Medical Imaging: Techniques, Reflection and Evaluation PDF
Preview Medical Imaging: Techniques, Reflection and Evaluation
Medical Imaging TECHNIQUES, REFLECTION & EVALUATION Second Edition Edited by Elizabeth Carver BSc(Hons) DCR(R) FAETC Deputy Director of Radiography, Lead for Clinical Education, Bangor University, Wales, UK Barry Carver PgDipCT PGCE DCR(R) Director of Radiography, Bangor University, Wales, UK Foreword by Richard C. Price PhD MSc FCR Head of School of Health and Emergency Professions, University of Hertfordshire, UK Edinburgh London New York Oxford Philadelphia St Louis Sydney Toronto 2012 B978-0-7020-3933-1.00042-6 10.1016/B978-0-7020-3933-1.00042-6 978-0-7020-3933-1 Elsevier Inc. Copyright © 2012 Elsevier Ltd. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency can be found at our website: www.elsevier.com/permissions. 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 2006 Second edition 2012 ISBN 978 0 7020 3933 1 British Library Cataloguing in Publication Data 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 understand- ing, 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 recom- mended 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. Working together to grow The libraries in developing countries publisher’s policy is to use www.elsevier.com | www.bookaid.org | www.sabre.org paper manufactured from sustainable forests Printed in China B978-0-7020-3933-1.00049-9 10.1016/B978-0-7020-3933-1.00049-9 978-0-7020-3933-1 Elsevier Inc. Dedication For those who have loved or inspired us. And friends we have found on our way. Commissioning Editor: Claire Wilson Development Editor: Catherine Jackson Project Managers: Anita Somaroutu/Shereen Jameel Designer: Miles Hitchen Illustration Manager: Jennifer Rose Contents Contents Foreword...............................................................................vii 11. Cervical.spine.............................................................121 Preface.to.first.edition..........................................................ix Barry Carver Preface....................................................................................xi 12. Thoracic.spine............................................................135 Acknowledgements.............................................................xiii Linda Williams List.of.contributors..............................................................xv 13. Lumbar.spine.............................................................141 Abbreviations.....................................................................xvii Barry Carver, Elizabeth Carver 14. Sacrum.and.coccyx....................................................153 SECTION 1: Imaging principles Elizabeth Carver 1. Digital.imaging..............................................................3 15. Thoracic.skeleton.......................................................159 Mark McEntee, Barry Carver Elizabeth Carver 2. Film/screen.imaging....................................................11 16. Principles.of.radiography.of.the.head.....................167 Barry Carver Elizabeth Carver 3. Exposure.factors,.manipulation.and.dose.................17 17. Cranial.vault...............................................................173 Barry Carver, Mark McEntee Barry Carver 18. Facial.bones................................................................183 SECTION 2: Skeletal radiography Elizabeth Carver 4. Introduction.to.skeletal,.chest.and.abdominal. 19. Paranasal.sinuses.......................................................199 radiography..................................................................25 Elizabeth Carver Elizabeth Carver 20. Specialised.projections.of.the.skull..........................205 5. Fingers,.hand.and.wrist...............................................31 Elizabeth Carver Elizabeth Carver 21. Dental.radiography....................................................215 6. Forearm,.elbow.and.humerus....................................53 Elizabeth Carver Elizabeth Carver 22. Orthopantomography.and.cephalometry................229 7. The.shoulder.girdle......................................................67 Elizabeth Carver Linda Williams, Elizabeth Carver 8. Foot,.toes,.ankle,.tibia.and.fibula...............................79 SECTION 3: Chest and abdomen Linda Williams 9. Knee.and.femur...........................................................97 23. Chest.and.thoracic.contents.....................................237 Linda Williams Elizabeth Carver 10. Pelvis.and.hips...........................................................109 24. Abdomen....................................................................257 Linda Williams Elizabeth Carver v Contents SECTION 4: Accident and emergency 32. Cardiovascular.system...............................................377 Mark Cowling, Colin Monaghan 25. Accident.and.emergency...........................................263 33. Vascular.imaging.of.the.head.and.neck...................385 Darren Wood, Elizabeth Carver Patricia Fowler, Andrew Layt 34. Interventional.and.therapeutic.procedures..............395 SECTION 5: Breast imaging Mark Cowling 26. Breast.imaging...........................................................285 Judith Kelly, Sara Millington, Julie Burnage SECTION 8: Additional imaging methods SECTION 6: Paediatric imaging 35. Computed.tomography.............................................417 Barry Carver 27. Paediatric.imaging.in.general.radiography..............303 36. Magnetic.resonance.imaging....................................439 Donna Jane Dimond, Tim Palarm John Talbot 37. Nuclear.medicine.imaging........................................477 SECTION 7: Contrast studies David Wyn Jones, Julian MacDonald, 28. Contrast.media..........................................................323 Peter Hogg Susan Cutler 38. Ultrasound.................................................................497 29. Gastrointestinal.tract.................................................335 Rita Phillips, Julie Burnage, Barry Carver Joanne Rudd, Michael Smith, Darren Wood 30. Accessory.organs.of.the.gastrointestinal.tract..........353 Glossary.of.radiographic.terms.........................................519 Darren Wood, Elizabeth Carver Index...................................................................................521 31. Investigations.of.the.genitourinary.tract..................363 Elizabeth Carver, Darren Wood vi Foreword Foreword The new edition of this now well established text, edited by Elizabeth from being merely the professional who acquires the image, is now Carver and Barry Carver, continues to provide an unparalleled and someone who by education and training is able to evaluate images, all-inclusive approach to the practice of radiography and medical comment on their findings and provide an interpretation to the refer- imaging. As well as their own major inputs to the text, they have ring clinician. The profession has taken a giant leap to reassert itself once again successfully integrated contributions from a range of in image interpretation. Even 10 to 15 years ago it is highly unlikely experts within the field. that a chapter such as this one on Accident and Emergency would have The book with its eight sections and 38 chapters provides a superb been included in a radiography textbook. However, the chapter now and comprehensive coverage of key topics. The reader will find a rightly reflects ‘the modernisation’ of the profession and the giant leap wealth of information from imaging principles and skeletal radiogra- it has made over a relatively short period. The editors deserve full phy to contrast studies, breast imaging, MRI, paediatrics, ultrasound credit for the chapter’s inclusion. and much more. The design of the chapters with well delineated sec- In a world where technology development and diffusion continues tions on indications for examinations and pathologies, clearly labelled to drive change there are a number of consequences: old equipment line diagrams and images and coloured prints provide clarity that the is replaced by new; old procedures are discarded and replaced by new reader will value. However, the holistic approach to each chapter techniques; and there is a shift in the definition of accepted practice. ensures that the book is not only about ‘how to’ position; it is much The impact of these changes is profound and more than ever radiog- more than that. The book’s subtitle ‘Techniques, Reflection and Evalu- raphers must be able to evolve their practice and adapt to the demands ation’ reflects what the editors have set out to achieve. Adaptations to of modern evidence-based health care. Students who join the profes- basic techniques are discussed, and criteria for assessing image quality sion do so from a different starting point than previous generations are prominent features. If an image does not turn out as expected, the but their need to develop from a strong foundation for practice has ‘boxed’ sections on common errors and possible reasons are particu- not changed. This is a book that caters for students, learners and larly helpful. In Section 8 where CT, MRI, nuclear medicine and practitioners of all ages. The new edition provides that solid and reas- ultrasound are considered, equipment chronologies are presented. suring platform which will give support and the confidence that stu- These are excellent features and provide important background and dents and practitioners alike seek in their professional journey. For context to the stage of technology development today. The discussion the editors to produce a text that is cognisant of change and new sections in each chapter are well referenced, providing the reader with development while providing the basic grounding for the practitioners additional sources of reading which will be particularly helpful to of tomorrow is a challenge that has been met head-on. Elizabeth students and researchers alike. Carver and Barry Carver are to be complimented on the second edition I am particularly pleased to see the chapter on Accident and Emer- of their book which will be sought by departments, institutional gency. There is a clear focus on adaptations and the section on the libraries and individuals wherever radiography is practised. mechanisms of injury related to examination requirements is innova- tive and clearly reflects the knowledge and understanding that radiog- Dr Richard Price raphers need in the trauma setting today. The chapter stresses the Hatfield UK advancing role of the radiographer and the fact that radiographers are March 2012 key members of the multidisciplinary team. The radiographer, far vii Preface to first edition Preface to first edition The role of practitioners in medical imaging has been developing for to exposure factors and image recording systems. Information is not many years and professional practice now requires an evidence-based merely descriptive; at times the authors consider and discuss pub- approach to this practice. In a rapidly expanding field this can seem lished sources and relate this information to the concepts they present. overwhelming, especially for the undergraduate or newly qualified The next section has familiar aspects in that it offers descriptions of radiographer. No one can hope to reach advanced or consultant status radiographic positioning and provides images of suggested patient as a diagnostic imaging professional without a reflective attitude. positions and resulting radiographs, which also bear anatomical label- Before even considering these requirements, professionals in ling. A step-by-step approach is used, making the requirements of each medical imaging are required to acquire and implement skills that position easier to follow. Often a radiographer or student will only provide a safe, caring and efficient diagnostic service. Basically, we need to check a centring point or angle of central ray rather than read cannot expect professionals to be reflective if they do not first have the whole position descriptor, and for this reason these sections are access to information regarding the core requirements of medical clearly identified under separate headings after the position descriptor. imaging techniques. They have to know what their choices are before Often there are several methods described for one position require- making their final choice on appropriate clinical practice, whilst con- ment. These chapters are supplemented by a range of approaches: sidering the challenges that present themselves in a variety of guises: • There is discussion, or even questioning, regarding suitability of patient condition, the clinical question, image quality, dose from projections or methods related to patient condition, practicality ionising radiation and related legislation, contraindications related to of the position used, radiation dose and imaging principles. use of pharmaceuticals, contraindications related to the imaging References are used, either as a basis for reflection or to present modality in question and imaging principles. This list names but a an argument. At times questions are raised to promote further few of the most relevant considerations, yet the concept of the reflec- reflection by the reader. tive approach becomes even more complex when we realise that each • Tips for improved practical implementation are provided where one affects others in this important list and often we must consider a relevant. trade-off of one important consideration against another. • Full image quality criteria for all radiographic projections are In order to cultivate this evidence-based approach we can no longer provided. apply our skills without questioning the suitability of the techniques • Advice on causes and correction of common errors is given. we employ. Most educators in medical imaging attempt to promote the reflective, evidence-based approach to all aspects of diagnostic As an additional note, it should be mentioned that ‘general radio- imaging but it is often difficult for undergraduates, and even gradu- graphy’ is often considered as a non-specialist area, yet it relies so ates, to continue this approach, especially during independent clinical heavily on high level skills such as an understanding of human practice or study. anatomy and related surface markings, an intuitive approach to com- Having considered these points it became clear to us that we needed munication which ensures patient concordance and compliance, and to produce a resource which addressed these issues by providing an understanding of the use of ionising radiation and its impact on information on a core of knowledge, sensibly presented and related image quality and human tissue. The editors acknowledge that to medical imaging techniques, whilst promoting the reflective general radiography still provides the higher proportion of a medical approach. The result is this text, a project which has brought together imaging service and stress that medical imaging professionals must contributions from radiographers, radiography lecturers, radiologists not exclude general radiography as a specialist area in itself. By and other experts from the commercial sector of medical imaging, all emphasising the reflective aspects of this section we hope to highlight selected for their clinical and academic expertise. this most clearly. The first section of the book provides the basic information that is Moving on to other sections in the text, other non-contrast radio- required to understand and initiate diagnostic imaging techniques, graphic imaging is also covered in sections on mammography, including implications for image quality and radiation dose related accident and emergency, and paediatric imaging. A descriptive and ix Preface to first edition reflective approach continues in these sections, which are again sup- further reading is undertaken via up-to-date specialist texts or journal ported by references. articles relating to physics, radiation science, imaging recording, CT, In the contrast examinations chapters, the descriptive and reflective MRI, radionuclide imaging (RNI), ultrasound, accident and emer- philosophy continues. Improved imaging via complementary imaging gency, paediatrics, interventional radiology, gastrointestinal and geni- methods posed a problem regarding what to include in this section; tourinary investigations, mammography and health psychology. many angiographic examinations have been replaced by other However, we believe that this text will provide a good basis for a core methods such as computed tomography (CT) and magnetic resonance of knowledge, leading to safe and holistic practice that is based on imaging (MRI) contrast studies and this is considered alongside evaluation and reflection. descriptions of techniques used. We conclude by mentioning that production of this text would The final section on comparative imaging considers the basic prin- not have been possible without a large number of people and institu- ciples and clinical applications associated with these techniques, also tions. The authors feature as key to its success and their names will with some reflective content and considerations for future develop- obviously be associated with their chapters but others have helped ments, thus complementing the other sections of the text to provide with this project in various ways: provision of images or permissions an all round medical imaging approach. Every attempt has been made to reproduce images from other authors’ work, use of equipment in to ensure that the information provided in this section is as up to date hospitals, modelling, providing advice or undertaking administrative as is possible in the rapidly developing areas it covers, but the authors tasks. A separate list of those we wish to acknowledge is given after acknowledge that even the time in production between manuscript this preface. submission and publication may see developments beyond those described. Elizabeth M. Carver It would have been unrealistic to hope to provide a text which was Barry Carver all things to everyone, and for this reason the editors would urge that Stoke-on-Trent, UK, 2006 x Preface Preface The first edition of this text addressed vital aspects of the role of the The project, again, has been huge and has taken over two years to radiographer: understanding theory, evaluating practice and using an complete. During that period we saw developments dictate changes evidence base in this evaluation. We are pleased to say that it was well in manuscripts on more than one occasion to ensure that the text received and considered to be a very relevant text for use on graduate remains as up to date as is possible in the publishing world. courses. Of course this success demanded that we produce a second Since the last edition was published we have been saddened by the edition, a very necessary project in view of the rapidly changing field death of Penny Nash. Penny played an important part in the first in which we work. edition, both as an author and support mechanism as our manager We have retained the broad aims of the first edition: to develop in the Radiography department at Bangor University. Without her skills that provide a safe, caring and efficient radiographer who will understanding the massive project that led to the success of the first subscribe to a quality diagnostic service. It still includes a logical edition would never have been completed. We will always remember approach to radiographic techniques and image evaluation, aspects her with much fondness, as will many in the Radiography profession, that have proved very popular with readers. We continue to use experts and the dedication on the opening pages of this edition has Penny in in their field for our contributors, ensuring that information is kept mind along with other important people in our lives. up to date and retains credibility; we also welcome our new authors We hope the resulting second edition will be as well received as the to the team. As a result we believe that we have again created a resource first and that it will be of value to those who choose to use it. that provides a good basis for a core of knowledge that can be used at all levels of undergraduate study, and act as a basis for postgraduate Elizabeth and Barry Carver study. Stoke-on-Trent, UK, 2012 xi
The list of books you might like
