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+fig_num,image_path,image_caption,golden_corpus,positive_corpus
+Figure 11.2,undergradimage/images/Figure 11.2.jpg,Figure 11.2A Pelvic ultrasound in a female with an ovarian cyst.,"ODIN Link for Ovarian Cyst images (Ultrasound), Figure 11.2A and B – https://mistr.usask.ca/odin/?caseID=20170123215147808","{'fad3b073-7682-4fce-a78b-e2f3bd57baa1': 'There was a reniform shaped mass in the left upper abdomen with areas of low attenuation throughout the mass.', '98240e00-9b89-45da-a4d0-ccee79a971c9': 'Ultrasound was used to aspirate some fluid from the largest cyst on the left.\xa0 It was frankly purulent and a 10F drain was inserted.', 'd66f4c5d-a62e-401a-b19d-875e54fe2c4b': 'Polycystic kidney with an infected cyst in the left upper kidney.', '198bdf51-8cd3-4e86-9a96-6fad5be992a3': 'ODIN Link for Ovarian Cyst images (Ultrasound), Figure 11.2A and B –\xa0https://mistr.usask.ca/odin/?caseID=20170123215147808', '600785f7-7398-4b95-9e6f-69f5224f3fb4': 'The images revealed a simple cyst in the right ovary with no nodules in the cyst wall or abnormal Doppler signal.'}"
+Figure 11.2,undergradimage/images/Figure 11.2.jpg,Figure 11.2B Sagittal ultrasound of a right ovarian cyst.,"ODIN Link for Ovarian Cyst images (Ultrasound), Figure 11.2A and B – https://mistr.usask.ca/odin/?caseID=20170123215147808","{'fad3b073-7682-4fce-a78b-e2f3bd57baa1': 'There was a reniform shaped mass in the left upper abdomen with areas of low attenuation throughout the mass.', '98240e00-9b89-45da-a4d0-ccee79a971c9': 'Ultrasound was used to aspirate some fluid from the largest cyst on the left.\xa0 It was frankly purulent and a 10F drain was inserted.', 'd66f4c5d-a62e-401a-b19d-875e54fe2c4b': 'Polycystic kidney with an infected cyst in the left upper kidney.', '198bdf51-8cd3-4e86-9a96-6fad5be992a3': 'ODIN Link for Ovarian Cyst images (Ultrasound), Figure 11.2A and B –\xa0https://mistr.usask.ca/odin/?caseID=20170123215147808', '600785f7-7398-4b95-9e6f-69f5224f3fb4': 'The images revealed a simple cyst in the right ovary with no nodules in the cyst wall or abnormal Doppler signal.'}"
+Figure 11.3,undergradimage/images/Figure 11.3.jpg,"Figure 11.3A Ultrasound of female uterus, echogenic mass with acoustic shadowing.","ODIN Link for Ovarian Dermoid images (Ultrasound and CT), Figure 11.3A and B: https://mistr.usask.ca/odin/?caseID=20170123215550360","{'f1708550-1382-4177-ae7f-690861d6a153': 'ACR – Women’s Imaging – Clinically Suspected Adnexal/Pelvic Mass, Variant 1', '780c7a8d-4bb7-4029-8696-158902cd37b2': 'ODIN Link for Ovarian Dermoid images (Ultrasound and CT), Figure 11.3A and B: https://mistr.usask.ca/odin/?caseID=20170123215550360', '15d9bf71-8ccb-460b-ba44-7716b012632f': 'Ultrasound detected a left adnexal mass that demonstrated increased echogenicity and shadowing of the ultrasound beam.\xa0 No focal calcification detected.'}"
+Figure 11.3,undergradimage/images/Figure 11.3.jpg,"Figure 11.3B CT Scan of female pelvis, left adnexal mass with bone, fat and soft tissue.","ODIN Link for Ovarian Dermoid images (Ultrasound and CT), Figure 11.3A and B: https://mistr.usask.ca/odin/?caseID=20170123215550360","{'f1708550-1382-4177-ae7f-690861d6a153': 'ACR – Women’s Imaging – Clinically Suspected Adnexal/Pelvic Mass, Variant 1', '780c7a8d-4bb7-4029-8696-158902cd37b2': 'ODIN Link for Ovarian Dermoid images (Ultrasound and CT), Figure 11.3A and B: https://mistr.usask.ca/odin/?caseID=20170123215550360', '15d9bf71-8ccb-460b-ba44-7716b012632f': 'Ultrasound detected a left adnexal mass that demonstrated increased echogenicity and shadowing of the ultrasound beam.\xa0 No focal calcification detected.'}"
+Figure 7.2,undergradimage/images/Figure 7.2.jpg,"Figure 7.2A Normal Mammography Image, CC Projection",Note how the above figures (Figure 7.2 and Figure 7.3) contrast from the following figure (Figure 7.4) which shows a breast mass that can be visualized both on mammography and ultrasound.,{'fb3a124b-d60b-4b19-a81d-522cafadece2': 'Note how the above figures (Figure 7.2 and Figure 7.3) contrast from the following figure (Figure 7.4) which shows a breast mass that can be visualized both on mammography and ultrasound.'}
+Figure 7.2,undergradimage/images/Figure 7.2.jpg,"Figure 7.2B Normal Mammography Image, MLO projection.",Note how the above figures (Figure 7.2 and Figure 7.3) contrast from the following figure (Figure 7.4) which shows a breast mass that can be visualized both on mammography and ultrasound.,{'fb3a124b-d60b-4b19-a81d-522cafadece2': 'Note how the above figures (Figure 7.2 and Figure 7.3) contrast from the following figure (Figure 7.4) which shows a breast mass that can be visualized both on mammography and ultrasound.'}
+Figure 5.12,undergradimage/images/Figure 5.12.jpg,Figure 5.12 Colon anatomy emphasized by the distribution of barium and gas in the colon.,"The colon, with barium and air to highlight the anatomic distribution, of this structure is seen in Figure 5.12.","{'5c10d65a-a8df-4ad9-8fb0-f4265c1b31a7': 'The colon, with barium and air to highlight the anatomic distribution, of this structure is seen in Figure 5.12.', '35ddd301-b6c5-4206-a849-45573b30acaf': 'Note: Organ margins and psoas shadow details are not visible due the overlapping bowel gas.'}"
+Figure 5.3,undergradimage/images/Figure 5.3.jpg,Figure 5.3A Positioning for a Posterior-Anterior Chest x-ray,"The standard chest x-ray is routinely taken in two views at near total lung capacity:
+
+1. A posteroanterior (PA) view (Figure 5.3A) with the patient in the standing position opposing the front of their chest against the film cassette or image detector housing, and
+
+2. A lateral view (Figure 5.3B). The lateral view is helpful in localizing the position of an abnormality from ventral to dorsal and also because on the PA view the lower lungs are obscured by the hemidiaphragms.","{'85810617-4388-4f37-94bd-8d20adc0792e': 'The standard chest x-ray is routinely taken in two views at near total lung capacity:\n\n1. A posteroanterior (PA) view (Figure 5.3A) with the patient in the standing position opposing the front of their chest against the film cassette or image detector housing, and\n\n2. A lateral view (Figure 5.3B). The lateral view is helpful in localizing the position of an abnormality from ventral to dorsal and also because on the PA view the lower lungs are obscured by the hemidiaphragms.'}"
+Figure 5.3,undergradimage/images/Figure 5.3.jpg,Figure 5.3B Positioning for a Lateral Chest x-ray,"The standard chest x-ray is routinely taken in two views at near total lung capacity:
+
+1. A posteroanterior (PA) view (Figure 5.3A) with the patient in the standing position opposing the front of their chest against the film cassette or image detector housing, and
+
+2. A lateral view (Figure 5.3B). The lateral view is helpful in localizing the position of an abnormality from ventral to dorsal and also because on the PA view the lower lungs are obscured by the hemidiaphragms.","{'85810617-4388-4f37-94bd-8d20adc0792e': 'The standard chest x-ray is routinely taken in two views at near total lung capacity:\n\n1. A posteroanterior (PA) view (Figure 5.3A) with the patient in the standing position opposing the front of their chest against the film cassette or image detector housing, and\n\n2. A lateral view (Figure 5.3B). The lateral view is helpful in localizing the position of an abnormality from ventral to dorsal and also because on the PA view the lower lungs are obscured by the hemidiaphragms.'}"
+Figure 3.44,undergradimage/images/Figure 3.44.jpg,"Figure 3.44A Normal, Pediatric, Nuclear Medicine Bone Scan","An example of a normal bone scan for a pediatric patient is provided in Figure 3.44A, while the normal bone scan for an adult is in Figure 3.44B.","{'4f687d04-2641-4ed8-ba71-1d54193e4320': '6) ACR Appropriateness Criteria: Chapter in this book – ACR Website Last accessed July 2017.', '44543e24-8e2a-48df-8bb4-5c97c5bf904b': '7) Choosing Wisely – Canada: Chapter in this book\xa0– CWC Website Last accessed July 2017.', '281dab91-c75f-4d7c-b767-4ca09d02e7ec': '8) Seldinger, I. Catheter Replacement of the Needle in Percutaneous Arteriography: A new technique. Acta Radiologica 1953, 39:5,368 — 376.', 'ce044b47-3bf5-4e71-8c15-202154f18797': 'For example, the radioactive substance for a bone scan, Technetium 99m (99mTc), is chemically bound to a pharmacologic agent, diphosphonate , and this is injected intravenously. Technetium is a Gamma-emitter and this radioactivity is emitted as the radionuclide decays.\xa0 The detector system registers the emitted photons and transforms the energy emitted into pixels on an image display. Therefore, a nuclear medicine bone scan depicts radioactivity arising from bone as the the pharmacologic agent, diphosphonate, physiologically interacts with living bone. Similarly, a renal Nuclear Medicine scan depicts the kidneys, ureters and bladder as the pharmacologic agent is preferentially metabolized and concentrated in these tissues.', 'db8f3d8a-72c2-45e4-84a2-34857b96671b': 'An example of a normal bone scan for a pediatric patient is provided in Figure 3.44A, while the normal bone scan for an adult is in Figure 3.44B.', '1944dbd1-2598-4c88-9718-63bdfef9b583': 'The images above depict a normal pediatric bone scan.\xa0 Areas of active bone growth i.e. epiphyseal growth plates, demonstrate more radioactivity as the pharmacologic substrate bound to the radioactive Technetium concentrates in areas of heightened bone metabolic activity. This is in contrast to Figure 3.44B, where the adult does not have the same areas of uptake of the Technetium-diphosphonate.', '0edbe285-0a8f-4ee8-bf20-920d167ed357': 'Due to the physics of the detection of emitted photons, the images acquired are low in anatomic detail (spatial resolution), but provide information about the physiology of the tissue being imaged related to the quantitative uptake of the radioactivity into the target tissues.\xa0 Therefore, regions of the patient’s anatomy that harbor a larger concentration of the injected radioactive substance emit the largest amount of detectable radiation. The areas emitting radiation are displayed in black on static, standard, nuclear medicine images. More detected radiation results in a blacker region of the resulting image. For the pediatric bone scan displayed previously one can appreciate that the growth centres of the child’s bones are more metabolically active and are blacker on the bone scan.'}"
+Figure 3.44,undergradimage/images/Figure 3.44.jpg,"Figure 3.44B Normal, Adult, Nuclear Medicine Bone Scan","An example of a normal bone scan for a pediatric patient is provided in Figure 3.44A, while the normal bone scan for an adult is in Figure 3.44B.","{'4f687d04-2641-4ed8-ba71-1d54193e4320': '6) ACR Appropriateness Criteria: Chapter in this book – ACR Website Last accessed July 2017.', '44543e24-8e2a-48df-8bb4-5c97c5bf904b': '7) Choosing Wisely – Canada: Chapter in this book\xa0– CWC Website Last accessed July 2017.', '281dab91-c75f-4d7c-b767-4ca09d02e7ec': '8) Seldinger, I. Catheter Replacement of the Needle in Percutaneous Arteriography: A new technique. Acta Radiologica 1953, 39:5,368 — 376.', 'ce044b47-3bf5-4e71-8c15-202154f18797': 'For example, the radioactive substance for a bone scan, Technetium 99m (99mTc), is chemically bound to a pharmacologic agent, diphosphonate , and this is injected intravenously. Technetium is a Gamma-emitter and this radioactivity is emitted as the radionuclide decays.\xa0 The detector system registers the emitted photons and transforms the energy emitted into pixels on an image display. Therefore, a nuclear medicine bone scan depicts radioactivity arising from bone as the the pharmacologic agent, diphosphonate, physiologically interacts with living bone. Similarly, a renal Nuclear Medicine scan depicts the kidneys, ureters and bladder as the pharmacologic agent is preferentially metabolized and concentrated in these tissues.', 'db8f3d8a-72c2-45e4-84a2-34857b96671b': 'An example of a normal bone scan for a pediatric patient is provided in Figure 3.44A, while the normal bone scan for an adult is in Figure 3.44B.', '1944dbd1-2598-4c88-9718-63bdfef9b583': 'The images above depict a normal pediatric bone scan.\xa0 Areas of active bone growth i.e. epiphyseal growth plates, demonstrate more radioactivity as the pharmacologic substrate bound to the radioactive Technetium concentrates in areas of heightened bone metabolic activity. This is in contrast to Figure 3.44B, where the adult does not have the same areas of uptake of the Technetium-diphosphonate.', '0edbe285-0a8f-4ee8-bf20-920d167ed357': 'Due to the physics of the detection of emitted photons, the images acquired are low in anatomic detail (spatial resolution), but provide information about the physiology of the tissue being imaged related to the quantitative uptake of the radioactivity into the target tissues.\xa0 Therefore, regions of the patient’s anatomy that harbor a larger concentration of the injected radioactive substance emit the largest amount of detectable radiation. The areas emitting radiation are displayed in black on static, standard, nuclear medicine images. More detected radiation results in a blacker region of the resulting image. For the pediatric bone scan displayed previously one can appreciate that the growth centres of the child’s bones are more metabolically active and are blacker on the bone scan.'}"
+Figure 3.44,undergradimage/images/Figure 3.44.jpg,"Figure 3.44A Normal, Pediatric, Nuclear Medicine Bone Scan","An example of a normal bone scan for a pediatric patient is provided in Figure 3.44A, while the normal bone scan for an adult is in Figure 3.44B.","{'4f687d04-2641-4ed8-ba71-1d54193e4320': '6) ACR Appropriateness Criteria: Chapter in this book – ACR Website Last accessed July 2017.', '44543e24-8e2a-48df-8bb4-5c97c5bf904b': '7) Choosing Wisely – Canada: Chapter in this book\xa0– CWC Website Last accessed July 2017.', '281dab91-c75f-4d7c-b767-4ca09d02e7ec': '8) Seldinger, I. Catheter Replacement of the Needle in Percutaneous Arteriography: A new technique. Acta Radiologica 1953, 39:5,368 — 376.', 'ce044b47-3bf5-4e71-8c15-202154f18797': 'For example, the radioactive substance for a bone scan, Technetium 99m (99mTc), is chemically bound to a pharmacologic agent, diphosphonate , and this is injected intravenously. Technetium is a Gamma-emitter and this radioactivity is emitted as the radionuclide decays.\xa0 The detector system registers the emitted photons and transforms the energy emitted into pixels on an image display. Therefore, a nuclear medicine bone scan depicts radioactivity arising from bone as the the pharmacologic agent, diphosphonate, physiologically interacts with living bone. Similarly, a renal Nuclear Medicine scan depicts the kidneys, ureters and bladder as the pharmacologic agent is preferentially metabolized and concentrated in these tissues.', 'db8f3d8a-72c2-45e4-84a2-34857b96671b': 'An example of a normal bone scan for a pediatric patient is provided in Figure 3.44A, while the normal bone scan for an adult is in Figure 3.44B.', '1944dbd1-2598-4c88-9718-63bdfef9b583': 'The images above depict a normal pediatric bone scan.\xa0 Areas of active bone growth i.e. epiphyseal growth plates, demonstrate more radioactivity as the pharmacologic substrate bound to the radioactive Technetium concentrates in areas of heightened bone metabolic activity. This is in contrast to Figure 3.44B, where the adult does not have the same areas of uptake of the Technetium-diphosphonate.', '0edbe285-0a8f-4ee8-bf20-920d167ed357': 'Due to the physics of the detection of emitted photons, the images acquired are low in anatomic detail (spatial resolution), but provide information about the physiology of the tissue being imaged related to the quantitative uptake of the radioactivity into the target tissues.\xa0 Therefore, regions of the patient’s anatomy that harbor a larger concentration of the injected radioactive substance emit the largest amount of detectable radiation. The areas emitting radiation are displayed in black on static, standard, nuclear medicine images. More detected radiation results in a blacker region of the resulting image. For the pediatric bone scan displayed previously one can appreciate that the growth centres of the child’s bones are more metabolically active and are blacker on the bone scan.'}"
+Figure 3.44,undergradimage/images/Figure 3.44.jpg,"Figure 3.44B Normal, Adult, Nuclear Medicine Bone Scan","An example of a normal bone scan for a pediatric patient is provided in Figure 3.44A, while the normal bone scan for an adult is in Figure 3.44B.","{'4f687d04-2641-4ed8-ba71-1d54193e4320': '6) ACR Appropriateness Criteria: Chapter in this book – ACR Website Last accessed July 2017.', '44543e24-8e2a-48df-8bb4-5c97c5bf904b': '7) Choosing Wisely – Canada: Chapter in this book\xa0– CWC Website Last accessed July 2017.', '281dab91-c75f-4d7c-b767-4ca09d02e7ec': '8) Seldinger, I. Catheter Replacement of the Needle in Percutaneous Arteriography: A new technique. Acta Radiologica 1953, 39:5,368 — 376.', 'ce044b47-3bf5-4e71-8c15-202154f18797': 'For example, the radioactive substance for a bone scan, Technetium 99m (99mTc), is chemically bound to a pharmacologic agent, diphosphonate , and this is injected intravenously. Technetium is a Gamma-emitter and this radioactivity is emitted as the radionuclide decays.\xa0 The detector system registers the emitted photons and transforms the energy emitted into pixels on an image display. Therefore, a nuclear medicine bone scan depicts radioactivity arising from bone as the the pharmacologic agent, diphosphonate, physiologically interacts with living bone. Similarly, a renal Nuclear Medicine scan depicts the kidneys, ureters and bladder as the pharmacologic agent is preferentially metabolized and concentrated in these tissues.', 'db8f3d8a-72c2-45e4-84a2-34857b96671b': 'An example of a normal bone scan for a pediatric patient is provided in Figure 3.44A, while the normal bone scan for an adult is in Figure 3.44B.', '1944dbd1-2598-4c88-9718-63bdfef9b583': 'The images above depict a normal pediatric bone scan.\xa0 Areas of active bone growth i.e. epiphyseal growth plates, demonstrate more radioactivity as the pharmacologic substrate bound to the radioactive Technetium concentrates in areas of heightened bone metabolic activity. This is in contrast to Figure 3.44B, where the adult does not have the same areas of uptake of the Technetium-diphosphonate.', '0edbe285-0a8f-4ee8-bf20-920d167ed357': 'Due to the physics of the detection of emitted photons, the images acquired are low in anatomic detail (spatial resolution), but provide information about the physiology of the tissue being imaged related to the quantitative uptake of the radioactivity into the target tissues.\xa0 Therefore, regions of the patient’s anatomy that harbor a larger concentration of the injected radioactive substance emit the largest amount of detectable radiation. The areas emitting radiation are displayed in black on static, standard, nuclear medicine images. More detected radiation results in a blacker region of the resulting image. For the pediatric bone scan displayed previously one can appreciate that the growth centres of the child’s bones are more metabolically active and are blacker on the bone scan.'}"
+Figure 3.45,undergradimage/images/Figure 3.45.jpg,Figure 3.45 PET/CT Scanner,Positron Emission Tomography – Computed Tomography (PET-CT) is a fused imaging technology that detects positron emission from the radioactive source (Fluorine) and creates images for display. There is a CT scanner built into the same apparatus that houses the positron detector and the two examinations can be acquired with the patient remaining in the same anatomic position.  The patient lies supine on the table while the table-top moves into the scanner housing. Since the CT and the PET scan are obtained simultaneously it is subsequently possible to overlay (fuse) one image set on the other to correlate the activity level of positron emission with the anatomy seen on the CT.  Figure 3.45 illustrates the appearance of a PET/CT scanner.,"{'27bda85f-a9f4-4068-b211-af4795e2ffc6': 'Positron Emission Tomography – Computed Tomography (PET-CT) is a fused imaging technology that detects positron emission from the radioactive source (Fluorine) and creates images for display. There is a CT scanner built into the same apparatus that houses the positron detector and the two examinations can be acquired with the patient remaining in the same anatomic position.\xa0 The patient lies supine on the table while the table-top moves into the scanner housing. Since the CT and the PET scan are obtained simultaneously it is subsequently possible to overlay (fuse) one image set on the other to correlate the activity level of positron emission with the anatomy seen on the CT.\xa0 Figure 3.45\xa0illustrates the appearance of a PET/CT scanner.', '550c1272-790f-4f41-bf16-92d0634c9990': 'PET-CT has emerged as a very important imaging tool for the detection of metabolically active tissue. The most common radioactive substance used for PET-CT is fluorine bound to glucose. Elevated tissue metabolic activity for glucose will result in more of the radioactive fluorine concentrating in those tissues.\xa0 Malignancies and infections metabolize glucose at an accelerated rate and can be imaged with PET even when the CT scan, taken for correlation, is normal.', 'a807a8d7-82f3-4197-a64e-738f5db3d93d': 'The regions of the fused PET/CT axial scans that have the most metabolic activity are registered as a bright red/orange colour while those areas with little metabolic activity are black. A PET/CT axial scan for a patient with widespread lymphoma and is provided for review in Figure 3.46A.', 'a044c293-4733-42a8-8840-e8e0898dfb10': 'A PET whole body image is displayed in Figure 3.46B. The regions of greater metabolic activity results in a blacker pixels for the PET portion of the scan.'}"
+Figure 3.46,undergradimage/images/Figure 3.46.jpg,"Figure 3.46A PET/CT – Fused image, PET image superimposed on the of the axial chest CT for a patient with lymphoma",The regions of the fused PET/CT axial scans that have the most metabolic activity are registered as a bright red/orange colour while those areas with little metabolic activity are black. A PET/CT axial scan for a patient with widespread lymphoma and is provided for review in Figure 3.46A.,"{'27bda85f-a9f4-4068-b211-af4795e2ffc6': 'Positron Emission Tomography – Computed Tomography (PET-CT) is a fused imaging technology that detects positron emission from the radioactive source (Fluorine) and creates images for display. There is a CT scanner built into the same apparatus that houses the positron detector and the two examinations can be acquired with the patient remaining in the same anatomic position.\xa0 The patient lies supine on the table while the table-top moves into the scanner housing. Since the CT and the PET scan are obtained simultaneously it is subsequently possible to overlay (fuse) one image set on the other to correlate the activity level of positron emission with the anatomy seen on the CT.\xa0 Figure 3.45\xa0illustrates the appearance of a PET/CT scanner.', '550c1272-790f-4f41-bf16-92d0634c9990': 'PET-CT has emerged as a very important imaging tool for the detection of metabolically active tissue. The most common radioactive substance used for PET-CT is fluorine bound to glucose. Elevated tissue metabolic activity for glucose will result in more of the radioactive fluorine concentrating in those tissues.\xa0 Malignancies and infections metabolize glucose at an accelerated rate and can be imaged with PET even when the CT scan, taken for correlation, is normal.', 'a807a8d7-82f3-4197-a64e-738f5db3d93d': 'The regions of the fused PET/CT axial scans that have the most metabolic activity are registered as a bright red/orange colour while those areas with little metabolic activity are black. A PET/CT axial scan for a patient with widespread lymphoma and is provided for review in Figure 3.46A.', 'a044c293-4733-42a8-8840-e8e0898dfb10': 'A PET whole body image is displayed in Figure 3.46B. The regions of greater metabolic activity results in a blacker pixels for the PET portion of the scan.'}"
+Figure 3.46,undergradimage/images/Figure 3.46.jpg,"Figure 3.46B PET, whole body image, for a patient with lymphoma",The regions of the fused PET/CT axial scans that have the most metabolic activity are registered as a bright red/orange colour while those areas with little metabolic activity are black. A PET/CT axial scan for a patient with widespread lymphoma and is provided for review in Figure 3.46A.,"{'27bda85f-a9f4-4068-b211-af4795e2ffc6': 'Positron Emission Tomography – Computed Tomography (PET-CT) is a fused imaging technology that detects positron emission from the radioactive source (Fluorine) and creates images for display. There is a CT scanner built into the same apparatus that houses the positron detector and the two examinations can be acquired with the patient remaining in the same anatomic position.\xa0 The patient lies supine on the table while the table-top moves into the scanner housing. Since the CT and the PET scan are obtained simultaneously it is subsequently possible to overlay (fuse) one image set on the other to correlate the activity level of positron emission with the anatomy seen on the CT.\xa0 Figure 3.45\xa0illustrates the appearance of a PET/CT scanner.', '550c1272-790f-4f41-bf16-92d0634c9990': 'PET-CT has emerged as a very important imaging tool for the detection of metabolically active tissue. The most common radioactive substance used for PET-CT is fluorine bound to glucose. Elevated tissue metabolic activity for glucose will result in more of the radioactive fluorine concentrating in those tissues.\xa0 Malignancies and infections metabolize glucose at an accelerated rate and can be imaged with PET even when the CT scan, taken for correlation, is normal.', 'a807a8d7-82f3-4197-a64e-738f5db3d93d': 'The regions of the fused PET/CT axial scans that have the most metabolic activity are registered as a bright red/orange colour while those areas with little metabolic activity are black. A PET/CT axial scan for a patient with widespread lymphoma and is provided for review in Figure 3.46A.', 'a044c293-4733-42a8-8840-e8e0898dfb10': 'A PET whole body image is displayed in Figure 3.46B. The regions of greater metabolic activity results in a blacker pixels for the PET portion of the scan.'}"
+Figure 3.31,undergradimage/images/Figure 3.31.jpg,Figure 3.31 B-Mode Ultrasound of the Carotid bulb with atherosclerotic plaque,"The returning sound is altered in wavelength and intensity and arrives back to the probe after being reflected from tissues of different depths beneath the skin. Based upon the absorptive or reflective properties of the anatomy being assessed, the ultrasound machine assigns a pixel brightness to that particular tissue. A complex, computer driven, algorithm determines the characteristics of the returning echoes and displays the sound on a gray scale. No echoes returning to the transducer is represented as black, while areas that return a larger proportion of the sound to the transducer are white. The image displayed on the ultrasound machine monitor is a real-time, constantly refreshing, image that actively displays the changing location of the ultrasound probe.  Images stored for future review in PACS are screen captures from the real-time imaging feed and are stored to preserve images that become part of the patients’ medical record. These images are called B-mode. (Figure 3.31)","{'2e32c4af-884f-472f-8ac8-d6e5f03612c9': 'Fig 3.40 Magnetic Resonance Imaging Machine by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'd1dde2dd-6318-4399-b13c-ebc850041c55': 'The returning sound is altered in wavelength and intensity and arrives back to the probe after being reflected from tissues of different depths beneath the skin. Based upon the absorptive or reflective properties of the anatomy being assessed, the ultrasound machine assigns a pixel brightness to that particular tissue. A complex, computer driven, algorithm determines the characteristics of the returning echoes and displays the sound on a gray scale. No echoes returning to the transducer is represented as black, while areas that return a larger proportion of the sound to the transducer are white. The image displayed on the ultrasound machine monitor is a real-time, constantly refreshing, image that actively displays the changing location of the ultrasound probe.\xa0 Images stored for future review in PACS are screen captures from the real-time imaging feed and are stored to preserve images that become part of the patients’ medical record. These images are called B-mode. (Figure 3.31)', '23084d85-1919-47f4-8be4-6087fdc808e1': 'The patient lies in anatomic position for the most part but may be asked to roll to different positions to determine if entities such as calculi or fluid move with change in patient position.\xa0 Ultrasound is the most difficult modality to understand from an anatomic standpoint as ultrasound images are not acquired with a standardized position of the ultrasound transducer in reference to anatomic position, or in reference to the patient’s anatomy. Also, as the patient moves during the ultrasound examination this introduces further variability in the appearance of the acquired images that is not a factor for other imaging modalities. Figure 3.32A\xa0depicts standard fixed location ultrasound machine, while Figure 3.32B\xa0demonstrates a smaller, mobile unit.'}"
+Figure 3.32,undergradimage/images/Figure 3.32.jpg,Figure 3.32A Ultrasound Machine,"The patient lies in anatomic position for the most part but may be asked to roll to different positions to determine if entities such as calculi or fluid move with change in patient position.  Ultrasound is the most difficult modality to understand from an anatomic standpoint as ultrasound images are not acquired with a standardized position of the ultrasound transducer in reference to anatomic position, or in reference to the patient’s anatomy. Also, as the patient moves during the ultrasound examination this introduces further variability in the appearance of the acquired images that is not a factor for other imaging modalities. Figure 3.32A depicts standard fixed location ultrasound machine, while Figure 3.32B demonstrates a smaller, mobile unit.","{'2e32c4af-884f-472f-8ac8-d6e5f03612c9': 'Fig 3.40 Magnetic Resonance Imaging Machine by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'd1dde2dd-6318-4399-b13c-ebc850041c55': 'The returning sound is altered in wavelength and intensity and arrives back to the probe after being reflected from tissues of different depths beneath the skin. Based upon the absorptive or reflective properties of the anatomy being assessed, the ultrasound machine assigns a pixel brightness to that particular tissue. A complex, computer driven, algorithm determines the characteristics of the returning echoes and displays the sound on a gray scale. No echoes returning to the transducer is represented as black, while areas that return a larger proportion of the sound to the transducer are white. The image displayed on the ultrasound machine monitor is a real-time, constantly refreshing, image that actively displays the changing location of the ultrasound probe.\xa0 Images stored for future review in PACS are screen captures from the real-time imaging feed and are stored to preserve images that become part of the patients’ medical record. These images are called B-mode. (Figure 3.31)', '23084d85-1919-47f4-8be4-6087fdc808e1': 'The patient lies in anatomic position for the most part but may be asked to roll to different positions to determine if entities such as calculi or fluid move with change in patient position.\xa0 Ultrasound is the most difficult modality to understand from an anatomic standpoint as ultrasound images are not acquired with a standardized position of the ultrasound transducer in reference to anatomic position, or in reference to the patient’s anatomy. Also, as the patient moves during the ultrasound examination this introduces further variability in the appearance of the acquired images that is not a factor for other imaging modalities. Figure 3.32A\xa0depicts standard fixed location ultrasound machine, while Figure 3.32B\xa0demonstrates a smaller, mobile unit.'}"
+Figure 3.32,undergradimage/images/Figure 3.32.jpg,Figure 3.32B Mobile Ultrasound Machine,"The patient lies in anatomic position for the most part but may be asked to roll to different positions to determine if entities such as calculi or fluid move with change in patient position.  Ultrasound is the most difficult modality to understand from an anatomic standpoint as ultrasound images are not acquired with a standardized position of the ultrasound transducer in reference to anatomic position, or in reference to the patient’s anatomy. Also, as the patient moves during the ultrasound examination this introduces further variability in the appearance of the acquired images that is not a factor for other imaging modalities. Figure 3.32A depicts standard fixed location ultrasound machine, while Figure 3.32B demonstrates a smaller, mobile unit.","{'2e32c4af-884f-472f-8ac8-d6e5f03612c9': 'Fig 3.40 Magnetic Resonance Imaging Machine by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'd1dde2dd-6318-4399-b13c-ebc850041c55': 'The returning sound is altered in wavelength and intensity and arrives back to the probe after being reflected from tissues of different depths beneath the skin. Based upon the absorptive or reflective properties of the anatomy being assessed, the ultrasound machine assigns a pixel brightness to that particular tissue. A complex, computer driven, algorithm determines the characteristics of the returning echoes and displays the sound on a gray scale. No echoes returning to the transducer is represented as black, while areas that return a larger proportion of the sound to the transducer are white. The image displayed on the ultrasound machine monitor is a real-time, constantly refreshing, image that actively displays the changing location of the ultrasound probe.\xa0 Images stored for future review in PACS are screen captures from the real-time imaging feed and are stored to preserve images that become part of the patients’ medical record. These images are called B-mode. (Figure 3.31)', '23084d85-1919-47f4-8be4-6087fdc808e1': 'The patient lies in anatomic position for the most part but may be asked to roll to different positions to determine if entities such as calculi or fluid move with change in patient position.\xa0 Ultrasound is the most difficult modality to understand from an anatomic standpoint as ultrasound images are not acquired with a standardized position of the ultrasound transducer in reference to anatomic position, or in reference to the patient’s anatomy. Also, as the patient moves during the ultrasound examination this introduces further variability in the appearance of the acquired images that is not a factor for other imaging modalities. Figure 3.32A\xa0depicts standard fixed location ultrasound machine, while Figure 3.32B\xa0demonstrates a smaller, mobile unit.'}"
+Figure 3.33,undergradimage/images/Figure 3.33.jpg,Figure 3.33 Ultrasound image of the normal liver and kidney. The echogenicity of the liver is greater than the echogenicity of the adjacent renal cortex,"Ultrasound images are described in terms of their relative echogenicity.  Water is the least complex structure seen on ultrasound and it returns very few echoes back to the transducer, therefore, it has very low echogenicity (anechoic) and is seen as a black structure on the image. An example, of a low echogenicity anatomic structure is a renal cyst or bile in the gallbladder. More complex anatomy results in more sound being echoed back to the ultrasound transducer for conversion to image pixels and is described as being echogenic (brighter) on ultrasound.  The liver is an echogenic anatomic structure and is usually more echogenic than the renal cortex. See Figure 3.33.","{'5118b94a-e45f-4ca5-9030-218cef8f592c': 'Ultrasound images are described in terms of their relative echogenicity.\xa0 Water is the least complex structure seen on ultrasound and it returns very few echoes back to the transducer, therefore, it has very low echogenicity (anechoic) and is seen as a black structure on the image. An example, of a low echogenicity anatomic structure is a renal cyst or bile in the gallbladder. More complex anatomy results in more sound being echoed back to the ultrasound transducer for conversion to image pixels and is described as being echogenic (brighter) on ultrasound.\xa0 The liver is an echogenic anatomic structure and is usually more echogenic than the renal cortex. See Figure 3.33.', '805b63b6-632a-4ab1-8b5f-c88a7d0e5f7d': 'Note the much lower echogenicity of the normal gallbladder contents in Figure 3.34:', '0daba412-1935-4948-a15d-3a8a3ecb3506': 'The echogenicity of an organ can change dependent upon the infiltration of tissues with lipid.\xa0 Hepatosteatosis (fatty liver) is an abnormal increase in lipid within the hepatocytes of the liver.\xa0 It is often associated with an enlarged liver.\xa0 Figure 3.35\xa0demonstrates an image of a normal liver and then an enlarged liver (20.9 cm cranial-caudal, normal < 15 cm) with a very increased liver echogenicity and absorption of the ultrasound beam leading to loss of anatomic detail in the deep liver.'}"
+Figure 3.34,undergradimage/images/Figure 3.34.jpg,Figure 3.34 Gallbladder,Note the much lower echogenicity of the normal gallbladder contents in Figure 3.34:,"{'5118b94a-e45f-4ca5-9030-218cef8f592c': 'Ultrasound images are described in terms of their relative echogenicity.\xa0 Water is the least complex structure seen on ultrasound and it returns very few echoes back to the transducer, therefore, it has very low echogenicity (anechoic) and is seen as a black structure on the image. An example, of a low echogenicity anatomic structure is a renal cyst or bile in the gallbladder. More complex anatomy results in more sound being echoed back to the ultrasound transducer for conversion to image pixels and is described as being echogenic (brighter) on ultrasound.\xa0 The liver is an echogenic anatomic structure and is usually more echogenic than the renal cortex. See Figure 3.33.', '805b63b6-632a-4ab1-8b5f-c88a7d0e5f7d': 'Note the much lower echogenicity of the normal gallbladder contents in Figure 3.34:', '0daba412-1935-4948-a15d-3a8a3ecb3506': 'The echogenicity of an organ can change dependent upon the infiltration of tissues with lipid.\xa0 Hepatosteatosis (fatty liver) is an abnormal increase in lipid within the hepatocytes of the liver.\xa0 It is often associated with an enlarged liver.\xa0 Figure 3.35\xa0demonstrates an image of a normal liver and then an enlarged liver (20.9 cm cranial-caudal, normal < 15 cm) with a very increased liver echogenicity and absorption of the ultrasound beam leading to loss of anatomic detail in the deep liver.'}"
+Figure 3.35,undergradimage/images/Figure 3.35.jpg,Figure 3.35A Normal Liver Ultrasound,"The echogenicity of an organ can change dependent upon the infiltration of tissues with lipid.  Hepatosteatosis (fatty liver) is an abnormal increase in lipid within the hepatocytes of the liver.  It is often associated with an enlarged liver.  Figure 3.35 demonstrates an image of a normal liver and then an enlarged liver (20.9 cm cranial-caudal, normal < 15 cm) with a very increased liver echogenicity and absorption of the ultrasound beam leading to loss of anatomic detail in the deep liver.","{'5118b94a-e45f-4ca5-9030-218cef8f592c': 'Ultrasound images are described in terms of their relative echogenicity.\xa0 Water is the least complex structure seen on ultrasound and it returns very few echoes back to the transducer, therefore, it has very low echogenicity (anechoic) and is seen as a black structure on the image. An example, of a low echogenicity anatomic structure is a renal cyst or bile in the gallbladder. More complex anatomy results in more sound being echoed back to the ultrasound transducer for conversion to image pixels and is described as being echogenic (brighter) on ultrasound.\xa0 The liver is an echogenic anatomic structure and is usually more echogenic than the renal cortex. See Figure 3.33.', '805b63b6-632a-4ab1-8b5f-c88a7d0e5f7d': 'Note the much lower echogenicity of the normal gallbladder contents in Figure 3.34:', '0daba412-1935-4948-a15d-3a8a3ecb3506': 'The echogenicity of an organ can change dependent upon the infiltration of tissues with lipid.\xa0 Hepatosteatosis (fatty liver) is an abnormal increase in lipid within the hepatocytes of the liver.\xa0 It is often associated with an enlarged liver.\xa0 Figure 3.35\xa0demonstrates an image of a normal liver and then an enlarged liver (20.9 cm cranial-caudal, normal < 15 cm) with a very increased liver echogenicity and absorption of the ultrasound beam leading to loss of anatomic detail in the deep liver.'}"
+Figure 3.35,undergradimage/images/Figure 3.35.jpg,Figure 3.35B Hepatomegaly and hepatic steatosis on Ultrasound,"The echogenicity of an organ can change dependent upon the infiltration of tissues with lipid.  Hepatosteatosis (fatty liver) is an abnormal increase in lipid within the hepatocytes of the liver.  It is often associated with an enlarged liver.  Figure 3.35 demonstrates an image of a normal liver and then an enlarged liver (20.9 cm cranial-caudal, normal < 15 cm) with a very increased liver echogenicity and absorption of the ultrasound beam leading to loss of anatomic detail in the deep liver.","{'5118b94a-e45f-4ca5-9030-218cef8f592c': 'Ultrasound images are described in terms of their relative echogenicity.\xa0 Water is the least complex structure seen on ultrasound and it returns very few echoes back to the transducer, therefore, it has very low echogenicity (anechoic) and is seen as a black structure on the image. An example, of a low echogenicity anatomic structure is a renal cyst or bile in the gallbladder. More complex anatomy results in more sound being echoed back to the ultrasound transducer for conversion to image pixels and is described as being echogenic (brighter) on ultrasound.\xa0 The liver is an echogenic anatomic structure and is usually more echogenic than the renal cortex. See Figure 3.33.', '805b63b6-632a-4ab1-8b5f-c88a7d0e5f7d': 'Note the much lower echogenicity of the normal gallbladder contents in Figure 3.34:', '0daba412-1935-4948-a15d-3a8a3ecb3506': 'The echogenicity of an organ can change dependent upon the infiltration of tissues with lipid.\xa0 Hepatosteatosis (fatty liver) is an abnormal increase in lipid within the hepatocytes of the liver.\xa0 It is often associated with an enlarged liver.\xa0 Figure 3.35\xa0demonstrates an image of a normal liver and then an enlarged liver (20.9 cm cranial-caudal, normal < 15 cm) with a very increased liver echogenicity and absorption of the ultrasound beam leading to loss of anatomic detail in the deep liver.'}"
+Figure 3.39,undergradimage/images/Figure 3.39.jpg,Figure 3.39 Linear probe and two curved array probes,"Different anatomic structures can be better visualized if the ultrasound transducer is designed to fit the anatomy of the area i.e. convex (curved) transducers are optimal for abdominal and obstetric imaging, linear probes are best adapted to vascular and small superficial structures (thyroid), while the prostate gland is best visualized with a long, wand-shaped ultrasound transducer that can reach the gland via the rectum (endo-cavitary probe). This same physical configuration of the ultrasound probe can be used for intra-vaginal image acquisition for the assessment of female pelvic anatomy (uterus, endometrium, and ovaries). Figure 3.39 contains three common probes, a linear 20 MHz, a curved array 4 MHz and a larger curved array 6 MHz.","{'0290c26c-a1c9-4507-be67-0347046fc141': 'Different anatomic structures can be better visualized if the ultrasound transducer is designed to fit the anatomy of the area i.e. convex (curved) transducers are optimal for abdominal and obstetric imaging, linear probes are best adapted to vascular and small superficial structures (thyroid), while the prostate gland is best visualized with a long, wand-shaped ultrasound transducer that can reach the gland via the rectum (endo-cavitary probe). This same physical configuration of the ultrasound probe can be used for intra-vaginal image acquisition for the assessment of female pelvic anatomy (uterus, endometrium, and ovaries). Figure 3.39 contains three common probes, a linear 20 MHz, a curved array 4 MHz and a larger curved array 6 MHz.', 'b16b25b4-c718-448c-a640-4dbe821c8182': 'A feature of ultrasound probes that effects image quality is the correlation of the frequency of sound emitted with the depth of tissue interrogated.\xa0 Higher frequency probes have a limited depth of field but provide better image resolution of the near field anatomy.\xa0 Lower frequency probes are best for deep tissue imaging.\xa0 Hence, a thyroid ultrasound may be performed with a 20 MHz probe while deep abdomen ultrasound probes are in the 4 – 5 MHz range.\xa0 Maximal tissue depth for the low frequency probes is approximately 20 cm and these probes do not provide imaging details of the subcutaneous tissues.', '726730c8-23ca-451a-8d41-d11c5a474b67': 'The depth of the tissue being imaged from the skin surface limits the ability of ultrasound to view patient anatomy i.e. it would be very unusual to be able to see all of the structures of the abdomen from front to back due to the depth limitation of ultrasound of approximately 15 – 20 cm. Two physical entities that negatively impact ultrasound image quality are the presence of gas in the area (lung, intestinal gas) and bone.'}"
+Figure 3.22,undergradimage/images/Figure 3.22.jpg,Figure 3.22 The plane of imaging related to the cantho-meatal line,"The CT gantry can be tipped cranially and caudally to deviate from the axial plane by 30 degrees in either direction and this can be used to correct for patient anatomic variability to maintain the axial plane, if necessary.  It also allows for unique imaging along an angled plane that can be used when requested by the referring physician or the radiologist.  A widely used example of imaging in an angled plane is found for CT Head examinations. It is not conventional to acquire these images in the axial plane but to image the brain on the canthomeatal (lateral orbit canthus to the aural meatus) line and therefore, the CT gantry must be tilted to ensure that all CT Head images are acquired in this plane.  Originally, this plane was chosen as it maximizes information about the intra-cranial contents while minimizing the exposure of the orbits (lens) to radiation. The orbito-meatal line has become the internationally recognized plane for acquiring CT head images. This line is depicted in Figure 3.22.","{'9d9da8c6-2e61-47f2-ba4d-6a20496f0d3a': 'All figures in “Chapter 17: Musculoskeletal” by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan are used under a CC-BY-NC-SA 4.0 license.', '42459c0f-ddfe-46c5-b1fd-6793f01031b5': '2) Gaillard, F. Salter-Harris Classification, Radiopaedia.org. https://radiopaedia.org/articles/salter-harris-classification', '99a28b8c-45c1-4a34-b607-d24433ffd59c': '3) Boaz K. Karmazyn, MD; Adina L Alazraki, MD; Sudha A. Anupindi, MD, et al. ACR Appropriateness Criteria® Pediatric – Urinary Tract Infection. Available at https://acsearch.acr.org/docs/69444/Narrative/\xa0 American College of Radiology. Accessed June 30, 2017.', 'ff59e5e9-8d3d-4318-86bd-c8746ebe5e27': '4) Urinary Tract Infection: Clinical Practice Guideline for\n\nthe Diagnosis and Management of the Initial UTI in\n\nFebrile Infants and Children 2 to 24 Months. Pediatrics 2011, 128 (3): 595 – 610.', '95839fcd-3dad-4370-b8c9-efa3ae8fee8d': '5) Dr. Matt Skalski, Ureteric reflux, Radiopaedia.org. “https://radiopaedia.org/\xa0 From the case “https://radiopaedia.org/cases/22569 rID: 22569', '26535aad-e785-402b-9277-4da9563c4525': '6) Molly E. Raske, MD; Molly E. Dempsey, MD; Jonathan R. Dillman, MD, et al. ACR Appropriateness Criteria® Pediatric – Vomiting in Infants Up to 3 Months of Age. Available at https://acsearch.acr.org/docs/69445/Narrative/ American College of Radiology. Accessed June 30, 2017.', '6ec32d8a-c136-48d5-9703-61624050f9f6': '7) Learning\xa0radiology\xa0: recognizing the basics. William Herring author. Elsevier 2016 Online access University of Saskatchewan Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK Accessed, June 30, 2017.', '3db9d0ef-38dd-4332-812d-6af2dfa4db69': '8) Grainger and Allison’s diagnostic\xa0radiology\xa0: a textbook of medical imaging. Andy Adam editor.; Adrian K. Dixon editor.; Jonathan H. Gillard 1964- editor.; Cornelia Schaefer-Prokop editor.; David J Allison; Elsevier (Firm) 2015, Online access University of Saskatchewan Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK\xa0 Accessed June 30, 2017.', '5bf49964-973b-4c4d-88b4-2696683964c1': '2) Radiopaedia.org – https://radiopaedia.org/articles/rockwood-classification-of-acromioclavicular-joint-injury Rockwood classification of AC-Joint injuries. Accessed June 30, 2017.', '59261295-fce8-49b2-a2de-77852eccc04a': '3) Common Forearm Fractures in Adults. American Family Physician 2009: 80 (10): 1096 – 1102.', '2f360c6a-b1f6-4af3-a4c8-e0b8438b9a58': '4) Diagnosis and Management of Scaphoid Fractures.\xa0 American Family Physician 2004; 70 (5); 879 – 884.', 'a5a2c608-b474-4203-bd8a-41a1f1ceb548': '5) Michael A. Bruno, MD; Barbara N. Weissman, MD; Mark J. Kransdorf, MD, et al. MSK – Hand and Wrist Trauma. \xa0Available at https://acsearch.acr.org/docs/69418/Narrative/ American College of Radiology. Accessed June 30, 2017.', '3548e3f8-9289-4063-8539-de870f48b911': '6) Robert J. Ward, MD, CCD; Barbara N. Weissman, MD; Mark J. Kransdorf, MD., et al. ACR Appropriateness Criteria®, MSK – Acute Hip Pain – Suspected Fracture. \xa0Available at https://acsearch.acr.org/docs/3082587/Narrative/ American College of Radiology. Accessed June 30, 2017.', '59596a80-aaf5-43e7-985e-7b2593951114': '7) Radiopaedia.org – https://radiopaedia.org/articles/femoral-neck-fracture Accessed June 30, 2017.', '469c112e-865a-482d-9b7e-5830232cee0e': '8) Michael J. Tuite, MD; Mark J. Kransdorf, MD; Francesca D. Beaman, MD, et al. ACR Appropriateness Criteria®, MSK – Acute Trauma to the Knee. Available at https://acsearch.acr.org/docs/69419/Narrative/ American College of Radiology. Accessed June 30, 2017.', '61b9265e-5af7-4d75-833f-a9344ce39570': '9) Ottawa Knee Rule – Stiell IG, Wells GA, Hoag RH, Sivilotti ML, et al (1997). “Implementation of the Ottawa Knee Rule for the use of radiography in acute knee injuries.”. JAMA. 278 (27): 2075–9. PMID\xa09403421. doi:10.1001/jama.1997.03550230051036. Accessed June 30, 2017.', 'd567b915-ef5d-4c0d-8e5b-f533c7036e91': '10) Ottawa Ankle Rule – Stiell IG, McKnight RD, Greenberg GH, et al. (March 1994). “Implementation of the Ottawa ankle rules”. JAMA. 271 (11): 827–32. PMID\xa08114236. doi:10.1001/jama.1994.03510350037034. Accessed June 30, 2017.', '92efbc09-23c1-4b33-b265-50b693fca389': '11) Jon A. Jacobson, MD; Catherine C. Roberts, MD; Jenny T. Bencardino, MD, et al. ACR Appropriateness Criteria®, \xa0MSK – Chronic Extremity Joint Pain Available at https://acsearch.acr.org/docs/3097211/Narrative/ American College of Radiology. Accessed June 30, 2017.', '170f0345-ab5f-45e0-8acd-470a44d17663': '2) Catheter Replacement of the Needle for Arteriography. Seldinger, S. I. Acta Radiologica, 1953: 39 (5); 368 – 376.', 'd55b79a0-51d8-4933-a57a-7d6b6cb5597b': '3) Thomas B. Kinney, MD; Hamed Aryafar, MD; Charles E. Ray, Jr, MD, PhD, et al. ACR Appropriateness Criteria® Management of Inferior Vena Cava Filters. Available at https://acsearch.acr.org/docs/69342/Narrative/ American College of Radiology. Accessed June 30, 2017', 'ba20e351-4219-47c3-b9c5-b61de5ab8fd9': '4) Learning\xa0radiology:recognizing the basics. William Herring author. Elsevier 2016, Online access University of Saskatchewan Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK Accessed, June 30, 2017.', '3fc9b447-cac6-4420-ac4e-05f656e81f43': '5) Grainger and Allison’s diagnostic\xa0radiology\xa0: a textbook of medical imaging. Andy Adam editor.; Adrian K. Dixon editor.; Jonathan H. Gillard 1964- editor.; Cornelia Schaefer-Prokop editor.; David J Allison; Elsevier (Firm) 2015, Online access University of Saskatchewan Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK\xa0 Accessed June 30, 2017.', 'a53e9698-8be5-4b56-ba59-87393e1e60b7': '2) Vahid Yaghmai, MD, MS; Max P. Rosen, MD, MPH; Tasneem Lalani, MD. ACR Appropriateness Criteria® \xa0– Gastrointestinal – Acute (non-localized) Abdominal Pain and Fever – Pneumoperitoneum. Available at\xa0 https://acsearch.acr.org/docs/69467/Narrative/ American College of Radiology. Accessed June 30, 2017.', '23ab0a22-ea4d-4c3f-9d72-f3a49ca4f6fd': '3) Douglas S. Katz, MD; Mark E. Baker, MD; Max P. Rosen, MD, MPH. ACR Appropriateness Criteria® – Gastrointestinal – Suspected Small Bowel Obstruction. Available at https://acsearch.acr.org/docs/69476/Narrative/ American College of Radiology. Accessed June 30, 2017.', 'f3c446dd-aa8d-4d22-aed4-b5e89863cd27': '4) Martin P. Smith, MD; Douglas S. Katz, MD; Max P. Rosen, MD, MPH. ACR Appropriateness Criteria® – Gastrointestinal – Right Lower Quadrant Pain – Suspected Appendicitis. Available at https://acsearch.acr.org/docs/69357/Narrative/ American College of Radiology. Accessed June 30, 2017.', 'e40080ff-07b5-4509-a9d8-3d7ff39b3c19': '5) Michelle M. McNamara, MD; Tasneem Lalani, MD; Marc Anthony Camacho, MD. ACR Appropriateness Criteria® \xa0– Gastrointestinal – Left Lower Quadrant Pain – Suspected Diverticulitis. Available at https://acsearch.acr.org/docs/69356/Narrative/ American College of Radiology. Accessed June 30, 2017.', 'a6f6cc9d-0ee1-42b0-ba1b-410ac9dc0387': '6) Rendon C. Nelson, MD; Ihab R. Kamel, MD, PhD; Mark E. Baker, MD. ACR Appropriateness Criteria® \xa0– Gastrointestinal – Liver Lesion – Initial Characterization. Available at https://acsearch.acr.org/docs/69472/Narrative/ American College of Radiology. Accessed June 30, 2017.', '154ec87b-5220-4418-99a5-75ec9d9fafec': '7) Tasneem Lalani, MD; Corey A. Couto, MD; Max P. Rosen, MD, MPH. ACR Appropriateness Criteria® \xa0– Gastrointestinal – Jaundice. Available at https://acsearch.acr.org/docs/69497/Narrative/ American College of Radiology. Accessed June 30, 2017.', '740ebf07-9cb8-4ed5-9cac-8bb79c578c8d': '2) Jacobo Kirsch, MD; Tan-Lucien H. Mohammed, MD, et al.\xa0 ACR Appropriateness Criteria®, Chest – Acute Respiratory Illness in Immunocompetent Patient. Available at https://acsearch.acr.org/docs/69446/Narrative/ Accessed, June 30, 2017.', '571524ec-b296-4a2d-95dc-97db963c3fcb': '3) Debra Sue Dyer, MD; Tan-Lucien H. Mohammed, MD; Jacobo Kirsch, MD, et al. ACR Appropriateness Criteria®, Chest – Chronic Dyspnea – Suspected Pulmonary Origin. \xa0Available at https://acsearch.acr.org/docs/69448/Narrative/ Accessed June 30, 2017.', 'f22ed822-b387-44e5-8a22-dd8a867b8b01': '4) Learning\xa0radiology\xa0: recognizing the basics. William Herring author. Elsevier 2016 Online access USask Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK Accessed, June 30, 2017.', '87cb046f-4dac-41ec-84d0-bed36b33d265': '5) Jeffrey P. Kanne, MD, Leif E. Jensen, MD, MPH, Tan-Lucien H. Mohammed, MD, et al. ACR Appropriateness Criteria®,\xa0 Chest – Radiographically Detected Solitary Pulmonary Nodule. Available at https://acsearch.acr.org/docs/69455/Narrative/ Accessed June 30, 2017.', '3159e24d-3174-4315-993d-23dd449b06b4': '6) Fleischner Society – https://fleischnersociety.org', 'd07c0b2d-9413-4046-ab1e-55f117865c2a': '7) Michael A. Bettmann, MD, Scott G. Baginski, MD, Richard D. White, MD, et al. ACR Appropriateness Criteria®, Chest – Acute Chest Pain – Suspected Pulmonary Embolism. Available at https://acsearch.acr.org/docs/69404/Narrative/\xa0 Accessed June 30, 2017.', 'cd973045-ca97-4b36-a285-52581f60f304': 'Ultrasound uses traditional probes with higher frequency to better image the breast tissue that is in close proximity to the overlying skin.', '13e1e8e0-e640-4941-8300-c31710b3a53c': 'Mammography/Breast Imaging Centres in Canada are accredited and audited for quality by the Canada Association of Radiologists.', 'eca3d4b9-a2c4-43c7-ae2b-3ec757983d8b': '2) Vilaas S. Shetty, MD; Martin N. Reis, MD; Joseph M. Aulino, MD, et al. ACR Appropriateness Criteria® Head Trauma. Available at https://acsearch.acr.org/docs/69481/Narrative/ American College of Radiology. Accessed, June 30, 2017.', 'a923162d-9460-4587-991e-319c82bf5c9f': 'https://acsearch.acr.org/docs/69481/Narrative/', '96ac01aa-0380-4fa5-be27-55a5b787830c': '3) Michael B. Salmela, MD; Shabnam Mortazavi, MD; Bharathi D. Jagadeesan, MD, ACR, et al. Appropriateness Criteria® Cerebrovascular Disease. https://acsearch.acr.org/docs/69478/Narrative/ American College of Radiology. Accessed, June 30, 2017.', 'b68256b4-9387-4475-8f5a-41b599bfaf04': 'https://acsearch.acr.org/docs/69478/Narrative/', 'd4f105b8-2855-4af9-a3cb-f9d88fcdbf18': '4) Annette C. Douglas, MD; Franz J. Wippold II, MD; Daniel F. Broderick, MD, et al. Appropriateness Criteria® Headache. https://acsearch.acr.org/docs/69482/Narrative/ American College of Radiology. Accessed, June 30, 2017.', '74770c44-e954-4084-abd6-2740860fa07d': 'https://acsearch.acr.org/docs/69482/Narrative/', 'edab0354-1c57-4db0-b1dd-6ea014cb5e00': '5) Nandini D. Patel, MD; Daniel F. Broderick, MD; Judah Burns, MD, et al. Appropriateness Criteria® Low Back Pain. https://acsearch.acr.org/docs/69483/Narrative/ American College of Radiology. Accessed, June 30, 2017.', 'd0966524-e032-4f5a-9faf-1e8f783d8061': 'https://acsearch.acr.org/docs/69483/Narrative/', 'aa597d16-b4a3-404a-889f-e4a901c750d6': '6) Richard H. Daffner, MD; Barbara N. Weissman, MD; Franz J. Wippold II, MD, et al. Appropriateness Criteria®  Suspected Spine Trauma. https://acsearch.acr.org/docs/69359/Narrative/ American College of Radiology. Accessed, June 30, 2017.', '6945685d-8bdd-48ba-9299-88cd95cdcccc': 'https://acsearch.acr.org/docs/69359/Narrative/', 'd6137ceb-35ba-41f9-b5ad-909c0c93c831': 'The standard views are AP (anterior-posterior) and lateral.\xa0 These two views are taken at right angles (orthogonal) to each other.\xa0 If these images are not helpful, ancillary views such as oblique views, or special views such as, an axillary or carpal tunnel view, may be required based upon the clinical scenario.', '8da19a7d-ea8a-48f7-802b-c3e6ad2879ea': 'Stress views i.e. a force is applied to a bone or joint to determine if an injury is present, such as, a subtle avulsion or a suspected tendon or ligament tear causing joint instability. These are acquired as special requests and should be performed in a manner that minimizes patient pain and discomfort.', 'c1ddb6e5-c42b-4c10-ac0d-ed3b6ab5cbad': 'At least one joint space should be visible in relation to the suspected bone injury.\xa0 Additional x-ray views and views of another adjacent joint space may be required in some circumstances.', 'd8ec4a87-ef98-4bd8-9ee3-47f8c6612a49': 'Comparison views to the contralateral, normal bone, or joint, may be required, this is especially true if a subtle growth plate injury is suspected in a child.\xa0 Comparison views should not be ordered routinely, but should be used if clinically necessary.', 'd76a51e5-d391-4400-aa76-b67e2d5a4233': 'It is important to remember that some bone and ligament injuries occur as a common pattern of multiple injuries i.e. the Colle fracture of the distal radius is often associated with an avulsion fracture of the ulnar styloid.\xa0 Ankle ligament injuries and fractures often occur in a sequence i.e. medial malleolar avulsion fracture (or medial ligament tear), interosseous ligament tear between the tibia and fibula, and a subsequent oblique fracture of the proximal fibula (Maisonneuve fracture complex).\xa0 Keep this in mind as you encounter various patients and you will develop knowledge and experience of these associated bone and soft tissue injuries.', 'd26261d6-1894-4731-a4bc-cb382c5fc4b8': 'Fractures usually present as a lucent line on x-rays involving the cortex and medulla of the bone that can be followed from one cortex to the opposite cortex with varying degrees of displacement and malalignment of the involved bone.', '6d3c05b4-f04f-464e-828c-e219309240b2': 'There are some fractures that may be associated with bone ischemia and avascular necrosis i.e. capital femoral fractures and scaphoid fractures.\xa0 Be aware of this and learn the importance of aggressive and pre-emptive management for these patients.', '9efc69ef-d567-4c20-b7da-5b5faae548f8': 'Fig 5.7 Abdomen Quadrants/Regions\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'c17eee8e-a5a7-4b3d-aa39-e9562f679745': 'Fig 5.8\xa0Supine Positioning for Abdomen x-ray, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', 'e428391c-3d1e-4c3d-a0ee-4e39fd82ee4d': 'Fig 5.9 Upright Positioning for Abdomen x-ray, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', '4fe76b20-0ac2-49ac-a875-af27033355ec': 'Fig 5.10 Decubitus Positioning for Abdomen x-ray, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', '1e50fdef-529f-4fe1-b3f4-ab42378ca31f': 'Fig 5.11 Normal Abdominal x-ray by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '27e0addc-368c-4208-9970-6559705ff1e8': 'Fig 5.12 Colon anatomy emphasized by the presence of barium and air by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '990d74a2-1431-4705-8efd-4cf210fa9ce3': 'Fig 5.13 Bones and Musculoskeletal Landmarks in the Abdomen by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '3d050294-a087-4835-a5ed-7961069e1f0a': 'Fig 5.14 Possible Artifacts on Abdomen x-rays. The image demonstrates two umbilical piercings, fallopian tube clips, and the buttons on the patient’s pants by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'cbf4613b-cbd6-4078-b9c3-b1c333a37c48': 'The standard upright views of the chest are made when a patient is typically placed between an x-ray source and an x-ray detector. When the x-rays penetrate the tissues of the patient, they stimulate an x-ray detector that alters the energy of the x-ray beam into a digital pixel grid. The radiograph produced is referred to as a roentgenogram and named after Wilhelm Konrad Roentgen who received the first Nobel Prize for Physics in 1901 for his work in defining the major properties of x-rays and the conditions necessary for their production. It was Roentgen who coined the term “x-ray”.', '9da044bd-e951-4eb4-8cf9-ccb9398a2423': 'Fig 5.1 A portable upright x-ray where the image is not taken with proper body alignment, the patient is rotated and tilted\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '0bc6ae7d-c9c2-4d6d-ae6c-f07a5a647792': 'Fig 5.2 A portable upright x-ray taken with patient in proper alignment\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'e27384e1-63ef-4a65-a138-41a0d8870a95': 'Fig 4.1A Fluoroscopy – Shoulder Arthrogram Early Phase of Injection\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '2f124311-a640-4063-9232-06af6006da7a': 'Fig 4.1B\xa0Shoulder Arthrogram Fluoroscopy Mid-Phase of Injection by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'bb7b38f9-ff02-462d-8d99-621dd444c05e': 'Fig 4.1C Shoulder Arthrogram Late Phase of Injection\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'b6d8041f-18d1-40b8-a5b0-44c6bfeb9405': 'Fig 4.2A\xa0CT Aorta, C-\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'b98a8c21-5a63-4b95-b9ce-f7e38e6999bc': 'Fig 4.2B CT Iliac Arteries, C-\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '43da027d-17e8-4ba4-b312-67fba1bd1511': 'Fig 4.2C CT Aorta, C+\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'b66fdc16-e8ca-433f-8a6e-1d0f3f659bb3': 'Fig 4.2D CT Iliac Arteries, C+\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '8964941e-dc07-44fd-954a-0403c1bfd992': '2) Image Wisely. http://www.imagewisely.org/ Last accessed, Aug. 22, 2017.', 'ed5f284b-a74a-4376-b274-77e0e2303fc9': '3) Image Gently. http://www.imagegently.org/ Last accessed Aug 22, 2017.', 'fc2d1e7a-fa5b-4dbc-917f-25f258eb23d6': '4) Novelline, R. A., & Squire, L. F. (2004), sixth edition. Squire’s fundamentals of radiology. Cambridge, Mass: Harvard University Press.', 'ce057be0-807e-4b88-a477-0d87c59e607b': 'Fig 3.43 Nuclear Medicine Scanner by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'dce81a39-f2bd-47ee-847d-9205bbc446e1': 'Fig 3.44A Normal, Pediatric Nuclear Medicine Bone Scan by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '8bed792d-6442-4cbd-89db-89b5a4cb4541': 'Fig 3.44B Normal, Adult Nuclear Medicine Bone Scan\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '41bf79b1-bfd9-4a16-9b5d-900405a59176': 'Fib 3.45 PET/CT Scanner\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '8fcd15af-34e1-492f-91a7-3b8b671387ed': 'Fig 3.46A PET/CT image of the chest for a patient with lymphoma\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '211a4b55-451b-4858-aa60-ce4253c9d555': 'Fig 3.46B PET image of the whole body for a patient with lymphoma\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '15d4a271-c53b-449d-8385-a1b6030fd923': 'The appearance of different tissue on MR images is described as displaying greater, or lesser, signal in comparison the other anatomy in the region. The signal in question is the energy that the perturbed protons liberated when they fall back into alignment with the magnetic field. The signal intensity of the tissue in question changes based upon the image acquisition parameters set by the MR Technologist, under the direction of a supervising Radiologist.\xa0 The parameters set result in the acquisition of a set of images called an MR imaging sequence. On one sequence cerebrospinal fluid will appear as black pixels (T1 sequence) while on another sequence it is white pixels (T2 sequence). This difference in tissue appearance can be exploited to determine if pathology is present.', '33f25041-480d-4bb9-95fc-0a28bc2224ed': 'Fig 3.31\xa0B-Mode Ultrasound of the Carotid bulb with atherosclerotic plaque\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '18658974-a7a2-499b-881c-5a51baaa9854': 'Fig 3.32A\xa0Ultrasound Machine\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '5c75f45f-6624-42df-b964-dddafeae9d32': 'Fig 3.32B Mobile Ultrasound Machine\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'f351a841-d5dd-4048-8f36-831f0bbf09d9': 'Fig 3.33 Ultrasound image of the normal liver and kidney. The echogenicity of the liver is greater than the echogenicity of the adjacent renal cortex by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '059ddd7b-14ba-4290-92ad-7382c9156fc4': 'Fig 3.34 Gallbladder\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '5db401cc-d0ff-4f03-945a-f50dd89e4be9': 'Fig 3.35A Normal Liver Ultrasound by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'fae31525-31fa-491b-8fcf-6206343abf74': 'Fig 3.35B Hepatomegaly and hepatic steatosis on Ultrasound\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '4aa1ffad-a8df-4cef-8f34-a9695f5958bc': 'Fig 3.36 Colour Doppler, of the neck\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '99b1c66a-6cc2-4a4e-872f-476d28cdab03': 'Fig 3.37 Colour Doppler of the neck with Spectral Display\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '21a2827a-f5ed-4e96-a0d9-b91bdf773c22': 'Fig 3.38A\xa0Internal Carotid Doppler Ultrasound Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '6bf5c327-c3cb-4f8c-b09c-7b96d908326a': 'Fig 3.38B Carotid Bulb Doppler Ultrasound\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '8d123159-7ce7-4972-bc0c-86aa528a32ae': 'Fig 3.38C\xa0Vertebral Doppler Ultrasound\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'b8f04a00-104c-40e3-8e47-1dc899d44ca1': 'Fig 3.39 Linear probe and two curved array probes\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'c15107ec-6f70-4702-929e-61aeee36a137': 'The patient does not need to be moved, or re-positioned, to obtain CT images in different anatomic planes.\xa0 The patient lies on the CT table in anatomic position and remains in that position throughout the study.\xa0 The standard orientation of image acquisition for CT is in the axial plane, hence the old name for this machine of CAT (computed axial tomography) scanner.\xa0 Often the axial images obtained during the initial x-ray exposure will be digitally reformatted into other anatomic planes i.e. sagittal and coronal.\xa0 These reformatted images are the result of a computer algorithm reformatting the original digital image data and, as such, these supplemental anatomic planes of imaging do not require additional x-ray exposure.', '23a6edd0-ea0d-4597-87b7-d94ca733c3a5': 'The CT gantry can be tipped cranially and caudally to deviate from the axial plane by 30 degrees in either direction and this can be used to correct for patient anatomic variability to maintain the axial plane, if necessary.\xa0 It also allows for unique imaging along an angled plane that can be used when requested by the referring physician or the radiologist.\xa0 A widely used example of imaging in an angled plane is found for CT Head examinations. It is not conventional to acquire these images in the axial plane but to image the brain on the canthomeatal (lateral orbit canthus to the aural meatus) line and therefore, the CT gantry must be tilted to ensure that all CT Head images are acquired in this plane.\xa0 Originally, this plane was chosen as it maximizes information about the intra-cranial contents while minimizing the exposure of the orbits (lens) to radiation. The orbito-meatal line has become the internationally recognized plane for acquiring CT head images. This line is depicted in Figure 3.22.', '2a01449e-f80d-44b8-b5f1-9fbd2293de89': 'The physics of CT image creation are complex and require complex computer processing to create images that are visible for clinical use.\xa0 As the x-ray tube and the x-ray detectors revolve around the patient thousands of mathematical calculations are performed to determine how much of the incident x-ray beam was absorbed by a volume of tissue. This volume of tissue is called a voxel. The calculated absorption of the x-rays by a voxel is converted into a pixel density that is displayed on a gray scale from -1,000 (air) to +1,000 (metal).\xa0 This scale is called the Hounsfield unit (HU) scale after one of the principle inventors of CT, Sir Godfrey Hounsfield.\xa0 The calculated density of this voxel is then allocated to a pixel on a grid of the 512 x 512 pixels that forms each individual CT image.', '7630aac5-da71-4093-992f-e3de7e0777cf': 'Therefore, if the volume of tissue contained air, or gas, the pixel density allocated would be close to -1,000 HU, while if the volume of tissue analyzed contained metal (bullet fragment, etc.) the pixel would be assigned a density close to the +1,000 HU.\xa0 The assignment of pixel density to voxels spans the entire possible range of pixels from -1,000 – +1,000 HU, resulting in 2,000 shades of grey.\xa0 An image with the HU measurements of specific anatomic regions is provided in Figure 3.23.', '194d89df-a49e-4ba0-a141-fedb5b7d0e3d': 'CT density: a region on a CT image is described as being more, or less, dense than another region. The liver is more dense than the renal cortex.\xa0 This variation in pixel density can be quantified by measuring all the pixels in a region and creating an average pixel density i.e. region of interest of an area of liver can be measured, with a standard deviation, 50 HU +/- 5 HU, etc. The HU density of some common structures is provided in Table 3.2.', '7fd3f166-8080-4a1e-b564-5aaedace0274': 'Table 3.2 HU Scale', 'bf48f853-55d2-4b0d-a952-97052c04fccc': 'The viewer of the CT can decide how to adjust the level and window of the displayed CT images to accentuate tissues of a defined pixel density. \xa0The level and window are at the discretion of the viewing radiologist and can be set to their preferences. There are a variety of established level and window settings, i.e. abdomen, bone, brain, etc. These help to provide some level of uniformity for comparison of multiple CT examinations. Level and window setting for six common tissues are as follows:', 'b2f1f965-5bd4-4a65-bbcb-a0c74bb6849b': 'Table 3.3 Six common tissue levels and windows', '1c89c10d-2e57-46d5-873c-753aa9d9fd25': 'CT images demonstrating the appearance of these six different level and window settings are provided in Figure 3.24.', '0c5a4d4a-1a8a-45e7-82a1-3975c585d2e6': 'Level and Window are unique physical properties of CT images that allow the user to adjust the centre and the width of the gray scale that is portrayed on the images.\xa0 This is an adjustment that is applied to the raw CT data and does not require repeated patient imaging to obtain the different levels and windows. The level is the centre of the gray scale, set to the HU of the tissue of most interest i.e. the centre (level) of the gray scale for brain window is 35 HU.\xa0 The window is the width of the gray scale that surrounds the level setting, thus defining the range of HU for white and black seen on the image. For the brain images the width of the HU scale is 80 HU. A illustration depicting this for brain and bone level and window setting are provided in Figure 3.25.', '22baea2d-4734-448a-b8d2-ff98cc34c126': 'Fig 3.21\xa0Helical CT Scanner\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '997a9bef-3a49-4a5c-baaa-b5f4e9a60244': 'Fig 3.22 The plane of imaging related to the cantho-meatal line\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'e620fc79-fe54-4e1b-937a-f2f6d1ae88b4': 'Fig 3.23 Images of CT with HU measurements\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '47384920-3878-4fd3-a2cb-6676f1ecd6b4': 'Fig 3.24 CT Images with different level and window settings\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '27c1bf77-b175-46e2-8f3c-8b044f235e7a': 'Fig 3.25A Brain Level and Window\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'ae550a20-25ad-452b-9c36-d593b30cda0b': 'Fig 3.25B Bone Level and Window\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '4c06c22c-a218-43c6-b6d2-8b86614cb44f': 'Fig 3.26A Head CT visible on brain level and window. Bone not well seen by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '09e44bf9-1b1b-4b30-ac75-268a90c19141': 'Fig 3.26B Head CT on bone level and window. Brain not well seen by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'b14da7a2-6e23-4800-9645-0f1ea9841b25': 'Fig 3.27 Standard viewing orientation for an axial CT image\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '1aaea852-a349-4e12-9f42-4e7db0ccde67': 'Fig 3.28A CT image displayed in axial orientation from one radiation exposure event\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'cb4dd03b-6e19-4678-85ec-4798a6b00fe9': 'Fig 3.28B CT image displayed in sagittal orientation from one radiation exposure event\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '06e1bc4e-3c56-472e-b82f-5ca979851270': 'Fig 3.28C CT image displayed in coronal orientation from one radiation exposure event\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '82ba8ff7-a04c-4efb-9328-b4216ab73f8e': 'Fig 3.29A CT of the chest on lung level/window by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '2bb589c6-5d7e-4ca5-9add-0533ae22ad66': 'Fig 3.29B CT of the chest on mediastinal level/window by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '80b61eb5-0c49-4c26-bba6-34a715289fbc': 'Fig 3.30 CT PE image maximizing the injected contrast in the pulmonary arteries\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '7586c4b7-5466-4c34-b19e-28c580057600': 'An angiography machine is essentially a fluoroscopy unit that has the added feature of having the x-ray source and detectors mounted on a c-arm apparatus. The c-arm allows for movement of the source and detector around the patient who lies supine on the angiography table. The operator can acquire images in a wide variety of anatomic projections.\xa0 Therefore, patient movement is not required for this imaging modality. The angiography unit also has advanced software applications that facilitate complex arterial and body interventional procedures beyond the capabilities of a standard fluoroscopy unit. As with fluoroscopy, the images are viewed inverted in comparison to standard radiographs.', '8321eb02-784a-4088-a939-b2f9c46e47ce': 'The x-ray dose for Angiography is controlled by multiple detectors that adjust the radiation exposure to maximize image quality and minimize x-ray exposure. The machine only emits radiation when the operator uses a foot pedal to activate the x-ray tube. The area imaged can be collimated, or coned, to minimize the area exposed to x-rays.\xa0 The anatomy can also be magnified to improved diagnostic capacity.', 'c01d6355-58d2-4339-a8e1-0b13cb0a2a27': 'The images acquired are obtained very rapidly in cine mode resulting in a set of stacked images, that when stored and viewed, simulate a video recording.\xa0 Cine mode allows for the dynamic assessment of moving contrast and movement of catheters and guide wires inside the anatomy of the patient. A standard c-arm angiography unit is depicted in Figure 3.19.', '75c40a34-0496-4f50-853a-4a34b85893f5': 'For angiography, the radio-opaque contrast agent used is injected intra-arterially while x-ray images are acquired.\xa0 This is an invasive process that requires the injection to be performed via a small intra-arterial catheter that administers the contrast in close proximity to the origin of the arterial structure being investigated, i.e. carotid angiography requires an injection of contrast into the selected carotid artery.\xa0 The catheter used is usually manipulated into position using fluoroscopy from a remote arterial access site i.e. the common femoral artery, the radial artery, or the brachial artery.', 'b87262ac-93be-41c5-a829-b396ffcd5495': 'Arterial access relies upon the “Seldinger” technique, using local anesthetic, to insert the intra-arterial catheter used for the procedure. Blood vessels lack internal innervation and therefore, the catheter and guidewire can be manipulated without causing patient pain or discomfort.', 'e2e27594-969f-4065-afca-fc9d4d9d539d': 'This machine can also be used for Interventional Radiology procedures where catheters, guidewires, stents, feeding tubes, etc. are visualized with the c-arm fluoroscopy.\xa0 Water-soluble contrast agents can also be injected during these procedures to depict the anatomy of structures such as, the bile ducts, intestine, renal collecting system, veins, etc.', 'ba4bd9f0-d4d3-4160-998d-e606f08e785b': 'All modern angiography units capture images and present them in subtracted mode.\xa0 The subtraction process is digital using a computer to superimpose a non-contrast enhanced image onto a set of contrast enhanced cine images, resulting in subtracted images that depict only the anatomic structure filled with contrast since the background anatomy has been subtracted away by the digital image modification process. A digital, subtracted, carotid angiogram is depicted in Figure 3.20.', '9507b590-4a7c-43a4-ab86-48655f636346': 'The contrast used for angiography is an iodine based pharmaceutical and is water soluble.\xa0 During angiography, it is injected into the artery of interest and replaces the blood for a very short period of time.\xa0 This contrast agent progresses antegrade in the vascular tree related to the direction of blood flow.\xa0 It quickly clears from the arteries and exits the region via venous drainage.\xa0 The circulating contrast is predominantly excreted by the kidneys into the urine.', '3276ecac-6f99-4922-9d4c-37154b7ae129': 'Fig 3.19 Angiography Machine with C-Arm by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '0d7266b7-752c-4049-b830-7e4dca6ea0db': 'Fig 3.20\xa0Carotid Angiography, Digital Subtraction Cerebral Angiography\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '07ea0f57-4c84-4133-93c0-83121c89f01d': 'An example of a fluoroscopic examination is the esophogram and upper gastrointestinal series.\xa0 The patient is asked to swallow barium sulfate and gas-forming granules.\xa0 The barium can be seen to move with positioning (gravity) and peristalsis as it moves antegrade through the digestive tract while the gas rises to the highest point of the intestinal tract based upon patient positioning. The barium and the gas help to outline the inner lining of the intestine.\xa0 The live fluoroscopic x-rays visualize the motion of the barium and the gas. It is also possible to capture still images and/or cine mode images that are stored in the Picture Archive and Communication System (PACS).', 'bc96ce7d-d729-4227-95fa-225665741a10': 'Cine mode images are still images captured at a rapid rate and can be viewed sequentially, like a video, after being stored in the PACS. Other fluoroscopy aided examinations include arthrography, barium enema, cystourethrogram, sinus tract injections, myelography and hysterosalpingography, to name a few.', '87cf4657-0272-4db3-aa75-969547958014': 'The positioning of the patient is dependent on the physical capabilities of the patient and the exam that is to be performed. For example, when carrying out an esophogram, the best positioning would be an upright (standing) patient and an oblique or lateral view of the anatomy to watch the barium proceeding down the esophagus. Additional oblique and lateral views allow one to visualize abnormalities in multiple planes and to determine if any abnormality of the intestinal mucosa is concealed by swallowed barium on one view. If aspiration of ingested fluid or food into the lungs is clinically suspected the lateral projection allows one to determine if fluids are entering the trachea during swallowing.', 'b74d40ce-5391-4b64-a394-581b4a112089': 'A Fluoroscopy machine is seen in Figure 3.15.', 'bbd4cc27-e511-4d95-a60e-9f436bbc4a41': 'The video in Figure 3.17\xa0depicts live fluoroscopy of the upper esophagus for a patient whose images demonstrate aspiration of the barium into the trachea.', 'dbaf432f-8185-4365-a9d3-beed0ab25975': 'Fluoroscopy images are most often displayed for review inverted in comparison to standard x-ray images.\xa0 Hence, air is white and metal is black.\xa0 They can also be displayed as standard x-rays if this is advantageous for interpretation, see the barium enema images. The principles of absorption and transmission of the x-rays is unchanged, but the images are digitally manipulated to be the inverse of x-rays, much like film negatives in photography. The effect of image inversion for Fluoroscopy images is depicted in Figure 3.18.', '6891ccd4-5787-4995-8269-5f022f52e891': 'Fig 3.3\xa0X-ray Tube by\xa0Kieranmaher is in the Public Domain.', '39c648ca-5e19-4388-a61f-bdd02372eda8': 'Fig 3.4\xa0X-ray Tube. Lead Housing with Portal for x-ray Emission, bench top image by Rschiedon is available under a CC-BY-SA 3.0 Unported License.', '33964476-071d-4239-b632-398ccd10bb4f': 'Fig 3.5\xa0X-ray Image Creation and Display by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'f39c28ae-5cbf-4339-a557-42e3a1322037': 'Fig 3.6A\xa0A standard, fixed location, wall x-ray detector used for upright chest and abdomen x-rays by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'fb953c13-b4fe-4531-a6f1-80bdb7074953': 'Fig 3.6B\xa0A Portable x-ray Machine by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '6e34bafd-8b52-44e0-ad2d-cf1e331df04d': 'Fig 3.6C\xa0The Portable x-ray machine with the x-ray tube extended for use by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'ca28bfcc-132a-4473-a28f-bd495247e213': 'Fig 3.6D\xa0A Portable, Mini, C-Arm x-ray Unit by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '4711a96b-6775-4db5-9866-04674d98a3f6': 'Fig 3.7\xa0Appearance of different entities on x-rays\xa0by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '1258fb9d-5c95-4aae-80d3-54f946489f6b': 'Fig 3.8\xa0Left Shoulder x-ray\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license. Accessible from\xa0https://mistr.usask.ca/odin/?caseID=20160214201450302', '547b4d9c-36c8-45f6-b22d-82adda75b216': 'Fig 3.9\xa0Effect of tissue thickness on x-ray appearance\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '69e45b9a-1ecf-45d7-8796-3255b76aa319': 'Fig 3.10\xa0Common x-ray Test Object, Lucite Plastic Board\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '57b3432c-9730-4d69-9cce-4f4007438233': 'Fig 3.11A Posterior-anterior, upright, chest x-ray positioning, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', '32b6ba4a-63ec-4e10-9990-f380de9fee0d': 'Fig 3.11B Lateral, upright, chest x-ray positioning, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', 'b22e4373-8d85-42d1-a469-1a583e765d15': 'Fig 3.11C Decubitus x-ray positioning, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', '8b26404e-eca4-432c-a4a4-406c267732a6': 'Fig 3.1\xa0PACS Imaging Viewing Station (Workstation) by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC–BY-NC-SA 4.0 license.', '8a1454eb-adb0-43dd-b455-381ef4a0fa33': 'Fig 3.2 Sample MRI Request Form\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC–BY-NC-SA 4.0 license.', '32fc7f20-73b7-4d42-8e8e-a55c8e933865': '2) Sievert. Wikipedia. https://en.wikipedia.org/wiki/Sievert Accessed Sep. 3, 2018', '808e953e-3ced-45ab-8c29-dcb633e825d7': '3) Radiation Safety Review, Jeff Sanderson. Cancer Care Manitoba, 2001. https://www.cancercare.mb.ca/Research/medical-physics/radiaion-protection-services/index.html', '7a5b86bc-d27b-4f09-94d3-eacd0a26d733': '4) ICRP, 2007. ‘The 2007 Recommendations of the International Commission on Radiological Protection’. ICRP Publication 103. Ann. ICRP 37 (2-4).\n\n(see http://www.icrp.org/publication.asp?id=ICRP%20Publication%20103) Last accessed Feb. 12, 2019.', '0e4fd872-fed4-4829-aad6-b29fb5207e16': '5) United States Nuclear Regulatory Commission. https://www.nrc.gov/reading-rm/basic-ref/glossary/alara.html Last accessed February 5, 2019.', '31a16705-8334-4d0b-ba2c-7b3ba4903d3d': '6) Guidelines for Diagnostic Imaging During Pregnancy and Lactation ACOG October 2017 e210; 130(4):e210 – e216.', '61c798cb-9b2c-44a5-a50f-094104e0d923': '7) Image Gently Alliance. https://www.imagegently.org/ Last accessed February 6, 2019.', '95aa939a-bd18-4918-8163-3f0eda02ba68': '8) American College of Radiology. ‘ACR appropriateness criteria.’ Radiology, 2000; 215 (Suppl): 1-1511.', 'b562ff2f-9eea-4eba-9d13-f84bcac6c6d9': '9) ACR Appropriateness Criteria List. https://acsearch.acr.org/list Last accessed Feb. 13, 2019.', '15e3ec31-d27d-49ba-9d6a-a28f7211c03f': '10) The Royal Australian and New Zealand College of Radiologists. Imaging Guidelines. 4th edn. Surrey Hills: National Library of Australia Cataloguing-in-Publication Data, 2001.', '42757543-7fdd-42ee-bddd-5c70293e2ef9': '11) Canadian Association of Radiologists – Referral Guidelines https://car.ca/patient-care/referral-guidelines/ Last accessed Feb. 13, 2019.', '627e3917-cc9d-4355-b236-a11cc5382386': 'Most professional imaging associations have created and disseminated scientifically validated, peer-reviewed guidelines that provide assistance in ordering the most appropriate imaging test while avoiding less useful, or non-contributory, tests that could unnecessarily expose the patient to ionizing radiation. These guidelines also will provide information about the relative radiation exposure that can be expected for one examination vs. another.', 'dde178ba-da97-448c-b369-5277c0dd80ae': 'If possible, the use of imaging modalities that do not use ionizing radiation (ultrasound and MRI) should be considered.', '1a1b453c-73a4-4269-aed3-97a05e6abdcb': 'Hence, it is hoped that fewer examinations will be requested and the most useful and appropriate examination will be performed, reducing the use of inappropriate ionizing radiation. Also, if an examination with radiation is required the dose experienced by the patient can be justified with the argument that the most useful, appropriate, diagnostic examination has been utilized limiting the total radiation dose experienced by the patient. (8 – 11)'}"
+Figure 3.23,undergradimage/images/Figure 3.23.jpg,Figure 3.23 Images of CT with HU measurements,"Therefore, if the volume of tissue contained air, or gas, the pixel density allocated would be close to -1,000 HU, while if the volume of tissue analyzed contained metal (bullet fragment, etc.) the pixel would be assigned a density close to the +1,000 HU.  The assignment of pixel density to voxels spans the entire possible range of pixels from -1,000 – +1,000 HU, resulting in 2,000 shades of grey.  An image with the HU measurements of specific anatomic regions is provided in Figure 3.23.","{'9d9da8c6-2e61-47f2-ba4d-6a20496f0d3a': 'All figures in “Chapter 17: Musculoskeletal” by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan are used under a CC-BY-NC-SA 4.0 license.', '42459c0f-ddfe-46c5-b1fd-6793f01031b5': '2) Gaillard, F. Salter-Harris Classification, Radiopaedia.org. https://radiopaedia.org/articles/salter-harris-classification', '99a28b8c-45c1-4a34-b607-d24433ffd59c': '3) Boaz K. Karmazyn, MD; Adina L Alazraki, MD; Sudha A. Anupindi, MD, et al. ACR Appropriateness Criteria® Pediatric – Urinary Tract Infection. Available at https://acsearch.acr.org/docs/69444/Narrative/\xa0 American College of Radiology. Accessed June 30, 2017.', 'ff59e5e9-8d3d-4318-86bd-c8746ebe5e27': '4) Urinary Tract Infection: Clinical Practice Guideline for\n\nthe Diagnosis and Management of the Initial UTI in\n\nFebrile Infants and Children 2 to 24 Months. Pediatrics 2011, 128 (3): 595 – 610.', '95839fcd-3dad-4370-b8c9-efa3ae8fee8d': '5) Dr. Matt Skalski, Ureteric reflux, Radiopaedia.org. “https://radiopaedia.org/\xa0 From the case “https://radiopaedia.org/cases/22569 rID: 22569', '26535aad-e785-402b-9277-4da9563c4525': '6) Molly E. Raske, MD; Molly E. Dempsey, MD; Jonathan R. Dillman, MD, et al. ACR Appropriateness Criteria® Pediatric – Vomiting in Infants Up to 3 Months of Age. Available at https://acsearch.acr.org/docs/69445/Narrative/ American College of Radiology. Accessed June 30, 2017.', '6ec32d8a-c136-48d5-9703-61624050f9f6': '7) Learning\xa0radiology\xa0: recognizing the basics. William Herring author. Elsevier 2016 Online access University of Saskatchewan Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK Accessed, June 30, 2017.', '3db9d0ef-38dd-4332-812d-6af2dfa4db69': '8) Grainger and Allison’s diagnostic\xa0radiology\xa0: a textbook of medical imaging. Andy Adam editor.; Adrian K. Dixon editor.; Jonathan H. Gillard 1964- editor.; Cornelia Schaefer-Prokop editor.; David J Allison; Elsevier (Firm) 2015, Online access University of Saskatchewan Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK\xa0 Accessed June 30, 2017.', '5bf49964-973b-4c4d-88b4-2696683964c1': '2) Radiopaedia.org – https://radiopaedia.org/articles/rockwood-classification-of-acromioclavicular-joint-injury Rockwood classification of AC-Joint injuries. Accessed June 30, 2017.', '59261295-fce8-49b2-a2de-77852eccc04a': '3) Common Forearm Fractures in Adults. American Family Physician 2009: 80 (10): 1096 – 1102.', '2f360c6a-b1f6-4af3-a4c8-e0b8438b9a58': '4) Diagnosis and Management of Scaphoid Fractures.\xa0 American Family Physician 2004; 70 (5); 879 – 884.', 'a5a2c608-b474-4203-bd8a-41a1f1ceb548': '5) Michael A. Bruno, MD; Barbara N. Weissman, MD; Mark J. Kransdorf, MD, et al. 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Accessed June 30, 2017.', '61b9265e-5af7-4d75-833f-a9344ce39570': '9) Ottawa Knee Rule – Stiell IG, Wells GA, Hoag RH, Sivilotti ML, et al (1997). “Implementation of the Ottawa Knee Rule for the use of radiography in acute knee injuries.”. JAMA. 278 (27): 2075–9. PMID\xa09403421. doi:10.1001/jama.1997.03550230051036. Accessed June 30, 2017.', 'd567b915-ef5d-4c0d-8e5b-f533c7036e91': '10) Ottawa Ankle Rule – Stiell IG, McKnight RD, Greenberg GH, et al. (March 1994). “Implementation of the Ottawa ankle rules”. JAMA. 271 (11): 827–32. PMID\xa08114236. doi:10.1001/jama.1994.03510350037034. Accessed June 30, 2017.', '92efbc09-23c1-4b33-b265-50b693fca389': '11) Jon A. Jacobson, MD; Catherine C. Roberts, MD; Jenny T. Bencardino, MD, et al. ACR Appropriateness Criteria®, \xa0MSK – Chronic Extremity Joint Pain Available at https://acsearch.acr.org/docs/3097211/Narrative/ American College of Radiology. Accessed June 30, 2017.', '170f0345-ab5f-45e0-8acd-470a44d17663': '2) Catheter Replacement of the Needle for Arteriography. Seldinger, S. I. Acta Radiologica, 1953: 39 (5); 368 – 376.', 'd55b79a0-51d8-4933-a57a-7d6b6cb5597b': '3) Thomas B. Kinney, MD; Hamed Aryafar, MD; Charles E. Ray, Jr, MD, PhD, et al. ACR Appropriateness Criteria® Management of Inferior Vena Cava Filters. Available at https://acsearch.acr.org/docs/69342/Narrative/ American College of Radiology. Accessed June 30, 2017', 'ba20e351-4219-47c3-b9c5-b61de5ab8fd9': '4) Learning\xa0radiology:recognizing the basics. William Herring author. Elsevier 2016, Online access University of Saskatchewan Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK Accessed, June 30, 2017.', '3fc9b447-cac6-4420-ac4e-05f656e81f43': '5) Grainger and Allison’s diagnostic\xa0radiology\xa0: a textbook of medical imaging. Andy Adam editor.; Adrian K. Dixon editor.; Jonathan H. Gillard 1964- editor.; Cornelia Schaefer-Prokop editor.; David J Allison; Elsevier (Firm) 2015, Online access University of Saskatchewan Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK\xa0 Accessed June 30, 2017.', 'a53e9698-8be5-4b56-ba59-87393e1e60b7': '2) Vahid Yaghmai, MD, MS; Max P. Rosen, MD, MPH; Tasneem Lalani, MD. ACR Appropriateness Criteria® \xa0– Gastrointestinal – Acute (non-localized) Abdominal Pain and Fever – Pneumoperitoneum. Available at\xa0 https://acsearch.acr.org/docs/69467/Narrative/ American College of Radiology. Accessed June 30, 2017.', '23ab0a22-ea4d-4c3f-9d72-f3a49ca4f6fd': '3) Douglas S. Katz, MD; Mark E. Baker, MD; Max P. Rosen, MD, MPH. ACR Appropriateness Criteria® – Gastrointestinal – Suspected Small Bowel Obstruction. Available at https://acsearch.acr.org/docs/69476/Narrative/ American College of Radiology. Accessed June 30, 2017.', 'f3c446dd-aa8d-4d22-aed4-b5e89863cd27': '4) Martin P. Smith, MD; Douglas S. Katz, MD; Max P. Rosen, MD, MPH. ACR Appropriateness Criteria® – Gastrointestinal – Right Lower Quadrant Pain – Suspected Appendicitis. Available at https://acsearch.acr.org/docs/69357/Narrative/ American College of Radiology. Accessed June 30, 2017.', 'e40080ff-07b5-4509-a9d8-3d7ff39b3c19': '5) Michelle M. McNamara, MD; Tasneem Lalani, MD; Marc Anthony Camacho, MD. ACR Appropriateness Criteria® \xa0– Gastrointestinal – Left Lower Quadrant Pain – Suspected Diverticulitis. Available at https://acsearch.acr.org/docs/69356/Narrative/ American College of Radiology. Accessed June 30, 2017.', 'a6f6cc9d-0ee1-42b0-ba1b-410ac9dc0387': '6) Rendon C. Nelson, MD; Ihab R. Kamel, MD, PhD; Mark E. Baker, MD. ACR Appropriateness Criteria® \xa0– Gastrointestinal – Liver Lesion – Initial Characterization. Available at https://acsearch.acr.org/docs/69472/Narrative/ American College of Radiology. Accessed June 30, 2017.', '154ec87b-5220-4418-99a5-75ec9d9fafec': '7) Tasneem Lalani, MD; Corey A. Couto, MD; Max P. Rosen, MD, MPH. ACR Appropriateness Criteria® \xa0– Gastrointestinal – Jaundice. Available at https://acsearch.acr.org/docs/69497/Narrative/ American College of Radiology. Accessed June 30, 2017.', '740ebf07-9cb8-4ed5-9cac-8bb79c578c8d': '2) Jacobo Kirsch, MD; Tan-Lucien H. Mohammed, MD, et al.\xa0 ACR Appropriateness Criteria®, Chest – Acute Respiratory Illness in Immunocompetent Patient. Available at https://acsearch.acr.org/docs/69446/Narrative/ Accessed, June 30, 2017.', '571524ec-b296-4a2d-95dc-97db963c3fcb': '3) Debra Sue Dyer, MD; Tan-Lucien H. Mohammed, MD; Jacobo Kirsch, MD, et al. ACR Appropriateness Criteria®, Chest – Chronic Dyspnea – Suspected Pulmonary Origin. \xa0Available at https://acsearch.acr.org/docs/69448/Narrative/ Accessed June 30, 2017.', 'f22ed822-b387-44e5-8a22-dd8a867b8b01': '4) Learning\xa0radiology\xa0: recognizing the basics. William Herring author. Elsevier 2016 Online access USask Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK Accessed, June 30, 2017.', '87cb046f-4dac-41ec-84d0-bed36b33d265': '5) Jeffrey P. Kanne, MD, Leif E. Jensen, MD, MPH, Tan-Lucien H. Mohammed, MD, et al. ACR Appropriateness Criteria®,\xa0 Chest – Radiographically Detected Solitary Pulmonary Nodule. Available at https://acsearch.acr.org/docs/69455/Narrative/ Accessed June 30, 2017.', '3159e24d-3174-4315-993d-23dd449b06b4': '6) Fleischner Society – https://fleischnersociety.org', 'd07c0b2d-9413-4046-ab1e-55f117865c2a': '7) Michael A. Bettmann, MD, Scott G. Baginski, MD, Richard D. White, MD, et al. ACR Appropriateness Criteria®, Chest – Acute Chest Pain – Suspected Pulmonary Embolism. Available at https://acsearch.acr.org/docs/69404/Narrative/\xa0 Accessed June 30, 2017.', 'cd973045-ca97-4b36-a285-52581f60f304': 'Ultrasound uses traditional probes with higher frequency to better image the breast tissue that is in close proximity to the overlying skin.', '13e1e8e0-e640-4941-8300-c31710b3a53c': 'Mammography/Breast Imaging Centres in Canada are accredited and audited for quality by the Canada Association of Radiologists.', 'eca3d4b9-a2c4-43c7-ae2b-3ec757983d8b': '2) Vilaas S. Shetty, MD; Martin N. Reis, MD; Joseph M. Aulino, MD, et al. ACR Appropriateness Criteria® Head Trauma. Available at https://acsearch.acr.org/docs/69481/Narrative/ American College of Radiology. Accessed, June 30, 2017.', 'a923162d-9460-4587-991e-319c82bf5c9f': 'https://acsearch.acr.org/docs/69481/Narrative/', '96ac01aa-0380-4fa5-be27-55a5b787830c': '3) Michael B. Salmela, MD; Shabnam Mortazavi, MD; Bharathi D. Jagadeesan, MD, ACR, et al. Appropriateness Criteria® Cerebrovascular Disease. https://acsearch.acr.org/docs/69478/Narrative/ American College of Radiology. Accessed, June 30, 2017.', 'b68256b4-9387-4475-8f5a-41b599bfaf04': 'https://acsearch.acr.org/docs/69478/Narrative/', 'd4f105b8-2855-4af9-a3cb-f9d88fcdbf18': '4) Annette C. Douglas, MD; Franz J. Wippold II, MD; Daniel F. Broderick, MD, et al. Appropriateness Criteria® Headache. https://acsearch.acr.org/docs/69482/Narrative/ American College of Radiology. Accessed, June 30, 2017.', '74770c44-e954-4084-abd6-2740860fa07d': 'https://acsearch.acr.org/docs/69482/Narrative/', 'edab0354-1c57-4db0-b1dd-6ea014cb5e00': '5) Nandini D. Patel, MD; Daniel F. Broderick, MD; Judah Burns, MD, et al. Appropriateness Criteria® Low Back Pain. https://acsearch.acr.org/docs/69483/Narrative/ American College of Radiology. Accessed, June 30, 2017.', 'd0966524-e032-4f5a-9faf-1e8f783d8061': 'https://acsearch.acr.org/docs/69483/Narrative/', 'aa597d16-b4a3-404a-889f-e4a901c750d6': '6) Richard H. Daffner, MD; Barbara N. Weissman, MD; Franz J. Wippold II, MD, et al. Appropriateness Criteria®  Suspected Spine Trauma. https://acsearch.acr.org/docs/69359/Narrative/ American College of Radiology. Accessed, June 30, 2017.', '6945685d-8bdd-48ba-9299-88cd95cdcccc': 'https://acsearch.acr.org/docs/69359/Narrative/', 'd6137ceb-35ba-41f9-b5ad-909c0c93c831': 'The standard views are AP (anterior-posterior) and lateral.\xa0 These two views are taken at right angles (orthogonal) to each other.\xa0 If these images are not helpful, ancillary views such as oblique views, or special views such as, an axillary or carpal tunnel view, may be required based upon the clinical scenario.', '8da19a7d-ea8a-48f7-802b-c3e6ad2879ea': 'Stress views i.e. a force is applied to a bone or joint to determine if an injury is present, such as, a subtle avulsion or a suspected tendon or ligament tear causing joint instability. These are acquired as special requests and should be performed in a manner that minimizes patient pain and discomfort.', 'c1ddb6e5-c42b-4c10-ac0d-ed3b6ab5cbad': 'At least one joint space should be visible in relation to the suspected bone injury.\xa0 Additional x-ray views and views of another adjacent joint space may be required in some circumstances.', 'd8ec4a87-ef98-4bd8-9ee3-47f8c6612a49': 'Comparison views to the contralateral, normal bone, or joint, may be required, this is especially true if a subtle growth plate injury is suspected in a child.\xa0 Comparison views should not be ordered routinely, but should be used if clinically necessary.', 'd76a51e5-d391-4400-aa76-b67e2d5a4233': 'It is important to remember that some bone and ligament injuries occur as a common pattern of multiple injuries i.e. the Colle fracture of the distal radius is often associated with an avulsion fracture of the ulnar styloid.\xa0 Ankle ligament injuries and fractures often occur in a sequence i.e. medial malleolar avulsion fracture (or medial ligament tear), interosseous ligament tear between the tibia and fibula, and a subsequent oblique fracture of the proximal fibula (Maisonneuve fracture complex).\xa0 Keep this in mind as you encounter various patients and you will develop knowledge and experience of these associated bone and soft tissue injuries.', 'd26261d6-1894-4731-a4bc-cb382c5fc4b8': 'Fractures usually present as a lucent line on x-rays involving the cortex and medulla of the bone that can be followed from one cortex to the opposite cortex with varying degrees of displacement and malalignment of the involved bone.', '6d3c05b4-f04f-464e-828c-e219309240b2': 'There are some fractures that may be associated with bone ischemia and avascular necrosis i.e. capital femoral fractures and scaphoid fractures.\xa0 Be aware of this and learn the importance of aggressive and pre-emptive management for these patients.', '9efc69ef-d567-4c20-b7da-5b5faae548f8': 'Fig 5.7 Abdomen Quadrants/Regions\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'c17eee8e-a5a7-4b3d-aa39-e9562f679745': 'Fig 5.8\xa0Supine Positioning for Abdomen x-ray, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', 'e428391c-3d1e-4c3d-a0ee-4e39fd82ee4d': 'Fig 5.9 Upright Positioning for Abdomen x-ray, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', '4fe76b20-0ac2-49ac-a875-af27033355ec': 'Fig 5.10 Decubitus Positioning for Abdomen x-ray, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', '1e50fdef-529f-4fe1-b3f4-ab42378ca31f': 'Fig 5.11 Normal Abdominal x-ray by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '27e0addc-368c-4208-9970-6559705ff1e8': 'Fig 5.12 Colon anatomy emphasized by the presence of barium and air by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '990d74a2-1431-4705-8efd-4cf210fa9ce3': 'Fig 5.13 Bones and Musculoskeletal Landmarks in the Abdomen by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '3d050294-a087-4835-a5ed-7961069e1f0a': 'Fig 5.14 Possible Artifacts on Abdomen x-rays. The image demonstrates two umbilical piercings, fallopian tube clips, and the buttons on the patient’s pants by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'cbf4613b-cbd6-4078-b9c3-b1c333a37c48': 'The standard upright views of the chest are made when a patient is typically placed between an x-ray source and an x-ray detector. When the x-rays penetrate the tissues of the patient, they stimulate an x-ray detector that alters the energy of the x-ray beam into a digital pixel grid. The radiograph produced is referred to as a roentgenogram and named after Wilhelm Konrad Roentgen who received the first Nobel Prize for Physics in 1901 for his work in defining the major properties of x-rays and the conditions necessary for their production. It was Roentgen who coined the term “x-ray”.', '9da044bd-e951-4eb4-8cf9-ccb9398a2423': 'Fig 5.1 A portable upright x-ray where the image is not taken with proper body alignment, the patient is rotated and tilted\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '0bc6ae7d-c9c2-4d6d-ae6c-f07a5a647792': 'Fig 5.2 A portable upright x-ray taken with patient in proper alignment\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'e27384e1-63ef-4a65-a138-41a0d8870a95': 'Fig 4.1A Fluoroscopy – Shoulder Arthrogram Early Phase of Injection\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '2f124311-a640-4063-9232-06af6006da7a': 'Fig 4.1B\xa0Shoulder Arthrogram Fluoroscopy Mid-Phase of Injection by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'bb7b38f9-ff02-462d-8d99-621dd444c05e': 'Fig 4.1C Shoulder Arthrogram Late Phase of Injection\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'b6d8041f-18d1-40b8-a5b0-44c6bfeb9405': 'Fig 4.2A\xa0CT Aorta, C-\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'b98a8c21-5a63-4b95-b9ce-f7e38e6999bc': 'Fig 4.2B CT Iliac Arteries, C-\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '43da027d-17e8-4ba4-b312-67fba1bd1511': 'Fig 4.2C CT Aorta, C+\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'b66fdc16-e8ca-433f-8a6e-1d0f3f659bb3': 'Fig 4.2D CT Iliac Arteries, C+\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '8964941e-dc07-44fd-954a-0403c1bfd992': '2) Image Wisely. http://www.imagewisely.org/ Last accessed, Aug. 22, 2017.', 'ed5f284b-a74a-4376-b274-77e0e2303fc9': '3) Image Gently. http://www.imagegently.org/ Last accessed Aug 22, 2017.', 'fc2d1e7a-fa5b-4dbc-917f-25f258eb23d6': '4) Novelline, R. A., & Squire, L. F. (2004), sixth edition. Squire’s fundamentals of radiology. Cambridge, Mass: Harvard University Press.', 'ce057be0-807e-4b88-a477-0d87c59e607b': 'Fig 3.43 Nuclear Medicine Scanner by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'dce81a39-f2bd-47ee-847d-9205bbc446e1': 'Fig 3.44A Normal, Pediatric Nuclear Medicine Bone Scan by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '8bed792d-6442-4cbd-89db-89b5a4cb4541': 'Fig 3.44B Normal, Adult Nuclear Medicine Bone Scan\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '41bf79b1-bfd9-4a16-9b5d-900405a59176': 'Fib 3.45 PET/CT Scanner\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '8fcd15af-34e1-492f-91a7-3b8b671387ed': 'Fig 3.46A PET/CT image of the chest for a patient with lymphoma\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '211a4b55-451b-4858-aa60-ce4253c9d555': 'Fig 3.46B PET image of the whole body for a patient with lymphoma\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '15d4a271-c53b-449d-8385-a1b6030fd923': 'The appearance of different tissue on MR images is described as displaying greater, or lesser, signal in comparison the other anatomy in the region. The signal in question is the energy that the perturbed protons liberated when they fall back into alignment with the magnetic field. The signal intensity of the tissue in question changes based upon the image acquisition parameters set by the MR Technologist, under the direction of a supervising Radiologist.\xa0 The parameters set result in the acquisition of a set of images called an MR imaging sequence. On one sequence cerebrospinal fluid will appear as black pixels (T1 sequence) while on another sequence it is white pixels (T2 sequence). This difference in tissue appearance can be exploited to determine if pathology is present.', '33f25041-480d-4bb9-95fc-0a28bc2224ed': 'Fig 3.31\xa0B-Mode Ultrasound of the Carotid bulb with atherosclerotic plaque\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '18658974-a7a2-499b-881c-5a51baaa9854': 'Fig 3.32A\xa0Ultrasound Machine\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '5c75f45f-6624-42df-b964-dddafeae9d32': 'Fig 3.32B Mobile Ultrasound Machine\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'f351a841-d5dd-4048-8f36-831f0bbf09d9': 'Fig 3.33 Ultrasound image of the normal liver and kidney. The echogenicity of the liver is greater than the echogenicity of the adjacent renal cortex by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '059ddd7b-14ba-4290-92ad-7382c9156fc4': 'Fig 3.34 Gallbladder\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '5db401cc-d0ff-4f03-945a-f50dd89e4be9': 'Fig 3.35A Normal Liver Ultrasound by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'fae31525-31fa-491b-8fcf-6206343abf74': 'Fig 3.35B Hepatomegaly and hepatic steatosis on Ultrasound\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '4aa1ffad-a8df-4cef-8f34-a9695f5958bc': 'Fig 3.36 Colour Doppler, of the neck\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '99b1c66a-6cc2-4a4e-872f-476d28cdab03': 'Fig 3.37 Colour Doppler of the neck with Spectral Display\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '21a2827a-f5ed-4e96-a0d9-b91bdf773c22': 'Fig 3.38A\xa0Internal Carotid Doppler Ultrasound Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '6bf5c327-c3cb-4f8c-b09c-7b96d908326a': 'Fig 3.38B Carotid Bulb Doppler Ultrasound\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '8d123159-7ce7-4972-bc0c-86aa528a32ae': 'Fig 3.38C\xa0Vertebral Doppler Ultrasound\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'b8f04a00-104c-40e3-8e47-1dc899d44ca1': 'Fig 3.39 Linear probe and two curved array probes\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'c15107ec-6f70-4702-929e-61aeee36a137': 'The patient does not need to be moved, or re-positioned, to obtain CT images in different anatomic planes.\xa0 The patient lies on the CT table in anatomic position and remains in that position throughout the study.\xa0 The standard orientation of image acquisition for CT is in the axial plane, hence the old name for this machine of CAT (computed axial tomography) scanner.\xa0 Often the axial images obtained during the initial x-ray exposure will be digitally reformatted into other anatomic planes i.e. sagittal and coronal.\xa0 These reformatted images are the result of a computer algorithm reformatting the original digital image data and, as such, these supplemental anatomic planes of imaging do not require additional x-ray exposure.', '23a6edd0-ea0d-4597-87b7-d94ca733c3a5': 'The CT gantry can be tipped cranially and caudally to deviate from the axial plane by 30 degrees in either direction and this can be used to correct for patient anatomic variability to maintain the axial plane, if necessary.\xa0 It also allows for unique imaging along an angled plane that can be used when requested by the referring physician or the radiologist.\xa0 A widely used example of imaging in an angled plane is found for CT Head examinations. It is not conventional to acquire these images in the axial plane but to image the brain on the canthomeatal (lateral orbit canthus to the aural meatus) line and therefore, the CT gantry must be tilted to ensure that all CT Head images are acquired in this plane.\xa0 Originally, this plane was chosen as it maximizes information about the intra-cranial contents while minimizing the exposure of the orbits (lens) to radiation. The orbito-meatal line has become the internationally recognized plane for acquiring CT head images. This line is depicted in Figure 3.22.', '2a01449e-f80d-44b8-b5f1-9fbd2293de89': 'The physics of CT image creation are complex and require complex computer processing to create images that are visible for clinical use.\xa0 As the x-ray tube and the x-ray detectors revolve around the patient thousands of mathematical calculations are performed to determine how much of the incident x-ray beam was absorbed by a volume of tissue. This volume of tissue is called a voxel. The calculated absorption of the x-rays by a voxel is converted into a pixel density that is displayed on a gray scale from -1,000 (air) to +1,000 (metal).\xa0 This scale is called the Hounsfield unit (HU) scale after one of the principle inventors of CT, Sir Godfrey Hounsfield.\xa0 The calculated density of this voxel is then allocated to a pixel on a grid of the 512 x 512 pixels that forms each individual CT image.', '7630aac5-da71-4093-992f-e3de7e0777cf': 'Therefore, if the volume of tissue contained air, or gas, the pixel density allocated would be close to -1,000 HU, while if the volume of tissue analyzed contained metal (bullet fragment, etc.) the pixel would be assigned a density close to the +1,000 HU.\xa0 The assignment of pixel density to voxels spans the entire possible range of pixels from -1,000 – +1,000 HU, resulting in 2,000 shades of grey.\xa0 An image with the HU measurements of specific anatomic regions is provided in Figure 3.23.', '194d89df-a49e-4ba0-a141-fedb5b7d0e3d': 'CT density: a region on a CT image is described as being more, or less, dense than another region. The liver is more dense than the renal cortex.\xa0 This variation in pixel density can be quantified by measuring all the pixels in a region and creating an average pixel density i.e. region of interest of an area of liver can be measured, with a standard deviation, 50 HU +/- 5 HU, etc. The HU density of some common structures is provided in Table 3.2.', '7fd3f166-8080-4a1e-b564-5aaedace0274': 'Table 3.2 HU Scale', 'bf48f853-55d2-4b0d-a952-97052c04fccc': 'The viewer of the CT can decide how to adjust the level and window of the displayed CT images to accentuate tissues of a defined pixel density. \xa0The level and window are at the discretion of the viewing radiologist and can be set to their preferences. There are a variety of established level and window settings, i.e. abdomen, bone, brain, etc. These help to provide some level of uniformity for comparison of multiple CT examinations. Level and window setting for six common tissues are as follows:', 'b2f1f965-5bd4-4a65-bbcb-a0c74bb6849b': 'Table 3.3 Six common tissue levels and windows', '1c89c10d-2e57-46d5-873c-753aa9d9fd25': 'CT images demonstrating the appearance of these six different level and window settings are provided in Figure 3.24.', '0c5a4d4a-1a8a-45e7-82a1-3975c585d2e6': 'Level and Window are unique physical properties of CT images that allow the user to adjust the centre and the width of the gray scale that is portrayed on the images.\xa0 This is an adjustment that is applied to the raw CT data and does not require repeated patient imaging to obtain the different levels and windows. The level is the centre of the gray scale, set to the HU of the tissue of most interest i.e. the centre (level) of the gray scale for brain window is 35 HU.\xa0 The window is the width of the gray scale that surrounds the level setting, thus defining the range of HU for white and black seen on the image. For the brain images the width of the HU scale is 80 HU. A illustration depicting this for brain and bone level and window setting are provided in Figure 3.25.', '22baea2d-4734-448a-b8d2-ff98cc34c126': 'Fig 3.21\xa0Helical CT Scanner\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '997a9bef-3a49-4a5c-baaa-b5f4e9a60244': 'Fig 3.22 The plane of imaging related to the cantho-meatal line\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'e620fc79-fe54-4e1b-937a-f2f6d1ae88b4': 'Fig 3.23 Images of CT with HU measurements\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '47384920-3878-4fd3-a2cb-6676f1ecd6b4': 'Fig 3.24 CT Images with different level and window settings\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '27c1bf77-b175-46e2-8f3c-8b044f235e7a': 'Fig 3.25A Brain Level and Window\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'ae550a20-25ad-452b-9c36-d593b30cda0b': 'Fig 3.25B Bone Level and Window\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '4c06c22c-a218-43c6-b6d2-8b86614cb44f': 'Fig 3.26A Head CT visible on brain level and window. Bone not well seen by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '09e44bf9-1b1b-4b30-ac75-268a90c19141': 'Fig 3.26B Head CT on bone level and window. Brain not well seen by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'b14da7a2-6e23-4800-9645-0f1ea9841b25': 'Fig 3.27 Standard viewing orientation for an axial CT image\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '1aaea852-a349-4e12-9f42-4e7db0ccde67': 'Fig 3.28A CT image displayed in axial orientation from one radiation exposure event\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'cb4dd03b-6e19-4678-85ec-4798a6b00fe9': 'Fig 3.28B CT image displayed in sagittal orientation from one radiation exposure event\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '06e1bc4e-3c56-472e-b82f-5ca979851270': 'Fig 3.28C CT image displayed in coronal orientation from one radiation exposure event\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '82ba8ff7-a04c-4efb-9328-b4216ab73f8e': 'Fig 3.29A CT of the chest on lung level/window by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '2bb589c6-5d7e-4ca5-9add-0533ae22ad66': 'Fig 3.29B CT of the chest on mediastinal level/window by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '80b61eb5-0c49-4c26-bba6-34a715289fbc': 'Fig 3.30 CT PE image maximizing the injected contrast in the pulmonary arteries\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '7586c4b7-5466-4c34-b19e-28c580057600': 'An angiography machine is essentially a fluoroscopy unit that has the added feature of having the x-ray source and detectors mounted on a c-arm apparatus. The c-arm allows for movement of the source and detector around the patient who lies supine on the angiography table. The operator can acquire images in a wide variety of anatomic projections.\xa0 Therefore, patient movement is not required for this imaging modality. The angiography unit also has advanced software applications that facilitate complex arterial and body interventional procedures beyond the capabilities of a standard fluoroscopy unit. As with fluoroscopy, the images are viewed inverted in comparison to standard radiographs.', '8321eb02-784a-4088-a939-b2f9c46e47ce': 'The x-ray dose for Angiography is controlled by multiple detectors that adjust the radiation exposure to maximize image quality and minimize x-ray exposure. The machine only emits radiation when the operator uses a foot pedal to activate the x-ray tube. The area imaged can be collimated, or coned, to minimize the area exposed to x-rays.\xa0 The anatomy can also be magnified to improved diagnostic capacity.', 'c01d6355-58d2-4339-a8e1-0b13cb0a2a27': 'The images acquired are obtained very rapidly in cine mode resulting in a set of stacked images, that when stored and viewed, simulate a video recording.\xa0 Cine mode allows for the dynamic assessment of moving contrast and movement of catheters and guide wires inside the anatomy of the patient. A standard c-arm angiography unit is depicted in Figure 3.19.', '75c40a34-0496-4f50-853a-4a34b85893f5': 'For angiography, the radio-opaque contrast agent used is injected intra-arterially while x-ray images are acquired.\xa0 This is an invasive process that requires the injection to be performed via a small intra-arterial catheter that administers the contrast in close proximity to the origin of the arterial structure being investigated, i.e. carotid angiography requires an injection of contrast into the selected carotid artery.\xa0 The catheter used is usually manipulated into position using fluoroscopy from a remote arterial access site i.e. the common femoral artery, the radial artery, or the brachial artery.', 'b87262ac-93be-41c5-a829-b396ffcd5495': 'Arterial access relies upon the “Seldinger” technique, using local anesthetic, to insert the intra-arterial catheter used for the procedure. Blood vessels lack internal innervation and therefore, the catheter and guidewire can be manipulated without causing patient pain or discomfort.', 'e2e27594-969f-4065-afca-fc9d4d9d539d': 'This machine can also be used for Interventional Radiology procedures where catheters, guidewires, stents, feeding tubes, etc. are visualized with the c-arm fluoroscopy.\xa0 Water-soluble contrast agents can also be injected during these procedures to depict the anatomy of structures such as, the bile ducts, intestine, renal collecting system, veins, etc.', 'ba4bd9f0-d4d3-4160-998d-e606f08e785b': 'All modern angiography units capture images and present them in subtracted mode.\xa0 The subtraction process is digital using a computer to superimpose a non-contrast enhanced image onto a set of contrast enhanced cine images, resulting in subtracted images that depict only the anatomic structure filled with contrast since the background anatomy has been subtracted away by the digital image modification process. A digital, subtracted, carotid angiogram is depicted in Figure 3.20.', '9507b590-4a7c-43a4-ab86-48655f636346': 'The contrast used for angiography is an iodine based pharmaceutical and is water soluble.\xa0 During angiography, it is injected into the artery of interest and replaces the blood for a very short period of time.\xa0 This contrast agent progresses antegrade in the vascular tree related to the direction of blood flow.\xa0 It quickly clears from the arteries and exits the region via venous drainage.\xa0 The circulating contrast is predominantly excreted by the kidneys into the urine.', '3276ecac-6f99-4922-9d4c-37154b7ae129': 'Fig 3.19 Angiography Machine with C-Arm by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '0d7266b7-752c-4049-b830-7e4dca6ea0db': 'Fig 3.20\xa0Carotid Angiography, Digital Subtraction Cerebral Angiography\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '07ea0f57-4c84-4133-93c0-83121c89f01d': 'An example of a fluoroscopic examination is the esophogram and upper gastrointestinal series.\xa0 The patient is asked to swallow barium sulfate and gas-forming granules.\xa0 The barium can be seen to move with positioning (gravity) and peristalsis as it moves antegrade through the digestive tract while the gas rises to the highest point of the intestinal tract based upon patient positioning. The barium and the gas help to outline the inner lining of the intestine.\xa0 The live fluoroscopic x-rays visualize the motion of the barium and the gas. It is also possible to capture still images and/or cine mode images that are stored in the Picture Archive and Communication System (PACS).', 'bc96ce7d-d729-4227-95fa-225665741a10': 'Cine mode images are still images captured at a rapid rate and can be viewed sequentially, like a video, after being stored in the PACS. Other fluoroscopy aided examinations include arthrography, barium enema, cystourethrogram, sinus tract injections, myelography and hysterosalpingography, to name a few.', '87cf4657-0272-4db3-aa75-969547958014': 'The positioning of the patient is dependent on the physical capabilities of the patient and the exam that is to be performed. For example, when carrying out an esophogram, the best positioning would be an upright (standing) patient and an oblique or lateral view of the anatomy to watch the barium proceeding down the esophagus. Additional oblique and lateral views allow one to visualize abnormalities in multiple planes and to determine if any abnormality of the intestinal mucosa is concealed by swallowed barium on one view. If aspiration of ingested fluid or food into the lungs is clinically suspected the lateral projection allows one to determine if fluids are entering the trachea during swallowing.', 'b74d40ce-5391-4b64-a394-581b4a112089': 'A Fluoroscopy machine is seen in Figure 3.15.', 'bbd4cc27-e511-4d95-a60e-9f436bbc4a41': 'The video in Figure 3.17\xa0depicts live fluoroscopy of the upper esophagus for a patient whose images demonstrate aspiration of the barium into the trachea.', 'dbaf432f-8185-4365-a9d3-beed0ab25975': 'Fluoroscopy images are most often displayed for review inverted in comparison to standard x-ray images.\xa0 Hence, air is white and metal is black.\xa0 They can also be displayed as standard x-rays if this is advantageous for interpretation, see the barium enema images. The principles of absorption and transmission of the x-rays is unchanged, but the images are digitally manipulated to be the inverse of x-rays, much like film negatives in photography. The effect of image inversion for Fluoroscopy images is depicted in Figure 3.18.', '6891ccd4-5787-4995-8269-5f022f52e891': 'Fig 3.3\xa0X-ray Tube by\xa0Kieranmaher is in the Public Domain.', '39c648ca-5e19-4388-a61f-bdd02372eda8': 'Fig 3.4\xa0X-ray Tube. Lead Housing with Portal for x-ray Emission, bench top image by Rschiedon is available under a CC-BY-SA 3.0 Unported License.', '33964476-071d-4239-b632-398ccd10bb4f': 'Fig 3.5\xa0X-ray Image Creation and Display by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'f39c28ae-5cbf-4339-a557-42e3a1322037': 'Fig 3.6A\xa0A standard, fixed location, wall x-ray detector used for upright chest and abdomen x-rays by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'fb953c13-b4fe-4531-a6f1-80bdb7074953': 'Fig 3.6B\xa0A Portable x-ray Machine by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '6e34bafd-8b52-44e0-ad2d-cf1e331df04d': 'Fig 3.6C\xa0The Portable x-ray machine with the x-ray tube extended for use by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'ca28bfcc-132a-4473-a28f-bd495247e213': 'Fig 3.6D\xa0A Portable, Mini, C-Arm x-ray Unit by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '4711a96b-6775-4db5-9866-04674d98a3f6': 'Fig 3.7\xa0Appearance of different entities on x-rays\xa0by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '1258fb9d-5c95-4aae-80d3-54f946489f6b': 'Fig 3.8\xa0Left Shoulder x-ray\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license. Accessible from\xa0https://mistr.usask.ca/odin/?caseID=20160214201450302', '547b4d9c-36c8-45f6-b22d-82adda75b216': 'Fig 3.9\xa0Effect of tissue thickness on x-ray appearance\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '69e45b9a-1ecf-45d7-8796-3255b76aa319': 'Fig 3.10\xa0Common x-ray Test Object, Lucite Plastic Board\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '57b3432c-9730-4d69-9cce-4f4007438233': 'Fig 3.11A Posterior-anterior, upright, chest x-ray positioning, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', '32b6ba4a-63ec-4e10-9990-f380de9fee0d': 'Fig 3.11B Lateral, upright, chest x-ray positioning, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', 'b22e4373-8d85-42d1-a469-1a583e765d15': 'Fig 3.11C Decubitus x-ray positioning, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', '8b26404e-eca4-432c-a4a4-406c267732a6': 'Fig 3.1\xa0PACS Imaging Viewing Station (Workstation) by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC–BY-NC-SA 4.0 license.', '8a1454eb-adb0-43dd-b455-381ef4a0fa33': 'Fig 3.2 Sample MRI Request Form\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC–BY-NC-SA 4.0 license.', '32fc7f20-73b7-4d42-8e8e-a55c8e933865': '2) Sievert. Wikipedia. https://en.wikipedia.org/wiki/Sievert Accessed Sep. 3, 2018', '808e953e-3ced-45ab-8c29-dcb633e825d7': '3) Radiation Safety Review, Jeff Sanderson. Cancer Care Manitoba, 2001. https://www.cancercare.mb.ca/Research/medical-physics/radiaion-protection-services/index.html', '7a5b86bc-d27b-4f09-94d3-eacd0a26d733': '4) ICRP, 2007. ‘The 2007 Recommendations of the International Commission on Radiological Protection’. ICRP Publication 103. Ann. ICRP 37 (2-4).\n\n(see http://www.icrp.org/publication.asp?id=ICRP%20Publication%20103) Last accessed Feb. 12, 2019.', '0e4fd872-fed4-4829-aad6-b29fb5207e16': '5) United States Nuclear Regulatory Commission. https://www.nrc.gov/reading-rm/basic-ref/glossary/alara.html Last accessed February 5, 2019.', '31a16705-8334-4d0b-ba2c-7b3ba4903d3d': '6) Guidelines for Diagnostic Imaging During Pregnancy and Lactation ACOG October 2017 e210; 130(4):e210 – e216.', '61c798cb-9b2c-44a5-a50f-094104e0d923': '7) Image Gently Alliance. https://www.imagegently.org/ Last accessed February 6, 2019.', '95aa939a-bd18-4918-8163-3f0eda02ba68': '8) American College of Radiology. ‘ACR appropriateness criteria.’ Radiology, 2000; 215 (Suppl): 1-1511.', 'b562ff2f-9eea-4eba-9d13-f84bcac6c6d9': '9) ACR Appropriateness Criteria List. https://acsearch.acr.org/list Last accessed Feb. 13, 2019.', '15e3ec31-d27d-49ba-9d6a-a28f7211c03f': '10) The Royal Australian and New Zealand College of Radiologists. Imaging Guidelines. 4th edn. Surrey Hills: National Library of Australia Cataloguing-in-Publication Data, 2001.', '42757543-7fdd-42ee-bddd-5c70293e2ef9': '11) Canadian Association of Radiologists – Referral Guidelines https://car.ca/patient-care/referral-guidelines/ Last accessed Feb. 13, 2019.', '627e3917-cc9d-4355-b236-a11cc5382386': 'Most professional imaging associations have created and disseminated scientifically validated, peer-reviewed guidelines that provide assistance in ordering the most appropriate imaging test while avoiding less useful, or non-contributory, tests that could unnecessarily expose the patient to ionizing radiation. These guidelines also will provide information about the relative radiation exposure that can be expected for one examination vs. another.', 'dde178ba-da97-448c-b369-5277c0dd80ae': 'If possible, the use of imaging modalities that do not use ionizing radiation (ultrasound and MRI) should be considered.', '1a1b453c-73a4-4269-aed3-97a05e6abdcb': 'Hence, it is hoped that fewer examinations will be requested and the most useful and appropriate examination will be performed, reducing the use of inappropriate ionizing radiation. Also, if an examination with radiation is required the dose experienced by the patient can be justified with the argument that the most useful, appropriate, diagnostic examination has been utilized limiting the total radiation dose experienced by the patient. (8 – 11)'}"
+Figure 3.25,undergradimage/images/Figure 3.25.jpg,Figure 3.25A Brain Level and Window,"Level and Window are unique physical properties of CT images that allow the user to adjust the centre and the width of the gray scale that is portrayed on the images.  This is an adjustment that is applied to the raw CT data and does not require repeated patient imaging to obtain the different levels and windows. The level is the centre of the gray scale, set to the HU of the tissue of most interest i.e. the centre (level) of the gray scale for brain window is 35 HU.  The window is the width of the gray scale that surrounds the level setting, thus defining the range of HU for white and black seen on the image. For the brain images the width of the HU scale is 80 HU. A illustration depicting this for brain and bone level and window setting are provided in Figure 3.25.","{'9d9da8c6-2e61-47f2-ba4d-6a20496f0d3a': 'All figures in “Chapter 17: Musculoskeletal” by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan are used under a CC-BY-NC-SA 4.0 license.', '42459c0f-ddfe-46c5-b1fd-6793f01031b5': '2) Gaillard, F. Salter-Harris Classification, Radiopaedia.org. https://radiopaedia.org/articles/salter-harris-classification', '99a28b8c-45c1-4a34-b607-d24433ffd59c': '3) Boaz K. Karmazyn, MD; Adina L Alazraki, MD; Sudha A. Anupindi, MD, et al. ACR Appropriateness Criteria® Pediatric – Urinary Tract Infection. Available at https://acsearch.acr.org/docs/69444/Narrative/\xa0 American College of Radiology. Accessed June 30, 2017.', 'ff59e5e9-8d3d-4318-86bd-c8746ebe5e27': '4) Urinary Tract Infection: Clinical Practice Guideline for\n\nthe Diagnosis and Management of the Initial UTI in\n\nFebrile Infants and Children 2 to 24 Months. Pediatrics 2011, 128 (3): 595 – 610.', '95839fcd-3dad-4370-b8c9-efa3ae8fee8d': '5) Dr. Matt Skalski, Ureteric reflux, Radiopaedia.org. “https://radiopaedia.org/\xa0 From the case “https://radiopaedia.org/cases/22569 rID: 22569', '26535aad-e785-402b-9277-4da9563c4525': '6) Molly E. Raske, MD; Molly E. Dempsey, MD; Jonathan R. Dillman, MD, et al. ACR Appropriateness Criteria® Pediatric – Vomiting in Infants Up to 3 Months of Age. Available at https://acsearch.acr.org/docs/69445/Narrative/ American College of Radiology. Accessed June 30, 2017.', '6ec32d8a-c136-48d5-9703-61624050f9f6': '7) Learning\xa0radiology\xa0: recognizing the basics. William Herring author. Elsevier 2016 Online access University of Saskatchewan Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK Accessed, June 30, 2017.', '3db9d0ef-38dd-4332-812d-6af2dfa4db69': '8) Grainger and Allison’s diagnostic\xa0radiology\xa0: a textbook of medical imaging. Andy Adam editor.; Adrian K. Dixon editor.; Jonathan H. Gillard 1964- editor.; Cornelia Schaefer-Prokop editor.; David J Allison; Elsevier (Firm) 2015, Online access University of Saskatchewan Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK\xa0 Accessed June 30, 2017.', '5bf49964-973b-4c4d-88b4-2696683964c1': '2) Radiopaedia.org – https://radiopaedia.org/articles/rockwood-classification-of-acromioclavicular-joint-injury Rockwood classification of AC-Joint injuries. Accessed June 30, 2017.', '59261295-fce8-49b2-a2de-77852eccc04a': '3) Common Forearm Fractures in Adults. American Family Physician 2009: 80 (10): 1096 – 1102.', '2f360c6a-b1f6-4af3-a4c8-e0b8438b9a58': '4) Diagnosis and Management of Scaphoid Fractures.\xa0 American Family Physician 2004; 70 (5); 879 – 884.', 'a5a2c608-b474-4203-bd8a-41a1f1ceb548': '5) Michael A. Bruno, MD; Barbara N. Weissman, MD; Mark J. Kransdorf, MD, et al. MSK – Hand and Wrist Trauma. \xa0Available at https://acsearch.acr.org/docs/69418/Narrative/ American College of Radiology. Accessed June 30, 2017.', '3548e3f8-9289-4063-8539-de870f48b911': '6) Robert J. Ward, MD, CCD; Barbara N. Weissman, MD; Mark J. Kransdorf, MD., et al. ACR Appropriateness Criteria®, MSK – Acute Hip Pain – Suspected Fracture. \xa0Available at https://acsearch.acr.org/docs/3082587/Narrative/ American College of Radiology. Accessed June 30, 2017.', '59596a80-aaf5-43e7-985e-7b2593951114': '7) Radiopaedia.org – https://radiopaedia.org/articles/femoral-neck-fracture Accessed June 30, 2017.', '469c112e-865a-482d-9b7e-5830232cee0e': '8) Michael J. Tuite, MD; Mark J. Kransdorf, MD; Francesca D. Beaman, MD, et al. ACR Appropriateness Criteria®, MSK – Acute Trauma to the Knee. Available at https://acsearch.acr.org/docs/69419/Narrative/ American College of Radiology. Accessed June 30, 2017.', '61b9265e-5af7-4d75-833f-a9344ce39570': '9) Ottawa Knee Rule – Stiell IG, Wells GA, Hoag RH, Sivilotti ML, et al (1997). “Implementation of the Ottawa Knee Rule for the use of radiography in acute knee injuries.”. JAMA. 278 (27): 2075–9. PMID\xa09403421. doi:10.1001/jama.1997.03550230051036. Accessed June 30, 2017.', 'd567b915-ef5d-4c0d-8e5b-f533c7036e91': '10) Ottawa Ankle Rule – Stiell IG, McKnight RD, Greenberg GH, et al. (March 1994). “Implementation of the Ottawa ankle rules”. JAMA. 271 (11): 827–32. PMID\xa08114236. doi:10.1001/jama.1994.03510350037034. Accessed June 30, 2017.', '92efbc09-23c1-4b33-b265-50b693fca389': '11) Jon A. Jacobson, MD; Catherine C. Roberts, MD; Jenny T. Bencardino, MD, et al. ACR Appropriateness Criteria®, \xa0MSK – Chronic Extremity Joint Pain Available at https://acsearch.acr.org/docs/3097211/Narrative/ American College of Radiology. Accessed June 30, 2017.', '170f0345-ab5f-45e0-8acd-470a44d17663': '2) Catheter Replacement of the Needle for Arteriography. Seldinger, S. I. Acta Radiologica, 1953: 39 (5); 368 – 376.', 'd55b79a0-51d8-4933-a57a-7d6b6cb5597b': '3) Thomas B. Kinney, MD; Hamed Aryafar, MD; Charles E. Ray, Jr, MD, PhD, et al. ACR Appropriateness Criteria® Management of Inferior Vena Cava Filters. Available at https://acsearch.acr.org/docs/69342/Narrative/ American College of Radiology. Accessed June 30, 2017', 'ba20e351-4219-47c3-b9c5-b61de5ab8fd9': '4) Learning\xa0radiology:recognizing the basics. William Herring author. Elsevier 2016, Online access University of Saskatchewan Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK Accessed, June 30, 2017.', '3fc9b447-cac6-4420-ac4e-05f656e81f43': '5) Grainger and Allison’s diagnostic\xa0radiology\xa0: a textbook of medical imaging. Andy Adam editor.; Adrian K. Dixon editor.; Jonathan H. Gillard 1964- editor.; Cornelia Schaefer-Prokop editor.; David J Allison; Elsevier (Firm) 2015, Online access University of Saskatchewan Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK\xa0 Accessed June 30, 2017.', 'a53e9698-8be5-4b56-ba59-87393e1e60b7': '2) Vahid Yaghmai, MD, MS; Max P. Rosen, MD, MPH; Tasneem Lalani, MD. ACR Appropriateness Criteria® \xa0– Gastrointestinal – Acute (non-localized) Abdominal Pain and Fever – Pneumoperitoneum. Available at\xa0 https://acsearch.acr.org/docs/69467/Narrative/ American College of Radiology. Accessed June 30, 2017.', '23ab0a22-ea4d-4c3f-9d72-f3a49ca4f6fd': '3) Douglas S. Katz, MD; Mark E. Baker, MD; Max P. Rosen, MD, MPH. ACR Appropriateness Criteria® – Gastrointestinal – Suspected Small Bowel Obstruction. Available at https://acsearch.acr.org/docs/69476/Narrative/ American College of Radiology. Accessed June 30, 2017.', 'f3c446dd-aa8d-4d22-aed4-b5e89863cd27': '4) Martin P. Smith, MD; Douglas S. Katz, MD; Max P. Rosen, MD, MPH. ACR Appropriateness Criteria® – Gastrointestinal – Right Lower Quadrant Pain – Suspected Appendicitis. Available at https://acsearch.acr.org/docs/69357/Narrative/ American College of Radiology. Accessed June 30, 2017.', 'e40080ff-07b5-4509-a9d8-3d7ff39b3c19': '5) Michelle M. McNamara, MD; Tasneem Lalani, MD; Marc Anthony Camacho, MD. ACR Appropriateness Criteria® \xa0– Gastrointestinal – Left Lower Quadrant Pain – Suspected Diverticulitis. Available at https://acsearch.acr.org/docs/69356/Narrative/ American College of Radiology. Accessed June 30, 2017.', 'a6f6cc9d-0ee1-42b0-ba1b-410ac9dc0387': '6) Rendon C. Nelson, MD; Ihab R. Kamel, MD, PhD; Mark E. Baker, MD. ACR Appropriateness Criteria® \xa0– Gastrointestinal – Liver Lesion – Initial Characterization. Available at https://acsearch.acr.org/docs/69472/Narrative/ American College of Radiology. Accessed June 30, 2017.', '154ec87b-5220-4418-99a5-75ec9d9fafec': '7) Tasneem Lalani, MD; Corey A. Couto, MD; Max P. Rosen, MD, MPH. ACR Appropriateness Criteria® \xa0– Gastrointestinal – Jaundice. Available at https://acsearch.acr.org/docs/69497/Narrative/ American College of Radiology. Accessed June 30, 2017.', '740ebf07-9cb8-4ed5-9cac-8bb79c578c8d': '2) Jacobo Kirsch, MD; Tan-Lucien H. Mohammed, MD, et al.\xa0 ACR Appropriateness Criteria®, Chest – Acute Respiratory Illness in Immunocompetent Patient. Available at https://acsearch.acr.org/docs/69446/Narrative/ Accessed, June 30, 2017.', '571524ec-b296-4a2d-95dc-97db963c3fcb': '3) Debra Sue Dyer, MD; Tan-Lucien H. Mohammed, MD; Jacobo Kirsch, MD, et al. ACR Appropriateness Criteria®, Chest – Chronic Dyspnea – Suspected Pulmonary Origin. \xa0Available at https://acsearch.acr.org/docs/69448/Narrative/ Accessed June 30, 2017.', 'f22ed822-b387-44e5-8a22-dd8a867b8b01': '4) Learning\xa0radiology\xa0: recognizing the basics. William Herring author. Elsevier 2016 Online access USask Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK Accessed, June 30, 2017.', '87cb046f-4dac-41ec-84d0-bed36b33d265': '5) Jeffrey P. Kanne, MD, Leif E. Jensen, MD, MPH, Tan-Lucien H. Mohammed, MD, et al. ACR Appropriateness Criteria®,\xa0 Chest – Radiographically Detected Solitary Pulmonary Nodule. Available at https://acsearch.acr.org/docs/69455/Narrative/ Accessed June 30, 2017.', '3159e24d-3174-4315-993d-23dd449b06b4': '6) Fleischner Society – https://fleischnersociety.org', 'd07c0b2d-9413-4046-ab1e-55f117865c2a': '7) Michael A. Bettmann, MD, Scott G. Baginski, MD, Richard D. White, MD, et al. ACR Appropriateness Criteria®, Chest – Acute Chest Pain – Suspected Pulmonary Embolism. Available at https://acsearch.acr.org/docs/69404/Narrative/\xa0 Accessed June 30, 2017.', 'cd973045-ca97-4b36-a285-52581f60f304': 'Ultrasound uses traditional probes with higher frequency to better image the breast tissue that is in close proximity to the overlying skin.', '13e1e8e0-e640-4941-8300-c31710b3a53c': 'Mammography/Breast Imaging Centres in Canada are accredited and audited for quality by the Canada Association of Radiologists.', 'eca3d4b9-a2c4-43c7-ae2b-3ec757983d8b': '2) Vilaas S. Shetty, MD; Martin N. Reis, MD; Joseph M. Aulino, MD, et al. ACR Appropriateness Criteria® Head Trauma. Available at https://acsearch.acr.org/docs/69481/Narrative/ American College of Radiology. Accessed, June 30, 2017.', 'a923162d-9460-4587-991e-319c82bf5c9f': 'https://acsearch.acr.org/docs/69481/Narrative/', '96ac01aa-0380-4fa5-be27-55a5b787830c': '3) Michael B. Salmela, MD; Shabnam Mortazavi, MD; Bharathi D. Jagadeesan, MD, ACR, et al. Appropriateness Criteria® Cerebrovascular Disease. https://acsearch.acr.org/docs/69478/Narrative/ American College of Radiology. Accessed, June 30, 2017.', 'b68256b4-9387-4475-8f5a-41b599bfaf04': 'https://acsearch.acr.org/docs/69478/Narrative/', 'd4f105b8-2855-4af9-a3cb-f9d88fcdbf18': '4) Annette C. Douglas, MD; Franz J. Wippold II, MD; Daniel F. Broderick, MD, et al. Appropriateness Criteria® Headache. https://acsearch.acr.org/docs/69482/Narrative/ American College of Radiology. Accessed, June 30, 2017.', '74770c44-e954-4084-abd6-2740860fa07d': 'https://acsearch.acr.org/docs/69482/Narrative/', 'edab0354-1c57-4db0-b1dd-6ea014cb5e00': '5) Nandini D. Patel, MD; Daniel F. Broderick, MD; Judah Burns, MD, et al. Appropriateness Criteria® Low Back Pain. https://acsearch.acr.org/docs/69483/Narrative/ American College of Radiology. Accessed, June 30, 2017.', 'd0966524-e032-4f5a-9faf-1e8f783d8061': 'https://acsearch.acr.org/docs/69483/Narrative/', 'aa597d16-b4a3-404a-889f-e4a901c750d6': '6) Richard H. Daffner, MD; Barbara N. Weissman, MD; Franz J. Wippold II, MD, et al. Appropriateness Criteria®  Suspected Spine Trauma. https://acsearch.acr.org/docs/69359/Narrative/ American College of Radiology. Accessed, June 30, 2017.', '6945685d-8bdd-48ba-9299-88cd95cdcccc': 'https://acsearch.acr.org/docs/69359/Narrative/', 'd6137ceb-35ba-41f9-b5ad-909c0c93c831': 'The standard views are AP (anterior-posterior) and lateral.\xa0 These two views are taken at right angles (orthogonal) to each other.\xa0 If these images are not helpful, ancillary views such as oblique views, or special views such as, an axillary or carpal tunnel view, may be required based upon the clinical scenario.', '8da19a7d-ea8a-48f7-802b-c3e6ad2879ea': 'Stress views i.e. a force is applied to a bone or joint to determine if an injury is present, such as, a subtle avulsion or a suspected tendon or ligament tear causing joint instability. These are acquired as special requests and should be performed in a manner that minimizes patient pain and discomfort.', 'c1ddb6e5-c42b-4c10-ac0d-ed3b6ab5cbad': 'At least one joint space should be visible in relation to the suspected bone injury.\xa0 Additional x-ray views and views of another adjacent joint space may be required in some circumstances.', 'd8ec4a87-ef98-4bd8-9ee3-47f8c6612a49': 'Comparison views to the contralateral, normal bone, or joint, may be required, this is especially true if a subtle growth plate injury is suspected in a child.\xa0 Comparison views should not be ordered routinely, but should be used if clinically necessary.', 'd76a51e5-d391-4400-aa76-b67e2d5a4233': 'It is important to remember that some bone and ligament injuries occur as a common pattern of multiple injuries i.e. the Colle fracture of the distal radius is often associated with an avulsion fracture of the ulnar styloid.\xa0 Ankle ligament injuries and fractures often occur in a sequence i.e. medial malleolar avulsion fracture (or medial ligament tear), interosseous ligament tear between the tibia and fibula, and a subsequent oblique fracture of the proximal fibula (Maisonneuve fracture complex).\xa0 Keep this in mind as you encounter various patients and you will develop knowledge and experience of these associated bone and soft tissue injuries.', 'd26261d6-1894-4731-a4bc-cb382c5fc4b8': 'Fractures usually present as a lucent line on x-rays involving the cortex and medulla of the bone that can be followed from one cortex to the opposite cortex with varying degrees of displacement and malalignment of the involved bone.', '6d3c05b4-f04f-464e-828c-e219309240b2': 'There are some fractures that may be associated with bone ischemia and avascular necrosis i.e. capital femoral fractures and scaphoid fractures.\xa0 Be aware of this and learn the importance of aggressive and pre-emptive management for these patients.', '9efc69ef-d567-4c20-b7da-5b5faae548f8': 'Fig 5.7 Abdomen Quadrants/Regions\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'c17eee8e-a5a7-4b3d-aa39-e9562f679745': 'Fig 5.8\xa0Supine Positioning for Abdomen x-ray, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', 'e428391c-3d1e-4c3d-a0ee-4e39fd82ee4d': 'Fig 5.9 Upright Positioning for Abdomen x-ray, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', '4fe76b20-0ac2-49ac-a875-af27033355ec': 'Fig 5.10 Decubitus Positioning for Abdomen x-ray, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', '1e50fdef-529f-4fe1-b3f4-ab42378ca31f': 'Fig 5.11 Normal Abdominal x-ray by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '27e0addc-368c-4208-9970-6559705ff1e8': 'Fig 5.12 Colon anatomy emphasized by the presence of barium and air by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '990d74a2-1431-4705-8efd-4cf210fa9ce3': 'Fig 5.13 Bones and Musculoskeletal Landmarks in the Abdomen by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '3d050294-a087-4835-a5ed-7961069e1f0a': 'Fig 5.14 Possible Artifacts on Abdomen x-rays. The image demonstrates two umbilical piercings, fallopian tube clips, and the buttons on the patient’s pants by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'cbf4613b-cbd6-4078-b9c3-b1c333a37c48': 'The standard upright views of the chest are made when a patient is typically placed between an x-ray source and an x-ray detector. When the x-rays penetrate the tissues of the patient, they stimulate an x-ray detector that alters the energy of the x-ray beam into a digital pixel grid. The radiograph produced is referred to as a roentgenogram and named after Wilhelm Konrad Roentgen who received the first Nobel Prize for Physics in 1901 for his work in defining the major properties of x-rays and the conditions necessary for their production. It was Roentgen who coined the term “x-ray”.', '9da044bd-e951-4eb4-8cf9-ccb9398a2423': 'Fig 5.1 A portable upright x-ray where the image is not taken with proper body alignment, the patient is rotated and tilted\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '0bc6ae7d-c9c2-4d6d-ae6c-f07a5a647792': 'Fig 5.2 A portable upright x-ray taken with patient in proper alignment\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'e27384e1-63ef-4a65-a138-41a0d8870a95': 'Fig 4.1A Fluoroscopy – Shoulder Arthrogram Early Phase of Injection\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '2f124311-a640-4063-9232-06af6006da7a': 'Fig 4.1B\xa0Shoulder Arthrogram Fluoroscopy Mid-Phase of Injection by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'bb7b38f9-ff02-462d-8d99-621dd444c05e': 'Fig 4.1C Shoulder Arthrogram Late Phase of Injection\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'b6d8041f-18d1-40b8-a5b0-44c6bfeb9405': 'Fig 4.2A\xa0CT Aorta, C-\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'b98a8c21-5a63-4b95-b9ce-f7e38e6999bc': 'Fig 4.2B CT Iliac Arteries, C-\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '43da027d-17e8-4ba4-b312-67fba1bd1511': 'Fig 4.2C CT Aorta, C+\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'b66fdc16-e8ca-433f-8a6e-1d0f3f659bb3': 'Fig 4.2D CT Iliac Arteries, C+\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '8964941e-dc07-44fd-954a-0403c1bfd992': '2) Image Wisely. http://www.imagewisely.org/ Last accessed, Aug. 22, 2017.', 'ed5f284b-a74a-4376-b274-77e0e2303fc9': '3) Image Gently. http://www.imagegently.org/ Last accessed Aug 22, 2017.', 'fc2d1e7a-fa5b-4dbc-917f-25f258eb23d6': '4) Novelline, R. A., & Squire, L. F. (2004), sixth edition. Squire’s fundamentals of radiology. Cambridge, Mass: Harvard University Press.', 'ce057be0-807e-4b88-a477-0d87c59e607b': 'Fig 3.43 Nuclear Medicine Scanner by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'dce81a39-f2bd-47ee-847d-9205bbc446e1': 'Fig 3.44A Normal, Pediatric Nuclear Medicine Bone Scan by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '8bed792d-6442-4cbd-89db-89b5a4cb4541': 'Fig 3.44B Normal, Adult Nuclear Medicine Bone Scan\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '41bf79b1-bfd9-4a16-9b5d-900405a59176': 'Fib 3.45 PET/CT Scanner\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '8fcd15af-34e1-492f-91a7-3b8b671387ed': 'Fig 3.46A PET/CT image of the chest for a patient with lymphoma\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '211a4b55-451b-4858-aa60-ce4253c9d555': 'Fig 3.46B PET image of the whole body for a patient with lymphoma\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '15d4a271-c53b-449d-8385-a1b6030fd923': 'The appearance of different tissue on MR images is described as displaying greater, or lesser, signal in comparison the other anatomy in the region. The signal in question is the energy that the perturbed protons liberated when they fall back into alignment with the magnetic field. The signal intensity of the tissue in question changes based upon the image acquisition parameters set by the MR Technologist, under the direction of a supervising Radiologist.\xa0 The parameters set result in the acquisition of a set of images called an MR imaging sequence. On one sequence cerebrospinal fluid will appear as black pixels (T1 sequence) while on another sequence it is white pixels (T2 sequence). This difference in tissue appearance can be exploited to determine if pathology is present.', '33f25041-480d-4bb9-95fc-0a28bc2224ed': 'Fig 3.31\xa0B-Mode Ultrasound of the Carotid bulb with atherosclerotic plaque\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '18658974-a7a2-499b-881c-5a51baaa9854': 'Fig 3.32A\xa0Ultrasound Machine\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '5c75f45f-6624-42df-b964-dddafeae9d32': 'Fig 3.32B Mobile Ultrasound Machine\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'f351a841-d5dd-4048-8f36-831f0bbf09d9': 'Fig 3.33 Ultrasound image of the normal liver and kidney. The echogenicity of the liver is greater than the echogenicity of the adjacent renal cortex by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '059ddd7b-14ba-4290-92ad-7382c9156fc4': 'Fig 3.34 Gallbladder\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '5db401cc-d0ff-4f03-945a-f50dd89e4be9': 'Fig 3.35A Normal Liver Ultrasound by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'fae31525-31fa-491b-8fcf-6206343abf74': 'Fig 3.35B Hepatomegaly and hepatic steatosis on Ultrasound\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '4aa1ffad-a8df-4cef-8f34-a9695f5958bc': 'Fig 3.36 Colour Doppler, of the neck\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '99b1c66a-6cc2-4a4e-872f-476d28cdab03': 'Fig 3.37 Colour Doppler of the neck with Spectral Display\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '21a2827a-f5ed-4e96-a0d9-b91bdf773c22': 'Fig 3.38A\xa0Internal Carotid Doppler Ultrasound Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '6bf5c327-c3cb-4f8c-b09c-7b96d908326a': 'Fig 3.38B Carotid Bulb Doppler Ultrasound\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '8d123159-7ce7-4972-bc0c-86aa528a32ae': 'Fig 3.38C\xa0Vertebral Doppler Ultrasound\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'b8f04a00-104c-40e3-8e47-1dc899d44ca1': 'Fig 3.39 Linear probe and two curved array probes\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'c15107ec-6f70-4702-929e-61aeee36a137': 'The patient does not need to be moved, or re-positioned, to obtain CT images in different anatomic planes.\xa0 The patient lies on the CT table in anatomic position and remains in that position throughout the study.\xa0 The standard orientation of image acquisition for CT is in the axial plane, hence the old name for this machine of CAT (computed axial tomography) scanner.\xa0 Often the axial images obtained during the initial x-ray exposure will be digitally reformatted into other anatomic planes i.e. sagittal and coronal.\xa0 These reformatted images are the result of a computer algorithm reformatting the original digital image data and, as such, these supplemental anatomic planes of imaging do not require additional x-ray exposure.', '23a6edd0-ea0d-4597-87b7-d94ca733c3a5': 'The CT gantry can be tipped cranially and caudally to deviate from the axial plane by 30 degrees in either direction and this can be used to correct for patient anatomic variability to maintain the axial plane, if necessary.\xa0 It also allows for unique imaging along an angled plane that can be used when requested by the referring physician or the radiologist.\xa0 A widely used example of imaging in an angled plane is found for CT Head examinations. It is not conventional to acquire these images in the axial plane but to image the brain on the canthomeatal (lateral orbit canthus to the aural meatus) line and therefore, the CT gantry must be tilted to ensure that all CT Head images are acquired in this plane.\xa0 Originally, this plane was chosen as it maximizes information about the intra-cranial contents while minimizing the exposure of the orbits (lens) to radiation. The orbito-meatal line has become the internationally recognized plane for acquiring CT head images. This line is depicted in Figure 3.22.', '2a01449e-f80d-44b8-b5f1-9fbd2293de89': 'The physics of CT image creation are complex and require complex computer processing to create images that are visible for clinical use.\xa0 As the x-ray tube and the x-ray detectors revolve around the patient thousands of mathematical calculations are performed to determine how much of the incident x-ray beam was absorbed by a volume of tissue. This volume of tissue is called a voxel. The calculated absorption of the x-rays by a voxel is converted into a pixel density that is displayed on a gray scale from -1,000 (air) to +1,000 (metal).\xa0 This scale is called the Hounsfield unit (HU) scale after one of the principle inventors of CT, Sir Godfrey Hounsfield.\xa0 The calculated density of this voxel is then allocated to a pixel on a grid of the 512 x 512 pixels that forms each individual CT image.', '7630aac5-da71-4093-992f-e3de7e0777cf': 'Therefore, if the volume of tissue contained air, or gas, the pixel density allocated would be close to -1,000 HU, while if the volume of tissue analyzed contained metal (bullet fragment, etc.) the pixel would be assigned a density close to the +1,000 HU.\xa0 The assignment of pixel density to voxels spans the entire possible range of pixels from -1,000 – +1,000 HU, resulting in 2,000 shades of grey.\xa0 An image with the HU measurements of specific anatomic regions is provided in Figure 3.23.', '194d89df-a49e-4ba0-a141-fedb5b7d0e3d': 'CT density: a region on a CT image is described as being more, or less, dense than another region. The liver is more dense than the renal cortex.\xa0 This variation in pixel density can be quantified by measuring all the pixels in a region and creating an average pixel density i.e. region of interest of an area of liver can be measured, with a standard deviation, 50 HU +/- 5 HU, etc. The HU density of some common structures is provided in Table 3.2.', '7fd3f166-8080-4a1e-b564-5aaedace0274': 'Table 3.2 HU Scale', 'bf48f853-55d2-4b0d-a952-97052c04fccc': 'The viewer of the CT can decide how to adjust the level and window of the displayed CT images to accentuate tissues of a defined pixel density. \xa0The level and window are at the discretion of the viewing radiologist and can be set to their preferences. There are a variety of established level and window settings, i.e. abdomen, bone, brain, etc. These help to provide some level of uniformity for comparison of multiple CT examinations. Level and window setting for six common tissues are as follows:', 'b2f1f965-5bd4-4a65-bbcb-a0c74bb6849b': 'Table 3.3 Six common tissue levels and windows', '1c89c10d-2e57-46d5-873c-753aa9d9fd25': 'CT images demonstrating the appearance of these six different level and window settings are provided in Figure 3.24.', '0c5a4d4a-1a8a-45e7-82a1-3975c585d2e6': 'Level and Window are unique physical properties of CT images that allow the user to adjust the centre and the width of the gray scale that is portrayed on the images.\xa0 This is an adjustment that is applied to the raw CT data and does not require repeated patient imaging to obtain the different levels and windows. The level is the centre of the gray scale, set to the HU of the tissue of most interest i.e. the centre (level) of the gray scale for brain window is 35 HU.\xa0 The window is the width of the gray scale that surrounds the level setting, thus defining the range of HU for white and black seen on the image. For the brain images the width of the HU scale is 80 HU. A illustration depicting this for brain and bone level and window setting are provided in Figure 3.25.', '22baea2d-4734-448a-b8d2-ff98cc34c126': 'Fig 3.21\xa0Helical CT Scanner\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '997a9bef-3a49-4a5c-baaa-b5f4e9a60244': 'Fig 3.22 The plane of imaging related to the cantho-meatal line\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'e620fc79-fe54-4e1b-937a-f2f6d1ae88b4': 'Fig 3.23 Images of CT with HU measurements\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '47384920-3878-4fd3-a2cb-6676f1ecd6b4': 'Fig 3.24 CT Images with different level and window settings\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '27c1bf77-b175-46e2-8f3c-8b044f235e7a': 'Fig 3.25A Brain Level and Window\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'ae550a20-25ad-452b-9c36-d593b30cda0b': 'Fig 3.25B Bone Level and Window\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '4c06c22c-a218-43c6-b6d2-8b86614cb44f': 'Fig 3.26A Head CT visible on brain level and window. Bone not well seen by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '09e44bf9-1b1b-4b30-ac75-268a90c19141': 'Fig 3.26B Head CT on bone level and window. Brain not well seen by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'b14da7a2-6e23-4800-9645-0f1ea9841b25': 'Fig 3.27 Standard viewing orientation for an axial CT image\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '1aaea852-a349-4e12-9f42-4e7db0ccde67': 'Fig 3.28A CT image displayed in axial orientation from one radiation exposure event\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'cb4dd03b-6e19-4678-85ec-4798a6b00fe9': 'Fig 3.28B CT image displayed in sagittal orientation from one radiation exposure event\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '06e1bc4e-3c56-472e-b82f-5ca979851270': 'Fig 3.28C CT image displayed in coronal orientation from one radiation exposure event\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '82ba8ff7-a04c-4efb-9328-b4216ab73f8e': 'Fig 3.29A CT of the chest on lung level/window by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '2bb589c6-5d7e-4ca5-9add-0533ae22ad66': 'Fig 3.29B CT of the chest on mediastinal level/window by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '80b61eb5-0c49-4c26-bba6-34a715289fbc': 'Fig 3.30 CT PE image maximizing the injected contrast in the pulmonary arteries\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '7586c4b7-5466-4c34-b19e-28c580057600': 'An angiography machine is essentially a fluoroscopy unit that has the added feature of having the x-ray source and detectors mounted on a c-arm apparatus. The c-arm allows for movement of the source and detector around the patient who lies supine on the angiography table. The operator can acquire images in a wide variety of anatomic projections.\xa0 Therefore, patient movement is not required for this imaging modality. The angiography unit also has advanced software applications that facilitate complex arterial and body interventional procedures beyond the capabilities of a standard fluoroscopy unit. As with fluoroscopy, the images are viewed inverted in comparison to standard radiographs.', '8321eb02-784a-4088-a939-b2f9c46e47ce': 'The x-ray dose for Angiography is controlled by multiple detectors that adjust the radiation exposure to maximize image quality and minimize x-ray exposure. The machine only emits radiation when the operator uses a foot pedal to activate the x-ray tube. The area imaged can be collimated, or coned, to minimize the area exposed to x-rays.\xa0 The anatomy can also be magnified to improved diagnostic capacity.', 'c01d6355-58d2-4339-a8e1-0b13cb0a2a27': 'The images acquired are obtained very rapidly in cine mode resulting in a set of stacked images, that when stored and viewed, simulate a video recording.\xa0 Cine mode allows for the dynamic assessment of moving contrast and movement of catheters and guide wires inside the anatomy of the patient. A standard c-arm angiography unit is depicted in Figure 3.19.', '75c40a34-0496-4f50-853a-4a34b85893f5': 'For angiography, the radio-opaque contrast agent used is injected intra-arterially while x-ray images are acquired.\xa0 This is an invasive process that requires the injection to be performed via a small intra-arterial catheter that administers the contrast in close proximity to the origin of the arterial structure being investigated, i.e. carotid angiography requires an injection of contrast into the selected carotid artery.\xa0 The catheter used is usually manipulated into position using fluoroscopy from a remote arterial access site i.e. the common femoral artery, the radial artery, or the brachial artery.', 'b87262ac-93be-41c5-a829-b396ffcd5495': 'Arterial access relies upon the “Seldinger” technique, using local anesthetic, to insert the intra-arterial catheter used for the procedure. Blood vessels lack internal innervation and therefore, the catheter and guidewire can be manipulated without causing patient pain or discomfort.', 'e2e27594-969f-4065-afca-fc9d4d9d539d': 'This machine can also be used for Interventional Radiology procedures where catheters, guidewires, stents, feeding tubes, etc. are visualized with the c-arm fluoroscopy.\xa0 Water-soluble contrast agents can also be injected during these procedures to depict the anatomy of structures such as, the bile ducts, intestine, renal collecting system, veins, etc.', 'ba4bd9f0-d4d3-4160-998d-e606f08e785b': 'All modern angiography units capture images and present them in subtracted mode.\xa0 The subtraction process is digital using a computer to superimpose a non-contrast enhanced image onto a set of contrast enhanced cine images, resulting in subtracted images that depict only the anatomic structure filled with contrast since the background anatomy has been subtracted away by the digital image modification process. A digital, subtracted, carotid angiogram is depicted in Figure 3.20.', '9507b590-4a7c-43a4-ab86-48655f636346': 'The contrast used for angiography is an iodine based pharmaceutical and is water soluble.\xa0 During angiography, it is injected into the artery of interest and replaces the blood for a very short period of time.\xa0 This contrast agent progresses antegrade in the vascular tree related to the direction of blood flow.\xa0 It quickly clears from the arteries and exits the region via venous drainage.\xa0 The circulating contrast is predominantly excreted by the kidneys into the urine.', '3276ecac-6f99-4922-9d4c-37154b7ae129': 'Fig 3.19 Angiography Machine with C-Arm by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '0d7266b7-752c-4049-b830-7e4dca6ea0db': 'Fig 3.20\xa0Carotid Angiography, Digital Subtraction Cerebral Angiography\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '07ea0f57-4c84-4133-93c0-83121c89f01d': 'An example of a fluoroscopic examination is the esophogram and upper gastrointestinal series.\xa0 The patient is asked to swallow barium sulfate and gas-forming granules.\xa0 The barium can be seen to move with positioning (gravity) and peristalsis as it moves antegrade through the digestive tract while the gas rises to the highest point of the intestinal tract based upon patient positioning. The barium and the gas help to outline the inner lining of the intestine.\xa0 The live fluoroscopic x-rays visualize the motion of the barium and the gas. It is also possible to capture still images and/or cine mode images that are stored in the Picture Archive and Communication System (PACS).', 'bc96ce7d-d729-4227-95fa-225665741a10': 'Cine mode images are still images captured at a rapid rate and can be viewed sequentially, like a video, after being stored in the PACS. Other fluoroscopy aided examinations include arthrography, barium enema, cystourethrogram, sinus tract injections, myelography and hysterosalpingography, to name a few.', '87cf4657-0272-4db3-aa75-969547958014': 'The positioning of the patient is dependent on the physical capabilities of the patient and the exam that is to be performed. For example, when carrying out an esophogram, the best positioning would be an upright (standing) patient and an oblique or lateral view of the anatomy to watch the barium proceeding down the esophagus. Additional oblique and lateral views allow one to visualize abnormalities in multiple planes and to determine if any abnormality of the intestinal mucosa is concealed by swallowed barium on one view. If aspiration of ingested fluid or food into the lungs is clinically suspected the lateral projection allows one to determine if fluids are entering the trachea during swallowing.', 'b74d40ce-5391-4b64-a394-581b4a112089': 'A Fluoroscopy machine is seen in Figure 3.15.', 'bbd4cc27-e511-4d95-a60e-9f436bbc4a41': 'The video in Figure 3.17\xa0depicts live fluoroscopy of the upper esophagus for a patient whose images demonstrate aspiration of the barium into the trachea.', 'dbaf432f-8185-4365-a9d3-beed0ab25975': 'Fluoroscopy images are most often displayed for review inverted in comparison to standard x-ray images.\xa0 Hence, air is white and metal is black.\xa0 They can also be displayed as standard x-rays if this is advantageous for interpretation, see the barium enema images. The principles of absorption and transmission of the x-rays is unchanged, but the images are digitally manipulated to be the inverse of x-rays, much like film negatives in photography. The effect of image inversion for Fluoroscopy images is depicted in Figure 3.18.', '6891ccd4-5787-4995-8269-5f022f52e891': 'Fig 3.3\xa0X-ray Tube by\xa0Kieranmaher is in the Public Domain.', '39c648ca-5e19-4388-a61f-bdd02372eda8': 'Fig 3.4\xa0X-ray Tube. Lead Housing with Portal for x-ray Emission, bench top image by Rschiedon is available under a CC-BY-SA 3.0 Unported License.', '33964476-071d-4239-b632-398ccd10bb4f': 'Fig 3.5\xa0X-ray Image Creation and Display by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'f39c28ae-5cbf-4339-a557-42e3a1322037': 'Fig 3.6A\xa0A standard, fixed location, wall x-ray detector used for upright chest and abdomen x-rays by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'fb953c13-b4fe-4531-a6f1-80bdb7074953': 'Fig 3.6B\xa0A Portable x-ray Machine by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '6e34bafd-8b52-44e0-ad2d-cf1e331df04d': 'Fig 3.6C\xa0The Portable x-ray machine with the x-ray tube extended for use by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'ca28bfcc-132a-4473-a28f-bd495247e213': 'Fig 3.6D\xa0A Portable, Mini, C-Arm x-ray Unit by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '4711a96b-6775-4db5-9866-04674d98a3f6': 'Fig 3.7\xa0Appearance of different entities on x-rays\xa0by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '1258fb9d-5c95-4aae-80d3-54f946489f6b': 'Fig 3.8\xa0Left Shoulder x-ray\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license. Accessible from\xa0https://mistr.usask.ca/odin/?caseID=20160214201450302', '547b4d9c-36c8-45f6-b22d-82adda75b216': 'Fig 3.9\xa0Effect of tissue thickness on x-ray appearance\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '69e45b9a-1ecf-45d7-8796-3255b76aa319': 'Fig 3.10\xa0Common x-ray Test Object, Lucite Plastic Board\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '57b3432c-9730-4d69-9cce-4f4007438233': 'Fig 3.11A Posterior-anterior, upright, chest x-ray positioning, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', '32b6ba4a-63ec-4e10-9990-f380de9fee0d': 'Fig 3.11B Lateral, upright, chest x-ray positioning, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', 'b22e4373-8d85-42d1-a469-1a583e765d15': 'Fig 3.11C Decubitus x-ray positioning, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', '8b26404e-eca4-432c-a4a4-406c267732a6': 'Fig 3.1\xa0PACS Imaging Viewing Station (Workstation) by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC–BY-NC-SA 4.0 license.', '8a1454eb-adb0-43dd-b455-381ef4a0fa33': 'Fig 3.2 Sample MRI Request Form\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC–BY-NC-SA 4.0 license.', '32fc7f20-73b7-4d42-8e8e-a55c8e933865': '2) Sievert. Wikipedia. https://en.wikipedia.org/wiki/Sievert Accessed Sep. 3, 2018', '808e953e-3ced-45ab-8c29-dcb633e825d7': '3) Radiation Safety Review, Jeff Sanderson. Cancer Care Manitoba, 2001. https://www.cancercare.mb.ca/Research/medical-physics/radiaion-protection-services/index.html', '7a5b86bc-d27b-4f09-94d3-eacd0a26d733': '4) ICRP, 2007. ‘The 2007 Recommendations of the International Commission on Radiological Protection’. ICRP Publication 103. Ann. ICRP 37 (2-4).\n\n(see http://www.icrp.org/publication.asp?id=ICRP%20Publication%20103) Last accessed Feb. 12, 2019.', '0e4fd872-fed4-4829-aad6-b29fb5207e16': '5) United States Nuclear Regulatory Commission. https://www.nrc.gov/reading-rm/basic-ref/glossary/alara.html Last accessed February 5, 2019.', '31a16705-8334-4d0b-ba2c-7b3ba4903d3d': '6) Guidelines for Diagnostic Imaging During Pregnancy and Lactation ACOG October 2017 e210; 130(4):e210 – e216.', '61c798cb-9b2c-44a5-a50f-094104e0d923': '7) Image Gently Alliance. https://www.imagegently.org/ Last accessed February 6, 2019.', '95aa939a-bd18-4918-8163-3f0eda02ba68': '8) American College of Radiology. ‘ACR appropriateness criteria.’ Radiology, 2000; 215 (Suppl): 1-1511.', 'b562ff2f-9eea-4eba-9d13-f84bcac6c6d9': '9) ACR Appropriateness Criteria List. https://acsearch.acr.org/list Last accessed Feb. 13, 2019.', '15e3ec31-d27d-49ba-9d6a-a28f7211c03f': '10) The Royal Australian and New Zealand College of Radiologists. Imaging Guidelines. 4th edn. Surrey Hills: National Library of Australia Cataloguing-in-Publication Data, 2001.', '42757543-7fdd-42ee-bddd-5c70293e2ef9': '11) Canadian Association of Radiologists – Referral Guidelines https://car.ca/patient-care/referral-guidelines/ Last accessed Feb. 13, 2019.', '627e3917-cc9d-4355-b236-a11cc5382386': 'Most professional imaging associations have created and disseminated scientifically validated, peer-reviewed guidelines that provide assistance in ordering the most appropriate imaging test while avoiding less useful, or non-contributory, tests that could unnecessarily expose the patient to ionizing radiation. These guidelines also will provide information about the relative radiation exposure that can be expected for one examination vs. another.', 'dde178ba-da97-448c-b369-5277c0dd80ae': 'If possible, the use of imaging modalities that do not use ionizing radiation (ultrasound and MRI) should be considered.', '1a1b453c-73a4-4269-aed3-97a05e6abdcb': 'Hence, it is hoped that fewer examinations will be requested and the most useful and appropriate examination will be performed, reducing the use of inappropriate ionizing radiation. Also, if an examination with radiation is required the dose experienced by the patient can be justified with the argument that the most useful, appropriate, diagnostic examination has been utilized limiting the total radiation dose experienced by the patient. (8 – 11)'}"
+Figure 3.25,undergradimage/images/Figure 3.25.jpg,Figure 3.25B Bone Level and Window,"Level and Window are unique physical properties of CT images that allow the user to adjust the centre and the width of the gray scale that is portrayed on the images.  This is an adjustment that is applied to the raw CT data and does not require repeated patient imaging to obtain the different levels and windows. The level is the centre of the gray scale, set to the HU of the tissue of most interest i.e. the centre (level) of the gray scale for brain window is 35 HU.  The window is the width of the gray scale that surrounds the level setting, thus defining the range of HU for white and black seen on the image. For the brain images the width of the HU scale is 80 HU. A illustration depicting this for brain and bone level and window setting are provided in Figure 3.25.","{'9d9da8c6-2e61-47f2-ba4d-6a20496f0d3a': 'All figures in “Chapter 17: Musculoskeletal” by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan are used under a CC-BY-NC-SA 4.0 license.', '42459c0f-ddfe-46c5-b1fd-6793f01031b5': '2) Gaillard, F. Salter-Harris Classification, Radiopaedia.org. https://radiopaedia.org/articles/salter-harris-classification', '99a28b8c-45c1-4a34-b607-d24433ffd59c': '3) Boaz K. Karmazyn, MD; Adina L Alazraki, MD; Sudha A. Anupindi, MD, et al. ACR Appropriateness Criteria® Pediatric – Urinary Tract Infection. Available at https://acsearch.acr.org/docs/69444/Narrative/\xa0 American College of Radiology. Accessed June 30, 2017.', 'ff59e5e9-8d3d-4318-86bd-c8746ebe5e27': '4) Urinary Tract Infection: Clinical Practice Guideline for\n\nthe Diagnosis and Management of the Initial UTI in\n\nFebrile Infants and Children 2 to 24 Months. Pediatrics 2011, 128 (3): 595 – 610.', '95839fcd-3dad-4370-b8c9-efa3ae8fee8d': '5) Dr. Matt Skalski, Ureteric reflux, Radiopaedia.org. “https://radiopaedia.org/\xa0 From the case “https://radiopaedia.org/cases/22569 rID: 22569', '26535aad-e785-402b-9277-4da9563c4525': '6) Molly E. Raske, MD; Molly E. Dempsey, MD; Jonathan R. Dillman, MD, et al. ACR Appropriateness Criteria® Pediatric – Vomiting in Infants Up to 3 Months of Age. Available at https://acsearch.acr.org/docs/69445/Narrative/ American College of Radiology. Accessed June 30, 2017.', '6ec32d8a-c136-48d5-9703-61624050f9f6': '7) Learning\xa0radiology\xa0: recognizing the basics. William Herring author. Elsevier 2016 Online access University of Saskatchewan Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK Accessed, June 30, 2017.', '3db9d0ef-38dd-4332-812d-6af2dfa4db69': '8) Grainger and Allison’s diagnostic\xa0radiology\xa0: a textbook of medical imaging. Andy Adam editor.; Adrian K. Dixon editor.; Jonathan H. Gillard 1964- editor.; Cornelia Schaefer-Prokop editor.; David J Allison; Elsevier (Firm) 2015, Online access University of Saskatchewan Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK\xa0 Accessed June 30, 2017.', '5bf49964-973b-4c4d-88b4-2696683964c1': '2) Radiopaedia.org – https://radiopaedia.org/articles/rockwood-classification-of-acromioclavicular-joint-injury Rockwood classification of AC-Joint injuries. Accessed June 30, 2017.', '59261295-fce8-49b2-a2de-77852eccc04a': '3) Common Forearm Fractures in Adults. American Family Physician 2009: 80 (10): 1096 – 1102.', '2f360c6a-b1f6-4af3-a4c8-e0b8438b9a58': '4) Diagnosis and Management of Scaphoid Fractures.\xa0 American Family Physician 2004; 70 (5); 879 – 884.', 'a5a2c608-b474-4203-bd8a-41a1f1ceb548': '5) Michael A. Bruno, MD; Barbara N. Weissman, MD; Mark J. Kransdorf, MD, et al. MSK – Hand and Wrist Trauma. \xa0Available at https://acsearch.acr.org/docs/69418/Narrative/ American College of Radiology. Accessed June 30, 2017.', '3548e3f8-9289-4063-8539-de870f48b911': '6) Robert J. Ward, MD, CCD; Barbara N. Weissman, MD; Mark J. Kransdorf, MD., et al. ACR Appropriateness Criteria®, MSK – Acute Hip Pain – Suspected Fracture. \xa0Available at https://acsearch.acr.org/docs/3082587/Narrative/ American College of Radiology. Accessed June 30, 2017.', '59596a80-aaf5-43e7-985e-7b2593951114': '7) Radiopaedia.org – https://radiopaedia.org/articles/femoral-neck-fracture Accessed June 30, 2017.', '469c112e-865a-482d-9b7e-5830232cee0e': '8) Michael J. Tuite, MD; Mark J. Kransdorf, MD; Francesca D. Beaman, MD, et al. ACR Appropriateness Criteria®, MSK – Acute Trauma to the Knee. Available at https://acsearch.acr.org/docs/69419/Narrative/ American College of Radiology. Accessed June 30, 2017.', '61b9265e-5af7-4d75-833f-a9344ce39570': '9) Ottawa Knee Rule – Stiell IG, Wells GA, Hoag RH, Sivilotti ML, et al (1997). “Implementation of the Ottawa Knee Rule for the use of radiography in acute knee injuries.”. JAMA. 278 (27): 2075–9. PMID\xa09403421. doi:10.1001/jama.1997.03550230051036. Accessed June 30, 2017.', 'd567b915-ef5d-4c0d-8e5b-f533c7036e91': '10) Ottawa Ankle Rule – Stiell IG, McKnight RD, Greenberg GH, et al. (March 1994). “Implementation of the Ottawa ankle rules”. JAMA. 271 (11): 827–32. PMID\xa08114236. doi:10.1001/jama.1994.03510350037034. Accessed June 30, 2017.', '92efbc09-23c1-4b33-b265-50b693fca389': '11) Jon A. Jacobson, MD; Catherine C. Roberts, MD; Jenny T. Bencardino, MD, et al. ACR Appropriateness Criteria®, \xa0MSK – Chronic Extremity Joint Pain Available at https://acsearch.acr.org/docs/3097211/Narrative/ American College of Radiology. Accessed June 30, 2017.', '170f0345-ab5f-45e0-8acd-470a44d17663': '2) Catheter Replacement of the Needle for Arteriography. Seldinger, S. I. Acta Radiologica, 1953: 39 (5); 368 – 376.', 'd55b79a0-51d8-4933-a57a-7d6b6cb5597b': '3) Thomas B. Kinney, MD; Hamed Aryafar, MD; Charles E. Ray, Jr, MD, PhD, et al. ACR Appropriateness Criteria® Management of Inferior Vena Cava Filters. Available at https://acsearch.acr.org/docs/69342/Narrative/ American College of Radiology. Accessed June 30, 2017', 'ba20e351-4219-47c3-b9c5-b61de5ab8fd9': '4) Learning\xa0radiology:recognizing the basics. William Herring author. Elsevier 2016, Online access University of Saskatchewan Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK Accessed, June 30, 2017.', '3fc9b447-cac6-4420-ac4e-05f656e81f43': '5) Grainger and Allison’s diagnostic\xa0radiology\xa0: a textbook of medical imaging. Andy Adam editor.; Adrian K. Dixon editor.; Jonathan H. Gillard 1964- editor.; Cornelia Schaefer-Prokop editor.; David J Allison; Elsevier (Firm) 2015, Online access University of Saskatchewan Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK\xa0 Accessed June 30, 2017.', 'a53e9698-8be5-4b56-ba59-87393e1e60b7': '2) Vahid Yaghmai, MD, MS; Max P. Rosen, MD, MPH; Tasneem Lalani, MD. ACR Appropriateness Criteria® \xa0– Gastrointestinal – Acute (non-localized) Abdominal Pain and Fever – Pneumoperitoneum. Available at\xa0 https://acsearch.acr.org/docs/69467/Narrative/ American College of Radiology. Accessed June 30, 2017.', '23ab0a22-ea4d-4c3f-9d72-f3a49ca4f6fd': '3) Douglas S. Katz, MD; Mark E. Baker, MD; Max P. Rosen, MD, MPH. ACR Appropriateness Criteria® – Gastrointestinal – Suspected Small Bowel Obstruction. Available at https://acsearch.acr.org/docs/69476/Narrative/ American College of Radiology. Accessed June 30, 2017.', 'f3c446dd-aa8d-4d22-aed4-b5e89863cd27': '4) Martin P. Smith, MD; Douglas S. Katz, MD; Max P. Rosen, MD, MPH. ACR Appropriateness Criteria® – Gastrointestinal – Right Lower Quadrant Pain – Suspected Appendicitis. Available at https://acsearch.acr.org/docs/69357/Narrative/ American College of Radiology. Accessed June 30, 2017.', 'e40080ff-07b5-4509-a9d8-3d7ff39b3c19': '5) Michelle M. McNamara, MD; Tasneem Lalani, MD; Marc Anthony Camacho, MD. ACR Appropriateness Criteria® \xa0– Gastrointestinal – Left Lower Quadrant Pain – Suspected Diverticulitis. Available at https://acsearch.acr.org/docs/69356/Narrative/ American College of Radiology. Accessed June 30, 2017.', 'a6f6cc9d-0ee1-42b0-ba1b-410ac9dc0387': '6) Rendon C. Nelson, MD; Ihab R. Kamel, MD, PhD; Mark E. Baker, MD. ACR Appropriateness Criteria® \xa0– Gastrointestinal – Liver Lesion – Initial Characterization. Available at https://acsearch.acr.org/docs/69472/Narrative/ American College of Radiology. Accessed June 30, 2017.', '154ec87b-5220-4418-99a5-75ec9d9fafec': '7) Tasneem Lalani, MD; Corey A. Couto, MD; Max P. Rosen, MD, MPH. ACR Appropriateness Criteria® \xa0– Gastrointestinal – Jaundice. Available at https://acsearch.acr.org/docs/69497/Narrative/ American College of Radiology. Accessed June 30, 2017.', '740ebf07-9cb8-4ed5-9cac-8bb79c578c8d': '2) Jacobo Kirsch, MD; Tan-Lucien H. Mohammed, MD, et al.\xa0 ACR Appropriateness Criteria®, Chest – Acute Respiratory Illness in Immunocompetent Patient. Available at https://acsearch.acr.org/docs/69446/Narrative/ Accessed, June 30, 2017.', '571524ec-b296-4a2d-95dc-97db963c3fcb': '3) Debra Sue Dyer, MD; Tan-Lucien H. Mohammed, MD; Jacobo Kirsch, MD, et al. ACR Appropriateness Criteria®, Chest – Chronic Dyspnea – Suspected Pulmonary Origin. \xa0Available at https://acsearch.acr.org/docs/69448/Narrative/ Accessed June 30, 2017.', 'f22ed822-b387-44e5-8a22-dd8a867b8b01': '4) Learning\xa0radiology\xa0: recognizing the basics. William Herring author. Elsevier 2016 Online access USask Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK Accessed, June 30, 2017.', '87cb046f-4dac-41ec-84d0-bed36b33d265': '5) Jeffrey P. Kanne, MD, Leif E. Jensen, MD, MPH, Tan-Lucien H. Mohammed, MD, et al. ACR Appropriateness Criteria®,\xa0 Chest – Radiographically Detected Solitary Pulmonary Nodule. Available at https://acsearch.acr.org/docs/69455/Narrative/ Accessed June 30, 2017.', '3159e24d-3174-4315-993d-23dd449b06b4': '6) Fleischner Society – https://fleischnersociety.org', 'd07c0b2d-9413-4046-ab1e-55f117865c2a': '7) Michael A. Bettmann, MD, Scott G. Baginski, MD, Richard D. White, MD, et al. ACR Appropriateness Criteria®, Chest – Acute Chest Pain – Suspected Pulmonary Embolism. Available at https://acsearch.acr.org/docs/69404/Narrative/\xa0 Accessed June 30, 2017.', 'cd973045-ca97-4b36-a285-52581f60f304': 'Ultrasound uses traditional probes with higher frequency to better image the breast tissue that is in close proximity to the overlying skin.', '13e1e8e0-e640-4941-8300-c31710b3a53c': 'Mammography/Breast Imaging Centres in Canada are accredited and audited for quality by the Canada Association of Radiologists.', 'eca3d4b9-a2c4-43c7-ae2b-3ec757983d8b': '2) Vilaas S. Shetty, MD; Martin N. Reis, MD; Joseph M. Aulino, MD, et al. ACR Appropriateness Criteria® Head Trauma. Available at https://acsearch.acr.org/docs/69481/Narrative/ American College of Radiology. Accessed, June 30, 2017.', 'a923162d-9460-4587-991e-319c82bf5c9f': 'https://acsearch.acr.org/docs/69481/Narrative/', '96ac01aa-0380-4fa5-be27-55a5b787830c': '3) Michael B. Salmela, MD; Shabnam Mortazavi, MD; Bharathi D. Jagadeesan, MD, ACR, et al. Appropriateness Criteria® Cerebrovascular Disease. https://acsearch.acr.org/docs/69478/Narrative/ American College of Radiology. Accessed, June 30, 2017.', 'b68256b4-9387-4475-8f5a-41b599bfaf04': 'https://acsearch.acr.org/docs/69478/Narrative/', 'd4f105b8-2855-4af9-a3cb-f9d88fcdbf18': '4) Annette C. Douglas, MD; Franz J. Wippold II, MD; Daniel F. Broderick, MD, et al. Appropriateness Criteria® Headache. https://acsearch.acr.org/docs/69482/Narrative/ American College of Radiology. Accessed, June 30, 2017.', '74770c44-e954-4084-abd6-2740860fa07d': 'https://acsearch.acr.org/docs/69482/Narrative/', 'edab0354-1c57-4db0-b1dd-6ea014cb5e00': '5) Nandini D. Patel, MD; Daniel F. Broderick, MD; Judah Burns, MD, et al. Appropriateness Criteria® Low Back Pain. https://acsearch.acr.org/docs/69483/Narrative/ American College of Radiology. Accessed, June 30, 2017.', 'd0966524-e032-4f5a-9faf-1e8f783d8061': 'https://acsearch.acr.org/docs/69483/Narrative/', 'aa597d16-b4a3-404a-889f-e4a901c750d6': '6) Richard H. Daffner, MD; Barbara N. Weissman, MD; Franz J. Wippold II, MD, et al. Appropriateness Criteria®  Suspected Spine Trauma. https://acsearch.acr.org/docs/69359/Narrative/ American College of Radiology. Accessed, June 30, 2017.', '6945685d-8bdd-48ba-9299-88cd95cdcccc': 'https://acsearch.acr.org/docs/69359/Narrative/', 'd6137ceb-35ba-41f9-b5ad-909c0c93c831': 'The standard views are AP (anterior-posterior) and lateral.\xa0 These two views are taken at right angles (orthogonal) to each other.\xa0 If these images are not helpful, ancillary views such as oblique views, or special views such as, an axillary or carpal tunnel view, may be required based upon the clinical scenario.', '8da19a7d-ea8a-48f7-802b-c3e6ad2879ea': 'Stress views i.e. a force is applied to a bone or joint to determine if an injury is present, such as, a subtle avulsion or a suspected tendon or ligament tear causing joint instability. These are acquired as special requests and should be performed in a manner that minimizes patient pain and discomfort.', 'c1ddb6e5-c42b-4c10-ac0d-ed3b6ab5cbad': 'At least one joint space should be visible in relation to the suspected bone injury.\xa0 Additional x-ray views and views of another adjacent joint space may be required in some circumstances.', 'd8ec4a87-ef98-4bd8-9ee3-47f8c6612a49': 'Comparison views to the contralateral, normal bone, or joint, may be required, this is especially true if a subtle growth plate injury is suspected in a child.\xa0 Comparison views should not be ordered routinely, but should be used if clinically necessary.', 'd76a51e5-d391-4400-aa76-b67e2d5a4233': 'It is important to remember that some bone and ligament injuries occur as a common pattern of multiple injuries i.e. the Colle fracture of the distal radius is often associated with an avulsion fracture of the ulnar styloid.\xa0 Ankle ligament injuries and fractures often occur in a sequence i.e. medial malleolar avulsion fracture (or medial ligament tear), interosseous ligament tear between the tibia and fibula, and a subsequent oblique fracture of the proximal fibula (Maisonneuve fracture complex).\xa0 Keep this in mind as you encounter various patients and you will develop knowledge and experience of these associated bone and soft tissue injuries.', 'd26261d6-1894-4731-a4bc-cb382c5fc4b8': 'Fractures usually present as a lucent line on x-rays involving the cortex and medulla of the bone that can be followed from one cortex to the opposite cortex with varying degrees of displacement and malalignment of the involved bone.', '6d3c05b4-f04f-464e-828c-e219309240b2': 'There are some fractures that may be associated with bone ischemia and avascular necrosis i.e. capital femoral fractures and scaphoid fractures.\xa0 Be aware of this and learn the importance of aggressive and pre-emptive management for these patients.', '9efc69ef-d567-4c20-b7da-5b5faae548f8': 'Fig 5.7 Abdomen Quadrants/Regions\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'c17eee8e-a5a7-4b3d-aa39-e9562f679745': 'Fig 5.8\xa0Supine Positioning for Abdomen x-ray, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', 'e428391c-3d1e-4c3d-a0ee-4e39fd82ee4d': 'Fig 5.9 Upright Positioning for Abdomen x-ray, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', '4fe76b20-0ac2-49ac-a875-af27033355ec': 'Fig 5.10 Decubitus Positioning for Abdomen x-ray, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', '1e50fdef-529f-4fe1-b3f4-ab42378ca31f': 'Fig 5.11 Normal Abdominal x-ray by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '27e0addc-368c-4208-9970-6559705ff1e8': 'Fig 5.12 Colon anatomy emphasized by the presence of barium and air by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '990d74a2-1431-4705-8efd-4cf210fa9ce3': 'Fig 5.13 Bones and Musculoskeletal Landmarks in the Abdomen by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '3d050294-a087-4835-a5ed-7961069e1f0a': 'Fig 5.14 Possible Artifacts on Abdomen x-rays. The image demonstrates two umbilical piercings, fallopian tube clips, and the buttons on the patient’s pants by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'cbf4613b-cbd6-4078-b9c3-b1c333a37c48': 'The standard upright views of the chest are made when a patient is typically placed between an x-ray source and an x-ray detector. When the x-rays penetrate the tissues of the patient, they stimulate an x-ray detector that alters the energy of the x-ray beam into a digital pixel grid. The radiograph produced is referred to as a roentgenogram and named after Wilhelm Konrad Roentgen who received the first Nobel Prize for Physics in 1901 for his work in defining the major properties of x-rays and the conditions necessary for their production. It was Roentgen who coined the term “x-ray”.', '9da044bd-e951-4eb4-8cf9-ccb9398a2423': 'Fig 5.1 A portable upright x-ray where the image is not taken with proper body alignment, the patient is rotated and tilted\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '0bc6ae7d-c9c2-4d6d-ae6c-f07a5a647792': 'Fig 5.2 A portable upright x-ray taken with patient in proper alignment\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'e27384e1-63ef-4a65-a138-41a0d8870a95': 'Fig 4.1A Fluoroscopy – Shoulder Arthrogram Early Phase of Injection\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '2f124311-a640-4063-9232-06af6006da7a': 'Fig 4.1B\xa0Shoulder Arthrogram Fluoroscopy Mid-Phase of Injection by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'bb7b38f9-ff02-462d-8d99-621dd444c05e': 'Fig 4.1C Shoulder Arthrogram Late Phase of Injection\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'b6d8041f-18d1-40b8-a5b0-44c6bfeb9405': 'Fig 4.2A\xa0CT Aorta, C-\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'b98a8c21-5a63-4b95-b9ce-f7e38e6999bc': 'Fig 4.2B CT Iliac Arteries, C-\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '43da027d-17e8-4ba4-b312-67fba1bd1511': 'Fig 4.2C CT Aorta, C+\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'b66fdc16-e8ca-433f-8a6e-1d0f3f659bb3': 'Fig 4.2D CT Iliac Arteries, C+\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '8964941e-dc07-44fd-954a-0403c1bfd992': '2) Image Wisely. http://www.imagewisely.org/ Last accessed, Aug. 22, 2017.', 'ed5f284b-a74a-4376-b274-77e0e2303fc9': '3) Image Gently. http://www.imagegently.org/ Last accessed Aug 22, 2017.', 'fc2d1e7a-fa5b-4dbc-917f-25f258eb23d6': '4) Novelline, R. A., & Squire, L. F. (2004), sixth edition. Squire’s fundamentals of radiology. Cambridge, Mass: Harvard University Press.', 'ce057be0-807e-4b88-a477-0d87c59e607b': 'Fig 3.43 Nuclear Medicine Scanner by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'dce81a39-f2bd-47ee-847d-9205bbc446e1': 'Fig 3.44A Normal, Pediatric Nuclear Medicine Bone Scan by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '8bed792d-6442-4cbd-89db-89b5a4cb4541': 'Fig 3.44B Normal, Adult Nuclear Medicine Bone Scan\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '41bf79b1-bfd9-4a16-9b5d-900405a59176': 'Fib 3.45 PET/CT Scanner\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '8fcd15af-34e1-492f-91a7-3b8b671387ed': 'Fig 3.46A PET/CT image of the chest for a patient with lymphoma\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '211a4b55-451b-4858-aa60-ce4253c9d555': 'Fig 3.46B PET image of the whole body for a patient with lymphoma\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '15d4a271-c53b-449d-8385-a1b6030fd923': 'The appearance of different tissue on MR images is described as displaying greater, or lesser, signal in comparison the other anatomy in the region. The signal in question is the energy that the perturbed protons liberated when they fall back into alignment with the magnetic field. The signal intensity of the tissue in question changes based upon the image acquisition parameters set by the MR Technologist, under the direction of a supervising Radiologist.\xa0 The parameters set result in the acquisition of a set of images called an MR imaging sequence. On one sequence cerebrospinal fluid will appear as black pixels (T1 sequence) while on another sequence it is white pixels (T2 sequence). This difference in tissue appearance can be exploited to determine if pathology is present.', '33f25041-480d-4bb9-95fc-0a28bc2224ed': 'Fig 3.31\xa0B-Mode Ultrasound of the Carotid bulb with atherosclerotic plaque\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '18658974-a7a2-499b-881c-5a51baaa9854': 'Fig 3.32A\xa0Ultrasound Machine\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '5c75f45f-6624-42df-b964-dddafeae9d32': 'Fig 3.32B Mobile Ultrasound Machine\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'f351a841-d5dd-4048-8f36-831f0bbf09d9': 'Fig 3.33 Ultrasound image of the normal liver and kidney. The echogenicity of the liver is greater than the echogenicity of the adjacent renal cortex by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '059ddd7b-14ba-4290-92ad-7382c9156fc4': 'Fig 3.34 Gallbladder\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '5db401cc-d0ff-4f03-945a-f50dd89e4be9': 'Fig 3.35A Normal Liver Ultrasound by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'fae31525-31fa-491b-8fcf-6206343abf74': 'Fig 3.35B Hepatomegaly and hepatic steatosis on Ultrasound\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '4aa1ffad-a8df-4cef-8f34-a9695f5958bc': 'Fig 3.36 Colour Doppler, of the neck\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '99b1c66a-6cc2-4a4e-872f-476d28cdab03': 'Fig 3.37 Colour Doppler of the neck with Spectral Display\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '21a2827a-f5ed-4e96-a0d9-b91bdf773c22': 'Fig 3.38A\xa0Internal Carotid Doppler Ultrasound Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '6bf5c327-c3cb-4f8c-b09c-7b96d908326a': 'Fig 3.38B Carotid Bulb Doppler Ultrasound\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '8d123159-7ce7-4972-bc0c-86aa528a32ae': 'Fig 3.38C\xa0Vertebral Doppler Ultrasound\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'b8f04a00-104c-40e3-8e47-1dc899d44ca1': 'Fig 3.39 Linear probe and two curved array probes\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'c15107ec-6f70-4702-929e-61aeee36a137': 'The patient does not need to be moved, or re-positioned, to obtain CT images in different anatomic planes.\xa0 The patient lies on the CT table in anatomic position and remains in that position throughout the study.\xa0 The standard orientation of image acquisition for CT is in the axial plane, hence the old name for this machine of CAT (computed axial tomography) scanner.\xa0 Often the axial images obtained during the initial x-ray exposure will be digitally reformatted into other anatomic planes i.e. sagittal and coronal.\xa0 These reformatted images are the result of a computer algorithm reformatting the original digital image data and, as such, these supplemental anatomic planes of imaging do not require additional x-ray exposure.', '23a6edd0-ea0d-4597-87b7-d94ca733c3a5': 'The CT gantry can be tipped cranially and caudally to deviate from the axial plane by 30 degrees in either direction and this can be used to correct for patient anatomic variability to maintain the axial plane, if necessary.\xa0 It also allows for unique imaging along an angled plane that can be used when requested by the referring physician or the radiologist.\xa0 A widely used example of imaging in an angled plane is found for CT Head examinations. It is not conventional to acquire these images in the axial plane but to image the brain on the canthomeatal (lateral orbit canthus to the aural meatus) line and therefore, the CT gantry must be tilted to ensure that all CT Head images are acquired in this plane.\xa0 Originally, this plane was chosen as it maximizes information about the intra-cranial contents while minimizing the exposure of the orbits (lens) to radiation. The orbito-meatal line has become the internationally recognized plane for acquiring CT head images. This line is depicted in Figure 3.22.', '2a01449e-f80d-44b8-b5f1-9fbd2293de89': 'The physics of CT image creation are complex and require complex computer processing to create images that are visible for clinical use.\xa0 As the x-ray tube and the x-ray detectors revolve around the patient thousands of mathematical calculations are performed to determine how much of the incident x-ray beam was absorbed by a volume of tissue. This volume of tissue is called a voxel. The calculated absorption of the x-rays by a voxel is converted into a pixel density that is displayed on a gray scale from -1,000 (air) to +1,000 (metal).\xa0 This scale is called the Hounsfield unit (HU) scale after one of the principle inventors of CT, Sir Godfrey Hounsfield.\xa0 The calculated density of this voxel is then allocated to a pixel on a grid of the 512 x 512 pixels that forms each individual CT image.', '7630aac5-da71-4093-992f-e3de7e0777cf': 'Therefore, if the volume of tissue contained air, or gas, the pixel density allocated would be close to -1,000 HU, while if the volume of tissue analyzed contained metal (bullet fragment, etc.) the pixel would be assigned a density close to the +1,000 HU.\xa0 The assignment of pixel density to voxels spans the entire possible range of pixels from -1,000 – +1,000 HU, resulting in 2,000 shades of grey.\xa0 An image with the HU measurements of specific anatomic regions is provided in Figure 3.23.', '194d89df-a49e-4ba0-a141-fedb5b7d0e3d': 'CT density: a region on a CT image is described as being more, or less, dense than another region. The liver is more dense than the renal cortex.\xa0 This variation in pixel density can be quantified by measuring all the pixels in a region and creating an average pixel density i.e. region of interest of an area of liver can be measured, with a standard deviation, 50 HU +/- 5 HU, etc. The HU density of some common structures is provided in Table 3.2.', '7fd3f166-8080-4a1e-b564-5aaedace0274': 'Table 3.2 HU Scale', 'bf48f853-55d2-4b0d-a952-97052c04fccc': 'The viewer of the CT can decide how to adjust the level and window of the displayed CT images to accentuate tissues of a defined pixel density. \xa0The level and window are at the discretion of the viewing radiologist and can be set to their preferences. There are a variety of established level and window settings, i.e. abdomen, bone, brain, etc. These help to provide some level of uniformity for comparison of multiple CT examinations. Level and window setting for six common tissues are as follows:', 'b2f1f965-5bd4-4a65-bbcb-a0c74bb6849b': 'Table 3.3 Six common tissue levels and windows', '1c89c10d-2e57-46d5-873c-753aa9d9fd25': 'CT images demonstrating the appearance of these six different level and window settings are provided in Figure 3.24.', '0c5a4d4a-1a8a-45e7-82a1-3975c585d2e6': 'Level and Window are unique physical properties of CT images that allow the user to adjust the centre and the width of the gray scale that is portrayed on the images.\xa0 This is an adjustment that is applied to the raw CT data and does not require repeated patient imaging to obtain the different levels and windows. The level is the centre of the gray scale, set to the HU of the tissue of most interest i.e. the centre (level) of the gray scale for brain window is 35 HU.\xa0 The window is the width of the gray scale that surrounds the level setting, thus defining the range of HU for white and black seen on the image. For the brain images the width of the HU scale is 80 HU. A illustration depicting this for brain and bone level and window setting are provided in Figure 3.25.', '22baea2d-4734-448a-b8d2-ff98cc34c126': 'Fig 3.21\xa0Helical CT Scanner\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '997a9bef-3a49-4a5c-baaa-b5f4e9a60244': 'Fig 3.22 The plane of imaging related to the cantho-meatal line\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'e620fc79-fe54-4e1b-937a-f2f6d1ae88b4': 'Fig 3.23 Images of CT with HU measurements\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '47384920-3878-4fd3-a2cb-6676f1ecd6b4': 'Fig 3.24 CT Images with different level and window settings\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '27c1bf77-b175-46e2-8f3c-8b044f235e7a': 'Fig 3.25A Brain Level and Window\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'ae550a20-25ad-452b-9c36-d593b30cda0b': 'Fig 3.25B Bone Level and Window\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '4c06c22c-a218-43c6-b6d2-8b86614cb44f': 'Fig 3.26A Head CT visible on brain level and window. Bone not well seen by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '09e44bf9-1b1b-4b30-ac75-268a90c19141': 'Fig 3.26B Head CT on bone level and window. Brain not well seen by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'b14da7a2-6e23-4800-9645-0f1ea9841b25': 'Fig 3.27 Standard viewing orientation for an axial CT image\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '1aaea852-a349-4e12-9f42-4e7db0ccde67': 'Fig 3.28A CT image displayed in axial orientation from one radiation exposure event\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'cb4dd03b-6e19-4678-85ec-4798a6b00fe9': 'Fig 3.28B CT image displayed in sagittal orientation from one radiation exposure event\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '06e1bc4e-3c56-472e-b82f-5ca979851270': 'Fig 3.28C CT image displayed in coronal orientation from one radiation exposure event\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '82ba8ff7-a04c-4efb-9328-b4216ab73f8e': 'Fig 3.29A CT of the chest on lung level/window by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '2bb589c6-5d7e-4ca5-9add-0533ae22ad66': 'Fig 3.29B CT of the chest on mediastinal level/window by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '80b61eb5-0c49-4c26-bba6-34a715289fbc': 'Fig 3.30 CT PE image maximizing the injected contrast in the pulmonary arteries\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '7586c4b7-5466-4c34-b19e-28c580057600': 'An angiography machine is essentially a fluoroscopy unit that has the added feature of having the x-ray source and detectors mounted on a c-arm apparatus. The c-arm allows for movement of the source and detector around the patient who lies supine on the angiography table. The operator can acquire images in a wide variety of anatomic projections.\xa0 Therefore, patient movement is not required for this imaging modality. The angiography unit also has advanced software applications that facilitate complex arterial and body interventional procedures beyond the capabilities of a standard fluoroscopy unit. As with fluoroscopy, the images are viewed inverted in comparison to standard radiographs.', '8321eb02-784a-4088-a939-b2f9c46e47ce': 'The x-ray dose for Angiography is controlled by multiple detectors that adjust the radiation exposure to maximize image quality and minimize x-ray exposure. The machine only emits radiation when the operator uses a foot pedal to activate the x-ray tube. The area imaged can be collimated, or coned, to minimize the area exposed to x-rays.\xa0 The anatomy can also be magnified to improved diagnostic capacity.', 'c01d6355-58d2-4339-a8e1-0b13cb0a2a27': 'The images acquired are obtained very rapidly in cine mode resulting in a set of stacked images, that when stored and viewed, simulate a video recording.\xa0 Cine mode allows for the dynamic assessment of moving contrast and movement of catheters and guide wires inside the anatomy of the patient. A standard c-arm angiography unit is depicted in Figure 3.19.', '75c40a34-0496-4f50-853a-4a34b85893f5': 'For angiography, the radio-opaque contrast agent used is injected intra-arterially while x-ray images are acquired.\xa0 This is an invasive process that requires the injection to be performed via a small intra-arterial catheter that administers the contrast in close proximity to the origin of the arterial structure being investigated, i.e. carotid angiography requires an injection of contrast into the selected carotid artery.\xa0 The catheter used is usually manipulated into position using fluoroscopy from a remote arterial access site i.e. the common femoral artery, the radial artery, or the brachial artery.', 'b87262ac-93be-41c5-a829-b396ffcd5495': 'Arterial access relies upon the “Seldinger” technique, using local anesthetic, to insert the intra-arterial catheter used for the procedure. Blood vessels lack internal innervation and therefore, the catheter and guidewire can be manipulated without causing patient pain or discomfort.', 'e2e27594-969f-4065-afca-fc9d4d9d539d': 'This machine can also be used for Interventional Radiology procedures where catheters, guidewires, stents, feeding tubes, etc. are visualized with the c-arm fluoroscopy.\xa0 Water-soluble contrast agents can also be injected during these procedures to depict the anatomy of structures such as, the bile ducts, intestine, renal collecting system, veins, etc.', 'ba4bd9f0-d4d3-4160-998d-e606f08e785b': 'All modern angiography units capture images and present them in subtracted mode.\xa0 The subtraction process is digital using a computer to superimpose a non-contrast enhanced image onto a set of contrast enhanced cine images, resulting in subtracted images that depict only the anatomic structure filled with contrast since the background anatomy has been subtracted away by the digital image modification process. A digital, subtracted, carotid angiogram is depicted in Figure 3.20.', '9507b590-4a7c-43a4-ab86-48655f636346': 'The contrast used for angiography is an iodine based pharmaceutical and is water soluble.\xa0 During angiography, it is injected into the artery of interest and replaces the blood for a very short period of time.\xa0 This contrast agent progresses antegrade in the vascular tree related to the direction of blood flow.\xa0 It quickly clears from the arteries and exits the region via venous drainage.\xa0 The circulating contrast is predominantly excreted by the kidneys into the urine.', '3276ecac-6f99-4922-9d4c-37154b7ae129': 'Fig 3.19 Angiography Machine with C-Arm by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '0d7266b7-752c-4049-b830-7e4dca6ea0db': 'Fig 3.20\xa0Carotid Angiography, Digital Subtraction Cerebral Angiography\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '07ea0f57-4c84-4133-93c0-83121c89f01d': 'An example of a fluoroscopic examination is the esophogram and upper gastrointestinal series.\xa0 The patient is asked to swallow barium sulfate and gas-forming granules.\xa0 The barium can be seen to move with positioning (gravity) and peristalsis as it moves antegrade through the digestive tract while the gas rises to the highest point of the intestinal tract based upon patient positioning. The barium and the gas help to outline the inner lining of the intestine.\xa0 The live fluoroscopic x-rays visualize the motion of the barium and the gas. It is also possible to capture still images and/or cine mode images that are stored in the Picture Archive and Communication System (PACS).', 'bc96ce7d-d729-4227-95fa-225665741a10': 'Cine mode images are still images captured at a rapid rate and can be viewed sequentially, like a video, after being stored in the PACS. Other fluoroscopy aided examinations include arthrography, barium enema, cystourethrogram, sinus tract injections, myelography and hysterosalpingography, to name a few.', '87cf4657-0272-4db3-aa75-969547958014': 'The positioning of the patient is dependent on the physical capabilities of the patient and the exam that is to be performed. For example, when carrying out an esophogram, the best positioning would be an upright (standing) patient and an oblique or lateral view of the anatomy to watch the barium proceeding down the esophagus. Additional oblique and lateral views allow one to visualize abnormalities in multiple planes and to determine if any abnormality of the intestinal mucosa is concealed by swallowed barium on one view. If aspiration of ingested fluid or food into the lungs is clinically suspected the lateral projection allows one to determine if fluids are entering the trachea during swallowing.', 'b74d40ce-5391-4b64-a394-581b4a112089': 'A Fluoroscopy machine is seen in Figure 3.15.', 'bbd4cc27-e511-4d95-a60e-9f436bbc4a41': 'The video in Figure 3.17\xa0depicts live fluoroscopy of the upper esophagus for a patient whose images demonstrate aspiration of the barium into the trachea.', 'dbaf432f-8185-4365-a9d3-beed0ab25975': 'Fluoroscopy images are most often displayed for review inverted in comparison to standard x-ray images.\xa0 Hence, air is white and metal is black.\xa0 They can also be displayed as standard x-rays if this is advantageous for interpretation, see the barium enema images. The principles of absorption and transmission of the x-rays is unchanged, but the images are digitally manipulated to be the inverse of x-rays, much like film negatives in photography. The effect of image inversion for Fluoroscopy images is depicted in Figure 3.18.', '6891ccd4-5787-4995-8269-5f022f52e891': 'Fig 3.3\xa0X-ray Tube by\xa0Kieranmaher is in the Public Domain.', '39c648ca-5e19-4388-a61f-bdd02372eda8': 'Fig 3.4\xa0X-ray Tube. Lead Housing with Portal for x-ray Emission, bench top image by Rschiedon is available under a CC-BY-SA 3.0 Unported License.', '33964476-071d-4239-b632-398ccd10bb4f': 'Fig 3.5\xa0X-ray Image Creation and Display by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'f39c28ae-5cbf-4339-a557-42e3a1322037': 'Fig 3.6A\xa0A standard, fixed location, wall x-ray detector used for upright chest and abdomen x-rays by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'fb953c13-b4fe-4531-a6f1-80bdb7074953': 'Fig 3.6B\xa0A Portable x-ray Machine by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '6e34bafd-8b52-44e0-ad2d-cf1e331df04d': 'Fig 3.6C\xa0The Portable x-ray machine with the x-ray tube extended for use by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'ca28bfcc-132a-4473-a28f-bd495247e213': 'Fig 3.6D\xa0A Portable, Mini, C-Arm x-ray Unit by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '4711a96b-6775-4db5-9866-04674d98a3f6': 'Fig 3.7\xa0Appearance of different entities on x-rays\xa0by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '1258fb9d-5c95-4aae-80d3-54f946489f6b': 'Fig 3.8\xa0Left Shoulder x-ray\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license. Accessible from\xa0https://mistr.usask.ca/odin/?caseID=20160214201450302', '547b4d9c-36c8-45f6-b22d-82adda75b216': 'Fig 3.9\xa0Effect of tissue thickness on x-ray appearance\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '69e45b9a-1ecf-45d7-8796-3255b76aa319': 'Fig 3.10\xa0Common x-ray Test Object, Lucite Plastic Board\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '57b3432c-9730-4d69-9cce-4f4007438233': 'Fig 3.11A Posterior-anterior, upright, chest x-ray positioning, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', '32b6ba4a-63ec-4e10-9990-f380de9fee0d': 'Fig 3.11B Lateral, upright, chest x-ray positioning, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', 'b22e4373-8d85-42d1-a469-1a583e765d15': 'Fig 3.11C Decubitus x-ray positioning, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', '8b26404e-eca4-432c-a4a4-406c267732a6': 'Fig 3.1\xa0PACS Imaging Viewing Station (Workstation) by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC–BY-NC-SA 4.0 license.', '8a1454eb-adb0-43dd-b455-381ef4a0fa33': 'Fig 3.2 Sample MRI Request Form\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC–BY-NC-SA 4.0 license.', '32fc7f20-73b7-4d42-8e8e-a55c8e933865': '2) Sievert. Wikipedia. https://en.wikipedia.org/wiki/Sievert Accessed Sep. 3, 2018', '808e953e-3ced-45ab-8c29-dcb633e825d7': '3) Radiation Safety Review, Jeff Sanderson. Cancer Care Manitoba, 2001. https://www.cancercare.mb.ca/Research/medical-physics/radiaion-protection-services/index.html', '7a5b86bc-d27b-4f09-94d3-eacd0a26d733': '4) ICRP, 2007. ‘The 2007 Recommendations of the International Commission on Radiological Protection’. ICRP Publication 103. Ann. ICRP 37 (2-4).\n\n(see http://www.icrp.org/publication.asp?id=ICRP%20Publication%20103) Last accessed Feb. 12, 2019.', '0e4fd872-fed4-4829-aad6-b29fb5207e16': '5) United States Nuclear Regulatory Commission. https://www.nrc.gov/reading-rm/basic-ref/glossary/alara.html Last accessed February 5, 2019.', '31a16705-8334-4d0b-ba2c-7b3ba4903d3d': '6) Guidelines for Diagnostic Imaging During Pregnancy and Lactation ACOG October 2017 e210; 130(4):e210 – e216.', '61c798cb-9b2c-44a5-a50f-094104e0d923': '7) Image Gently Alliance. https://www.imagegently.org/ Last accessed February 6, 2019.', '95aa939a-bd18-4918-8163-3f0eda02ba68': '8) American College of Radiology. ‘ACR appropriateness criteria.’ Radiology, 2000; 215 (Suppl): 1-1511.', 'b562ff2f-9eea-4eba-9d13-f84bcac6c6d9': '9) ACR Appropriateness Criteria List. https://acsearch.acr.org/list Last accessed Feb. 13, 2019.', '15e3ec31-d27d-49ba-9d6a-a28f7211c03f': '10) The Royal Australian and New Zealand College of Radiologists. Imaging Guidelines. 4th edn. Surrey Hills: National Library of Australia Cataloguing-in-Publication Data, 2001.', '42757543-7fdd-42ee-bddd-5c70293e2ef9': '11) Canadian Association of Radiologists – Referral Guidelines https://car.ca/patient-care/referral-guidelines/ Last accessed Feb. 13, 2019.', '627e3917-cc9d-4355-b236-a11cc5382386': 'Most professional imaging associations have created and disseminated scientifically validated, peer-reviewed guidelines that provide assistance in ordering the most appropriate imaging test while avoiding less useful, or non-contributory, tests that could unnecessarily expose the patient to ionizing radiation. These guidelines also will provide information about the relative radiation exposure that can be expected for one examination vs. another.', 'dde178ba-da97-448c-b369-5277c0dd80ae': 'If possible, the use of imaging modalities that do not use ionizing radiation (ultrasound and MRI) should be considered.', '1a1b453c-73a4-4269-aed3-97a05e6abdcb': 'Hence, it is hoped that fewer examinations will be requested and the most useful and appropriate examination will be performed, reducing the use of inappropriate ionizing radiation. Also, if an examination with radiation is required the dose experienced by the patient can be justified with the argument that the most useful, appropriate, diagnostic examination has been utilized limiting the total radiation dose experienced by the patient. (8 – 11)'}"
+Figure 3.26,undergradimage/images/Figure 3.26.jpg,Figure 3.26A Head CT visible on brain level and window. Bone not well seen.,"Once the window range is set, any structures with a pixel density greater than the defined window will appear white and everything with a pixel density less than the defined window will appear black. The ability to adjust the range of greys that are displayed on the image, makes it possible for the interpreter to analyze and compare structures of interest. It is important to remember that when viewing images on a particular level and window setting the anatomy of structures that fall outside the gray scale you are viewing will not be optimally analyzed.  This is particularly evident when you assess the difference in appearance of the head images provided demonstrating the brain and the bone level and window settings.  Brain tissue is well visualized on the brain level and window while there is no useful information about the bone of the skull and vice versa when the bone level and window is viewed, see Figure 3.26.","{'84713707-b6d7-4a10-86d7-485f10152a80': 'Once the window range is set, any structures with a pixel density greater than the defined window will appear white and everything with a pixel density less than the defined window will appear black. The ability to adjust the range of greys that are displayed on the image, makes it possible for the interpreter to analyze and compare structures of interest. It is important to remember that when viewing images on a particular level and window setting the anatomy of structures that fall outside the gray scale you are viewing will not be optimally analyzed.\xa0 This is particularly evident when you assess the difference in appearance of the head images provided demonstrating the brain and the bone level and window settings.\xa0 Brain tissue is well visualized on the brain level and window while there is no useful information about the bone of the skull and vice versa when the bone level and window is viewed, see Figure 3.26.', 'ae2a72e5-a6c4-4519-ae4c-eb4a18f3eaf6': 'It is important to realize the effect of level and window and review the image data set provided to you at all the appropriate level and window settings.\xa0 For example, in the thorax one should view the images on lung, mediastinal, and bone level and window settings to perform a full assessment of the patient’s anatomy.', '71c3f3ec-29cf-403b-b710-5696540ea948': 'The standard viewing format for the CT image display is to look at the images like a loaf of sliced bread with the observer standing at the foot end of the table while the patient is in anatomic position.\xa0 Therefore, the patient’s right sided anatomy is on the left side when looking at the display monitor.\xa0 The image is marked with a R (right), L (left), A (anterior), and P (posterior) indicators to orient the viewer. See Figure 3.27.', '0812bd01-fc02-465b-80b3-6300c0c66426': 'CT imaging administers a high radiation exposure to the patient compared to other imaging modalities.\xa0 The best way to limit patient radiation exposure is to not image excessive anatomy i.e. plan the CT scan to image as little anatomy as possible.\xa0 Newer CT scanners have the ability to adjust the x-ray dose administered based upon the changes in volume and thickness of the patient anatomy. Also, newer scanners can use software algorithms to reformat images obtained with very low dose radiation and achieve diagnostic quality.', '9dda4b4e-b32a-4e36-972f-7511c0b723e5': 'There are two major technical features of the CT data set that helps to minimize overall patient radiation exposure:', 'e40041a3-07c4-44c7-b47d-2bf30bbb4e84': 'a) The images are obtained as such thin slices, so closely aligned to each other, that the digital data can be reformatted with software in the coronal and sagittal planes with resulting very high image quality.\xa0 Therefore, the patient only requires one dose of radiation to achieve visualization of their anatomy in the axial, coronal, and sagittal planes, this minimizing overall radiation exposure.\xa0 (See Figure 3.28)'}"
+Figure 3.26,undergradimage/images/Figure 3.26.jpg,Figure 3.26B Head CT on bone level and window. Brain not well seen.,"Once the window range is set, any structures with a pixel density greater than the defined window will appear white and everything with a pixel density less than the defined window will appear black. The ability to adjust the range of greys that are displayed on the image, makes it possible for the interpreter to analyze and compare structures of interest. It is important to remember that when viewing images on a particular level and window setting the anatomy of structures that fall outside the gray scale you are viewing will not be optimally analyzed.  This is particularly evident when you assess the difference in appearance of the head images provided demonstrating the brain and the bone level and window settings.  Brain tissue is well visualized on the brain level and window while there is no useful information about the bone of the skull and vice versa when the bone level and window is viewed, see Figure 3.26.","{'84713707-b6d7-4a10-86d7-485f10152a80': 'Once the window range is set, any structures with a pixel density greater than the defined window will appear white and everything with a pixel density less than the defined window will appear black. The ability to adjust the range of greys that are displayed on the image, makes it possible for the interpreter to analyze and compare structures of interest. It is important to remember that when viewing images on a particular level and window setting the anatomy of structures that fall outside the gray scale you are viewing will not be optimally analyzed.\xa0 This is particularly evident when you assess the difference in appearance of the head images provided demonstrating the brain and the bone level and window settings.\xa0 Brain tissue is well visualized on the brain level and window while there is no useful information about the bone of the skull and vice versa when the bone level and window is viewed, see Figure 3.26.', 'ae2a72e5-a6c4-4519-ae4c-eb4a18f3eaf6': 'It is important to realize the effect of level and window and review the image data set provided to you at all the appropriate level and window settings.\xa0 For example, in the thorax one should view the images on lung, mediastinal, and bone level and window settings to perform a full assessment of the patient’s anatomy.', '71c3f3ec-29cf-403b-b710-5696540ea948': 'The standard viewing format for the CT image display is to look at the images like a loaf of sliced bread with the observer standing at the foot end of the table while the patient is in anatomic position.\xa0 Therefore, the patient’s right sided anatomy is on the left side when looking at the display monitor.\xa0 The image is marked with a R (right), L (left), A (anterior), and P (posterior) indicators to orient the viewer. See Figure 3.27.', '0812bd01-fc02-465b-80b3-6300c0c66426': 'CT imaging administers a high radiation exposure to the patient compared to other imaging modalities.\xa0 The best way to limit patient radiation exposure is to not image excessive anatomy i.e. plan the CT scan to image as little anatomy as possible.\xa0 Newer CT scanners have the ability to adjust the x-ray dose administered based upon the changes in volume and thickness of the patient anatomy. Also, newer scanners can use software algorithms to reformat images obtained with very low dose radiation and achieve diagnostic quality.', '9dda4b4e-b32a-4e36-972f-7511c0b723e5': 'There are two major technical features of the CT data set that helps to minimize overall patient radiation exposure:', 'e40041a3-07c4-44c7-b47d-2bf30bbb4e84': 'a) The images are obtained as such thin slices, so closely aligned to each other, that the digital data can be reformatted with software in the coronal and sagittal planes with resulting very high image quality.\xa0 Therefore, the patient only requires one dose of radiation to achieve visualization of their anatomy in the axial, coronal, and sagittal planes, this minimizing overall radiation exposure.\xa0 (See Figure 3.28)'}"
+Figure 3.27,undergradimage/images/Figure 3.27.jpg,Figure 3.27 Standard viewing orientation for an axial CT image,"The standard viewing format for the CT image display is to look at the images like a loaf of sliced bread with the observer standing at the foot end of the table while the patient is in anatomic position.  Therefore, the patient’s right sided anatomy is on the left side when looking at the display monitor.  The image is marked with a R (right), L (left), A (anterior), and P (posterior) indicators to orient the viewer. See Figure 3.27.","{'84713707-b6d7-4a10-86d7-485f10152a80': 'Once the window range is set, any structures with a pixel density greater than the defined window will appear white and everything with a pixel density less than the defined window will appear black. The ability to adjust the range of greys that are displayed on the image, makes it possible for the interpreter to analyze and compare structures of interest. It is important to remember that when viewing images on a particular level and window setting the anatomy of structures that fall outside the gray scale you are viewing will not be optimally analyzed.\xa0 This is particularly evident when you assess the difference in appearance of the head images provided demonstrating the brain and the bone level and window settings.\xa0 Brain tissue is well visualized on the brain level and window while there is no useful information about the bone of the skull and vice versa when the bone level and window is viewed, see Figure 3.26.', 'ae2a72e5-a6c4-4519-ae4c-eb4a18f3eaf6': 'It is important to realize the effect of level and window and review the image data set provided to you at all the appropriate level and window settings.\xa0 For example, in the thorax one should view the images on lung, mediastinal, and bone level and window settings to perform a full assessment of the patient’s anatomy.', '71c3f3ec-29cf-403b-b710-5696540ea948': 'The standard viewing format for the CT image display is to look at the images like a loaf of sliced bread with the observer standing at the foot end of the table while the patient is in anatomic position.\xa0 Therefore, the patient’s right sided anatomy is on the left side when looking at the display monitor.\xa0 The image is marked with a R (right), L (left), A (anterior), and P (posterior) indicators to orient the viewer. See Figure 3.27.', '0812bd01-fc02-465b-80b3-6300c0c66426': 'CT imaging administers a high radiation exposure to the patient compared to other imaging modalities.\xa0 The best way to limit patient radiation exposure is to not image excessive anatomy i.e. plan the CT scan to image as little anatomy as possible.\xa0 Newer CT scanners have the ability to adjust the x-ray dose administered based upon the changes in volume and thickness of the patient anatomy. Also, newer scanners can use software algorithms to reformat images obtained with very low dose radiation and achieve diagnostic quality.', '9dda4b4e-b32a-4e36-972f-7511c0b723e5': 'There are two major technical features of the CT data set that helps to minimize overall patient radiation exposure:', 'e40041a3-07c4-44c7-b47d-2bf30bbb4e84': 'a) The images are obtained as such thin slices, so closely aligned to each other, that the digital data can be reformatted with software in the coronal and sagittal planes with resulting very high image quality.\xa0 Therefore, the patient only requires one dose of radiation to achieve visualization of their anatomy in the axial, coronal, and sagittal planes, this minimizing overall radiation exposure.\xa0 (See Figure 3.28)'}"
+Figure 3.28,undergradimage/images/Figure 3.28.jpg,Figure 3.28A CT image displayed in axial orientation,"a) The images are obtained as such thin slices, so closely aligned to each other, that the digital data can be reformatted with software in the coronal and sagittal planes with resulting very high image quality.  Therefore, the patient only requires one dose of radiation to achieve visualization of their anatomy in the axial, coronal, and sagittal planes, this minimizing overall radiation exposure.  (See Figure 3.28)","{'84713707-b6d7-4a10-86d7-485f10152a80': 'Once the window range is set, any structures with a pixel density greater than the defined window will appear white and everything with a pixel density less than the defined window will appear black. The ability to adjust the range of greys that are displayed on the image, makes it possible for the interpreter to analyze and compare structures of interest. It is important to remember that when viewing images on a particular level and window setting the anatomy of structures that fall outside the gray scale you are viewing will not be optimally analyzed.\xa0 This is particularly evident when you assess the difference in appearance of the head images provided demonstrating the brain and the bone level and window settings.\xa0 Brain tissue is well visualized on the brain level and window while there is no useful information about the bone of the skull and vice versa when the bone level and window is viewed, see Figure 3.26.', 'ae2a72e5-a6c4-4519-ae4c-eb4a18f3eaf6': 'It is important to realize the effect of level and window and review the image data set provided to you at all the appropriate level and window settings.\xa0 For example, in the thorax one should view the images on lung, mediastinal, and bone level and window settings to perform a full assessment of the patient’s anatomy.', '71c3f3ec-29cf-403b-b710-5696540ea948': 'The standard viewing format for the CT image display is to look at the images like a loaf of sliced bread with the observer standing at the foot end of the table while the patient is in anatomic position.\xa0 Therefore, the patient’s right sided anatomy is on the left side when looking at the display monitor.\xa0 The image is marked with a R (right), L (left), A (anterior), and P (posterior) indicators to orient the viewer. See Figure 3.27.', '0812bd01-fc02-465b-80b3-6300c0c66426': 'CT imaging administers a high radiation exposure to the patient compared to other imaging modalities.\xa0 The best way to limit patient radiation exposure is to not image excessive anatomy i.e. plan the CT scan to image as little anatomy as possible.\xa0 Newer CT scanners have the ability to adjust the x-ray dose administered based upon the changes in volume and thickness of the patient anatomy. Also, newer scanners can use software algorithms to reformat images obtained with very low dose radiation and achieve diagnostic quality.', '9dda4b4e-b32a-4e36-972f-7511c0b723e5': 'There are two major technical features of the CT data set that helps to minimize overall patient radiation exposure:', 'e40041a3-07c4-44c7-b47d-2bf30bbb4e84': 'a) The images are obtained as such thin slices, so closely aligned to each other, that the digital data can be reformatted with software in the coronal and sagittal planes with resulting very high image quality.\xa0 Therefore, the patient only requires one dose of radiation to achieve visualization of their anatomy in the axial, coronal, and sagittal planes, this minimizing overall radiation exposure.\xa0 (See Figure 3.28)'}"
+Figure 3.28,undergradimage/images/Figure 3.28.jpg,Figure 3.28B CT image displayed in sagittal orientation,"a) The images are obtained as such thin slices, so closely aligned to each other, that the digital data can be reformatted with software in the coronal and sagittal planes with resulting very high image quality.  Therefore, the patient only requires one dose of radiation to achieve visualization of their anatomy in the axial, coronal, and sagittal planes, this minimizing overall radiation exposure.  (See Figure 3.28)","{'84713707-b6d7-4a10-86d7-485f10152a80': 'Once the window range is set, any structures with a pixel density greater than the defined window will appear white and everything with a pixel density less than the defined window will appear black. The ability to adjust the range of greys that are displayed on the image, makes it possible for the interpreter to analyze and compare structures of interest. It is important to remember that when viewing images on a particular level and window setting the anatomy of structures that fall outside the gray scale you are viewing will not be optimally analyzed.\xa0 This is particularly evident when you assess the difference in appearance of the head images provided demonstrating the brain and the bone level and window settings.\xa0 Brain tissue is well visualized on the brain level and window while there is no useful information about the bone of the skull and vice versa when the bone level and window is viewed, see Figure 3.26.', 'ae2a72e5-a6c4-4519-ae4c-eb4a18f3eaf6': 'It is important to realize the effect of level and window and review the image data set provided to you at all the appropriate level and window settings.\xa0 For example, in the thorax one should view the images on lung, mediastinal, and bone level and window settings to perform a full assessment of the patient’s anatomy.', '71c3f3ec-29cf-403b-b710-5696540ea948': 'The standard viewing format for the CT image display is to look at the images like a loaf of sliced bread with the observer standing at the foot end of the table while the patient is in anatomic position.\xa0 Therefore, the patient’s right sided anatomy is on the left side when looking at the display monitor.\xa0 The image is marked with a R (right), L (left), A (anterior), and P (posterior) indicators to orient the viewer. See Figure 3.27.', '0812bd01-fc02-465b-80b3-6300c0c66426': 'CT imaging administers a high radiation exposure to the patient compared to other imaging modalities.\xa0 The best way to limit patient radiation exposure is to not image excessive anatomy i.e. plan the CT scan to image as little anatomy as possible.\xa0 Newer CT scanners have the ability to adjust the x-ray dose administered based upon the changes in volume and thickness of the patient anatomy. Also, newer scanners can use software algorithms to reformat images obtained with very low dose radiation and achieve diagnostic quality.', '9dda4b4e-b32a-4e36-972f-7511c0b723e5': 'There are two major technical features of the CT data set that helps to minimize overall patient radiation exposure:', 'e40041a3-07c4-44c7-b47d-2bf30bbb4e84': 'a) The images are obtained as such thin slices, so closely aligned to each other, that the digital data can be reformatted with software in the coronal and sagittal planes with resulting very high image quality.\xa0 Therefore, the patient only requires one dose of radiation to achieve visualization of their anatomy in the axial, coronal, and sagittal planes, this minimizing overall radiation exposure.\xa0 (See Figure 3.28)'}"
+Figure 3.28,undergradimage/images/Figure 3.28.jpg,Figure 3.28C CT image displayed in coronal orientation,"a) The images are obtained as such thin slices, so closely aligned to each other, that the digital data can be reformatted with software in the coronal and sagittal planes with resulting very high image quality.  Therefore, the patient only requires one dose of radiation to achieve visualization of their anatomy in the axial, coronal, and sagittal planes, this minimizing overall radiation exposure.  (See Figure 3.28)","{'84713707-b6d7-4a10-86d7-485f10152a80': 'Once the window range is set, any structures with a pixel density greater than the defined window will appear white and everything with a pixel density less than the defined window will appear black. The ability to adjust the range of greys that are displayed on the image, makes it possible for the interpreter to analyze and compare structures of interest. It is important to remember that when viewing images on a particular level and window setting the anatomy of structures that fall outside the gray scale you are viewing will not be optimally analyzed.\xa0 This is particularly evident when you assess the difference in appearance of the head images provided demonstrating the brain and the bone level and window settings.\xa0 Brain tissue is well visualized on the brain level and window while there is no useful information about the bone of the skull and vice versa when the bone level and window is viewed, see Figure 3.26.', 'ae2a72e5-a6c4-4519-ae4c-eb4a18f3eaf6': 'It is important to realize the effect of level and window and review the image data set provided to you at all the appropriate level and window settings.\xa0 For example, in the thorax one should view the images on lung, mediastinal, and bone level and window settings to perform a full assessment of the patient’s anatomy.', '71c3f3ec-29cf-403b-b710-5696540ea948': 'The standard viewing format for the CT image display is to look at the images like a loaf of sliced bread with the observer standing at the foot end of the table while the patient is in anatomic position.\xa0 Therefore, the patient’s right sided anatomy is on the left side when looking at the display monitor.\xa0 The image is marked with a R (right), L (left), A (anterior), and P (posterior) indicators to orient the viewer. See Figure 3.27.', '0812bd01-fc02-465b-80b3-6300c0c66426': 'CT imaging administers a high radiation exposure to the patient compared to other imaging modalities.\xa0 The best way to limit patient radiation exposure is to not image excessive anatomy i.e. plan the CT scan to image as little anatomy as possible.\xa0 Newer CT scanners have the ability to adjust the x-ray dose administered based upon the changes in volume and thickness of the patient anatomy. Also, newer scanners can use software algorithms to reformat images obtained with very low dose radiation and achieve diagnostic quality.', '9dda4b4e-b32a-4e36-972f-7511c0b723e5': 'There are two major technical features of the CT data set that helps to minimize overall patient radiation exposure:', 'e40041a3-07c4-44c7-b47d-2bf30bbb4e84': 'a) The images are obtained as such thin slices, so closely aligned to each other, that the digital data can be reformatted with software in the coronal and sagittal planes with resulting very high image quality.\xa0 Therefore, the patient only requires one dose of radiation to achieve visualization of their anatomy in the axial, coronal, and sagittal planes, this minimizing overall radiation exposure.\xa0 (See Figure 3.28)'}"
+Figure 3.30,undergradimage/images/Figure 3.30.jpg,Figure 3.30 CT PE image maximizing the injected contrast in the pulmonary arteries,"CT has also become highly adapted to imaging arterial and venous anatomy and in some instances has replaced catheter based angiography as the gold standard examination, e.g. pulmonary angiography has been supplanted by CT PE (pulmonary embolism) studies.  This is due to the ability of the newer, multi-detector, helical, CT scanners to rapidly cover a large area of patient anatomy due to the size of the detectors.  Hence, contrast enhanced CT images can be obtained during a narrow window of time when a particular vascular structure is maximally enhanced with intravenous contrast agent.  The image acquisition can be timed to maximally enhance arteries or veins.  Figure 3.30 demonstrates optimal timing of the CT images for enhancement of the pulmonary arteries.","{'aaa2a13b-0f63-4c89-ac78-37d86300141d': 'CT has also become highly adapted to imaging arterial and venous anatomy and in some instances has replaced catheter based angiography as the gold standard examination, e.g. pulmonary angiography has been supplanted by CT PE (pulmonary embolism) studies.\xa0 This is due to the ability of the newer, multi-detector, helical, CT scanners to rapidly cover a large area of patient anatomy due to the size of the detectors.\xa0 Hence, contrast enhanced CT images can be obtained during a narrow window of time when a particular vascular structure is maximally enhanced with intravenous contrast agent.\xa0 The image acquisition can be timed to maximally enhance arteries or veins.\xa0 Figure 3.30\xa0demonstrates optimal timing of the CT images for enhancement of the pulmonary arteries.'}"
+Figure 3.19,undergradimage/images/Figure 3.19.jpg,Figure 3.19 Angiography Machine with C-Arm,"The images acquired are obtained very rapidly in cine mode resulting in a set of stacked images, that when stored and viewed, simulate a video recording.  Cine mode allows for the dynamic assessment of moving contrast and movement of catheters and guide wires inside the anatomy of the patient. A standard c-arm angiography unit is depicted in Figure 3.19.","{'9d9da8c6-2e61-47f2-ba4d-6a20496f0d3a': 'All figures in “Chapter 17: Musculoskeletal” by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan are used under a CC-BY-NC-SA 4.0 license.', '42459c0f-ddfe-46c5-b1fd-6793f01031b5': '2) Gaillard, F. Salter-Harris Classification, Radiopaedia.org. https://radiopaedia.org/articles/salter-harris-classification', '99a28b8c-45c1-4a34-b607-d24433ffd59c': '3) Boaz K. Karmazyn, MD; Adina L Alazraki, MD; Sudha A. Anupindi, MD, et al. ACR Appropriateness Criteria® Pediatric – Urinary Tract Infection. Available at https://acsearch.acr.org/docs/69444/Narrative/\xa0 American College of Radiology. Accessed June 30, 2017.', 'ff59e5e9-8d3d-4318-86bd-c8746ebe5e27': '4) Urinary Tract Infection: Clinical Practice Guideline for\n\nthe Diagnosis and Management of the Initial UTI in\n\nFebrile Infants and Children 2 to 24 Months. Pediatrics 2011, 128 (3): 595 – 610.', '95839fcd-3dad-4370-b8c9-efa3ae8fee8d': '5) Dr. Matt Skalski, Ureteric reflux, Radiopaedia.org. “https://radiopaedia.org/\xa0 From the case “https://radiopaedia.org/cases/22569 rID: 22569', '26535aad-e785-402b-9277-4da9563c4525': '6) Molly E. Raske, MD; Molly E. Dempsey, MD; Jonathan R. Dillman, MD, et al. ACR Appropriateness Criteria® Pediatric – Vomiting in Infants Up to 3 Months of Age. Available at https://acsearch.acr.org/docs/69445/Narrative/ American College of Radiology. Accessed June 30, 2017.', '6ec32d8a-c136-48d5-9703-61624050f9f6': '7) Learning\xa0radiology\xa0: recognizing the basics. William Herring author. Elsevier 2016 Online access University of Saskatchewan Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK Accessed, June 30, 2017.', '3db9d0ef-38dd-4332-812d-6af2dfa4db69': '8) Grainger and Allison’s diagnostic\xa0radiology\xa0: a textbook of medical imaging. Andy Adam editor.; Adrian K. Dixon editor.; Jonathan H. Gillard 1964- editor.; Cornelia Schaefer-Prokop editor.; David J Allison; Elsevier (Firm) 2015, Online access University of Saskatchewan Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK\xa0 Accessed June 30, 2017.', '5bf49964-973b-4c4d-88b4-2696683964c1': '2) Radiopaedia.org – https://radiopaedia.org/articles/rockwood-classification-of-acromioclavicular-joint-injury Rockwood classification of AC-Joint injuries. Accessed June 30, 2017.', '59261295-fce8-49b2-a2de-77852eccc04a': '3) Common Forearm Fractures in Adults. American Family Physician 2009: 80 (10): 1096 – 1102.', '2f360c6a-b1f6-4af3-a4c8-e0b8438b9a58': '4) Diagnosis and Management of Scaphoid Fractures.\xa0 American Family Physician 2004; 70 (5); 879 – 884.', 'a5a2c608-b474-4203-bd8a-41a1f1ceb548': '5) Michael A. Bruno, MD; Barbara N. Weissman, MD; Mark J. Kransdorf, MD, et al. MSK – Hand and Wrist Trauma. \xa0Available at https://acsearch.acr.org/docs/69418/Narrative/ American College of Radiology. Accessed June 30, 2017.', '3548e3f8-9289-4063-8539-de870f48b911': '6) Robert J. Ward, MD, CCD; Barbara N. Weissman, MD; Mark J. Kransdorf, MD., et al. ACR Appropriateness Criteria®, MSK – Acute Hip Pain – Suspected Fracture. \xa0Available at https://acsearch.acr.org/docs/3082587/Narrative/ American College of Radiology. Accessed June 30, 2017.', '59596a80-aaf5-43e7-985e-7b2593951114': '7) Radiopaedia.org – https://radiopaedia.org/articles/femoral-neck-fracture Accessed June 30, 2017.', '469c112e-865a-482d-9b7e-5830232cee0e': '8) Michael J. Tuite, MD; Mark J. Kransdorf, MD; Francesca D. Beaman, MD, et al. ACR Appropriateness Criteria®, MSK – Acute Trauma to the Knee. Available at https://acsearch.acr.org/docs/69419/Narrative/ American College of Radiology. Accessed June 30, 2017.', '61b9265e-5af7-4d75-833f-a9344ce39570': '9) Ottawa Knee Rule – Stiell IG, Wells GA, Hoag RH, Sivilotti ML, et al (1997). “Implementation of the Ottawa Knee Rule for the use of radiography in acute knee injuries.”. JAMA. 278 (27): 2075–9. PMID\xa09403421. doi:10.1001/jama.1997.03550230051036. Accessed June 30, 2017.', 'd567b915-ef5d-4c0d-8e5b-f533c7036e91': '10) Ottawa Ankle Rule – Stiell IG, McKnight RD, Greenberg GH, et al. (March 1994). “Implementation of the Ottawa ankle rules”. JAMA. 271 (11): 827–32. PMID\xa08114236. doi:10.1001/jama.1994.03510350037034. Accessed June 30, 2017.', '92efbc09-23c1-4b33-b265-50b693fca389': '11) Jon A. Jacobson, MD; Catherine C. Roberts, MD; Jenny T. Bencardino, MD, et al. ACR Appropriateness Criteria®, \xa0MSK – Chronic Extremity Joint Pain Available at https://acsearch.acr.org/docs/3097211/Narrative/ American College of Radiology. Accessed June 30, 2017.', '170f0345-ab5f-45e0-8acd-470a44d17663': '2) Catheter Replacement of the Needle for Arteriography. Seldinger, S. I. Acta Radiologica, 1953: 39 (5); 368 – 376.', 'd55b79a0-51d8-4933-a57a-7d6b6cb5597b': '3) Thomas B. Kinney, MD; Hamed Aryafar, MD; Charles E. Ray, Jr, MD, PhD, et al. ACR Appropriateness Criteria® Management of Inferior Vena Cava Filters. Available at https://acsearch.acr.org/docs/69342/Narrative/ American College of Radiology. Accessed June 30, 2017', 'ba20e351-4219-47c3-b9c5-b61de5ab8fd9': '4) Learning\xa0radiology:recognizing the basics. William Herring author. Elsevier 2016, Online access University of Saskatchewan Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK Accessed, June 30, 2017.', '3fc9b447-cac6-4420-ac4e-05f656e81f43': '5) Grainger and Allison’s diagnostic\xa0radiology\xa0: a textbook of medical imaging. Andy Adam editor.; Adrian K. Dixon editor.; Jonathan H. Gillard 1964- editor.; Cornelia Schaefer-Prokop editor.; David J Allison; Elsevier (Firm) 2015, Online access University of Saskatchewan Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK\xa0 Accessed June 30, 2017.', 'a53e9698-8be5-4b56-ba59-87393e1e60b7': '2) Vahid Yaghmai, MD, MS; Max P. Rosen, MD, MPH; Tasneem Lalani, MD. ACR Appropriateness Criteria® \xa0– Gastrointestinal – Acute (non-localized) Abdominal Pain and Fever – Pneumoperitoneum. Available at\xa0 https://acsearch.acr.org/docs/69467/Narrative/ American College of Radiology. Accessed June 30, 2017.', '23ab0a22-ea4d-4c3f-9d72-f3a49ca4f6fd': '3) Douglas S. Katz, MD; Mark E. Baker, MD; Max P. Rosen, MD, MPH. ACR Appropriateness Criteria® – Gastrointestinal – Suspected Small Bowel Obstruction. Available at https://acsearch.acr.org/docs/69476/Narrative/ American College of Radiology. Accessed June 30, 2017.', 'f3c446dd-aa8d-4d22-aed4-b5e89863cd27': '4) Martin P. Smith, MD; Douglas S. Katz, MD; Max P. Rosen, MD, MPH. ACR Appropriateness Criteria® – Gastrointestinal – Right Lower Quadrant Pain – Suspected Appendicitis. Available at https://acsearch.acr.org/docs/69357/Narrative/ American College of Radiology. Accessed June 30, 2017.', 'e40080ff-07b5-4509-a9d8-3d7ff39b3c19': '5) Michelle M. McNamara, MD; Tasneem Lalani, MD; Marc Anthony Camacho, MD. ACR Appropriateness Criteria® \xa0– Gastrointestinal – Left Lower Quadrant Pain – Suspected Diverticulitis. Available at https://acsearch.acr.org/docs/69356/Narrative/ American College of Radiology. Accessed June 30, 2017.', 'a6f6cc9d-0ee1-42b0-ba1b-410ac9dc0387': '6) Rendon C. Nelson, MD; Ihab R. Kamel, MD, PhD; Mark E. Baker, MD. ACR Appropriateness Criteria® \xa0– Gastrointestinal – Liver Lesion – Initial Characterization. Available at https://acsearch.acr.org/docs/69472/Narrative/ American College of Radiology. Accessed June 30, 2017.', '154ec87b-5220-4418-99a5-75ec9d9fafec': '7) Tasneem Lalani, MD; Corey A. Couto, MD; Max P. Rosen, MD, MPH. ACR Appropriateness Criteria® \xa0– Gastrointestinal – Jaundice. Available at https://acsearch.acr.org/docs/69497/Narrative/ American College of Radiology. Accessed June 30, 2017.', '740ebf07-9cb8-4ed5-9cac-8bb79c578c8d': '2) Jacobo Kirsch, MD; Tan-Lucien H. Mohammed, MD, et al.\xa0 ACR Appropriateness Criteria®, Chest – Acute Respiratory Illness in Immunocompetent Patient. Available at https://acsearch.acr.org/docs/69446/Narrative/ Accessed, June 30, 2017.', '571524ec-b296-4a2d-95dc-97db963c3fcb': '3) Debra Sue Dyer, MD; Tan-Lucien H. Mohammed, MD; Jacobo Kirsch, MD, et al. ACR Appropriateness Criteria®, Chest – Chronic Dyspnea – Suspected Pulmonary Origin. \xa0Available at https://acsearch.acr.org/docs/69448/Narrative/ Accessed June 30, 2017.', 'f22ed822-b387-44e5-8a22-dd8a867b8b01': '4) Learning\xa0radiology\xa0: recognizing the basics. William Herring author. Elsevier 2016 Online access USask Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK Accessed, June 30, 2017.', '87cb046f-4dac-41ec-84d0-bed36b33d265': '5) Jeffrey P. Kanne, MD, Leif E. Jensen, MD, MPH, Tan-Lucien H. Mohammed, MD, et al. ACR Appropriateness Criteria®,\xa0 Chest – Radiographically Detected Solitary Pulmonary Nodule. Available at https://acsearch.acr.org/docs/69455/Narrative/ Accessed June 30, 2017.', '3159e24d-3174-4315-993d-23dd449b06b4': '6) Fleischner Society – https://fleischnersociety.org', 'd07c0b2d-9413-4046-ab1e-55f117865c2a': '7) Michael A. Bettmann, MD, Scott G. Baginski, MD, Richard D. White, MD, et al. ACR Appropriateness Criteria®, Chest – Acute Chest Pain – Suspected Pulmonary Embolism. Available at https://acsearch.acr.org/docs/69404/Narrative/\xa0 Accessed June 30, 2017.', 'cd973045-ca97-4b36-a285-52581f60f304': 'Ultrasound uses traditional probes with higher frequency to better image the breast tissue that is in close proximity to the overlying skin.', '13e1e8e0-e640-4941-8300-c31710b3a53c': 'Mammography/Breast Imaging Centres in Canada are accredited and audited for quality by the Canada Association of Radiologists.', 'eca3d4b9-a2c4-43c7-ae2b-3ec757983d8b': '2) Vilaas S. Shetty, MD; Martin N. Reis, MD; Joseph M. Aulino, MD, et al. ACR Appropriateness Criteria® Head Trauma. Available at https://acsearch.acr.org/docs/69481/Narrative/ American College of Radiology. Accessed, June 30, 2017.', 'a923162d-9460-4587-991e-319c82bf5c9f': 'https://acsearch.acr.org/docs/69481/Narrative/', '96ac01aa-0380-4fa5-be27-55a5b787830c': '3) Michael B. Salmela, MD; Shabnam Mortazavi, MD; Bharathi D. Jagadeesan, MD, ACR, et al. Appropriateness Criteria® Cerebrovascular Disease. https://acsearch.acr.org/docs/69478/Narrative/ American College of Radiology. Accessed, June 30, 2017.', 'b68256b4-9387-4475-8f5a-41b599bfaf04': 'https://acsearch.acr.org/docs/69478/Narrative/', 'd4f105b8-2855-4af9-a3cb-f9d88fcdbf18': '4) Annette C. Douglas, MD; Franz J. Wippold II, MD; Daniel F. Broderick, MD, et al. Appropriateness Criteria® Headache. https://acsearch.acr.org/docs/69482/Narrative/ American College of Radiology. Accessed, June 30, 2017.', '74770c44-e954-4084-abd6-2740860fa07d': 'https://acsearch.acr.org/docs/69482/Narrative/', 'edab0354-1c57-4db0-b1dd-6ea014cb5e00': '5) Nandini D. Patel, MD; Daniel F. Broderick, MD; Judah Burns, MD, et al. Appropriateness Criteria® Low Back Pain. https://acsearch.acr.org/docs/69483/Narrative/ American College of Radiology. Accessed, June 30, 2017.', 'd0966524-e032-4f5a-9faf-1e8f783d8061': 'https://acsearch.acr.org/docs/69483/Narrative/', 'aa597d16-b4a3-404a-889f-e4a901c750d6': '6) Richard H. Daffner, MD; Barbara N. Weissman, MD; Franz J. Wippold II, MD, et al. Appropriateness Criteria®  Suspected Spine Trauma. https://acsearch.acr.org/docs/69359/Narrative/ American College of Radiology. Accessed, June 30, 2017.', '6945685d-8bdd-48ba-9299-88cd95cdcccc': 'https://acsearch.acr.org/docs/69359/Narrative/', 'd6137ceb-35ba-41f9-b5ad-909c0c93c831': 'The standard views are AP (anterior-posterior) and lateral.\xa0 These two views are taken at right angles (orthogonal) to each other.\xa0 If these images are not helpful, ancillary views such as oblique views, or special views such as, an axillary or carpal tunnel view, may be required based upon the clinical scenario.', '8da19a7d-ea8a-48f7-802b-c3e6ad2879ea': 'Stress views i.e. a force is applied to a bone or joint to determine if an injury is present, such as, a subtle avulsion or a suspected tendon or ligament tear causing joint instability. These are acquired as special requests and should be performed in a manner that minimizes patient pain and discomfort.', 'c1ddb6e5-c42b-4c10-ac0d-ed3b6ab5cbad': 'At least one joint space should be visible in relation to the suspected bone injury.\xa0 Additional x-ray views and views of another adjacent joint space may be required in some circumstances.', 'd8ec4a87-ef98-4bd8-9ee3-47f8c6612a49': 'Comparison views to the contralateral, normal bone, or joint, may be required, this is especially true if a subtle growth plate injury is suspected in a child.\xa0 Comparison views should not be ordered routinely, but should be used if clinically necessary.', 'd76a51e5-d391-4400-aa76-b67e2d5a4233': 'It is important to remember that some bone and ligament injuries occur as a common pattern of multiple injuries i.e. the Colle fracture of the distal radius is often associated with an avulsion fracture of the ulnar styloid.\xa0 Ankle ligament injuries and fractures often occur in a sequence i.e. medial malleolar avulsion fracture (or medial ligament tear), interosseous ligament tear between the tibia and fibula, and a subsequent oblique fracture of the proximal fibula (Maisonneuve fracture complex).\xa0 Keep this in mind as you encounter various patients and you will develop knowledge and experience of these associated bone and soft tissue injuries.', 'd26261d6-1894-4731-a4bc-cb382c5fc4b8': 'Fractures usually present as a lucent line on x-rays involving the cortex and medulla of the bone that can be followed from one cortex to the opposite cortex with varying degrees of displacement and malalignment of the involved bone.', '6d3c05b4-f04f-464e-828c-e219309240b2': 'There are some fractures that may be associated with bone ischemia and avascular necrosis i.e. capital femoral fractures and scaphoid fractures.\xa0 Be aware of this and learn the importance of aggressive and pre-emptive management for these patients.', '9efc69ef-d567-4c20-b7da-5b5faae548f8': 'Fig 5.7 Abdomen Quadrants/Regions\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'c17eee8e-a5a7-4b3d-aa39-e9562f679745': 'Fig 5.8\xa0Supine Positioning for Abdomen x-ray, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', 'e428391c-3d1e-4c3d-a0ee-4e39fd82ee4d': 'Fig 5.9 Upright Positioning for Abdomen x-ray, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', '4fe76b20-0ac2-49ac-a875-af27033355ec': 'Fig 5.10 Decubitus Positioning for Abdomen x-ray, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', '1e50fdef-529f-4fe1-b3f4-ab42378ca31f': 'Fig 5.11 Normal Abdominal x-ray by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '27e0addc-368c-4208-9970-6559705ff1e8': 'Fig 5.12 Colon anatomy emphasized by the presence of barium and air by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '990d74a2-1431-4705-8efd-4cf210fa9ce3': 'Fig 5.13 Bones and Musculoskeletal Landmarks in the Abdomen by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '3d050294-a087-4835-a5ed-7961069e1f0a': 'Fig 5.14 Possible Artifacts on Abdomen x-rays. The image demonstrates two umbilical piercings, fallopian tube clips, and the buttons on the patient’s pants by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'cbf4613b-cbd6-4078-b9c3-b1c333a37c48': 'The standard upright views of the chest are made when a patient is typically placed between an x-ray source and an x-ray detector. When the x-rays penetrate the tissues of the patient, they stimulate an x-ray detector that alters the energy of the x-ray beam into a digital pixel grid. The radiograph produced is referred to as a roentgenogram and named after Wilhelm Konrad Roentgen who received the first Nobel Prize for Physics in 1901 for his work in defining the major properties of x-rays and the conditions necessary for their production. It was Roentgen who coined the term “x-ray”.', '9da044bd-e951-4eb4-8cf9-ccb9398a2423': 'Fig 5.1 A portable upright x-ray where the image is not taken with proper body alignment, the patient is rotated and tilted\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '0bc6ae7d-c9c2-4d6d-ae6c-f07a5a647792': 'Fig 5.2 A portable upright x-ray taken with patient in proper alignment\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'e27384e1-63ef-4a65-a138-41a0d8870a95': 'Fig 4.1A Fluoroscopy – Shoulder Arthrogram Early Phase of Injection\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '2f124311-a640-4063-9232-06af6006da7a': 'Fig 4.1B\xa0Shoulder Arthrogram Fluoroscopy Mid-Phase of Injection by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'bb7b38f9-ff02-462d-8d99-621dd444c05e': 'Fig 4.1C Shoulder Arthrogram Late Phase of Injection\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'b6d8041f-18d1-40b8-a5b0-44c6bfeb9405': 'Fig 4.2A\xa0CT Aorta, C-\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'b98a8c21-5a63-4b95-b9ce-f7e38e6999bc': 'Fig 4.2B CT Iliac Arteries, C-\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '43da027d-17e8-4ba4-b312-67fba1bd1511': 'Fig 4.2C CT Aorta, C+\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'b66fdc16-e8ca-433f-8a6e-1d0f3f659bb3': 'Fig 4.2D CT Iliac Arteries, C+\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '8964941e-dc07-44fd-954a-0403c1bfd992': '2) Image Wisely. http://www.imagewisely.org/ Last accessed, Aug. 22, 2017.', 'ed5f284b-a74a-4376-b274-77e0e2303fc9': '3) Image Gently. http://www.imagegently.org/ Last accessed Aug 22, 2017.', 'fc2d1e7a-fa5b-4dbc-917f-25f258eb23d6': '4) Novelline, R. A., & Squire, L. F. (2004), sixth edition. Squire’s fundamentals of radiology. Cambridge, Mass: Harvard University Press.', 'ce057be0-807e-4b88-a477-0d87c59e607b': 'Fig 3.43 Nuclear Medicine Scanner by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'dce81a39-f2bd-47ee-847d-9205bbc446e1': 'Fig 3.44A Normal, Pediatric Nuclear Medicine Bone Scan by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '8bed792d-6442-4cbd-89db-89b5a4cb4541': 'Fig 3.44B Normal, Adult Nuclear Medicine Bone Scan\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '41bf79b1-bfd9-4a16-9b5d-900405a59176': 'Fib 3.45 PET/CT Scanner\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '8fcd15af-34e1-492f-91a7-3b8b671387ed': 'Fig 3.46A PET/CT image of the chest for a patient with lymphoma\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '211a4b55-451b-4858-aa60-ce4253c9d555': 'Fig 3.46B PET image of the whole body for a patient with lymphoma\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '15d4a271-c53b-449d-8385-a1b6030fd923': 'The appearance of different tissue on MR images is described as displaying greater, or lesser, signal in comparison the other anatomy in the region. The signal in question is the energy that the perturbed protons liberated when they fall back into alignment with the magnetic field. The signal intensity of the tissue in question changes based upon the image acquisition parameters set by the MR Technologist, under the direction of a supervising Radiologist.\xa0 The parameters set result in the acquisition of a set of images called an MR imaging sequence. On one sequence cerebrospinal fluid will appear as black pixels (T1 sequence) while on another sequence it is white pixels (T2 sequence). This difference in tissue appearance can be exploited to determine if pathology is present.', '33f25041-480d-4bb9-95fc-0a28bc2224ed': 'Fig 3.31\xa0B-Mode Ultrasound of the Carotid bulb with atherosclerotic plaque\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '18658974-a7a2-499b-881c-5a51baaa9854': 'Fig 3.32A\xa0Ultrasound Machine\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '5c75f45f-6624-42df-b964-dddafeae9d32': 'Fig 3.32B Mobile Ultrasound Machine\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'f351a841-d5dd-4048-8f36-831f0bbf09d9': 'Fig 3.33 Ultrasound image of the normal liver and kidney. The echogenicity of the liver is greater than the echogenicity of the adjacent renal cortex by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '059ddd7b-14ba-4290-92ad-7382c9156fc4': 'Fig 3.34 Gallbladder\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '5db401cc-d0ff-4f03-945a-f50dd89e4be9': 'Fig 3.35A Normal Liver Ultrasound by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'fae31525-31fa-491b-8fcf-6206343abf74': 'Fig 3.35B Hepatomegaly and hepatic steatosis on Ultrasound\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '4aa1ffad-a8df-4cef-8f34-a9695f5958bc': 'Fig 3.36 Colour Doppler, of the neck\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '99b1c66a-6cc2-4a4e-872f-476d28cdab03': 'Fig 3.37 Colour Doppler of the neck with Spectral Display\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '21a2827a-f5ed-4e96-a0d9-b91bdf773c22': 'Fig 3.38A\xa0Internal Carotid Doppler Ultrasound Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '6bf5c327-c3cb-4f8c-b09c-7b96d908326a': 'Fig 3.38B Carotid Bulb Doppler Ultrasound\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '8d123159-7ce7-4972-bc0c-86aa528a32ae': 'Fig 3.38C\xa0Vertebral Doppler Ultrasound\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'b8f04a00-104c-40e3-8e47-1dc899d44ca1': 'Fig 3.39 Linear probe and two curved array probes\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'c15107ec-6f70-4702-929e-61aeee36a137': 'The patient does not need to be moved, or re-positioned, to obtain CT images in different anatomic planes.\xa0 The patient lies on the CT table in anatomic position and remains in that position throughout the study.\xa0 The standard orientation of image acquisition for CT is in the axial plane, hence the old name for this machine of CAT (computed axial tomography) scanner.\xa0 Often the axial images obtained during the initial x-ray exposure will be digitally reformatted into other anatomic planes i.e. sagittal and coronal.\xa0 These reformatted images are the result of a computer algorithm reformatting the original digital image data and, as such, these supplemental anatomic planes of imaging do not require additional x-ray exposure.', '23a6edd0-ea0d-4597-87b7-d94ca733c3a5': 'The CT gantry can be tipped cranially and caudally to deviate from the axial plane by 30 degrees in either direction and this can be used to correct for patient anatomic variability to maintain the axial plane, if necessary.\xa0 It also allows for unique imaging along an angled plane that can be used when requested by the referring physician or the radiologist.\xa0 A widely used example of imaging in an angled plane is found for CT Head examinations. It is not conventional to acquire these images in the axial plane but to image the brain on the canthomeatal (lateral orbit canthus to the aural meatus) line and therefore, the CT gantry must be tilted to ensure that all CT Head images are acquired in this plane.\xa0 Originally, this plane was chosen as it maximizes information about the intra-cranial contents while minimizing the exposure of the orbits (lens) to radiation. The orbito-meatal line has become the internationally recognized plane for acquiring CT head images. This line is depicted in Figure 3.22.', '2a01449e-f80d-44b8-b5f1-9fbd2293de89': 'The physics of CT image creation are complex and require complex computer processing to create images that are visible for clinical use.\xa0 As the x-ray tube and the x-ray detectors revolve around the patient thousands of mathematical calculations are performed to determine how much of the incident x-ray beam was absorbed by a volume of tissue. This volume of tissue is called a voxel. The calculated absorption of the x-rays by a voxel is converted into a pixel density that is displayed on a gray scale from -1,000 (air) to +1,000 (metal).\xa0 This scale is called the Hounsfield unit (HU) scale after one of the principle inventors of CT, Sir Godfrey Hounsfield.\xa0 The calculated density of this voxel is then allocated to a pixel on a grid of the 512 x 512 pixels that forms each individual CT image.', '7630aac5-da71-4093-992f-e3de7e0777cf': 'Therefore, if the volume of tissue contained air, or gas, the pixel density allocated would be close to -1,000 HU, while if the volume of tissue analyzed contained metal (bullet fragment, etc.) the pixel would be assigned a density close to the +1,000 HU.\xa0 The assignment of pixel density to voxels spans the entire possible range of pixels from -1,000 – +1,000 HU, resulting in 2,000 shades of grey.\xa0 An image with the HU measurements of specific anatomic regions is provided in Figure 3.23.', '194d89df-a49e-4ba0-a141-fedb5b7d0e3d': 'CT density: a region on a CT image is described as being more, or less, dense than another region. The liver is more dense than the renal cortex.\xa0 This variation in pixel density can be quantified by measuring all the pixels in a region and creating an average pixel density i.e. region of interest of an area of liver can be measured, with a standard deviation, 50 HU +/- 5 HU, etc. The HU density of some common structures is provided in Table 3.2.', '7fd3f166-8080-4a1e-b564-5aaedace0274': 'Table 3.2 HU Scale', 'bf48f853-55d2-4b0d-a952-97052c04fccc': 'The viewer of the CT can decide how to adjust the level and window of the displayed CT images to accentuate tissues of a defined pixel density. \xa0The level and window are at the discretion of the viewing radiologist and can be set to their preferences. There are a variety of established level and window settings, i.e. abdomen, bone, brain, etc. These help to provide some level of uniformity for comparison of multiple CT examinations. Level and window setting for six common tissues are as follows:', 'b2f1f965-5bd4-4a65-bbcb-a0c74bb6849b': 'Table 3.3 Six common tissue levels and windows', '1c89c10d-2e57-46d5-873c-753aa9d9fd25': 'CT images demonstrating the appearance of these six different level and window settings are provided in Figure 3.24.', '0c5a4d4a-1a8a-45e7-82a1-3975c585d2e6': 'Level and Window are unique physical properties of CT images that allow the user to adjust the centre and the width of the gray scale that is portrayed on the images.\xa0 This is an adjustment that is applied to the raw CT data and does not require repeated patient imaging to obtain the different levels and windows. The level is the centre of the gray scale, set to the HU of the tissue of most interest i.e. the centre (level) of the gray scale for brain window is 35 HU.\xa0 The window is the width of the gray scale that surrounds the level setting, thus defining the range of HU for white and black seen on the image. For the brain images the width of the HU scale is 80 HU. A illustration depicting this for brain and bone level and window setting are provided in Figure 3.25.', '22baea2d-4734-448a-b8d2-ff98cc34c126': 'Fig 3.21\xa0Helical CT Scanner\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '997a9bef-3a49-4a5c-baaa-b5f4e9a60244': 'Fig 3.22 The plane of imaging related to the cantho-meatal line\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'e620fc79-fe54-4e1b-937a-f2f6d1ae88b4': 'Fig 3.23 Images of CT with HU measurements\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '47384920-3878-4fd3-a2cb-6676f1ecd6b4': 'Fig 3.24 CT Images with different level and window settings\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '27c1bf77-b175-46e2-8f3c-8b044f235e7a': 'Fig 3.25A Brain Level and Window\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'ae550a20-25ad-452b-9c36-d593b30cda0b': 'Fig 3.25B Bone Level and Window\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '4c06c22c-a218-43c6-b6d2-8b86614cb44f': 'Fig 3.26A Head CT visible on brain level and window. Bone not well seen by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '09e44bf9-1b1b-4b30-ac75-268a90c19141': 'Fig 3.26B Head CT on bone level and window. Brain not well seen by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'b14da7a2-6e23-4800-9645-0f1ea9841b25': 'Fig 3.27 Standard viewing orientation for an axial CT image\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '1aaea852-a349-4e12-9f42-4e7db0ccde67': 'Fig 3.28A CT image displayed in axial orientation from one radiation exposure event\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'cb4dd03b-6e19-4678-85ec-4798a6b00fe9': 'Fig 3.28B CT image displayed in sagittal orientation from one radiation exposure event\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '06e1bc4e-3c56-472e-b82f-5ca979851270': 'Fig 3.28C CT image displayed in coronal orientation from one radiation exposure event\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '82ba8ff7-a04c-4efb-9328-b4216ab73f8e': 'Fig 3.29A CT of the chest on lung level/window by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '2bb589c6-5d7e-4ca5-9add-0533ae22ad66': 'Fig 3.29B CT of the chest on mediastinal level/window by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '80b61eb5-0c49-4c26-bba6-34a715289fbc': 'Fig 3.30 CT PE image maximizing the injected contrast in the pulmonary arteries\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '7586c4b7-5466-4c34-b19e-28c580057600': 'An angiography machine is essentially a fluoroscopy unit that has the added feature of having the x-ray source and detectors mounted on a c-arm apparatus. The c-arm allows for movement of the source and detector around the patient who lies supine on the angiography table. The operator can acquire images in a wide variety of anatomic projections.\xa0 Therefore, patient movement is not required for this imaging modality. The angiography unit also has advanced software applications that facilitate complex arterial and body interventional procedures beyond the capabilities of a standard fluoroscopy unit. As with fluoroscopy, the images are viewed inverted in comparison to standard radiographs.', '8321eb02-784a-4088-a939-b2f9c46e47ce': 'The x-ray dose for Angiography is controlled by multiple detectors that adjust the radiation exposure to maximize image quality and minimize x-ray exposure. The machine only emits radiation when the operator uses a foot pedal to activate the x-ray tube. The area imaged can be collimated, or coned, to minimize the area exposed to x-rays.\xa0 The anatomy can also be magnified to improved diagnostic capacity.', 'c01d6355-58d2-4339-a8e1-0b13cb0a2a27': 'The images acquired are obtained very rapidly in cine mode resulting in a set of stacked images, that when stored and viewed, simulate a video recording.\xa0 Cine mode allows for the dynamic assessment of moving contrast and movement of catheters and guide wires inside the anatomy of the patient. A standard c-arm angiography unit is depicted in Figure 3.19.', '75c40a34-0496-4f50-853a-4a34b85893f5': 'For angiography, the radio-opaque contrast agent used is injected intra-arterially while x-ray images are acquired.\xa0 This is an invasive process that requires the injection to be performed via a small intra-arterial catheter that administers the contrast in close proximity to the origin of the arterial structure being investigated, i.e. carotid angiography requires an injection of contrast into the selected carotid artery.\xa0 The catheter used is usually manipulated into position using fluoroscopy from a remote arterial access site i.e. the common femoral artery, the radial artery, or the brachial artery.', 'b87262ac-93be-41c5-a829-b396ffcd5495': 'Arterial access relies upon the “Seldinger” technique, using local anesthetic, to insert the intra-arterial catheter used for the procedure. Blood vessels lack internal innervation and therefore, the catheter and guidewire can be manipulated without causing patient pain or discomfort.', 'e2e27594-969f-4065-afca-fc9d4d9d539d': 'This machine can also be used for Interventional Radiology procedures where catheters, guidewires, stents, feeding tubes, etc. are visualized with the c-arm fluoroscopy.\xa0 Water-soluble contrast agents can also be injected during these procedures to depict the anatomy of structures such as, the bile ducts, intestine, renal collecting system, veins, etc.', 'ba4bd9f0-d4d3-4160-998d-e606f08e785b': 'All modern angiography units capture images and present them in subtracted mode.\xa0 The subtraction process is digital using a computer to superimpose a non-contrast enhanced image onto a set of contrast enhanced cine images, resulting in subtracted images that depict only the anatomic structure filled with contrast since the background anatomy has been subtracted away by the digital image modification process. A digital, subtracted, carotid angiogram is depicted in Figure 3.20.', '9507b590-4a7c-43a4-ab86-48655f636346': 'The contrast used for angiography is an iodine based pharmaceutical and is water soluble.\xa0 During angiography, it is injected into the artery of interest and replaces the blood for a very short period of time.\xa0 This contrast agent progresses antegrade in the vascular tree related to the direction of blood flow.\xa0 It quickly clears from the arteries and exits the region via venous drainage.\xa0 The circulating contrast is predominantly excreted by the kidneys into the urine.', '3276ecac-6f99-4922-9d4c-37154b7ae129': 'Fig 3.19 Angiography Machine with C-Arm by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '0d7266b7-752c-4049-b830-7e4dca6ea0db': 'Fig 3.20\xa0Carotid Angiography, Digital Subtraction Cerebral Angiography\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '07ea0f57-4c84-4133-93c0-83121c89f01d': 'An example of a fluoroscopic examination is the esophogram and upper gastrointestinal series.\xa0 The patient is asked to swallow barium sulfate and gas-forming granules.\xa0 The barium can be seen to move with positioning (gravity) and peristalsis as it moves antegrade through the digestive tract while the gas rises to the highest point of the intestinal tract based upon patient positioning. The barium and the gas help to outline the inner lining of the intestine.\xa0 The live fluoroscopic x-rays visualize the motion of the barium and the gas. It is also possible to capture still images and/or cine mode images that are stored in the Picture Archive and Communication System (PACS).', 'bc96ce7d-d729-4227-95fa-225665741a10': 'Cine mode images are still images captured at a rapid rate and can be viewed sequentially, like a video, after being stored in the PACS. Other fluoroscopy aided examinations include arthrography, barium enema, cystourethrogram, sinus tract injections, myelography and hysterosalpingography, to name a few.', '87cf4657-0272-4db3-aa75-969547958014': 'The positioning of the patient is dependent on the physical capabilities of the patient and the exam that is to be performed. For example, when carrying out an esophogram, the best positioning would be an upright (standing) patient and an oblique or lateral view of the anatomy to watch the barium proceeding down the esophagus. Additional oblique and lateral views allow one to visualize abnormalities in multiple planes and to determine if any abnormality of the intestinal mucosa is concealed by swallowed barium on one view. If aspiration of ingested fluid or food into the lungs is clinically suspected the lateral projection allows one to determine if fluids are entering the trachea during swallowing.', 'b74d40ce-5391-4b64-a394-581b4a112089': 'A Fluoroscopy machine is seen in Figure 3.15.', 'bbd4cc27-e511-4d95-a60e-9f436bbc4a41': 'The video in Figure 3.17\xa0depicts live fluoroscopy of the upper esophagus for a patient whose images demonstrate aspiration of the barium into the trachea.', 'dbaf432f-8185-4365-a9d3-beed0ab25975': 'Fluoroscopy images are most often displayed for review inverted in comparison to standard x-ray images.\xa0 Hence, air is white and metal is black.\xa0 They can also be displayed as standard x-rays if this is advantageous for interpretation, see the barium enema images. The principles of absorption and transmission of the x-rays is unchanged, but the images are digitally manipulated to be the inverse of x-rays, much like film negatives in photography. The effect of image inversion for Fluoroscopy images is depicted in Figure 3.18.', '6891ccd4-5787-4995-8269-5f022f52e891': 'Fig 3.3\xa0X-ray Tube by\xa0Kieranmaher is in the Public Domain.', '39c648ca-5e19-4388-a61f-bdd02372eda8': 'Fig 3.4\xa0X-ray Tube. Lead Housing with Portal for x-ray Emission, bench top image by Rschiedon is available under a CC-BY-SA 3.0 Unported License.', '33964476-071d-4239-b632-398ccd10bb4f': 'Fig 3.5\xa0X-ray Image Creation and Display by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'f39c28ae-5cbf-4339-a557-42e3a1322037': 'Fig 3.6A\xa0A standard, fixed location, wall x-ray detector used for upright chest and abdomen x-rays by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'fb953c13-b4fe-4531-a6f1-80bdb7074953': 'Fig 3.6B\xa0A Portable x-ray Machine by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '6e34bafd-8b52-44e0-ad2d-cf1e331df04d': 'Fig 3.6C\xa0The Portable x-ray machine with the x-ray tube extended for use by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'ca28bfcc-132a-4473-a28f-bd495247e213': 'Fig 3.6D\xa0A Portable, Mini, C-Arm x-ray Unit by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '4711a96b-6775-4db5-9866-04674d98a3f6': 'Fig 3.7\xa0Appearance of different entities on x-rays\xa0by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '1258fb9d-5c95-4aae-80d3-54f946489f6b': 'Fig 3.8\xa0Left Shoulder x-ray\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license. Accessible from\xa0https://mistr.usask.ca/odin/?caseID=20160214201450302', '547b4d9c-36c8-45f6-b22d-82adda75b216': 'Fig 3.9\xa0Effect of tissue thickness on x-ray appearance\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '69e45b9a-1ecf-45d7-8796-3255b76aa319': 'Fig 3.10\xa0Common x-ray Test Object, Lucite Plastic Board\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '57b3432c-9730-4d69-9cce-4f4007438233': 'Fig 3.11A Posterior-anterior, upright, chest x-ray positioning, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', '32b6ba4a-63ec-4e10-9990-f380de9fee0d': 'Fig 3.11B Lateral, upright, chest x-ray positioning, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', 'b22e4373-8d85-42d1-a469-1a583e765d15': 'Fig 3.11C Decubitus x-ray positioning, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', '8b26404e-eca4-432c-a4a4-406c267732a6': 'Fig 3.1\xa0PACS Imaging Viewing Station (Workstation) by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC–BY-NC-SA 4.0 license.', '8a1454eb-adb0-43dd-b455-381ef4a0fa33': 'Fig 3.2 Sample MRI Request Form\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC–BY-NC-SA 4.0 license.', '32fc7f20-73b7-4d42-8e8e-a55c8e933865': '2) Sievert. Wikipedia. https://en.wikipedia.org/wiki/Sievert Accessed Sep. 3, 2018', '808e953e-3ced-45ab-8c29-dcb633e825d7': '3) Radiation Safety Review, Jeff Sanderson. Cancer Care Manitoba, 2001. https://www.cancercare.mb.ca/Research/medical-physics/radiaion-protection-services/index.html', '7a5b86bc-d27b-4f09-94d3-eacd0a26d733': '4) ICRP, 2007. ‘The 2007 Recommendations of the International Commission on Radiological Protection’. ICRP Publication 103. Ann. ICRP 37 (2-4).\n\n(see http://www.icrp.org/publication.asp?id=ICRP%20Publication%20103) Last accessed Feb. 12, 2019.', '0e4fd872-fed4-4829-aad6-b29fb5207e16': '5) United States Nuclear Regulatory Commission. https://www.nrc.gov/reading-rm/basic-ref/glossary/alara.html Last accessed February 5, 2019.', '31a16705-8334-4d0b-ba2c-7b3ba4903d3d': '6) Guidelines for Diagnostic Imaging During Pregnancy and Lactation ACOG October 2017 e210; 130(4):e210 – e216.', '61c798cb-9b2c-44a5-a50f-094104e0d923': '7) Image Gently Alliance. https://www.imagegently.org/ Last accessed February 6, 2019.', '95aa939a-bd18-4918-8163-3f0eda02ba68': '8) American College of Radiology. ‘ACR appropriateness criteria.’ Radiology, 2000; 215 (Suppl): 1-1511.', 'b562ff2f-9eea-4eba-9d13-f84bcac6c6d9': '9) ACR Appropriateness Criteria List. https://acsearch.acr.org/list Last accessed Feb. 13, 2019.', '15e3ec31-d27d-49ba-9d6a-a28f7211c03f': '10) The Royal Australian and New Zealand College of Radiologists. Imaging Guidelines. 4th edn. Surrey Hills: National Library of Australia Cataloguing-in-Publication Data, 2001.', '42757543-7fdd-42ee-bddd-5c70293e2ef9': '11) Canadian Association of Radiologists – Referral Guidelines https://car.ca/patient-care/referral-guidelines/ Last accessed Feb. 13, 2019.', '627e3917-cc9d-4355-b236-a11cc5382386': 'Most professional imaging associations have created and disseminated scientifically validated, peer-reviewed guidelines that provide assistance in ordering the most appropriate imaging test while avoiding less useful, or non-contributory, tests that could unnecessarily expose the patient to ionizing radiation. These guidelines also will provide information about the relative radiation exposure that can be expected for one examination vs. another.', 'dde178ba-da97-448c-b369-5277c0dd80ae': 'If possible, the use of imaging modalities that do not use ionizing radiation (ultrasound and MRI) should be considered.', '1a1b453c-73a4-4269-aed3-97a05e6abdcb': 'Hence, it is hoped that fewer examinations will be requested and the most useful and appropriate examination will be performed, reducing the use of inappropriate ionizing radiation. Also, if an examination with radiation is required the dose experienced by the patient can be justified with the argument that the most useful, appropriate, diagnostic examination has been utilized limiting the total radiation dose experienced by the patient. (8 – 11)'}"
+Figure 3.20,undergradimage/images/Figure 3.20.jpg,"Figure 3.20: Carotid Angiography, Digital Subtraction Angiography","All modern angiography units capture images and present them in subtracted mode.  The subtraction process is digital using a computer to superimpose a non-contrast enhanced image onto a set of contrast enhanced cine images, resulting in subtracted images that depict only the anatomic structure filled with contrast since the background anatomy has been subtracted away by the digital image modification process. A digital, subtracted, carotid angiogram is depicted in Figure 3.20.","{'9d9da8c6-2e61-47f2-ba4d-6a20496f0d3a': 'All figures in “Chapter 17: Musculoskeletal” by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan are used under a CC-BY-NC-SA 4.0 license.', '42459c0f-ddfe-46c5-b1fd-6793f01031b5': '2) Gaillard, F. Salter-Harris Classification, Radiopaedia.org. https://radiopaedia.org/articles/salter-harris-classification', '99a28b8c-45c1-4a34-b607-d24433ffd59c': '3) Boaz K. Karmazyn, MD; Adina L Alazraki, MD; Sudha A. Anupindi, MD, et al. ACR Appropriateness Criteria® Pediatric – Urinary Tract Infection. Available at https://acsearch.acr.org/docs/69444/Narrative/\xa0 American College of Radiology. Accessed June 30, 2017.', 'ff59e5e9-8d3d-4318-86bd-c8746ebe5e27': '4) Urinary Tract Infection: Clinical Practice Guideline for\n\nthe Diagnosis and Management of the Initial UTI in\n\nFebrile Infants and Children 2 to 24 Months. Pediatrics 2011, 128 (3): 595 – 610.', '95839fcd-3dad-4370-b8c9-efa3ae8fee8d': '5) Dr. Matt Skalski, Ureteric reflux, Radiopaedia.org. “https://radiopaedia.org/\xa0 From the case “https://radiopaedia.org/cases/22569 rID: 22569', '26535aad-e785-402b-9277-4da9563c4525': '6) Molly E. Raske, MD; Molly E. Dempsey, MD; Jonathan R. Dillman, MD, et al. ACR Appropriateness Criteria® Pediatric – Vomiting in Infants Up to 3 Months of Age. Available at https://acsearch.acr.org/docs/69445/Narrative/ American College of Radiology. Accessed June 30, 2017.', '6ec32d8a-c136-48d5-9703-61624050f9f6': '7) Learning\xa0radiology\xa0: recognizing the basics. William Herring author. Elsevier 2016 Online access University of Saskatchewan Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK Accessed, June 30, 2017.', '3db9d0ef-38dd-4332-812d-6af2dfa4db69': '8) Grainger and Allison’s diagnostic\xa0radiology\xa0: a textbook of medical imaging. Andy Adam editor.; Adrian K. Dixon editor.; Jonathan H. Gillard 1964- editor.; Cornelia Schaefer-Prokop editor.; David J Allison; Elsevier (Firm) 2015, Online access University of Saskatchewan Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK\xa0 Accessed June 30, 2017.', '5bf49964-973b-4c4d-88b4-2696683964c1': '2) Radiopaedia.org – https://radiopaedia.org/articles/rockwood-classification-of-acromioclavicular-joint-injury Rockwood classification of AC-Joint injuries. Accessed June 30, 2017.', '59261295-fce8-49b2-a2de-77852eccc04a': '3) Common Forearm Fractures in Adults. American Family Physician 2009: 80 (10): 1096 – 1102.', '2f360c6a-b1f6-4af3-a4c8-e0b8438b9a58': '4) Diagnosis and Management of Scaphoid Fractures.\xa0 American Family Physician 2004; 70 (5); 879 – 884.', 'a5a2c608-b474-4203-bd8a-41a1f1ceb548': '5) Michael A. Bruno, MD; Barbara N. Weissman, MD; Mark J. Kransdorf, MD, et al. MSK – Hand and Wrist Trauma. \xa0Available at https://acsearch.acr.org/docs/69418/Narrative/ American College of Radiology. Accessed June 30, 2017.', '3548e3f8-9289-4063-8539-de870f48b911': '6) Robert J. Ward, MD, CCD; Barbara N. Weissman, MD; Mark J. Kransdorf, MD., et al. ACR Appropriateness Criteria®, MSK – Acute Hip Pain – Suspected Fracture. \xa0Available at https://acsearch.acr.org/docs/3082587/Narrative/ American College of Radiology. Accessed June 30, 2017.', '59596a80-aaf5-43e7-985e-7b2593951114': '7) Radiopaedia.org – https://radiopaedia.org/articles/femoral-neck-fracture Accessed June 30, 2017.', '469c112e-865a-482d-9b7e-5830232cee0e': '8) Michael J. Tuite, MD; Mark J. Kransdorf, MD; Francesca D. Beaman, MD, et al. ACR Appropriateness Criteria®, MSK – Acute Trauma to the Knee. Available at https://acsearch.acr.org/docs/69419/Narrative/ American College of Radiology. Accessed June 30, 2017.', '61b9265e-5af7-4d75-833f-a9344ce39570': '9) Ottawa Knee Rule – Stiell IG, Wells GA, Hoag RH, Sivilotti ML, et al (1997). “Implementation of the Ottawa Knee Rule for the use of radiography in acute knee injuries.”. JAMA. 278 (27): 2075–9. PMID\xa09403421. doi:10.1001/jama.1997.03550230051036. Accessed June 30, 2017.', 'd567b915-ef5d-4c0d-8e5b-f533c7036e91': '10) Ottawa Ankle Rule – Stiell IG, McKnight RD, Greenberg GH, et al. (March 1994). “Implementation of the Ottawa ankle rules”. JAMA. 271 (11): 827–32. PMID\xa08114236. doi:10.1001/jama.1994.03510350037034. Accessed June 30, 2017.', '92efbc09-23c1-4b33-b265-50b693fca389': '11) Jon A. Jacobson, MD; Catherine C. Roberts, MD; Jenny T. Bencardino, MD, et al. ACR Appropriateness Criteria®, \xa0MSK – Chronic Extremity Joint Pain Available at https://acsearch.acr.org/docs/3097211/Narrative/ American College of Radiology. Accessed June 30, 2017.', '170f0345-ab5f-45e0-8acd-470a44d17663': '2) Catheter Replacement of the Needle for Arteriography. Seldinger, S. I. Acta Radiologica, 1953: 39 (5); 368 – 376.', 'd55b79a0-51d8-4933-a57a-7d6b6cb5597b': '3) Thomas B. Kinney, MD; Hamed Aryafar, MD; Charles E. Ray, Jr, MD, PhD, et al. ACR Appropriateness Criteria® Management of Inferior Vena Cava Filters. Available at https://acsearch.acr.org/docs/69342/Narrative/ American College of Radiology. Accessed June 30, 2017', 'ba20e351-4219-47c3-b9c5-b61de5ab8fd9': '4) Learning\xa0radiology:recognizing the basics. William Herring author. Elsevier 2016, Online access University of Saskatchewan Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK Accessed, June 30, 2017.', '3fc9b447-cac6-4420-ac4e-05f656e81f43': '5) Grainger and Allison’s diagnostic\xa0radiology\xa0: a textbook of medical imaging. Andy Adam editor.; Adrian K. Dixon editor.; Jonathan H. Gillard 1964- editor.; Cornelia Schaefer-Prokop editor.; David J Allison; Elsevier (Firm) 2015, Online access University of Saskatchewan Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK\xa0 Accessed June 30, 2017.', 'a53e9698-8be5-4b56-ba59-87393e1e60b7': '2) Vahid Yaghmai, MD, MS; Max P. Rosen, MD, MPH; Tasneem Lalani, MD. ACR Appropriateness Criteria® \xa0– Gastrointestinal – Acute (non-localized) Abdominal Pain and Fever – Pneumoperitoneum. Available at\xa0 https://acsearch.acr.org/docs/69467/Narrative/ American College of Radiology. Accessed June 30, 2017.', '23ab0a22-ea4d-4c3f-9d72-f3a49ca4f6fd': '3) Douglas S. Katz, MD; Mark E. Baker, MD; Max P. Rosen, MD, MPH. ACR Appropriateness Criteria® – Gastrointestinal – Suspected Small Bowel Obstruction. Available at https://acsearch.acr.org/docs/69476/Narrative/ American College of Radiology. Accessed June 30, 2017.', 'f3c446dd-aa8d-4d22-aed4-b5e89863cd27': '4) Martin P. Smith, MD; Douglas S. Katz, MD; Max P. Rosen, MD, MPH. ACR Appropriateness Criteria® – Gastrointestinal – Right Lower Quadrant Pain – Suspected Appendicitis. Available at https://acsearch.acr.org/docs/69357/Narrative/ American College of Radiology. Accessed June 30, 2017.', 'e40080ff-07b5-4509-a9d8-3d7ff39b3c19': '5) Michelle M. McNamara, MD; Tasneem Lalani, MD; Marc Anthony Camacho, MD. ACR Appropriateness Criteria® \xa0– Gastrointestinal – Left Lower Quadrant Pain – Suspected Diverticulitis. Available at https://acsearch.acr.org/docs/69356/Narrative/ American College of Radiology. Accessed June 30, 2017.', 'a6f6cc9d-0ee1-42b0-ba1b-410ac9dc0387': '6) Rendon C. Nelson, MD; Ihab R. Kamel, MD, PhD; Mark E. Baker, MD. ACR Appropriateness Criteria® \xa0– Gastrointestinal – Liver Lesion – Initial Characterization. Available at https://acsearch.acr.org/docs/69472/Narrative/ American College of Radiology. Accessed June 30, 2017.', '154ec87b-5220-4418-99a5-75ec9d9fafec': '7) Tasneem Lalani, MD; Corey A. Couto, MD; Max P. Rosen, MD, MPH. ACR Appropriateness Criteria® \xa0– Gastrointestinal – Jaundice. Available at https://acsearch.acr.org/docs/69497/Narrative/ American College of Radiology. Accessed June 30, 2017.', '740ebf07-9cb8-4ed5-9cac-8bb79c578c8d': '2) Jacobo Kirsch, MD; Tan-Lucien H. Mohammed, MD, et al.\xa0 ACR Appropriateness Criteria®, Chest – Acute Respiratory Illness in Immunocompetent Patient. Available at https://acsearch.acr.org/docs/69446/Narrative/ Accessed, June 30, 2017.', '571524ec-b296-4a2d-95dc-97db963c3fcb': '3) Debra Sue Dyer, MD; Tan-Lucien H. Mohammed, MD; Jacobo Kirsch, MD, et al. ACR Appropriateness Criteria®, Chest – Chronic Dyspnea – Suspected Pulmonary Origin. \xa0Available at https://acsearch.acr.org/docs/69448/Narrative/ Accessed June 30, 2017.', 'f22ed822-b387-44e5-8a22-dd8a867b8b01': '4) Learning\xa0radiology\xa0: recognizing the basics. William Herring author. Elsevier 2016 Online access USask Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK Accessed, June 30, 2017.', '87cb046f-4dac-41ec-84d0-bed36b33d265': '5) Jeffrey P. Kanne, MD, Leif E. Jensen, MD, MPH, Tan-Lucien H. Mohammed, MD, et al. ACR Appropriateness Criteria®,\xa0 Chest – Radiographically Detected Solitary Pulmonary Nodule. Available at https://acsearch.acr.org/docs/69455/Narrative/ Accessed June 30, 2017.', '3159e24d-3174-4315-993d-23dd449b06b4': '6) Fleischner Society – https://fleischnersociety.org', 'd07c0b2d-9413-4046-ab1e-55f117865c2a': '7) Michael A. Bettmann, MD, Scott G. Baginski, MD, Richard D. White, MD, et al. ACR Appropriateness Criteria®, Chest – Acute Chest Pain – Suspected Pulmonary Embolism. Available at https://acsearch.acr.org/docs/69404/Narrative/\xa0 Accessed June 30, 2017.', 'cd973045-ca97-4b36-a285-52581f60f304': 'Ultrasound uses traditional probes with higher frequency to better image the breast tissue that is in close proximity to the overlying skin.', '13e1e8e0-e640-4941-8300-c31710b3a53c': 'Mammography/Breast Imaging Centres in Canada are accredited and audited for quality by the Canada Association of Radiologists.', 'eca3d4b9-a2c4-43c7-ae2b-3ec757983d8b': '2) Vilaas S. Shetty, MD; Martin N. Reis, MD; Joseph M. Aulino, MD, et al. ACR Appropriateness Criteria® Head Trauma. Available at https://acsearch.acr.org/docs/69481/Narrative/ American College of Radiology. Accessed, June 30, 2017.', 'a923162d-9460-4587-991e-319c82bf5c9f': 'https://acsearch.acr.org/docs/69481/Narrative/', '96ac01aa-0380-4fa5-be27-55a5b787830c': '3) Michael B. Salmela, MD; Shabnam Mortazavi, MD; Bharathi D. Jagadeesan, MD, ACR, et al. Appropriateness Criteria® Cerebrovascular Disease. https://acsearch.acr.org/docs/69478/Narrative/ American College of Radiology. Accessed, June 30, 2017.', 'b68256b4-9387-4475-8f5a-41b599bfaf04': 'https://acsearch.acr.org/docs/69478/Narrative/', 'd4f105b8-2855-4af9-a3cb-f9d88fcdbf18': '4) Annette C. Douglas, MD; Franz J. Wippold II, MD; Daniel F. Broderick, MD, et al. Appropriateness Criteria® Headache. https://acsearch.acr.org/docs/69482/Narrative/ American College of Radiology. Accessed, June 30, 2017.', '74770c44-e954-4084-abd6-2740860fa07d': 'https://acsearch.acr.org/docs/69482/Narrative/', 'edab0354-1c57-4db0-b1dd-6ea014cb5e00': '5) Nandini D. Patel, MD; Daniel F. Broderick, MD; Judah Burns, MD, et al. Appropriateness Criteria® Low Back Pain. https://acsearch.acr.org/docs/69483/Narrative/ American College of Radiology. Accessed, June 30, 2017.', 'd0966524-e032-4f5a-9faf-1e8f783d8061': 'https://acsearch.acr.org/docs/69483/Narrative/', 'aa597d16-b4a3-404a-889f-e4a901c750d6': '6) Richard H. Daffner, MD; Barbara N. Weissman, MD; Franz J. Wippold II, MD, et al. Appropriateness Criteria®  Suspected Spine Trauma. https://acsearch.acr.org/docs/69359/Narrative/ American College of Radiology. Accessed, June 30, 2017.', '6945685d-8bdd-48ba-9299-88cd95cdcccc': 'https://acsearch.acr.org/docs/69359/Narrative/', 'd6137ceb-35ba-41f9-b5ad-909c0c93c831': 'The standard views are AP (anterior-posterior) and lateral.\xa0 These two views are taken at right angles (orthogonal) to each other.\xa0 If these images are not helpful, ancillary views such as oblique views, or special views such as, an axillary or carpal tunnel view, may be required based upon the clinical scenario.', '8da19a7d-ea8a-48f7-802b-c3e6ad2879ea': 'Stress views i.e. a force is applied to a bone or joint to determine if an injury is present, such as, a subtle avulsion or a suspected tendon or ligament tear causing joint instability. These are acquired as special requests and should be performed in a manner that minimizes patient pain and discomfort.', 'c1ddb6e5-c42b-4c10-ac0d-ed3b6ab5cbad': 'At least one joint space should be visible in relation to the suspected bone injury.\xa0 Additional x-ray views and views of another adjacent joint space may be required in some circumstances.', 'd8ec4a87-ef98-4bd8-9ee3-47f8c6612a49': 'Comparison views to the contralateral, normal bone, or joint, may be required, this is especially true if a subtle growth plate injury is suspected in a child.\xa0 Comparison views should not be ordered routinely, but should be used if clinically necessary.', 'd76a51e5-d391-4400-aa76-b67e2d5a4233': 'It is important to remember that some bone and ligament injuries occur as a common pattern of multiple injuries i.e. the Colle fracture of the distal radius is often associated with an avulsion fracture of the ulnar styloid.\xa0 Ankle ligament injuries and fractures often occur in a sequence i.e. medial malleolar avulsion fracture (or medial ligament tear), interosseous ligament tear between the tibia and fibula, and a subsequent oblique fracture of the proximal fibula (Maisonneuve fracture complex).\xa0 Keep this in mind as you encounter various patients and you will develop knowledge and experience of these associated bone and soft tissue injuries.', 'd26261d6-1894-4731-a4bc-cb382c5fc4b8': 'Fractures usually present as a lucent line on x-rays involving the cortex and medulla of the bone that can be followed from one cortex to the opposite cortex with varying degrees of displacement and malalignment of the involved bone.', '6d3c05b4-f04f-464e-828c-e219309240b2': 'There are some fractures that may be associated with bone ischemia and avascular necrosis i.e. capital femoral fractures and scaphoid fractures.\xa0 Be aware of this and learn the importance of aggressive and pre-emptive management for these patients.', '9efc69ef-d567-4c20-b7da-5b5faae548f8': 'Fig 5.7 Abdomen Quadrants/Regions\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'c17eee8e-a5a7-4b3d-aa39-e9562f679745': 'Fig 5.8\xa0Supine Positioning for Abdomen x-ray, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', 'e428391c-3d1e-4c3d-a0ee-4e39fd82ee4d': 'Fig 5.9 Upright Positioning for Abdomen x-ray, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', '4fe76b20-0ac2-49ac-a875-af27033355ec': 'Fig 5.10 Decubitus Positioning for Abdomen x-ray, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', '1e50fdef-529f-4fe1-b3f4-ab42378ca31f': 'Fig 5.11 Normal Abdominal x-ray by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '27e0addc-368c-4208-9970-6559705ff1e8': 'Fig 5.12 Colon anatomy emphasized by the presence of barium and air by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '990d74a2-1431-4705-8efd-4cf210fa9ce3': 'Fig 5.13 Bones and Musculoskeletal Landmarks in the Abdomen by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '3d050294-a087-4835-a5ed-7961069e1f0a': 'Fig 5.14 Possible Artifacts on Abdomen x-rays. The image demonstrates two umbilical piercings, fallopian tube clips, and the buttons on the patient’s pants by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'cbf4613b-cbd6-4078-b9c3-b1c333a37c48': 'The standard upright views of the chest are made when a patient is typically placed between an x-ray source and an x-ray detector. When the x-rays penetrate the tissues of the patient, they stimulate an x-ray detector that alters the energy of the x-ray beam into a digital pixel grid. The radiograph produced is referred to as a roentgenogram and named after Wilhelm Konrad Roentgen who received the first Nobel Prize for Physics in 1901 for his work in defining the major properties of x-rays and the conditions necessary for their production. It was Roentgen who coined the term “x-ray”.', '9da044bd-e951-4eb4-8cf9-ccb9398a2423': 'Fig 5.1 A portable upright x-ray where the image is not taken with proper body alignment, the patient is rotated and tilted\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '0bc6ae7d-c9c2-4d6d-ae6c-f07a5a647792': 'Fig 5.2 A portable upright x-ray taken with patient in proper alignment\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'e27384e1-63ef-4a65-a138-41a0d8870a95': 'Fig 4.1A Fluoroscopy – Shoulder Arthrogram Early Phase of Injection\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '2f124311-a640-4063-9232-06af6006da7a': 'Fig 4.1B\xa0Shoulder Arthrogram Fluoroscopy Mid-Phase of Injection by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'bb7b38f9-ff02-462d-8d99-621dd444c05e': 'Fig 4.1C Shoulder Arthrogram Late Phase of Injection\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'b6d8041f-18d1-40b8-a5b0-44c6bfeb9405': 'Fig 4.2A\xa0CT Aorta, C-\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'b98a8c21-5a63-4b95-b9ce-f7e38e6999bc': 'Fig 4.2B CT Iliac Arteries, C-\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '43da027d-17e8-4ba4-b312-67fba1bd1511': 'Fig 4.2C CT Aorta, C+\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'b66fdc16-e8ca-433f-8a6e-1d0f3f659bb3': 'Fig 4.2D CT Iliac Arteries, C+\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '8964941e-dc07-44fd-954a-0403c1bfd992': '2) Image Wisely. http://www.imagewisely.org/ Last accessed, Aug. 22, 2017.', 'ed5f284b-a74a-4376-b274-77e0e2303fc9': '3) Image Gently. http://www.imagegently.org/ Last accessed Aug 22, 2017.', 'fc2d1e7a-fa5b-4dbc-917f-25f258eb23d6': '4) Novelline, R. A., & Squire, L. F. (2004), sixth edition. Squire’s fundamentals of radiology. Cambridge, Mass: Harvard University Press.', 'ce057be0-807e-4b88-a477-0d87c59e607b': 'Fig 3.43 Nuclear Medicine Scanner by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'dce81a39-f2bd-47ee-847d-9205bbc446e1': 'Fig 3.44A Normal, Pediatric Nuclear Medicine Bone Scan by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '8bed792d-6442-4cbd-89db-89b5a4cb4541': 'Fig 3.44B Normal, Adult Nuclear Medicine Bone Scan\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '41bf79b1-bfd9-4a16-9b5d-900405a59176': 'Fib 3.45 PET/CT Scanner\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '8fcd15af-34e1-492f-91a7-3b8b671387ed': 'Fig 3.46A PET/CT image of the chest for a patient with lymphoma\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '211a4b55-451b-4858-aa60-ce4253c9d555': 'Fig 3.46B PET image of the whole body for a patient with lymphoma\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '15d4a271-c53b-449d-8385-a1b6030fd923': 'The appearance of different tissue on MR images is described as displaying greater, or lesser, signal in comparison the other anatomy in the region. The signal in question is the energy that the perturbed protons liberated when they fall back into alignment with the magnetic field. The signal intensity of the tissue in question changes based upon the image acquisition parameters set by the MR Technologist, under the direction of a supervising Radiologist.\xa0 The parameters set result in the acquisition of a set of images called an MR imaging sequence. On one sequence cerebrospinal fluid will appear as black pixels (T1 sequence) while on another sequence it is white pixels (T2 sequence). This difference in tissue appearance can be exploited to determine if pathology is present.', '33f25041-480d-4bb9-95fc-0a28bc2224ed': 'Fig 3.31\xa0B-Mode Ultrasound of the Carotid bulb with atherosclerotic plaque\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '18658974-a7a2-499b-881c-5a51baaa9854': 'Fig 3.32A\xa0Ultrasound Machine\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '5c75f45f-6624-42df-b964-dddafeae9d32': 'Fig 3.32B Mobile Ultrasound Machine\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'f351a841-d5dd-4048-8f36-831f0bbf09d9': 'Fig 3.33 Ultrasound image of the normal liver and kidney. The echogenicity of the liver is greater than the echogenicity of the adjacent renal cortex by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '059ddd7b-14ba-4290-92ad-7382c9156fc4': 'Fig 3.34 Gallbladder\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '5db401cc-d0ff-4f03-945a-f50dd89e4be9': 'Fig 3.35A Normal Liver Ultrasound by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'fae31525-31fa-491b-8fcf-6206343abf74': 'Fig 3.35B Hepatomegaly and hepatic steatosis on Ultrasound\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '4aa1ffad-a8df-4cef-8f34-a9695f5958bc': 'Fig 3.36 Colour Doppler, of the neck\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '99b1c66a-6cc2-4a4e-872f-476d28cdab03': 'Fig 3.37 Colour Doppler of the neck with Spectral Display\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '21a2827a-f5ed-4e96-a0d9-b91bdf773c22': 'Fig 3.38A\xa0Internal Carotid Doppler Ultrasound Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '6bf5c327-c3cb-4f8c-b09c-7b96d908326a': 'Fig 3.38B Carotid Bulb Doppler Ultrasound\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '8d123159-7ce7-4972-bc0c-86aa528a32ae': 'Fig 3.38C\xa0Vertebral Doppler Ultrasound\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'b8f04a00-104c-40e3-8e47-1dc899d44ca1': 'Fig 3.39 Linear probe and two curved array probes\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'c15107ec-6f70-4702-929e-61aeee36a137': 'The patient does not need to be moved, or re-positioned, to obtain CT images in different anatomic planes.\xa0 The patient lies on the CT table in anatomic position and remains in that position throughout the study.\xa0 The standard orientation of image acquisition for CT is in the axial plane, hence the old name for this machine of CAT (computed axial tomography) scanner.\xa0 Often the axial images obtained during the initial x-ray exposure will be digitally reformatted into other anatomic planes i.e. sagittal and coronal.\xa0 These reformatted images are the result of a computer algorithm reformatting the original digital image data and, as such, these supplemental anatomic planes of imaging do not require additional x-ray exposure.', '23a6edd0-ea0d-4597-87b7-d94ca733c3a5': 'The CT gantry can be tipped cranially and caudally to deviate from the axial plane by 30 degrees in either direction and this can be used to correct for patient anatomic variability to maintain the axial plane, if necessary.\xa0 It also allows for unique imaging along an angled plane that can be used when requested by the referring physician or the radiologist.\xa0 A widely used example of imaging in an angled plane is found for CT Head examinations. It is not conventional to acquire these images in the axial plane but to image the brain on the canthomeatal (lateral orbit canthus to the aural meatus) line and therefore, the CT gantry must be tilted to ensure that all CT Head images are acquired in this plane.\xa0 Originally, this plane was chosen as it maximizes information about the intra-cranial contents while minimizing the exposure of the orbits (lens) to radiation. The orbito-meatal line has become the internationally recognized plane for acquiring CT head images. This line is depicted in Figure 3.22.', '2a01449e-f80d-44b8-b5f1-9fbd2293de89': 'The physics of CT image creation are complex and require complex computer processing to create images that are visible for clinical use.\xa0 As the x-ray tube and the x-ray detectors revolve around the patient thousands of mathematical calculations are performed to determine how much of the incident x-ray beam was absorbed by a volume of tissue. This volume of tissue is called a voxel. The calculated absorption of the x-rays by a voxel is converted into a pixel density that is displayed on a gray scale from -1,000 (air) to +1,000 (metal).\xa0 This scale is called the Hounsfield unit (HU) scale after one of the principle inventors of CT, Sir Godfrey Hounsfield.\xa0 The calculated density of this voxel is then allocated to a pixel on a grid of the 512 x 512 pixels that forms each individual CT image.', '7630aac5-da71-4093-992f-e3de7e0777cf': 'Therefore, if the volume of tissue contained air, or gas, the pixel density allocated would be close to -1,000 HU, while if the volume of tissue analyzed contained metal (bullet fragment, etc.) the pixel would be assigned a density close to the +1,000 HU.\xa0 The assignment of pixel density to voxels spans the entire possible range of pixels from -1,000 – +1,000 HU, resulting in 2,000 shades of grey.\xa0 An image with the HU measurements of specific anatomic regions is provided in Figure 3.23.', '194d89df-a49e-4ba0-a141-fedb5b7d0e3d': 'CT density: a region on a CT image is described as being more, or less, dense than another region. The liver is more dense than the renal cortex.\xa0 This variation in pixel density can be quantified by measuring all the pixels in a region and creating an average pixel density i.e. region of interest of an area of liver can be measured, with a standard deviation, 50 HU +/- 5 HU, etc. The HU density of some common structures is provided in Table 3.2.', '7fd3f166-8080-4a1e-b564-5aaedace0274': 'Table 3.2 HU Scale', 'bf48f853-55d2-4b0d-a952-97052c04fccc': 'The viewer of the CT can decide how to adjust the level and window of the displayed CT images to accentuate tissues of a defined pixel density. \xa0The level and window are at the discretion of the viewing radiologist and can be set to their preferences. There are a variety of established level and window settings, i.e. abdomen, bone, brain, etc. These help to provide some level of uniformity for comparison of multiple CT examinations. Level and window setting for six common tissues are as follows:', 'b2f1f965-5bd4-4a65-bbcb-a0c74bb6849b': 'Table 3.3 Six common tissue levels and windows', '1c89c10d-2e57-46d5-873c-753aa9d9fd25': 'CT images demonstrating the appearance of these six different level and window settings are provided in Figure 3.24.', '0c5a4d4a-1a8a-45e7-82a1-3975c585d2e6': 'Level and Window are unique physical properties of CT images that allow the user to adjust the centre and the width of the gray scale that is portrayed on the images.\xa0 This is an adjustment that is applied to the raw CT data and does not require repeated patient imaging to obtain the different levels and windows. The level is the centre of the gray scale, set to the HU of the tissue of most interest i.e. the centre (level) of the gray scale for brain window is 35 HU.\xa0 The window is the width of the gray scale that surrounds the level setting, thus defining the range of HU for white and black seen on the image. For the brain images the width of the HU scale is 80 HU. A illustration depicting this for brain and bone level and window setting are provided in Figure 3.25.', '22baea2d-4734-448a-b8d2-ff98cc34c126': 'Fig 3.21\xa0Helical CT Scanner\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '997a9bef-3a49-4a5c-baaa-b5f4e9a60244': 'Fig 3.22 The plane of imaging related to the cantho-meatal line\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'e620fc79-fe54-4e1b-937a-f2f6d1ae88b4': 'Fig 3.23 Images of CT with HU measurements\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '47384920-3878-4fd3-a2cb-6676f1ecd6b4': 'Fig 3.24 CT Images with different level and window settings\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '27c1bf77-b175-46e2-8f3c-8b044f235e7a': 'Fig 3.25A Brain Level and Window\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'ae550a20-25ad-452b-9c36-d593b30cda0b': 'Fig 3.25B Bone Level and Window\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '4c06c22c-a218-43c6-b6d2-8b86614cb44f': 'Fig 3.26A Head CT visible on brain level and window. Bone not well seen by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '09e44bf9-1b1b-4b30-ac75-268a90c19141': 'Fig 3.26B Head CT on bone level and window. Brain not well seen by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'b14da7a2-6e23-4800-9645-0f1ea9841b25': 'Fig 3.27 Standard viewing orientation for an axial CT image\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '1aaea852-a349-4e12-9f42-4e7db0ccde67': 'Fig 3.28A CT image displayed in axial orientation from one radiation exposure event\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'cb4dd03b-6e19-4678-85ec-4798a6b00fe9': 'Fig 3.28B CT image displayed in sagittal orientation from one radiation exposure event\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '06e1bc4e-3c56-472e-b82f-5ca979851270': 'Fig 3.28C CT image displayed in coronal orientation from one radiation exposure event\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '82ba8ff7-a04c-4efb-9328-b4216ab73f8e': 'Fig 3.29A CT of the chest on lung level/window by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '2bb589c6-5d7e-4ca5-9add-0533ae22ad66': 'Fig 3.29B CT of the chest on mediastinal level/window by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '80b61eb5-0c49-4c26-bba6-34a715289fbc': 'Fig 3.30 CT PE image maximizing the injected contrast in the pulmonary arteries\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '7586c4b7-5466-4c34-b19e-28c580057600': 'An angiography machine is essentially a fluoroscopy unit that has the added feature of having the x-ray source and detectors mounted on a c-arm apparatus. The c-arm allows for movement of the source and detector around the patient who lies supine on the angiography table. The operator can acquire images in a wide variety of anatomic projections.\xa0 Therefore, patient movement is not required for this imaging modality. The angiography unit also has advanced software applications that facilitate complex arterial and body interventional procedures beyond the capabilities of a standard fluoroscopy unit. As with fluoroscopy, the images are viewed inverted in comparison to standard radiographs.', '8321eb02-784a-4088-a939-b2f9c46e47ce': 'The x-ray dose for Angiography is controlled by multiple detectors that adjust the radiation exposure to maximize image quality and minimize x-ray exposure. The machine only emits radiation when the operator uses a foot pedal to activate the x-ray tube. The area imaged can be collimated, or coned, to minimize the area exposed to x-rays.\xa0 The anatomy can also be magnified to improved diagnostic capacity.', 'c01d6355-58d2-4339-a8e1-0b13cb0a2a27': 'The images acquired are obtained very rapidly in cine mode resulting in a set of stacked images, that when stored and viewed, simulate a video recording.\xa0 Cine mode allows for the dynamic assessment of moving contrast and movement of catheters and guide wires inside the anatomy of the patient. A standard c-arm angiography unit is depicted in Figure 3.19.', '75c40a34-0496-4f50-853a-4a34b85893f5': 'For angiography, the radio-opaque contrast agent used is injected intra-arterially while x-ray images are acquired.\xa0 This is an invasive process that requires the injection to be performed via a small intra-arterial catheter that administers the contrast in close proximity to the origin of the arterial structure being investigated, i.e. carotid angiography requires an injection of contrast into the selected carotid artery.\xa0 The catheter used is usually manipulated into position using fluoroscopy from a remote arterial access site i.e. the common femoral artery, the radial artery, or the brachial artery.', 'b87262ac-93be-41c5-a829-b396ffcd5495': 'Arterial access relies upon the “Seldinger” technique, using local anesthetic, to insert the intra-arterial catheter used for the procedure. Blood vessels lack internal innervation and therefore, the catheter and guidewire can be manipulated without causing patient pain or discomfort.', 'e2e27594-969f-4065-afca-fc9d4d9d539d': 'This machine can also be used for Interventional Radiology procedures where catheters, guidewires, stents, feeding tubes, etc. are visualized with the c-arm fluoroscopy.\xa0 Water-soluble contrast agents can also be injected during these procedures to depict the anatomy of structures such as, the bile ducts, intestine, renal collecting system, veins, etc.', 'ba4bd9f0-d4d3-4160-998d-e606f08e785b': 'All modern angiography units capture images and present them in subtracted mode.\xa0 The subtraction process is digital using a computer to superimpose a non-contrast enhanced image onto a set of contrast enhanced cine images, resulting in subtracted images that depict only the anatomic structure filled with contrast since the background anatomy has been subtracted away by the digital image modification process. A digital, subtracted, carotid angiogram is depicted in Figure 3.20.', '9507b590-4a7c-43a4-ab86-48655f636346': 'The contrast used for angiography is an iodine based pharmaceutical and is water soluble.\xa0 During angiography, it is injected into the artery of interest and replaces the blood for a very short period of time.\xa0 This contrast agent progresses antegrade in the vascular tree related to the direction of blood flow.\xa0 It quickly clears from the arteries and exits the region via venous drainage.\xa0 The circulating contrast is predominantly excreted by the kidneys into the urine.', '3276ecac-6f99-4922-9d4c-37154b7ae129': 'Fig 3.19 Angiography Machine with C-Arm by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '0d7266b7-752c-4049-b830-7e4dca6ea0db': 'Fig 3.20\xa0Carotid Angiography, Digital Subtraction Cerebral Angiography\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '07ea0f57-4c84-4133-93c0-83121c89f01d': 'An example of a fluoroscopic examination is the esophogram and upper gastrointestinal series.\xa0 The patient is asked to swallow barium sulfate and gas-forming granules.\xa0 The barium can be seen to move with positioning (gravity) and peristalsis as it moves antegrade through the digestive tract while the gas rises to the highest point of the intestinal tract based upon patient positioning. The barium and the gas help to outline the inner lining of the intestine.\xa0 The live fluoroscopic x-rays visualize the motion of the barium and the gas. It is also possible to capture still images and/or cine mode images that are stored in the Picture Archive and Communication System (PACS).', 'bc96ce7d-d729-4227-95fa-225665741a10': 'Cine mode images are still images captured at a rapid rate and can be viewed sequentially, like a video, after being stored in the PACS. Other fluoroscopy aided examinations include arthrography, barium enema, cystourethrogram, sinus tract injections, myelography and hysterosalpingography, to name a few.', '87cf4657-0272-4db3-aa75-969547958014': 'The positioning of the patient is dependent on the physical capabilities of the patient and the exam that is to be performed. For example, when carrying out an esophogram, the best positioning would be an upright (standing) patient and an oblique or lateral view of the anatomy to watch the barium proceeding down the esophagus. Additional oblique and lateral views allow one to visualize abnormalities in multiple planes and to determine if any abnormality of the intestinal mucosa is concealed by swallowed barium on one view. If aspiration of ingested fluid or food into the lungs is clinically suspected the lateral projection allows one to determine if fluids are entering the trachea during swallowing.', 'b74d40ce-5391-4b64-a394-581b4a112089': 'A Fluoroscopy machine is seen in Figure 3.15.', 'bbd4cc27-e511-4d95-a60e-9f436bbc4a41': 'The video in Figure 3.17\xa0depicts live fluoroscopy of the upper esophagus for a patient whose images demonstrate aspiration of the barium into the trachea.', 'dbaf432f-8185-4365-a9d3-beed0ab25975': 'Fluoroscopy images are most often displayed for review inverted in comparison to standard x-ray images.\xa0 Hence, air is white and metal is black.\xa0 They can also be displayed as standard x-rays if this is advantageous for interpretation, see the barium enema images. The principles of absorption and transmission of the x-rays is unchanged, but the images are digitally manipulated to be the inverse of x-rays, much like film negatives in photography. The effect of image inversion for Fluoroscopy images is depicted in Figure 3.18.', '6891ccd4-5787-4995-8269-5f022f52e891': 'Fig 3.3\xa0X-ray Tube by\xa0Kieranmaher is in the Public Domain.', '39c648ca-5e19-4388-a61f-bdd02372eda8': 'Fig 3.4\xa0X-ray Tube. Lead Housing with Portal for x-ray Emission, bench top image by Rschiedon is available under a CC-BY-SA 3.0 Unported License.', '33964476-071d-4239-b632-398ccd10bb4f': 'Fig 3.5\xa0X-ray Image Creation and Display by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'f39c28ae-5cbf-4339-a557-42e3a1322037': 'Fig 3.6A\xa0A standard, fixed location, wall x-ray detector used for upright chest and abdomen x-rays by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'fb953c13-b4fe-4531-a6f1-80bdb7074953': 'Fig 3.6B\xa0A Portable x-ray Machine by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '6e34bafd-8b52-44e0-ad2d-cf1e331df04d': 'Fig 3.6C\xa0The Portable x-ray machine with the x-ray tube extended for use by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'ca28bfcc-132a-4473-a28f-bd495247e213': 'Fig 3.6D\xa0A Portable, Mini, C-Arm x-ray Unit by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '4711a96b-6775-4db5-9866-04674d98a3f6': 'Fig 3.7\xa0Appearance of different entities on x-rays\xa0by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '1258fb9d-5c95-4aae-80d3-54f946489f6b': 'Fig 3.8\xa0Left Shoulder x-ray\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license. Accessible from\xa0https://mistr.usask.ca/odin/?caseID=20160214201450302', '547b4d9c-36c8-45f6-b22d-82adda75b216': 'Fig 3.9\xa0Effect of tissue thickness on x-ray appearance\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '69e45b9a-1ecf-45d7-8796-3255b76aa319': 'Fig 3.10\xa0Common x-ray Test Object, Lucite Plastic Board\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '57b3432c-9730-4d69-9cce-4f4007438233': 'Fig 3.11A Posterior-anterior, upright, chest x-ray positioning, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', '32b6ba4a-63ec-4e10-9990-f380de9fee0d': 'Fig 3.11B Lateral, upright, chest x-ray positioning, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', 'b22e4373-8d85-42d1-a469-1a583e765d15': 'Fig 3.11C Decubitus x-ray positioning, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', '8b26404e-eca4-432c-a4a4-406c267732a6': 'Fig 3.1\xa0PACS Imaging Viewing Station (Workstation) by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC–BY-NC-SA 4.0 license.', '8a1454eb-adb0-43dd-b455-381ef4a0fa33': 'Fig 3.2 Sample MRI Request Form\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC–BY-NC-SA 4.0 license.', '32fc7f20-73b7-4d42-8e8e-a55c8e933865': '2) Sievert. Wikipedia. https://en.wikipedia.org/wiki/Sievert Accessed Sep. 3, 2018', '808e953e-3ced-45ab-8c29-dcb633e825d7': '3) Radiation Safety Review, Jeff Sanderson. Cancer Care Manitoba, 2001. https://www.cancercare.mb.ca/Research/medical-physics/radiaion-protection-services/index.html', '7a5b86bc-d27b-4f09-94d3-eacd0a26d733': '4) ICRP, 2007. ‘The 2007 Recommendations of the International Commission on Radiological Protection’. ICRP Publication 103. Ann. ICRP 37 (2-4).\n\n(see http://www.icrp.org/publication.asp?id=ICRP%20Publication%20103) Last accessed Feb. 12, 2019.', '0e4fd872-fed4-4829-aad6-b29fb5207e16': '5) United States Nuclear Regulatory Commission. https://www.nrc.gov/reading-rm/basic-ref/glossary/alara.html Last accessed February 5, 2019.', '31a16705-8334-4d0b-ba2c-7b3ba4903d3d': '6) Guidelines for Diagnostic Imaging During Pregnancy and Lactation ACOG October 2017 e210; 130(4):e210 – e216.', '61c798cb-9b2c-44a5-a50f-094104e0d923': '7) Image Gently Alliance. https://www.imagegently.org/ Last accessed February 6, 2019.', '95aa939a-bd18-4918-8163-3f0eda02ba68': '8) American College of Radiology. ‘ACR appropriateness criteria.’ Radiology, 2000; 215 (Suppl): 1-1511.', 'b562ff2f-9eea-4eba-9d13-f84bcac6c6d9': '9) ACR Appropriateness Criteria List. https://acsearch.acr.org/list Last accessed Feb. 13, 2019.', '15e3ec31-d27d-49ba-9d6a-a28f7211c03f': '10) The Royal Australian and New Zealand College of Radiologists. Imaging Guidelines. 4th edn. Surrey Hills: National Library of Australia Cataloguing-in-Publication Data, 2001.', '42757543-7fdd-42ee-bddd-5c70293e2ef9': '11) Canadian Association of Radiologists – Referral Guidelines https://car.ca/patient-care/referral-guidelines/ Last accessed Feb. 13, 2019.', '627e3917-cc9d-4355-b236-a11cc5382386': 'Most professional imaging associations have created and disseminated scientifically validated, peer-reviewed guidelines that provide assistance in ordering the most appropriate imaging test while avoiding less useful, or non-contributory, tests that could unnecessarily expose the patient to ionizing radiation. These guidelines also will provide information about the relative radiation exposure that can be expected for one examination vs. another.', 'dde178ba-da97-448c-b369-5277c0dd80ae': 'If possible, the use of imaging modalities that do not use ionizing radiation (ultrasound and MRI) should be considered.', '1a1b453c-73a4-4269-aed3-97a05e6abdcb': 'Hence, it is hoped that fewer examinations will be requested and the most useful and appropriate examination will be performed, reducing the use of inappropriate ionizing radiation. Also, if an examination with radiation is required the dose experienced by the patient can be justified with the argument that the most useful, appropriate, diagnostic examination has been utilized limiting the total radiation dose experienced by the patient. (8 – 11)'}"
+Figure 3.15,undergradimage/images/Figure 3.15.jpg,Figure 3.15 A Fluoroscopy Machine,A Fluoroscopy machine is seen in Figure 3.15.,"{'9d9da8c6-2e61-47f2-ba4d-6a20496f0d3a': 'All figures in “Chapter 17: Musculoskeletal” by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan are used under a CC-BY-NC-SA 4.0 license.', '42459c0f-ddfe-46c5-b1fd-6793f01031b5': '2) Gaillard, F. Salter-Harris Classification, Radiopaedia.org. https://radiopaedia.org/articles/salter-harris-classification', '99a28b8c-45c1-4a34-b607-d24433ffd59c': '3) Boaz K. Karmazyn, MD; Adina L Alazraki, MD; Sudha A. Anupindi, MD, et al. ACR Appropriateness Criteria® Pediatric – Urinary Tract Infection. Available at https://acsearch.acr.org/docs/69444/Narrative/\xa0 American College of Radiology. Accessed June 30, 2017.', 'ff59e5e9-8d3d-4318-86bd-c8746ebe5e27': '4) Urinary Tract Infection: Clinical Practice Guideline for\n\nthe Diagnosis and Management of the Initial UTI in\n\nFebrile Infants and Children 2 to 24 Months. Pediatrics 2011, 128 (3): 595 – 610.', '95839fcd-3dad-4370-b8c9-efa3ae8fee8d': '5) Dr. Matt Skalski, Ureteric reflux, Radiopaedia.org. “https://radiopaedia.org/\xa0 From the case “https://radiopaedia.org/cases/22569 rID: 22569', '26535aad-e785-402b-9277-4da9563c4525': '6) Molly E. Raske, MD; Molly E. Dempsey, MD; Jonathan R. Dillman, MD, et al. ACR Appropriateness Criteria® Pediatric – Vomiting in Infants Up to 3 Months of Age. Available at https://acsearch.acr.org/docs/69445/Narrative/ American College of Radiology. Accessed June 30, 2017.', '6ec32d8a-c136-48d5-9703-61624050f9f6': '7) Learning\xa0radiology\xa0: recognizing the basics. William Herring author. Elsevier 2016 Online access University of Saskatchewan Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK Accessed, June 30, 2017.', '3db9d0ef-38dd-4332-812d-6af2dfa4db69': '8) Grainger and Allison’s diagnostic\xa0radiology\xa0: a textbook of medical imaging. Andy Adam editor.; Adrian K. Dixon editor.; Jonathan H. Gillard 1964- editor.; Cornelia Schaefer-Prokop editor.; David J Allison; Elsevier (Firm) 2015, Online access University of Saskatchewan Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK\xa0 Accessed June 30, 2017.', '5bf49964-973b-4c4d-88b4-2696683964c1': '2) Radiopaedia.org – https://radiopaedia.org/articles/rockwood-classification-of-acromioclavicular-joint-injury Rockwood classification of AC-Joint injuries. Accessed June 30, 2017.', '59261295-fce8-49b2-a2de-77852eccc04a': '3) Common Forearm Fractures in Adults. American Family Physician 2009: 80 (10): 1096 – 1102.', '2f360c6a-b1f6-4af3-a4c8-e0b8438b9a58': '4) Diagnosis and Management of Scaphoid Fractures.\xa0 American Family Physician 2004; 70 (5); 879 – 884.', 'a5a2c608-b474-4203-bd8a-41a1f1ceb548': '5) Michael A. Bruno, MD; Barbara N. Weissman, MD; Mark J. Kransdorf, MD, et al. MSK – Hand and Wrist Trauma. \xa0Available at https://acsearch.acr.org/docs/69418/Narrative/ American College of Radiology. Accessed June 30, 2017.', '3548e3f8-9289-4063-8539-de870f48b911': '6) Robert J. Ward, MD, CCD; Barbara N. Weissman, MD; Mark J. Kransdorf, MD., et al. ACR Appropriateness Criteria®, MSK – Acute Hip Pain – Suspected Fracture. \xa0Available at https://acsearch.acr.org/docs/3082587/Narrative/ American College of Radiology. Accessed June 30, 2017.', '59596a80-aaf5-43e7-985e-7b2593951114': '7) Radiopaedia.org – https://radiopaedia.org/articles/femoral-neck-fracture Accessed June 30, 2017.', '469c112e-865a-482d-9b7e-5830232cee0e': '8) Michael J. Tuite, MD; Mark J. Kransdorf, MD; Francesca D. Beaman, MD, et al. ACR Appropriateness Criteria®, MSK – Acute Trauma to the Knee. Available at https://acsearch.acr.org/docs/69419/Narrative/ American College of Radiology. Accessed June 30, 2017.', '61b9265e-5af7-4d75-833f-a9344ce39570': '9) Ottawa Knee Rule – Stiell IG, Wells GA, Hoag RH, Sivilotti ML, et al (1997). “Implementation of the Ottawa Knee Rule for the use of radiography in acute knee injuries.”. JAMA. 278 (27): 2075–9. PMID\xa09403421. doi:10.1001/jama.1997.03550230051036. Accessed June 30, 2017.', 'd567b915-ef5d-4c0d-8e5b-f533c7036e91': '10) Ottawa Ankle Rule – Stiell IG, McKnight RD, Greenberg GH, et al. (March 1994). “Implementation of the Ottawa ankle rules”. JAMA. 271 (11): 827–32. PMID\xa08114236. doi:10.1001/jama.1994.03510350037034. Accessed June 30, 2017.', '92efbc09-23c1-4b33-b265-50b693fca389': '11) Jon A. Jacobson, MD; Catherine C. Roberts, MD; Jenny T. Bencardino, MD, et al. ACR Appropriateness Criteria®, \xa0MSK – Chronic Extremity Joint Pain Available at https://acsearch.acr.org/docs/3097211/Narrative/ American College of Radiology. Accessed June 30, 2017.', '170f0345-ab5f-45e0-8acd-470a44d17663': '2) Catheter Replacement of the Needle for Arteriography. Seldinger, S. I. Acta Radiologica, 1953: 39 (5); 368 – 376.', 'd55b79a0-51d8-4933-a57a-7d6b6cb5597b': '3) Thomas B. Kinney, MD; Hamed Aryafar, MD; Charles E. Ray, Jr, MD, PhD, et al. ACR Appropriateness Criteria® Management of Inferior Vena Cava Filters. Available at https://acsearch.acr.org/docs/69342/Narrative/ American College of Radiology. Accessed June 30, 2017', 'ba20e351-4219-47c3-b9c5-b61de5ab8fd9': '4) Learning\xa0radiology:recognizing the basics. William Herring author. Elsevier 2016, Online access University of Saskatchewan Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK Accessed, June 30, 2017.', '3fc9b447-cac6-4420-ac4e-05f656e81f43': '5) Grainger and Allison’s diagnostic\xa0radiology\xa0: a textbook of medical imaging. Andy Adam editor.; Adrian K. Dixon editor.; Jonathan H. Gillard 1964- editor.; Cornelia Schaefer-Prokop editor.; David J Allison; Elsevier (Firm) 2015, Online access University of Saskatchewan Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK\xa0 Accessed June 30, 2017.', 'a53e9698-8be5-4b56-ba59-87393e1e60b7': '2) Vahid Yaghmai, MD, MS; Max P. Rosen, MD, MPH; Tasneem Lalani, MD. ACR Appropriateness Criteria® \xa0– Gastrointestinal – Acute (non-localized) Abdominal Pain and Fever – Pneumoperitoneum. Available at\xa0 https://acsearch.acr.org/docs/69467/Narrative/ American College of Radiology. Accessed June 30, 2017.', '23ab0a22-ea4d-4c3f-9d72-f3a49ca4f6fd': '3) Douglas S. Katz, MD; Mark E. Baker, MD; Max P. Rosen, MD, MPH. ACR Appropriateness Criteria® – Gastrointestinal – Suspected Small Bowel Obstruction. Available at https://acsearch.acr.org/docs/69476/Narrative/ American College of Radiology. Accessed June 30, 2017.', 'f3c446dd-aa8d-4d22-aed4-b5e89863cd27': '4) Martin P. Smith, MD; Douglas S. Katz, MD; Max P. Rosen, MD, MPH. ACR Appropriateness Criteria® – Gastrointestinal – Right Lower Quadrant Pain – Suspected Appendicitis. Available at https://acsearch.acr.org/docs/69357/Narrative/ American College of Radiology. Accessed June 30, 2017.', 'e40080ff-07b5-4509-a9d8-3d7ff39b3c19': '5) Michelle M. McNamara, MD; Tasneem Lalani, MD; Marc Anthony Camacho, MD. ACR Appropriateness Criteria® \xa0– Gastrointestinal – Left Lower Quadrant Pain – Suspected Diverticulitis. Available at https://acsearch.acr.org/docs/69356/Narrative/ American College of Radiology. Accessed June 30, 2017.', 'a6f6cc9d-0ee1-42b0-ba1b-410ac9dc0387': '6) Rendon C. Nelson, MD; Ihab R. Kamel, MD, PhD; Mark E. Baker, MD. ACR Appropriateness Criteria® \xa0– Gastrointestinal – Liver Lesion – Initial Characterization. Available at https://acsearch.acr.org/docs/69472/Narrative/ American College of Radiology. Accessed June 30, 2017.', '154ec87b-5220-4418-99a5-75ec9d9fafec': '7) Tasneem Lalani, MD; Corey A. Couto, MD; Max P. Rosen, MD, MPH. ACR Appropriateness Criteria® \xa0– Gastrointestinal – Jaundice. Available at https://acsearch.acr.org/docs/69497/Narrative/ American College of Radiology. Accessed June 30, 2017.', '740ebf07-9cb8-4ed5-9cac-8bb79c578c8d': '2) Jacobo Kirsch, MD; Tan-Lucien H. Mohammed, MD, et al.\xa0 ACR Appropriateness Criteria®, Chest – Acute Respiratory Illness in Immunocompetent Patient. Available at https://acsearch.acr.org/docs/69446/Narrative/ Accessed, June 30, 2017.', '571524ec-b296-4a2d-95dc-97db963c3fcb': '3) Debra Sue Dyer, MD; Tan-Lucien H. Mohammed, MD; Jacobo Kirsch, MD, et al. ACR Appropriateness Criteria®, Chest – Chronic Dyspnea – Suspected Pulmonary Origin. \xa0Available at https://acsearch.acr.org/docs/69448/Narrative/ Accessed June 30, 2017.', 'f22ed822-b387-44e5-8a22-dd8a867b8b01': '4) Learning\xa0radiology\xa0: recognizing the basics. William Herring author. Elsevier 2016 Online access USask Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK Accessed, June 30, 2017.', '87cb046f-4dac-41ec-84d0-bed36b33d265': '5) Jeffrey P. Kanne, MD, Leif E. Jensen, MD, MPH, Tan-Lucien H. Mohammed, MD, et al. ACR Appropriateness Criteria®,\xa0 Chest – Radiographically Detected Solitary Pulmonary Nodule. Available at https://acsearch.acr.org/docs/69455/Narrative/ Accessed June 30, 2017.', '3159e24d-3174-4315-993d-23dd449b06b4': '6) Fleischner Society – https://fleischnersociety.org', 'd07c0b2d-9413-4046-ab1e-55f117865c2a': '7) Michael A. Bettmann, MD, Scott G. Baginski, MD, Richard D. White, MD, et al. ACR Appropriateness Criteria®, Chest – Acute Chest Pain – Suspected Pulmonary Embolism. Available at https://acsearch.acr.org/docs/69404/Narrative/\xa0 Accessed June 30, 2017.', 'cd973045-ca97-4b36-a285-52581f60f304': 'Ultrasound uses traditional probes with higher frequency to better image the breast tissue that is in close proximity to the overlying skin.', '13e1e8e0-e640-4941-8300-c31710b3a53c': 'Mammography/Breast Imaging Centres in Canada are accredited and audited for quality by the Canada Association of Radiologists.', 'eca3d4b9-a2c4-43c7-ae2b-3ec757983d8b': '2) Vilaas S. Shetty, MD; Martin N. Reis, MD; Joseph M. Aulino, MD, et al. ACR Appropriateness Criteria® Head Trauma. Available at https://acsearch.acr.org/docs/69481/Narrative/ American College of Radiology. Accessed, June 30, 2017.', 'a923162d-9460-4587-991e-319c82bf5c9f': 'https://acsearch.acr.org/docs/69481/Narrative/', '96ac01aa-0380-4fa5-be27-55a5b787830c': '3) Michael B. Salmela, MD; Shabnam Mortazavi, MD; Bharathi D. Jagadeesan, MD, ACR, et al. Appropriateness Criteria® Cerebrovascular Disease. https://acsearch.acr.org/docs/69478/Narrative/ American College of Radiology. Accessed, June 30, 2017.', 'b68256b4-9387-4475-8f5a-41b599bfaf04': 'https://acsearch.acr.org/docs/69478/Narrative/', 'd4f105b8-2855-4af9-a3cb-f9d88fcdbf18': '4) Annette C. Douglas, MD; Franz J. Wippold II, MD; Daniel F. Broderick, MD, et al. Appropriateness Criteria® Headache. https://acsearch.acr.org/docs/69482/Narrative/ American College of Radiology. Accessed, June 30, 2017.', '74770c44-e954-4084-abd6-2740860fa07d': 'https://acsearch.acr.org/docs/69482/Narrative/', 'edab0354-1c57-4db0-b1dd-6ea014cb5e00': '5) Nandini D. Patel, MD; Daniel F. Broderick, MD; Judah Burns, MD, et al. Appropriateness Criteria® Low Back Pain. https://acsearch.acr.org/docs/69483/Narrative/ American College of Radiology. Accessed, June 30, 2017.', 'd0966524-e032-4f5a-9faf-1e8f783d8061': 'https://acsearch.acr.org/docs/69483/Narrative/', 'aa597d16-b4a3-404a-889f-e4a901c750d6': '6) Richard H. Daffner, MD; Barbara N. Weissman, MD; Franz J. Wippold II, MD, et al. Appropriateness Criteria®  Suspected Spine Trauma. https://acsearch.acr.org/docs/69359/Narrative/ American College of Radiology. Accessed, June 30, 2017.', '6945685d-8bdd-48ba-9299-88cd95cdcccc': 'https://acsearch.acr.org/docs/69359/Narrative/', 'd6137ceb-35ba-41f9-b5ad-909c0c93c831': 'The standard views are AP (anterior-posterior) and lateral.\xa0 These two views are taken at right angles (orthogonal) to each other.\xa0 If these images are not helpful, ancillary views such as oblique views, or special views such as, an axillary or carpal tunnel view, may be required based upon the clinical scenario.', '8da19a7d-ea8a-48f7-802b-c3e6ad2879ea': 'Stress views i.e. a force is applied to a bone or joint to determine if an injury is present, such as, a subtle avulsion or a suspected tendon or ligament tear causing joint instability. These are acquired as special requests and should be performed in a manner that minimizes patient pain and discomfort.', 'c1ddb6e5-c42b-4c10-ac0d-ed3b6ab5cbad': 'At least one joint space should be visible in relation to the suspected bone injury.\xa0 Additional x-ray views and views of another adjacent joint space may be required in some circumstances.', 'd8ec4a87-ef98-4bd8-9ee3-47f8c6612a49': 'Comparison views to the contralateral, normal bone, or joint, may be required, this is especially true if a subtle growth plate injury is suspected in a child.\xa0 Comparison views should not be ordered routinely, but should be used if clinically necessary.', 'd76a51e5-d391-4400-aa76-b67e2d5a4233': 'It is important to remember that some bone and ligament injuries occur as a common pattern of multiple injuries i.e. the Colle fracture of the distal radius is often associated with an avulsion fracture of the ulnar styloid.\xa0 Ankle ligament injuries and fractures often occur in a sequence i.e. medial malleolar avulsion fracture (or medial ligament tear), interosseous ligament tear between the tibia and fibula, and a subsequent oblique fracture of the proximal fibula (Maisonneuve fracture complex).\xa0 Keep this in mind as you encounter various patients and you will develop knowledge and experience of these associated bone and soft tissue injuries.', 'd26261d6-1894-4731-a4bc-cb382c5fc4b8': 'Fractures usually present as a lucent line on x-rays involving the cortex and medulla of the bone that can be followed from one cortex to the opposite cortex with varying degrees of displacement and malalignment of the involved bone.', '6d3c05b4-f04f-464e-828c-e219309240b2': 'There are some fractures that may be associated with bone ischemia and avascular necrosis i.e. capital femoral fractures and scaphoid fractures.\xa0 Be aware of this and learn the importance of aggressive and pre-emptive management for these patients.', '9efc69ef-d567-4c20-b7da-5b5faae548f8': 'Fig 5.7 Abdomen Quadrants/Regions\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'c17eee8e-a5a7-4b3d-aa39-e9562f679745': 'Fig 5.8\xa0Supine Positioning for Abdomen x-ray, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', 'e428391c-3d1e-4c3d-a0ee-4e39fd82ee4d': 'Fig 5.9 Upright Positioning for Abdomen x-ray, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', '4fe76b20-0ac2-49ac-a875-af27033355ec': 'Fig 5.10 Decubitus Positioning for Abdomen x-ray, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', '1e50fdef-529f-4fe1-b3f4-ab42378ca31f': 'Fig 5.11 Normal Abdominal x-ray by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '27e0addc-368c-4208-9970-6559705ff1e8': 'Fig 5.12 Colon anatomy emphasized by the presence of barium and air by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '990d74a2-1431-4705-8efd-4cf210fa9ce3': 'Fig 5.13 Bones and Musculoskeletal Landmarks in the Abdomen by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '3d050294-a087-4835-a5ed-7961069e1f0a': 'Fig 5.14 Possible Artifacts on Abdomen x-rays. The image demonstrates two umbilical piercings, fallopian tube clips, and the buttons on the patient’s pants by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'cbf4613b-cbd6-4078-b9c3-b1c333a37c48': 'The standard upright views of the chest are made when a patient is typically placed between an x-ray source and an x-ray detector. When the x-rays penetrate the tissues of the patient, they stimulate an x-ray detector that alters the energy of the x-ray beam into a digital pixel grid. The radiograph produced is referred to as a roentgenogram and named after Wilhelm Konrad Roentgen who received the first Nobel Prize for Physics in 1901 for his work in defining the major properties of x-rays and the conditions necessary for their production. It was Roentgen who coined the term “x-ray”.', '9da044bd-e951-4eb4-8cf9-ccb9398a2423': 'Fig 5.1 A portable upright x-ray where the image is not taken with proper body alignment, the patient is rotated and tilted\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '0bc6ae7d-c9c2-4d6d-ae6c-f07a5a647792': 'Fig 5.2 A portable upright x-ray taken with patient in proper alignment\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'e27384e1-63ef-4a65-a138-41a0d8870a95': 'Fig 4.1A Fluoroscopy – Shoulder Arthrogram Early Phase of Injection\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '2f124311-a640-4063-9232-06af6006da7a': 'Fig 4.1B\xa0Shoulder Arthrogram Fluoroscopy Mid-Phase of Injection by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'bb7b38f9-ff02-462d-8d99-621dd444c05e': 'Fig 4.1C Shoulder Arthrogram Late Phase of Injection\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'b6d8041f-18d1-40b8-a5b0-44c6bfeb9405': 'Fig 4.2A\xa0CT Aorta, C-\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'b98a8c21-5a63-4b95-b9ce-f7e38e6999bc': 'Fig 4.2B CT Iliac Arteries, C-\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '43da027d-17e8-4ba4-b312-67fba1bd1511': 'Fig 4.2C CT Aorta, C+\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'b66fdc16-e8ca-433f-8a6e-1d0f3f659bb3': 'Fig 4.2D CT Iliac Arteries, C+\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '8964941e-dc07-44fd-954a-0403c1bfd992': '2) Image Wisely. http://www.imagewisely.org/ Last accessed, Aug. 22, 2017.', 'ed5f284b-a74a-4376-b274-77e0e2303fc9': '3) Image Gently. http://www.imagegently.org/ Last accessed Aug 22, 2017.', 'fc2d1e7a-fa5b-4dbc-917f-25f258eb23d6': '4) Novelline, R. A., & Squire, L. F. (2004), sixth edition. Squire’s fundamentals of radiology. Cambridge, Mass: Harvard University Press.', 'ce057be0-807e-4b88-a477-0d87c59e607b': 'Fig 3.43 Nuclear Medicine Scanner by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'dce81a39-f2bd-47ee-847d-9205bbc446e1': 'Fig 3.44A Normal, Pediatric Nuclear Medicine Bone Scan by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '8bed792d-6442-4cbd-89db-89b5a4cb4541': 'Fig 3.44B Normal, Adult Nuclear Medicine Bone Scan\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '41bf79b1-bfd9-4a16-9b5d-900405a59176': 'Fib 3.45 PET/CT Scanner\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '8fcd15af-34e1-492f-91a7-3b8b671387ed': 'Fig 3.46A PET/CT image of the chest for a patient with lymphoma\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '211a4b55-451b-4858-aa60-ce4253c9d555': 'Fig 3.46B PET image of the whole body for a patient with lymphoma\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '15d4a271-c53b-449d-8385-a1b6030fd923': 'The appearance of different tissue on MR images is described as displaying greater, or lesser, signal in comparison the other anatomy in the region. The signal in question is the energy that the perturbed protons liberated when they fall back into alignment with the magnetic field. The signal intensity of the tissue in question changes based upon the image acquisition parameters set by the MR Technologist, under the direction of a supervising Radiologist.\xa0 The parameters set result in the acquisition of a set of images called an MR imaging sequence. On one sequence cerebrospinal fluid will appear as black pixels (T1 sequence) while on another sequence it is white pixels (T2 sequence). This difference in tissue appearance can be exploited to determine if pathology is present.', '33f25041-480d-4bb9-95fc-0a28bc2224ed': 'Fig 3.31\xa0B-Mode Ultrasound of the Carotid bulb with atherosclerotic plaque\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '18658974-a7a2-499b-881c-5a51baaa9854': 'Fig 3.32A\xa0Ultrasound Machine\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '5c75f45f-6624-42df-b964-dddafeae9d32': 'Fig 3.32B Mobile Ultrasound Machine\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'f351a841-d5dd-4048-8f36-831f0bbf09d9': 'Fig 3.33 Ultrasound image of the normal liver and kidney. The echogenicity of the liver is greater than the echogenicity of the adjacent renal cortex by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '059ddd7b-14ba-4290-92ad-7382c9156fc4': 'Fig 3.34 Gallbladder\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '5db401cc-d0ff-4f03-945a-f50dd89e4be9': 'Fig 3.35A Normal Liver Ultrasound by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'fae31525-31fa-491b-8fcf-6206343abf74': 'Fig 3.35B Hepatomegaly and hepatic steatosis on Ultrasound\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '4aa1ffad-a8df-4cef-8f34-a9695f5958bc': 'Fig 3.36 Colour Doppler, of the neck\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '99b1c66a-6cc2-4a4e-872f-476d28cdab03': 'Fig 3.37 Colour Doppler of the neck with Spectral Display\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '21a2827a-f5ed-4e96-a0d9-b91bdf773c22': 'Fig 3.38A\xa0Internal Carotid Doppler Ultrasound Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '6bf5c327-c3cb-4f8c-b09c-7b96d908326a': 'Fig 3.38B Carotid Bulb Doppler Ultrasound\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '8d123159-7ce7-4972-bc0c-86aa528a32ae': 'Fig 3.38C\xa0Vertebral Doppler Ultrasound\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'b8f04a00-104c-40e3-8e47-1dc899d44ca1': 'Fig 3.39 Linear probe and two curved array probes\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'c15107ec-6f70-4702-929e-61aeee36a137': 'The patient does not need to be moved, or re-positioned, to obtain CT images in different anatomic planes.\xa0 The patient lies on the CT table in anatomic position and remains in that position throughout the study.\xa0 The standard orientation of image acquisition for CT is in the axial plane, hence the old name for this machine of CAT (computed axial tomography) scanner.\xa0 Often the axial images obtained during the initial x-ray exposure will be digitally reformatted into other anatomic planes i.e. sagittal and coronal.\xa0 These reformatted images are the result of a computer algorithm reformatting the original digital image data and, as such, these supplemental anatomic planes of imaging do not require additional x-ray exposure.', '23a6edd0-ea0d-4597-87b7-d94ca733c3a5': 'The CT gantry can be tipped cranially and caudally to deviate from the axial plane by 30 degrees in either direction and this can be used to correct for patient anatomic variability to maintain the axial plane, if necessary.\xa0 It also allows for unique imaging along an angled plane that can be used when requested by the referring physician or the radiologist.\xa0 A widely used example of imaging in an angled plane is found for CT Head examinations. It is not conventional to acquire these images in the axial plane but to image the brain on the canthomeatal (lateral orbit canthus to the aural meatus) line and therefore, the CT gantry must be tilted to ensure that all CT Head images are acquired in this plane.\xa0 Originally, this plane was chosen as it maximizes information about the intra-cranial contents while minimizing the exposure of the orbits (lens) to radiation. The orbito-meatal line has become the internationally recognized plane for acquiring CT head images. This line is depicted in Figure 3.22.', '2a01449e-f80d-44b8-b5f1-9fbd2293de89': 'The physics of CT image creation are complex and require complex computer processing to create images that are visible for clinical use.\xa0 As the x-ray tube and the x-ray detectors revolve around the patient thousands of mathematical calculations are performed to determine how much of the incident x-ray beam was absorbed by a volume of tissue. This volume of tissue is called a voxel. The calculated absorption of the x-rays by a voxel is converted into a pixel density that is displayed on a gray scale from -1,000 (air) to +1,000 (metal).\xa0 This scale is called the Hounsfield unit (HU) scale after one of the principle inventors of CT, Sir Godfrey Hounsfield.\xa0 The calculated density of this voxel is then allocated to a pixel on a grid of the 512 x 512 pixels that forms each individual CT image.', '7630aac5-da71-4093-992f-e3de7e0777cf': 'Therefore, if the volume of tissue contained air, or gas, the pixel density allocated would be close to -1,000 HU, while if the volume of tissue analyzed contained metal (bullet fragment, etc.) the pixel would be assigned a density close to the +1,000 HU.\xa0 The assignment of pixel density to voxels spans the entire possible range of pixels from -1,000 – +1,000 HU, resulting in 2,000 shades of grey.\xa0 An image with the HU measurements of specific anatomic regions is provided in Figure 3.23.', '194d89df-a49e-4ba0-a141-fedb5b7d0e3d': 'CT density: a region on a CT image is described as being more, or less, dense than another region. The liver is more dense than the renal cortex.\xa0 This variation in pixel density can be quantified by measuring all the pixels in a region and creating an average pixel density i.e. region of interest of an area of liver can be measured, with a standard deviation, 50 HU +/- 5 HU, etc. The HU density of some common structures is provided in Table 3.2.', '7fd3f166-8080-4a1e-b564-5aaedace0274': 'Table 3.2 HU Scale', 'bf48f853-55d2-4b0d-a952-97052c04fccc': 'The viewer of the CT can decide how to adjust the level and window of the displayed CT images to accentuate tissues of a defined pixel density. \xa0The level and window are at the discretion of the viewing radiologist and can be set to their preferences. There are a variety of established level and window settings, i.e. abdomen, bone, brain, etc. These help to provide some level of uniformity for comparison of multiple CT examinations. Level and window setting for six common tissues are as follows:', 'b2f1f965-5bd4-4a65-bbcb-a0c74bb6849b': 'Table 3.3 Six common tissue levels and windows', '1c89c10d-2e57-46d5-873c-753aa9d9fd25': 'CT images demonstrating the appearance of these six different level and window settings are provided in Figure 3.24.', '0c5a4d4a-1a8a-45e7-82a1-3975c585d2e6': 'Level and Window are unique physical properties of CT images that allow the user to adjust the centre and the width of the gray scale that is portrayed on the images.\xa0 This is an adjustment that is applied to the raw CT data and does not require repeated patient imaging to obtain the different levels and windows. The level is the centre of the gray scale, set to the HU of the tissue of most interest i.e. the centre (level) of the gray scale for brain window is 35 HU.\xa0 The window is the width of the gray scale that surrounds the level setting, thus defining the range of HU for white and black seen on the image. For the brain images the width of the HU scale is 80 HU. A illustration depicting this for brain and bone level and window setting are provided in Figure 3.25.', '22baea2d-4734-448a-b8d2-ff98cc34c126': 'Fig 3.21\xa0Helical CT Scanner\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '997a9bef-3a49-4a5c-baaa-b5f4e9a60244': 'Fig 3.22 The plane of imaging related to the cantho-meatal line\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'e620fc79-fe54-4e1b-937a-f2f6d1ae88b4': 'Fig 3.23 Images of CT with HU measurements\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '47384920-3878-4fd3-a2cb-6676f1ecd6b4': 'Fig 3.24 CT Images with different level and window settings\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '27c1bf77-b175-46e2-8f3c-8b044f235e7a': 'Fig 3.25A Brain Level and Window\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'ae550a20-25ad-452b-9c36-d593b30cda0b': 'Fig 3.25B Bone Level and Window\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '4c06c22c-a218-43c6-b6d2-8b86614cb44f': 'Fig 3.26A Head CT visible on brain level and window. Bone not well seen by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '09e44bf9-1b1b-4b30-ac75-268a90c19141': 'Fig 3.26B Head CT on bone level and window. Brain not well seen by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'b14da7a2-6e23-4800-9645-0f1ea9841b25': 'Fig 3.27 Standard viewing orientation for an axial CT image\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '1aaea852-a349-4e12-9f42-4e7db0ccde67': 'Fig 3.28A CT image displayed in axial orientation from one radiation exposure event\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'cb4dd03b-6e19-4678-85ec-4798a6b00fe9': 'Fig 3.28B CT image displayed in sagittal orientation from one radiation exposure event\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '06e1bc4e-3c56-472e-b82f-5ca979851270': 'Fig 3.28C CT image displayed in coronal orientation from one radiation exposure event\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '82ba8ff7-a04c-4efb-9328-b4216ab73f8e': 'Fig 3.29A CT of the chest on lung level/window by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '2bb589c6-5d7e-4ca5-9add-0533ae22ad66': 'Fig 3.29B CT of the chest on mediastinal level/window by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '80b61eb5-0c49-4c26-bba6-34a715289fbc': 'Fig 3.30 CT PE image maximizing the injected contrast in the pulmonary arteries\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '7586c4b7-5466-4c34-b19e-28c580057600': 'An angiography machine is essentially a fluoroscopy unit that has the added feature of having the x-ray source and detectors mounted on a c-arm apparatus. The c-arm allows for movement of the source and detector around the patient who lies supine on the angiography table. The operator can acquire images in a wide variety of anatomic projections.\xa0 Therefore, patient movement is not required for this imaging modality. The angiography unit also has advanced software applications that facilitate complex arterial and body interventional procedures beyond the capabilities of a standard fluoroscopy unit. As with fluoroscopy, the images are viewed inverted in comparison to standard radiographs.', '8321eb02-784a-4088-a939-b2f9c46e47ce': 'The x-ray dose for Angiography is controlled by multiple detectors that adjust the radiation exposure to maximize image quality and minimize x-ray exposure. The machine only emits radiation when the operator uses a foot pedal to activate the x-ray tube. The area imaged can be collimated, or coned, to minimize the area exposed to x-rays.\xa0 The anatomy can also be magnified to improved diagnostic capacity.', 'c01d6355-58d2-4339-a8e1-0b13cb0a2a27': 'The images acquired are obtained very rapidly in cine mode resulting in a set of stacked images, that when stored and viewed, simulate a video recording.\xa0 Cine mode allows for the dynamic assessment of moving contrast and movement of catheters and guide wires inside the anatomy of the patient. A standard c-arm angiography unit is depicted in Figure 3.19.', '75c40a34-0496-4f50-853a-4a34b85893f5': 'For angiography, the radio-opaque contrast agent used is injected intra-arterially while x-ray images are acquired.\xa0 This is an invasive process that requires the injection to be performed via a small intra-arterial catheter that administers the contrast in close proximity to the origin of the arterial structure being investigated, i.e. carotid angiography requires an injection of contrast into the selected carotid artery.\xa0 The catheter used is usually manipulated into position using fluoroscopy from a remote arterial access site i.e. the common femoral artery, the radial artery, or the brachial artery.', 'b87262ac-93be-41c5-a829-b396ffcd5495': 'Arterial access relies upon the “Seldinger” technique, using local anesthetic, to insert the intra-arterial catheter used for the procedure. Blood vessels lack internal innervation and therefore, the catheter and guidewire can be manipulated without causing patient pain or discomfort.', 'e2e27594-969f-4065-afca-fc9d4d9d539d': 'This machine can also be used for Interventional Radiology procedures where catheters, guidewires, stents, feeding tubes, etc. are visualized with the c-arm fluoroscopy.\xa0 Water-soluble contrast agents can also be injected during these procedures to depict the anatomy of structures such as, the bile ducts, intestine, renal collecting system, veins, etc.', 'ba4bd9f0-d4d3-4160-998d-e606f08e785b': 'All modern angiography units capture images and present them in subtracted mode.\xa0 The subtraction process is digital using a computer to superimpose a non-contrast enhanced image onto a set of contrast enhanced cine images, resulting in subtracted images that depict only the anatomic structure filled with contrast since the background anatomy has been subtracted away by the digital image modification process. A digital, subtracted, carotid angiogram is depicted in Figure 3.20.', '9507b590-4a7c-43a4-ab86-48655f636346': 'The contrast used for angiography is an iodine based pharmaceutical and is water soluble.\xa0 During angiography, it is injected into the artery of interest and replaces the blood for a very short period of time.\xa0 This contrast agent progresses antegrade in the vascular tree related to the direction of blood flow.\xa0 It quickly clears from the arteries and exits the region via venous drainage.\xa0 The circulating contrast is predominantly excreted by the kidneys into the urine.', '3276ecac-6f99-4922-9d4c-37154b7ae129': 'Fig 3.19 Angiography Machine with C-Arm by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '0d7266b7-752c-4049-b830-7e4dca6ea0db': 'Fig 3.20\xa0Carotid Angiography, Digital Subtraction Cerebral Angiography\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '07ea0f57-4c84-4133-93c0-83121c89f01d': 'An example of a fluoroscopic examination is the esophogram and upper gastrointestinal series.\xa0 The patient is asked to swallow barium sulfate and gas-forming granules.\xa0 The barium can be seen to move with positioning (gravity) and peristalsis as it moves antegrade through the digestive tract while the gas rises to the highest point of the intestinal tract based upon patient positioning. The barium and the gas help to outline the inner lining of the intestine.\xa0 The live fluoroscopic x-rays visualize the motion of the barium and the gas. It is also possible to capture still images and/or cine mode images that are stored in the Picture Archive and Communication System (PACS).', 'bc96ce7d-d729-4227-95fa-225665741a10': 'Cine mode images are still images captured at a rapid rate and can be viewed sequentially, like a video, after being stored in the PACS. Other fluoroscopy aided examinations include arthrography, barium enema, cystourethrogram, sinus tract injections, myelography and hysterosalpingography, to name a few.', '87cf4657-0272-4db3-aa75-969547958014': 'The positioning of the patient is dependent on the physical capabilities of the patient and the exam that is to be performed. For example, when carrying out an esophogram, the best positioning would be an upright (standing) patient and an oblique or lateral view of the anatomy to watch the barium proceeding down the esophagus. Additional oblique and lateral views allow one to visualize abnormalities in multiple planes and to determine if any abnormality of the intestinal mucosa is concealed by swallowed barium on one view. If aspiration of ingested fluid or food into the lungs is clinically suspected the lateral projection allows one to determine if fluids are entering the trachea during swallowing.', 'b74d40ce-5391-4b64-a394-581b4a112089': 'A Fluoroscopy machine is seen in Figure 3.15.', 'bbd4cc27-e511-4d95-a60e-9f436bbc4a41': 'The video in Figure 3.17\xa0depicts live fluoroscopy of the upper esophagus for a patient whose images demonstrate aspiration of the barium into the trachea.', 'dbaf432f-8185-4365-a9d3-beed0ab25975': 'Fluoroscopy images are most often displayed for review inverted in comparison to standard x-ray images.\xa0 Hence, air is white and metal is black.\xa0 They can also be displayed as standard x-rays if this is advantageous for interpretation, see the barium enema images. The principles of absorption and transmission of the x-rays is unchanged, but the images are digitally manipulated to be the inverse of x-rays, much like film negatives in photography. The effect of image inversion for Fluoroscopy images is depicted in Figure 3.18.', '6891ccd4-5787-4995-8269-5f022f52e891': 'Fig 3.3\xa0X-ray Tube by\xa0Kieranmaher is in the Public Domain.', '39c648ca-5e19-4388-a61f-bdd02372eda8': 'Fig 3.4\xa0X-ray Tube. Lead Housing with Portal for x-ray Emission, bench top image by Rschiedon is available under a CC-BY-SA 3.0 Unported License.', '33964476-071d-4239-b632-398ccd10bb4f': 'Fig 3.5\xa0X-ray Image Creation and Display by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'f39c28ae-5cbf-4339-a557-42e3a1322037': 'Fig 3.6A\xa0A standard, fixed location, wall x-ray detector used for upright chest and abdomen x-rays by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'fb953c13-b4fe-4531-a6f1-80bdb7074953': 'Fig 3.6B\xa0A Portable x-ray Machine by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '6e34bafd-8b52-44e0-ad2d-cf1e331df04d': 'Fig 3.6C\xa0The Portable x-ray machine with the x-ray tube extended for use by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'ca28bfcc-132a-4473-a28f-bd495247e213': 'Fig 3.6D\xa0A Portable, Mini, C-Arm x-ray Unit by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '4711a96b-6775-4db5-9866-04674d98a3f6': 'Fig 3.7\xa0Appearance of different entities on x-rays\xa0by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '1258fb9d-5c95-4aae-80d3-54f946489f6b': 'Fig 3.8\xa0Left Shoulder x-ray\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license. Accessible from\xa0https://mistr.usask.ca/odin/?caseID=20160214201450302', '547b4d9c-36c8-45f6-b22d-82adda75b216': 'Fig 3.9\xa0Effect of tissue thickness on x-ray appearance\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '69e45b9a-1ecf-45d7-8796-3255b76aa319': 'Fig 3.10\xa0Common x-ray Test Object, Lucite Plastic Board\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '57b3432c-9730-4d69-9cce-4f4007438233': 'Fig 3.11A Posterior-anterior, upright, chest x-ray positioning, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', '32b6ba4a-63ec-4e10-9990-f380de9fee0d': 'Fig 3.11B Lateral, upright, chest x-ray positioning, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', 'b22e4373-8d85-42d1-a469-1a583e765d15': 'Fig 3.11C Decubitus x-ray positioning, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', '8b26404e-eca4-432c-a4a4-406c267732a6': 'Fig 3.1\xa0PACS Imaging Viewing Station (Workstation) by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC–BY-NC-SA 4.0 license.', '8a1454eb-adb0-43dd-b455-381ef4a0fa33': 'Fig 3.2 Sample MRI Request Form\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC–BY-NC-SA 4.0 license.', '32fc7f20-73b7-4d42-8e8e-a55c8e933865': '2) Sievert. Wikipedia. https://en.wikipedia.org/wiki/Sievert Accessed Sep. 3, 2018', '808e953e-3ced-45ab-8c29-dcb633e825d7': '3) Radiation Safety Review, Jeff Sanderson. Cancer Care Manitoba, 2001. https://www.cancercare.mb.ca/Research/medical-physics/radiaion-protection-services/index.html', '7a5b86bc-d27b-4f09-94d3-eacd0a26d733': '4) ICRP, 2007. ‘The 2007 Recommendations of the International Commission on Radiological Protection’. ICRP Publication 103. Ann. ICRP 37 (2-4).\n\n(see http://www.icrp.org/publication.asp?id=ICRP%20Publication%20103) Last accessed Feb. 12, 2019.', '0e4fd872-fed4-4829-aad6-b29fb5207e16': '5) United States Nuclear Regulatory Commission. https://www.nrc.gov/reading-rm/basic-ref/glossary/alara.html Last accessed February 5, 2019.', '31a16705-8334-4d0b-ba2c-7b3ba4903d3d': '6) Guidelines for Diagnostic Imaging During Pregnancy and Lactation ACOG October 2017 e210; 130(4):e210 – e216.', '61c798cb-9b2c-44a5-a50f-094104e0d923': '7) Image Gently Alliance. https://www.imagegently.org/ Last accessed February 6, 2019.', '95aa939a-bd18-4918-8163-3f0eda02ba68': '8) American College of Radiology. ‘ACR appropriateness criteria.’ Radiology, 2000; 215 (Suppl): 1-1511.', 'b562ff2f-9eea-4eba-9d13-f84bcac6c6d9': '9) ACR Appropriateness Criteria List. https://acsearch.acr.org/list Last accessed Feb. 13, 2019.', '15e3ec31-d27d-49ba-9d6a-a28f7211c03f': '10) The Royal Australian and New Zealand College of Radiologists. Imaging Guidelines. 4th edn. Surrey Hills: National Library of Australia Cataloguing-in-Publication Data, 2001.', '42757543-7fdd-42ee-bddd-5c70293e2ef9': '11) Canadian Association of Radiologists – Referral Guidelines https://car.ca/patient-care/referral-guidelines/ Last accessed Feb. 13, 2019.', '627e3917-cc9d-4355-b236-a11cc5382386': 'Most professional imaging associations have created and disseminated scientifically validated, peer-reviewed guidelines that provide assistance in ordering the most appropriate imaging test while avoiding less useful, or non-contributory, tests that could unnecessarily expose the patient to ionizing radiation. These guidelines also will provide information about the relative radiation exposure that can be expected for one examination vs. another.', 'dde178ba-da97-448c-b369-5277c0dd80ae': 'If possible, the use of imaging modalities that do not use ionizing radiation (ultrasound and MRI) should be considered.', '1a1b453c-73a4-4269-aed3-97a05e6abdcb': 'Hence, it is hoped that fewer examinations will be requested and the most useful and appropriate examination will be performed, reducing the use of inappropriate ionizing radiation. Also, if an examination with radiation is required the dose experienced by the patient can be justified with the argument that the most useful, appropriate, diagnostic examination has been utilized limiting the total radiation dose experienced by the patient. (8 – 11)'}"
+Figure 3.18,undergradimage/images/Figure 3.18.jpg,Figure 3.18 Fluoroscopy Images are Inverted in Comparison to x-rays,"Fluoroscopy images are most often displayed for review inverted in comparison to standard x-ray images.  Hence, air is white and metal is black.  They can also be displayed as standard x-rays if this is advantageous for interpretation, see the barium enema images. The principles of absorption and transmission of the x-rays is unchanged, but the images are digitally manipulated to be the inverse of x-rays, much like film negatives in photography. The effect of image inversion for Fluoroscopy images is depicted in Figure 3.18.","{'9d9da8c6-2e61-47f2-ba4d-6a20496f0d3a': 'All figures in “Chapter 17: Musculoskeletal” by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan are used under a CC-BY-NC-SA 4.0 license.', '42459c0f-ddfe-46c5-b1fd-6793f01031b5': '2) Gaillard, F. Salter-Harris Classification, Radiopaedia.org. https://radiopaedia.org/articles/salter-harris-classification', '99a28b8c-45c1-4a34-b607-d24433ffd59c': '3) Boaz K. Karmazyn, MD; Adina L Alazraki, MD; Sudha A. Anupindi, MD, et al. ACR Appropriateness Criteria® Pediatric – Urinary Tract Infection. Available at https://acsearch.acr.org/docs/69444/Narrative/\xa0 American College of Radiology. Accessed June 30, 2017.', 'ff59e5e9-8d3d-4318-86bd-c8746ebe5e27': '4) Urinary Tract Infection: Clinical Practice Guideline for\n\nthe Diagnosis and Management of the Initial UTI in\n\nFebrile Infants and Children 2 to 24 Months. Pediatrics 2011, 128 (3): 595 – 610.', '95839fcd-3dad-4370-b8c9-efa3ae8fee8d': '5) Dr. Matt Skalski, Ureteric reflux, Radiopaedia.org. “https://radiopaedia.org/\xa0 From the case “https://radiopaedia.org/cases/22569 rID: 22569', '26535aad-e785-402b-9277-4da9563c4525': '6) Molly E. Raske, MD; Molly E. Dempsey, MD; Jonathan R. Dillman, MD, et al. ACR Appropriateness Criteria® Pediatric – Vomiting in Infants Up to 3 Months of Age. Available at https://acsearch.acr.org/docs/69445/Narrative/ American College of Radiology. Accessed June 30, 2017.', '6ec32d8a-c136-48d5-9703-61624050f9f6': '7) Learning\xa0radiology\xa0: recognizing the basics. William Herring author. Elsevier 2016 Online access University of Saskatchewan Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK Accessed, June 30, 2017.', '3db9d0ef-38dd-4332-812d-6af2dfa4db69': '8) Grainger and Allison’s diagnostic\xa0radiology\xa0: a textbook of medical imaging. Andy Adam editor.; Adrian K. Dixon editor.; Jonathan H. Gillard 1964- editor.; Cornelia Schaefer-Prokop editor.; David J Allison; Elsevier (Firm) 2015, Online access University of Saskatchewan Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK\xa0 Accessed June 30, 2017.', '5bf49964-973b-4c4d-88b4-2696683964c1': '2) Radiopaedia.org – https://radiopaedia.org/articles/rockwood-classification-of-acromioclavicular-joint-injury Rockwood classification of AC-Joint injuries. Accessed June 30, 2017.', '59261295-fce8-49b2-a2de-77852eccc04a': '3) Common Forearm Fractures in Adults. American Family Physician 2009: 80 (10): 1096 – 1102.', '2f360c6a-b1f6-4af3-a4c8-e0b8438b9a58': '4) Diagnosis and Management of Scaphoid Fractures.\xa0 American Family Physician 2004; 70 (5); 879 – 884.', 'a5a2c608-b474-4203-bd8a-41a1f1ceb548': '5) Michael A. Bruno, MD; Barbara N. Weissman, MD; Mark J. Kransdorf, MD, et al. MSK – Hand and Wrist Trauma. \xa0Available at https://acsearch.acr.org/docs/69418/Narrative/ American College of Radiology. Accessed June 30, 2017.', '3548e3f8-9289-4063-8539-de870f48b911': '6) Robert J. Ward, MD, CCD; Barbara N. Weissman, MD; Mark J. Kransdorf, MD., et al. ACR Appropriateness Criteria®, MSK – Acute Hip Pain – Suspected Fracture. \xa0Available at https://acsearch.acr.org/docs/3082587/Narrative/ American College of Radiology. Accessed June 30, 2017.', '59596a80-aaf5-43e7-985e-7b2593951114': '7) Radiopaedia.org – https://radiopaedia.org/articles/femoral-neck-fracture Accessed June 30, 2017.', '469c112e-865a-482d-9b7e-5830232cee0e': '8) Michael J. Tuite, MD; Mark J. Kransdorf, MD; Francesca D. Beaman, MD, et al. ACR Appropriateness Criteria®, MSK – Acute Trauma to the Knee. Available at https://acsearch.acr.org/docs/69419/Narrative/ American College of Radiology. Accessed June 30, 2017.', '61b9265e-5af7-4d75-833f-a9344ce39570': '9) Ottawa Knee Rule – Stiell IG, Wells GA, Hoag RH, Sivilotti ML, et al (1997). “Implementation of the Ottawa Knee Rule for the use of radiography in acute knee injuries.”. JAMA. 278 (27): 2075–9. PMID\xa09403421. doi:10.1001/jama.1997.03550230051036. Accessed June 30, 2017.', 'd567b915-ef5d-4c0d-8e5b-f533c7036e91': '10) Ottawa Ankle Rule – Stiell IG, McKnight RD, Greenberg GH, et al. (March 1994). “Implementation of the Ottawa ankle rules”. JAMA. 271 (11): 827–32. PMID\xa08114236. doi:10.1001/jama.1994.03510350037034. Accessed June 30, 2017.', '92efbc09-23c1-4b33-b265-50b693fca389': '11) Jon A. Jacobson, MD; Catherine C. Roberts, MD; Jenny T. Bencardino, MD, et al. ACR Appropriateness Criteria®, \xa0MSK – Chronic Extremity Joint Pain Available at https://acsearch.acr.org/docs/3097211/Narrative/ American College of Radiology. Accessed June 30, 2017.', '170f0345-ab5f-45e0-8acd-470a44d17663': '2) Catheter Replacement of the Needle for Arteriography. Seldinger, S. I. Acta Radiologica, 1953: 39 (5); 368 – 376.', 'd55b79a0-51d8-4933-a57a-7d6b6cb5597b': '3) Thomas B. Kinney, MD; Hamed Aryafar, MD; Charles E. Ray, Jr, MD, PhD, et al. ACR Appropriateness Criteria® Management of Inferior Vena Cava Filters. Available at https://acsearch.acr.org/docs/69342/Narrative/ American College of Radiology. Accessed June 30, 2017', 'ba20e351-4219-47c3-b9c5-b61de5ab8fd9': '4) Learning\xa0radiology:recognizing the basics. William Herring author. Elsevier 2016, Online access University of Saskatchewan Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK Accessed, June 30, 2017.', '3fc9b447-cac6-4420-ac4e-05f656e81f43': '5) Grainger and Allison’s diagnostic\xa0radiology\xa0: a textbook of medical imaging. Andy Adam editor.; Adrian K. Dixon editor.; Jonathan H. Gillard 1964- editor.; Cornelia Schaefer-Prokop editor.; David J Allison; Elsevier (Firm) 2015, Online access University of Saskatchewan Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK\xa0 Accessed June 30, 2017.', 'a53e9698-8be5-4b56-ba59-87393e1e60b7': '2) Vahid Yaghmai, MD, MS; Max P. Rosen, MD, MPH; Tasneem Lalani, MD. ACR Appropriateness Criteria® \xa0– Gastrointestinal – Acute (non-localized) Abdominal Pain and Fever – Pneumoperitoneum. Available at\xa0 https://acsearch.acr.org/docs/69467/Narrative/ American College of Radiology. Accessed June 30, 2017.', '23ab0a22-ea4d-4c3f-9d72-f3a49ca4f6fd': '3) Douglas S. Katz, MD; Mark E. Baker, MD; Max P. Rosen, MD, MPH. ACR Appropriateness Criteria® – Gastrointestinal – Suspected Small Bowel Obstruction. Available at https://acsearch.acr.org/docs/69476/Narrative/ American College of Radiology. Accessed June 30, 2017.', 'f3c446dd-aa8d-4d22-aed4-b5e89863cd27': '4) Martin P. Smith, MD; Douglas S. Katz, MD; Max P. Rosen, MD, MPH. ACR Appropriateness Criteria® – Gastrointestinal – Right Lower Quadrant Pain – Suspected Appendicitis. Available at https://acsearch.acr.org/docs/69357/Narrative/ American College of Radiology. Accessed June 30, 2017.', 'e40080ff-07b5-4509-a9d8-3d7ff39b3c19': '5) Michelle M. McNamara, MD; Tasneem Lalani, MD; Marc Anthony Camacho, MD. ACR Appropriateness Criteria® \xa0– Gastrointestinal – Left Lower Quadrant Pain – Suspected Diverticulitis. Available at https://acsearch.acr.org/docs/69356/Narrative/ American College of Radiology. Accessed June 30, 2017.', 'a6f6cc9d-0ee1-42b0-ba1b-410ac9dc0387': '6) Rendon C. Nelson, MD; Ihab R. Kamel, MD, PhD; Mark E. Baker, MD. ACR Appropriateness Criteria® \xa0– Gastrointestinal – Liver Lesion – Initial Characterization. Available at https://acsearch.acr.org/docs/69472/Narrative/ American College of Radiology. Accessed June 30, 2017.', '154ec87b-5220-4418-99a5-75ec9d9fafec': '7) Tasneem Lalani, MD; Corey A. Couto, MD; Max P. Rosen, MD, MPH. ACR Appropriateness Criteria® \xa0– Gastrointestinal – Jaundice. Available at https://acsearch.acr.org/docs/69497/Narrative/ American College of Radiology. Accessed June 30, 2017.', '740ebf07-9cb8-4ed5-9cac-8bb79c578c8d': '2) Jacobo Kirsch, MD; Tan-Lucien H. Mohammed, MD, et al.\xa0 ACR Appropriateness Criteria®, Chest – Acute Respiratory Illness in Immunocompetent Patient. Available at https://acsearch.acr.org/docs/69446/Narrative/ Accessed, June 30, 2017.', '571524ec-b296-4a2d-95dc-97db963c3fcb': '3) Debra Sue Dyer, MD; Tan-Lucien H. Mohammed, MD; Jacobo Kirsch, MD, et al. ACR Appropriateness Criteria®, Chest – Chronic Dyspnea – Suspected Pulmonary Origin. \xa0Available at https://acsearch.acr.org/docs/69448/Narrative/ Accessed June 30, 2017.', 'f22ed822-b387-44e5-8a22-dd8a867b8b01': '4) Learning\xa0radiology\xa0: recognizing the basics. William Herring author. Elsevier 2016 Online access USask Library. http://usl-primo.hosted.exlibrisgroup.com/primo_library/libweb/action/search.do?vid=USASK Accessed, June 30, 2017.', '87cb046f-4dac-41ec-84d0-bed36b33d265': '5) Jeffrey P. Kanne, MD, Leif E. Jensen, MD, MPH, Tan-Lucien H. Mohammed, MD, et al. ACR Appropriateness Criteria®,\xa0 Chest – Radiographically Detected Solitary Pulmonary Nodule. Available at https://acsearch.acr.org/docs/69455/Narrative/ Accessed June 30, 2017.', '3159e24d-3174-4315-993d-23dd449b06b4': '6) Fleischner Society – https://fleischnersociety.org', 'd07c0b2d-9413-4046-ab1e-55f117865c2a': '7) Michael A. Bettmann, MD, Scott G. Baginski, MD, Richard D. White, MD, et al. ACR Appropriateness Criteria®, Chest – Acute Chest Pain – Suspected Pulmonary Embolism. Available at https://acsearch.acr.org/docs/69404/Narrative/\xa0 Accessed June 30, 2017.', 'cd973045-ca97-4b36-a285-52581f60f304': 'Ultrasound uses traditional probes with higher frequency to better image the breast tissue that is in close proximity to the overlying skin.', '13e1e8e0-e640-4941-8300-c31710b3a53c': 'Mammography/Breast Imaging Centres in Canada are accredited and audited for quality by the Canada Association of Radiologists.', 'eca3d4b9-a2c4-43c7-ae2b-3ec757983d8b': '2) Vilaas S. Shetty, MD; Martin N. Reis, MD; Joseph M. Aulino, MD, et al. ACR Appropriateness Criteria® Head Trauma. Available at https://acsearch.acr.org/docs/69481/Narrative/ American College of Radiology. Accessed, June 30, 2017.', 'a923162d-9460-4587-991e-319c82bf5c9f': 'https://acsearch.acr.org/docs/69481/Narrative/', '96ac01aa-0380-4fa5-be27-55a5b787830c': '3) Michael B. Salmela, MD; Shabnam Mortazavi, MD; Bharathi D. Jagadeesan, MD, ACR, et al. Appropriateness Criteria® Cerebrovascular Disease. https://acsearch.acr.org/docs/69478/Narrative/ American College of Radiology. Accessed, June 30, 2017.', 'b68256b4-9387-4475-8f5a-41b599bfaf04': 'https://acsearch.acr.org/docs/69478/Narrative/', 'd4f105b8-2855-4af9-a3cb-f9d88fcdbf18': '4) Annette C. Douglas, MD; Franz J. Wippold II, MD; Daniel F. Broderick, MD, et al. Appropriateness Criteria® Headache. https://acsearch.acr.org/docs/69482/Narrative/ American College of Radiology. Accessed, June 30, 2017.', '74770c44-e954-4084-abd6-2740860fa07d': 'https://acsearch.acr.org/docs/69482/Narrative/', 'edab0354-1c57-4db0-b1dd-6ea014cb5e00': '5) Nandini D. Patel, MD; Daniel F. Broderick, MD; Judah Burns, MD, et al. Appropriateness Criteria® Low Back Pain. https://acsearch.acr.org/docs/69483/Narrative/ American College of Radiology. Accessed, June 30, 2017.', 'd0966524-e032-4f5a-9faf-1e8f783d8061': 'https://acsearch.acr.org/docs/69483/Narrative/', 'aa597d16-b4a3-404a-889f-e4a901c750d6': '6) Richard H. Daffner, MD; Barbara N. Weissman, MD; Franz J. Wippold II, MD, et al. Appropriateness Criteria®  Suspected Spine Trauma. https://acsearch.acr.org/docs/69359/Narrative/ American College of Radiology. Accessed, June 30, 2017.', '6945685d-8bdd-48ba-9299-88cd95cdcccc': 'https://acsearch.acr.org/docs/69359/Narrative/', 'd6137ceb-35ba-41f9-b5ad-909c0c93c831': 'The standard views are AP (anterior-posterior) and lateral.\xa0 These two views are taken at right angles (orthogonal) to each other.\xa0 If these images are not helpful, ancillary views such as oblique views, or special views such as, an axillary or carpal tunnel view, may be required based upon the clinical scenario.', '8da19a7d-ea8a-48f7-802b-c3e6ad2879ea': 'Stress views i.e. a force is applied to a bone or joint to determine if an injury is present, such as, a subtle avulsion or a suspected tendon or ligament tear causing joint instability. These are acquired as special requests and should be performed in a manner that minimizes patient pain and discomfort.', 'c1ddb6e5-c42b-4c10-ac0d-ed3b6ab5cbad': 'At least one joint space should be visible in relation to the suspected bone injury.\xa0 Additional x-ray views and views of another adjacent joint space may be required in some circumstances.', 'd8ec4a87-ef98-4bd8-9ee3-47f8c6612a49': 'Comparison views to the contralateral, normal bone, or joint, may be required, this is especially true if a subtle growth plate injury is suspected in a child.\xa0 Comparison views should not be ordered routinely, but should be used if clinically necessary.', 'd76a51e5-d391-4400-aa76-b67e2d5a4233': 'It is important to remember that some bone and ligament injuries occur as a common pattern of multiple injuries i.e. the Colle fracture of the distal radius is often associated with an avulsion fracture of the ulnar styloid.\xa0 Ankle ligament injuries and fractures often occur in a sequence i.e. medial malleolar avulsion fracture (or medial ligament tear), interosseous ligament tear between the tibia and fibula, and a subsequent oblique fracture of the proximal fibula (Maisonneuve fracture complex).\xa0 Keep this in mind as you encounter various patients and you will develop knowledge and experience of these associated bone and soft tissue injuries.', 'd26261d6-1894-4731-a4bc-cb382c5fc4b8': 'Fractures usually present as a lucent line on x-rays involving the cortex and medulla of the bone that can be followed from one cortex to the opposite cortex with varying degrees of displacement and malalignment of the involved bone.', '6d3c05b4-f04f-464e-828c-e219309240b2': 'There are some fractures that may be associated with bone ischemia and avascular necrosis i.e. capital femoral fractures and scaphoid fractures.\xa0 Be aware of this and learn the importance of aggressive and pre-emptive management for these patients.', '9efc69ef-d567-4c20-b7da-5b5faae548f8': 'Fig 5.7 Abdomen Quadrants/Regions\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'c17eee8e-a5a7-4b3d-aa39-e9562f679745': 'Fig 5.8\xa0Supine Positioning for Abdomen x-ray, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', 'e428391c-3d1e-4c3d-a0ee-4e39fd82ee4d': 'Fig 5.9 Upright Positioning for Abdomen x-ray, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', '4fe76b20-0ac2-49ac-a875-af27033355ec': 'Fig 5.10 Decubitus Positioning for Abdomen x-ray, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', '1e50fdef-529f-4fe1-b3f4-ab42378ca31f': 'Fig 5.11 Normal Abdominal x-ray by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '27e0addc-368c-4208-9970-6559705ff1e8': 'Fig 5.12 Colon anatomy emphasized by the presence of barium and air by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '990d74a2-1431-4705-8efd-4cf210fa9ce3': 'Fig 5.13 Bones and Musculoskeletal Landmarks in the Abdomen by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '3d050294-a087-4835-a5ed-7961069e1f0a': 'Fig 5.14 Possible Artifacts on Abdomen x-rays. The image demonstrates two umbilical piercings, fallopian tube clips, and the buttons on the patient’s pants by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'cbf4613b-cbd6-4078-b9c3-b1c333a37c48': 'The standard upright views of the chest are made when a patient is typically placed between an x-ray source and an x-ray detector. When the x-rays penetrate the tissues of the patient, they stimulate an x-ray detector that alters the energy of the x-ray beam into a digital pixel grid. The radiograph produced is referred to as a roentgenogram and named after Wilhelm Konrad Roentgen who received the first Nobel Prize for Physics in 1901 for his work in defining the major properties of x-rays and the conditions necessary for their production. It was Roentgen who coined the term “x-ray”.', '9da044bd-e951-4eb4-8cf9-ccb9398a2423': 'Fig 5.1 A portable upright x-ray where the image is not taken with proper body alignment, the patient is rotated and tilted\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '0bc6ae7d-c9c2-4d6d-ae6c-f07a5a647792': 'Fig 5.2 A portable upright x-ray taken with patient in proper alignment\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'e27384e1-63ef-4a65-a138-41a0d8870a95': 'Fig 4.1A Fluoroscopy – Shoulder Arthrogram Early Phase of Injection\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '2f124311-a640-4063-9232-06af6006da7a': 'Fig 4.1B\xa0Shoulder Arthrogram Fluoroscopy Mid-Phase of Injection by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'bb7b38f9-ff02-462d-8d99-621dd444c05e': 'Fig 4.1C Shoulder Arthrogram Late Phase of Injection\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'b6d8041f-18d1-40b8-a5b0-44c6bfeb9405': 'Fig 4.2A\xa0CT Aorta, C-\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'b98a8c21-5a63-4b95-b9ce-f7e38e6999bc': 'Fig 4.2B CT Iliac Arteries, C-\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '43da027d-17e8-4ba4-b312-67fba1bd1511': 'Fig 4.2C CT Aorta, C+\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'b66fdc16-e8ca-433f-8a6e-1d0f3f659bb3': 'Fig 4.2D CT Iliac Arteries, C+\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '8964941e-dc07-44fd-954a-0403c1bfd992': '2) Image Wisely. http://www.imagewisely.org/ Last accessed, Aug. 22, 2017.', 'ed5f284b-a74a-4376-b274-77e0e2303fc9': '3) Image Gently. http://www.imagegently.org/ Last accessed Aug 22, 2017.', 'fc2d1e7a-fa5b-4dbc-917f-25f258eb23d6': '4) Novelline, R. A., & Squire, L. F. (2004), sixth edition. Squire’s fundamentals of radiology. Cambridge, Mass: Harvard University Press.', 'ce057be0-807e-4b88-a477-0d87c59e607b': 'Fig 3.43 Nuclear Medicine Scanner by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'dce81a39-f2bd-47ee-847d-9205bbc446e1': 'Fig 3.44A Normal, Pediatric Nuclear Medicine Bone Scan by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '8bed792d-6442-4cbd-89db-89b5a4cb4541': 'Fig 3.44B Normal, Adult Nuclear Medicine Bone Scan\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '41bf79b1-bfd9-4a16-9b5d-900405a59176': 'Fib 3.45 PET/CT Scanner\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '8fcd15af-34e1-492f-91a7-3b8b671387ed': 'Fig 3.46A PET/CT image of the chest for a patient with lymphoma\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '211a4b55-451b-4858-aa60-ce4253c9d555': 'Fig 3.46B PET image of the whole body for a patient with lymphoma\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '15d4a271-c53b-449d-8385-a1b6030fd923': 'The appearance of different tissue on MR images is described as displaying greater, or lesser, signal in comparison the other anatomy in the region. The signal in question is the energy that the perturbed protons liberated when they fall back into alignment with the magnetic field. The signal intensity of the tissue in question changes based upon the image acquisition parameters set by the MR Technologist, under the direction of a supervising Radiologist.\xa0 The parameters set result in the acquisition of a set of images called an MR imaging sequence. On one sequence cerebrospinal fluid will appear as black pixels (T1 sequence) while on another sequence it is white pixels (T2 sequence). This difference in tissue appearance can be exploited to determine if pathology is present.', '33f25041-480d-4bb9-95fc-0a28bc2224ed': 'Fig 3.31\xa0B-Mode Ultrasound of the Carotid bulb with atherosclerotic plaque\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '18658974-a7a2-499b-881c-5a51baaa9854': 'Fig 3.32A\xa0Ultrasound Machine\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '5c75f45f-6624-42df-b964-dddafeae9d32': 'Fig 3.32B Mobile Ultrasound Machine\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'f351a841-d5dd-4048-8f36-831f0bbf09d9': 'Fig 3.33 Ultrasound image of the normal liver and kidney. The echogenicity of the liver is greater than the echogenicity of the adjacent renal cortex by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '059ddd7b-14ba-4290-92ad-7382c9156fc4': 'Fig 3.34 Gallbladder\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '5db401cc-d0ff-4f03-945a-f50dd89e4be9': 'Fig 3.35A Normal Liver Ultrasound by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'fae31525-31fa-491b-8fcf-6206343abf74': 'Fig 3.35B Hepatomegaly and hepatic steatosis on Ultrasound\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '4aa1ffad-a8df-4cef-8f34-a9695f5958bc': 'Fig 3.36 Colour Doppler, of the neck\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '99b1c66a-6cc2-4a4e-872f-476d28cdab03': 'Fig 3.37 Colour Doppler of the neck with Spectral Display\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '21a2827a-f5ed-4e96-a0d9-b91bdf773c22': 'Fig 3.38A\xa0Internal Carotid Doppler Ultrasound Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '6bf5c327-c3cb-4f8c-b09c-7b96d908326a': 'Fig 3.38B Carotid Bulb Doppler Ultrasound\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '8d123159-7ce7-4972-bc0c-86aa528a32ae': 'Fig 3.38C\xa0Vertebral Doppler Ultrasound\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'b8f04a00-104c-40e3-8e47-1dc899d44ca1': 'Fig 3.39 Linear probe and two curved array probes\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', 'c15107ec-6f70-4702-929e-61aeee36a137': 'The patient does not need to be moved, or re-positioned, to obtain CT images in different anatomic planes.\xa0 The patient lies on the CT table in anatomic position and remains in that position throughout the study.\xa0 The standard orientation of image acquisition for CT is in the axial plane, hence the old name for this machine of CAT (computed axial tomography) scanner.\xa0 Often the axial images obtained during the initial x-ray exposure will be digitally reformatted into other anatomic planes i.e. sagittal and coronal.\xa0 These reformatted images are the result of a computer algorithm reformatting the original digital image data and, as such, these supplemental anatomic planes of imaging do not require additional x-ray exposure.', '23a6edd0-ea0d-4597-87b7-d94ca733c3a5': 'The CT gantry can be tipped cranially and caudally to deviate from the axial plane by 30 degrees in either direction and this can be used to correct for patient anatomic variability to maintain the axial plane, if necessary.\xa0 It also allows for unique imaging along an angled plane that can be used when requested by the referring physician or the radiologist.\xa0 A widely used example of imaging in an angled plane is found for CT Head examinations. It is not conventional to acquire these images in the axial plane but to image the brain on the canthomeatal (lateral orbit canthus to the aural meatus) line and therefore, the CT gantry must be tilted to ensure that all CT Head images are acquired in this plane.\xa0 Originally, this plane was chosen as it maximizes information about the intra-cranial contents while minimizing the exposure of the orbits (lens) to radiation. The orbito-meatal line has become the internationally recognized plane for acquiring CT head images. This line is depicted in Figure 3.22.', '2a01449e-f80d-44b8-b5f1-9fbd2293de89': 'The physics of CT image creation are complex and require complex computer processing to create images that are visible for clinical use.\xa0 As the x-ray tube and the x-ray detectors revolve around the patient thousands of mathematical calculations are performed to determine how much of the incident x-ray beam was absorbed by a volume of tissue. This volume of tissue is called a voxel. The calculated absorption of the x-rays by a voxel is converted into a pixel density that is displayed on a gray scale from -1,000 (air) to +1,000 (metal).\xa0 This scale is called the Hounsfield unit (HU) scale after one of the principle inventors of CT, Sir Godfrey Hounsfield.\xa0 The calculated density of this voxel is then allocated to a pixel on a grid of the 512 x 512 pixels that forms each individual CT image.', '7630aac5-da71-4093-992f-e3de7e0777cf': 'Therefore, if the volume of tissue contained air, or gas, the pixel density allocated would be close to -1,000 HU, while if the volume of tissue analyzed contained metal (bullet fragment, etc.) the pixel would be assigned a density close to the +1,000 HU.\xa0 The assignment of pixel density to voxels spans the entire possible range of pixels from -1,000 – +1,000 HU, resulting in 2,000 shades of grey.\xa0 An image with the HU measurements of specific anatomic regions is provided in Figure 3.23.', '194d89df-a49e-4ba0-a141-fedb5b7d0e3d': 'CT density: a region on a CT image is described as being more, or less, dense than another region. The liver is more dense than the renal cortex.\xa0 This variation in pixel density can be quantified by measuring all the pixels in a region and creating an average pixel density i.e. region of interest of an area of liver can be measured, with a standard deviation, 50 HU +/- 5 HU, etc. The HU density of some common structures is provided in Table 3.2.', '7fd3f166-8080-4a1e-b564-5aaedace0274': 'Table 3.2 HU Scale', 'bf48f853-55d2-4b0d-a952-97052c04fccc': 'The viewer of the CT can decide how to adjust the level and window of the displayed CT images to accentuate tissues of a defined pixel density. \xa0The level and window are at the discretion of the viewing radiologist and can be set to their preferences. There are a variety of established level and window settings, i.e. abdomen, bone, brain, etc. These help to provide some level of uniformity for comparison of multiple CT examinations. Level and window setting for six common tissues are as follows:', 'b2f1f965-5bd4-4a65-bbcb-a0c74bb6849b': 'Table 3.3 Six common tissue levels and windows', '1c89c10d-2e57-46d5-873c-753aa9d9fd25': 'CT images demonstrating the appearance of these six different level and window settings are provided in Figure 3.24.', '0c5a4d4a-1a8a-45e7-82a1-3975c585d2e6': 'Level and Window are unique physical properties of CT images that allow the user to adjust the centre and the width of the gray scale that is portrayed on the images.\xa0 This is an adjustment that is applied to the raw CT data and does not require repeated patient imaging to obtain the different levels and windows. The level is the centre of the gray scale, set to the HU of the tissue of most interest i.e. the centre (level) of the gray scale for brain window is 35 HU.\xa0 The window is the width of the gray scale that surrounds the level setting, thus defining the range of HU for white and black seen on the image. For the brain images the width of the HU scale is 80 HU. A illustration depicting this for brain and bone level and window setting are provided in Figure 3.25.', '22baea2d-4734-448a-b8d2-ff98cc34c126': 'Fig 3.21\xa0Helical CT Scanner\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '997a9bef-3a49-4a5c-baaa-b5f4e9a60244': 'Fig 3.22 The plane of imaging related to the cantho-meatal line\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'e620fc79-fe54-4e1b-937a-f2f6d1ae88b4': 'Fig 3.23 Images of CT with HU measurements\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '47384920-3878-4fd3-a2cb-6676f1ecd6b4': 'Fig 3.24 CT Images with different level and window settings\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '27c1bf77-b175-46e2-8f3c-8b044f235e7a': 'Fig 3.25A Brain Level and Window\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'ae550a20-25ad-452b-9c36-d593b30cda0b': 'Fig 3.25B Bone Level and Window\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '4c06c22c-a218-43c6-b6d2-8b86614cb44f': 'Fig 3.26A Head CT visible on brain level and window. Bone not well seen by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '09e44bf9-1b1b-4b30-ac75-268a90c19141': 'Fig 3.26B Head CT on bone level and window. Brain not well seen by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'b14da7a2-6e23-4800-9645-0f1ea9841b25': 'Fig 3.27 Standard viewing orientation for an axial CT image\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '1aaea852-a349-4e12-9f42-4e7db0ccde67': 'Fig 3.28A CT image displayed in axial orientation from one radiation exposure event\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'cb4dd03b-6e19-4678-85ec-4798a6b00fe9': 'Fig 3.28B CT image displayed in sagittal orientation from one radiation exposure event\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '06e1bc4e-3c56-472e-b82f-5ca979851270': 'Fig 3.28C CT image displayed in coronal orientation from one radiation exposure event\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '82ba8ff7-a04c-4efb-9328-b4216ab73f8e': 'Fig 3.29A CT of the chest on lung level/window by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '2bb589c6-5d7e-4ca5-9add-0533ae22ad66': 'Fig 3.29B CT of the chest on mediastinal level/window by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '80b61eb5-0c49-4c26-bba6-34a715289fbc': 'Fig 3.30 CT PE image maximizing the injected contrast in the pulmonary arteries\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a\xa0CC-BY-NC-SA 4.0 license.', '7586c4b7-5466-4c34-b19e-28c580057600': 'An angiography machine is essentially a fluoroscopy unit that has the added feature of having the x-ray source and detectors mounted on a c-arm apparatus. The c-arm allows for movement of the source and detector around the patient who lies supine on the angiography table. The operator can acquire images in a wide variety of anatomic projections.\xa0 Therefore, patient movement is not required for this imaging modality. The angiography unit also has advanced software applications that facilitate complex arterial and body interventional procedures beyond the capabilities of a standard fluoroscopy unit. As with fluoroscopy, the images are viewed inverted in comparison to standard radiographs.', '8321eb02-784a-4088-a939-b2f9c46e47ce': 'The x-ray dose for Angiography is controlled by multiple detectors that adjust the radiation exposure to maximize image quality and minimize x-ray exposure. The machine only emits radiation when the operator uses a foot pedal to activate the x-ray tube. The area imaged can be collimated, or coned, to minimize the area exposed to x-rays.\xa0 The anatomy can also be magnified to improved diagnostic capacity.', 'c01d6355-58d2-4339-a8e1-0b13cb0a2a27': 'The images acquired are obtained very rapidly in cine mode resulting in a set of stacked images, that when stored and viewed, simulate a video recording.\xa0 Cine mode allows for the dynamic assessment of moving contrast and movement of catheters and guide wires inside the anatomy of the patient. A standard c-arm angiography unit is depicted in Figure 3.19.', '75c40a34-0496-4f50-853a-4a34b85893f5': 'For angiography, the radio-opaque contrast agent used is injected intra-arterially while x-ray images are acquired.\xa0 This is an invasive process that requires the injection to be performed via a small intra-arterial catheter that administers the contrast in close proximity to the origin of the arterial structure being investigated, i.e. carotid angiography requires an injection of contrast into the selected carotid artery.\xa0 The catheter used is usually manipulated into position using fluoroscopy from a remote arterial access site i.e. the common femoral artery, the radial artery, or the brachial artery.', 'b87262ac-93be-41c5-a829-b396ffcd5495': 'Arterial access relies upon the “Seldinger” technique, using local anesthetic, to insert the intra-arterial catheter used for the procedure. Blood vessels lack internal innervation and therefore, the catheter and guidewire can be manipulated without causing patient pain or discomfort.', 'e2e27594-969f-4065-afca-fc9d4d9d539d': 'This machine can also be used for Interventional Radiology procedures where catheters, guidewires, stents, feeding tubes, etc. are visualized with the c-arm fluoroscopy.\xa0 Water-soluble contrast agents can also be injected during these procedures to depict the anatomy of structures such as, the bile ducts, intestine, renal collecting system, veins, etc.', 'ba4bd9f0-d4d3-4160-998d-e606f08e785b': 'All modern angiography units capture images and present them in subtracted mode.\xa0 The subtraction process is digital using a computer to superimpose a non-contrast enhanced image onto a set of contrast enhanced cine images, resulting in subtracted images that depict only the anatomic structure filled with contrast since the background anatomy has been subtracted away by the digital image modification process. A digital, subtracted, carotid angiogram is depicted in Figure 3.20.', '9507b590-4a7c-43a4-ab86-48655f636346': 'The contrast used for angiography is an iodine based pharmaceutical and is water soluble.\xa0 During angiography, it is injected into the artery of interest and replaces the blood for a very short period of time.\xa0 This contrast agent progresses antegrade in the vascular tree related to the direction of blood flow.\xa0 It quickly clears from the arteries and exits the region via venous drainage.\xa0 The circulating contrast is predominantly excreted by the kidneys into the urine.', '3276ecac-6f99-4922-9d4c-37154b7ae129': 'Fig 3.19 Angiography Machine with C-Arm by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '0d7266b7-752c-4049-b830-7e4dca6ea0db': 'Fig 3.20\xa0Carotid Angiography, Digital Subtraction Cerebral Angiography\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '07ea0f57-4c84-4133-93c0-83121c89f01d': 'An example of a fluoroscopic examination is the esophogram and upper gastrointestinal series.\xa0 The patient is asked to swallow barium sulfate and gas-forming granules.\xa0 The barium can be seen to move with positioning (gravity) and peristalsis as it moves antegrade through the digestive tract while the gas rises to the highest point of the intestinal tract based upon patient positioning. The barium and the gas help to outline the inner lining of the intestine.\xa0 The live fluoroscopic x-rays visualize the motion of the barium and the gas. It is also possible to capture still images and/or cine mode images that are stored in the Picture Archive and Communication System (PACS).', 'bc96ce7d-d729-4227-95fa-225665741a10': 'Cine mode images are still images captured at a rapid rate and can be viewed sequentially, like a video, after being stored in the PACS. Other fluoroscopy aided examinations include arthrography, barium enema, cystourethrogram, sinus tract injections, myelography and hysterosalpingography, to name a few.', '87cf4657-0272-4db3-aa75-969547958014': 'The positioning of the patient is dependent on the physical capabilities of the patient and the exam that is to be performed. For example, when carrying out an esophogram, the best positioning would be an upright (standing) patient and an oblique or lateral view of the anatomy to watch the barium proceeding down the esophagus. Additional oblique and lateral views allow one to visualize abnormalities in multiple planes and to determine if any abnormality of the intestinal mucosa is concealed by swallowed barium on one view. If aspiration of ingested fluid or food into the lungs is clinically suspected the lateral projection allows one to determine if fluids are entering the trachea during swallowing.', 'b74d40ce-5391-4b64-a394-581b4a112089': 'A Fluoroscopy machine is seen in Figure 3.15.', 'bbd4cc27-e511-4d95-a60e-9f436bbc4a41': 'The video in Figure 3.17\xa0depicts live fluoroscopy of the upper esophagus for a patient whose images demonstrate aspiration of the barium into the trachea.', 'dbaf432f-8185-4365-a9d3-beed0ab25975': 'Fluoroscopy images are most often displayed for review inverted in comparison to standard x-ray images.\xa0 Hence, air is white and metal is black.\xa0 They can also be displayed as standard x-rays if this is advantageous for interpretation, see the barium enema images. The principles of absorption and transmission of the x-rays is unchanged, but the images are digitally manipulated to be the inverse of x-rays, much like film negatives in photography. The effect of image inversion for Fluoroscopy images is depicted in Figure 3.18.', '6891ccd4-5787-4995-8269-5f022f52e891': 'Fig 3.3\xa0X-ray Tube by\xa0Kieranmaher is in the Public Domain.', '39c648ca-5e19-4388-a61f-bdd02372eda8': 'Fig 3.4\xa0X-ray Tube. Lead Housing with Portal for x-ray Emission, bench top image by Rschiedon is available under a CC-BY-SA 3.0 Unported License.', '33964476-071d-4239-b632-398ccd10bb4f': 'Fig 3.5\xa0X-ray Image Creation and Display by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'f39c28ae-5cbf-4339-a557-42e3a1322037': 'Fig 3.6A\xa0A standard, fixed location, wall x-ray detector used for upright chest and abdomen x-rays by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'fb953c13-b4fe-4531-a6f1-80bdb7074953': 'Fig 3.6B\xa0A Portable x-ray Machine by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '6e34bafd-8b52-44e0-ad2d-cf1e331df04d': 'Fig 3.6C\xa0The Portable x-ray machine with the x-ray tube extended for use by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'ca28bfcc-132a-4473-a28f-bd495247e213': 'Fig 3.6D\xa0A Portable, Mini, C-Arm x-ray Unit by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '4711a96b-6775-4db5-9866-04674d98a3f6': 'Fig 3.7\xa0Appearance of different entities on x-rays\xa0by\xa0Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '1258fb9d-5c95-4aae-80d3-54f946489f6b': 'Fig 3.8\xa0Left Shoulder x-ray\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license. Accessible from\xa0https://mistr.usask.ca/odin/?caseID=20160214201450302', '547b4d9c-36c8-45f6-b22d-82adda75b216': 'Fig 3.9\xa0Effect of tissue thickness on x-ray appearance\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '69e45b9a-1ecf-45d7-8796-3255b76aa319': 'Fig 3.10\xa0Common x-ray Test Object, Lucite Plastic Board\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '57b3432c-9730-4d69-9cce-4f4007438233': 'Fig 3.11A Posterior-anterior, upright, chest x-ray positioning, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', '32b6ba4a-63ec-4e10-9990-f380de9fee0d': 'Fig 3.11B Lateral, upright, chest x-ray positioning, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', 'b22e4373-8d85-42d1-a469-1a583e765d15': 'Fig 3.11C Decubitus x-ray positioning, by the Distance Education Unit, University of Saskatchewan, is published using a\xa0CC-BY-NC-SA 4.0 International License.', '8b26404e-eca4-432c-a4a4-406c267732a6': 'Fig 3.1\xa0PACS Imaging Viewing Station (Workstation) by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC–BY-NC-SA 4.0 license.', '8a1454eb-adb0-43dd-b455-381ef4a0fa33': 'Fig 3.2 Sample MRI Request Form\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC–BY-NC-SA 4.0 license.', '32fc7f20-73b7-4d42-8e8e-a55c8e933865': '2) Sievert. Wikipedia. https://en.wikipedia.org/wiki/Sievert Accessed Sep. 3, 2018', '808e953e-3ced-45ab-8c29-dcb633e825d7': '3) Radiation Safety Review, Jeff Sanderson. Cancer Care Manitoba, 2001. https://www.cancercare.mb.ca/Research/medical-physics/radiaion-protection-services/index.html', '7a5b86bc-d27b-4f09-94d3-eacd0a26d733': '4) ICRP, 2007. ‘The 2007 Recommendations of the International Commission on Radiological Protection’. ICRP Publication 103. Ann. ICRP 37 (2-4).\n\n(see http://www.icrp.org/publication.asp?id=ICRP%20Publication%20103) Last accessed Feb. 12, 2019.', '0e4fd872-fed4-4829-aad6-b29fb5207e16': '5) United States Nuclear Regulatory Commission. https://www.nrc.gov/reading-rm/basic-ref/glossary/alara.html Last accessed February 5, 2019.', '31a16705-8334-4d0b-ba2c-7b3ba4903d3d': '6) Guidelines for Diagnostic Imaging During Pregnancy and Lactation ACOG October 2017 e210; 130(4):e210 – e216.', '61c798cb-9b2c-44a5-a50f-094104e0d923': '7) Image Gently Alliance. https://www.imagegently.org/ Last accessed February 6, 2019.', '95aa939a-bd18-4918-8163-3f0eda02ba68': '8) American College of Radiology. ‘ACR appropriateness criteria.’ Radiology, 2000; 215 (Suppl): 1-1511.', 'b562ff2f-9eea-4eba-9d13-f84bcac6c6d9': '9) ACR Appropriateness Criteria List. https://acsearch.acr.org/list Last accessed Feb. 13, 2019.', '15e3ec31-d27d-49ba-9d6a-a28f7211c03f': '10) The Royal Australian and New Zealand College of Radiologists. Imaging Guidelines. 4th edn. Surrey Hills: National Library of Australia Cataloguing-in-Publication Data, 2001.', '42757543-7fdd-42ee-bddd-5c70293e2ef9': '11) Canadian Association of Radiologists – Referral Guidelines https://car.ca/patient-care/referral-guidelines/ Last accessed Feb. 13, 2019.', '627e3917-cc9d-4355-b236-a11cc5382386': 'Most professional imaging associations have created and disseminated scientifically validated, peer-reviewed guidelines that provide assistance in ordering the most appropriate imaging test while avoiding less useful, or non-contributory, tests that could unnecessarily expose the patient to ionizing radiation. These guidelines also will provide information about the relative radiation exposure that can be expected for one examination vs. another.', 'dde178ba-da97-448c-b369-5277c0dd80ae': 'If possible, the use of imaging modalities that do not use ionizing radiation (ultrasound and MRI) should be considered.', '1a1b453c-73a4-4269-aed3-97a05e6abdcb': 'Hence, it is hoped that fewer examinations will be requested and the most useful and appropriate examination will be performed, reducing the use of inappropriate ionizing radiation. Also, if an examination with radiation is required the dose experienced by the patient can be justified with the argument that the most useful, appropriate, diagnostic examination has been utilized limiting the total radiation dose experienced by the patient. (8 – 11)'}"
+Figure 3.12,undergradimage/images/Figure 3.12.jpg,Figure 3.12 Mammography x-ray Machine,"This physical change to the x-ray tube anode results in a different spectrum of x-rays that are better suited to assessing the fat, connective tissue, and mammary tissue found in the breast.  This allows for very detailed images of soft tissues using x-rays as the source of radiation.  This imaging modality is predominantly used to image the female breast tissue but it is also capable of imaging male breast tissue for assessment of a palpable nodule or mass. A standard, digital, mammography unit is seen in Figure 3.12.","{'ab183861-39bd-4acd-ba01-839ed9e1ce50': 'Fig 3.15\xa0A Fluoroscopy Machine\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '3937b270-7427-4cb4-85ba-34e045e02bd8': 'Fig 3.16\xa0Barium Enema images\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '0bff03dc-2905-4cc9-85fe-ebce2d016c03': 'Fig 3.17\xa0Fluoroscopy of the Pharynx and Upper Esophagus, video\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license. Video can be accessed at\xa0http://openpress.usask.ca/undergradimaging/wp-content/uploads/sites/34/2017/07/Fluoroscopy-cine-2.mp4. Static images can be accessed at\xa0https://mistr.usask.ca/odin/?caseID=20160216105351798.', '2a034d81-1e04-4521-8842-e32d86a9a19f': 'Fig 3.18\xa0Fluoroscopy Images are Inverted in Comparison to x-rays\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'db4e8e1a-d1ef-4199-8d4f-081e14b20644': 'This physical change to the x-ray tube anode results in a different spectrum of x-rays that are better suited to assessing the fat, connective tissue, and mammary tissue found in the breast.\xa0 This allows for very detailed images of soft tissues using x-rays as the source of radiation.\xa0 This imaging modality is predominantly used to image the female breast tissue but it is also capable of imaging male breast tissue for assessment of a palpable nodule or mass. A standard, digital, mammography unit is seen in Figure 3.12.', '60172089-5f9c-43cc-8bd8-72291154bd80': 'The standard positions for image acquisition in mammography is the cranial-caudal view and an oblique view. Additional mammographic positions, such as the lateral view, are used to problem solve complex abnormalities.\xa0 The mammographic x-ray tube and detector are able to rotate along the coronal axis of the machine to allow for image acquisition in various planes to maintain stable patient positioning without the need for the patient to lean or tip in any particular direction. Newer mammography machines routinely obtain images as the x-ray tube and the detector plate rotate resulting in a process called tomosynthesis.', 'bd1ce04c-fbbb-4437-91fa-65a50e7c0e54': 'In order to minimize x-ray scatter and create a relatively uniform tissue density prior to x-ray exposure of the breast tissue it is standard practice to compress the breast tissue between radiolucent plastic plates.\xa0 This can be uncomfortable for some patients but it is not dangerous or overly painful. An image of a patient positioned for a cranial-caudal mammographic image is provided (Figure 3.13).', '28574a15-a932-44f0-8382-50c167c24787': 'The same general concepts of appearance of different tissues on x-rays applies to mammography, i.e. air is black, fat is lower opacity than mammary glands and connective tissue and calcium is the most opaque element visualized.\xa0 The detection of small calcifications is a common finding on mammograms depicting breast cancer. \xa0The resulting x-rays generated by mammography are seen in Figure 3.14.', '2b6ee13a-cdfa-4562-842c-3fc094922bf1': 'These screening images depict normal breast tissue, fat, and connective tissue.\xa0 The more opaque tissue at the back edge of the images is the pectoralis major muscle. The breast tissue is predominantly fat replaced and there is no evidence of atypical calcifications, a nodule, mass, or architectural distortion. Normal lymph nodes are seen in the axillary area.', 'f2a44948-360a-4de7-9ae8-82bb05154c77': 'Fig 3.12\xa0Mammography x-ray Machine\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license', 'fd3ba600-b8b7-4897-9e51-051000ecf2bb': 'Fig 3.13A\xa0 Illustration for positioning for a Cranial-Caudal (CC) Mammogram by Bruce Blausen. Used under Creative Commons Atribution CC BY, 3.0, Unported. https://en.wikipedia.org/wiki/Mammography#/media/File:Blausen_0628_Mammogram.png', '72c7944a-7b83-4681-8c1e-3d24b67ec261': 'Fig 3.13B Imaging of a patient being positioned for a CC Mammogram.\xa0 National Cancer Institute, Bill Branson. This image is in the public domain and can be freely reused. cancergovstaff@mail.nih.gov', '96ea471a-f94d-45bd-9e64-9275cf42bcbb': 'Fig 3.14A\xa0Mammography CC image, left side, normal screening mammography image\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license. Can be accessed from https://mistr.usask.ca/odin/?caseID=20170410101815189', 'cb51e920-2739-4b4f-9f31-23cb8fda5fbf': 'Fig 3.14B\xa0Mammography, MLO image, left side, normal screening mammography image by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license. Can be accessed from\xa0https://mistr.usask.ca/odin/?caseID=20170410101815189', '941a5a9e-2c28-491a-ae69-b2e8ac4950f7': 'The x-rays that result from the electron bombardment of the anode are constrained within a heavy lead housing that contains circulating oil to cool the tube. The dispersal of the x-ray beam is limited to a small port in the lead housing of the x-ray tube and by mechanical metal filters that collimate the x-ray beam and prevent the uncontrolled, dissemination of x-rays. Therefore, the emitted x-rays expose only the desired region of the patient’s anatomy in a controlled manner.\xa0 The limitation of the x-rays by the lead housing and the collimation filters is how small part x-rays, i.e. wrist, scaphoid bone, can be done, as well as, large field x-rays such as a full field chest x-ray.\xa0 (Figure 3.4)', '3f282e99-f481-4765-be0c-eb3cbc31a535': 'The quantity and energy of the x-rays produced is controlled by the parameters set on the machine by the MRT.\xa0 Every effort is made to optimize the exposure parameters to minimize the radiation dose, but there are times when the patient receives too few, or too many, x-rays resulting in a poor quality image.\xa0 Often, this can be managed by adjusting the contrast and brightness of the display monitor during viewing, but rarely some images must be repeated in order for them to be of diagnostic quality.', '582b1c07-c210-485d-bc24-c00f1ac055ba': 'Historically, x-rays were photo-emulsion embedded in plastic sheets that required development in a processor of developer and fixer solutions after exposure to diagnostic x-rays.\xa0 The dried radiographic images were stored as hard-copies for viewing. The image detectors used today rely on complex electronic systems that converts x-rays into electrical signals that then results in pixels of different intensity on the monitor of a digital display system.', 'b20b5869-5b9d-4f1d-b6d7-00bf621c5699': 'The radiographic (x-ray) image has been described by Dr. Lucy Squire as a, “summation shadowgram”, highlighting the fact that the final image is a summation of all the interactions between the anatomy of the patient and the original x-ray beam prior to the beam reaching the x-ray detector. The x-ray beam is altered by absorption and scattering, during the interaction with the patient, before it finally reaches the x-ray detector. The resulting image ranges between bright white to dark black with hundreds of shades of grey in between. The blackest region of the x-ray image is related to the larger number of x-rays that reached the detector in that region. This phenomenon is analogous to black and white photographic emulsion as those areas with more light exposure are blacker on the photograph.\xa0 The digital image creation process is depicted in Figure 3.5.'}"
+Figure 3.13,undergradimage/images/Figure 3.13.jpg,Figure 3.13A – CC Mammography Illustration,In order to minimize x-ray scatter and create a relatively uniform tissue density prior to x-ray exposure of the breast tissue it is standard practice to compress the breast tissue between radiolucent plastic plates.  This can be uncomfortable for some patients but it is not dangerous or overly painful. An image of a patient positioned for a cranial-caudal mammographic image is provided (Figure 3.13).,"{'ab183861-39bd-4acd-ba01-839ed9e1ce50': 'Fig 3.15\xa0A Fluoroscopy Machine\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '3937b270-7427-4cb4-85ba-34e045e02bd8': 'Fig 3.16\xa0Barium Enema images\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '0bff03dc-2905-4cc9-85fe-ebce2d016c03': 'Fig 3.17\xa0Fluoroscopy of the Pharynx and Upper Esophagus, video\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license. Video can be accessed at\xa0http://openpress.usask.ca/undergradimaging/wp-content/uploads/sites/34/2017/07/Fluoroscopy-cine-2.mp4. Static images can be accessed at\xa0https://mistr.usask.ca/odin/?caseID=20160216105351798.', '2a034d81-1e04-4521-8842-e32d86a9a19f': 'Fig 3.18\xa0Fluoroscopy Images are Inverted in Comparison to x-rays\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'db4e8e1a-d1ef-4199-8d4f-081e14b20644': 'This physical change to the x-ray tube anode results in a different spectrum of x-rays that are better suited to assessing the fat, connective tissue, and mammary tissue found in the breast.\xa0 This allows for very detailed images of soft tissues using x-rays as the source of radiation.\xa0 This imaging modality is predominantly used to image the female breast tissue but it is also capable of imaging male breast tissue for assessment of a palpable nodule or mass. A standard, digital, mammography unit is seen in Figure 3.12.', '60172089-5f9c-43cc-8bd8-72291154bd80': 'The standard positions for image acquisition in mammography is the cranial-caudal view and an oblique view. Additional mammographic positions, such as the lateral view, are used to problem solve complex abnormalities.\xa0 The mammographic x-ray tube and detector are able to rotate along the coronal axis of the machine to allow for image acquisition in various planes to maintain stable patient positioning without the need for the patient to lean or tip in any particular direction. Newer mammography machines routinely obtain images as the x-ray tube and the detector plate rotate resulting in a process called tomosynthesis.', 'bd1ce04c-fbbb-4437-91fa-65a50e7c0e54': 'In order to minimize x-ray scatter and create a relatively uniform tissue density prior to x-ray exposure of the breast tissue it is standard practice to compress the breast tissue between radiolucent plastic plates.\xa0 This can be uncomfortable for some patients but it is not dangerous or overly painful. An image of a patient positioned for a cranial-caudal mammographic image is provided (Figure 3.13).', '28574a15-a932-44f0-8382-50c167c24787': 'The same general concepts of appearance of different tissues on x-rays applies to mammography, i.e. air is black, fat is lower opacity than mammary glands and connective tissue and calcium is the most opaque element visualized.\xa0 The detection of small calcifications is a common finding on mammograms depicting breast cancer. \xa0The resulting x-rays generated by mammography are seen in Figure 3.14.', '2b6ee13a-cdfa-4562-842c-3fc094922bf1': 'These screening images depict normal breast tissue, fat, and connective tissue.\xa0 The more opaque tissue at the back edge of the images is the pectoralis major muscle. The breast tissue is predominantly fat replaced and there is no evidence of atypical calcifications, a nodule, mass, or architectural distortion. Normal lymph nodes are seen in the axillary area.', 'f2a44948-360a-4de7-9ae8-82bb05154c77': 'Fig 3.12\xa0Mammography x-ray Machine\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license', 'fd3ba600-b8b7-4897-9e51-051000ecf2bb': 'Fig 3.13A\xa0 Illustration for positioning for a Cranial-Caudal (CC) Mammogram by Bruce Blausen. Used under Creative Commons Atribution CC BY, 3.0, Unported. https://en.wikipedia.org/wiki/Mammography#/media/File:Blausen_0628_Mammogram.png', '72c7944a-7b83-4681-8c1e-3d24b67ec261': 'Fig 3.13B Imaging of a patient being positioned for a CC Mammogram.\xa0 National Cancer Institute, Bill Branson. This image is in the public domain and can be freely reused. cancergovstaff@mail.nih.gov', '96ea471a-f94d-45bd-9e64-9275cf42bcbb': 'Fig 3.14A\xa0Mammography CC image, left side, normal screening mammography image\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license. Can be accessed from https://mistr.usask.ca/odin/?caseID=20170410101815189', 'cb51e920-2739-4b4f-9f31-23cb8fda5fbf': 'Fig 3.14B\xa0Mammography, MLO image, left side, normal screening mammography image by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license. Can be accessed from\xa0https://mistr.usask.ca/odin/?caseID=20170410101815189', '941a5a9e-2c28-491a-ae69-b2e8ac4950f7': 'The x-rays that result from the electron bombardment of the anode are constrained within a heavy lead housing that contains circulating oil to cool the tube. The dispersal of the x-ray beam is limited to a small port in the lead housing of the x-ray tube and by mechanical metal filters that collimate the x-ray beam and prevent the uncontrolled, dissemination of x-rays. Therefore, the emitted x-rays expose only the desired region of the patient’s anatomy in a controlled manner.\xa0 The limitation of the x-rays by the lead housing and the collimation filters is how small part x-rays, i.e. wrist, scaphoid bone, can be done, as well as, large field x-rays such as a full field chest x-ray.\xa0 (Figure 3.4)', '3f282e99-f481-4765-be0c-eb3cbc31a535': 'The quantity and energy of the x-rays produced is controlled by the parameters set on the machine by the MRT.\xa0 Every effort is made to optimize the exposure parameters to minimize the radiation dose, but there are times when the patient receives too few, or too many, x-rays resulting in a poor quality image.\xa0 Often, this can be managed by adjusting the contrast and brightness of the display monitor during viewing, but rarely some images must be repeated in order for them to be of diagnostic quality.', '582b1c07-c210-485d-bc24-c00f1ac055ba': 'Historically, x-rays were photo-emulsion embedded in plastic sheets that required development in a processor of developer and fixer solutions after exposure to diagnostic x-rays.\xa0 The dried radiographic images were stored as hard-copies for viewing. The image detectors used today rely on complex electronic systems that converts x-rays into electrical signals that then results in pixels of different intensity on the monitor of a digital display system.', 'b20b5869-5b9d-4f1d-b6d7-00bf621c5699': 'The radiographic (x-ray) image has been described by Dr. Lucy Squire as a, “summation shadowgram”, highlighting the fact that the final image is a summation of all the interactions between the anatomy of the patient and the original x-ray beam prior to the beam reaching the x-ray detector. The x-ray beam is altered by absorption and scattering, during the interaction with the patient, before it finally reaches the x-ray detector. The resulting image ranges between bright white to dark black with hundreds of shades of grey in between. The blackest region of the x-ray image is related to the larger number of x-rays that reached the detector in that region. This phenomenon is analogous to black and white photographic emulsion as those areas with more light exposure are blacker on the photograph.\xa0 The digital image creation process is depicted in Figure 3.5.'}"
+Figure 3.13,undergradimage/images/Figure 3.13.jpg,Figure 3.13B – Patient being positioned for a CC Mammogram,In order to minimize x-ray scatter and create a relatively uniform tissue density prior to x-ray exposure of the breast tissue it is standard practice to compress the breast tissue between radiolucent plastic plates.  This can be uncomfortable for some patients but it is not dangerous or overly painful. An image of a patient positioned for a cranial-caudal mammographic image is provided (Figure 3.13).,"{'ab183861-39bd-4acd-ba01-839ed9e1ce50': 'Fig 3.15\xa0A Fluoroscopy Machine\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '3937b270-7427-4cb4-85ba-34e045e02bd8': 'Fig 3.16\xa0Barium Enema images\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '0bff03dc-2905-4cc9-85fe-ebce2d016c03': 'Fig 3.17\xa0Fluoroscopy of the Pharynx and Upper Esophagus, video\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license. Video can be accessed at\xa0http://openpress.usask.ca/undergradimaging/wp-content/uploads/sites/34/2017/07/Fluoroscopy-cine-2.mp4. Static images can be accessed at\xa0https://mistr.usask.ca/odin/?caseID=20160216105351798.', '2a034d81-1e04-4521-8842-e32d86a9a19f': 'Fig 3.18\xa0Fluoroscopy Images are Inverted in Comparison to x-rays\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'db4e8e1a-d1ef-4199-8d4f-081e14b20644': 'This physical change to the x-ray tube anode results in a different spectrum of x-rays that are better suited to assessing the fat, connective tissue, and mammary tissue found in the breast.\xa0 This allows for very detailed images of soft tissues using x-rays as the source of radiation.\xa0 This imaging modality is predominantly used to image the female breast tissue but it is also capable of imaging male breast tissue for assessment of a palpable nodule or mass. A standard, digital, mammography unit is seen in Figure 3.12.', '60172089-5f9c-43cc-8bd8-72291154bd80': 'The standard positions for image acquisition in mammography is the cranial-caudal view and an oblique view. Additional mammographic positions, such as the lateral view, are used to problem solve complex abnormalities.\xa0 The mammographic x-ray tube and detector are able to rotate along the coronal axis of the machine to allow for image acquisition in various planes to maintain stable patient positioning without the need for the patient to lean or tip in any particular direction. Newer mammography machines routinely obtain images as the x-ray tube and the detector plate rotate resulting in a process called tomosynthesis.', 'bd1ce04c-fbbb-4437-91fa-65a50e7c0e54': 'In order to minimize x-ray scatter and create a relatively uniform tissue density prior to x-ray exposure of the breast tissue it is standard practice to compress the breast tissue between radiolucent plastic plates.\xa0 This can be uncomfortable for some patients but it is not dangerous or overly painful. An image of a patient positioned for a cranial-caudal mammographic image is provided (Figure 3.13).', '28574a15-a932-44f0-8382-50c167c24787': 'The same general concepts of appearance of different tissues on x-rays applies to mammography, i.e. air is black, fat is lower opacity than mammary glands and connective tissue and calcium is the most opaque element visualized.\xa0 The detection of small calcifications is a common finding on mammograms depicting breast cancer. \xa0The resulting x-rays generated by mammography are seen in Figure 3.14.', '2b6ee13a-cdfa-4562-842c-3fc094922bf1': 'These screening images depict normal breast tissue, fat, and connective tissue.\xa0 The more opaque tissue at the back edge of the images is the pectoralis major muscle. The breast tissue is predominantly fat replaced and there is no evidence of atypical calcifications, a nodule, mass, or architectural distortion. Normal lymph nodes are seen in the axillary area.', 'f2a44948-360a-4de7-9ae8-82bb05154c77': 'Fig 3.12\xa0Mammography x-ray Machine\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license', 'fd3ba600-b8b7-4897-9e51-051000ecf2bb': 'Fig 3.13A\xa0 Illustration for positioning for a Cranial-Caudal (CC) Mammogram by Bruce Blausen. Used under Creative Commons Atribution CC BY, 3.0, Unported. https://en.wikipedia.org/wiki/Mammography#/media/File:Blausen_0628_Mammogram.png', '72c7944a-7b83-4681-8c1e-3d24b67ec261': 'Fig 3.13B Imaging of a patient being positioned for a CC Mammogram.\xa0 National Cancer Institute, Bill Branson. This image is in the public domain and can be freely reused. cancergovstaff@mail.nih.gov', '96ea471a-f94d-45bd-9e64-9275cf42bcbb': 'Fig 3.14A\xa0Mammography CC image, left side, normal screening mammography image\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license. Can be accessed from https://mistr.usask.ca/odin/?caseID=20170410101815189', 'cb51e920-2739-4b4f-9f31-23cb8fda5fbf': 'Fig 3.14B\xa0Mammography, MLO image, left side, normal screening mammography image by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license. Can be accessed from\xa0https://mistr.usask.ca/odin/?caseID=20170410101815189', '941a5a9e-2c28-491a-ae69-b2e8ac4950f7': 'The x-rays that result from the electron bombardment of the anode are constrained within a heavy lead housing that contains circulating oil to cool the tube. The dispersal of the x-ray beam is limited to a small port in the lead housing of the x-ray tube and by mechanical metal filters that collimate the x-ray beam and prevent the uncontrolled, dissemination of x-rays. Therefore, the emitted x-rays expose only the desired region of the patient’s anatomy in a controlled manner.\xa0 The limitation of the x-rays by the lead housing and the collimation filters is how small part x-rays, i.e. wrist, scaphoid bone, can be done, as well as, large field x-rays such as a full field chest x-ray.\xa0 (Figure 3.4)', '3f282e99-f481-4765-be0c-eb3cbc31a535': 'The quantity and energy of the x-rays produced is controlled by the parameters set on the machine by the MRT.\xa0 Every effort is made to optimize the exposure parameters to minimize the radiation dose, but there are times when the patient receives too few, or too many, x-rays resulting in a poor quality image.\xa0 Often, this can be managed by adjusting the contrast and brightness of the display monitor during viewing, but rarely some images must be repeated in order for them to be of diagnostic quality.', '582b1c07-c210-485d-bc24-c00f1ac055ba': 'Historically, x-rays were photo-emulsion embedded in plastic sheets that required development in a processor of developer and fixer solutions after exposure to diagnostic x-rays.\xa0 The dried radiographic images were stored as hard-copies for viewing. The image detectors used today rely on complex electronic systems that converts x-rays into electrical signals that then results in pixels of different intensity on the monitor of a digital display system.', 'b20b5869-5b9d-4f1d-b6d7-00bf621c5699': 'The radiographic (x-ray) image has been described by Dr. Lucy Squire as a, “summation shadowgram”, highlighting the fact that the final image is a summation of all the interactions between the anatomy of the patient and the original x-ray beam prior to the beam reaching the x-ray detector. The x-ray beam is altered by absorption and scattering, during the interaction with the patient, before it finally reaches the x-ray detector. The resulting image ranges between bright white to dark black with hundreds of shades of grey in between. The blackest region of the x-ray image is related to the larger number of x-rays that reached the detector in that region. This phenomenon is analogous to black and white photographic emulsion as those areas with more light exposure are blacker on the photograph.\xa0 The digital image creation process is depicted in Figure 3.5.'}"
+Figure 3.14,undergradimage/images/Figure 3.14.jpg,"Figure 3.14A Mammography CC image, left side, normal screening mammography image","The same general concepts of appearance of different tissues on x-rays applies to mammography, i.e. air is black, fat is lower opacity than mammary glands and connective tissue and calcium is the most opaque element visualized.  The detection of small calcifications is a common finding on mammograms depicting breast cancer.  The resulting x-rays generated by mammography are seen in Figure 3.14.","{'ab183861-39bd-4acd-ba01-839ed9e1ce50': 'Fig 3.15\xa0A Fluoroscopy Machine\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '3937b270-7427-4cb4-85ba-34e045e02bd8': 'Fig 3.16\xa0Barium Enema images\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '0bff03dc-2905-4cc9-85fe-ebce2d016c03': 'Fig 3.17\xa0Fluoroscopy of the Pharynx and Upper Esophagus, video\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license. Video can be accessed at\xa0http://openpress.usask.ca/undergradimaging/wp-content/uploads/sites/34/2017/07/Fluoroscopy-cine-2.mp4. Static images can be accessed at\xa0https://mistr.usask.ca/odin/?caseID=20160216105351798.', '2a034d81-1e04-4521-8842-e32d86a9a19f': 'Fig 3.18\xa0Fluoroscopy Images are Inverted in Comparison to x-rays\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'db4e8e1a-d1ef-4199-8d4f-081e14b20644': 'This physical change to the x-ray tube anode results in a different spectrum of x-rays that are better suited to assessing the fat, connective tissue, and mammary tissue found in the breast.\xa0 This allows for very detailed images of soft tissues using x-rays as the source of radiation.\xa0 This imaging modality is predominantly used to image the female breast tissue but it is also capable of imaging male breast tissue for assessment of a palpable nodule or mass. A standard, digital, mammography unit is seen in Figure 3.12.', '60172089-5f9c-43cc-8bd8-72291154bd80': 'The standard positions for image acquisition in mammography is the cranial-caudal view and an oblique view. Additional mammographic positions, such as the lateral view, are used to problem solve complex abnormalities.\xa0 The mammographic x-ray tube and detector are able to rotate along the coronal axis of the machine to allow for image acquisition in various planes to maintain stable patient positioning without the need for the patient to lean or tip in any particular direction. Newer mammography machines routinely obtain images as the x-ray tube and the detector plate rotate resulting in a process called tomosynthesis.', 'bd1ce04c-fbbb-4437-91fa-65a50e7c0e54': 'In order to minimize x-ray scatter and create a relatively uniform tissue density prior to x-ray exposure of the breast tissue it is standard practice to compress the breast tissue between radiolucent plastic plates.\xa0 This can be uncomfortable for some patients but it is not dangerous or overly painful. An image of a patient positioned for a cranial-caudal mammographic image is provided (Figure 3.13).', '28574a15-a932-44f0-8382-50c167c24787': 'The same general concepts of appearance of different tissues on x-rays applies to mammography, i.e. air is black, fat is lower opacity than mammary glands and connective tissue and calcium is the most opaque element visualized.\xa0 The detection of small calcifications is a common finding on mammograms depicting breast cancer. \xa0The resulting x-rays generated by mammography are seen in Figure 3.14.', '2b6ee13a-cdfa-4562-842c-3fc094922bf1': 'These screening images depict normal breast tissue, fat, and connective tissue.\xa0 The more opaque tissue at the back edge of the images is the pectoralis major muscle. The breast tissue is predominantly fat replaced and there is no evidence of atypical calcifications, a nodule, mass, or architectural distortion. Normal lymph nodes are seen in the axillary area.', 'f2a44948-360a-4de7-9ae8-82bb05154c77': 'Fig 3.12\xa0Mammography x-ray Machine\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license', 'fd3ba600-b8b7-4897-9e51-051000ecf2bb': 'Fig 3.13A\xa0 Illustration for positioning for a Cranial-Caudal (CC) Mammogram by Bruce Blausen. Used under Creative Commons Atribution CC BY, 3.0, Unported. https://en.wikipedia.org/wiki/Mammography#/media/File:Blausen_0628_Mammogram.png', '72c7944a-7b83-4681-8c1e-3d24b67ec261': 'Fig 3.13B Imaging of a patient being positioned for a CC Mammogram.\xa0 National Cancer Institute, Bill Branson. This image is in the public domain and can be freely reused. cancergovstaff@mail.nih.gov', '96ea471a-f94d-45bd-9e64-9275cf42bcbb': 'Fig 3.14A\xa0Mammography CC image, left side, normal screening mammography image\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license. Can be accessed from https://mistr.usask.ca/odin/?caseID=20170410101815189', 'cb51e920-2739-4b4f-9f31-23cb8fda5fbf': 'Fig 3.14B\xa0Mammography, MLO image, left side, normal screening mammography image by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license. Can be accessed from\xa0https://mistr.usask.ca/odin/?caseID=20170410101815189', '941a5a9e-2c28-491a-ae69-b2e8ac4950f7': 'The x-rays that result from the electron bombardment of the anode are constrained within a heavy lead housing that contains circulating oil to cool the tube. The dispersal of the x-ray beam is limited to a small port in the lead housing of the x-ray tube and by mechanical metal filters that collimate the x-ray beam and prevent the uncontrolled, dissemination of x-rays. Therefore, the emitted x-rays expose only the desired region of the patient’s anatomy in a controlled manner.\xa0 The limitation of the x-rays by the lead housing and the collimation filters is how small part x-rays, i.e. wrist, scaphoid bone, can be done, as well as, large field x-rays such as a full field chest x-ray.\xa0 (Figure 3.4)', '3f282e99-f481-4765-be0c-eb3cbc31a535': 'The quantity and energy of the x-rays produced is controlled by the parameters set on the machine by the MRT.\xa0 Every effort is made to optimize the exposure parameters to minimize the radiation dose, but there are times when the patient receives too few, or too many, x-rays resulting in a poor quality image.\xa0 Often, this can be managed by adjusting the contrast and brightness of the display monitor during viewing, but rarely some images must be repeated in order for them to be of diagnostic quality.', '582b1c07-c210-485d-bc24-c00f1ac055ba': 'Historically, x-rays were photo-emulsion embedded in plastic sheets that required development in a processor of developer and fixer solutions after exposure to diagnostic x-rays.\xa0 The dried radiographic images were stored as hard-copies for viewing. The image detectors used today rely on complex electronic systems that converts x-rays into electrical signals that then results in pixels of different intensity on the monitor of a digital display system.', 'b20b5869-5b9d-4f1d-b6d7-00bf621c5699': 'The radiographic (x-ray) image has been described by Dr. Lucy Squire as a, “summation shadowgram”, highlighting the fact that the final image is a summation of all the interactions between the anatomy of the patient and the original x-ray beam prior to the beam reaching the x-ray detector. The x-ray beam is altered by absorption and scattering, during the interaction with the patient, before it finally reaches the x-ray detector. The resulting image ranges between bright white to dark black with hundreds of shades of grey in between. The blackest region of the x-ray image is related to the larger number of x-rays that reached the detector in that region. This phenomenon is analogous to black and white photographic emulsion as those areas with more light exposure are blacker on the photograph.\xa0 The digital image creation process is depicted in Figure 3.5.'}"
+Figure 3.14,undergradimage/images/Figure 3.14.jpg,"Figure 3.14B Mammography, MLO image, left side, normal screening mammography image","The same general concepts of appearance of different tissues on x-rays applies to mammography, i.e. air is black, fat is lower opacity than mammary glands and connective tissue and calcium is the most opaque element visualized.  The detection of small calcifications is a common finding on mammograms depicting breast cancer.  The resulting x-rays generated by mammography are seen in Figure 3.14.","{'ab183861-39bd-4acd-ba01-839ed9e1ce50': 'Fig 3.15\xa0A Fluoroscopy Machine\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '3937b270-7427-4cb4-85ba-34e045e02bd8': 'Fig 3.16\xa0Barium Enema images\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '0bff03dc-2905-4cc9-85fe-ebce2d016c03': 'Fig 3.17\xa0Fluoroscopy of the Pharynx and Upper Esophagus, video\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license. Video can be accessed at\xa0http://openpress.usask.ca/undergradimaging/wp-content/uploads/sites/34/2017/07/Fluoroscopy-cine-2.mp4. Static images can be accessed at\xa0https://mistr.usask.ca/odin/?caseID=20160216105351798.', '2a034d81-1e04-4521-8842-e32d86a9a19f': 'Fig 3.18\xa0Fluoroscopy Images are Inverted in Comparison to x-rays\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'db4e8e1a-d1ef-4199-8d4f-081e14b20644': 'This physical change to the x-ray tube anode results in a different spectrum of x-rays that are better suited to assessing the fat, connective tissue, and mammary tissue found in the breast.\xa0 This allows for very detailed images of soft tissues using x-rays as the source of radiation.\xa0 This imaging modality is predominantly used to image the female breast tissue but it is also capable of imaging male breast tissue for assessment of a palpable nodule or mass. A standard, digital, mammography unit is seen in Figure 3.12.', '60172089-5f9c-43cc-8bd8-72291154bd80': 'The standard positions for image acquisition in mammography is the cranial-caudal view and an oblique view. Additional mammographic positions, such as the lateral view, are used to problem solve complex abnormalities.\xa0 The mammographic x-ray tube and detector are able to rotate along the coronal axis of the machine to allow for image acquisition in various planes to maintain stable patient positioning without the need for the patient to lean or tip in any particular direction. Newer mammography machines routinely obtain images as the x-ray tube and the detector plate rotate resulting in a process called tomosynthesis.', 'bd1ce04c-fbbb-4437-91fa-65a50e7c0e54': 'In order to minimize x-ray scatter and create a relatively uniform tissue density prior to x-ray exposure of the breast tissue it is standard practice to compress the breast tissue between radiolucent plastic plates.\xa0 This can be uncomfortable for some patients but it is not dangerous or overly painful. An image of a patient positioned for a cranial-caudal mammographic image is provided (Figure 3.13).', '28574a15-a932-44f0-8382-50c167c24787': 'The same general concepts of appearance of different tissues on x-rays applies to mammography, i.e. air is black, fat is lower opacity than mammary glands and connective tissue and calcium is the most opaque element visualized.\xa0 The detection of small calcifications is a common finding on mammograms depicting breast cancer. \xa0The resulting x-rays generated by mammography are seen in Figure 3.14.', '2b6ee13a-cdfa-4562-842c-3fc094922bf1': 'These screening images depict normal breast tissue, fat, and connective tissue.\xa0 The more opaque tissue at the back edge of the images is the pectoralis major muscle. The breast tissue is predominantly fat replaced and there is no evidence of atypical calcifications, a nodule, mass, or architectural distortion. Normal lymph nodes are seen in the axillary area.', 'f2a44948-360a-4de7-9ae8-82bb05154c77': 'Fig 3.12\xa0Mammography x-ray Machine\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license', 'fd3ba600-b8b7-4897-9e51-051000ecf2bb': 'Fig 3.13A\xa0 Illustration for positioning for a Cranial-Caudal (CC) Mammogram by Bruce Blausen. Used under Creative Commons Atribution CC BY, 3.0, Unported. https://en.wikipedia.org/wiki/Mammography#/media/File:Blausen_0628_Mammogram.png', '72c7944a-7b83-4681-8c1e-3d24b67ec261': 'Fig 3.13B Imaging of a patient being positioned for a CC Mammogram.\xa0 National Cancer Institute, Bill Branson. This image is in the public domain and can be freely reused. cancergovstaff@mail.nih.gov', '96ea471a-f94d-45bd-9e64-9275cf42bcbb': 'Fig 3.14A\xa0Mammography CC image, left side, normal screening mammography image\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license. Can be accessed from https://mistr.usask.ca/odin/?caseID=20170410101815189', 'cb51e920-2739-4b4f-9f31-23cb8fda5fbf': 'Fig 3.14B\xa0Mammography, MLO image, left side, normal screening mammography image by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license. Can be accessed from\xa0https://mistr.usask.ca/odin/?caseID=20170410101815189', '941a5a9e-2c28-491a-ae69-b2e8ac4950f7': 'The x-rays that result from the electron bombardment of the anode are constrained within a heavy lead housing that contains circulating oil to cool the tube. The dispersal of the x-ray beam is limited to a small port in the lead housing of the x-ray tube and by mechanical metal filters that collimate the x-ray beam and prevent the uncontrolled, dissemination of x-rays. Therefore, the emitted x-rays expose only the desired region of the patient’s anatomy in a controlled manner.\xa0 The limitation of the x-rays by the lead housing and the collimation filters is how small part x-rays, i.e. wrist, scaphoid bone, can be done, as well as, large field x-rays such as a full field chest x-ray.\xa0 (Figure 3.4)', '3f282e99-f481-4765-be0c-eb3cbc31a535': 'The quantity and energy of the x-rays produced is controlled by the parameters set on the machine by the MRT.\xa0 Every effort is made to optimize the exposure parameters to minimize the radiation dose, but there are times when the patient receives too few, or too many, x-rays resulting in a poor quality image.\xa0 Often, this can be managed by adjusting the contrast and brightness of the display monitor during viewing, but rarely some images must be repeated in order for them to be of diagnostic quality.', '582b1c07-c210-485d-bc24-c00f1ac055ba': 'Historically, x-rays were photo-emulsion embedded in plastic sheets that required development in a processor of developer and fixer solutions after exposure to diagnostic x-rays.\xa0 The dried radiographic images were stored as hard-copies for viewing. The image detectors used today rely on complex electronic systems that converts x-rays into electrical signals that then results in pixels of different intensity on the monitor of a digital display system.', 'b20b5869-5b9d-4f1d-b6d7-00bf621c5699': 'The radiographic (x-ray) image has been described by Dr. Lucy Squire as a, “summation shadowgram”, highlighting the fact that the final image is a summation of all the interactions between the anatomy of the patient and the original x-ray beam prior to the beam reaching the x-ray detector. The x-ray beam is altered by absorption and scattering, during the interaction with the patient, before it finally reaches the x-ray detector. The resulting image ranges between bright white to dark black with hundreds of shades of grey in between. The blackest region of the x-ray image is related to the larger number of x-rays that reached the detector in that region. This phenomenon is analogous to black and white photographic emulsion as those areas with more light exposure are blacker on the photograph.\xa0 The digital image creation process is depicted in Figure 3.5.'}"
+Figure 3.4,undergradimage/images/Figure 3.4.jpg,"Figure 3.4 X-ray Tube, Lead Housing with Portal for x-ray emission, bench top image","The x-rays that result from the electron bombardment of the anode are constrained within a heavy lead housing that contains circulating oil to cool the tube. The dispersal of the x-ray beam is limited to a small port in the lead housing of the x-ray tube and by mechanical metal filters that collimate the x-ray beam and prevent the uncontrolled, dissemination of x-rays. Therefore, the emitted x-rays expose only the desired region of the patient’s anatomy in a controlled manner.  The limitation of the x-rays by the lead housing and the collimation filters is how small part x-rays, i.e. wrist, scaphoid bone, can be done, as well as, large field x-rays such as a full field chest x-ray.  (Figure 3.4)","{'ab183861-39bd-4acd-ba01-839ed9e1ce50': 'Fig 3.15\xa0A Fluoroscopy Machine\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '3937b270-7427-4cb4-85ba-34e045e02bd8': 'Fig 3.16\xa0Barium Enema images\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '0bff03dc-2905-4cc9-85fe-ebce2d016c03': 'Fig 3.17\xa0Fluoroscopy of the Pharynx and Upper Esophagus, video\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license. Video can be accessed at\xa0http://openpress.usask.ca/undergradimaging/wp-content/uploads/sites/34/2017/07/Fluoroscopy-cine-2.mp4. Static images can be accessed at\xa0https://mistr.usask.ca/odin/?caseID=20160216105351798.', '2a034d81-1e04-4521-8842-e32d86a9a19f': 'Fig 3.18\xa0Fluoroscopy Images are Inverted in Comparison to x-rays\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'db4e8e1a-d1ef-4199-8d4f-081e14b20644': 'This physical change to the x-ray tube anode results in a different spectrum of x-rays that are better suited to assessing the fat, connective tissue, and mammary tissue found in the breast.\xa0 This allows for very detailed images of soft tissues using x-rays as the source of radiation.\xa0 This imaging modality is predominantly used to image the female breast tissue but it is also capable of imaging male breast tissue for assessment of a palpable nodule or mass. A standard, digital, mammography unit is seen in Figure 3.12.', '60172089-5f9c-43cc-8bd8-72291154bd80': 'The standard positions for image acquisition in mammography is the cranial-caudal view and an oblique view. Additional mammographic positions, such as the lateral view, are used to problem solve complex abnormalities.\xa0 The mammographic x-ray tube and detector are able to rotate along the coronal axis of the machine to allow for image acquisition in various planes to maintain stable patient positioning without the need for the patient to lean or tip in any particular direction. Newer mammography machines routinely obtain images as the x-ray tube and the detector plate rotate resulting in a process called tomosynthesis.', 'bd1ce04c-fbbb-4437-91fa-65a50e7c0e54': 'In order to minimize x-ray scatter and create a relatively uniform tissue density prior to x-ray exposure of the breast tissue it is standard practice to compress the breast tissue between radiolucent plastic plates.\xa0 This can be uncomfortable for some patients but it is not dangerous or overly painful. An image of a patient positioned for a cranial-caudal mammographic image is provided (Figure 3.13).', '28574a15-a932-44f0-8382-50c167c24787': 'The same general concepts of appearance of different tissues on x-rays applies to mammography, i.e. air is black, fat is lower opacity than mammary glands and connective tissue and calcium is the most opaque element visualized.\xa0 The detection of small calcifications is a common finding on mammograms depicting breast cancer. \xa0The resulting x-rays generated by mammography are seen in Figure 3.14.', '2b6ee13a-cdfa-4562-842c-3fc094922bf1': 'These screening images depict normal breast tissue, fat, and connective tissue.\xa0 The more opaque tissue at the back edge of the images is the pectoralis major muscle. The breast tissue is predominantly fat replaced and there is no evidence of atypical calcifications, a nodule, mass, or architectural distortion. Normal lymph nodes are seen in the axillary area.', 'f2a44948-360a-4de7-9ae8-82bb05154c77': 'Fig 3.12\xa0Mammography x-ray Machine\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license', 'fd3ba600-b8b7-4897-9e51-051000ecf2bb': 'Fig 3.13A\xa0 Illustration for positioning for a Cranial-Caudal (CC) Mammogram by Bruce Blausen. Used under Creative Commons Atribution CC BY, 3.0, Unported. https://en.wikipedia.org/wiki/Mammography#/media/File:Blausen_0628_Mammogram.png', '72c7944a-7b83-4681-8c1e-3d24b67ec261': 'Fig 3.13B Imaging of a patient being positioned for a CC Mammogram.\xa0 National Cancer Institute, Bill Branson. This image is in the public domain and can be freely reused. cancergovstaff@mail.nih.gov', '96ea471a-f94d-45bd-9e64-9275cf42bcbb': 'Fig 3.14A\xa0Mammography CC image, left side, normal screening mammography image\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license. Can be accessed from https://mistr.usask.ca/odin/?caseID=20170410101815189', 'cb51e920-2739-4b4f-9f31-23cb8fda5fbf': 'Fig 3.14B\xa0Mammography, MLO image, left side, normal screening mammography image by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license. Can be accessed from\xa0https://mistr.usask.ca/odin/?caseID=20170410101815189', '941a5a9e-2c28-491a-ae69-b2e8ac4950f7': 'The x-rays that result from the electron bombardment of the anode are constrained within a heavy lead housing that contains circulating oil to cool the tube. The dispersal of the x-ray beam is limited to a small port in the lead housing of the x-ray tube and by mechanical metal filters that collimate the x-ray beam and prevent the uncontrolled, dissemination of x-rays. Therefore, the emitted x-rays expose only the desired region of the patient’s anatomy in a controlled manner.\xa0 The limitation of the x-rays by the lead housing and the collimation filters is how small part x-rays, i.e. wrist, scaphoid bone, can be done, as well as, large field x-rays such as a full field chest x-ray.\xa0 (Figure 3.4)', '3f282e99-f481-4765-be0c-eb3cbc31a535': 'The quantity and energy of the x-rays produced is controlled by the parameters set on the machine by the MRT.\xa0 Every effort is made to optimize the exposure parameters to minimize the radiation dose, but there are times when the patient receives too few, or too many, x-rays resulting in a poor quality image.\xa0 Often, this can be managed by adjusting the contrast and brightness of the display monitor during viewing, but rarely some images must be repeated in order for them to be of diagnostic quality.', '582b1c07-c210-485d-bc24-c00f1ac055ba': 'Historically, x-rays were photo-emulsion embedded in plastic sheets that required development in a processor of developer and fixer solutions after exposure to diagnostic x-rays.\xa0 The dried radiographic images were stored as hard-copies for viewing. The image detectors used today rely on complex electronic systems that converts x-rays into electrical signals that then results in pixels of different intensity on the monitor of a digital display system.', 'b20b5869-5b9d-4f1d-b6d7-00bf621c5699': 'The radiographic (x-ray) image has been described by Dr. Lucy Squire as a, “summation shadowgram”, highlighting the fact that the final image is a summation of all the interactions between the anatomy of the patient and the original x-ray beam prior to the beam reaching the x-ray detector. The x-ray beam is altered by absorption and scattering, during the interaction with the patient, before it finally reaches the x-ray detector. The resulting image ranges between bright white to dark black with hundreds of shades of grey in between. The blackest region of the x-ray image is related to the larger number of x-rays that reached the detector in that region. This phenomenon is analogous to black and white photographic emulsion as those areas with more light exposure are blacker on the photograph.\xa0 The digital image creation process is depicted in Figure 3.5.'}"
+Figure 3.5,undergradimage/images/Figure 3.5.jpg,Figure 3.5 X-ray Image Creation and Display,"The radiographic (x-ray) image has been described by Dr. Lucy Squire as a, “summation shadowgram”, highlighting the fact that the final image is a summation of all the interactions between the anatomy of the patient and the original x-ray beam prior to the beam reaching the x-ray detector. The x-ray beam is altered by absorption and scattering, during the interaction with the patient, before it finally reaches the x-ray detector. The resulting image ranges between bright white to dark black with hundreds of shades of grey in between. The blackest region of the x-ray image is related to the larger number of x-rays that reached the detector in that region. This phenomenon is analogous to black and white photographic emulsion as those areas with more light exposure are blacker on the photograph.  The digital image creation process is depicted in Figure 3.5.","{'ab183861-39bd-4acd-ba01-839ed9e1ce50': 'Fig 3.15\xa0A Fluoroscopy Machine\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '3937b270-7427-4cb4-85ba-34e045e02bd8': 'Fig 3.16\xa0Barium Enema images\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', '0bff03dc-2905-4cc9-85fe-ebce2d016c03': 'Fig 3.17\xa0Fluoroscopy of the Pharynx and Upper Esophagus, video\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license. Video can be accessed at\xa0http://openpress.usask.ca/undergradimaging/wp-content/uploads/sites/34/2017/07/Fluoroscopy-cine-2.mp4. Static images can be accessed at\xa0https://mistr.usask.ca/odin/?caseID=20160216105351798.', '2a034d81-1e04-4521-8842-e32d86a9a19f': 'Fig 3.18\xa0Fluoroscopy Images are Inverted in Comparison to x-rays\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.', 'db4e8e1a-d1ef-4199-8d4f-081e14b20644': 'This physical change to the x-ray tube anode results in a different spectrum of x-rays that are better suited to assessing the fat, connective tissue, and mammary tissue found in the breast.\xa0 This allows for very detailed images of soft tissues using x-rays as the source of radiation.\xa0 This imaging modality is predominantly used to image the female breast tissue but it is also capable of imaging male breast tissue for assessment of a palpable nodule or mass. A standard, digital, mammography unit is seen in Figure 3.12.', '60172089-5f9c-43cc-8bd8-72291154bd80': 'The standard positions for image acquisition in mammography is the cranial-caudal view and an oblique view. Additional mammographic positions, such as the lateral view, are used to problem solve complex abnormalities.\xa0 The mammographic x-ray tube and detector are able to rotate along the coronal axis of the machine to allow for image acquisition in various planes to maintain stable patient positioning without the need for the patient to lean or tip in any particular direction. Newer mammography machines routinely obtain images as the x-ray tube and the detector plate rotate resulting in a process called tomosynthesis.', 'bd1ce04c-fbbb-4437-91fa-65a50e7c0e54': 'In order to minimize x-ray scatter and create a relatively uniform tissue density prior to x-ray exposure of the breast tissue it is standard practice to compress the breast tissue between radiolucent plastic plates.\xa0 This can be uncomfortable for some patients but it is not dangerous or overly painful. An image of a patient positioned for a cranial-caudal mammographic image is provided (Figure 3.13).', '28574a15-a932-44f0-8382-50c167c24787': 'The same general concepts of appearance of different tissues on x-rays applies to mammography, i.e. air is black, fat is lower opacity than mammary glands and connective tissue and calcium is the most opaque element visualized.\xa0 The detection of small calcifications is a common finding on mammograms depicting breast cancer. \xa0The resulting x-rays generated by mammography are seen in Figure 3.14.', '2b6ee13a-cdfa-4562-842c-3fc094922bf1': 'These screening images depict normal breast tissue, fat, and connective tissue.\xa0 The more opaque tissue at the back edge of the images is the pectoralis major muscle. The breast tissue is predominantly fat replaced and there is no evidence of atypical calcifications, a nodule, mass, or architectural distortion. Normal lymph nodes are seen in the axillary area.', 'f2a44948-360a-4de7-9ae8-82bb05154c77': 'Fig 3.12\xa0Mammography x-ray Machine\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license', 'fd3ba600-b8b7-4897-9e51-051000ecf2bb': 'Fig 3.13A\xa0 Illustration for positioning for a Cranial-Caudal (CC) Mammogram by Bruce Blausen. Used under Creative Commons Atribution CC BY, 3.0, Unported. https://en.wikipedia.org/wiki/Mammography#/media/File:Blausen_0628_Mammogram.png', '72c7944a-7b83-4681-8c1e-3d24b67ec261': 'Fig 3.13B Imaging of a patient being positioned for a CC Mammogram.\xa0 National Cancer Institute, Bill Branson. This image is in the public domain and can be freely reused. cancergovstaff@mail.nih.gov', '96ea471a-f94d-45bd-9e64-9275cf42bcbb': 'Fig 3.14A\xa0Mammography CC image, left side, normal screening mammography image\xa0by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license. Can be accessed from https://mistr.usask.ca/odin/?caseID=20170410101815189', 'cb51e920-2739-4b4f-9f31-23cb8fda5fbf': 'Fig 3.14B\xa0Mammography, MLO image, left side, normal screening mammography image by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license. Can be accessed from\xa0https://mistr.usask.ca/odin/?caseID=20170410101815189', '941a5a9e-2c28-491a-ae69-b2e8ac4950f7': 'The x-rays that result from the electron bombardment of the anode are constrained within a heavy lead housing that contains circulating oil to cool the tube. The dispersal of the x-ray beam is limited to a small port in the lead housing of the x-ray tube and by mechanical metal filters that collimate the x-ray beam and prevent the uncontrolled, dissemination of x-rays. Therefore, the emitted x-rays expose only the desired region of the patient’s anatomy in a controlled manner.\xa0 The limitation of the x-rays by the lead housing and the collimation filters is how small part x-rays, i.e. wrist, scaphoid bone, can be done, as well as, large field x-rays such as a full field chest x-ray.\xa0 (Figure 3.4)', '3f282e99-f481-4765-be0c-eb3cbc31a535': 'The quantity and energy of the x-rays produced is controlled by the parameters set on the machine by the MRT.\xa0 Every effort is made to optimize the exposure parameters to minimize the radiation dose, but there are times when the patient receives too few, or too many, x-rays resulting in a poor quality image.\xa0 Often, this can be managed by adjusting the contrast and brightness of the display monitor during viewing, but rarely some images must be repeated in order for them to be of diagnostic quality.', '582b1c07-c210-485d-bc24-c00f1ac055ba': 'Historically, x-rays were photo-emulsion embedded in plastic sheets that required development in a processor of developer and fixer solutions after exposure to diagnostic x-rays.\xa0 The dried radiographic images were stored as hard-copies for viewing. The image detectors used today rely on complex electronic systems that converts x-rays into electrical signals that then results in pixels of different intensity on the monitor of a digital display system.', 'b20b5869-5b9d-4f1d-b6d7-00bf621c5699': 'The radiographic (x-ray) image has been described by Dr. Lucy Squire as a, “summation shadowgram”, highlighting the fact that the final image is a summation of all the interactions between the anatomy of the patient and the original x-ray beam prior to the beam reaching the x-ray detector. The x-ray beam is altered by absorption and scattering, during the interaction with the patient, before it finally reaches the x-ray detector. The resulting image ranges between bright white to dark black with hundreds of shades of grey in between. The blackest region of the x-ray image is related to the larger number of x-rays that reached the detector in that region. This phenomenon is analogous to black and white photographic emulsion as those areas with more light exposure are blacker on the photograph.\xa0 The digital image creation process is depicted in Figure 3.5.'}"
+Figure 3.8,undergradimage/images/Figure 3.8.jpg,Figure 3.8 Left Shoulder x-ray,A clinical example of the different absorption spectra seen on x-rays is provided in Figure 3.8.  This is an image of a patient with a knife embedded in his left shoulder.,"{'73c009d1-142a-47a5-a66b-770362d66d11': 'Opaque (opacity) – an area of the patient that absorbed, or scattered, a large amount of the incident x-ray beam prior to it reaching the detector, i.e. the tissues in question block the x-rays from reaching the detector (whiter on the x-ray image). For example, one would describe metal as opaque on x-ray imaging.', 'c6fc8f9d-7e20-4bb4-8fb1-e864335bb24e': 'Lucent (lucency) – an area of the image where a larger amount of the x-ray beam passed through unimpeded to reach the detector (blacker on the x-ray image). For example, one would describe air as lucent on x-ray imaging.', 'bb3725c9-d2b5-4eaf-9f30-2d6f95a0541d': 'A clinical example of the different absorption spectra seen on x-rays is provided in Figure 3.8.\xa0 This is an image of a patient with a knife embedded in his left shoulder.', 'b3fccb48-1a3a-48c9-938f-609550c06a95': 'Thickness of the imaged anatomy also effects x-ray absorption. This is depicted in Figure 3.9.', 'c4b22ca7-2dc0-4613-98eb-8fde764c075f': 'This is depicted on a quality control image taken for x-ray tube calibration.\xa0 Figure 3.10 shows an x-ray of a Lucite plastic plate with variable depth holes drilled into it causing the appearance of the circles.\xa0 The circles become more lucent as the thickness of the Lucite diminishes. The vertical stripes are progressively thicker layers of aluminum that has been applied to the Lucite.'}"
+Figure 3.9,undergradimage/images/Figure 3.9.jpg,Figure 3.9 Effect of tissue thickness on x-ray appearance,Thickness of the imaged anatomy also effects x-ray absorption. This is depicted in Figure 3.9.,"{'73c009d1-142a-47a5-a66b-770362d66d11': 'Opaque (opacity) – an area of the patient that absorbed, or scattered, a large amount of the incident x-ray beam prior to it reaching the detector, i.e. the tissues in question block the x-rays from reaching the detector (whiter on the x-ray image). For example, one would describe metal as opaque on x-ray imaging.', 'c6fc8f9d-7e20-4bb4-8fb1-e864335bb24e': 'Lucent (lucency) – an area of the image where a larger amount of the x-ray beam passed through unimpeded to reach the detector (blacker on the x-ray image). For example, one would describe air as lucent on x-ray imaging.', 'bb3725c9-d2b5-4eaf-9f30-2d6f95a0541d': 'A clinical example of the different absorption spectra seen on x-rays is provided in Figure 3.8.\xa0 This is an image of a patient with a knife embedded in his left shoulder.', 'b3fccb48-1a3a-48c9-938f-609550c06a95': 'Thickness of the imaged anatomy also effects x-ray absorption. This is depicted in Figure 3.9.', 'c4b22ca7-2dc0-4613-98eb-8fde764c075f': 'This is depicted on a quality control image taken for x-ray tube calibration.\xa0 Figure 3.10 shows an x-ray of a Lucite plastic plate with variable depth holes drilled into it causing the appearance of the circles.\xa0 The circles become more lucent as the thickness of the Lucite diminishes. The vertical stripes are progressively thicker layers of aluminum that has been applied to the Lucite.'}"
+Figure 3.10,undergradimage/images/Figure 3.10.jpg,"Figure 3.10 Common x-ray Test Object, Lucite Plastic Board",This is depicted on a quality control image taken for x-ray tube calibration.  Figure 3.10 shows an x-ray of a Lucite plastic plate with variable depth holes drilled into it causing the appearance of the circles.  The circles become more lucent as the thickness of the Lucite diminishes. The vertical stripes are progressively thicker layers of aluminum that has been applied to the Lucite.,"{'73c009d1-142a-47a5-a66b-770362d66d11': 'Opaque (opacity) – an area of the patient that absorbed, or scattered, a large amount of the incident x-ray beam prior to it reaching the detector, i.e. the tissues in question block the x-rays from reaching the detector (whiter on the x-ray image). For example, one would describe metal as opaque on x-ray imaging.', 'c6fc8f9d-7e20-4bb4-8fb1-e864335bb24e': 'Lucent (lucency) – an area of the image where a larger amount of the x-ray beam passed through unimpeded to reach the detector (blacker on the x-ray image). For example, one would describe air as lucent on x-ray imaging.', 'bb3725c9-d2b5-4eaf-9f30-2d6f95a0541d': 'A clinical example of the different absorption spectra seen on x-rays is provided in Figure 3.8.\xa0 This is an image of a patient with a knife embedded in his left shoulder.', 'b3fccb48-1a3a-48c9-938f-609550c06a95': 'Thickness of the imaged anatomy also effects x-ray absorption. This is depicted in Figure 3.9.', 'c4b22ca7-2dc0-4613-98eb-8fde764c075f': 'This is depicted on a quality control image taken for x-ray tube calibration.\xa0 Figure 3.10 shows an x-ray of a Lucite plastic plate with variable depth holes drilled into it causing the appearance of the circles.\xa0 The circles become more lucent as the thickness of the Lucite diminishes. The vertical stripes are progressively thicker layers of aluminum that has been applied to the Lucite.'}"
+Figure 3.11,undergradimage/images/Figure 3.11.jpg,"Figure 3.11A Posterior-anterior, upright, chest x-ray positioning.","Examples of PA and Lateral chest x-ray positioning are shown in Figure 3.11A and 3.11B while a left side up Decubitus, Abdomen x-ray is seen in Figure 3.11C.","{'ebd256ce-5f82-48fb-87bd-1cbcdc9fb2ab': 'Most x-ray equipment has a relatively fixed positions of the x-ray tube and the x-ray detector.\xa0 In order to acquire images in different anatomic projections the patient must be moved and be positioned.\xa0 This may require the image detector to be on a wall or table mounted apparatus or the detector may be in a hand-held cassette.\xa0 The patient may need to be quite mobile for some images i.e. they need to lie on their side or stand upright.', 'b9cb6c2a-00ee-4bef-8cdd-b4b02efdd3eb': 'A basic tenet of plain x-rays is to obtain at least two views of the anatomy in question, usually taken 90 degrees apart from each other (orthogonal). One of the images is usually obtained in anatomic position and the second image is 90 degrees to the original anatomic position. Therefore, the minimum two views are usually a anterior-posterior (AP) and a lateral.\xa0 If the x-rays enter the patient from the posterior anatomic side the image will be called a posterior-anterior (PA) view.', '8de074e0-207a-4cea-99f1-b29387a64488': 'Some anatomy is better assessed by obtaining additional views i.e. odontoid view for the high cervical spine, axillary view of the shoulder, skyline view of the patella.\xa0 These special views must be requested at the time of completing the original request form in order for them to be included with the standard image set.\xa0 Some special views take advantage of the fact that air rises in any space and fluid falls with gravity, i.e. gas in the peritoneal space and mobile pleural fluid on the decubitus chest x-ray.\xa0 Also, taking an image in expiration can facilitate the detection of a pneumothorax due to the elastic recoil of the lung on expiration and a reduction in gas within the lung at full expiration.', '708c061a-3af6-40c4-bac2-2e4871e6bf88': 'It may be difficult to obtain quality images, if the patient is unconscious, traumatized, in pain, or uncooperative.\xa0 This must be kept in mind when requesting x-ray examinations.', '5d0215bd-d8e1-45b1-af84-25b065507904': 'Examples of PA and Lateral chest x-ray positioning are shown in Figure 3.11A and 3.11B while a left side up Decubitus, Abdomen x-ray is seen in Figure 3.11C.'}"
+Figure 3.11,undergradimage/images/Figure 3.11.jpg,"Figure 3.11B Lateral, upright, chest x-ray positioning.","Examples of PA and Lateral chest x-ray positioning are shown in Figure 3.11A and 3.11B while a left side up Decubitus, Abdomen x-ray is seen in Figure 3.11C.","{'ebd256ce-5f82-48fb-87bd-1cbcdc9fb2ab': 'Most x-ray equipment has a relatively fixed positions of the x-ray tube and the x-ray detector.\xa0 In order to acquire images in different anatomic projections the patient must be moved and be positioned.\xa0 This may require the image detector to be on a wall or table mounted apparatus or the detector may be in a hand-held cassette.\xa0 The patient may need to be quite mobile for some images i.e. they need to lie on their side or stand upright.', 'b9cb6c2a-00ee-4bef-8cdd-b4b02efdd3eb': 'A basic tenet of plain x-rays is to obtain at least two views of the anatomy in question, usually taken 90 degrees apart from each other (orthogonal). One of the images is usually obtained in anatomic position and the second image is 90 degrees to the original anatomic position. Therefore, the minimum two views are usually a anterior-posterior (AP) and a lateral.\xa0 If the x-rays enter the patient from the posterior anatomic side the image will be called a posterior-anterior (PA) view.', '8de074e0-207a-4cea-99f1-b29387a64488': 'Some anatomy is better assessed by obtaining additional views i.e. odontoid view for the high cervical spine, axillary view of the shoulder, skyline view of the patella.\xa0 These special views must be requested at the time of completing the original request form in order for them to be included with the standard image set.\xa0 Some special views take advantage of the fact that air rises in any space and fluid falls with gravity, i.e. gas in the peritoneal space and mobile pleural fluid on the decubitus chest x-ray.\xa0 Also, taking an image in expiration can facilitate the detection of a pneumothorax due to the elastic recoil of the lung on expiration and a reduction in gas within the lung at full expiration.', '708c061a-3af6-40c4-bac2-2e4871e6bf88': 'It may be difficult to obtain quality images, if the patient is unconscious, traumatized, in pain, or uncooperative.\xa0 This must be kept in mind when requesting x-ray examinations.', '5d0215bd-d8e1-45b1-af84-25b065507904': 'Examples of PA and Lateral chest x-ray positioning are shown in Figure 3.11A and 3.11B while a left side up Decubitus, Abdomen x-ray is seen in Figure 3.11C.'}"
+Figure 3.11,undergradimage/images/Figure 3.11.jpg,Figure 3.11 Decubitus positioning for a chest or abdomen x-ray.,"Examples of PA and Lateral chest x-ray positioning are shown in Figure 3.11A and 3.11B while a left side up Decubitus, Abdomen x-ray is seen in Figure 3.11C.","{'ebd256ce-5f82-48fb-87bd-1cbcdc9fb2ab': 'Most x-ray equipment has a relatively fixed positions of the x-ray tube and the x-ray detector.\xa0 In order to acquire images in different anatomic projections the patient must be moved and be positioned.\xa0 This may require the image detector to be on a wall or table mounted apparatus or the detector may be in a hand-held cassette.\xa0 The patient may need to be quite mobile for some images i.e. they need to lie on their side or stand upright.', 'b9cb6c2a-00ee-4bef-8cdd-b4b02efdd3eb': 'A basic tenet of plain x-rays is to obtain at least two views of the anatomy in question, usually taken 90 degrees apart from each other (orthogonal). One of the images is usually obtained in anatomic position and the second image is 90 degrees to the original anatomic position. Therefore, the minimum two views are usually a anterior-posterior (AP) and a lateral.\xa0 If the x-rays enter the patient from the posterior anatomic side the image will be called a posterior-anterior (PA) view.', '8de074e0-207a-4cea-99f1-b29387a64488': 'Some anatomy is better assessed by obtaining additional views i.e. odontoid view for the high cervical spine, axillary view of the shoulder, skyline view of the patella.\xa0 These special views must be requested at the time of completing the original request form in order for them to be included with the standard image set.\xa0 Some special views take advantage of the fact that air rises in any space and fluid falls with gravity, i.e. gas in the peritoneal space and mobile pleural fluid on the decubitus chest x-ray.\xa0 Also, taking an image in expiration can facilitate the detection of a pneumothorax due to the elastic recoil of the lung on expiration and a reduction in gas within the lung at full expiration.', '708c061a-3af6-40c4-bac2-2e4871e6bf88': 'It may be difficult to obtain quality images, if the patient is unconscious, traumatized, in pain, or uncooperative.\xa0 This must be kept in mind when requesting x-ray examinations.', '5d0215bd-d8e1-45b1-af84-25b065507904': 'Examples of PA and Lateral chest x-ray positioning are shown in Figure 3.11A and 3.11B while a left side up Decubitus, Abdomen x-ray is seen in Figure 3.11C.'}"
+Figure 3.1,undergradimage/images/Figure 3.1.jpg,Figure 3.1 PACS Imaging Viewing Station (Workstation),"The PACS offers a methodology for searching for patients and their imaging studies.  This is usually done using a unique patient identifier such as a hospital number and/or a provincial health number.  Thus, one can find new and old imaging studies by searching the PACS database and having them displayed on a PACS compatible viewing station with appropriate monitor resolution for accurate image interpretation.  A PACS image review station is depicted in Figure 3.1.","{'8e084082-1d64-4d3a-870f-c19e9b671990': 'The patient images, acquired for clinical use, must be identified, stored, and be retrievable for same day and future use. As most images acquired are in the digital format there must be software and hardware solution available to digitally transport, save, and archive images for retrieval and viewing.\xa0 This is what PACS is designed for. PACS is more often than not a proprietary solution provided to the imaging centre by a large Information Technology (IT) vendor such as Philips, General Electric, Agfa, etc.', 'a6738e2b-4046-4199-8e7c-413d5f986a4f': 'The patient images must be stored in a manner that protects the patient’s confidentiality and thus these systems are secured within complex IT networks with stringent security.\xa0 Qualified members of the healthcare team, with an approved username and password, can access the images for the purpose of engaging in the care of the patient.\xa0 Access to the PACS is controlled by local IT staff and via secured networks.\xa0 In order for you to be actively engaged in image utilization you must apply for access to PACS via the IT department of your facility.', '33f167cd-695a-44b9-b9ec-49dfa98e4b8c': 'The PACS offers a methodology for searching for patients and their imaging studies.\xa0 This is usually done using a unique patient identifier such as a hospital number and/or a provincial health number.\xa0 Thus, one can find new and old imaging studies by searching the PACS database and having them displayed on a PACS compatible viewing station with appropriate monitor resolution for accurate image interpretation.\xa0 A PACS image review station is depicted in Figure 3.1.'}"
+Figure 3.2,undergradimage/images/Figure 3.2.jpg,Figure 3.2 – MRI Request Form,"The RIS used at your local health care facilities will have a mechanism for requesting imaging examinations. It may be a digital, software driven, online, order entry module that facilitates the requisition of imaging examinations or it may rely upon some other form of communication with the scheduling component of the system e.g. facsimile, hand-written requests, postal service, etc.  Most facilities will have established standardized request forms for specific types of procedures i.e. MRI, PET/CT, etc. Figure 3.2 provides an example of a MRI request form.","{'0137abd8-3a0f-46c1-ba8e-d5b2e5727a3b': 'The RIS used at your local health care facilities will have a mechanism for requesting imaging examinations. It may be a digital, software driven, online, order entry module that facilitates the requisition of imaging examinations or it may rely upon some other form of communication with the scheduling component of the system e.g. facsimile, hand-written requests, postal service, etc.\xa0 Most facilities will have established standardized request forms for specific types of procedures i.e. MRI, PET/CT, etc. Figure 3.2 provides an example of a MRI request form.', '7f20d131-4185-4ff0-9e1d-ddc4bde06834': 'In addition, local imaging facilities will have established policies surrounding the mechanism to be used for requesting elective, urgent, or emergency, imaging studies. Some of the above strategies work well for non-emergent imaging but usually urgent or emergent examinations should be requested by contacting the resident(s), or radiologist(s) on duty for that modality.\xa0 The identity of the radiologist(s) on duty is known by the hospital switchboard and the Diagnostic Radiology Department.', '1bf014ba-b40b-472b-90e3-903d39c2f10c': 'As a healthcare provider it is your responsibility to ascertain the methods used for requesting imaging studies in your jurisdiction and understand how to contact the appropriate imaging facilities, and personnel, in your area.'}"