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The Pulmonary Hila

CT is helpful in the diagnosis of endobronchial lesions, hilar and parahilar masses, and hilar vascular lesions. Technique In most patients the hila are adequately assessed with spiral CT with a 5-mm slice thickness (it takes about 15 contiguous 5-mm slices to image the hila), but thinner slices are optimal in identifying some findings such as bronchial abnormalities, small lymph nodes, and hilar vessels. Scans with…

Mediastinum: Lymph Node Abnormalities and Masses

Lymph Node Groups Mediastinal lymph nodes are generally classified by location. Most descriptive systems are based on a modification of Rouvière’s classification of lymph node groups. The names used in describing lymph nodes groups for the purpose of lung cancer staging may differ and are reviewed in Table 4.1 . TABLE 4.1 Relationship of the International Association for the Study of Lung Cancer Lymph Node Zones…

Mediastinum: Vascular Abnormalities and Pulmonary Embolism

Aortic Abnormalities Computed tomography (CT) is commonly used to diagnose abnormalities of the aorta or its branches when they are suspected clinically or because of radiographic abnormalities. Congenital Anomalies Congenital abnormalities of the aorta and its branches are readily diagnosed with CT, and no other study is usually needed unless the anomaly is complex or is associated with congenital heart disease. Aberrant Right Subclavian Artery Aberrant…

Mediastinum: Introduction and Normal Anatomy

Computed tomography (CT) is commonly used in patients suspected of having a mediastinal mass or vascular abnormality (e.g., an aortic aneurysm). In general, CT is performed in two situations. First, in patients with a mediastinal abnormality visible on plain radiographs, CT is almost always the preferred imaging procedure. CT is used to confirm the presence of a significant lesion, determine its location and relationship to vascular…

Introduction to CT of the Thorax: Chest CT Techniques

S piral (helical) computed tomography (CT) allows the entire chest to be imaged in a few seconds or less (i.e., during a single breath hold), with volumetric acquisition of scan data. Two- and three-dimensional reformations may be performed if desired. Because scanning is rapid, contrast agents can be injected quickly, excellent vascular opacification can be achieved, and reduced volumes of contrast agent can be used. Multidetector…

Emergency Procedures for Spills of Radioactive Materials and Special Circumstances

Spills of Radioactive Materials Accidental spillage of radioactive material is rare; however, spills may occur in the laboratory, in public areas such as facility hallways, in elevators, or in any hospital room or ward through contamination by patient body fluids. Spill procedures should be posted in the restricted areas where radioactive materials are used or stored and should specifically state the names and telephone numbers of…

Sample Techniques for Nuclear Imaging

This appendix is provided as a guide to the technical aspects of various imaging procedures. Some of the less common procedures have not been included, and the procedures described herein may need to be adjusted, depending on the equipment available and user preferences. The protocols for positron emission tomography (PET) examinations are at the end of this appendix. Each nuclear medicine laboratory should have a standardized…

Answers to Unknown Case Sets

Answers to Unknown Case Sets Case 1.1 1.1a. What is the most likely diagnosis? Unobstructed patulous collecting system of the right kidney with prompt washout of activity from the collecting system after Lasix. 1.1b. If 370 MBq (10 mCi) of 99m TcO 4 − had been administered to the patient inadvertently instead of 99m Tc-MAG3, would this constitute a reportable “medical event”? No. An administration of a wrong…

Unknown Case Sets

The following case sets have been designed to assess your overall knowledge in nuclear imaging. Each set contains 10 cases, and almost all sets have an example of central nervous system, thyroid, cardiac, respiratory, gastrointestinal, musculoskeletal, tumor, or abscess and positron emission tomography (PET) cases. This is a common review format. In addition, there are several questions regarding each case. You should be able to recognize…

Authorized User and Radioisotope Safety Issues

Overview In the United States, personnel qualifications and safety requirements for the medical use of radioisotopes as they apply to the practitioners of clinical nuclear medicine are set nationally by the US Nuclear Regulatory Commission (NRC). These may be found primarily in Title 10 of the Code of Federal Regulations Part 35 (10 CFR 35), Medical Uses of Byproduct Material. Implementation, oversight, and enforcement of these…