Electro Diagnostic Testing, Imaging · following ventricular repolarization ... o Bright or...

HMCL223Clinical Diagnostic Techniques

Session 9:

Electro Diagnostic

Testing, Imaging

Session ObjectivesElectro Diagnostic Tests

o Electrocardiograph

o Holter monitor

o Electroencephalograph

o Electromyograph

Imaging

o X-ray studies: X-ray, CT Scans, DEXA

o Ultrasound studies: Ultrasound

o Magnetic Resonance Imaging (MRI)

o Nuclear Scanning: Radionucleotide testing - PET scan

o Clinical Digital Thermography

Electro Diagnostic Tests

o The use of electrical activity with in the body can be used

to evaluate disease or injury.

o This electrical activity can be endogenous

(electrocardiograph mapping the electrical activity of the

heart) or exogenous (electromyography a shock is

applied to the body and the body’s electrical impulses

are mapped).

(Pagana & Pagana, 2014, p. 536)

Peripheral Nervous System

(Nucleus medical media, 2015, Peripheral nervous system, viewed 08/09/2015

<http://ebsco.smartimagebase.com.ezproxy.endeavour.edu.au/peripheral-nervous-

system/download?ItemID=73695>)

Electrocardiograph (ECG)

Atrial Fibrillation

(Nucleus medical media, 2015, Atrial fibrillation – medical animation ANH11047, viewed

7/09/2015 http://ebsco.smartimagebase.com.ezproxy.endeavour.edu.au/atrial-

fibrillation/view-item?ItemID=72535)

o Electrodes attached to the skin measure electrical

impulses from the conduction system of the heart.

o Generates a graphical representation of cardiac

contraction (depolarization), recovery (repolarization)

and rest period (asystole).

o Used to determine electrical and structural changes to

the heart.

(Labtestsonline, 2012; Pagana & Pagana, 2014, p. 544)

Electrodes are attached

at two main points:

o Limbs: electrode

attached to each arm

o Chest: 6 electrodes

extending form the

fourth intercostal

space (RHS sternum)

to the LHS mid-

axillary line.

Source: www.medlineplus.gov

ECG tracing denotes a complete cardiac cycle:

P wave depolarisation of the atria

complex

depolarization of the

ventricles

T wave repolarization of the

ventricles

U wave refractory period

following ventricular

repolarization

(Nuclear medical media, 2015, ECG / EKG strip components – medical illustration, viewed 7/09/2015

http://ebsco.smartimagebase.com.ezproxy.endeavour.edu.au/ekg-ecg-strip-components-qrs-complex/view-

item?ItemID=8281)

o The P to R interval: time

it takes for the electrical

impulse to travel from the

SA node to the ventricles.

o The Q to T interval: time

it takes for the ventricles

to depolarize (contract)

and then repolarize (relax)

o The QRS duration: total

time of ventricle

contraction

Source: http://www.merckmanuals.com/home/sec03/ch021/ch021c.html

ECG information aids the

assessment of:

o Functional capability of

heart muscle

o Damage to the heart

muscle

o Major arrhythmia’s

o Presence of valve

dysfunction

Requires specialist

interpretation by a cardiologist

Source: http://www.merckmanuals.com/home/sec03/ch021/ch021c.html

o Normal ECG:

o Cardiac Ischaemia:

(Nucleus medical media, 2014, EKG revealing cardiac ischaemia, viewed 7/09/2015

<http://ebsco.smartimagebase.com.ezproxy.endeavour.edu.au/ekgs-revealing-cardiac-

ischemia/view-item?ItemID=863>)

Normal ECG:

Atrial Fibrillation:

(Nucleus medical media, 2014, Atrial fibrillation, viewed 7/09/2015

<http://ebsco.smartimagebase.com.ezproxy.endeavour.edu.au/external-cardioversion/view-

item?ItemID=10364>)

ECG: Interpreting the Results

Common causes of changes are:

o CNS disease (i.e. subarachnoid haemorrhage, stroke,

trauma), Coronary heart disease (some post MI

patients), Myocardial ischemia (infarct or angina)

o Hereditary Long QT Syndrome

o Ectopic beats or accessory pathways causing arrhythmia

o Subacute or chronic pericarditis

o Myocarditis and myocardial contusion

o Cardiomyopathy or ventricular hypertrophy

o Valve prolapse

ECG: Interfering FactorsInterfering Factors:

o Electrode placement or attachment issues

o Movement or muscle tremors through the test

o Drugs: anti-arrhythmics, tricyclics, phenothiazine, digoxin

effect (cardiac glycoside from foxglove)

Electrolyte Abnormalities ECG Abnormalities

Increased calcium Prolonged PR interval

Shortened QT interval

Decreased calcium Prolonged QT interval

Increased potassium Narrowed, elevated T waves

AV conduction changes

Widened QRS complex

Decreased potassium Prolonged U wave

Prolonged QT interval

(Pagana & Pagana, 2014, Table 3.2, p. 549)

ECG: Referral

Symptoms that may warrant

referral for ECG:

o Chest paino Shortness of breath (on

exertion or at rest)o Fatigue (particularly on

exertion)o Tiredness (even at rest)o Palpitationso Peripheral oedema (i.e.

ankle swelling) or pulmonary oedema

o Dizzinesso Postural hypertension

(nuclear medical media, 2015, Heart attack symptoms, viewed 7/09/2015

http://ebsco.smartimagebase.com.ezproxy.endeavour.edu.au/heart-attack-symptoms/view-

item?ItemID=3770)

Exercise Stress Test

Stress Test

Assessment of cardiac function

o Measuring ECG and blood pressure while the heart is under stress can identify the risk of cardiac ischaemia.

o The patient exercises (treadmill or stationary bike) and the ECG & blood pressure are recorded.

Chemical Stress Test

o Administration of a drug (e.g. dobutamine) that increases heart function or that dilates the heart vessels (e.g. dipyridamole) while the ECG & blood pressure are recorded. Considered safer and more accurate than the exercise stress test.

(Pagana & Pagana, p. 540-1)

(Medical expo, 2015, Cardiac stress test equipment viewed 7/09/2015

<http://www.medicalexpo.com/prod/neurosoft/product-69506-454324.html>)

Electroencephalograph (EEG)

o Electrodes (applied to the scalp) detect & record

electrical impulses. Results are graphed & classified

according to frequency, amplitude, shape & position.

(Nucleus medical material, 2014, EEG – medical illustration, viewed 7/09/2015

http://ebsco.smartimagebase.com.ezproxy.endeavour.edu.au/eeg/view-item?ItemID=20180)

Brain Anatomy & Functional Areas

Language,

comprehension

Vision

Speech

Voluntary motor function

HearingCo-ordination

Association

(Jkwchui, 2013, Cerebrum lobes, viewed 8/09/2015

<https://upload.wikimedia.org/wikipedia/commons/thumb/d/d8/Cerebrum_lobes.svg/640px-

Cerebrum_lobes.svg.png>)

Adapted from Nucleus medical media, 2014, Brain anatomy & functional areas, viewed 08/09/2015

http://ebsco.smartimagebase.com.ezproxy.endeavour.edu.au/brain-anatomy-and-functional-areas/view-

item?ItemID=14614)

Waveform Description Wave Pattern

Delta (∆) (up to 4 Hz)

Highest amplitude &

slowest wave.

Adults: indicates slow

wave sleep. Babies:

common

Theta (ᶱ)

(4-7 Hz)

Slow: drowsiness &

meditation. Common:

young children.

Increasing age:

abnormal with

increased presence

Mu (μ)

(8-13 Hz )

Partly overlaps with

other frequencies.

Synchronous firing of

motor neurons in rest

state.

Electroencephalograph (EEG)Waveform Description Wave Pattern

(8-12Hz)

Posterior &

dominant

Occurs: relaxation,

eyes closed.

Disappears: opening

the eyes, stress &

mental exertion.

Beta (β)

(12–30Hz)

Anterior /

frontal &

both sides

Occurs: motor

behaviour.

Disappears: active

movements.

Drugs: generate

benzodiazapines &

barbituarates

Gamma (γ) (30-100 Hz)

Binding of different

populations of neurons

together into a network

(neuroplasticity) for

certain cognitive or

motor function.

Clinically used to assess:

o Clients presenting with seizures

o Pathological conditions involving the brain cortex (such

as tumours, infarction)

o Extent of trauma & drug intoxication

o Monitor cervical blood flow in surgery

o Identification of brain death

o Adjunctive measure in the exploration of sleep pathology

(Pagana & Pagana, 2014, p. 549-60)

EEG: Interfering Factors

Abstain prior to test:

o No fasting prior to test, hypoglycaemia affects brain activity

o Avoiding stimulants (caffeine, energy drinks) or sedative

medication

During the test:

o Bright or flashing lights can alter the test

o Body or eye movements during the test can alter the brain

wave patterns (not required in sleep studies)

o Sleep study: the patient may need to adjust their sleep time

in preparation for the study

(Pagana & Pagana, 2014, p. 550-1)

Electromyograph (EMG)

Electromyograph:

o Assesses muscle & motor neuron health.

o Indicates: nerve dysfunction, muscle dysfunction or

transmission issues.

o Indicates: primary muscular disorders or abnormalities

caused by other system diseases ( e.g. nerve

dysfunction, sarcoidosis, paraneoplastic syndrome).

o Spontaneous muscle movement (eg. fibrillation &

fasciculation) may indicate injury or disease of the nerve

innervating that muscle or spastic myotonic muscle

disease. (Pagana & Pagana, 2014, p. 554;

Mayo Foundation, 2015)

o Recording electrodes are inserted

into skeletal muscle to monitor

the electrical activity of the

muscle.

o This can be graphed & sound

added (audio electrical amplifier)

so that electrical potential can be

compared & analyses

simultaneously.

(Source: www.medlineplus.gov)

(Nucleus medical media, 2012, Nerve conduction studies with abnormal findings, viewed 8/09/2015

<http://ebsco.smartimagebase.com.ezproxy.endeavour.edu.au/nerve-conduction-studies-with-

abnormal-findings/view-item?ItemID=63102>)

EMG: Interfering Factors

Interfering factors that alter the transmission of electrical

waves to the electrodes include:

o Oedema

o Haemorrhage

o Thick subcutaneous fat

o Patients with excessive pain

Holter Monitor

Holter Monitor:

o Portable machine that continuously records the heart's

rhythms (a portable ECG). The monitor is usually worn

for 24 - 48 hours during normal activity (including sleep).

o The monitor constantly measures the heart's electrical

activity and records a single continuous lead as a

reference. A change to the heart rhythm it will

automatically record a more detailed tracing.

(Pagana & Pagana, 2014, p. 571; U.S National Library of

Medicine, 2015)

Holter Monitor

o Electrodes (2 to 4) are attached to the chest.

o The battery operated Holter monitor is then worn in a

pocket or small pouch worn around the neck or waist.

Holter Monitor

o The heart rate varies during various activities, however,

the heart should remain in sinus rhythm and not develop

any arrhythmia. Holter monitoring is used to determine

how the heart responds to normal activity.

o Holter monitoring is requested when:

o Post heart attack or other heart event

o To diagnose heart rhythm problems

o When starting a new heart medication

Holter Monitor

Results may be useful in identifying:

o Atrial fibrillation/flutter

o Multifocal atrial tachycardia

o Palpitations

o Paroxysmal supraventricular tachycardia

o Reasons for dizzyness or fainting

o Slow heart rate (bradycardia)

o Ventricular tachycardia

Imaging

Used to investigate the internal structures that are

suspected of being involved in a disease process.

o Creating images of what is inside the body

o Derive clinically useful information from living organisms

by an imaging modality

o Confirmation of a diagnosis to direct clinical interventions

o Monitoring the effect of clinical interventions and

treatments

o Newer techniques facilitate our understanding of normal

and abnormal physiology (e.g. Functional MRI)

X-Ray:

o Single burst of x-rays which

penetrate the tissues to

varying degrees, depending

on density, to produce a 2D

film, known as a radiograph (x-

ray). May also use contrast.

o Lighter areas are dense (e.g.

bone) & dark areas are soft

tissue, fluids or gases.

(O’Sullivan & Goergen, 2009; Pagana &

Pagana, 2014, p. 982)(Upfal J & O’Callaghan, 2001)

o Useful in the detection of pathology of the skeletal system. Also detecting some disease processes in soft tissue including:

• Chest: identify lung diseases eg. pneumonia, lung cancer or pulmonary oedema

• Abdomen: detect ileus (blockage of the intestine), free air (from visceral perforations) and free fluid (in ascites).

o In some cases, the use of X-rays is debatable, such as:

• Gallstones (rarely radiopaque)

• Kidney stones (often visible, but not always)

X-Ray: Limitations

Limitations:

o Skewed 2D image of a 3D structure

o Requires specialist interpretation

o Structures can be masked by other structures

o Cannot view soft tissue damage unless a large mass is

present with little use in the imaging of soft tissues such

as the brain or muscle.

o Radiation hazards (not used in pregnancy) and potential

overuse

(Pagana & Pagana, 2014, p. 985-7)

X-Ray Images

Bone tumour (enchondroma) in distal femur (Upfal & O’Callaghan, 2001)

Image A: normal chest Image B: pneumonia

(Upfal & O’Callaghan, 2001)

X-Ray Images

Congestive Heart Failure (Upfal & O’Callaghan, 2001)Eosinophilic oesophagitis (Upfal & O’Callaghan, 2001)

X-Ray Images

Star Shaped Bladder Urolith (Upfal & O’Callaghan, 2001)

Small bowel obstruction with multiple pockets of air

(Upfal & O’Callaghan, 2001)

X-Ray Images

(Nucleus medical media, 2015, Progression of breast mass, viewed 17/09/2015

http://ebsco.smartimagebase.com.ezproxy.endeavour.edu.au/progression-of-breast-

mass/download?ItemID=830)

X-Ray Images

Nucleus medical media, 2015, Mammograpy, viewed 20/09/2015

<http://ebsco.smartimagebase.com.ezproxy.endeavour.edu.au/mammography/view-

item?ItemID=65448>)

Computed Tomography (CT)

(Nucleus medical media, 2015, CT scan, viewed 17/09/2015

http://ebsco.smartimagebase.com.ezproxy.endeavour.edu.au/ct-scan/view-

item?ItemID=74923)

o Creates a 3D cross-sectional view of body structures

from many x-rays taken at multiple angles around 360o

o Different densities of tissues are computed as various

shades of grey and displayed as a composite image.

o Unlike conventional x-ray films which can only produce a

limited 2D aspect, CTs are able to give greater detail at a

higher resolution, including better imaging of soft tissues

o The image can be further enhanced by using radiopaque

contrast, although often this may not be necessary

(McKenzie & Goergen, 2009; Pagana & Pagana, 2014, p. 1020)

CT: Limitations

Computed Tomography (CT) Limitations:

o Cost and availability (~$200-500 per process)

o Still potential to miss areas

o Accuracy varies when viewing small structures

o Radiation hazards

o Cannot use in pregnancy

Images

(Nucleus medical media, 2015, Progression of lung cancer, viewed 17/09/2015

http://ebsco.smartimagebase.com.ezproxy.endeavour.edu.au/progression-of-lung-cancer/view-

item?ItemID=3544)

Image:

Progression of

Metastatic Lung Cancer

(axial cross section).

Images

(Nucleaus medical media, 2015, CT guided percutaneous drainage of

pelvic abscess, viewed

20/09/2015<http://ebsco.smartimagebase.com.ezproxy.endeavour.edu.

au/ct-guided-percutaneous-drainage-of-pelvic-abscess/view-

item?ItemID=18144>)

Dual-Energy X-ray

Absorptiometry (DEXA)

Dual-Energy X-ray Absorptiometry

(DEXA)

o Determines bone mineral content & density to diagnose

osteoporosis or assess treatment.

o Bone mineral assessment at early stages in osteoporotic

disease have far better clinical outcomes if treatment

begins early.

o Test has double the x-ray energies to provide greater

soft tissue penetration and subsequent image clarity

(spine, hip including femoral neck).

(Hendrich, 2013; Pagana & Pagana, 2014, p. 1003)

(DEXA)

Dual-Energy X-ray Absorptiometry (DEXA) Interfering

Factors:

o Barium (contrast agent used in other imaging studies) &

radionuclide (radioactive positively charged ions used in

PET scans) may falsely increase the density of the

lumbar spine. Separate by 10 days.

o Surgically implanted screws, metal clips or overlying

jewellery will alter the images produced.

DEXA: Images

(Smith, N, 2011, DEXA scanner in use ALSPAC.jpg, viewed 20/09/2015

<https://en.wikipedia.org/wiki/Dual-energy_X-

ray_absorptiometry#/media/File:DEXA_scanner_in_use_ALSPAC.jpg>)

Images

(Maher K, 2006, Dual Energy Image Demo.jpg

viewd 20/09/2015

<https://commons.wikimedia.org/wiki/File:DualE

nergyImageDemo.jpg)

DEXA: Images

(Lebreton, C, 2010, Morbus Fabry DXA 01.jpg, viewed 20/09/2015

<https://commons.wikimedia.org/wiki/File:Morbus_Fabry_DXA_01.jpg.

Ultrasound

Ultrasound:

o Uses ultrasonic (high-frequency) sound waves to

determine the density of the underlying structures based

on the degree with which the sound is reflected back.

o This echo is then detected by the ultrasound machine

and converted into a real-time moving image, from which

still images can be captured.

o The image produced on the screen is similar to the

image of an x-ray.

(Coombs & Goergen, 2009; Pagana & Pagana, 2014, p.

Ultrasound

o Doppler ultrasound is generally used to image blood flow

through blood vessels or the heart. It is similar to the

standard ultrasound, except that the image is formed by

analysing the change in the sound wave frequency,

which is caused by the moving red blood cells.

o The faster the blood is moving, the more distortion there

is to the frequency wave, the slower the blood flow, the

less distortion. The difference in frequency is displayed

in the image as different colours, or can be converted

into sound (e.g. fetal heart rate, echocardiography)

Ultrasound

o Assess size, structure & position of body organs, blood

flow in arteries & veins

o Assess functional movements in real time

o Foetal visualisation for early health checks & position

o Detection (cysts, tumours, calculi)

o Treatment assessment

o Support medical procedures

(Pagana & Pagana, 2014, p. 861-2)

Ultrasound

Advantages Disadvantages

Non invasive (except trans-vaginal,

per rectal, trans-oesophageal and per

rectal) and painless

Resolution difficult to maintain

Requires no Ionizing radiation or use

of contrast

Specialist interpretation

Repeated studies may be performed

and multiple images obtained with no

May miss entire structures as they can

be masked by another structure

Less expensive that CT or MRI Suggested there may be side effects

in using ultrasound, however there is

insufficient evidence to support this

Can be performed at an office/lab/at

the bedside

(Pagana & Pagana, 2014, p. 865-6)

Ultrasound

(Nucleus medical media, 2015, Fetal ultrasound – medical animation, viewed 16/09/2015

<http://ebsco.smartimagebase.com.ezproxy.endeavour.edu.au/fetal-

ultrasound/download?ItemID=68388>)

Ultrasound: Images

Sonogram of 14 week old foetus (Upfal & O’Callaghan, 2001)

Ovary: PCOS (Upfal & O’Callaghan, 2001)

Ultrasound: Images

Magnetic Resonance Imaging

Magnetic Resonance Imaging (MRI)

o Body is placed in high-level electro-magnetic field. All body

tissue has H atoms & these H protons align parallel to this

field.

o At the point of required imaging, a pulse of radio waves is

sent through the body generating excitation in the hydrogen

protons.

o This is then converted into a calculation of pre, post to pre

excited state. This time is measured, analysed &

constructed into detailed images.

(McIntyre & Goergen, 2013; Pagana & Pagana, 2014, p.

Magnetic Resonance Imaging (MRI) Uses:

o H atoms in all tissue: very fine detail of solid structures and

& soft tissues

o More imaging power than a CT scan with 10-20 times

better resolution for detail & hence more reliable (high

resolution)

o Detects tumors (even small), nerve pathways (including

MS), blood flow (including aneurysm and tissue changes

due to hypoxia)

o In cancer treatment, ongoing imaging can be performed

without the use of contrast dyes or x-rays

MRI: Limitations

Magnetic Resonance Imaging (MRI) Limitations:

o No metal objects (powerful magnetic field): no

pacemakers, prostheses, plates, screw etc.

o Obese clients (130kg+) may exceed the safe working

capacity of the machine

o Very expensive (~$2000-5000 per exam)

o Movement during MRI causes significant distortion of

images: clients in pain, confused, agitated,

claustrophobic

(Pagana & Pagana, 2014, p. 1110-1111)

MRI: Images

(Nucleus medical media, 2014, Cervical spine MRI, viewed 17/09/2015

http://ebsco.smartimagebase.com.ezproxy.endeavour.edu.au/cervical-spine-mri/download-

one?id=4230&mt=tmp&decIDs=31870#content)

MRI: Images

(Nucleus medical media, 2015, Brain injuries, viewed 17/09/2015

http://ebsco.smartimagebase.com.ezproxy.endeavour.edu.au/brain-injuries/view-

item?ItemID=16730)

MRI: Images

(Nucleus medical media, 2015, Brain injuries, viewed 17/09/2015

http://ebsco.smartimagebase.com.ezproxy.endeavour.edu.au/brain-injuries/view-

item?ItemID=16730)

CT Scans & MRI

(Nucleus medical media, 2014, Muscular inflammation & infection, viewed 17/09/2015

http://ebsco.smartimagebase.com.ezproxy.endeavour.edu.au/muscular-inflammation-and-

infection/view-item?ItemID=79283)

Nuclear Scanning:

Radionucleotide Testing

Nuclear Scanning: Radionucleotide

Testing

Positron Emission Tomography (PET Scan)

o A radio active substance that emits positively charged

particles called positrons, is injected into the body

o The collision of these with negatively charged electrons in

body tissues releases gamma radiation, similar to

x-rays

o Sensors positioned around the patient detects this gamma

radiation for a computer generated image on a colour

monitor

o Used widely in Neurology, Cardiology and Oncology

(Gunn, 2008, p. 304; Hofman & Nandurkur, 2009; Pagana &

Pagana, 2014, p. 821)

Testing

Positron Emission Tomography (PET Scan) Uses:

o Provide information on function & structure.

o Detect metabolic changes in healthy & diseased organs

(i.e. heart, brain). This indicates blood flow & glucose

metabolism.

o Combined with CT or MRI imaging to produce an

anatomically accurate image of physiology / metabolism

of the organ or area being explored.

(Pagana & Pagana, 2014, p. 822, 827)

Testing

Positron Emission Tomography (PET Scan) Interfering

Factors:

o Caffeine, alcohol &/ or tobacco intake in the previous 24

hours can affect results.

o Recent anxiety, exercise and food can alter the delivery

to target sites of the radionucleotide.

PET Scan:

Images

(Nucleus medical media, 2015 , Positron emission

tomography (PET) scan, viewed 20/09/2015

<http://ebsco.smartimagebase.com.ezproxy.endeavour.ed

u.au/positron-emission-tomography-pet-scans/view-

item?ItemID=11811>)

PET Scan:

Images

(Nucleus medical media, 2015 , Positron emission

tomography (PET) scan, viewed 20/09/2015

<http://ebsco.smartimagebase.com.ezproxy.endeavour.ed

u.au/positron-emission-tomography-pet-scans/view-

item?ItemID=11811>)

PET Scan:

Images

(Klunkwe, 2008, PiB PET Images AD.jpg,

viewed 20/09/2015

<https://upload.wikimedia.org/wikipedia/common

s/thumb/b/b9/PiB_PET_Images_AD.jpg/622px-

PiB_PET_Images_AD.jpg>)

PET Scan: Images

(Kouchiyama A, 2009, PET-CT scanning of lymph node metastases in cancer 2.jpg, viewed 20/09/2015,

https://commons.wikimedia.org/wiki/File:PET-CT_scanning_of_lymph_node_metastases_in_cancer_2.jpg)

Clinical Digital Thermography

Digital Infrared Thermal Imaging (DITI)

o Investigation that detects minute temperature differences

in body’s radiant heat. (Gunn, 2008, p. 372)

o Due to this can detect disease in the vascular, muscular,

neural and skeletal systems

o Can identify physiological or functional changes and

metabolic processes via heat signatures & or asymmetry

(Damnjanovic, Petrovic, Pantovic & Smiljanic, 2010, p. 426)

Digital Infrared Thermal Imaging (DITI) Advantages:

o Infrared: no exposure to radiation

o May identify early illness & a number of different

illnesses

o Images body function & body systems: overall image &

awareness to asymmetry

o Doesn’t require client pre-preparation

(Damnjanovic, et al, 2010, p. 426-7)

Digital Infrared Thermal Imaging (DITI) Common uses:

o Early detection of some cancers, i.e. breast, prostate

o Monitoring changes in overall health: metabolic change,

degeneration

o Monitoring healing processes: healing and repair

o Disease and Virus Monitoring: temperature heat

signatures including fever Screening (i.e. H1N1)

(Damnjanovic, et al, 2010, p. 426-7)

Images

References

o Damnjanovic Z, Petrovic D, Pantovic R & Smiljanic Z 2010, Infrared imaging in

medicine, International journal of collaborative research on internal medicine

and public health, Vol. 2, Iss 12, p. 425-434 Viewed 20/09/2015

<http://ezproxy.qa.proquest.com.ezproxy.endeavour.edu.au/docview/847198517

?accountid=45102>

o Gunn C 2008, Pocket radiography and medical imaging dictionary, Churchill

Livingstone Elsevier, Nottinghamshire, UK

o Coombs P & Goergen S 2009, Ultrasound, The Royal Australian and New Zealand

College of Radiologists, viewed 20/09/2015

http://www.insideradiology.com.au/pages/view.php?T_id=5#.VgDWWH0b0eE

o Hofman M & Nandurkur D, 2009, PET Scan, The Royal Australian and New Zealand

College of Radiologists, viewed 20/09/2015

http://www.insideradiology.com.au/pages/view.php?T_id=16#.VgDXJn0b0eE

o Hendrich E 2013, Bone Mineral Density Scan (Bone Densitometry or DXA scan) The

Royal Australian and New Zealand College of Radiologists, viewed 20/09/2015

http://www.insideradiology.com.au/pages/view.php?T_id=51#.VgDVj30b0eE

References

o McIntyre R & Goergen S, 2013, Magnetic Resonance Imaging (MRI) The Royal

Australian and New Zealand College of Radiologists, viewed 20/09/2015

http://www.insideradiology.com.au/pages/view.php?T_id=53#.VgDTD30b0eE

o McKenzie J & Goergen S, 2009, Computed Tomography (CT), The Royal

http://www.insideradiology.com.au/pages/view.php?T_id=61#.VgDUyH0b0eE

o O’Sullivan B & Goergen S, 2009, Plain Radiography/X-rays, The Royal

http://www.insideradiology.com.au/pages/view.php?T_id=24#.VgDT4n0b0eE

o Pagana KD & Pagana, TJ (eds) 2014, Mosby’s manual of Diagnostic and

Laboratory tests, 5th Edition, Elsevier, Missouri, USA

o Upfal J & O’Callaghan, 2001, Your Medical Tests. What do they really mean?

Black Inc. Melbourne, Australia.

Electro Diagnostic Testing, Imaging · following ventricular repolarization ... o Bright or...

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The Role of Serotonin in Ventricular Repolarization in ... · 279 The Role of Serotonin in Ventricular Repolarization in Pregnant Mice Shanyu Cui 1, Hyewon Park 1, Hyelim Park1,2,

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Validation of the V-index as a metric of ventricular repolarization …cinc.org/archives/2015/pdf/0673.pdf · Validation of the V-index as a metric of ventricular repolarization dispersion

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