Radiation

tonic Non
ionic
L J
Particle Photon
L P Cosmic 8 X
rays
P n No mars same
velocity as light
Only V varies

comic Gamma tray UV Visible

Infrared Microwave Radio

Mort penetrating power 18

rays
Mort Mars Damaging power Energy transfer
Biological effect I 2 rays
Mechannism of heat
loss in modern X-ray
tubes is Radiation

Protons exhibit
Bragg e ect (lose
almost all their
energy before
coming to rest)

Artefact : Non
anatomic opacity d/t
pt movement,
improper lm
handling
 CT Scan
By Godfrey Houns eld

Houns eld units = mX - mWater

mWater - mAir

1000 Bone, 100 Bleed, 30-40 Tissue, 0 water, -100 Fat, -1000 Air

2D pixel, 3D voxel

I slice 1cm
X 10 Conventional CT scan
Im

10 slices HRCT
10 at 10mm Middle portionsskipped
an
intervals Done only diffuse
for
conditions

ILD Bronchiectasis Miliary tb

SOM Temporal CSF leak

spiral CT Slip ring technology

Multi slice
Multidetector CT
1cm
 1cm
tray tube

10cm

I Detector
5mm 5mm

105 20 images 2X 5mm X 10s

105 40 images 4 2 S X 10
10s 80 images 8 1 25 x 10
105 160 images 16 0.625 10 HRCT 16slice

55 160 images 32 0.625 5 HRCT 32 slice

256 Slice HRCT Full body Scan in 3 seconds

Hounsefield modern CT
1cm 1 second to Scan
Phasing Liver studies
Normal liver : 20% HA, 80% PV. HCC : 100% HA

N Liver HCC
Pr contrast 40 40
HA 50 90
PV 80 60
Delayed scan 45 50 45 so
Coronary CT angiography
Cardiac motion alters image
Ideal : Fully lled but not contracting ie MID DIASTOLE
We detect mid diastole with the help of ECG gating, ideal HR is 60-70

Newer methods of CT scan

1) DUAL SOURCE CT (2 X-ray tubes)
Best for RENAL CALCULI DENSITY ESTIMATION, CORONARY CT
ANGIOGRAPHY AT ANY HEART RATE

NC Ct Bone Calcification Bleeding

stroke Head Trauma Air

C ECT Inflammation Infection

Tumor
Trauma except head trauma NC CT
and unstable pt FAST
Coronary CT angiography
USG
Piezoelectric principle : Electricity makes crystal vibrate, sound waves given
o , re ected back, picked up by transducer, image made

PZT : Plumbum, Zirconium, Titanium ( 2 - 20 MHz)

RV
Frequency dpt Resolution, Frequency dpt 1/Depth RA
LV
Endoscopic USG / TEE LA
1) 5 layers of GIT (wbwbw)
2) T staging of GI malignancy
3) Pancreatic nodule
Best seen
ESO
4) EUS guided FNAC
Hyper echoic
Air, Fat, calci cation ( Acoustic shadowing )

Hypo echoic
Any uid ( Acoustic enhancement )

Types of USG
1) Amplitude / A mode : Eyeball axial length
2) Brightness / B mode : Regular
3) Motion / M mode : Echocardiography

4) Doppler
Presence/abscence of ow
Towards (red) or away (blue), Turbulent (Violet)
Calculate velocity = Vcos@, optimum angle is 60°

Doppler waveforms

h
Artery vein
Systole Diastole PR
Ionopause
Peripheral All 3 No pulsation
TRIPHASK Resp variation
go
Viscerall has no PR
M
MONO PULSATIONS RV X
5) Elastography for Cirrhosis, nodular characteristics

6) MRG-HIFU : Acoustic cavitation for Fibroids, RCC, Prostate Ca

Head to toe uses of USG
1) Neonate AF closes at 18m, till then transcranial USG can be done to detect
hydrocephalus

2) A and B scan for ophthalmologist

3) Breast < 40 years IOC

4) TEE / EUS

5) Can’t be used for lungs, But used for pleura (Most sensitivity test for Pleural
e usion, detects as little as 5ml)

6) IN THE ABDOMEN
Can’t be used for Retroperitoneal organs ie Kidney pancreas ureter, do CT scan
Liver : 1st line inv
Gall bladder : IOC, fast 4-6 hrs to distend
Biliary tract : Proximal CBD can be seen (IOC for cholelithiasis), Distal CBD is
behind airy loop of duodenum (IOC choledocholithiasis is MRCP)

7) Pregnancy IOC

8) Pelvis 1st line, Best is MRI

TAS full bladder, TVS empty bladder

9) Scrotum IOC

10) Fluid (pericardial pleural e usion or ascities) IOC

11) DDH cartilaginous part cannot be seen by X-ray or CT, 1st line is USG, Best
is MRI

12) Lower limbs : Varocosie, DVT, PVD IOC

MRI

FaradayCage Copper
Negates earth magnetism
Strength of MRI Tesla Quality of Image

IIe
Bo
Repulse
MRIMaghet
I Unpaired
no
Bo
protons
vector n
y u
some t some
pendulous
Ispin
L
Some Bo SomestayBo
Lattice
Switch off
RF pulse v

Release energy on Relaxation

 Relaxation times

L
Ti W Taw
Longitudinal Transverse
Lattice Spin Lattice Spin phase i
spin not
TR d TEL TRT TET

Water black water white

Grey matter grey Grey matter white
White matter white white matter
grey
Anatomy Pathology
Pathology hypointense Pathe is hyperintense

hyper intense FIBS MP2

Fat both T Tz Bleed Subacute Melanin

Paramagnetic S Proteinaceous substances

Ti and T2 hypointense

General tissue Calcium Flowing blood

Chronic hematoma
ABSOLUTE CONTRAINDICATIONS
1) Free metallic object in body (pacemaker, aneurysm clip, Cochlear implants,
metallic valves but not orthopaedic implants)
RELATIVE CONTRAINDICATIONS
Claustrophobic, 1st trimester of pregnancy

INDICATION OF MRI
Neural tissue (including NETs at distant sites like Pancoast tumours)
Soft tissue in detail

VARIANTS OF MRI
1) FLAIR : T2W but CSF appears dark

2) DWI : Based on Brownian motion of molecules, dead tissue appears bright

3) SWI : Best for micro-hemmorrhages DAI

4) Di usion tensor MRI : Based on water molecule di usion

5) Tractography : Visualize White matter tracts

6) Functional MRI : BOLD (blood oxygen level dependent)

7) STIR : Darkens Fat (Bone marrow imaging)

8) MR Spectroscopy

a NAA u in all Brain DX Canavan disease

b Choline marker of cell division d abscess

necrotic tissue

c Creatine is a stable marker

Ch
NA N

with tin
TUMOR
 NUCLEAR SCAN
A carrier molecule is bound to Tc99, which releases gamma rays and is
detected to make an image

1) RENAL : DMSA anatomy, MAG3 > DTPA Renal functioning

2) Pertechnate : Gastric (bleed from Meckels), Thyroid, Salivary glands (Warthin

vs Pleomophic, in warthins the ducts are poorly formed and Donot take up the
pertechnate )

3) THYROID
I123 scans, 125 Brachytherapy, I127 is normal, I131 for Systemic RT

4) HEART : Thallium (myocardial viability), Pyrophosphate (accumulates in dead

myocardium), MUGA (ventricular functioning)

5) Pancreas : Selenium Methionine

6) Biliary tract : HIDA (Gold std for biliary atresia and acute cholecystokinin)

7) Bone : MDP for osteoblast activity

8) TUMORS
MIBG/Ga68 DOTATATE (Pheochromocytoma), SESTAmibi (PT), Octreotide (NET)

9) Bleeding : TcRbc

10) Blood ow : TcRbc, HMPAOspect (Cerebral ow)

PET Scan
It is a functional scan, not an anatomical scan
Can be combined with CT (anatomical) to obtain SPECT

RADIOTRACER is binded to metabolite eg 18F-deoxyglucose, and it releases a

positron.
Positron collides with shell electrons, results in annihilation and releases 2 x
511 keV gamma rays
Detected by Gamma/Anger/Scintigraphy camera
NORMAL AREAS OF HIGH ACTIVITY
BRAIN, BROWN FAT, MARROW, THYMUS, MYOCARDIUM

FALSE POSITIVE
INFECTION, INFLAMMATION, GENITOURINARY TRACT (as it excretes the IV
dye given)

ZERO ACTIVITY : Typical Carcinoids

CONTRAST AGENTS
Can be POSITIVE (brightens image) or NEGATIVE (darkens image)

MRI CONTRAST AGENTS

Gd-DTPA (renal)
Gadoxetic acid, Gd-Bentate Demeglumine (biliary)

These make T1 hyper intense and T2 hypo intense

1) Donot cross BBB (Leptomeningeal enhancement is Meningitis)

2) Cross placenta, CI in pregnancy

3) Accumalate in breast milk, donot feed until 24 hrs

4) At equimolAr concentrations, they are MORE NEPHROTOXIC compared to

the iodinated dyes

USG CONTRAST AGENTS

LEVOVIST AND SONOVIEW
They are gas lled microbubbles (0.5ml is given)
Echogenicity dpt vascularity

X-RAY AND CT CONTRASTS

ODINATED WATER SOL

 L
IONIC NON IONIC
2 particles 1 particle

MONO DIMER MONO DIMER

OPINE 3 2 6 2 3 1 6 1
PARTICLE

Osmolarity 1600 800 300

Urograffin loxaglate lohexol lodixano
Omnipaquevisipaque
Gastrograffin
Ditrizoate lopamidol

Opacification S E

COST

Side effects Anaphylaxis Non IgE complemen

mediated
Contrast induced nephropathy
S Creat To 5mg de baseline 24 hours
from
Occurs dit intense vasconstriction Medulla hypoxia
Avoid s IV hydration
an Iso osmolar contrast
NAC
Excellent PROG N in a week Dialysis usually not req
 aly y
INV

Renal Dye excretion

NO YES

IONIC cheap RFT

L
5 Creat 1.2 760 725,430
NON IONIC
GFR MONOMER
1.2 2 5,30 60
NON IONIC DIMER
GIT Contrast

Regular Bason

Perforation Acute obs Gastrograffin

TEF Esophageal perf NON IONIC Gastro
will cause P edema
graffin if aspirated
too high Osm

Myelography 1 NON IONIC Others cause

irritative Arachnoiditis
 Musculoskeletal

Cortical Simple tray

1
Complex CT scan

Cancellous marrow Local MRI

I
Diffure Bone Scan

Density DEXA Soft tissue Osteomyelitis

MRI

Pathologies
Champagneglass
pelvis
Chevron
epiphysis

Bullet Trident hand

vertebra

ACHONDROPLASIA
 SCURVY

Osteogenesis imperfecta

AD AR 1 is MC 2 is most
12types fatal
Blue Sclera Hearing I Diaphyseal
Warmian bone
Van Der Hoene Sx

DONUT SIGN
Lytic area surrounded by
sclerotic reactive area
ANEURYSMAL CYST GCT Chondrosal coma

Telangiectic Osteosarcoma
Not 10 CNS it is a solid tumor
lymphoma
Bone within bone sign
PAGET OSTEO PETROS IS CAFFEY DX

LUXAT IO ERECTA
HYPERABDUCT

Tube light sign PII Loc

NOT FACING NOT VENTRAL

n n n

FOLLES
SMITH

BARTON VOLAR TYPE

SCAPHOLUNATE DIS LOC

Erlenmeyer Flask Deformity

902T

Gaucher Osteoporosis
Leukemia Thalassemia
 Leukemia Thalassemia

EWING ONION PEEL OSTEOSARCO

CODMAN D
QUESTION MARK SIGN

ACL
injuryYavne PCL
buckling

Medial meniscal tear

SUBCHONDRAL LUCENCY
AVN LOW AUN chances
Empty Thecalsas sign DOUBLE CONTOUR

GOUT
SPADE PHALANX

ACROMEGALY
Hyperparathyroidism
SALT PEPPER SKULL RUGGER JERSEY

BROWN TUMOR OSTEITIS

FIBROSA CYSTICA VON
RECKLINGHAUSEN DX
PUNCHEDOUT LYTIC COTTON WOOL SKULL

DIPLOIC WIDEN

TAM O
SHANTER

PAGET
Multiple myeloma
Types of Vertebra

D Bullet Achondroplasia
I Codfish Osteoporosis
H shape Sickle cell
1 Rugger
HyperP Osteopetrosis

1111 Courdroy Jail Hemangioma

Picture frame Pagets
at Plana Mets Eosinophilic granuloma
 PULMONARY
PA view : Oblique ribs, Oblique clavicle, Scapula out of eld

AP view : Straight ribs, Straight clavicle, Scapula in eld

Best views
Ipsi lung : CL anterior oblique
Ipsi Rib : Ipsi Posterior oblique
Middle lobe : Lordotic

Hilar shadows
Bronchus + Pulm Artery + Upper lobe veins
Left is higher because Left bronchus is also higher

SPINNAKER SAIL SIGN

PNEUMO MEDIASTINUM
PNEUMOTHORAX CAR PA expiratory view
DEEPSULCUSSIGN
SUPINE X RAY

CgtungW PARIETAL PLEURA

VISCERAL PLEURA

B mode

ÉÉ
Aline B line

Motion I
Sandy
M mode
1 Static Barcode

Lung Barcode above P pleura Sandy below it

P effusion
BEST I Ipsi Lateral Decubitus 25mi t
PA 7200 me
Supine 75 me Blunted CP Sign
PA supine lat Decub

Empyema

split pleura sign

Silhouetting
Upper R heart / Asc aorta : RUL anterior

R heart border : RML medial

Aortic knuckle : LUL Apical

Upper L heart border : LUL Anterior

Lower L heart border : Lingula

Hemidiaphragm : Lower lobes anterior

Consolidation
Left upper lobe involvement

AIR BRONCHOGRAM t

Pulmonary edema
Kerley lines

C
A Periphery to hilum
B Short to Pleura
C Basal

Pulmonary embolism
Infections
BULGING FISSURE SIGN PNEUMATOCELE

Klebsiella Legionella Strep

TB Cancer Fulminant S aureus
pus

WATER LILY CYST TREE IN BUD

TB
Hydatid cyst

Lung collapse
GOLDEN S
Sign LUFTSICHEL
Air between

2
aorta and
y
collapsed segment

RUL LOL
Sarcoidosis
PANDA FACE
RParatrachea

Rhilar Lhilar
Galaxy
Garland triad
sign

Aspergillus manifestations

Aspergilloma Fungal ball

Yan ABPAdlt hypersensitivity

Whiteinfarct
around glass halo bleed
Invasive aspergillosis

Miliary mottling
Tb Pneumoconiosis
Histoplasmosis Longstanding
Sarcoidosis hemosiderosis
 Bronchiectasis Round Atelectasis
COMET TAIL SIGN

Silicosis
Asbestosis

Lower ONLY PARENCHYMA

upper

Anthracosis
upper

CRAZYPAVEMENT
V
ACUTESILICOSIS
Lung Ca

Collapse MC
CAR
Bronchogenic
Ca Adenoca
spreads indepidic patternalong
Bronchial tree Mimics consolidation dlt air
bronchogram retro sternal
CANONBALLMETS
cen'T N Lateral
opacityT XR
Retro lucency

Chorioca Rcc u
Most
Dep part

Mediastinal tumors
Anterior ( 4 Ts)
Thymoma (MC adults and overall)
Teratoma, Thyroid, Terrible
lymphoma
IOC is CECT

Posterior : Neurogenic (MC in

children)
IOC is MRI d/t neurogenic tissue
 CRAZY PAVING PATTERN

PULMONARY ALV PROTEINOSIS

IOC in lungs

ILD, Bronchiectasis : HRCT

PE : CTPA
Calci cation, Solitary nodule on CXR, Malignancies
suspicion : CT
CARDIOVASCULAR
WATER BOTTLE SIGN HEART IN AN EGGSHELL

PERICARDIAL EFFUSION

CONSTRICTIVE PERICARDITIS

Signs of LA enlargement
1) 1st sign is increase of Left
atrial appendage

2) Straigtening of left border

3) Double atrial shadow,

widening of carina
Congenital anomalies SNOWMAN 8
BOOT EGGON STRING

TOF TGA
TA PVC

BOX

Truggesrious

EBSTEIN ANOMALY

Hilardance on fluoroscopy ASD

Coarctation of aorta
1) CoA after all great branches have emerged : BL 3-9 rib
inferior notching

2) CoA before Left subclavian : UL right 3-9 rib inferior notch

3) CoA before anomalous origin of R subclavian : UL left 3-9

rib inferior notch
Rib notching
1) Inferior : CoA, Aortitis, SVC-IVC pathology, Pulmonary
oligemia (Right side anomalies)

2) Superior : SLE RA

3) Both : Hyperparathyroidism, NF1

DOUBLE
PRUNING
LUMEN

AORTIC DISSECTION
1
PULMONARY HTN

CNS
Intracranial bleed
Trauma : MC lesion is Parenchymal contusion, MC bleed is
SAH
Hypertension : MC site of bleed is Basal ganglia

Epidural
subdural say Parench mal

Swirl sign in EDH I Hypodense areas within

the bleed indicates active bleeding
DAI ( RTA + Unconscious + Normal NCCT)
Within 2-3 hrs, B-amyloidPP rises, best prognostic indicator
12-24 hrs : Globes / Retraction balls (clubbed damaged
axons)

NCCT is normal 80%, 20% it shows Punctate hemorrhages

If NCCT normal, do SWI MRI

PUFF SMOKE ON MOUNT FUJI Sian

Cerebralangio

PNEUMOCEPHALUS
MOYA MOYA DX TENSION
 DW

1) Sylvia dot sign

2) Hyperdense MCA sign Empty 0 Sign
Ischemic stroke in MCA

VT
congenital anomalies

HOLOPROSENCEPHA LISSENSEPHALY SCHIZENCEPHALY

POSTERIOR FOSSA ARNOLD CHIARI

CYST

CORP CALL AGEN DANDY WALKER

Dandy walker : Large posterior fossa, Posterior fossa cyst

Arnold Chiari : Small posterior fossa + Tonsillar herniation

(type 1), + Lumbar meningomyelocele (Type 2)

CALCIFICATION IN THE BRAIN

MC physiological : Pineal gland

1) Periventricular : CMV
2) Di use nodular : Toxoplasmosis
3) Starry sky : Neurocysticercosis
4) Tram track : Strurge Weber Sx, Optic nerve sheath
meningioma
5) Bracket : Corpus callous lipoma
6) Subependymal : Tuberous sclerosis

I 2 3

4 5 6

Other congenital anomalies

MOLARTOOTH BRAIN EYE OF THE TIGER
STEM

JOUBERT SX HOLLERVANDEN SPATZ

Signs of Raised ICT
1st sign : Sutural diastases in children, Posterior clinic
erosion in adults

Later : Silver beaten skull in children, Erosion of Dorsum sella

in adults

Vein of Galen malformation : Aw R to L shunt and high output

cardiac failure

Spotters
DAWSON FINGERS PANDA SIGN
TIGER BANDING
TIGROID PATTERN

MULTIPLESCLEROSIS META LEUKO WILSONS DX

HUMMINGBIRD SIGN HOTCROSS BUN BOX CAR VENTRICLE

PSP MSA C HUNTINGTONS

OWL EYE MONKEY PARKINSON

CENTRAL Pontin my

CORTICAL RIBBONS

HOCKEY STICK SIGN

Sporadic CJD Variant CJD

Skull tray patterns

HAIR ON END GEOGRAPHIC PUNCHED out
BEVELLED

THALASSEMIA EOSINO GRANULOMA MULTIPLE Myeloma

Brain tumours
MC overall : Metastasis

MC 1° : Meningioma
MC 1° intraparenchymal : Astrocytoma

MC calci cation : Craniopharyngioma

MC intraparenchymal calci cation: Oligodendroglioma

MC necrotic / crosses midline : Glioblastoma

Associated syndromes
NF1 : Optic glioma

NF2 : Acoustic neuroma, Meningioma

Tuberous sclerosis : Subependymal Astrocytoma (also causes

Subependymal calci cation)

VHL : Cerebellar hemangioblastoma

CRANIOPHARYN SNOWMAN SIGN

GIOMA

PITUITARY ADENOMA

Medulloblastoma : MC 1° malignant brain Tumor in children,

almost exclusively in cerebellum
 v

Triad of Meningioma on X-ray

1) Calci cation
2) Hyperostosis of overlying
bone
3) Increased vasculature

CP angle mass (SAME)

Schwannoma, Aneurysm, Meningioma, Epidermoid cyst

Ring enhancing lesions in CNS

Tuberculous, Neurocysticercosis, Toxoplasmosis, Abscess
Not 1° CNS lymphoma, it is a solid mass

Genetic Dysmyelinating
disorders
1) MetaLeuko :
Periventricular white
matter
2) AdrenoLeuko : Occiput
White matter
3) Canavan : Di use
4) Alexander : Frontal
 On myelography, widening
of space is seen in
INTRADURAL
EXTRAMEDULLARY
TUMOR

Intractable epilepsy
D/t hippocampus/mesial temporal sclerosis, MC cause of
surgically treatable epilepsy

IOC : MRI epilepsy protocol, we measure volume of

hippocampus (Usually done : Oblique coronal plane, Gold std
is coronal plane)

Gold std : Video EEG + Ictal HMPAO-Spect

FRONTAL TEMPORAL Thalamus

Encephalitis

HSV 1 JE

HIV encephalopathy
BL symm, Deep

PML JC virus
BL Assym, subcortical
 GIT radiology
Ba swallow Bameal Ba meal Ba enema
follow
thru

corkscrew so feline Eso Bird beak

Eosinophilic eso Achalasia

Diffuse spasm Reflux so Candia

Outpouching Apple Core Deform

Divert Esoca
Zenker
 smooth semilunar
Schatzkiring filling
defect

Eso
Web

Eso Leiomyoma

Esophageal perforation
We use non-ionic contrast rather then gastrogra n, chances
of aspiration may lead to pulmonary edema

Gastric ulcers
Benign : Outpouches, Hampton hump

Malignant : Goes inward from margin, Carmans meniscus +

Kirklin complex
 KIRKLIN COMPLEX

CARMAN
MENISCUS

Intestinal obstruction
IOC is CECT in adults, USG in kids
Initial inv is X-ray

Erect : > 3 air uid levels

Supine : Tells us about site of obstruction
Jejunum : Step ladder / Concertina
Ileum : Featureless loops of Wangenstein
Colon : Incomplete haustrations

single bubble Double bubble triple bubble

CHPS Duodenal atresia Jejunal atresia

intestinal Best lat Decub

perforation tray is L
 Riglerdouble
Gas under wall
sign sign
Diaphragm

CUPOLA SIGN

FOOTBALLSIGN

FALCIFORM LIGSIGN

Ba meal follow thru > NJ tube (Bilbao dotter tube) > Inject
dye under high pressure, see it move live via uoroscopy >
This is Ba enteroclysis > If seen live on CT > CT
eneteroclysis > If negative contrast given > CT enterography

Focused Assessment Sonography Trauma (FAST)

Subxiphoid > RUQ (Morrisons pouch) > LUQ > Suprapubic

In eFAST, R and L hemithorax also checked

intussusception
 CLAW PINCERSIGN

COILED
SPRING
SIGN

Midgut volvulus
WHIRLPOOL SIGN

Sigmoid Volvulus
COFFEE BEAN
BIRD OF PREY
 CHILAIDITISY
MIMICS PERFORATION

ACCORDION SIGN

Pseudomembranous Colitis

Crohnsdiseare
1) Comb sign (me sent Eric
hypervascularity)
2) Target sign (aphthous
ulcers)
3) Rose thorn sign (serpentine
ulcers)
4) String of Kantor sign
(Strictures)

Lead pipe Colon

Ulcerative Colitis
Other radiological signs in Ileocecal Tb
1) Goose neck deformity : Pulled up caecum + Terminal
strictures ileum + Proximal dilated ileum

2) Sterlein sign : Terminal ileum narrowing

3) Fleischner sign / Inverted umbrella sign

4) Obtuse ileocecal angle, normally is acute

Colon Ca Diverticulosis

HIRSCHSPRUNG DX
MERCEDES BENZ

HOLELITHIASIS

WES
Sign CHOLEDOCHOLITHIASIS

Chronic Cholecystitis

IRREGULAR FILLING DEFECTS

cord

BILIARYASCARIASIS
R hep duct

BILIARY ATRESIA

TOMET TAIL Gallbladder adenomyomatosis

 COLON CUT OFF SIGN Signs of Acute Pancreatitis
1) Colon cut o sign (abrupt
narrowing of splenic exure
due to surrounding
in ammation)

2) Sentinel loop sign :

Adynamic ileal loop

3) Left Renal halo sign :

Perinephric fat edema
Ca Pancreas
INVERTED 3
sign Frostberg Double Duct
Sign

Both Dilated t obstruction

SUNBURST CALCIFICATION

CAROLIS DISEASE
 CENTRAL STELLATE SCAR
SURROUNDING HYPERINT

FOIAL NODULAR HYPER

temangioma Adenoma HCC Metastasi

Non Iso 150 Hypo Hypo
contrast
Peripheral
Arterial enhance Hyper Hyper Hypo

Washout Full enhance Iso Hypo Hypo

Spleen rupture X-ray signs

1) Loss of spleen outline
2) Loss of psoas outline
3) Lower rib #
4) Left hemidiaphragm elevation

GENITOURINARY
In IVP, if the dye is retained for >3 mins it indicates acute
ureteric obstruction

Renal agenesis / Multicystic dysplastic kidney : No

visualisation at all

HANDSHAKE SIGN DROOPING LILY

EMPHYSEMATO US
PYELO

HORSE SHOE KIDNEY DUPLEX COLLECTING

Signs of Renal papillary

necrosis
B) Ball on tee

D) Lobster claw

E) Signet ring

F) Clubbed calyx sloughed

papilla
 STRIATED NEPHROGRAM
Oc
CT IVP

Causes of Striated nephrogram

1) Literally any acute renal insult
2) ARPKD

Medullary calcinosis
Systemic Hypercalcemia, Acidosis, Medullary sponge kidney

Cortical calcinosis (Acute insult)

Graft rejection, HUS, Alport Sx

BOUQETOF FLOWER STRING OF BEADS

FMD
Med Sponge kid
SMALL ATROPHIC BLADDER CALCIFIED RIM BLADDER THAT
Resembles fetal skull

Tb schistosomiasis
Caused by
PINE CONE CHRISTMAS PEAR SHAPE external
TREE BLADDER manipulation
of bladder
1) Pelvic
abscess
2) Pelvic
hematoma
3) Pelvic
lymphadenop
athy
NEUROGENIC BLADDER

RETROCAVAL URETER VUR

KEYHOLE BLADER MAIDEN WAIST COBRA ADDER
HEAD

Ureterocele

PUV app

APPLE CORE URETER HYPODENSE LESION FLANK

PAIN and HYPOTENSION

TCC Ureter ANGIOMYOLIPOMA

Investigations of choice
RCC IOC : CECT

RCC beyond kidney (including renal vein, soft tissue

invasion) : MRI

Renal calculi : NCCT

Testicular torsion : Doppler

RADIOTHERAPY
Old and SI units in this order
Radioactivity : Curie, Becquerel

Exposure : Roentgen, C/kg

Absorbed dose : Rad, Gray

Dose equivalent : Rem, Sievert

Maximum permissible doses, measured by TLD

(Thermoluminescent dosimeters) in mSv/year
Normal human : 1

Occupational worked : 20

Patient : 50

Pregnant : 1/term, Pregnant patient : 5/term

Deterministic e ects : Can be dose determined or predicted

Stochastic e ects : Unpredictable

Radiosnoftissues
MOST LEAST
Cell cycle 92 5

Organ Ovary Testis Vagina

Tissue Marrow Nervous tissue
Blood Lymphocyte Platelet
Radiosnoftumors
MOST WELMS
Wilms Ewings Lymphoma Myeloma Medulloblas
Seminoma

LEAST I HOMP
Hepatoma Osteosarcoma Melanoma Pancreas

Radiosensitizer 102
Radio protector ZnO Amifostine Pentoxyphy

Cesium BRACHY RI SYSTEMIC 13

L particles TELE 060 5137

8 knife
Linear Ac elevator
LINAC

C A

E Both L
Only cathode
Xray Cyber knife e beam