QUIZ 3
Nervous System, Reproductive, Hematology/Cancer, Miscellaneous
Areas of focus include:
When to order MRI vs MRA
MRA, magnetic resonance angiography, is used specifically to examine blood vessels and is
primarily meant to diagnose abnormalities in blood vessels, while MRI is used mainly to
examine various organs and tissues, including the brain. MRI generates images of organs,
bones, and tissues.
Landmarks of normal anatomy for the brain, lumbar, and cervical spine
Annulus fibrosus-The tough, outer ring of the intervertebral disc that surrounds the
nucleus pulposus, which stabilizes the spine
Nucleus pulposus-Gelatinous inner core of an intervertebral disc that functions as a
shock absorber for the spine
Intervertebral disc-A tough, elastic cushion located between the vertebrae
Cauda equina-A collection of nerve roots at the end of the spinal cord which controls
sensation and motor function in the legs, bladder, and bowels at the end of the spinal
cord
Facet joints-small joints located on the posterior spine that connect each vertebra to
the next providing stability to allow for bending and twisting motions
Lamina-The flattened part of the vertebral arch that forms the roof or back part of the
spinal canal
Nerve root-The initial portion of a spinal nerve as it originates from the spinal cord.
Neural arch-The posterior portion of the vertebra that surrounds the spinal cord,
consisting of the spinous process and lamina
Pedicle-The bony part of each side of the neural arch of a vertebra that connects the
lamina with the vertebral body
Foramen-An opening in the vertebrae of the spine through which the spinal nerve
roots travel
Herniated disc-Protrusion of the disc nucleus into the spinal canal
*Disease or injury of the spinal cord at a particular level may result in a temporary or
permanent loss of sensation and motor function below that level*
Imaging studies of back injury as ordered in primary care
Imaging: Imaging studies are not recommended in patients with acute back pain unless they
have red flag symptoms that include weakness, tingling in the extremities, bowel or bladder
incontinence, immunocompromised, cancer, or long-term steroid use.
,Treatment of back pain: Patients with acute back pain are recommended conservative treatment
with analgesics, mild exercise or stretching, and physical therapy.
Most back pain is a result of mild strains and will resolve on its own. If after conservative
treatments and the pain progresses, then an X-ray can be ordered. It is important to perform and
document a thorough history and physical and make sure to say the patient has no complaints of
bowel or bladder incontinence and no tingling. Never write WNL, as it can get you into
malpractice problems or trouble.
DEXA Scan
Dual x-ray absorptiometry (Dexa Scan) is used to screen for osteoporosis by measuring
bone density with a high- and low-energy x-ray beam, usually of the hip and the spine
Types of X-rays
X-ray studies can be performed with contrast (to provide better visualization) or without
contrast. They are used to evaluate a wide variety of body structures to evaluate pain,
fractures, infections, arterial occlusive disease, and abdominal pain. Some common X-ray
tests include arteriography, barium enema, bone densitometry, bones, chest, sinuses, thyroid,
cardiac cath, CT scan, PET, CT angiography, kidney/ureter/bladder (KUB),
hysterosalpingography, mammography, skull, extremities, spinal X-ray, upper GI series, and
venography.
*CT, PET, and cardiac nuclear stress testing and abdominal angiograms have the highest
radiation exposure*
Both computed tomography (CT) and MRI are useful in ruling out other conditions
In patients with Alzheimer’s dementia (AD) and patients with other symptoms such as chronic
or severe headaches, change in level of consciousness, and head trauma. These imaging
studies can visualize the entire brain (cerebrum, cerebellum, and brainstem)
Magnetic resonance venography (MRV) is used to visualize venous disorders such as DVT
and cerebral venous thrombosis
Magnetic Resonance Angiography (MRA) is used to diagnose blood vessel blockages or
abnormalities
Conditions that an MRA can help diagnose include:
Aneurysms
Arteriovenous malformations
Arterial or venous obstruction
Coronary artery disease
Congenital blood vessel abnormalities
Arterial injury
, Embolism
Magnetic resonance imaging (MRI)-Noninvasive imaging that uses magnets to examine
various organs and tissues, including the brain. There is no exposure to ionizing radiation
Conditions that an MRI can help diagnose include:
Tumors
Aneurysms
CVA
Multiple sclerosis
Spinal cord damage
Traumatic brain injuries
Contraindications of MRI
Patients weighing over 300 lbs.
Confused patients
Claustrophobia (if antianxiety meds are ineffective and no open-air MRI is available)
Unstable patients or life support patients
Patients who have implantable metal objects, pacemakers, defibrillators, metal
implants or fragments, patches with metallic backing (such as nicotine patches)
*Patients are checked for these devices and for body piercings before undergoing MRI
Electroencephalogram (EEG) is used to diagnose and evaluate for seizure disorders. Useful
when considering differential diagnosis in patients with dementia, and is also used to diagnose
sleep disorders and to determine brain death.
Single-photon emission CT (SPECT)-Measures cerebral blood flow and can help diagnose
Alzheimer's disease by showing areas of hypoperfusion in the posterior regions of the brain. It
can also evaluate neurotransmitter activity and differentiate between neurologic disorders (for
example, AD versus frontotemporal dementia)
Positron emission tomography (PET)-Looks for increased amyloid plaques and tau tangles
and reduced brain activity related to glucose metabolism in patients with AD
*Both SPECT and PET use radioactive tracers
*Despite the many diagnostic tests used to evaluate and rule out other causes of AD, the
diagnosis is usually made clinically
Mammogram, BIRADS, and breast density
A mammogram is a low-dose X-ray for breast cancer detection, monitoring of benign breast
conditions, and monitoring of breast cancer
Breast Imaging Classification
Nervous System, Reproductive, Hematology/Cancer, Miscellaneous
Areas of focus include:
When to order MRI vs MRA
MRA, magnetic resonance angiography, is used specifically to examine blood vessels and is
primarily meant to diagnose abnormalities in blood vessels, while MRI is used mainly to
examine various organs and tissues, including the brain. MRI generates images of organs,
bones, and tissues.
Landmarks of normal anatomy for the brain, lumbar, and cervical spine
Annulus fibrosus-The tough, outer ring of the intervertebral disc that surrounds the
nucleus pulposus, which stabilizes the spine
Nucleus pulposus-Gelatinous inner core of an intervertebral disc that functions as a
shock absorber for the spine
Intervertebral disc-A tough, elastic cushion located between the vertebrae
Cauda equina-A collection of nerve roots at the end of the spinal cord which controls
sensation and motor function in the legs, bladder, and bowels at the end of the spinal
cord
Facet joints-small joints located on the posterior spine that connect each vertebra to
the next providing stability to allow for bending and twisting motions
Lamina-The flattened part of the vertebral arch that forms the roof or back part of the
spinal canal
Nerve root-The initial portion of a spinal nerve as it originates from the spinal cord.
Neural arch-The posterior portion of the vertebra that surrounds the spinal cord,
consisting of the spinous process and lamina
Pedicle-The bony part of each side of the neural arch of a vertebra that connects the
lamina with the vertebral body
Foramen-An opening in the vertebrae of the spine through which the spinal nerve
roots travel
Herniated disc-Protrusion of the disc nucleus into the spinal canal
*Disease or injury of the spinal cord at a particular level may result in a temporary or
permanent loss of sensation and motor function below that level*
Imaging studies of back injury as ordered in primary care
Imaging: Imaging studies are not recommended in patients with acute back pain unless they
have red flag symptoms that include weakness, tingling in the extremities, bowel or bladder
incontinence, immunocompromised, cancer, or long-term steroid use.
,Treatment of back pain: Patients with acute back pain are recommended conservative treatment
with analgesics, mild exercise or stretching, and physical therapy.
Most back pain is a result of mild strains and will resolve on its own. If after conservative
treatments and the pain progresses, then an X-ray can be ordered. It is important to perform and
document a thorough history and physical and make sure to say the patient has no complaints of
bowel or bladder incontinence and no tingling. Never write WNL, as it can get you into
malpractice problems or trouble.
DEXA Scan
Dual x-ray absorptiometry (Dexa Scan) is used to screen for osteoporosis by measuring
bone density with a high- and low-energy x-ray beam, usually of the hip and the spine
Types of X-rays
X-ray studies can be performed with contrast (to provide better visualization) or without
contrast. They are used to evaluate a wide variety of body structures to evaluate pain,
fractures, infections, arterial occlusive disease, and abdominal pain. Some common X-ray
tests include arteriography, barium enema, bone densitometry, bones, chest, sinuses, thyroid,
cardiac cath, CT scan, PET, CT angiography, kidney/ureter/bladder (KUB),
hysterosalpingography, mammography, skull, extremities, spinal X-ray, upper GI series, and
venography.
*CT, PET, and cardiac nuclear stress testing and abdominal angiograms have the highest
radiation exposure*
Both computed tomography (CT) and MRI are useful in ruling out other conditions
In patients with Alzheimer’s dementia (AD) and patients with other symptoms such as chronic
or severe headaches, change in level of consciousness, and head trauma. These imaging
studies can visualize the entire brain (cerebrum, cerebellum, and brainstem)
Magnetic resonance venography (MRV) is used to visualize venous disorders such as DVT
and cerebral venous thrombosis
Magnetic Resonance Angiography (MRA) is used to diagnose blood vessel blockages or
abnormalities
Conditions that an MRA can help diagnose include:
Aneurysms
Arteriovenous malformations
Arterial or venous obstruction
Coronary artery disease
Congenital blood vessel abnormalities
Arterial injury
, Embolism
Magnetic resonance imaging (MRI)-Noninvasive imaging that uses magnets to examine
various organs and tissues, including the brain. There is no exposure to ionizing radiation
Conditions that an MRI can help diagnose include:
Tumors
Aneurysms
CVA
Multiple sclerosis
Spinal cord damage
Traumatic brain injuries
Contraindications of MRI
Patients weighing over 300 lbs.
Confused patients
Claustrophobia (if antianxiety meds are ineffective and no open-air MRI is available)
Unstable patients or life support patients
Patients who have implantable metal objects, pacemakers, defibrillators, metal
implants or fragments, patches with metallic backing (such as nicotine patches)
*Patients are checked for these devices and for body piercings before undergoing MRI
Electroencephalogram (EEG) is used to diagnose and evaluate for seizure disorders. Useful
when considering differential diagnosis in patients with dementia, and is also used to diagnose
sleep disorders and to determine brain death.
Single-photon emission CT (SPECT)-Measures cerebral blood flow and can help diagnose
Alzheimer's disease by showing areas of hypoperfusion in the posterior regions of the brain. It
can also evaluate neurotransmitter activity and differentiate between neurologic disorders (for
example, AD versus frontotemporal dementia)
Positron emission tomography (PET)-Looks for increased amyloid plaques and tau tangles
and reduced brain activity related to glucose metabolism in patients with AD
*Both SPECT and PET use radioactive tracers
*Despite the many diagnostic tests used to evaluate and rule out other causes of AD, the
diagnosis is usually made clinically
Mammogram, BIRADS, and breast density
A mammogram is a low-dose X-ray for breast cancer detection, monitoring of benign breast
conditions, and monitoring of breast cancer
Breast Imaging Classification
