This page intentionally left blank Radiology for Anaesthesia and Intensive Care Second edition Radiology for Anaesthesia and Intensive Care Second Edition RichardHopkins, CarolPedenand SanjayGandhi CAMBRIDGEUNIVERSITYPRESS Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo, Delhi, Dubai, Tokyo Cambridge University Press The Edinburgh Building, Cambridge CB2 8RU, UK Published in the United States of America by Cambridge University Press, New York www.cambridge.org Information on this title: www.cambridge.org/9780521735636 © Cambridge University Press 2010 This publication is in copyright. Subject to statutory exception and to the provision of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press. First published in print format 2009 ISBN-13 978-0-511-64156-5 eBook (NetLibrary) ISBN-13 978-0-521-73563-6 Paperback Cambridge University Press has no responsibility for the persistence or accuracy of urls for external or third-party internet websites referred to in this publication, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. Every effort has been made in preparing this publication to provide accurate and up-to-date information which is in accord with accepted standards and practice at the time of publication. Although case histories are drawn from actual cases, every effort has been made to disguise the identities of the individuals involved. Nevertheless, the authors, editors and publishers can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation. The authors, editors and publishers therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this publication. Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use. Tomyparents,lovingwifeIlaand inspirationalchildrenSanchitandSahaj. SanjayGandhi ToMartinforhiscontinuingsupport. CarolPeden Tomylovingfamily–Carol,Rhysand Rheannaandmyparents. RichardHopkins Contents Contributors pageix Acknowledgements xi Introduction xiii AbouttheFRCAexamination xv ThePrimaryexamination xv TheFinalexamination xv Preparation xvi Competency-basedtrainingandassessment xvi Thepre-operativeassessment xix LookingatX-rayfilmsaspartofthepre-operativeassessment xix AssociationofAnaesthetistsofGreatBritainandIreland xix RoyalCollegeofRadiologists xix TaskForceonPreanaestheticEvaluationoftheAmericanSocietyof Anaesthesiologists xx 1. Imagingthechest 1 6. Anaesthesiaintheradiology HowtoreadachestX-ray 2 department.MRIand interventionalradiology 209 2. Imagingtheabdomen 59 Anaesthesiaintheradiology PlainabdominalX-rays 60 department 210 Caseillustrations:plainfilms MRI:principlesofimage andCT 62 formation 212 3. Traumaradiology 96 MRI:anaestheticmonitoring 216 Chesttrauma:caseillustrations 97 MRI:caseillustrations 223 Bluntabdominalandpelvic Interventionalprocedures:case trauma:caseillustrations 104 illustrations 233 4. Thecervicalspine 129 7. Ultrasound 250 Introduction:clearingthe Introduction 251 cervicalspine 130 Ultrasoundimaging:principles Non-traumaticconditions ofimageformation 251 affectingthecervicalspine 142 Applicationsofultrasoundfor Traumaofthecervicalspine 155 patientsonintensivecareunits 255 Ultrasoundguidedprocedures 259 5. CThead 172 Ultrasoundguidedprocedures: PrinciplesofCTimage needlevisualisation 259 formationandinterpretation 173 Ultrasoundimaging:case PrinciplesofinterpretingCT illustrations 271 head 176 Caseillustrations 177 vii Contents Echocardiographyforpatients onintensivecareunits R.OrmeandC.McKinstry 279 Ultrasoundguidedregional anaesthesia JulieLewisandBarryNicholls 287 Index 305 viii