Learn it all ~ MED IMAGING

What are some things that CT can see on bone?

- bone tumors - articular surfaces - comminuted fractures - tibial plateau fractures

Ventilation

- inhale gas with radioactive particles (PE does not affect ventilation)

Perfusion

- inject radioactive particles IV; trapped in capillary bed of lungs (PE affects perfusion)

Cerebellar Hemangioblastoma MRI of brain shows a cystic lesion in the cerebellum with an enhancing nodule (post-Gadolinium)

...

pulmonary embolism

46 year old male: recent diagnosis of pancreatic cancer. sudden onset chest pain and shortness of breath

Left subphrenic abscess

48 year old male: Recent hemicolectomy for colorectal carcinoma. Severe left upper abdominal pain and fever

Difficulty swallowing -video esophagram / swallowing study -modified barium swallow Impacted food or foreign body Persistent heartburn / reflux disease (GERD) Chest pain

ESOPHAGRAM(Barium Swallow) indications

igns of ectopic pregnancy on TVUS include:

Empty uterus • Free fluid in the pelvis • Direct visualization of the ectopic gestation as a complex adnexal mass (Fig. 6.2) • On rare occasions, fetal cardiac activity may be seen within the adnexal mass.

is the most common gynaecological malignancy.

Endometrial carcinoma

Upper GIT bleeding

Endoscopy

Dysphagia

Endoscopy where malignancy suspected Barium swallow for other indications

Stent-graft placement

Endovascular Abdominal Aortic Aneurysm Repair

Double contrast technique Long nasogastric tube placed Barium and methyl cellulose infused

Enteroclysis

AP

Portable chest x-rays are almost always done

gross hematuria, flank pain and palpable mass

RENAL TUMOR - MALIGNANTRENAL CELL CARCINOMA (RCC) classic triad of

solid

RENAL TUMOR - MALIGNANTRENAL CELL CARCINOMA (RCC) most are

cystic

RENAL TUMOR - MALIGNANTRENAL CELL CARCINOMA (RCC) small percentage are

local lymph nodes, lung and bone

RENAL TUMOR - MALIGNANTRENAL CELL CARCINOMA (RCC) spreads (metastasizes) to

film exposed

RETROGRADE PYELOGRAM contrast injected as

a cystoscope procedure

RETROGRADE PYELOGRAM done during a

ureter and intrarenal collecting system

RETROGRADE PYELOGRAM shows

distal ureter

RETROGRADE PYELOGRAM small catheter placed into

Prostate CA Breast CA Gastric CA Carcinoid tumor

SCLEROTIC LESION Typical for metastatic disease from

making new bone

SCLEROTIC LESIONS lower destruction of bone; allows body to respond by

Epididymo-orchitis

SCROTAL US infection

Surgical emergency Loss of blood flow

SCROTAL US torsion

testis

SCROTAL US tumor usually within the

Single contrast small bowel exam Small bowel follow-through Enteroclysis

SMALL BOWEL STUDIES

Suspected obstruction / paralytic ileus Hematoschezia (blood in stools) Suspected malabsorption Unintended weight loss Suspected Crohn's disease

SMALL BOWEL STUDIES indications

Findings often subjective or difficult to appreciate on plain films Usually assessed with echocardiography as next test Sometimes need MR or other imaging

SPECIFIC CHAMBER OR VESSEL ABNORMALITIES

Coins, bone, food, plastic

SWALLOWED (INGESTED) FOREIGN BODY examples

Thoracic inlet Aortic arch level Just above diaphragm

SWALLOWED (INGESTED) FOREIGN BODY stick at

What is the system stating?

Salter harris 1 --> epiphyseal plate cartilage fracture salter harris 2 -->fracture of metaphysis salter harris 3 -->fracture of epipyhysis only salter harris 4 --> fracture of metaphysis and epiphysis salter harris 5--> compaction and compression of epiphyseal plate

Fractures around the epiphysis of bones (growth spots) are normally classified as ____?

Salter-harris system

tumor infection torsion hematoma

Scrotal US for

s the commonest type of ovarian malignancy. These are usually large (>15 cm) and seen on US as multiloculated cystic masses with thick, irregular septations and soft tissue masses

Serous cystadenocarcinoma

plain films

Slipped capital femoral epiphysis (SCFE) diagnosed with

low yield

Small bowel studies are generally

Which fracture of the wrist ocurs when you fall and your wrist is FLEXED?

Smith

fracture of transverse processes

T1 weighted- fat saturated sagittal contrast enhanced MRI of the lumbar spine

burst fracture

T2 weighted sagittal MRI of the lumbar spine

Transjugular intrahepatic portosystemic stent

TIPSS

Abnormal connection between the trachea and esophagus

TRACHEO-ESOPHAGEAL (TE) FISTULA

of tip or do esophagram

TRACHEO-ESOPHAGEAL (TE) FISTULA look for position

other congenital defects VATER

TRACHEO-ESOPHAGEAL (TE) FISTULA may have

NG tube and do a lateral film

TRACHEO-ESOPHAGEAL (TE) FISTULA put in

For all other patients with suspected ectopic pregnancy,

TVUS

should be performed to measure endometrial thickness. The ideal time for TVUS is on days 4-6 of the menstrual cycle, when the endometrial echo should be at its thinnest. The likelihood of endometrial hyperplasia is low if the endometrial thickness measured with TVUS is <12 mm.

Transvaginal US

haemorrhagic ovarian cyst

Transvaginal US with color doppler. 30 year old female sudden onset of acute pelvic pain

Most prostate carcinomas are now diagnosed through

creening. Screening methods include digital rectal examination (DRE) and prostate specific antigen (PSA) blood assay. PSA screening is controversial for a number of reasons:

not imaged

cystitis is usually

portable AP films obesity pregnant ascites straight back syndrome pectus excavatum

extracardiac causes of cardiac enlargement where CTR is more than 50% but heart is normal

penetration

factors to evaluate the quality of chest X-rays are

The majority of solid masses that arise from the uterus are

fibroids. Fibroids are often multiple. Fibroids are usually seen on US as masses of variable echogenicity in the smooth muscle wall of the uterus (myometrium).

Causes of a solid ovarian mass include

fibroma and Brenner tumour. A pedunculated fibroma may extend into the adnexa and mimic a solid ovarian mass.

Painless haematuria may be classified clinically as

macroscopic or microscopic. Initial clinical tests in the patient with haematuria consist of urine culture to exclude infection, examination of urine for protein and red cell casts, and measurement of blood pressure.

bowel obstruction

many different causes

conceptual age (menstrual age used)

menstrual age is 2 weeks greater than

The most common indication for renal mass biopsy is for management of a

small mass (<3 cm), where a positive biopsy result would indicate a non-operative approach.

What are the 4 characterisitcs of rheumatoid arthritis?

soft tissue swelling bone erosion reduced bone density abnormalities of joint alignment

What are some characteristics of inflammatory polyarthyopathy?

soft tissue swelling pain gets worse when walking morning stiffness

Ultrasound in the skeletal system is used to look at?

soft tissues (tendons, ligaments, muscles) *can tell tears in any of these very easily

What is another name for these fractures?

spiral, transverse or oblique

19-21 weeks' gestation Most major fetal malformations are able to be diagnosed on US at this

stage of pregnancy

Calculi

stones

What is another fracture that is common in athletes due to repetative trauma to a normal bone? Where is it mostly located?

stress fracture metatarsals

What are the 3 locations in which femoral neck fractures are classified as?

subcapital basilar transcervical

Which muscle is mostly teared during the rotator cuff tear and the calcific tenonisis?

suprasinatus

Humeral fractures are common among the elderly and are seen in mostly which parts of the humerous bone?

surgical neck anatomical neck lesser tuberosity greater tuberosity

What part of the femur is usually fractured? What is this common in?

surgical neck osteoporosis

Seminoma is usually seen as a localized hypoechoic mass outlined by

surrounding hyperechoic testicular tissue

what may be helpful in threatened abortion, when bleeding and pain are mild and the cervix is closed

transvaginal US

Most fractures in the metatarsals are _____?

transverse

buckle fracture

type of distal radius fracture shown

greenstick fracture

type of distal radius fracture shown

impacted, comminuted fracture

type of distal radius fracture shown

avulsion

type of fracture shown

comminuted fracture

type of fracture shown

compound fracture

type of fracture shown

pathological fracture

type of fracture shown

stress fracture

type of fracture shown

what is gout caused by?

uric acid and deposition in soft tissue

The primary imaging investigation in the assessment of prostatism is

urinary tract US. Urinary tract US includes assessment of prostate, bladder and upper urinary tracts.

Pelvic ring fractures have a high rate of association with _____?

urinary tract injuries

the tip is in the right main bronchus

you are sent to check on the position of a dobbhoff feeding tube that was just inserted before feeding the patient you say:

Perthes disease

(avascular necrosis of the femoral epiphysis)

acute cholecystitis

43 year old female: acute right upper quadrant pain

angiomyolipoma

43 year old female: incidental finding on CT

urinary tract obstruction due to ureteric calculus

43 year old male. Acute right upper quadrant pain and fever

hepatocellular carcinoma

46 year old male: Hepatitis-B positive. Recent deterioration of liver function

SVC thrombosis

69 year old female: swelling of arms and face. Recent removal of central venous catheter

Width of heart Width of chest Ratio should be less than .55 (or about 50% or less)

CARDIOTHORACIC RATIO

physiology as well as anatomy

CAROTID DUPLEXULTRASOUND (US) images

carotid bifurcation

CAROTID DUPLEXULTRASOUND (US) useful to assess the

initial process (HMD/RDS) improves

CHRONIC LUNG DISEASEBRONCHOPULMONARY DYSPLASIA (BPD) develops as

round and linear densities

CHRONIC LUNG DISEASEBRONCHOPULMONARY DYSPLASIA (BPD) diffuse

cystic changes

CHRONIC LUNG DISEASEBRONCHOPULMONARY DYSPLASIA (BPD) progresses to

a respirator

CHRONIC LUNG DISEASEBRONCHOPULMONARY DYSPLASIA (BPD) usually on

fat, muscle and vessel tissue

RENAL TUMOR - BENIGNANGIOMYOLIPOMA (AML) contains

large

RENAL TUMOR - BENIGNANGIOMYOLIPOMA (AML) may bleed, if

Don't bother Almost always negative High gonadal dose Even if it's fractured Will you put the butt in a cast?

COCCYX

Which fracture of the wrist occurs when you fall and your wrist is EXTENDED?

COLLE

incidentally

RENAL TUMOR - BENIGNANGIOMYOLIPOMA (AML) often found

CT

RENAL TUMOR - MALIGNANTRENAL CELL CARCINOMA (RCC) _____ is most sensitive

growth plate

SALTER-HARRIS PEDIATRIC FRACTURE CLASSIFICATION SYSTEM involvement of the

What are another name for these?

buckle torus greenstick plastic

Ionizing radiation 1, 4, 8,16, 64 or more "rows"

COMPUTED TOMOGRAPHY (CT) image formation

fusion of sagittal suture

***couldn't download entire photo newborn male abnormal head shape

Trauma Abdominal pain Suspected mass Suspected inflammatory process

COMPUTED TOMOGRAPHY (CT) indications

NPO (sometimes not)

COMPUTED TOMOGRAPHY (CT) patient prepartion

valve function and chamber appearance

ECHOCARDIOGRAPHY(CARDIAC ULTRASOUND) also allows assessment of

abnormal wall motion

ECHOCARDIOGRAPHY(CARDIAC ULTRASOUND) areas with decreased blood flow will show

wall motion in real time

ECHOCARDIOGRAPHY(CARDIAC ULTRASOUND) noninvasive shows

pain or vaginal bleeding

ECTOPIC PREGNANCY may or may not cause

bleeding within the pelvis

ECTOPIC PREGNANCY may rupture and/or cause

What is shown in the following picture?

*CT coronary calcium scoring*: Note calcification in the left anterior descending artery (arrow) in a middle-aged male with atherosclerosis of the coronary arteries.

What condition is pictured?

"water bag" or "carpet bag" heart - indicative of Pericardial effusion

What is shown in the following picture?

*Calculation of ejection fraction: echocardiography.* b) measurement of left ventricular volume at end of diastole c) measurement of left ventricular volume at end of systole

What is shown in the following picture?

*Covered stent for aortic aneurysm.* AXR shows the position of the stent graft (arrows).

What is shown in the following picture?

*Abdominal aortic aneurysm*: A reconstructed image from a CT angiogram shows the following structures: • aorta (Ao) • left and right renal arteries (LRA, RRA) • left and right kidneys (LK, RK) • left and right common iliac arteries (LCIA, RCIA)

What is shown in the following picture?

*Aortic dissection*: CT scan. Note the thin intimal flap in the ascending aorta (arrow). In the descending aorta the flap is seen separating the true lumen (TL) from the false lumen (FL).

What is shown in the following picture? (Part a)

*Aortic dissection*: CXR show intimal calcification (arrow) displaced centrally by blood in the false lumen.

What is shown in the following picture? (Part b)

*Aortic dissection*: Coronal contrast-enhanced CT in the same patient as previous slide shows true lumen and false lumen separated by intimal flap. The intimal flap contains calcification (arrow), which is displaced on previous slide of CXR.

What is shown in the following picture?

*Covered stent for aortic aneurysm.* CT with intravenous contrast injection shows the stent graft (G) within the aortic aneurysm. Note the presence of contrast enhancement in the aneurysm sac anterior to the graft indicating an endoleak (arrow).

What is shown in the following picture?

*CT angiogram of the coronary arteries - normal anatomy* • aorta (A) • pulmonary artery (PA) • pulmonary vein (PV) • left atrium (LA) • left main coronary artery (LCA) • left anterior descending artery (LAD) • circumflex artery (CIR)

What is shown in the following picture?

*Deep vein thrombosis (DVT)*: thrombus is seen as echogenic material (arrow) projecting into the common femoral vein (CFV).

What is indicated within the yellow box?

*Kerley B Lines* Progress up the sides of the lungs that go further up as it gets worse. Lymphatics get congested with chronic failure (lymphatic vascular congestion) When you see these on the right or left it means CHRONIC heart failure.

What is shown in the following picture?

*Leaking abdominal aortic aneurysm*: CT obtained in a patient with acute onset of abdominal pain shows an aortic aneurysm (A) and a large left retroperitoneal hematoma (H).

What is shown in the following picture?

*Left atrial enlargement and mitral annular calcification.* Heart is enlarged with prominence of the left atrial appendage producing a bulge of the upper left cardiac border (white arrow). Curvilinear calcification in the mitral valve annulus (black arrow).

What is shown in the following picture?

*Left ventricular aneurysm*: Transverse MRI scan showing a four chamber view of the heart. The apex of the left ventricle has a markedly thinned wall and is dilated (arrows). Note that 'P' stands for pericardial effusion.

What is shown in the following picture?

*Myocardial ischemia: thallium scintigraphy*: Top 3 images are of the left ventricle after exercise; below these are corresponding images after a rest period. Note the presence of a region of reduced myocardial uptake of thallium with exercise (arrows). There is normal distribution of activity at rest, indicating reversible ischemia rather than established infarction

What is shown in the following picture?

*Normal deep veins*: duplex Ultrasound. US images obtained just below the inguinal ligament in the transverse plane showing the common femoral artery (FA) and vein (FV). The common femoral vein is able to be compressed with gentle pressure (arrow), excluding the presence of deep vein thrombosis (DVT)

What is shown in the following picture?

*Percutaneous transluminal angioplasty (PTA)*. a) Catheter angiography shows a stenosis of the superficial femoral artery in the upper thigh (arrow). b) Following PTA the stenosis is no longer seen.

What is shown in the following picture?

*Pulmonary arterial hypertension*: Dilated main pulmonary artery produces a bulge of the upper left cardiac border (arrow), higher than the left atrial appendage. Prominent hila due to enlarged right and left pulmonary arteries. Rapid tapering of calibre of pulmonary arteries as they extend through the lungs.

What is shown in the following picture?

*Pulmonary embolism*: CT pulmonary angiogram. Pulmonary embolus seen as a low density filling defect in the right pulmonary artery (arrow). • ascending aorta (A) • descending aorta (D) • main pulmonary artery (PA)

What is shown in the following picture?

*Renal trauma and embolization*: b) Catheter angiogram shows extravasation of contrast material (arrow). c) Post-embolization angiogram shows embolic material (arrow) with cessation of bleeding.

What is shown in the following picture?

*Renal trauma*. CT post-trauma shows a lacerated left kidney surrounded by a large hematoma. Small pools of extravasated contrast material indicate active bleeding (arrows).

What is shown in the following picture?

*Situs inversus*: Orientation of visible organs is a 'mirror image' of normal, with heart and stomach to the right, and liver to the left.

What is shown in the following picture?

*Stenosis of left common iliac artery (arrow)*. CT angiogram

What is shown in the following picture?

*Tunnelled central venous port.* The tip of the catheter is well positioned at the junction of the superior vena cava and right atrium (arrow).

What is pictured in the following PAL CXR?

*congestive heart failure (CHF)* • Heart is enlarged. • Bilateral pleural effusions (bilateral blunted costophrenic angles) • The left atrium is double the normal density (this means atrial enlargement) • Left bronchus is elevated from L atrial enlargement • Cephilization: vessels in upper part are congested • No clear spino-phrenic angle on the lateral view

What is shown in the following picture?

*coronary stenosis (arrow)* on CT angiogram of coronary arteries

Fahr's Disease Unenhanced CT reveals dense calcifications within the basal ganglia, subcortical white matter of the posterior parietal lobes, and the dentate nuclei of the cerebellum.

...

Fun fact:

...

Most ovarian tumours are well seen with US (see above). CT of abdomen and pelvis is the investigation of choice for pretreatment staging of ovarian cancer. CT is used to search for signs of peritoneal spread, such as ascites and peritoneal masses, liver metastases, and lymphadenopathy (Fig. 6.13). Chest CT/CXR are also performed to detect pulmonary metastases and pleural effusion.

...

NORMAL SACRUM

...

The most common cause of IUGR is placental insufficiency.

...

Pheochromocytoma

10 % are malignant Can cause HTN

A gestational sac should become visible on TVUS at a β-hCG level of

1000 mlU/ml

Nuchal thickness US at

11-14 weeks gestation

slipped upper femoral epiphysis

13 year old female left hip pain

avulsion anterior superior iliac spine: sartorius origin

14 year old male acute right hip region pain while playing soccer

osteochondritis dissecans medial femoral condyle

15 year old male recurrent knee pain and locking

right urinary tract obstruction

15 year old male: History of recurrent left flank pain. MAG3 scintigraphy (Series of sequential images of the kidneys. The numbers on the image represent minutes following injection of MAG3. Note the orientation on the first image in the top left corner.

grade 2 VUR, reflux into lower moiety of duplex collecting system

18 month old female. Micturating cystourethrogram to investigate recurrent urinary tract infection

Fetal morphology scan at

19-21 weeks gestation

bstetric US scan for assessment of fetal morphology is best performed at

19-21 weeks' gestation

a minimal requirement for trauma is that ___ views need to be taken on the radiograph?

2 (lateral view) (frontal view AP)

Tumour is graded histologically using the Gleason scale from

2 (well differentiated) to 10 (anaplastic, highly aggressive).

mediastinal mass

2 year old female mild shortness of breath and cough for a few days

Toddler's fracture

2 year old male acute presentation with a limp

placenta praevia

26 year old female us for 3rd trimester bleed image is longitudinal pelvic

For suspected ankle trauma ____ views are needed?

3 (lateral, oblique, AP)

Grade 4 VUR

3 month old male micturating cystourethrogram to investigate recurrent urinary tract infection

round pneumonia

3 year old male cough and fever

left lower lobe collapse

3 year old male known asthma, acute presentation

Which of the following is the least likely cause of RUQ pain? 1. Cholecystitis 2. Acute Hepatitis 3. Aortic Dissection 4. Duodenal Ulcer

3. Aortic Dissection

benign cystic teratoma (ovarian dermoid)

30 year old female mild intermittent pelvic pian transvaginal US

orchitis

30 year old male acute scrotal pain

testicular tumour

30 year old male acute scrotal pain

multicystic dysplastic kidney

34 year old female 3rd trimester obstretric US for follow up of foetal anomaly

acute pyelonephritis

34 year old female. Acute right upper quadrant pain and fever

acute pancreatitis

38 year old male: acute, severe epigastric pain

ankylosing spondylitis • Vertically orientated bony spurs arising from vertebral bodies (syndesmophytes) • Fusion or ankylosis of the spine giving the 'bamboo spine' appearance • Sacroiliac joint changes including erosions producing an irregular joint margin • Sclerosis and fusion of sacroiliac joints later in the disease process.

38 year old male: chronic back pain and stiffness

malrotation

4 month old female upper gastrointestinal tract barium study to investigate bile stained vomiting

empyema

4 year old male severe respiratory distress, cough, and fever

Acute appendicitis

40 year old female: acute right iliac fossa pain

chronic gouty arthropathy

52 year old male: chronic foot pain

reversed (hepatofugal) portal vein flow

53 year old male: history of hepatic cirrhosis

severe coronary artery stenosis

54 year old male: several episodes of central chest pain

stricture bulbous urethra

55 year old male poor urinary stream with micturition

rheumatoid arthritis

56 year old female: severe chronic foot pain and deformity

acute diverticulitis

57 year old male: acute left iliac fossa pain

endotracheal tube misplaced in right main bronchus left pulmonary collapse

6 month old female. severe bronchiolitis requiring respiratory support

cystic fibrosis

6 year old male chronic respiratory disease with recent deterioration

A PE

60% of patients dying the hospital have had

mucinous cystadenocarcina of the ovary

67 year old female pelvic swelling transvaginal US image including color power doppler

small bowel obstruction

67 year old female: acute abdominal pain and distension

adenocarcinoma of the pancreas

67 year old female: chronic, severe epigastric pain

thoracic aortic aneurysm

68 year old female: vague central chest pain

osteoarthritis

69 year old female: chronic left hip pain

aortic dissection

76 year old male: acute onset of intrascapular chest pain

metastases from adenocarcinoma of the prostate

78 year old male: Sclerotic lesions on Xray of pelvis

aortic aneurysm: ruptured

78 year old male: acute abdominal pain

paget disease

78 year old male: chronic bilateral hip pain

perthes disease

8 year old male left hip pain

Yolk sac should become visible when the average diameter of the gestational sac is _____; an embryo should be visible at _____.

8mm 16 mm

of little help

90% of low back pain cases resolve in 4-6 weeks plain films are

Fun fact: did you know sloths can turn their heads in a 270 degree angle around their bodies..

:)

No hemodynamically significant stenosis

< 10 mmHg pressure drop across stenosis

Hemodynamically significant stenosis

> 10 mmHg pressure drop across stenosis

Stomach 2 hours after birth Small bowel 6 hours after birth Rectum 24 hours after birth

Air in bowel (in a neonate)

RUQ liver uptake gallbladder and bile ducts bowel activity

HEPATOBILIARY EXAM images obtained over the

Therefore, if you look on pg. 173 in the book at the two pictures you can figure out the difference on which one is a fracture and which one is normal?

A) fracture B) normal pg 173

Suspected Obstruction / Perforation Foreign Bodies Tube / Line Positions (Trauma) (Pain) (Suspected Mass) (Suspected Inflammatory Process)

ABDOMINAL PLAIN FILMSEXAM INDICATIONS

US, CT, MR, angiogram

AORTA can be imaged with

45-70

AORTIC DISSECTION - common in ____ yrs of age

false channel channel dissects a variable distance

AORTIC DISSECTION Blood begins to flow through a wall defect, into a

Marfan syndrome, coarctation of aorta, bicuspid aortic valve Aortic atherosclerosis and hypertension

AORTIC DISSECTION for

Perforation of GIT

AXR

small bowel obstruction

AXR CT in doubtful cases, or to define location and cause

CT in doubtful cases, or to define location and cause

AXR Contrast enema to localize level of obstruction

Intussusception

AXR and US Imaging-guided reduction unless contraindicated

Stress fracture

Abnormal stresses on normal bone Common at the metatarsals

VESICOURETERAL REFLUX (VUR)

Abnormal ureter at its junction with the bladder

dense enough to see on plain films

About 85% of urinary tract calculi are

NPO

HEPATOBILIARY EXAM patient preparation

Indications for renal cortical scintigraphy with 99mTc-DMSA:

Acute pyelonephritis in infants and young children 115 116 • Renal scars complicating urinary tract infection in children

is usually unilateral, and is defined as sudden, painful scrotal swelling The main differential diagnosis in this situation is torsion versus acute epididymo-orchitis.

Acute scrotum

of the prostate is the second most common malignancy in males, its incidence increasing steadily with age.

Adenocarcinoma

Normal Adenoma Metastasis Pheochromocytoma

Adrenal glands can be

Small bowel follow-through

Also single contrast Done immediately after an UGI

"added up" to give a numeric score

Amount of calcium seen in coronary arteries

the presence of CAD

Amount of calcium seen in coronary arteries "added up" to give a numeric score The score correlates with the probability of

uterus and ovaries look normal

An ectopic pregnancy may be present even if the

from those that may cause local invasion and metastases.

An increasing PSA level If either DRE or PSA are abnormal, prostate biopsy is performed. This is done under transrectal ultrasound (TRUS) guidance (Fig. 5.11). Less commonly, biopsies may be performed using a US-guided transperineal approach under general anaesthetic.

is the commonest cause of a benign solid renal mass in adults. Eighty per cent occur sporadically, and are usually small and asymptomatic.

Angiomyolipoma (AML) AMLs contain fat, giving them a characteristic appearance on US and CT; visible fat in a renal mass usually implies a benign aetiology.

What is shown in the following picture?

Apical four chamber view of the heart using echocardiography

types of aortic dissection

Ascending (Type A) Descending (Type B)

Hematoschezia Constipation Suspected diverticulitis Weight loss / anemia of unknown cause

BARIUM ENEMA (BE) lower gastrointestinal exam (LGI) indications

Placement of rectal tube Barium instilled by gravity Air pumped in

BARIUM ENEMA (BE) lower gastrointestinal exam (LGI) procedure

proximal and distal

BARIUM EXAMS How to Review a Barium Study look for ______and_____ segments

normal, dilated, or narrowed

BARIUM EXAMS How to Review a Barium Study structure caliber

normal or displaced

BARIUM EXAMS How to Review a Barium Study structure position

See through structure

BARIUM EXAMS(GI STUDIES) Double contrast (air contrast)

aspiration

BARIUM EXAMS(GI STUDIES) Gastrografin contraindicated for

suspected perforation

BARIUM EXAMS(GI STUDIES) Gastrografin for

NPO; "bowel prep" for barium enema

BARIUM EXAMS(GI STUDIES) Patient preparation

structure with a solid column

BARIUM EXAMS(GI STUDIES) Single contrast Outlines

smoot, innie or outie

BARIUM EXAMS How to Review a Barium Study mucosal surface/margin

DO NOT PLACE A CATHETER Call urologist Ascending urethrogram

BLADDER TRAUMA - RUPTURE If there is blood at the tip of the penis after a trauma -

intraperitoneal or extraperitoneal

BLADDER TRAUMA - RUPTURE may be

DEXA (Dual Energy X-ray Absorptiometry) Measures bone mineral density (BMD) at hip and lumbar spine Measured against young normals

BONE MINERAL DENSITY ASSESSMENT

T-SCORE ABOVE -1.0

BONE MINERAL DENSITY ASSESSMENT NORMAL

consolidation round pneumonia more common 2-3 years

Bacterial pneumonias usually have

Percutaneous transluminal angioplasty (PTA) is a procedure that can open up a blocked blood vessel using a small, flexible plastic tube, or catheter, with a "balloon" at the end of it. When the tube is in place, it inflates to open the blood vessel, or artery, so that normal blood flow is restored.

Balloon dilatation, stent, thrombolysis

tuberous sclerosis

Base on the accompanying CT appearances, what is the most likely underlying syndrome in this patient?

Adenoma

Benign mass May need MR to diagnose

US may also be used as a guide for various procedures including:

Biopsy of solid lesions or complicated cysts • Cyst aspiration for diagnostic and therapeutic purposes • Cyst ablation by injection of ethanol • Radiofrequency ablation of small tumours.

Fractures of the calcaneous can be measure using ____ angle?

Boehlers (normal measurement is 25-40 degrees)

Vertebral metastases

Bone scintigraphy

small bowel and colon look similar in neonates

Bowel obstruction

level of abnormality

Bowel obstruction try to assess

Normal No hemodynamically significant stenosis Hemodynamically significant stenosis Critical stenosis Completely occluded vessel

CAROTID DUPLEX levels

Horseshoe kidney Duplication of ureter Ectopia In general there can be errors in number, size, form, fusion, position Often associated with genital tract anomalies

CONGENITAL ANOMALIES

pulmonary veins

CONGESTIVE HEART FAILURE (CHF) Blood "backs up" into the

pump enough blood

CONGESTIVE HEART FAILURE (CHF) Left sided heart chambers cannot

be enlarged cardiomegaly

CONGESTIVE HEART FAILURE (CHF) heart MAY

bat-wing shaped

CONGESTIVE HEART FAILURE (CHF) lung pattern may appear

interstitial edema to avelolar edema

CONGESTIVE HEART FAILURE (CHF) progression from plump vessels (cephalization) to _____ to ____

From mild to severe to death

CONTRAST RISKS Allergic Reaction

Contrast gets out of the vein and into the tissues May cause pain / tissue loss

CONTRAST RISKS Extravasation

Contrast can decrease renal function Usually avoided if known renal disease

CONTRAST RISKS renal function

to aortic root, and into a coronary artery Contrast injected (intra-arterial)

CORONARY ANGIOGRAM(CARDIAC CATHETERIZATION) is a catheter at femoral artery threaded up to

asymptomatic patients only

CORONARY ARTERY DISEASE CT CALCIUM SCREENING for what kind of patients?

LLQ Diverticulitis

CT

LUQ Splenic

CT

Midepigastric/back Panc / Aorta

CT

RLQ Appendicitis

CT

aortic dissection

CT

Left lower quadrant pain

CT US in children and women of childbearing age

Right lower quadrant pain

CT US in children and women of childbearing age

Acute pancreatitis

CT US to search for gallstones

...

CT CONTRAST When and which kind? for GI tract assessment Not usually given for trauma

Intravenous (IV)

CT CONTRAST When and which kind? for solid organ assessment Vascular structures Allergies, nephrotoxicity

Staging of adenocarcinoma of prostate

CT abdomen and pelvis Bone scintigraphy MRI prostate

Diagnostic Imaging for Midepigastric / Back Pain

CT best for most indications

IV oral rectal

CT contrast types

is usually also performed to search for retroperitoneal lymphadenopathy, liver metastases and lung metastases.

CT of abdomen and chest

Complex cysts or solid renal masses found with US usually require further assessment with

CT or MRI.

Simple renal cysts are extremely common in adults. They are usually small and asymptomatic, discovered incidentally on ________

CT or US examinations of the abdomen. Simple cysts have thin walls and clear fluid contents.

pulmonary embolism

CT pulmonary angiogram V/Q scintigraphy in selected cases. e.g allergy to iodinated contrast material

investigation of choice for painless haematuria.

CT urography CT urography is a term used to describe a contrast-enhanced CT technique designed to provide excellent delineation of the renal collecting systems, ureters and bladder, as well as cross-sectional images of the kidneys and adjacent structures. Although the precise method may vary, CT urography usually consists of a multiphase examination including scans performed with sufficient delay after contrast material injection to allow opacification of the collecting systems and ureters

Painless haematuria

CT urography and cystoscopy US for further definition in selected cases

splenic evulation

CT with IV

Renal colic/flank pain

CT without contrast enhancement is the imaging test of choice for acute flank pain. AXR/KUB if ureteric calculus seen on CT Radiograph of kidneys, ureters and bladder (KUB) refers to a supine AXR done to diagnose and follow up renal or ureteric calculi

Cystic fibrosis

CXR

Pulmonary infection

CXR

pneumonia

CXR

Congestive cardiac failure

CXR echocardiography

Oesophageal atresia and tracheo-oesophageal fistula

CXR and AXR

A valve

Can be normally functioning Can be stenotic (too tight) Can be regurgitant or insufficient (too loose) Can have vegetations (growths)

What is shown in the following image?

Cardiomegaly. CT ratio greater than 50%. Also, costophrenic angles are blunted, indicating pleural effusion.

Acute mesenteric ischaemia

Catheter angiogram Interventional radiology

affected as well

Chamber or vessel "behind" is often

are poor

Clinical exams for PE and DVT

radiolucent, including fish bones

Coins, bone, food, plastic Most (except coins) are

Crohn disease

Colonoscopy CT or MR enterography AXR in acute presentation

Ulcerative colitis

Colonoscopy AXR in acute presentation

HYDRONEPHROSIS

Congenital obstruction from duplex system Congenital UPJ obstruction

Characterization of complex renal cyst found on ultrasound

Contrast enhanced CT (CT urography)

is used for further characterization of a solid lesion or complex cyst found on US.

Contrast-enhanced CT CT is more accurate than US for characterization of internal contents of a mass, in particular to show areas of fat confirming the diagnosis of AML

heart muscle Primarily the left ventricle

Coronary arteries feed the

claudication

Crampy type pain in lower extremity

the gold standard investigation for tumours of the lower urinary tract.

Cystoscopy accompanied by ureteroscopy Retrograde pyelography may also be performed at the time of cystoscopy where upper urinary tract tumour is suspected.

TRANSIENT TACHYPNEA OF THE NEWBORN (TTN)

Delayed resorption of pulmonary amniotic fluid Increased lung volumes Linear densities Small pleural effusions Clears in 1-2 days

edema, pain and redness

DEEP VENOUS THROMBOSIS (DVT) causes

US (or venogram)

DEEP VENOUS THROMBOSIS (DVT) diagnosed with

veins

DEEP VENOUS THROMBOSIS (DVT) forms in

Thickening of the nuchal translucency may be associated with

Down syndrome and other types of fetal aneuploidy.

US and plain films

Developmental dysplasia of the hip (DDH) diagnosed with

Twin pregnancy, when recognized on US examination, may be classified as follows:

Dichorionic diamniotic • May be dizygotic or monozygotic May be dizygotic or monozygotic • Dizygotic may be different sex; monozygotic are same sex • Separating membrane seen between the fetuses • Separate placentas may be identified • Mortality rate 9 per cent Monochorionic diamniotic • Monozygotic, therefore same sex • Separating membrane between the fetuses may be seen • Single placenta • Mortality rate 26 per cent Monochorionic monoamniotic • Monozygotic, therefore same sex • No separating membrane • Single placenta • Mortality rate 44 per cent.

Atherosclerosis

Dilated, tortuous, plaque

The most likely diagnosis in this patient with LLQ pain is..

Diverticulitis

Liver mass: characterization

Dynamic contrast enhanced imaging: CT, MRI, CEUS

Screening for CAD

Exercise stress test: ECG echocardiography perfusion scintigraphy CT coronary angiography catheter coronary angiogrpahy CT calcium score

face, scalp

External carotid artery (ECA) to

Radiopaque

FOREIGN BODIES such as Metal, gravel, glass seen on on plain films as

CEUS, contrast-enhanced ultrasound; ERCP, endoscopic retrograde cholangiopancreatography; KUB, radiograph of kidneys, ureters and bladder; MRCP, magnetic resonance cholangiopancreatography; PTC, percutaneous transhepatic cholangiography; RBC, red blood cells.

FYI

may project into the endometrial cavity or, alternately, may lie on the surface of the uterus or may even be attached by a stalk of tissue (pedunculated). Pedunculated fibroids may lie in the pelvis lateral to the uterus (adnexa) and may be difficult to distinguish from a solid ovarian tumour.

Fibroids

HYPERTROPHIC PYLORIC STENOSIS

First-born male 2-6 weeks old Nonbilious vomiting Thickened pyloric muscle -Palpable "olive

acute Pyelonephritis

Flank pain, fever, pus in urine (pyuria) May progress to renal abscess usually to imaged

minor or major

Fluid in the fissures can be

Kerley B lines

Fluid in the interstitium

PERICARDIAL EFFUSION

Fluid in the pericardial space

What is pericardial effusion?

Fluid in the pericardial space

Aneurysm

Focal bulge in one or more areas

25% due to Carcinoma (CA) 25% due to Infection 15% due to calculi (stones) Cystoscope (sometimes with retrograde pyelogram) usually needed along with imaging

For Non-traumatic hematuria:

US

For most female genital system assessment, ___ is the first exam

total knee replacement: complicated by fracture

From the accompanying images of a patient that has undergone jt replacements, please choose the most likely diagnosis from the list below

Signs of a failed pregnancy on TVUS include:

Gestational sac >20 mm with no fetal pole identified Fetal pole >5 mm with no fetal heartbeat identified.

CT without contrast

Great for calculi, doesn't show much else

Macroscopic (visible) or Microscopic Traumatic or Non-traumatic

HEMATURIA can be

radiopharmaceutical -morphine/cck

HEPATOBILIARY EXAM _____ GIVEN IV

HIDA SCAN

HEPATOBILIARY EXAM aka

Surfactant deficiency -AKA respiratory distress syndrome (RDS) -prematurity Low lung volumes Patchy, granular densities in the lungs Air bronchograms Shows up 4-6 hours after birth

HYALINE MEMBRANE DISEASE (HMD)

obstruction

HYDRONEPHROSIS

US (IVP) Nuclear medicine renogram and renal scan with Lasix

HYDRONEPHROSIS may do

US (or UGI)

HYPERTROPHIC PYLORIC STENOSIS diagnosed by

From kidney, ureter, bladder, urethra

Hematuria from

the heart touches the lateral chest wall, it's enlarged

How can you tell if the heart is enlarged on an AP (usually portable) film

C - Upper lobe collapse and consolidation

How is the abnormality of the right lung best described? A - Pneumothorax B - Hyperexpansion C - Upper lobe collapse and consolidation D - Lower lobe collapse

Plain Films Barium Studies Nuclear Medicine Ultrasound (US) Computed Tomography (CT) Magnetic Resonance (MR)

IMAGING MODALITIES

Plain films series Then straight to the highest yield test Gallbladder/bile ducts: US or HIDA GI tract except for small bowel Endoscopy (versus barium studies) Small bowel: barium studies or CT Specialty exams for certain instances JUST ABOUT EVERYTHING ELSE: CT

IN THE REAL WORLD...

pyelonephritis cystitis

INFECTION can be

not very sensitive

INFECTIONS Plain films are ________ for these conditions, especially early osteomyelitis

If it completely obstructs the bronchus -Atelectasis -Volume loss Ball-valve (partial) obstruction -Air-trapping Peanut in RT main bronchus (more vertical) -Common from 9 months - 3 years of age Inspiration / expiration Bilateral decubitus films

INHALED (ASPIRATED) FOREIGN BODY

air trapping

INHALED (ASPIRATED) FOREIGN BODY Ball-valve (partial) obstruction

Atelectasis Volume loss

INHALED (ASPIRATED) FOREIGN BODY If it completely obstructs the bronchus Atelectasis Volume loss

pneumonia can develop

INHALED (ASPIRATED) FOREIGN BODY If undetected,

Biopsy - Angiography TIPSS Biliary drainage / stent placement

INTERVENTIONAL TECHNIQUES

venous access PTA IVC filter placement vascular embolization endovascular abdominal aoritc aneurysm repair

INTERVENTIONAL TECHNIQUES IN THE PERIPHERAL VASCULAR SYSTEM

Pain, vomiting, palpable abdominal mass, rectal bleeding

INTUSSUSCEPTION can cause

Currant-jelly

INTUSSUSCEPTION can cause _____ stools

barium enema, except with shock or perforation

INTUSSUSCEPTION may be reduced by

telescopes into the next part

INTUSSUSCEPTION one part of bowel

Order an MR hip (CT hip)

If a fracture is suspected, but the films look normal

Back pain

Imaging not indicated in most cases Radiography MRI/CT for radiculopathy/myelopathy Imaging indicated in neck and back pain for chronic, relapsing or unremitting pain, or in the presence of clinical 'red flags' (see above)

Neck pain

Imaging not indicated in most cases Radiography MRI/CT for radiculopathy/myelopathy Imaging indicated in neck and back pain for chronic, relapsing or unremitting pain, or in the presence of clinical 'red flags' (see above)

Pigg-o-stat

Immobilizes child Artifacts

heart is farther from the film and is more magnified

In an AP film, the heart is ____ from the film and is ____

First, do a thorough history and careful physical exam Next, obtain relevant blood work Then obtain relevant plain films Only then should a barium study or cross-sectional study be considered

In the ideal world...

brain

Internal carotid artery (ICA) to

Malignancies of the female reproductive system are staged by the

International Federation of Gynaecology and Obstetrics (FIGO) These classification systems are also converted into the TNM system and published by the American Joint Committee on Cancer (AJCC).

Percutaneous Nephrostomy (PCN) Ureteral Stent -Antegrade or retrograde Shock Wave Lithotripsy (ESWL) Percutaneous Nephrolithotomy Renal Artery Embolization

Interventional Techniques

is also known as intravenous urogram (IVU).

Intravenous pyelogram (IVP)

What is shown in the following picture?

Intravenous vena cava filter (arrow)

What is the cardiothoracic ratio (CT ratio), and what is the normal value?

It is the width of the heart compared to the width of the chest, and a normal value is ~50% or less.

Ectopia

Kidney in wrong spot

Lung CA Renal CA Breast CA Multiple myeloma

LYTIC LESION Typical for metastatic disease from

may invade beyond the bladder wall and cause hydronephrosis due to obstruction of the distal ureters

Large or advanced bladder tumors It follows from the above that the imaging assessment of painless haematuria requires visualization of the renal parenchyma to exclude a renal mass, plus visualization of the urothelium. This includes imaging of the collecting system, renal pelvis, ureters and bladder.

solid organ well

MAGNETIC RESONANCE IMAGING (MRI) Assesses ______ well

gadolinium

MAGNETIC RESONANCE IMAGING (MRI) ______ contrast often used

A very strong magnetic field Radiofrequency energy

MAGNETIC RESONANCE IMAGING (MRI) forms images by the interaction of:

for problem-solving in the abdomen

MAGNETIC RESONANCE IMAGING (MRI) mainly for

Chest radiography (PAL CXR) Ultrasound Nuclear Medicine / SPECT Computed Tomography (CT / CTA / CTV) Magnetic Resonance (MR / MRA / MRV) Contrast Angiography

MODALITIES

Intravenous Pyelogram (IVP) / Urogram (IVU) Cystogram / urethrogram Retrograde / antegrade pyelogram Hysterosalpingogram (HSG) Ultrasound CT Nuclear Medicine MR Angiography / interventional

MODALITIES

Radiculopathy New or worse neurological deficit

MR spine recommended for:

Radiographs are mostly used for arthopathy but you can also use ____for better synovial views?

MRI

increasingly used as a problem-solving modality in the characterization of renal and adrenal masses, and in the staging of prostatic carcinoma.

MRI

is the investigation of choice for early stage disease as it is more accurate than US in the assessment of depth of myometrial invasion and invasion of the cervix

MRI

is the investigation of choice for measuring tumour size and assessing depth of uterine invasion and local tumour extension in the pelvis.

MRI

may be used for the diagnosis of uterine disorders including adenomyosis and endometriosis. is also used for staging of gynaecological malignancies.

MRI

Sciatica

MRI CT where MRI is unavailable

is the imaging investigation of choice for local staging of prostate carcinoma.

MRI T2-weighted scans are able to display the architecture of the prostate including differentiation of central and peripheral zones. Carcinoma is usually seen as a low signal mass in the peripheral zone.

In some centers,_____ is used in preference to CT for the investigation and characterization of renal masses.

MRI The most common indication for renal mass biopsy is for management of a MRI generally gives similar information to CT in the detection, classification and staging of renal cysts and tumours.

acute crush fracture

MRI: saggittal STIR of the lumbar spine

pseudoaneurysm/tear

MVA motor vehicle accident likely to cause

at rest after IV injection of radioactive tracer Heart is imaged at rest after IV injection of radioactive tracer Patient exercises on treadmill Re-injection of tracer Heart is re-imaged Looking for differences between rest and stress images

MYOCARDIAL PERFUSION SPECT STRESS TEST Heart is imaged

NEPHROSTOMY

Method to relieve obstruction

CT with contrast

More complete picture Ionizing radiation, contrast risk

Rest pain

More severe, may lead to tissue loss

in women are ovarian in origin. Other possible causes of an adnexal mass would include bowel tumour, abscess or postoperative fluid collection.

Most adnexal masses

Properly positioned Thickened epiglottis (looks like a thumb)

NECK IMAGING Lateral soft tissue neck film

2 to 7 years old Severe sore throat and fever Difficult inspiration Patient may be drooling

NECK IMAGING Epiglottitis

drain to the outside

NEPHROSTOMY allows urine to

renal pelvis

NEPHROSTOMY need passed through to the

position the tip in the renal pelvis

NEPHROSTOMY wire and catheter use dot

neural crest

NEUROBLASTOMA has __ origin

adrenal glands

NEUROBLASTOMA often in

in posterior mediastinum or along sympathetic chain system

NEUROBLASTOMA sometimes

Uncomplicated febrile seizure -6 months to 4 years -generalized Uncomplicated asthma -Known asthmatics, simple attack Uncomplicated gastroenteritis -Acute onset of diarrhea +/or vomiting

NO IMAGING NEEDED

Fractures inconsistent with the history Fractures in different stages of healing Fractures at unusual sites -sternum or scapula Be aware of disease mimics -Vitamin D deficiency; -osteogenesis imperfecta Refer to pediatric radiologist

NON-ACCIDENTAL INJURY(CHILD ABUSE)

pediatric radiologist

NON-ACCIDENTAL INJURY(CHILD ABUSE) refer to

Menstrual age is 2 weeks greater than conceptual age (menstrual age used) Visible by about 5 weeks EGA (estimated gestational age - menstrual age) Shows the gestational sac within the uterus May see embryo, heartbeat, yolk sac

NORMAL 1ST TRIMESTER GESTATION

5 Weeks EGA (estimated gestational age - menstrual age)

NORMAL 1ST TRIMESTER GESTATION Visible by about

embryo, heartbeat, yolk sac

NORMAL 1ST TRIMESTER GESTATION may see

uterus

NORMAL 1ST TRIMESTER GESTATION shows the gestational sac within the

Routine OB US is not necessary -Often done to see fetal sex Allows measurement of fetus to determine if growth is normal Shows development of fetal anatomy Shows cervix, placenta and amniotic fluid Usually done at 18-22 weeks May be repeated as necessary

NORMAL 2ND / 3RD TRIMESTER GESTATION

if growth is normal

NORMAL 2ND / 3RD TRIMESTER GESTATION allows measurement of fetus to determine

not necessary Often done to see fetal sex

NORMAL 2ND / 3RD TRIMESTER GESTATION routine OB US is

cervix, placenta, and amniotic fluid

NORMAL 2ND / 3RD TRIMESTER GESTATION shows

of fetal anatomy

NORMAL 2ND / 3RD TRIMESTER GESTATION shows development

18-22 weeks

NORMAL 2ND / 3RD TRIMESTER GESTATION usually done at

Normal inspiration -Posterior 8th rib -Anterior 6th rib Normal thymus -Sail sign -Up to 2-3 years old "Babygram" Pigg-o-stat -Immobilizes child -Artifacts

NORMAL CHEST X-RAY

Check for stones -phleboliths Check gas pattern Assess patient for contrast reaction

NORMAL IVP - SCOUT check and assess for

Reflux (gastro-esophageal or GERD) exam Gastric emptying exam GI Bleeding scan Labeled white blood cell exam Liver-spleen scan Hepatobiliary scan Meckel's scan

NUCLEAR MEDICINE STUDIES

interventional techniques (stent, angioplasty)

Narrowing may be re-opened by

Laryngotracheobronchitis (LTB) 6 months to 3 years old "Brassy cough": barking seal Ballooning of pharynx / hypopharynx on lateral film Steeple sign on AP X-ray signs are not specific

Neck imaging Croup

IVP

No longer a common first test Ionizing radiation, contrast risk

Ultrasound

Noninvasive, but doesn't show ureters well

Posterior 8th rib Anterior 6th rib

Normal inspiration

vertebral body disk space pedicle posterior spinous process

Normal lumbar spine label Red lines from top to bottom

A chamber or vessel can be

Normal size Dilated (too big) Restricted (too small) Or it can have a thickened or thinned wall

Insufficiency fracture

Normal stresses on abnormal bone Common at the sacrum

Sail sign Up to 2-3 years old

Normal thymus

UPJ: ureteropelvic junction UVJ: ureterovesicular junction Where the ureter crosses over the pelvis margin

OBSTRUCTION (HYDRONEPHROSIS) common levels

decrease

OBSTRUCTION (HYDRONEPHROSIS) if long duration, renal function may

CT w/o contrast (stone protocol exam)

OBSTRUCTION (HYDRONEPHROSIS) protocol should be

Calculi (stones) Tumor Stricture (scarring)

OBSTRUCTION (HYDRONEPHROSIS) several causes, most often due to

Duodenal obstruction Atresia Hirschsprung disease Meconium ileus Meconium plug syndrome Malrotation Midgut volvulus

OTHER GI TRACT ABNORMALITIES

May be cystic, complex or solid May be benign or malignant

OVARIAN MASS may be

Metastasis

Often from lung CA

-1.0 and -2.5

Osteopenia: T-score between

below -2.5 Higher risk for fracture

Osteoporosis: T-score

removed

Ovarian mass often need to be

many indeterminate studies

PE Nuclear Medicine ventilation/perfusion (V/Q) lung scan:

CT pulmonary angiogram

PE most common method used currently

Developmental dysplasia of the hip (DDH) Perthes disease Slipped capital femoral epiphysis (SCFE)

PEDIATRIC HIP PROBLEMS

"water bag" configuration

PERICARDIAL EFFUSION described as a

Pressure waveform studies MRA, CTA, contrast angiogram

PERIPHERAL ARTERIAL DISEASE (PAD) Assessed with

the muscles of the affected limb due to vessel stenosis

PERIPHERAL ARTERIAL DISEASE (PAD) Decreased blood flow to

venous access

PICC line, tunnelled catheter, implanted port

Look at the lung bases and CP angles Follow the gas pattern (hollow organs) Look at the solid organs / positions Look at the psoas muscle margins Look at the skeleton Assess any calcifications Is everything where it should be?

PLAIN FILMS How to Review an Abdomen Film

medially or at lung base

PNEUMOTHORAX (PTX) look for lucency

difficult to detect

PNEUMOTHORAX (PTX) patient often supine, _______

claudication

PRESSURE WAVEFORM STUDYANKLE-BRACHIAL INDEX (ABI) 0.5 to 1.0

rest pain

PRESSURE WAVEFORM STUDYANKLE-BRACHIAL INDEX (ABI) < 0.5

Normal

PRESSURE WAVEFORM STUDYANKLE-BRACHIAL INDEX (ABI) About 1.0 or greater

both arms and ankles

PRESSURE WAVEFORM STUDYANKLE-BRACHIAL INDEX (ABI) blood pressures at

is non-specific and may be elevated in nodular hyperplasia and chronic prostatitis, as well as prostatic carcinoma.

PSA

if ruptured

PSEUDOANEURYSM / TEAR high mortality if

contained or ruptured

PSEUDOANEURYSM / TEAR may be

arch, just past origin of LT subclavian artery

PSEUDOANEURYSM / TEAR typically at

Percutaneous transluminal coronary angioplasty used in a coronary angiogram

PTCA stands for what? & used in ______?

IVC, right side of heart and then the pulmonary artery, where it plugs a vessel (embolizes)

PULMONARY EMBOLISM - PE Part of a clot (deep venous thrombus - DVT) from a leg or pelvic vein breaks loose and goes to the

Pneumothorax Pneumomediastinum Pneumopericardium

PULMONARY INTERSTITIAL EMPHYSEMA (PIE) can lead to

the periphery

PULMONARY INTERSTITIAL EMPHYSEMA (PIE) irregular radiolucencies extending towards

Cervical cancer is the third most common gynaecological malignancy. Mortality from cervical cancer has decreased over the last 40 years due to widespread use of the

Papanicolaou (pap) smear.

is usually performed under general anaesthetic. A retrograde ureteric catheter is inserted via cystoscopy to opacify the renal collecting system with contrast material and to prevent calculus fragments passing down the ureter. The renal collecting system is then punctured with a needle followed by passage of a guidewire. A tract into the collecting system is made with a series of dilators and the renal stone extracted.

Percutaneous nephrolithotomy

to plaque rupture (ACS)

Plaque buildup (atherosclerosis) narrows the vessel; may lead

enlargement of left atrium

Please choose the dominant finding relevant to cardiovascular disease with reference to the attached CXR

TORCH

Pneumonia ________ in neonates

viral, may be bacterial in orgin

Pneumonia often

ECTOPIC PREGNANCY

Pregnancy that develops outside the uterine cavity (tubal pregnancy)

refers to obstructive voiding symptoms due to prostatic enlargement

Prostatism

70% of cases

Pulmonany embolism diagnosis has been missed in up to

non specific

Pulmonary embolism CXR

acute chronic diabetics

Pyelonephritis can be

Lower GIT bleeding

RBC scintigraphy CT angiography Treat bleeding with interventional radiology or surgery

medications

RENAL ARTERY STENOSIS (RAS) HTN not controlled with

Atherosclerosis Fibromuscular dysplasia (FMD) common in young women

RENAL ARTERY STENOSIS (RAS) can cause

<5% o f HTN

RENAL ARTERY STENOSIS (RAS) causes

MRA (or Nuclear medicine captopril renogram or RA US or angiogram) Intervention

RENAL ARTERY STENOSIS (RAS) diagnosed with

CT

RENAL TRAUMA usually do ____ for gross (macroscopic) hematuria

CT easy to measure fat

RENAL TUMOR - BENIGNANGIOMYOLIPOMA (AML) ____ is often diagnostic

Fibrous dysplasia

Radiography CT for complex areas, e.g. craniofacial

Trauma: suspected fracture or dislocation

Radiography CT in selected cases for further definition of anatomy MRI in selected cases for detection of subtle fractures not shown on radiographs, e.g. scaphoid

Spondylolysis and spondylolisthesis

Radiography SPECT-CT MRI if sciatica is the dominant symptom

Non-accidental injury

Radiography (skeletal survey)

LYTIC LESION

Relatively rapid destruction of bone Leaves a "black hole" with irregular edges

is used to assess renal function and urodynamics, including calculation of the percentage of total renal function contributed by each kidney. is used in renal transplant to assess transplant perfusion and function, diagnose rejection or acute tubular necrosis, and detect urinary leak or outflow obstruction.

Renal scintigraphy

Angiotensin-converting enzyme (ACE) inhibitor renogram Indication: screening test for renal artery stenosis in suspected renovascular hypertension.

Renal scintigraphy with injection of captopril

Diuresis renogram Indication: differentiation of mechanical urinary tract obstruction from non-obstructive hydronephrosis

Renal scintigraphy with injection of furosemide

muscular HYPERTROPHY OR WALL THICKENING

Response to increased PRESSURE (HTN or valvular stenosis) is usually

CHAMBER ENLARGEMENT OR DILATATION

Response to increased VOLUME (valvular regurgitation / insufficiency or fluid overload) is usually

is usually performed in the operating theatre, in conjunction with formal cystoscopy.

Retrograde pyelogram (RPG)

The most common clinical presentation of endometrial carcinoma is postmenopausal bleeding. Fifteen per cent of women with postmenopausal bleeding will have endometrial carcinoma. The FIGO staging system for endometrial carcinoma is as follows: The most common clinical presentation of endometrial carcinoma is postmenopausal bleeding. Fifteen per cent of women with postmenopausal bleeding will have endometrial carcinoma. The FIGO staging system for endometrial carcinoma is as follows:

Stage 0: carcinoma in situ • Stage I: tumour limited to the uterus • Stage IA: tumour limited to the endometrium • Stage IB: invasion of less than 50 per cent of the myometrium • Stage IC: invasion of more than 50 per cent of the myometrium • Stage II: invasion of the cervix with no extrauterine extension • Stage III: extension beyond the uterus, but not outside the pelvis • Stage IV: invasion of bladder or rectum, or distant metastases.

RCC tumour up to 7 cm confined to kidney

Stage I

tumour >7 cm confined to kidney RCC

Stage II

RCC invasion of adrenal gland, perinephric fat or IVC, and/or involvement of one regional lymph node

Stage III

RCC local invasion beyond Gerota's fascia; spread to more than one lymph node; distant metastasis.

Stage IV

Hemodynamically significant stenosis

System unable to compensate

D - Bones A pacemaker is in place but the heart is not enlarged. There is minor shadowing of the right lung base adjacent to the pleural effusion. Elsewhere, detail of the lungs is reduced by the abnormal bones which are abnormally dense.

There is a small right pleural effusion. Which other structures are most strikingly abnormal? A - Heart chambers B - Lungs C - Soft tissues D - Bones

D - Left mastectomy

There is evidence of which previous operation? A - Thyroidectomy B - Mitral valve replacement C - Right pneumonectomy D - Left mastectomy

Pathological fracture

Through a point of weakness due to a bone abnormality or lesion

peptic ulcer disease

UGI

Suspected cholecystitis Abnormal lab values suggesting: -Liver disease -Biliary disease Suspected appendicitis (children) Follow-up

ULTRASOUND (US) indications

Patient size Intervening bowel gas

ULTRASOUND (US) limitations

NPO

ULTRASOUND (US) patient preparation

Liver, gallbladder, bile ducts Spleen, pancreas, appendix

ULTRASOUND (US) structures seen

Arterial access Pressure monitoring Enters umbilicus, curves down to pelvis, ascends to left of spine Tip should be at about: -T8 level OR -L3 level

UMBILICAL ARTERY CATHETER

T8 level OR L3 level

UMBILICAL ARTERY CATHETER Tip should be at about:

umbilicus, curves down to pelvis, ascends to left of spine

UMBILICAL ARTERY CATHETER enters

Venous access Pressure monitoring Enters at umbilicus, goes towards liver, along right side of spine Tip projects at IVC or right atrium level

UMBILICAL VEIN CATHETER

distal esophagus, stomach and duodenum

UPPER GASTROINTESTINAL EXAM (UGI) Usually includes what three structures?

Suspected ulcer Hematemesis Persistent vomiting Weight loss / anemia of unknown cause Abnormal plain films

UPPER GASTROINTESTINAL EXAM (UGI) indications

above or below

URETERAL STENT can be placed from

help urine get past an obstructing stone, tumor, or stricture

URETERAL STENT placed to

ureter renal pelvis cortex/medulla

URINARY TRACT CALCULI may be in

nephrocalcinosis

URINARY TRACT CALCULI may be in the cortex/medulla

nephrolithiasis if large, called a staghorn calculus

URINARY TRACT CALCULI may be in the renal pelvis

obstruction

URINARY TRACT CALCULI may or may not cause

Acute scrotum

US

Hypertrophic pyloric stenosis

US

Prostatism

US

RUQ Cholecystitis

US

Right upper quadrant pain

US

Scrotal mass

US

Second and third trimester complications, such as placental abruption or suspected intrauterine growth retardation,use what?

US

Urinary frequency and nocturia

US

What study should be performed first in a 20 yo female with RLQ pain?

US

Young female pelvic/LQ pain

US

spleen

US

Urinary tract infection

US MAG3 scintigraphy for suspected obstruction MCU ± DMSA in selected cases

Liver mass: detection

US CT or MRI following US

Hydronephrosis

US MAG3 scintigraphy

is the initial investigation of choice for diagnosis of suspected renal mass, followed by CT.

US US will accurately characterize a renal mass as a simple cyst, complex cyst or a solid mass.

For rotator cuff tear ' which is usually wear and tear' which two image modalities are best to be used?

US MRI

Abdominal trauma

US 'FAST' scan CT in haemodynamically stable ___________________________ Interventional radiology for acute bleeding Urethrogram and CT cystogram

the principal imaging investigations used for assessment of the urinary tract in both males and females.

US / CT

Renal mass

US and CT MRI in some centres Biopsy in selected cases

Abdominal mass

US for initial assessment CT/MRI for further characterization and staging

abdominal aortic aneurysm

US for surveillance CT for preoperative planning CT for suspected leak

acute epididymo-orchitis: where imaging is required, what is investigation of choice

US with color Doppler US is quick, non-invasive and highly accurate at differentiating torsion from inflammation.

is the first investigation of choice for a scrotal mass. The primary role is to differentiate intratesticular from extratesticular masses; in most cases, this is sufficient to distinguish malignant and benign lesions.

US with colour Doppler

Jaundice

US, MRCP Other imaging/intervention as indicated: ERCP, PTC

Varicocele consists of dilated veins of the pampiniform plexus producing a tortuous nest of veins well seen on

US. The vascular nature of the mass is confirmed with colour Doppler. Most varicoceles occur on the left and present with a clinically obvious mass or with infertility. Small asymptomatic varicoceles are common incidental findings on scrotal US. Varicoceles are caused by venous incompetence in most cases. Large varicoceles associated with infertility or discomfort may be amenable to therapeutic embolization of the testicular vein.

very

UTERINE MASS - FIBROID (LEIOMYOMA) is how common?

asymptomatic

UTERINE MASS - FIBROID (LEIOMYOMA) may be

vaginal bleeding

UTERINE MASS - FIBROID (LEIOMYOMA) may cause

menses or hormones

UTERINE MASS - FIBROID (LEIOMYOMA) may influence or be influenced by

Cardiac (Echocardiography / TEE) Vascular (Duplex / Color Doppler)

Ultrasound

Antegrade insertion is performed where the lower ureter is occluded making retrograde insertion impossible:

Under imaging guidance, the renal collecting system is punctured with a needle and a guidewire passed through the needle down the ureter and into the bladder. • The stent is then passed over the guide wire and pushed into position. • The upper pigtail of the stent should lie in the renal pelvis or upper pole calyx. • The lower pigtail should lie in the bladder (Fig. 5.13).

subcutaneous tissue

VENTRICULOPERITONEAL (VP) SHUNT CATHETER runs in the

tip is in the ventricle, and the tube brings excess CSF to the abdomen - peritoneum (or vascular system)

VENTRICULOPERITONEAL (VP) SHUNT CATHETER tip is in the

patients with hydrocephalus

VENTRICULOPERITONEAL (VP) SHUNT CATHETER used in

lead to recurrent infections

VESICOURETERAL REFLUX (VUR) if left untreated it can

cystourethrogram or nuclear medicine cystogram

VESICOURETERAL REFLUX (VUR) voiding

Greyscale Spectral Doppler Color / Power Doppler

Various modes of CAROTID DUPLEXULTRASOUND (US)

OVARIAN CYST

Very common May have more than one Change with menstrual cycle

normal or near normal, CXR interstitial pattern common up to 2 years

Viral pneumonias often have

10%

WILM'S TUMOR (NEPHROBLASTOMA) ______ bilateral

US Or CT

WILM'S TUMOR (NEPHROBLASTOMA) diagnosed by

1-5 years

WILM'S TUMOR (NEPHROBLASTOMA) presents at

Magnetic resonance cholangiopancreatography (MRCP) is a special type of magnetic resonance imaging (MRI) exam that produces detailed images of the hepatobiliary and pancreatic systems, including the liver, gallbladder, bile ducts, pancreas and pancreatic duct.

What is Magnetic Resonance Cholangiopancreatography (MRCP)?

B - Pneumoperitoneum Free gas under the diaphragm forms crescents of low density (black) under each hemidiaphragm. In the setting of acute abdominal pain this is a sign of bowel perforation.

What is the life threatening abnormality? A - Tension pneumothorax B - Pneumoperitoneum C - Pneumobilia D - Pulmonary oedema

A - Lung cancer Compare the meniscus sign with increased density beneath (effusion) with the normal right hemidiaphragm. When you see a pleural effusion don't forget to think of the causes. Sometimes the cause is visible, as on this image

What is the likely cause of the pleural effusion in this smoker with finger clubbing? A - Lung cancer B - Heart failure C - Sarcoidosis D - Systemic lupus erythematosus

A - Sarcoidosis Sarcoidosis is characterised by bilateral hilar adenopathy (arrowheads) and certain clinical features such as erythema nodosum (shin rash).

What is the likely diagnosis in this patient with a rash on the shins? A - Sarcoidosis B - Lung cancer C - HIV D - Asbestosis

autosomal dominant

What is the most likely mode of inheritance of the condition shown on the accompanying CT?

B - Extensive surgical emphysema

What is the striking abnormality? A - Poor quality image B - Extensive surgical emphysema C - Cardiomegaly D - Pneumoperitoneum

A - Lung fibrosis This patient has had a spontaneous pneumothorax secondary to underlying lung fibrosis. There is an extensive reticular pattern seen throughout both lungs.

What is the underlying cause of the right pneumothorax? A - Lung fibrosis B - Metastatic disease C - Emphysema D - Trauma

normal supine abdomen phleboliths

What position is this? what is arrow pointing to?

one of the pedicles is missing

What's missing is the key-1? this close up frontal view of the lower thoracic spine. Can you tell how the radiologist looked at this radiograph and wondered if the patient had lung cancer?

a metallic filling in the distal esophagus

Where did I put that tooth? the patient's physician ordered a barium swallow. This is a view of the esophagogastric junction. It shows

A - Azygos fissure

Which anatomical variant is visible? A - Azygos fissure B - Cervical rib C - Dextrocardia D - Pectus excavatum

B - Air bronchogram

Which radiological sign is beautifully demonstrated in the left lung? A - Air pneumogram B - Air bronchogram C - Air radiogram D - Air tomogram

CTA, MRA or angiogram

With Coronary Artery Disease we can image the narrowing with

flow laser, atherectomy, stent

With coronary angiogram lots of gadgets used to re-establish _____. What are some examples of gadgets?

Nonradiopaque: not seen on plain films May be able to see with US

Wood, plastic, pencil lead:

What is the choice for imagining for dislocations and fractures?

X-Rays (radiographs)

diabetics Pyelonephritis

Xanthogranulomatous pyelonephritis Emphysematous pyelonephritis

heavy alcohol ingestion pancreas (; most often from alcoholism

You look at this radiograph and say the patient's pain probably comes from

hyperinflated

______ lungs in CHRONIC LUNG DISEASEBRONCHOPULMONARY DYSPLASIA (BPD)

How will metastasis look like on a xray?

a less dense spot through the bone (gray)

small percentage of benign cysts have more complex features and are classified as complex cysts. Causes of a complex cyst include

a simple cyst complicated by haemorrhage or infection, benign cyst containing septations or calcifications, or a cystic tumou

Transvaginal US (TVUS) utilizes a

a transvaginal probe and provides better anatomical detail of the uterus and ovaries.

burst fracture

accompanying transverse CT of the lumbar spine

PULMONARY INTERSTITIAL EMPHYSEMA (PIE)

air in the interstitial space

A chromosomal abnormality can only be confirmed by

amniocentesis or chorionic villous sampling (CVS).

In first trimester the most important factors to establish on US are the presence and appearance of

an intrauterine gestational sac.

Hydrocele is seen on US as

anechoic fluid surrounding the testicle. Hydrocele may be congenital, idiopathic, or secondary to inflammation, torsion, trauma or tumour.

GI bleeding

angiography for

clavicle over 3rd rib

angulation

What does colles fracture consists of?

angulation of the bone and a transverse fracture

What is a seconday ossification center that arises from growing bone (forms from a protrussion of growing bone)?

apopyhsis

What are MRI and CT use for in the musculoskeltal system?

assessing specific problems

The most common ovarian tumour in premenopausal women is

benign cystic teratoma or 'dermoid cyst'. Dermoid cysts contain fat, hair and sometimes teeth, and are bilateral in 10 per cent of cases. Dermoid cysts are seen on US as complex cystic or solid lesions with markedly hyperechoic areas due to fat content

hematuria

blood in the urine

any primary tumor can metastases into ____?

bone

What is another name for scintigraphy in muscloskeltal?

bone scan

What are complete fractures?

bone that break all the way through

What does non-union mean?

bone will never unite unless there is some intervention

What are incomplete fractures?

bones that do not break all the way through

What are two rotator cuff disorders?

calcific tendonisis degenerative tendonosis of the rotator cuff tear

calcification of the stylohyoid ligament

calcification in the neck the blue arrows point to

Costal (rib) cartilages Gallstone (cholelithiasis) Kidney stone (nephrolithiasis) Appendicolith Phlebolith Arterial calcifications - aortoiliac, splenic Calcified uterine fibroid (leiomyoma) Calcified lymph nodes Prostate calcifications

calcifications examples

Pericardial effusion somewhat mimics ___________.

cardiomegaly

Internal carotid artery (ICA) External carotid artery (ECA)

carotid bifurcation consist of

____ is not seen on radiograph? Which modality is it seen best with?

cartilage (HYALINE) MRI

Where do you see most incomplete fractures?

children

investigation of choice for CAD depends on what factors

clinical presentations cardiac risk factors local expertise and availabilyt

angiography (For GI BLEEDING)

coils or vasopressin

What is a very popular distal radius fracture?

colles fracture

multiple pregnancy Risks to the fetuses include an increased incidence of

congenital anomalies, intrauterine growth retardation and low birthweight, and premature labour.

What disease do the following indicate? 1. left-sided heart chambers cannot pump enough blood 2. blood "backs up" into the pulmonary veins 3. heart *MAY* be enlarged 4. possible "bat wing" lung pattern 5. progression from "plump" vessels (cephalization), followed by interstitial edema, then alveolar edema (pulmonary congestion)

congestive heart failure (CHF)

Bone bruises are also seen which are?

contusions in the trabeculae due to compression

cardiac catherization

coronary angiogram aka

What is the two parts of the bone? and which one appears white on the xray and which one appears less dense?

cortex --> white medulla --> less dense

At_______ , the ureteric orifice is identified and a catheter passed into the ureter Contrast material is then injected via this catheter to outline the collecting system and ureter.

cystoscopy

Ureteric stent insertion may be either retrograde or antegrade. Retrograde insertion is done via

cystoscopy

longitudinal

direction of fracture line

oblique

direction of fracture line

spiral

direction of fracture line

transverse

direction of fracture line

emergency surgery

dissection type A of aorta treated by

medication

dissection type B of aorta treated by

_____ are the most common radius fractures?

distal radius

Fetal MRI may be useful in second and third trimester pregnancy for sorting out complex fetal anomalies. MRI is used increasingly in gynaecology for

diverse indications including suspected endometriosis, diagnosis of uterine pathology such as adenomyosis, and staging of gynaecological malignancies

high

does aortic dissection have high or low mortality

Sigmoid volvulus

dominant finding relevant to gastrointestinal disease for attached AXR

caecal volvulus

dominant finding relevant to gastrointestinal disease for attached AXR

distal large bowel obstruction due to colorectal carcinoma

dominant finding relevant to gastrointestinal disease for attached AXR

perforated gastric ulcer

dominant finding relevant to gastrointestinal disease for attached AXR

small bowel obstruction due to adhesions

dominant finding relevant to gastrointestinal disease for attached AXR

aortic dissection

dominant finding with reference to the accompanying chest CT

interstitial oedema

dominant finding with reference to the accompanying chest CT

pericardial calcification

dominant finding with reference to the accompanying chest CT

pulmonary arterial hypertension

dominant finding with reference to the accompanying chest CT

Deep venous thrombosis

duplex US

hypertension: suspected renal artery stenosis

duplex US

venous incompetence

duplex US

f a gestational sac cannot be identified in the uterus with TVUS despite a β-hCG level of 1000 mIU/mL or more,

ectopic pregnancy should be considered.

In non-pregnant premenopausal womenIf hormonal therapy does not control the bleeding, endometrial hyperplasia (precursor for endometrial carcinoma)

endometrial polyp are the primary diagnoses

he diagnostic sign of endometrial carcinoma on US is

endometrial thickening. An endometrial thickness of more than 5 mm in a postmenopausal woman is an indication for further assessment with hysteroscopy and endometrial sampling.

Transvaginal

exam gives more detailed view

Transabdominal

exam gives overview

What are the 3 technical assessments needed to look at bone on an xray?

fine bony detail --> sharp definition of surfaces soft tissue detail --> fat planes between muscles visible aurticular surfaces (minimal overlap)

What is lipohaemarthosis of the knee?

fluid levels of the knee that are low density

chronic Pyelonephritis

found incidentally, scarred kidney

there is no fracture

fracture or not? - part 2 the patient has pain where the arrow is pointing. After looking at this foot radiograph you say

Bones that are healing are called ____ and form into new bone in what 3 stages?

fracture union inflammatory stage reparative stage remodeling stage

What is a pathological fracture? What is an example?

fractures due to weak points in bones. Langerhans cells histiocytosis

What are communtion fractures?

fractures in multiple segments (fragments)

What are delayed unions?

fractures that do not heal in specific time, this can occur if their is immobilization as well as in the elderly

total hip replacement: dislocated

from the accompanying images of a patient has undergone joint replacements please choose the likely diagnosis

total hip replacement: periprosthetic fracture

from the accompanying images of a patient has undergone joint replacements please choose the likely diagnosis

PSA is unable to differentiate those tumours that may remain small and confined to the prostate from

from those that may cause local invasion and metastases.

fracture of transverse processes

frontal radiography of the lumbar spine

transabdominal US has a wider field of view and requires a

full bladder to visualize the pelvic organs.

Spectroscopy increases the accuracy of tumour detection with MRI, though has not replaced TRUS-guided biopsy.

fyi

What is an example of metabolic anthroplasty?

gout

What are 2 examples of apophysis?

greater trochanter and tibial tuberosity

What are some things you are looking for when looking at a bone xray?

head of bone facets articular surfuces epicondyle condyles tuberosity trochanter foramen processes

Glomerulonephritis is suspected where haematuria is accompanied by

heavy proteinuria and red cell casts. Glomerulonephritis is confirmed with renal biopsy, best done under imaging guidance, usually US. Patients with glomerulonephritis should have a CXR to search for cardiac enlargement and pulmonary oedema, plus a renal US to screen for underlying renal morphological abnormalities.

The most common CT appearance of renal cell carcinoma is a

heterogeneous soft tissue mass that enhances with intravenous contrast material (

w/ angulation anterior structures will be projected (like the clavicles) will be projected

higher on the film than posterior structures

Fractures of the femur are normally called ?

hip fractures

10 posterior ribs

how many posterior ribs visible in an excellent inspiration

Most (90 per cent) extratesticular lesions are benign. The most commonly encountered extratesticular masses are

hydrocele, varicocele and epididymal cyst.

Lymphoma of the testis is

hypoechoic and homogeneous and may be focal or diffuse.

On US, most intratesticular tumours are

hypoechoic. Weaker diffuse reflections produce grey dots

If the patient is infertile (cannot become pregnant), then a _______________ is also often ordered to assess the anatomy of the uterus and Fallopian tubes

hysterosalpingogram (HSG)

apical lordotic view

if the X-ray beam is angled toward the head the film is obtained is called

heart is closer to the film and thus less magnified

in a PA film, the heart is ________ and thus ____

narrowing

in a coronary angiogram images of enhanced vessels show area of

TVUS has a smaller field of view, and is not appropriate for very young or elderly patients. Apart from these constraints, TVUS is more accurate than transabdominal US in

in first trimester pregnancy and in most gynaecological conditions.

< than 50%

in most normal people cardio-thoroacic ratio is

Kerley B lines means there is fluid where?

in the pulmonary interstitium

Myositis

infected / inflamed muscle

Cellulitis

infected / inflamed subcutaneous fat

Osteomyelitis

infected bone / marrow

Septic arthritis

infected joint space

What are the 3 categories that arthopathies can be seperated into?

inflammatory degenerative metabolic

What is a major limitation for radiography when it comes to bones?

insensitivity for bones to change (early adultohood to adolescence)

at least 8-9 posterior ribs

inspiration

what is the fracture called when it is broken between the two trochanters?

intertrochanter fracture

TVUS may be used to guide

interventional procedures, such as biopsy, cyst aspiration, abscess drainage and ovarian harvest.

IVP consists of a series of radiographs performed after

intravenous injection of iodinated contrast material to show the kidneys, renal collecting systems, ureters and bladder.

What are arthopathies?

joint disease

When radiographing long bones what should be included?

joints at each end

Name some common sites of metastases?

kidney breast prostate lung GI thryoid melanoma

Patients with suspected ectopic pregnancy who are haemodynamically unstable should be assessed

laparoscopically

osteoarthritis

lateral radiograph of lumbar spine

hangman's fracture

lateral radiography of the cervical spine

normal cervical spine

lateral radiography of the cervical spine

osteoarthritis

lateral radiography of the cervical spine

anastomosis check post-radial prostatectomy

micturating (voiding) cystourethrogram (MCU/VCU

MCU

micturating cystourethrogram.

What is the name of the fracture that occurs in the anterior upper third? What is the name of the fracture that occurs in the lower third?

monteggia galeazzi

Figure 6.11 Cystadenocarcinoma of the ovary: US. Transvaginal US shows a multicystic ovarian mass with multiple septations and complex fluid contents.

most common cancer

Figure 6.10 Dermoid cyst of the ovary: US. The right ovary (arrows) is enlarged due to the presence of a hyperechoic mass. The mass contains focal calcification (C) casting an acoustic shadow (AS).

most common tumour

US is also usually the investigation of choice for

most gynaecological disorders, including pelvic mass, dysmenorrhoea and postmenopausal bleeding.

US, CT and scintigraphy have replaced IVP for

most indications including renal colic, prostatism, urinary tract infection and renal cell carcinoma.

Gallstones

most likely cause of the abnormal calcifications shown on this AXR

trans-scaphoid perilunate dislocation

most likely classification of the fracture shown in the accompanying wrist radiograph

myocardial viability

myocardial perfusion scintigraphy echocardiography

Which hand fracture is the classic 'punching injury'?

neck of the 5th metacarpal

prominent, normal thymus

neonate; mild transitory respiratory distress, now resolved

mild transitory respiratory distress, now resolved

neonate;radiography performed in expiration

It can be split into two categories, monoarthpathy and polyarpathy

no answer

Late union is when there is ossification of callous around the fracture.

no answer :)

on the skin

nodules but where? this view of the upper abdomen demonstrates multiple soft tissue nodules. these are most likely located where?

acute left flank pain and microhaematuria

non-constrast enhanced CT

Towards the end of the first trimester, a thin hypoechoic layer can be observed in the posterior neck of the fetus, deep to the skin. This is known as

nuchal translucency

s can be seen from this staging system, the most important factor in early endometrial carcinoma is the degree

of local invasion.

Polycystic ovarian syndrome (PCOS) is a common cause of chronic anovulation and infertility. PCOS refers to a spectrum of clinical disorders with the classic triad of

oligomenorrhoea, obesity and hirsutism (Stein-Leventhal syndrome) being the best known.

What is the difference between open and closed bone?

open --> also called compound goes through the skin closed --> no impediment of the skin

splenomegaly

photo wasn't attached to quiz. 11 year old male recurrent abdominal discomfort for about 10 days

As stated above, over 60 per cent of RCCs are diagnosed incidentally. Most of these are small, early-stage tumours (<4 cm) amenable to minimally invasive, nephron-sparing treatment options. Such treatment options include

open or laparoscopic partial nephrectomy and percutaneous tumour ablation. Percutaneous tumour ablation techniques are becoming widely available and include radiofrequency (RF) and cryoablation. Both techniques involve precise intratumoral placement of probes under imaging guidance. Ablation procedures may be performed with local anaesthesia and conscious sedation or general anaesthesia. Choice of imaging guidance technique (US, CT or MRI) depends on multiple factors including size and position of tumour, body habitus of patient, and local expertise and availability. Patient preparation includes: • Bleeding studies • Biopsy: up to 25 per cent of small renal tumours are benign and do not require treatment.

What is the prime example of degenerative arthoplasty? What is the main pathological change in OA?

osteoarthritis loss of articular cartilage

Clavicle fractures occur usually midshaft and which side of this is usually displaced downward?

outer fragment (lateral side)

there if free air

pain after sigmoidoscopy you look at this radiograph and decide

The classic clinical triad of ectopic pregnancy consists of

pain, vaginal bleeding and palpable adnexal mass.

paget's disease

pelvic pain this is a frontal radiograph of the pelvis radiograph of the pelvis in a 79 year old man what is the most likely diagnosis

_____ fractures are extremely common in motor accidents and significant trauma? How many planes do these fractures occur in?

pelvic ring fractures , 2

Avulsion fractures occur most often in ______ near the _____ and are distraction forces of muscles, tendons and ligaments?

pelvis athlets

see spine through the heart

penetration

Percutaneous nephrostomy refers to

percutaneous insertion of a drainage catheter into the renal collecting system.

When you hear the term "water bag" or "carpet bag", what should you think of?

pericardial effusion

What is the difference between a perilunate dislocation and a lunate dislocation?

perilunate --> will articulate with the other bones as well as the carpal bones lunate --> will not articulate with other bones

Claudication: PVD Peripheral vascular disease (PVD), commonly referred to as peripheral artery disease (PAD)

physiological testing and doppler US CTA/MRA ***** catheter angiogrpahy largely replaced by CTA/MRA for diagnosis of PVD

Third trimester US for a variety of indications, e.g

placenta praevia, suspected intrauterine growth retardation, follow-up of fetal anomalies.

Views Available Supine abdomen Upright abdomen Left lateral decubitus abdomen (LLD) Posteroanterior chest x-ray (PA CXR) Two views of the abdomen Three views (three-way) of the abdomen Four views of the abdomen "Obstruction Series"

plain films views available

MRI

please choose the imaging investigation of choice for the following clinical scenario: 35 year old male: severe,debilitating left leg pain in distribution of L5 dermatome

no imaging required

please choose the imaging investigation of choice for the following clinical scenario: 38 year old male acute lower back pain while gardening; afebrile; no leg pain; normal neurological examination

Scintigraphy with 99mTc-MDP (bone scan)

please choose the imaging investigation of choice for the following clinical scenario: 58 year old male: staging of adenocarcinoma of prostate; no back pain or neurological symptoms; exclude skeletal metastases

MRI

please choose the imaging investigation of choice for the following clinical scenario: 65 year old male: low back pain for 1 week; increasing in severity; febrile; sigmoid colectomy 1 month previous for complicated diverticulitis

radiograph of the spine

please choose the imaging investigation of choice for the following clinical scenario: 69 year old female: acute onset severe mechanical low back pain; no trauma; known osteoporosis

ultrasound

please choose the imaging investigation of choice with reference to the following clinical scenario: 18 year old male: acute scrotum

non-constrast enhanced CT

please choose the imaging investigation of choice with reference to the following clinical scenario: 50 year old male: acute left flank pain and microhaematuria

micturating (voiding) cystourethrogram (MCU/VCU

please choose the imaging investigation of choice with reference to the following clinical scenario: 55 year old male: anastomosis check post-radial prostatectomy

Contrast enhanced CT (CT urography)

please choose the imaging investigation of choice with reference to the following clinical scenario: 66 year old female: Characterization of complex renal cyst found on ultrasound

ultrasound

please choose the imaging investigation of choice with reference to the following clinical scenario: 76 year old male: Urinary frequency and nocturia

right-sided, or bilateral

pleural effusion is often

Second or third trimester vaginal bleeding may be due to

premature labour, or placental problems including placenta praevia, placental abruption and placenta accreta.

congestive cardiac failure

premature neonate; respiratory distress

surfactant deficiency syndrome (SDD) and pneumothorax

premature neonate; respiratory distress

Bones have primary and secondary ossification centers, which center is found before birth and where is it located and which is found after birth and where is it located?

primary --> before birth and located in the diaphysis secondary --> after birth and located in the epiphysis

PICC line

procedure shown on the accompanying CXR

aortic valve replacement

procedure shown on the accompanying CXR

mitral valve repair and pacemaker

procedure shown on the accompanying CXR

Contrast pulmonary angiogram

radiology contrast method used for PE

For MCU, the bladder is filled with contrast material via a urethral catheter. Images of the contrast-filled bladder are obtained. The catheter is then

removed and radiographs are taken during micturition.

Fibrous lamellae 3 types: I - connect renal capsule with _____ II - only connected to capsule, circumscribing kidney III - connect ARF to ------

renal fascia PRF

Most solid renal masses are malignant; _______ is the most common type.

renal cell carcinoma Over 60 per cent of RCC are diagnosed incidentally.

The imaging workup of patients with painless haematuria is therefore directed at excluding or diagnosing

renal cell carcinoma and urothelial carcinoma (transitional cell carcinoma or TCC).

WILM'S TUMOR (NEPHROBLASTOMA)

renal malignancy

Blunt trauma MVA Penetrating trauma Gunshot, stab wound Laceration, hematoma, avulsion from vascular pedicle

renal trauma

What is an example of inflammatory polyarthyopy? what is the main pathological issue of this?

rheumatoid arthritis synovial inflammation

spinous process between clavicle

rotation

A simple cyst appears on US as a

round anechoic (black) structure with a thin or invisible wall (Fig. 5.4). No further imaging is required for simple renal cysts diagnosed with US.

Where renal cell carcinoma is suspected, US is also used to look for specific findings such as

s invasion of renal vein and inferior vena cava (IVC), lymphadenopathy, and metastases in the liver and contralateral kidney.

pars interarticularis defect (spondyloysis)

sagittal CT of the lumbar spine

What is the most common type of fracture on a wrist?

scaphoid

stricture

scarring

_______ is the main screening of metastasis and tumors?

scintigraphy *BUT CT WITH SCINTIGRAPHY FOR GOOD RESULTS

Imaging for staging of testicular tumours consists of

scrotal US, abdomen CT for retroperitoneal lymphadenopathy, and chest CT for mediastinal lymphadenopathy and pulmonary metastases.

Epididymal cyst, also known as spermatocele, is a common incidental finding on

scrotal US, or may occasionally be large enough to present as a palpable mass. Epididymal cyst appears on US as a well-defined anechoic simple cyst in the head of the epididymis, i.e. posterolaterally at the superior pole of the testis.

Fetal MRI may be useful in what trimester pregnancy for sorting out complex fetal anomalies.?

second third

What are the three common patterns for anterior pelvic injury?

seperation of the pubic symphysis bilateral fractures of the pubic rami unilateral fractures of the pubic rami

uses highly focused sound waves to fragment renal or ureteric stones. is the technique of choice for the management of most renal stones.

shock wave lithotripsy

Ovarian masses may be classified on US as

simple cysts, complex cysts (cyst complicated by soft tissue septations or nodules) or solid.

Renal masses may be classified with imaging into

simple cysts, complex cysts and solid masses.

SPECT-CT

single photon emission CT-CT

CT is also used for staging of renal cell carcinoma. Factors relevant to staging of RCC include

size of tumour, invasion of local structures such as adrenal gland, vascular invasion of renal vein or IVC, lymphadenopathy, and metastases in the liver and skeleton.

What are some things you can see on an xray that would make you know is an arthopathy ?

symmetry or asymmetry small joints or large weight bearing joints erosions joint space narrowing oseophytes

Nodular hyperplasia with enlargement of the central prostate is the commonest cause of

symptomatic prostatic enlargement. Symptoms of prostatism include frequency, nocturia, poor stream, hesitancy and post-void fullness.

Osteochondral fractures of the ankle are most common in which bone?

talus

Most (over 90 per cent) intratesticular masses are malignant. Exceptions include

testicular abscess, TB, sarcoidosis and benign tumour such as Sertoli-Leydig tumour.

SCROTAL US IMAGE __________ ON EACH SIDE

testis and epididymis

normal gas in the joint space

the arrows point to

For ascending urethrogram, a small catheter is passed into

the distal urethra and contrast material injected. Radiographs are obtained in the oblique projection to show the urethra in profile.

calcification of an old tuberculous empyema

the most likely cause of this abnormality in the left hemithorax is

left atrial myxoma

the most likely diagnosis for the following clinical scenario with reference to accompanying image. 35 year old female: mild intermittent chest pain and shortness of breath

salter harris type 2

the most likely salter-harris classification for the accompanying image

salter-harris type 3

the most likely salter-harris classification for the accompanying image

salter-harris type 4

the most likely salter-harris classification for the accompanying image

US

the primary imaging investigation of choice for assessment of gynaecological disorders

PA

the standard chest X-ray is a ___ film

aspirated barium

this is a frontal radiograph of the chest in a patient who just did what

the silhouette sign

this is a radiograph of a hollow rubber ball that has been filled with water using a syringe. that the inside wall of the ball can no longer be seen is an example of

patient has an abdominal aortic aneurysm

this is the lateral lumbar spine radiograph on a 78 year old female with back pain what is the key finding

Based on CT appearances, cystic renal lesions may be classified according

to the Bosniak system

Radial and ulnar fractures usually occur ____?

together

Normal CT

top left - IVC bottom left - right adrenal gland right arrow - stomach

In the absence of compelling evidence of urinary tract infection or glomerulonephritis, painless haematuria should be considered to be due to

urinary tract tumour until proved otherwise.

MR (or bone scan)

usually done for suspected osteomyelitis

Is sctinigraphy sensitive or insensitive?

very sensitive therefore can see very specific things on bones

Micturating cystourethrogram (MCU) is also known as

voiding cystourethrogram (VCU).

lateral supine film

what film often shows the PTX better

Bilateral decubitus films

what films used for INHALED (ASPIRATED) FOREIGN BODY

[type of echocardiogram] A transesophageal echo (TEE) test is a type of echo test in which the ultrasound transducer, positioned on an endoscope, is guided down the patient's throat into the esophagus (the "food pipe" leading from the mouth into the stomach). An endoscope is a long, thin, flexible instrument that is about ½ inch in diameter.The TEE test provides a close look at the heart's valves and chambers, without interference from the ribs or lungs. TEE is often used when the results from standard echo tests are not sufficient, or when your doctor wants a closer look at your heart. TEE may be combined with Doppler ultrasound and color Doppler to evaluate blood flow across the heart's valves.

what is a TEE?

Flow: stagnant blood Wall abnormalities Hypercoagulability (thick blood)

what is virchow's triad?

film is under penetrated, you can't see heart through the spine. dEgree of inspiration is probably adequate. rotation can not be evaluated and there is slight amount of angulation. incidentally, there is large bronchogenic ca in the left lung

what is wrong with this photo

patient is rotated considerably toward her own left side notice how the hemidiaphragm appears elevated on the side to which the patient is rotated

what is wrong with this photo

the image is apical lordotic look at the high position of the clavicles. it is also under penetrated. you can't tell if its roared and the degree of inspiration is adequate

what is wrong with this photo

the patient has taken a poor inspiration. Also rotated toward his own right, it is slightly under penetrated and he is not angulated

what is wrong with this photo

normal supine abdomen

what position is this?

normal upright abdomen surgical clips (top arrow) air fluid level (bottom arrow)

what position is this? what are arrows pointing to?

Endoscopy (versus barium studies)

what test should use for GI tract except for small bowel

US or HIDA

what test should use for Gallbladder/bile ducts

CT

what test should use for JUST ABOUT EVERYTHING ELSE:

barium studies or CT

what test should use small bowel

normal lateral lumbar spine vertebral body disk space pedicle posterior spinous process iliac crest

what view is this? label yellow lines from top to bottom

liver, pancreas, spleen, nodes

what you biopsy

echocardiogram, myocardial perfusion SPECT stress test, MR or PET

with CAD the effects of the narrowing seen by

In what two areas in bone overlap unavoidable?

wrist and ankle

A gestational sac is seen as a round fluid-filled structure in the uterus. It contains a

yolk sac (arrow) and a single fetus

Management of placental insufficiency and other factors that may impact on fetal well-being is assisted by assessment of various US parameters including:

• Amniotic fluid volume • Doppler analysis of umbilical artery, umbilical vein, ductus venosus and fetal middle cerebral artery • Fetal breathing movements • Fetal limb movements • Fetal heart rate.

The 'Rotterdam criteria' for the diagnosis of PCOS include:

• Anovulation • Hyperandrogenism • US findings of 12 or more follicles measuring 2-9 mm, and ovarian volumes of more than 10 cc • Exclusion of other possible aetiologies such as Cushing's disease or androgen secreting tumour.

Technique of percutaneous nephrostomy:

• Antibiotic cover • Local anaesthetic and intravenous conscious sedation; general anaesthetic in children • Imaging guidance: US and fluoroscopy, or CT • Renal collecting system punctured with a needle • Passage of a guidewire • Insertion nephrostomy catheter over the guidewire.

Indications for MCU:

• Assessment of urinary tract infection in children (see Chapter 13) • Following radical prostatectomy to check the surgical anastomosis and the integrity of the bladder base • Assess posterior urethral problems in male adults • Stress incontinence in female adults.

The fetal morphology scan provides an assessment of gestational age accurate to ±1 week, based on a number of measurements including:

• Biparietal diameter of the fetal skull • Head circumference • Abdomen circumference • Femur length. placenta position aminiotic fluid volume

US of the urinary tract may supplement CT urography in selected cases. Indications for US include:

• Characterization of complex cysts • Differentiation of complex cysts from solid masses.

First trimester US used for

• Confirmation of live pregnancy • Accurate assessment of dates • Management of complications, e.g. suspected ectopic pregnancy

Goals of imaging a suspected renal mass include:

• Confirmation of presence and site of mass • Classification into simple cyst, complicated cyst or solid mass • Assessment of contents, such as the presence of fat • Differentiation of benign from malignant • Diagnosis of complications such as local invasion, venous invasion, lymphadenopathy and metastases.

US signs of testicular torsion:

• Decreased spermatic cord Doppler signal and lack of blood flow in the testis • Testis may be normal in appearance, or enlarged and hypoechoic.

US signs of acute epididymo-orchitis:

• Enlarged hypoechoic epididymis with increased blood flow • Enlarged hypoechoic testis with increased blood flow • Surrounding fluid/hydrocele.

Indications for ascending urethrogram:

• In the setting of trauma prior to urethral catheterization in a male patient with an anterior pelvic fracture or dislocation, or with blood at the urethral meatus \• Suspected urethral stricture, which may be the result of previous trauma or inflammation.

Limitations of US in this context include:

• Incomplete visualization of the kidneys due to obesity or intestinal gas • Inability to visualize small urothelial tumours.

Staging of testicular tumour incorporates four factors:

• Local growth within the testicle and invasion of adjacent structures including spermatic cord and scrotal skin • Spread to regional lymph nodes • Metastasis to distant lymph nodes or other organs, e.g. lung and brain • Serum tumour marker levels

An accurate risk assessment for fetal aneuploidy is calculated based on:

• Maternal age • Nuchal thickness • Presence or absence of the fetal nasal bone • Maternal levels of β-hCG and pregnancy-associated plasma protein A (PAPP-A).

Postprocedure follow-up includes:

• Observation for immediate complications, such as pain • Imaging with contrast-enhanced CT or MRI to ensure ablation of the tumour and exclude complications such as haemorrhage.

Histologically, most cervical carcinomas are squamous cell carcinoma. The mode of spread is by local invasion plus involvement of lymph nodes. The FIGO staging system for cervical carcinoma is as follows:

• Stage 0: carcinoma in situ • Stage 1: confined to the uterus • Stage 2: local invasion beyond the uterus not involving the lateral pelvic wall or lower third of vagina • Stage 3: more extensive invasion with involvement of pelvic wall or lower vagina or causing hydronephrosis • Stage 4: invasion of bladder or rectal mucosa or distant metastases, including pelvic and retroperitoneal lymph nodes.

The FIGO staging system for ovarian cancer is as follows:

• Stage I: tumour confined to the ovary • Stage II: tumour involving one or both ovaries with pelvic extension • Stage III: intraperitoneal metastases and/or regional lymphadenopathy • Stage IV: distant metastases beyond the peritoneal cavity, e.g. liver metastases or malignant pleural effusion.

Indications for RPG:

• To better define lesions of the upper renal tract identified by other imaging studies such as CT • Haematuria where other imaging studies are normal or equivocal • Guide for various interventional procedures including removal of ureteric calculus and ureteric stent placement.

Over 70 per cent of cases of haematuria have no demonstrable cause. Demonstrable causes of haematuria include:

• Urinary tract infection • Urinary calculi • Tumour of urinary tract • Trauma • Glomerulonephritis

Adenocarcinoma of the prostate may be diagnosed in a number of ways:

• Urinary tract symptoms, e.g. haematuria, obstructive voiding symptoms • Histological examination of tissue chips obtained by transurethral resection (TURP) for presumed benign prostatic enlargement • Bone metastases may be the initial finding due to a specific presentation like bone pain or spinal cord compression • Multiple sclerotic metastases are occasionally picked up as an incidental finding on a radiograph performed for unrelated reasons, e.g. pre-anaesthetic CXR or AXR for abdominal pain.