Download Free Medical Radiology Basics PowerPoint Presentation

Radiology Basics PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Check out this medical presentation on Radiology and Imaging, which is titled "Radiology Basics", to know about Radiology Basics.

Tags : Radiology, Imaging, Radiology Basics

Published on : Jul 28, 2021 | Views : 2254 | Downloads : 15

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

Radiology Basics David J. Eschelman, M.D., FSIR Professor of Radiology, Sidney Kimmel Medical College of Thomas Jefferson University Co-Director of Interventional Radiology, Thomas Jefferson University Hospital
Slide 2-

So what is a radiologist?
Slide 3-

So what is an interventional radiologist?
Slide 4-

Imaging Modalities CT (computed tomography) US (ultrasound) MRI (magnetic resonance imaging) PET-CT (positron emission tomography)
Slide 5-

CT Pros: Available everywhere, consistent quality, best option for whole-body evaluation Fast Cons: Less sensitive for small liver metastases than MRI Radiation (10-15 mSv)
Slide 6-

Chest CT – Lung Metastases
Slide 7-

Ultrasound Pros: Relatively inexpensive. No radiation. Can be very sensitive for small lesions Cons: Variable quality, depending on site and on patient. Not useful for whole-body surveillance.
Slide 8-

Biopsy
Slide 9-

MRI Pros: Most sensitive for liver mets. No radiation. No known harmful effects Cons: Does not cover entire body Can’t use in SOME people with pacers, anxiety, etc. Variability in how studies are done. Slow, noisy, easily affected by motion, etc.
Slide 10-

ppt slide no 10 content not found
Slide 11-

ppt slide no 11 content not found
Slide 12-

8/11/2010
Slide 13-

10/27/2010
Slide 14-

12/23/2010
Slide 15-

4/09/2010
Slide 16-

MRI is better than CT (another example) CT MRI
Slide 17-

MRI is better than CT (yet another example) CT MRI
Slide 18-

PET-CT
Slide 19-

PET - CT Pros Unique: Images metabolic activity May give information about efficacy of treatment Cons Not universally available Expensive Not sensitive for small metastases Takes about 2 hours Radiation (30 mSv)
Slide 20-

ppt slide no 20 content not found
Slide 21-

Surveillance Imaging Surveillance Scheduling No consensus: Varies from center to center Depends on tumor histology and genetics Jefferson protocol Low/intermediate risk: MRI q6-12 mo, CXR q12 mo for 5 years High risk: MRI q3 mo + CT chest q 6 mo for 2 years, then MRI q6 mo + CT q 12 mo for 3 years
Slide 22-

NCCN Guidelines v1.2018 RISK OF DISTANT METASTASIS - Low risk: Class 1A(x) Disomy 3 Gain of chromosome 6p EIF1AX mutation T1 (AJCC) (See ST-1 and ST-2) Spindle cells SYSTEMIC IMAGING BASED ON RISK STRATIFICATION Imaging to evaluate signs or symptoms as clinically indicated Consider surveillance imaging(y)
Slide 23-

NCCN Guidelines v1.2018 RISK OF DISTANT METASTASIS - Medium risk: Class 1B(x) SF3B1 mutation T2 and T3 (AJCC) (See ST-1 and ST-2) Mixed histology (spindle and epithelioid cells) SYSTEMIC IMAGING BASED ON RISK STRATIFICATION Imaging to evaluate signs or symptoms as clinically indicated Consider surveillance imaging(y) every 6–12 months for 10 years, then as clinically indicated
Slide 24-

NCCN Guidelines v1.2018 RISK OF DISTANT METASTASIS - High risk: PRAME mutation Epithelioid cells Extraocular extension Ciliary body involvement Class 2(x) Monosomy 3 Gain of chromosome 8q BAP1 mutation T4 (AJCC) (See ST-1 and ST-2) SYSTEMIC IMAGING BASED ON RISK STRATIFICATION Imaging to evaluate signs or symptoms as clinically indicated Consider surveillance imaging(y) every 3-6 months for 5 years, then every 6-12 months for 10 years, then as clinically indicated
Slide 25-

NCCN Guidelines v1.2018 Surveillance: The most frequent sites of metastasis are liver, lungs, skin/soft tissue, and bones. At minimum, all patients should have contrast-enhanced MR or ultrasound of the liver, with modality preference determined by expertise at the treating institution. Additional imaging modalities may include chest/abdominal/pelvic CT with contrast. However, screening should limit radiation exposure whenever possible. Scans should be performed with IV contrast unless contraindicated. . . . . . but also add: (y) Recognizing that there are limited options for systemic recurrence and that regular imaging may cause patient anxiety, some patients may elect to forgo surveillance imaging.
Slide 26-

Background Radiation Sources: Cosmic radiation Naturally occurring radioactive materials (radon, radium) Fallout Exposure in US: Approximately 3 mSv/yr (low altitude) 30-50% higher in Denver Transatlantic flight – 0.08 mSv (2-3x higher over poles) 2x higher in US Capitol (8 hrs/day) – granite, marble
Slide 27-

Radiation Dauer L et al. AJR 2011, 196
Slide 28-

Brenner: DJ, Hall EJ: Computed Tomography — An Increasing Source of Radiation Exposure. N Engl J Med 357:2277, November 29, 2007
Slide 29-

Contrast Risks CT contrast and MR contrast are completely unrelated materials Risk of reaction to CT contrast is very low (0.15%) Risk of reaction to MR contrast is extremely low (0.04%) Most reactions are minor
Slide 30-

Contrast Reactions Contrast and Renal Insufficiency CT: “Contrast nephropathy” MR: NSF
Slide 31-

FDA Drug Safety Communication: FDA warns that gadolinium-based contrast agents (GBCAs) are retained in the body; requires new class warnings May 22, 2017, updated December 19,2017
Slide 32-

Gadolinium Contrast for MRI Per FDA: Gadolinium retention has not been directly linked to adverse health effects in patients with normal kidney function, and we have concluded that the benefit of all approved GBCAs continues to outweigh any potential risks. Linear vs. macrocyclic Eovist is one of the lower linear “accumulators” (lower dose administered, excreted by kidneys and liver, more stable than other linear agents)
Slide 33-

RECIST Criteria Complete Response (CR) Disappearance of liver lesions Partial Response (PR) > 30% decrease in the sum of the longest diameters (“sum LD”) relative to baseline sum Stable Disease (SD) Absence of change which would qualify as response or progression Progression (PD) > 20% increase in the sum LD in liver lesions OR appearance of one or more new liver lesions
Slide 34-

Initial Presentation MRI was normal 6 months ago
Slide 35-

Rapid Growth without Treatment 12/17/2013 4/30/2014 6/2/2014
Slide 36-

Any Questions?