This document discusses various radiation methods used to diagnose thyroid diseases and conditions, including ultrasound, radionuclide imaging, CT, and MRI. It provides details on how each modality is used, what they image, and their indications. Specific attention is given to ultrasound-guided fine needle aspiration biopsy of thyroid nodules. Examples of thyroid conditions imaged by radionuclide scans are also shown, such as hyperthyroidism, multinodular goiter, and thyroid nodules. Emergency thoracic and abdominal conditions that can be imaged are also reviewed, including pneumothorax, pleural effusions, bowel obstructions, and perforated ulcers.

1. Radiation diagnosis of thyroid diseasesRadiation diagnosis of thyroid diseases
Radiation diagnosis of emergency conditions
Dr. Lenchuk Tatyana
Phd

2. Radiation methods of thyroid glandRadiation methods of thyroid gland
To investigate the thyroid gland (thyroid) using methods such basic radiationTo investigate the thyroid gland (thyroid) using methods such basic radiation
methods:methods:
1.1. Ultrasound:Ultrasound:
- Sonography (B - mode);- Sonography (B - mode);
- Color Doppler mapping;- Color Doppler mapping;
- Fine needle aspiration biopsy under ultrasound.- Fine needle aspiration biopsy under ultrasound.
2.2. Radionuclide:Radionuclide:
- Determination of thyroid iodine accumulation capacity;- Determination of thyroid iodine accumulation capacity;
- Dynamic scintigraphy;- Dynamic scintigraphy;
- Static scintigraphy;- Static scintigraphy;
- Radio immune analysis.- Radio immune analysis.
3.3. CTCT;;
4.4. MRIMRI..

3. UltrasonicUltrasonic
Ultrasound necessarily assigned all patients to confirm or excludeUltrasound necessarily assigned all patients to confirm or exclude
thyroid pathology .thyroid pathology . Indications for ultrasound:Indications for ultrasound:
1. determine the size , scope , structure cancer to differentiate1. determine the size , scope , structure cancer to differentiate
nodular mixed , diffuse goiter and autoimmune thyroiditis ;nodular mixed , diffuse goiter and autoimmune thyroiditis ;
2. determine the size , position , shape, structure ( echogenicity )2. determine the size , position , shape, structure ( echogenicity )
nodes , the presence of capsule micro calcifications ;nodes , the presence of capsule micro calcifications ;
3. determining topographic changes of the neck of their mutual3. determining topographic changes of the neck of their mutual
location of the thyroid , possible dislocation of the neck ;location of the thyroid , possible dislocation of the neck ;
4. definition enlarged regional lymph nodes.4. definition enlarged regional lymph nodes.
Preparing the patient for ultrasound is required. Studies conductedPreparing the patient for ultrasound is required. Studies conducted
in the supine position .in the supine position .
Normally the structure of thyroid isoechogenic , homogeneous, fine-Normally the structure of thyroid isoechogenic , homogeneous, fine-
grainedgrained . Volume not exceeding 25 cm3 men and 18 cm3 in women. Volume not exceeding 25 cm3 men and 18 cm3 in women

4. Nodular
Goiter
Ultrasound

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6. Fine needle aspiration biopsyFine needle aspiration biopsy has gained widelyhas gained widely
used in the diagnosis of thyroid disease. Theused in the diagnosis of thyroid disease. The
study of biopsy material to determine the naturestudy of biopsy material to determine the nature
of the process (benign or malignant) and toof the process (benign or malignant) and to
clarify the histological identity of the tumor.clarify the histological identity of the tumor.
Research MethodologyResearch Methodology. In ultrasound doctor. In ultrasound doctor
spends puncture site of thyroid fine needle thatspends puncture site of thyroid fine needle that
is connected to an empty syringe. Once the tipis connected to an empty syringe. Once the tip
of the needle enters the middle of node, theof the needle enters the middle of node, the
doctor repeatedly held aspiration of its contentsdoctor repeatedly held aspiration of its contents
with a syringe.with a syringe.

7. Fine needleFine needle
aspiration biopsyaspiration biopsy

8. Radionuclide diagnosisRadionuclide diagnosis of thyroid image more like a butterfly rarelyof thyroid image more like a butterfly rarely
horseshoe, the central part of each particle is more contrasting thanhorseshoe, the central part of each particle is more contrasting than
peripheral. In the case of toxic adenomas are detected "hot" nodesperipheral. In the case of toxic adenomas are detected "hot" nodes
(with high function)(with high function),, if cysts - "cold" areas where I131 will notif cysts - "cold" areas where I131 will not
accumulateaccumulate..
Indications for scintigraphy:Indications for scintigraphy:
1. Anatomical changes:1. Anatomical changes:
- Formation of focal neck (nodes);- Formation of focal neck (nodes);
- Ectopic thyroid tissue.- Ectopic thyroid tissue.
2. Functional changes ;2. Functional changes ;
- Hypothyroidism;- Hypothyroidism;
- Hyperthyroidism.- Hyperthyroidism.
3. Monitoring during treatment:3. Monitoring during treatment:
- Therapeutic - evaluation of effectiveness;- Therapeutic - evaluation of effectiveness;
- Surgery (preoperative preparation - definition of surgical- Surgery (preoperative preparation - definition of surgical
intervention, evaluation areas of the body that are subject tointervention, evaluation areas of the body that are subject to
removal and control of postoperative changes).removal and control of postoperative changes).

9. Radionuclide diagnosis

10. Hyperthyroidism Of Colloid Multinodular Goiter
Multiple foci of increased isotope uptake with suppressed concentration in
other areas
Radionuclide diagnosis

11. Hyperthyroid: Thyroid Nodule
•I-123 uptake
•One hot nodule
•Suppressed uptake of iodine in rest
of the gland
Graves Disease
•Bilateral diffuse
•Increased I-131 uptake
Radionuclide diagnosis

12. Radionuclide diagnosis
Thyroid Nodule

13. Indications for PET thyroid:Indications for PET thyroid:
1. Head and neck tumors:1. Head and neck tumors:
- Differential diagnosis of malignant and benign process;- Differential diagnosis of malignant and benign process;
- Definition of the regional lymph nodes metastases;- Definition of the regional lymph nodes metastases;
- Identification of distant metastases;- Identification of distant metastases;
- Determination of tumor recurrence.- Determination of tumor recurrence.
CT and MRICT and MRI
is used to identify tumors of small size in the case ofis used to identify tumors of small size in the case of
common processes to determine the true limits of defeat.common processes to determine the true limits of defeat.
CT before the operation provides information about theCT before the operation provides information about the
relationship of thyroid tumors with surroundingrelationship of thyroid tumors with surrounding
anatomical structures.anatomical structures.

14. Thyroid Cancer With Metastasis
Scans obtained 48 hours after I 131 therapy demonstrate increased isotope
accumulation in the thoracic spine, lumbar spine, left upper rib and left pelvis,
consistent with metastasis.

15. CT normal thyroid gland

16. Thyroid Carcinoma

17. Thyroid Carcinoma
Left lobe seen displacing the trachea.

18. Thyroid Cancer
Large mass with inhomogenous enhancement seen arising from the right lobe
of thyroid.
Arrow points to normal enhancement of the left lobe.

19. Thyroid Cancer
Large mass is seen arising from the left lobe of the thyroid gland with
inhomogenous enhancement.
Arrow points to normal right lobe.

20. Thyroid Cancer
Multiple lung metastasis

21. Emergency Conditions
Foreign body airway . Most often this happens with children.
Leads to disruption of bronchial obstruction . X-ray contrast
bodies based on radiographs of the chest cavity in two
perpendicular projections. Most often localized in the right
main bronchi or lower share bronchi . As a result of mucosal
edema developed three levels of violations of bronchial
obstruction - hypoventilation , emphysema, atelectasis. On
these grounds diagnosed low-contrast foreign bodies . It must
exclude using larynhotraheobronсhoscopy .

22. atelectasisforeign body

23. Hydropericardium-accumulation of transudate in the pericardial
cavity observed in inflammatory and neoplastic lesions and
wounds of the heart, in the development of cardiac, renal
failure, hypothyroidism and congestion in the lungs. When X-ray
observed a gradual increase in heart size, weakening and
disappearance waves along its contours . Ultrasound - an
effective and affordable method for the detection of even a
small amount of fluid in the pericardial cavity. CT and MRI - a
highly inaccessible.
Emergency Conditions

24. Hypothyroid: Pericardial Effusion
Incidental left subpulmonic pleural effusion

25. Hydrothorax, the presence of liquid contents into the pleural cavity. The
resulting tumor, systemic, inflammatory diseases, kidney and heart failure. X-
rays intense shade of oblique upper edge (line Alice - Damuazo) ultrasound - is
also an effective method for detecting fluid determining its structure. CT and
MRI - best practices to identify not only fluid but also in lung and mediastinal
organs .Organs shifted in the opposite direction.
Pleural Effusion
•White arrows point to bilateral pleural effusions.

26. Pleural Effusion
Homogenous density in dependent portion, right lung base.
Loss of diaphragmatic and right cardiac silhouette.
Meniscus high in axilla.

27. Massive Pleural Effusion
Left hemithorax completely opacified.
Mediastinum shifted to right.
Left hemithorax larger.

28. Pneumothorax-air accumulation in the pleural cavity occurs due to violation of
the integrity of the pleura and lung collapse, trauma surgery, breakthrough
pathological focus into the pleural cavity. On radiographs turns air into the
pleural cavity and descending lungs varying degrees. The diaphragm on the
affected side is lowered, the bodies of the mediastinum shifted to the healthy
side. Highly informative method for the diagnosis of pneumothorax is CT.
Pneumothorax
•No vascular markings on right.
•No shift of mediastinum to left.
•Deep sulcus.
•Atelectatic right lung.
•Increased haziness on left; diversion of
entire cardiac output.
Small fluid level near costophrenic angle;
hydro pneumothorax

29. Pneumothorax
•Air in the pleural cavity
•No vascular markings
•Dark
•Atelectatic lung margin.
•Shift of mediastinum to opposite side.
•Left hemithorax larger, closer to total lung capacity position.
•Increased vascular markings on right. Shift of cardiac output to right lung.

30. The X-ray picture of the acuteThe X-ray picture of the acute
abdomenabdomen
1.1. Bowel obstructionBowel obstruction..
- highhigh;;
- lowlow..
SymptomsSymptoms::
-- Kloyberg cupsKloyberg cups((at the background ofat the background of
swallen bowel there is the presence ofswallen bowel there is the presence of
horisontal level of fluidhorisontal level of fluid).).

31. Symptoms do not patency the small intestine:
Kloyberh bowl located in the central parts of the image;
-Height is greater than their width;
-Not see haustres.
Arrow: Dilated jejunum.
Arrowheads: Surgical clips.

32. Small Bowel Obstruction
•Multiple dilated fluid filled small
bowel loops. [white arrow ]
•C : colon with contrast.
•Incidentally note evidence of
laminectomy. [double arrows ]

33. Bowel Obstruction
•Dilated loops of bowel
•Air fluid levels.

34. Symptoms do not patency in the large intestine:
Kloyberh bowl located in peripheral parts of the image;
Their width is greater than height;
Haustres - see.

36. 2. Perforate ulcer.
- Symptom of sickle (the presence of air under the right cupola of the diaphragm).

37. Pneumoperitoneum
Arrow points to free air central tendon

38. Bowel Perforation / Pneumoperitoneum
Findings:
•White arrow points to diaphragm.
•Black arrow points to subdiaphragmatic air.