Anatomical aspects of radiology anatomy, differential diagnosis and the basis of pathology and...

MFDS Anatomical Aspects of Radiology

(Anatomy, Differential Diagnosis and the Basis of Pathology and Radiology)

Professor Peter Abrahams23 November 2004

Anatomy Seminars 2004/2005

Clinical Dental Sciences

AIMS

• REDUCE RADIATION• INTRODUCE “GOLD STANDARD”• STRUCTURES –MODERN TECHNIQUE• “BEST VALUE” – SOCIETY AT LARGE• STIMULATE DISCUSSION • INTRODUCE RCR GUIDELINES

IMAGES

• DO I NEED IT ?• DO I NEED IT NOW ?• DID SOMEONE DO IT BEFORE ?• HAVE I EXPLAINED THE PROBLEM ?• BEST TECHNIQUE / VIEW ?

MEDICO - LEGAL

• CLINICAL GROUNDS ONLY ?• ALTER MANAGEMENT ?• NOTE KEEPING- JUSTIFICATION ?• RCR GUIDELINE ADVICE• “DO SOMETHING” –PROTECTION

RADIATION EXPOSURE

4.5 yrs500CT. ABD/PEL3.2 yrs350BA ENEMA

16 months150BA MEAL7 months65LUMBAR

31CXR1 day0.5limbs

Natural radiation

CXR. equivalent

Examination

H

Fish-bone

LUMP

Barium swallow, Phanrygeal pouch due to Killian’s Dehiscence, Known also as Zenker’sDiverticulum. NB.HIGH Tone in Cricopharygeus muscle-This spasm causes the Pouch

Cricopharygeus Pouch

**

Parotid sialogram with strictures-*

Stone

Submandibular- Wharton’s Duct stone

Plain Xray- stone

Kick-boxfracture

Oedema

f

f

f

A

Normal sinuses with AIR “A” Blocked sinuses with Fluid “f”

A

T

SubmandibularCarcinoma –axial CT

T

Coronal CT nasal cavitycarcinomaNB Bone

T

Axial CT Lymphoma of Maxillary Sinus

Bony erosions in bilateral Glomus Jugulare Tumours

Coronal T1 wt + Gadolinium

T

T

CC= Common CarotidIC= Internal CarotidEC= Ext. Carotid

IC

CC CC CC

IC IC

DSA-Tumour DSA- post embolisation

EC

Carotid DSA, Arterial phase NB IC / ECdisplacement

IC

EC

Late arterial pathologicalVasculature= highlyvascular tumour

Saturday night knife -fight in St. Vincent W.I.- two days later patient complains of lump in root of neck, just above clavicle and an “orange “under his arm.What does this angiogram show?

Lymphadenopathy (Bilateral)Posterior Triangles

** =?

*

*= ?

Presented with lump inneck above clavicle and Typical facial appearance

Parotid PleomorphicAdenoma Axial T2 wt

Normal Parotids

*

*

*

Radionuclide thyroid scan- Multinodular Goitre

Sinogram

Thyroid Arteriogram

Thyroid MRI & DSA

Radionuclide Parathyroid Thallium

- 201 Scan

PARATHYROID Adenoma

Iodine-123 SubtractionScan NB. No Iodineuptake by Parathyroid

ULTRASOUNDULTRASOUND• REGIONAL ANATOMY-

eg. abdominal pain• NO RADIATION ? harm• CHEAP & MOBILE• BUT OPERATOR • POOR HARD COPY

• REGIONAL ANATOMY-eg. abdominal pain

• NO RADIATION ? harm• CHEAP & MOBILE• BUT OPERATOR • POOR HARD COPY

D.S.A.D.S.A.• VENOUS (IV DSA)• CAPILLARIES• ARTERIAL via venous (IA DSA)MANUAL SUBTRACTION• ? MRI for FUTURE ANGIO

• VENOUS (IV DSA)• CAPILLARIES• ARTERIAL via venous (IA DSA)MANUAL SUBTRACTION• ? MRI for FUTURE ANGIO

C.T. SCANSC.T. SCANS

• BONE DEFINITION 1mm. slice• SPEED• 3D POTENTIAL• SPIRAL CT

• BUT RADIATION 400 CXR• AXIAL ONLY-usually cf. ENT

• BONE DEFINITION 1mm. slice• SPEED• 3D POTENTIAL• SPIRAL CT

• BUT RADIATION 400 CXR• AXIAL ONLY-usually cf. ENT

M.R.I. SCANSM.R.I. SCANS

• REGIONAL ANATOMY• ALL PLANES• SOFT TISSUES • 1.Brain 2.Muscles 3. IVD• TISSUE PLANES• NO RADIATION ? harm.• BUT......COST

• REGIONAL ANATOMY• ALL PLANES• SOFT TISSUES • 1.Brain 2.Muscles 3. IVD• TISSUE PLANES• NO RADIATION ? harm.• BUT......COST

DOCTOR’S Guide to Radiology

Making the best use of Department of Clinical Radiology"Royal College of Radiologists , UK “Guidelines for Doctors” 5th Ed. 2003