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Interpreting chest & abdominal radiographs - Mr Jamie Dunn
- 1. Exeter Surgical Society Mr Jamie Dunn BVSc MBChB MRCVS MRCS Why do I always starting writing things at half past nine on a Saturday evening when all I really want to do is learn how to use Netflix...hummm
- 3. Abdominal Radiographs 1. How is an x-ray image created? 2. What are the relative X-ray doses? 3. Do we know enough core abdominal anatomy for interpretation? 4. Do we have a system for reviewing abdominal radiographs? Finally lets review some interesting radiographs...
- 5. How is the image created... 1. X-ray Source 2. Target Penetrance 3. Reduce scatter 4. Convert x-rays to an image Understand that the image created is a two dimensional rendering of a three dimensional structure... Think Pixels...
- 6. Image Quality Issues • Lack of personal data • Lack of side marking • Patient positioning • Image exposure • Movement blurr
- 8. Relative X-ray dose Chest X-Ray Test mSv Equiv Abdo X-Ray CT KUB Chest X-ray 0.1 10 days CT Urogram Abdominal X-ray 0.7 2 months CT KUB 1.4 mSv 4 months CT Abdo/Pelvis 12 mSv 3.5 Years Transatlantic Flight: 0.05 mSv CT Urogram 20 mSv 7 Years
- 9. Reviewing Abdominal films 1) Identify subject and date and orientation. 2) Comment on technical flaws preventing interpretation. 3) Is the image / scan contrast enhanced? 4) Comment on any specific abnormalities. 5) The rest...... Don’t be baffled into saying nothing ....don’t umm and arrh and don’t point... Try not to be so distracted by the amazing that you miss something else...
- 14. Bowel Pathology Distinguishing small verses large bowel... Thinking about distension / obstruction... Thinking about perforation Thinking about bowel bowel wall inflammation
- 15. Small Bowel: 5 cm Max Diameter... Valvulae Conniventes • Circular folds reach around the whole circumference of the small intestine
- 16. Large Bowel: 10 cm Max Diameter Haustra • Haustra of the large bowel do not cross the entire lumen on imaging
- 23. Consider a case... • 45 Male • Observations • 7/7 grumbling abdominal pain – Pulse 105 radiating into his back – BP 178/100 – RR 16 • Acute exacerbation at 15.15 – Sats 100% (A) today • Attended ED via ambulance at 15.37 • Abg – Ph 7.34 • PMH – PO2 16.7 – Asthma – PCo2 2.41 – Bicarb 24 – Planter fasciitis (on diclofenac) – Base Excess -4.5
- 27. Consider a case... • 45 Male • Observations • Weight loss for 3/12 – Pulse 86 – BP 145/85 • Change in bowel habit – RR 14 including diarrhoea and – Sats 100% (A) melena • Attended general take after GP referral today • Abg – Ph 7.34 • PMH – PO2 14.2 – Asthma – PCo2 4.71 – Bicarb 22 – Planter fasciitis (on diclofenac) – Base Excess 1.0
- 30. Ureteric Colic Most renal and Ureteric stones are made from calcium... Calcium is radio-dense... Look for stone’s on plain x-ray KUB initially Can Anyone tell me why I can sometimes see stones on CT but not on plain x-ray? Consider a Case...
- 33. Other Stuff....
- 41. In Conclusion... • You Understand how a radiograph is created. • You Know the important things to look for in an Abdominal radiograph. • You have had practice a describing what you can see.