) scanners, are rapidly changing the existing paradigm of MPI. Cardiac SPECT MPI is a versatile tool to diagnose obstructive CAD…

Angiography and Interventions

Introduction The bony thoracic cage and crowded vital organs in the thorax make open surgical access difficult and challenging. For these same reasons, the thorax is ideal for image-guided interventions. In addition to procedural skills, a thorough knowledge of the anatomy, physiology, pathology, imaging findings, and preprocedure and postprocedure care is required for successful practice of various interventional procedures. Thoracic interventions can be broadly divided into…

Cardiac MRI

■ Introduction Cardiac MRI is a study often used for the evaluation and diagnosis of a wide range of acquired and congenital cardiac abnormalities. Cardiac MRI offers excellent soft tissue contrast that is useful in evaluating cardiac masses and infiltrative diseases of the myocardium. Both ECG and respiratory gating improve temporal resolution, allowing for the detection of cardiac motion abnormalities and evaluation of small structures adjacent…

Pulmonary, Mediastinal, Vascular, and Chest Wall MRI

▪ Introduction and Background: Considerations for Using MRI Magnetic resonance imaging (MRI) is an important tool in imaging the mediastinum, chest wall, and chest vasculature, with a continuously expanding role. Excellent soft tissue contrast makes MRI a useful tool in the diagnosis, staging, surgical planning, and response to treatment evaluation in many cancers. MRI offers sensitivity to blood flow without ionizing radiation, which is particularly useful…

Cardiovascular CT

Introduction CT imaging of the heart plays an important role in anatomic and sometimes functional evaluation of the heart and coronary arteries. Coronary artery cardiac CT angiography (CTA) has substantially gained popularity, specifically for imaging acute chest pain in urgent care settings, allowing for a more rapid rule-out of acute coronary syndrome (ACS) and for imaging patients before and after coronary artery bypass graft (CABG) surgery.…

Pulmonary CT: The Scanner, the Protocol, and the Dose

Introduction CT has become an indispensable part of diagnostic imaging in recent times. With the help of the money that the Beatles’ records made for Electrical and Music Industries (EMI), Nobel Laureate Sir Godfrey Hounsfield invented CT in 1972, a technology that has evolved at a rapid pace since its introduction. The first CT scanner was an axial CT scanner, which took around 5 minutes for…

Radiographic Techniques

■ Conventional Chest X-Ray The chest radiograph is the most common radiographic procedure performed in the imaging department and is the initial imaging modality in a patient presenting with thoracic symptoms. The basic techniques of chest radiography have not changed significantly over the past 100 years. However, most centers are now using predominantly digital radiology as compared to the conventional screen-film technology. Preliminary Considerations W hy…

Step-by-Step Analysis of Cardiac Chambers in CT

■ Introduction Heart disease is a leading cause of morbidity and mortality worldwide. Noninvasive imaging plays a role in the diagnosis, monitoring, and treatment of heart disease. Hence, radiologists can increase the clinical utility of their imaging reports and consultations with basic knowledge of cardiac chamber assessment on computed tomography (CT) for dedicated cardiovascular and conventional thoracic imaging protocols. Although analysis of many CT scans can…

Imaging Anatomy of the Heart and Thoracic Great Vessels

▪ Introduction Various imaging techniques are used in the assessment of the normal anatomy and pathology of the heart and great vessels. Chest radiography is the most commonly used modality and is often the first imaging test used in the assessment of patients with suspected cardiovascular disorders. Advances in cross-sectional imaging, such as computed tomography (CT) and magnetic resonance imaging (MRI), have enabled dedicated and precise…

Mediastinum, Chest Wall, and Diaphragm

■ Introduction The mediastinum, chest wall, and diaphragm can be evaluated by multiple imaging modalities, such as radiography, computed tomography (CT), and magnetic resonance imaging (MRI). The chest radiograph is often the initial imaging modality used in the evaluation of these structures and their abnormalities. CT and MRI are important cross-sectional imaging modalities that are useful in the evaluation and characterization of abnormalities in these structures.…

Normal Anatomy of the Lungs

▪ Introduction The lungs incorporate the parenchyma, vasculature, bronchial tree (trachea, bronchi, and bronchioles), and a network of investing connective tissue that supports and connects the structures to one another. The human lungs are a pair of large spongy organs for gas exchange between blood and the air. The lungs are covered by a serous membrane called the visceral pleura, and the surrounding cavity formed between…

Imaging Physics

X-Ray Physics Production of X-Rays X-Ray Tube ( Fig. 14.1 ) An x-ray tube is an energy converter receiving electrical energy and producing heat and X-rays. For a diagnostic x-ray tube operating at 100 peak kilovoltage (kVp), the production of heat and X-rays is: Heat, 99% X-rays, 1% Electron deceleration (Bremsstrahlung), 0.9% Characteristic radiation through ionization, 0.1% X-ray tubes are designed to minimize heat production and…

Contrast Agents

X-Ray Contrast Agents Iodinated Contrast Agents Classification Iodinated contrast agents can be classified based on osmolarity (high, low, or iso) and ionitiy (ionic or nonionic). A variety of iodinated contrast agents have been developed and are distributed by different manufacturers. The agents all consist of iodinated benzene ring derivatives, and ionic agents are typically formulated as sodium and/or meglumine salts. Two generic classes of agents include:…

Nuclear Imaging

Pulmonary Imaging Radiopharmaceuticals Pulmonary scintigraphy uses ventilation agents and/or perfusion agents, depending on the specific imaging task. Overview Agent Half-life Main Energy Collimator Comments Ventilation 133 Xe 5.2 days 81 Low Inexpensive; washout images helpful 99m Tc DTPA aerosol 6 hr 140 keV Low Delivery not as good as with gases; multiple projections possible Perfusion 99m Tc MAA 6 hr 140 keV Low DTPA , Diethylenetriaminepentaacetic acid; keV , kiloelectron…

Pediatric Imaging

Respiratory Tract Upper Airway Approach Inspiratory stridor is the most common indication for radiographic upper airway evaluation. The main role of imaging is to identify conditions that need to be treated emergently and/or surgically (e.g., epiglottitis, foreign bodies). Technique: 1 Physician capable of emergency airway intervention should accompany child 2 Obtain 3 radiographs: Lateral neck: full inspiration, neck extended ( Fig. 11.1 ) Anteroposterior (AP) and…

Obstetric Imaging

First Trimester General Reference All ages in this section refer to the menstrual age or gestational age (GA) based on the last menstrual period (LMP) and not the embryonic age based on day of conception. A 4-week pregnancy by the LMP method thus corresponds to a 2-week pregnancy by the conception method. All measurements given in this section are for transvaginal sonography (TVS) unless otherwise stated.…

Breast Imaging

Mammography Mammography Techniques Mammography is primarily a screening and not a diagnostic tool. The mediolateral oblique (MLO) and craniocaudal (CC) views are standard screening views, whereas additional views described below are used mainly for diagnostic evaluation of lesions. Mammographic Views ( Fig. 9.1 ) MLO View This standard view is a projection parallel to the pectoralis major muscle (C-arm of mammographic unit is 40–60 degrees). The…

Vascular Imaging

Techniques General Preprocedure Evaluation 1 What is the indication for the procedure? Diagnosis Preoperative staging Therapy 2 Define the problem. What is the diagnostic question that is to be answered? Which study can best answer the question (ultrasound [US], computed tomography [CT], magnetic resonance imaging [MRI], angiography)? 3 Patient history, interview, examination Review chart Key data: signs and symptoms Previous vascular surgery/interventions Previous studies Laboratory values…