Chapman & Nakielny's Guide to Radiological Procedures

400 Pages·2013·4.45 MB·English

by  Nick Watson

For Alexander and Olivia
For Elsevier
Content Strategist: Jeremy Bowes
Content Development Specialist: Helen Leng
Project Manager: Julie Taylor
Designer/Design Direction: Miles Hitchen
Illustration Manager: Jennifer Rose
Illustrator: David Gardner and Antbits Ltd
CHAPMAN AND NAKIELNY’S
GUIDE TO

RADIOLOGICAL
PROCEDURES
Edited by
Nick Watson
MBChB MRCP FRCR
Consultant Radiologist,
University Hospital of North Staffordshire,
Stoke-on-Trent;
Senior Lecturer,
Keele University Medical School,
Keele, UK
SIXTH EDITION
Edinburgh • London • New York • Oxford • Philadelphia •
St Louis • Sydney • Toronto 2014
© 2014 Elsevier Ltd. All rights reserved.
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This book and the individual contributions contained in it are protected under
copyright by the publisher (other than as may be noted herein).
First edition 1981
Second edition 1986
Third edition 1993
Fourth edition 2001
Fifth edition 2009
Sixth edition 2014
ISBN 9780702051814
Ebook ISBN: 9780702054792
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A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
A catalog record for this book is available from the Library of Congress
Notices
Knowledge and best practice in this field are constantly changing. As new research and
experience broaden our understanding, changes in research methods, professional
practices, or medical treatment may become necessary. Practitioners and researchers
must always rely on their own experience and knowledge in evaluating and using any
information, methods, compounds, or experiments described herein. In using such
information or methods they should be mindful of their own safety and the safety of
others, including parties for whom they have a professional responsibility. With
respect to any drug or pharmaceutical products identified, readers are advised to check
the most current information provided (i) on procedures featured or (ii) by the
manufacturer of each product to be administered, to verify the recommended dose or
formula, the method and duration of administration, and contraindications. It is the
responsibility of practitioners, relying on their own experience and knowledge of their
patients, to make diagnoses, to determine dosages and the best treatment for each
individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the publisher nor the authors, contributors,
or editors, assume any liability for any injury and/or damage to persons or property as
a matter of products liability, negligence or otherwise, or from any use or operation of
any methods, products, instructions, or ideas contained in the material herein.
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Preface
Radiological techniques continue to evolve as the result of a
combination of many factors; particularly the on-going advances
in imaging hardware and software technology, and the continued
refinement of the physicochemical properties of intravenous
contrast media. Successive editions of this Guide have reflected
this constant progress and the consequent continual evolution of
our diagnostic and therapeutic armamentarium which is a central
feature of our specialty. Even in the five years since the previous
edition of this Guide, many routine day-to-day examinations have
changed led, in particular, by advances in CT scanner technology.
The barium enema, the IVP, V/Q isotope scanning and many
invasive catheter angiographic examinations have now largely
been replaced by their CT-based equivalents. Similar changes are
seen reflecting advances in MR and ultrasound technology and
radiologists continue to take on an ever-increasing role in
therapeutic interventions previously the domain of the surgeon.
We set out to reflect these changes but retain the compact
nature and accessible format and, therefore, the usefulness, of the
Guide. All chapters have been thoroughly reviewed and, where
appropriate, revised and rewritten to reflect current radiological
practice, and a new chapter on patient consent has been added.
As always, it is a difficult balance to ensure that current
radiological practice is faithfully reflected but not to dismiss older
techniques which may still be used in some centres or may
continue to be required where there are contraindications to
current preferred techniques such as MR imaging.
It has been a great privilege to be involved with this Guide; the
2nd edition of which rarely left my side as a junior radiologist. I
hope the book continues to be a valued resource for the current
generation of radiology trainees.
Nick Watson
2013
v
Acknowledgements
A number of new contributors have been involved in this latest
edition to whom I am very grateful, but I would particularly like
to acknowledge the work of previous contributors; J F C Oliff,
F M Bryden, M S Moss and P C Thomas, whose chapters have
been revised and updated.
I am also very grateful for the help given by colleagues,
particularly; Dr John Oxtoby for reviewing the Nuclear Medicine
elements of chapters 1, 7, 8 and 16; and senior radiographer
colleagues Phil Andrews and Peter Sutton for their input into
chapter 8.
I would like to acknowledge the great support I have had from
Jeremy Bowes, Content Strategist, and Helen Leng, Content
Development Specialist, at Elsevier.
vi
List of contributors
Frances Aitchison MBChB FRCP FRCR
Consultant Radiologist, City Hospital, Birmingham; Senior
Clinical Lecturer, University of Birmingham, Birmingham, UK
Chapters 1 and 2
Victor Cassar-Pullicino FRCR
Consultant Radiologist, The Robert Jones and Agnes Hunt
Orthopaedic Hospital, Oswestry; Senior Clinical Lecturer,
University of Birmingham, Birmingham, UK
Chapters 12 and 14
Floriana Coccia MB ChB MRCPsych
Consultant Psychiatrist, Heartlands Hospital, Birmingham, UK
Chapter 20
Mark Cowling MRCP FRCR
Consultant Radiologist, University Hospital of North Staffordshire,
Stoke-on-Trent, UK
Chapters 9 and 10
Hilary Dobson FRCP FRCP
Consultant Radiologist, Clinical Director, West of Scotland Breast
Screening Service; Honorary Clinical Senior Lecturer, University of
Glasgow, Glasgow, UK
Chapter 17
Colm Forde MBBCh FRCR
Consultant Radiologist, Queen Elizabeth Hospital,
Birmingham, UK
Chapters 3 and 4
Jonathan Freedman MBChB MRCS FRCR
Consultant Radiologist, Heartlands Hospital, Birmingham, UK
Chapter 20
Peter Guest FRCP FRCR
Consultant Radiologist, Queen Elizabeth Hospital, Birmingham;
Senior Clinical Lecturer, University of Birmingham,
Birmingham, UK
Chapters 5 and 11
xii
List of contributors
Amit Herwadkar MBBS FRCR
Consultant Neuroradiologist, Salford Royal Hospital, Salford, UK
Chapter 13
Arun Jacob FRCR
Consultant Radiologist, University Hospital of North Staffordshire,
Stoke-on-Trent, UK
Chapter 15
Zahid Khan MBBS DA FRCA FCCM FFICM
Consultant Anaesthesia and Critical Care, Queen Elizabeth
Hospital, Birmingham; Honorary Senior Clinical Lecturer,
University of Birmingham, Birmingham, UK
Chapters 18 and 19
Balashanmugam Rajashanker MRCP FRCR
Consultant Radiologist, Manchester Royal Infirmary and St Mary’s
Hospital, Manchester, UK
Chapter 6
Polly Richards BA MBBS MRCP FRCR
Consultant Radiologist, St Bartholomew’s Hospital, London, UK
Chapter 16
Nick Watson MRCP FRCR
University Hospital of North Staffordshire, Stoke-on-Trent;
Senior Lecturer, Keele University Medical School, Keele, UK
Chapters 7 and 8
xiii
1

General notes
RADIOLOGY
The procedures are laid out under a number of sub-headings,
which follow a standard sequence. The general order is outlined
below, together with certain points that have been omitted from
the discussion of each procedure in order to avoid repetition.
Minor deviations from this sequence will be found in the text
where this is felt to be more appropriate.
Methods
A description of the technique for each procedure.
Indications
Appropriate clinical reasons for using each procedure.
Contraindications
All radiological procedures carry a risk. The risk incurred by
undertaking the procedure must be balanced against the benefit
to the patient as deduced from the information obtained.
Contraindications may be relative (the majority) or absolute.
Factors that increase the risk to the patient can be categorized
under three headings: due to radiation; due to the contrast
medium; due to the technique.
Risk due to radiation
Radiation effects on humans may be:
• hereditary, i.e. revealed in the offspring of the exposed individual, or
• somatic injuries, which fall into two groups: deterministic and
stochastic.
1. Deterministic effects result in loss of tissue function, e.g. skin
erythema and cataracts. If the radiation dose is distributed over
a period of time, cellular mechanisms allow tissue repair. There
is then greater tolerance than if the dose had been administered
1