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RAD 235 Intro

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William Nelson

on 25 September 2014

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Transcript of RAD 235 Intro

RAD 235 Pathology for the Radiographer
Develop an understanding of basic principles of pathology and the processes within the body that result in the signs and symptoms of the disease.

Neoplastic growths are always considered malignant –



Course Goals

Recognize the different and appropriate imaging modalities available for visualization of pathological conditions and advanced disease processes.

Course Goals

Develop an awareness of the radiographic/imaging appearance of specific diseases using diagnostic imaging technology.

This patient would be diagnosed with the following condition-
Colon Cancer




Course Goals

1. Define the basic terminology associated with the health status of the human body.

The term
refers to –

The patient’s diagnosis

The physician’s perception of the disease

The patient’s perception of the disease

The sign of a disease

The patient’s prognosis

Course Objectives/Outcomes

2. Identify the general classification of disease and pathogenesis associated with the human body.

Pneumonia would be placed in the following disease classification based on its pathogenic characteristics-






Course Objectives/Outcomes

3. Discuss the anatomy and physiology of the anatomical system.

Course Objectives/Outcomes

4. Describe basic human diseases and pathogenesis processes associated with specific anatomical systems.

Course Objectives/Outcomes

5. Discuss the radiographic/imaging examinations used to visualize pathological conditions of the appropriate anatomical system.

An esophagram would be the appropriate procedure to visualize this digestive disorder-


Adynamic Ileus

Gastric Erosion


All of the above

Course Objectives/Outcomes

6. Explain the adjustments to radiation exposure factors, which may be required to compensate for disease and manifestations associated with corresponding pathology.

Which of the following would not require an increase radiographic exposure?


Paget’s Disease




Course Objectives/Outcomes

Unit 1: Introduction to Pathology and Human Disease
Unit 2: Diseases of the Respiratory System
Unit 3: Diseases of the Abdomen/Gastrointestinal System
Unit 4: Diseases of the Urinary System
Unit 5: Diseases of the Reproductive System
Unit 6: Diseases of the Skeletal System
Unit 7: Diseases of the Cardiovascular System
Unit 8: Diseases of the Nervous System

Course Outline

Course Evaluation – The grade for RAD 235 will be determined by percentages earned from module assessment/course assignments, three sectional and one final exam. The following structure will be used to calculate the final grade:

Grading Components:
Module Assessment/ Assignments 20%
Exams 40%
Final Exam 40%
Total 100%

Grading Method

A subjective complaint
the patient’s description.

An objective measurable/physical manifestation.

Process of Medical Treatment

Diagnosis Process

Treatment Process?

Radiographer’s Role & Pathology?

ARRT Code of Ethics 5 & 6
5. The radiologic technologist assesses situations; exercises care, discretion and judgment; assumes responsibility for professional decisions; and
acts in the best interest of the patient.

6. The radiologic technologist acts as an agent through observation and communication to obtain pertinent information for the physician to aid in the diagnosis and treatment of the patient
and recognizes that interpretation and diagnosis are outside the scope of practice for the profession.

What Does the ARRT Have to Say?

Any abnormal disturbance of the function or structure of the human body as a result of some type of injury.

Acute Disease
Chronic Disease

Pathology – The study of Disease.
The process by which an agent produces a disease.

Can viruses cause cancer?

Disease – Vascular (P.E.)

Disease – Lung Infection

For example- Let’s look at the lungs

Etiology – the study of the cause of a disease.

Disease – Trauma (Tension Pneumothorax)

Disease – Genetic Disorder (Cystic Fibrosis)

Staphylococcus infection of the prosthesis in a 54-year-old woman

Nosocomial Infections
– Diseases acquired in the healthcare setting.
Post-operative Infections

– a disease which is caused by a physician.
Disease – Etiology Other causes include:

"Medicine is now a high risk industry, like aviation. But, the chance of dying in an aviation accident is one in 2 million, while the risk of dying from a medical accident is one in 200!"
––Dr. Leape of the Harvard Medical School of Public Health

Disease - Etiology

"Medicine is now a high risk industry, like aviation. But, the chance of dying in an aviation accident is one in 2 million, while the risk of dying from a medical accident is one in 200!"
––Dr. Leape of the Harvard Medical School of Public Health

Disease - Etiology

Disease Classifications

response of vascular tissue to injury.

Protective response

Serves to bring defense & healing

Inflammation (Acute)

Blunt or penetrating injury

Chemical Agents


Causes of Inflammation

1. Vasodilatation

2. Emigration of cells

3. Phagocytosis

4. Tissue Repair

Inflammation - Mechanism

Mechanism of Inflammation:

Cardinal Signs of Inflammation

Rubor : Redness –
Calor : Warm –
Dolor : Pain –
Tumor: Swelling – Exudation
Loss of Function:

Pyogenic Bacteria
– Pus producing bacteria

Abscess (suppurative inflammation)
– pyogenic infection beneath the skin or in a solid organ.

Bacteremia (blood poisoning)

Pyogenic Bacteria
– Pus producing bacteria

Regeneration of injured tissue by parenchymal cells of the same type

Example – lung tissue


Replacement by
Granulation Tissue
Example – the heart

Repair Process of Inflammation

Chronic Inflammation

A nodular lesion


Increased interstitial fluid volume

- inflammation


Generalized -Anasarca
- Systemic causes
Pleural Effusion


Cavity Edema

Severe pain (angina).

" ischemia " is decreased blood supply affecting tissue or organ function.
Hypoxia –
- inadequate blood supply to tissue causing cellular damage.

Slowly obstructed blood vessels the effects of ischemia can be limited

Collateral vessels
Collateral circulation.

Death of tissue due to lack of blood supply is known as " Infarction”.
Anoxia – without oxygen

Necrosis (irreversible) – cell death.

Infarction -

Development of Coronary Arteriosclerosis

BV - Narrowing, aneurysm, rupture.

Thrombosis - Formation or presence of a thrombus

Embolism – Air, fat, foreign body

Infarction - Causes

Cerebral Infarction (Stroke) :

Necrosis due to obstructed arterial supply and a secondary bacterial infection.


– a collection of blood within body tissue

Erosive metabolic processes
Weakening of BV wall

Hemorrhage – ruptured blood vessel

Direct physical injury due to crushing or twisting of the body.

Traumatic Disease

Alterations of cell growth can lead to disease, organ failure, and death.

Alteration of cell Growth

Depending on the cell type, cells can cope with changes in their environment and with mild injury.

Alteration of cell Growth

To cope with these changes cells will either:

Decrease or Increase in size

Increase in number

Change cell type

Defective development or congenital absence of an organ or tissue

Aplasia (genetic)

Failure of normal development
Underdevelopment of a tissue or organs

Hypoplasia (genetic)

Reduction in the size and number of cells resulting in decreased function.

Physiological Effect (normal)
Thymus Gland


Pathologic Effect
Disuse, Ischemia, pressure, hormone deficiency


Depending on the stimulus or injury, cells may adapt by increasing in number or size.

Secondary / adaptation due to other cause.
cell growth due to
purpose or necessity.

Neoplastic (neoplasm).
Primary growth abnormality (DNA damage).
cell division out of control.
Tumor – Swelling / new growth / mass

Alteration of cell Growth

Cellular Characteristics
dependent upon cell division (mitosis)
is not neoplastic

– increase in the number of cells
Response due to stimuli or physiological necessity

Hormone Excess (endometriosis)
Non-Neoplastic –
Secondary / adaptation due to other causes.

– Increase in the size of cells in tissue and organs due to increased functional demand.

Occurs in cell tissue that cannot divide

Striated and Myocardial Muscle


Non-Neoplastic –
Secondary / adaptation due to other cause.

Section of myocardium in an area adjacent to a healed myocardial infarct ("heart attack"). Nearby muscle cells increase in size to compensate for cells that died.

At higher magnification, the enlargement of cardiac muscle cells and nuclei is apparent.

Cardiac Muscle

Normal Ventricular Muscle

Left Ventricular Hypertrophy

Myocardial Hypertrophy

Metaplasia – The replacement of one mature cell type with another mature cell type.

Dysplasia –

Chronic/excessive cellular “injury”

Cellular division may cause abnormalities in structure and function


Proliferation of cells characterized by loss of control over cell division

A neoplasm is the autonomous growth of tissue that have escaped the normal restraints on cell proliferation.

Tumor Growth
More cells are produced than die

Tumor is a disorder of cells

Tumor – Either benign or malignant
Cancer – malignant

Biological behavior of a tumor
Malignant tumors can kill
Benign tumors can spare the host.

Benign tumors
critical locations can be deadly.

Benign vs. Malignant Tumors

Develop in any tissue
Grow locally

Damage –
Local pressure

Common Feature
They do not spread to distant sites

Benign Tumors

Fast growing tumors!

developing tumors with a specific capacity to
invade and destroy
underlying tissue.
Malignant Tumors

Malignant Tumors

Invasion and Metastasis

Invasion - direct migration and penetration by cancer cells into tissues.

Seeding (invasion)
Malignant cells may spread into and along body cavities.

Hematogenous Spread –via the blood stream.
GI tract – Liver

Lymphatic Spread - Lungs and Breast Cancer
Metastasis Pathways


Metastasis Pathways


Neoplasms are named according to their cellular origin
suffix → type of neoplasm.

All Benign tumors have suffix " oma "

Neoplasia Histology

Fibrous tissue -Fibroma
Fat tissue - Lipoma
Bone – Osteoma
Muscle – Myoma
Squamous Epithelium – Polyp
Glandular Tissue – Adenoma
Cartliage - Chondroma

Benign Tumors – “oma”

Epithelium –
cells cover the external surface of the body
line internal cavities
Lining of glands

Carcinoma (Cancer of the epithelium) 85%

First point of contact of the body with environmental substances
fast turn over rate, i.e., fast cell division
DNA can be damaged by carcinogens more readily

Squamous Cell Carcinoma

Skin Cancer

skin, mouth, esophagus, and vagina

Carcinoma: Squamous cell

Adenocarcinoma –
carcinoma of glandular epithelium

Carcinoma: Adenocarcinoma

Sarcoma is a malignant tumor of connective tissue origin
Sarcoma is often used with a prefix that denotes the tissue of origin of the tumor,
leiomyosarcoma (smooth muscle)
rhabdomyosarcoma (skeletal muscle)
liposarcoma (fatty tissue)
osteosarcoma (bone)

Malignant Tumors - Sarcomas

Carcinogens – Chemical, physical & genetic  DNA damage  Neoplasm

Carcinogen – an agent that can cause cancer.

Etiology of Cancer

lung cancer
Sun exposure
squamous cell carcinoma of skin
Asbestos exposure
lung cancer
Smoked foods
adenocarcinoma of the stomach
Alcohol drinking
squamous cell carcinoma of esophagus/stomach
Low fiber diet
adenocarcinoma of colon

Chemical/environmental carcinogens

Radiation - powerful carcinogen
modern technology (to cure or to kill)

Etiology of Cancer - Carcinogens

HPV - Cervix cancer
HBV - hepatocell carcinoma
HIV - Kaposi’s sarcoma

Etiology of Cancer – Carcinogens
Viral Agents

Metastatic malignant neoplasms cause severe body wasting-cachexia.
Cachexia – Signs of terminal illness
severe weakness
loss of appetite
body wasting

Physiological Effects of Cancer

Grading - measures a malignant neoplasm's aggressiveness
Biological behavior
assesses the amount of invasion and metastasis
Determines patient’s prognosis & treatment

Evaluating Malignant Neoplasm

Grading - measures a malignant neoplasm's aggressiveness
Biological behavior
assesses the amount of invasion and metastasis
Determines patient’s prognosis & treatment

Evaluating Malignant Neoplasm

Grading - measures a malignant neoplasm's aggressiveness
Biological behavior
assesses the amount of invasion and metastasis
Determines patient’s prognosis & treatment

Evaluating Malignant Neoplasm

Foreign substances that cause the immune system to produce antibodies
Pathogens & toxins
a protein used to identify and neutralize antigens

Disorders of Immunity

Acquired Immunity

Artificial Immunity
Active Immunity – antibodies are formed from an introduction of a vaccine.
Passive Immunity - booster for an immediate response –tetanus, rabies.


Occur within minutes of exposure to antigen
Antibodies bind to mast cells
Anaphylactic shock
Can be fatal

Type I Allergic/Anaphylactic Reactions

Transfusion reactions:
Wrong blood type
Hemolytic disease of newborn

Type II (Cytotoxic) Reactions

Type III (Cell-Mediated) Reactions

Acquired Immunodeficiency Syndrome

Retrovirus - insert its genes into the cell's DNA permanently altering its genetic makeup.

Human Immunodeficiency Virus (HIV)

AIDS Associated Disease Categories
Gastrointestinal: Cause most of illness and death of late AIDS.
2. Respiratory: 70% of AIDS patients develop serious respiratory problems.
Pneumocystis Carinii Pneumonia

3. Neurological: Opportunistic diseases and tumors

AIDS Associated Disease Categories

4. Skin Disorders: 90% of AIDS patients develop skin or mucous membrane disorders.
Kaposi’s sarcoma
1/3 male AIDS patients develop KS
Most common type of cancer in AIDS patients
Herpes zoster (shingles)
Herpes simplex
Invasive cervical carcinoma

AIDS Associated Disease Categories

Hepatitis A
caused by virus
transmitted by contact with infected food or water


Hepatitis - Inflammation of the liver; usually from a viral infection, but sometimes from toxic agents.

Hepatitis B
caused by virus
transmitted by blood-to-blood contact and sexual contact

alcohol abuse
drug abuse


Hepatitis C Virus
transfusion or sexual contact
Hepatocellular carcinomas


Hepatitis - Inflammation of the liver; usually from a viral infection, but sometimes from toxic agents.

alcohol abuse
drug abuse


Epithelial High Rate – Why?
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