USMLE Step 2 Radiology英文电子书.pdfVIP

This concise section should help you understand when to order each of the different types of tests in radiology. A description of what is found on each type of test is provided. For example, What does a sonogram show, and what doesnt it show? When does one use a CT scan or an MRI?When is contrast the best answer in a test question? CHEST X-RAYS The most basic radiologic examination is a chest x-ray. Standardx-rays are based on the degree of density of tissue and how much x-ray energy each type of tissue will absorb. The closer to bone a structure is in density, the greater the energy it will absorb. Therefore, because bones block the most amount of x-ray energy, they will come out white on the film. Conversely, air absorbs or blocks the least amount of energy and thus will appear darkest. Chest x-rays are not routine screening tests. There is no routine screening of the general popu- lation for cancer or tuberculosis.You can do a chest x-ray if the PPD skin test is positive, but this is not the same thing asjust doing a general screening. Most x-rays are posterior-anterior (PA) films.The x-ray plate is placed in front of the chest, and the patient is leaning forward against the plate. The x-ray beam is directed from posterior to anterior. The patient must be able to stand for a PA film to be performed. Anterior-posterior (AP) films are less accurate but must be done in patients who are too ill or unstable to stand up. All patients with central venous lines or chest tubes, or unstable patients, such as those in the intensive care unit, undergo AP films. The single greatest difference on AP films is that the heart size is artificially enlarged on them because the heart is more anterior in the chest and will therefore cast a wider shadow. On a normal PA film, the heart should be SO% of the total transthoracic diameter. This is increased to 50% on an AP film. (This phe-