Who, why, when, and how to start with basic radiology ?

Denis Novak DVM MRCVS www.vetnovak.com

science

Visual perception and radiographic interpretation

Visual inacCcuracies
Slow dark adaptation
Peripheral glare

Theory of percepts
Visual signals are compared with mental images stored in memory Visual signals induce a compatible mental image in our mind The percepts are continuously modified by experience

What we see is a percept

Perceptual distortions

The density of the FOUR central squares is the same

Perceptual distortions

The density of the FOUR central squares is the same

Subjective contours
Position of the organ relative to film surface
Parallel Oblique Perpendicular

Dependent of object being fixed or movable

Bowel loop (movable) Heart (relatively fixed) Main-stem bronchus (fixed)

Subjective contours Relationship with the primary x-ray beam

Subjective contours

Shape

View 1

View 2

multistability of perceptions

principles of interpretation

Rabbit vs seagull (vs horse)

COUNT THE fs

FINISHED FILES ARE THE RESULT OF YEARS OF SCIENTIF IC STUDY COMBINED WITH THE EXPERIENCE OF MANY YEARS OF EXPERT OBSERVATION

How many f s??? 2

7 6 9 8

4
5

7 2 3 0
3

2 9

1
0

COUNT THE fs

FINISHED FILES ARE THE RESULT OF YEARS OF SCIENTIF IC STUDY COMBINED WITH THE EXPERIENCE OF MANY YEARS OF EXPERT OBSERVATION

COUNT THE fs

FINISHED FILES ARE THE RESULT OF YEARS OF SCIENTIF IC STUDY COMBINED WITH THE EXPERIENCE OF MANY YEARS OF EXPERT OBSERVATION

Knowledge, emotions, perception

See what we expect to see we do not see something that contradicts our thinking Search for pulmonary metastases
Young dog = probably negative study Older dog = probably positive study

Visual search for lesions

Vision is blurred during eye movement
We see only when the eye is still

3 dimensional concept
Radiograph is a

2 dimensional shadowgraph of a 3 D object

Create mental 3 D picture Minimum two views at 90 degree Anatomy and radiology textbooks for reference

Three dimensional image

Value of oblique views

Image formation
relative tissue densities

Radiolucent areas let more radiation pass through and expose the film and create a

darker shadow e.g. gas.

Radiodense areas prevent X rays reaching the film and create a

lighter shadow e.g. bone.

Radiographic techniques

Under

Optimum

Over

Tissue thickness
Thickness and radiopacity are interrelated
As thickness increases, radiopacity increases ________________________________________________

principles of interpretation

Tissue composition

water density tissues

Density

Contrast
fat is a friend in radiology

peritoneal fat contrasts with the liver

Lack of contrast

Peritoneal fluid erases the contrast and makes individual organ identification impossible

Silhouetting
If two structures of similar radio-opacity are in contact their margins cannot be distinguished

Projections
Latero - medial (Medio-lateral) - lateral Dorso ventral sternal recumbency / Ventro dorsal dorsal recumbency. Cranio caudal ; Caudo cranial Dorso palmar (carpus distally)/Dorso plantar (tarsus distally) Rostro - caudal / Rostro - cranial

Right lateral

Left to right lateral radiograph of the thorax

Dorsoventral

Right Medio-lateral

Right craniocaudal

Right lateral

Left to right lateral radiograph of the abdomen

flexed and extended view

contralateral limb

stress view

s t r e s s

Skyline view

Organ vs. Area

Please, take 2 views !

ART

Getting Started
Radiology (imaging) is applied anatomy use it

Pathology, surgery and medicine is very important

Understand how the image is generated Errors in perception or interpretation may lead to

incorrect assessment

Viewing area
Quiet area
Adequately darkened At least 2 view boxes

Bright light illuminator

Examining the radiograph

Check the label Views identified and right and left side marked Good quality radiographs

Identify the study Check the quality for: number of views, patient positioning, technique,technical errors, artifacts Position radiograph in a standard manner Try to look at both views while reading Read radiographs twice Use textbooks, atlas, models, normal radiographs Be consistent

Radiographic evaluation

X ray is only a picture in time

Clinical signs may precede radiographic signs
Take additional studies

Radiographic features
in the lungs change within 24 hours In the bone change within 7 days

Radiographic Interpretation
Errors:
False positive diagnosis False negative diagnosis

What does an error mean for the patient?

Inappropriate therapy Euthanasia Untreated disease

Review with experts to eliminate errors

Sources of errors
Scanning or searching errors
corner errors Did not find the expected lesion

Recognition errors
seen, perceived, BUT not recognized as an abnormality

Decision errors
What is important??

Egocentric errors - (I found what I knew would be there)

...keep in mind...
Imaging tests evaluate for normal vs. abnormal structure or function Some diseases do not change morphology Some images do not contain a lesion

Its ok to be normal!

causes & differential diagnoses

CONGENITAL/DEVELOPMENTAL METABOLIC/NUTRITIONAL TRAUMATIC INFLAMMATORY/INFECTIOUS NEOPLASTIC DEGENERATIVE

VITAMIND

Radiographic Interpretation
Knowledge Experience To tie together Make specific conclusion Practice, practice, practice

Radiographic interpretation
Anatomical method of examining the films
Identify visual features of the radiographs Possible structural changes Type of pathology Differential diagnosis Combination of findings with clinical data

Diagnosis

Prioritize

Next step

A systematic approach to interpretation is fundamental.

thx to j.p.morgan and p.mantis