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Applications and Limitations of Diagnostic Imaging

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General public
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medical...
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UFMG

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documents in English
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presentations
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  1. Radiographic techniques
  2. Ultrasound
  3. Computed tomography
  4. Magnetic resonance imaging
  5. Nuclear imaging and positron emission tomography
  6. Angiography and interventional radiology
  7. Principles of ordering imaging tests
  8. Screening
  9. Hematuria with flank pain
  10. Conclusions
  11. Bibliography

The traditional evaluation of the patient includes the history and physical examination and a well-planned set of diagnostic tests, often including imaging. Dramatic advances in imaging not only supplement the physical examination, but also now may begin to substitute for part of it. Medical imaging provides an approach for dividing patients into patients who have an acute compared with a chronic medical problem and patients who have an anatomic compared with a "biochemical" illness. These determinations are crucial for prompt and effective medical and surgical therapy.

[...] STAGING OF ONCOLOGIC DISEASES Diagnostic imaging is a principal method for presurgical staging of neoplastic disease and is essential for evaluating the response to therapy and long-term surveillance. Extent of the primary tumor, invasion or encasement of adjacent structures, presence of regional or distant lymphadenopathy, and distant metastases can be evaluated by cross-sectional imaging with great accuracy. PET is highly sensitive but nonspecific for neoplastic disease. The search for an unknown primary tumor in the presence of metastatic disease is challenging ( Chapter 210 With the advent of MRI and high-resolution multislice CT, more than 50% of initially unknown primary tumors now can be found. [...]


[...] Images are created based on the time delay and intensity of echos returned from tissue after a short pulse of ultrasonic energy, emitted and received by a transducer held in contact with the body. Ultrasound is nonionizing radiation and considered safe for the unborn fetus and other sensitive tissues. With appropriate instrumentation, it is possible to create "tomographic" or slice images, with real-time motion, of body parts if the path of the sound does not hit gas or bone, both of which severely attenuate the sound. [...]


[...] ACUTE RENAL FAILURE Imaging can be helpful in determining whether acute renal failure is due to obstruction and can determine the level, chronicity, and cause of the obstruction. In all but the most obese patients, ultrasound is sensitive and specific for hydronephrosis, but visualization of the ureters with ultrasound is difficult. Ultrasound is also useful for evaluating the size of the renal parenchyma and for determining the presence of medical renal disease. In larger patients, CT may be required. CT, which has the added benefit of visualizing all of the urinary structures to the base of the bladder, yields better visualization of the ureters and retroperitoneal masses. [...]

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