GENERAL RADIOLOGY

- Dr. Risheek Gupta

Kindly let me know of any errors in DM

@Gup2000109 or BTR group on Telegram
Terminologies [Link]

Black White

X-ray RadioLucent RadioOpaque

CT Hypodense Hyperdense

MRI Hypointense Hyperintense

USG Hypoechoic Hyperechoic

 NON-IONISING IONISING : X-RAYS IONISING: GAMMA RAYS

• MRI • XRay Nuclear Medicine scans

• USG & its • CT scan
modifications • Contrast study • Tc99 Sestamibi scan
(XRay contrast by • SPECT(Single Photon
default) Emission CT)
eg. HSG, IVP, ERCP • PET(Positron
• Mammography Emmision
• DEXA scan Tomography) scan
Modality Dose
CXR 0.02 mSv

Skull Xray 0.07 mSv

Abdomen Xray 1 mSv

Mammography 0.5-0.7mSv

CT head 2 mSv

CT chest 5 mSv

CT abdomen 10 mSv

PET 10-12 mSv PET-CT scan : 25-30mSv

Barium meal follow through/enema 7-8mSv

IVP 2-3mSv
X-RAY - CT 2D investigation : XRay;
3D investigation : CT(3D volumetric scan - Computed Tomography) [Link]

White
vessels

NCCT CECT
White bones = CT i.v. Contrast(iodinated)
Black bones = MRI eg. tumours, inflammation

Your Right = Patient’s Left

side on imaging

Lung window
a.k.a HRCT
 Hounsfield Units(HU)

Hypodense Isodense
Hyperdense

IOC Head Trauma : NCCT

Basis for using NCCT to
diagnose acute bleed in
head trauma

Basis for using NCCT

Soft tissue
for bone cortex or
Muscles
Acute foreign body
Distilled Hemorrhage
Bone
Water Calcium
Air Fat Contrast Metals

-1000 -10 to -100 0 20-30 60-90 100-300 1000 >1000

CT IOC : NCCT [Link]

ACUTE METALLIC FB
CALCIFICATION CALCULI BONE -CORTEX HEMORRHAGE C/I : MRI
Renal/Ureteric/ IOC for Bone Head trauma IOC : NCCT
Salivary fractures, Initial Ix : XRay
Except Gallstone Osteoid
(IOC : USG) Osteoma

TORCH infections
Nidus(PG production, lytic)

Periventricular: CMV EDH SDH

Parenchymal:Toxo Lt. Ureteric calculus Osteoid osteoma
GM-WM jn : Zika
 APPROACH TO FOREIGN BODY

Coin

EsOphagus Trachea Bevelled margin

Button battery
UGIE Remove w/ Rigid Remove immediately d/t
Bronchoscopy r/o rupture & alkali
(VS flexible bronchoscopy is burns(liq. necrosis)
Stomach : wait & diagnostic proc.)
watch
MRI Resonance b/w body’s self proton & external magnet to align positive charges in a same spin
Best contrast imaging; time taking(not useful in emergencies) [Link]

World War 2 : Scalp fat

Water is
White on T2

Use of FLAIR is appreciated in

SEQUENCE
T1 T2 FLAIR periventricular pathologies
where use of T2 sequence
would make it impossible to
distinguish b/w CSF in
FLUID Dark White Dark ventricle & periventricular
edema
GRAY MATTER Grey White White FLAIR : Fluid Attenuation
Inversion Recovery(T2 - CSF)
WHITE MATTER White Grey Grey

FAT White White White

 MRI SEQUENCES [Link]

STIR(Short Tau SWI-MRI DWI-MRI ADC Tractography a.k.a

Susceptibility weighted Diffusion weighted Hyperintense Diffusion Tensor
Inversion Recovery) Picks up diffusion
Gradient Echo regions on DWI
IOC for Bone restriction(based on appear Hypointense
imaging(DTI)
imaging(T2*)
Marrow Edema(kill brownian motion, on ADC White matter tract
Best for microbleeds
higher molecule Diffusion restriction seen in : assessment
the Fat; T2 - Fat) (blooming foci) • Abscess
eg. DAI density inhibits • Ischaemia stroke(d/t Na/K
diffusion) ATPase failure leading to
cellular swelling)
Most sn for • Hypercellular tumour
• Epidermoid cyst(VS
Ischaemia stroke Arachnoid cyst - no DR)
THUMB RULES-MRI [Link]

CNS SPINE NERVES BM EDEMA LIGAMENTS

Brain Neurogenic IOC : MRI-STIR
CARTILAGE
Tumours Acute OM
IOC : MRI Sacroilitis SOFT TISSUE
Stress fracture
Pancoast tumour(only lung tumour IOC : MRI
(only fracture where
where MRI is IOC - d/t neural
IOC is not NCCT)
involvement)
 Ultrasonic sound range(2-20MHz)
USG X radiation B-Mode USG(Brightness) [Link]

Shadowing Anechoic w/ posterior

• stones(esp. gallstones) acoustic enhancement
• Bones Fluid/Cysts
• Air(dirty shadow)
 [Link]

B-mode USG Doppler USG Spectral Doppler

Colour duplex Triplex
Direction of flow Factors in flow
Red : towards velocity
Blue : away
DOPPLER WAVEFORMS
1st Ix in Peripheral arterial disease : Doppler USG

Triphasic waveform Monophasic

Normal in extremity arteries Normal in Veins
A A

NORMAL VEIN DVT IOC DVT : Doppler

COMPRESSIBILITY Normal Non-compressible

Monophasic Absent
FLOW
 THUMB RULES-USG [Link]

GALL BLADDER FLUID PREGNANCY DVT IOC : Doppler ARTERIAL

IOC : USG 1st Ix
• Gallstones CYST VARICOSE VEINS DISEASES
• Acute cholecystitis IOC : USG 1st Ix : Doppler
• GB polyp Pleural IOC : CTA
Pericardial Gold std. : DSA
Ascites
Mickey Mouse sign at SFJ
 CONTRAST MEDIA [Link]

Contrast media Modality Route Pre- Complication

requisite
• GFR<30mL/kg : C/I
IODINATED XRay
i.v/oral RFT • Contrast induced nephropathy(CIN) :
CT
CONTRAST AKI w/in 48hrs of contrast administration

GADOLINIUM MRI i.v. RFT Nephrogenic Systemic

Fibrosis(NSF)

SONOVUE r/o Sulfa Safe in Renal failure

USG i.v. allergy Excreted via lungs
SF6 microbubbles

BARIUM SULFATE Oral/ CXR-PA C/I : Perforation/Obstruction/TEF/

XRay
enema erect Post-op(use Iodinated contrast instead)
 (-ate) Na (-ol)

(MC used) (Best)

a.k.a Gastrograffin
Best for Renal
derangement

I: P ratio 3:2 6:2 3:1 6:1

Osmolarity 1200(HOCM) 600(LOCM) 600(LOCM) 300(Iso-osmolar CM)

GI and HBP RADIOLOGY
 [Link]

Ba swallow Ba meal Ba Meal Follow Ba Enteroclysis Ba enema

Esophagus Stomach & Proximal Through(BMFT) Contrast injected Large bowel
duodenum Small bowel via a feeding tube
till DJ flexure for
better small bowel
distension
CT enterography done in practice. BMFT & Ba
enteroclysis are out of favour

Valvulae conniventes(complete circular fold): small bowel

Haustrations(incomplete folds) : large bowel
 Weight loss
+
Dysphagia

Bird beak app. Rat tail app.

Acahlasia cardia Ca Esophagus
Absence of LES relaxation d/t IOC : UGIE + Biopsy
loss of VIP & NO
IOC : HR Manometry(shows
absence of peristalsis)
 Pseudo-trachea Candidal esophagitis Diffuse esophageal spasm(DES)
Feline esophagus h/o HIV-AIDS Corkscrew app.
Eosinophilic esophagitis Shaggy app.
(AIDS defining lesion)
• DIAGNOSIS: Intussception

• AGE: 6-8 month old child on weaning/

received Rotavirus vaccine
• C/F:Red currant jelly stools - Painful bleeding USG
Inconsolably crying child Target/Donut/Sandwich/
Pseudo-kidney sign
• MC TYPE: Ileo-colic
Painless blood in stool : Meckel’s Claw/Coiled
spring sign
• INITIAL: USG

• IOC/GOLD STANDARD: Ba enema > Air enema > Saline enema

(XRay-g) (USGg)
• DIAGNOSIS: Congenital Diaphragmatic Hernia
• TYPES:
A) Morgagni Hernia : Right sided, Anteriorly placed,
adults>children
B) Bochdalek Hernia : Left sided, Postero-laterally
placed, Children MC
• C/F: Neonatal respiratory distress

• MOST IMPORTANT PROGNOSTIC FACTOR: Pulmonary

hypoplasia
• INITIAL MX:
ET tube f/b NGT f/b Surgical mgt

• CI: BMV(Bag & Mask ventilation)

 Hiatal Hernia

Sliding type(MC) Rolling type

GE junction slides up Fungus slides up
Higher r/o strangulation &
necrosis

Retrocardiac air fluid level

Width >4mm
Length >16mm

CHPS
Non-bilious vomiting
IOC : USG
Single bubble sign

Billous vomiting
DOUBLE
Double bubble sign
BUBBLE
Triple bubble sign
SIGN
Duodenal atresia
Down syndrome assn.
Jejunal atresia
 Billous vomiting

Whirlpool sign on CT

UGI Contrast - gastrograffin

Corkscrew sign Midgut Volvulus w/ Malrotation
Rx : Ladd proc.
 Fundal Gas

XRay in a pt. too sick to Most sn. : CECT +

stand in Lt. Lateral Decubitus
Perforation/ oral contrast
Pneumoperitoneum NEC 3b :
Pneumoperitoneum
Supine XRay :
Pain abd. +/- guarding/rigidity Football sign
Next Ix : CXR-PA erect>supine f/b
resuscitation & emergency laparotomy
 APPROACH TO INTESTINAL OBSTRUCTION [Link]

Pain abdomen + Obstipation + Abdominal distension + Vomiting

SBO LBO

MC Cause Adhesions
Ca Rectum MC
(prior Sx)
Distribution
Central Peripheral
Diameter >3cm >6cm
Valvulae conniventes ++ Absent
Stepladder sign ++ Absent
Haustra Absent ++
Stepladder sign Mx Conservative(24hrs). If fails,
then adhesiolysis Surgical
Resuscitate + NPO + NGT(bowel decompression) Rule of 3-6-9 : diameter of -
>3cm : small bowel obstruction
FPA Supine>Erect XRay to visualise air >6cm : large bowel obstruction
fluid levels f/b CECT(IOC) >9cm : caeca, obstruction
 Volvulus : bowel loop
SIGMOID VS CECAL VOLVULUS twisting on its own axis [Link]

Sigmoid Caecal
volvulus volvulus

Coffee
Bean sign
C-sign
IMPORTANT BARIUM SIGNS [Link]

String sign Lead pipe colon Apple core deformity Diverticulosis

Terminal ileum stricture Ulcerative colitis Ca colon Painless LGIB
A) string of Kantor : Sawtooth sign
Crohn ds(terminal ileum Diverticulitis : pain/fever
MC, non-necrotic LN Barium C/I
B) Pulled up caecum : IOC : CECT
TB(IC jn., necrotic LN)
Hinchey classification
 NCCT

Honey comb sign Water Lily sign Calcified cyst

Active disease WHO CE 2 Transitional stage Inactive stage
WHO CE3 WHO CE5
Hydatid cyst
MC in Liver > Lung
Echinococcus granulosus

Primary host : Dog

Secondary host :
Sheep
Accidental/dead end
host : Man
GB PATHOLOGIES IOC : USG [Link]

Gallstones Acute cholecystitis GB polyp Comet tailing Phrygian cap

IOC : USG Fever/RUQ pain/ X shadow Adenomyomatosis/ Normal variant
Shadow ++ Murphy’s sign >1cm : Surgery Cholesterolosis/
IOC : USG Strawberry GB

Tc99 HIDA : most accurate

Non-visualisation of GB
APPROACH TO OBSTRUCTIVE JAUNDICE
Direct bilirubin elevated
ALP/GT elevated [Link]

Double Filling
barrel sign defects

CBD
PV
Signal void
CBD stone

1st Ix : USG Endoscope

CBD dilated >6mm IOC : MRCP Gold std. : ERCP
No contrast Contrast used
T2W hyperintensity XRay guided Ix
X radiation Radiation +
Non invasive Invasive proc
Primary Sclerosing Cholangitis
Beaded appearance
IBD : UC > Crohn’s ds
Premalignant : Cholangio-carcinoma
 IOC : ERCP
Chronic calcific pancreatitis
Chain of lakes app.
GU RADIOLOGY
IVP SIGNS [Link]

CECT
IMA lies ant. to isthmus

Ureterocoele Shaking hand calyces Horseshoe kidney

Adder head app. Flower vase sign
Assn. w/ turner syndrome

ADDER HEAD SIGN

 IVP:

Staghorn calculus
Struvite(triple
phosphate)stones
Putty kidney Coffin lid app. Medullary nephrocalcinosis PUJO
End-stage : GU-TB Alkaline urine - Medullary sponge kidney
autonephrectomy proteus infected Hypercalcemia
Sterile pyuria
RENAL CYSTS [Link]

Simple Renal cyst

Spider led app. on IVP

ADPCKD(adults, outer contour
Swiss cheese app.
of kidney affected, large cysts)
VS
ARPCKD(affects children,
micro cysts, normal outer
contour of kidney)
RENAL MASSES [Link]

Oncocytoma/
Clear cell RCC Chromophobe RCC Angiomyolipoma
RENAL score:
Partial nephrectomy
BOSNIAK grade:
Complex cyst

Necrotic Hamartoma
Central
Stellate scar

Glycogen/lipid
laden cells Physalliferous/plant like cells
TSC(Chr 9/16)
VHL(3p del) Birt-Hogg-Dube Seizures, adenoma sebaceum
Cerebellar Syndrome(follicular gene#)
hemangioblastoma, Lung cysts, RP hemorrhage:
Pheochromocytoma fibrofolliculomas Wünderlich syndrome
Dermoid cyst(Mature teratoma)
MC germ cell tumour
 UB

Post. urethra
Prostatic
Membranous
Bulbar
Penile Keyhole sign on
Ant. urethra USG

Micturating Cysto- MCC of recurrent UTI in MCC congenital urinalysis

Urethrogram(MCU) child : VUR obstruction : PUV May be associated w/
Foley’s catheter used to fill IOC : MCU Oligohydramnios,Potter
300mL contrast in bladder f/b
sequence & subsequent
patient voiding
pulmonary hypoplasia
Grades of VUR
Ballooning +
I II III IV V
Mild Severe Severe
 [Link]
URETHRAL TRAUMA

C/F:

R/F-
Anterior:
Posterior:
 IOC FOR BLADDER TRAUMA: CT Cystography [Link]
43

Molar tooth/Flame sign

Peri/pre-vesical

TYPE: Extraperitoneal bladder TYPE: Intraperitoneal bladder

rupture(MC) rupture
MX: MX:
Foley’s catheter Surgery
Christmas tree bladder Extrinsic Schistosomiasis
Diverticulae compression of Fetal skull app.(Bladder wall
Bladder calcification)
Neurogenic bladder
Tear drop/pear shaped Premalignant - Sq,CC
bladder
Pelvic lipomatosis/
hematoma/LN+
UB stones Jack stone app. Perimenopausal female
Calcified fibroid
 Earliest : G-sac Yolk sac Embryo/Fetal pole Double bled
Intradecidual sign 5.5 wks TVS TVS : 6.5 wks Amniotic sac-yolk
• eccentric sac sac
• well defined wall FHR++
Double decidual sign (Surest sign of
TVS : 4.5 wks viability)
TAS : 5.5 wks

Best for GA : CRL

APPROACH TO ENLARGED OVARIES [Link]

Echogenicity & volume of

ovarian stroma increased

• Increased ovarian volume(>10cc) PCOD

• String of pearls sign An ovulation h/o IVF Molar preg.
• Multiple(>10), small(<10mm) - X Dominant follicle
peripheral OHSS Theca lutein
cyst
h/o irregular cycles/hirsutism/amenorrhea
DOC : infertility - letrozole>clomiphene
Overall mgt : OCPs + Lifestyle changes +/-
Metformin
THORACIC RADIOLOGY
 Hydrothorax
• DIAGNOSIS: Pleural effusion
Haemothorax
• SIGN: Meniscus sign/Ellis S curve

• EARLIEST FINDING: Blunting of CP angle

• MEDIASTINAL SHIFT: C/L

• MOST SENSITIVE IX: USG ~ 5-10mL

• MOST SENSITIVE XRAY:

I/L lateral decubitus(25-50mL)>Lateral(75-100mL)>CXR-PA
erect(200-250mL)>Supine(500mL)
 MEDIASTINUM
Opaque hemithorax

C/L I/L No shift

Massive pleural Consolidation
effusion Collapse Pneumonectomy
• DIAGNOSIS: Pneumothorax

• MEDIASTINAL SHIFT: C/L

• MOST SENSITIVE IX: CT

• MOST SENSITIVE XRAY: Expiratory CXR

• MX: UNSTABLE STABLE

Tension Ptx ICD

Needle thoractomy

ICD
 eFAST thorax :
M-mode USG

Seashore sign Barcode/Stratosphere sign

Normal lung Pneumothorax
Lung abscess Hydropneumothorax Diaphragm injury Retrocardiac air
Managed as C/I : ICD fluid level
haemothorax Hiatal hernia
 ML

Silhouette sign Lower lobe : spine sign Left LL consolidation +

RML consolidation Pmeumatocoele
S. Aureus pneumonia
HRCT APPROACH-FEVER + PRODUCTIVE COUGH

Consolidation w/ air bronchogram Tree in bud sign Bronchiectasis -

Pneumonia Endobronchial TB signet ring app.
Active TB(TB bacilli in Artery
bronchus) Dilated bronchus
Centrilobular nodules
 Fever - immunocompromised

HRCT of fungal
pneumonia
• interlobular
septum
• Peripheral
wedge shape
consolidation
• Pleural effusion
• Nodule w/ GGO

Reverse halo sign

Halo sign
Organising pneumonia(ILD)
Invasive Aspergillosis
D/d - mucor
Febrile neutropenia
HIV-AIDS Solid
DOC : Voriconazole GGO
Solid GGO
Aspergilloma(fungal ball) - air crescent sign
GGO - Multifocal, peripheral Military nodules Chronic dry cough
COVID19 MCC : TB Usually Interstitial
Typical : CORADS 5 • histoplasma Pneumonia/IPF
CORADS 0 - incomplete • coccidioidomycosis Honeycombing + Traction
1 - normal • blastomyces bronchiectasis + Basa(LL)
2/3/4 - atypical • Healed varicella
5 - Typical • Silicosis
6 - RTPCR proven • No cardia
• Tropical pulmonary eosinophilia
(Loefller syndrome)
Q. 28-year-old male with HIV and CD4 count of 120
cells/mm3 and non-productive cough. Diagnosis?

A. TB Lobar consolidation

B. Pneumococcus
Halo sign
C. Invasive aspergillosis

D. Pneumocystis carinii
CD4<200
Prophylaxis/Rx : TMP-SMX

B/L GGO + cysts

Perihilar central diffuse haziness
 Kerley lines A

Kelley lines B

Interlobular septal Bat wing : peri-hilar Peripheral consolidation

thickening
Earliest : cephalisation
Pulm. Edema

Cardiogenic Non cardiogenic(ARDS)

 Popcorn

Fibroadenoma Hamartoma
MC benign : Chordoma
 C/o dysphagia

Post. indentation Aberrant RSCA

Dysphagia lusoria
NEURORADIOLOGY
RADIOLOGICAL ANATOMY
 HEAD TRAUMA NCCT is IOC for head trauma except DAI(IOC : MRI) [Link]

Alcoholic-fall H/o RTA H/o RTA H/o RTA, GCS-9

Intraparenchymal
Star of death
Microbleeds : Blooming pattern
bleed/Contusion d/t
coup-countercoup #

Acute SDH Acute EDH Acute SAH Gold std. - DSA Diffusely Axonal
Thunderclap headache Injury
(Worst headache of life)
• Bridging veins • Artery Ant. div. of • Trauma> Aneurysm • NCCT Normal/
IOC : CTA
• Trivial trauma • RTA MMA • MC site: petechial
Circle of Willis TOC : Endovasvular
• Sutures: Can cross • Sutures: X hemorrhage
• Midline X • Midline Can cross ACA - ACOM jn. Coiling • IOC: MRI/SWI
Adam’s classification:
1 - GM-WM 2 - Corpus callosum
3 - Brainstem
HEAD TRAUMA
Transtentorial herniation

Base of
mandible

MC injured
Most accessible

Cricoid

Suprasternal
notch
3rd CN # Mount Fuji sign Max. mortality
Chronic SDH EDH
Tension
Swirl sign pneumocephalus
Active bleed is an
indication of I/L dilated pupil Penetrating neck trauma = Breach of platysma
Decompression using (Hutchinson pupil) • Expanding or pulsatile hematoma
Craniectomy/Burr • Active bleeding
I/L hemiplegia(d/t
• Shock
hole compression of C/L • Airway compromise
crus cerebri(false • Massive subcutaneous emphysema
localising sign) • Neurologic deficit
• ZONE 2
• DIAGNOSIS:Basal ganglia bleed/Ganglio-capsular bleed

• MC SITE: Putamen

• MC R/F: Hypertension

• VESSEL: Charcot’s artery - MCA lenticulostriate art.

Ischaemic stroke Charcot’s artery
MCA Lenticulostriate art.
Lipohyalinosis
Lacunar stroke(<15mm)
BRAIN TUMORS IN ADULTS IOC : CE-MRI [Link]

MC benign adults MC malignant MC CP angle tumour

Dural tail sign Grade IV Ice-cream cone app.
Meningioma Butterfly glioma Vestibular schwannoma
Glioblastoma multiforme NF2
BRAIN TUMORS IN CHILDREN [Link]

Prophylactic
Pilocytic Astrocytoma MC malignant Calcification, cystic, craniotomy-spinal
irradiation:
MC benign paediatric 4th ventricle wet keratin, • Medulloblastoma
• SCLC
tumour Medulloblastoma chiasma • ALL
Rosenthal fibres
Drop mets Craniopharyngioma
Mural nodule in cystic
lesion
CNS INFECTIONS IOC : CE-MRI [Link]

Cerebral abscess Neurocyticercosis TB Toxoplasmosis

T. sodium eggs/Scolex/ Conglomerating RELs
Diffusion restriction Target lesion
Starry sky app. MRS : lipid-lactate peak
Ring enhancement B/L BG
HIV/AIDS+
PNS X-RAY VIEWS [Link]

IOC : NCCT/HRCT

Pierre’s view Caldwell view

Mod. water’s view - open mouth Frontal sinus visualisation
Maxillary sinus visualisation
MSK RADIOLOGY
Epiphyseal tumors IOC : MRI [Link]

• Bone cortex pathology :

IOC = NCCT
• Bone marrow/Cartilage/Ligament/
Soft tissue pathology :
IOC = MRI

Chondroblastoma Giant cell tumour

Child Adult(30-40yrs)
Soap bubble app.
Diaphyseal tumors
Nidus

IOC : NCCT

Osteoid Osteoma Ewing sarcoma Adamantinoma

MC true benign bone tumour t(11;22), CD99/mic2 Tibial bowing
Nocturnal pain responsive to Child
NSAIDs Most radio-/chemo-sensitive
Central nidus - releases PGs
Rx : RFA
Metaphyseal tumors

Osteosarcoma Simple bone cyst/ Aneurysmal bone cyst

Sunburst app./Codman Unicarmel bone cyst Soap bubble app.
triangle Fallen leaf/trapdoor
MC malignant sign
Most radio-resistant
 Cartilage cap

Shepherd crook deformity

Exostosis/Osteochondroma Enchondroma Fibrous dysplasia
Has malignant potential Ground glass app.
to turn into McCune Albright
syndrome
chondrosarcoma(if Olliers syndrome Mafucci syndrome
cartilage cap >1.5cm) Multiple enchondroma Multiple enchondroma +
hemangioma
30% premalignant up to 100% premalignant
 Flat bones affected

Stippled ring/arc

Chondrosarcoma
 SPINE XRAYS-APPROACH [Link]

Dagger sign
Rugger jersey
Tram track sign
Ivory vertebrae Osteoporosis
spine Codfish vertebrae/ Young male with Cobb’s angle
Paget’s ds
2HPT/CKD/ compression # of spine inflammatory backache Scoliosis
Hodgkin’s HLA: B27 Ank. Spond.
Renal Biochemical analysis >10 : scoliosis
lymphoma Signs: B/L sacroilitis, tram track sign,
osteodystrophy normal bamboo spine, dagger sign >40 : surgery
Prostate/Breast
IOC : DEXA(T score needed
blastic mets <-2.5 = Osteoporosis) Uveitis B/L heel
B/L heel pain pain(enthesitis)

IOC : MRI
 55yr old back ache
Black discoloration of pinna

Oochronosis Diffuse Idiopathic Skeletal Hyperostosis

i.v. Disc calcification a.k.a Forrestrier’s disease
Anterior Longitudinal Ligament
ossification
 5yr old low SES, low bone density 5yr old short stature, normal bone density

Rickets Scurvy
• decreased Vit.D & subsequently decreased • Vit.C deficiency(collagen
decreased)
Calcium
• White line of frenkel Achondroplasia
• 1st radiological sign : Loss of Provisional Rhizomelic
• Pelkan spur
Zone of Calcification (PZC) Metaphyseal dysplasia
• Trummerfield zone
• Cupping-splaying-fraying
• Wimberger ring sign
• White line on XRay : healing rickets
RT/ NUCEAR MEDICINE
Effects of Radiation [Link]

STOCHASTIC “Chance effects” DETERMINISTIC

No threshold Threshold exists

Delayed Immediate

Cancer, Genetic mutations Skin erythema (MC), Cataracts, Epilation

“All or none”
Radiation Units [Link]

Entity SI Unit Conventional Unit

Radioactivity Becquerel Curie

(1Ci=3.7 X 1010 Bq)

Exposure C/Kg Roentgen

(1R=2.5x10-4 C/kg)

Absorbed dose

Air Kerma Gray Rad

ABG RAD (1Gy=100Rad)

Equivalent dose Sievert REM

(1Sv=100Rem)

Effective dose Sievert REM

MAXIMUM PERMISSIBLE DOSE
Background radiation [Link]

Occupational Exposure Public Exposure

• 20 mSv/ year averaged over 5-year 1 mSv/y
Overall
consecutive

• 30 mSv in any single year

150 mSv/y 15 mSv/y

Lens

500 mSv/y 50 mSv/y

Skin, Extremities

2 mSv/y 1 mSv/y
Pregnant female

1 mSv/y 0.5 mSv/y

Fetus
 [Link]

TLD(Thermo-Luminescent
Dosimeter) Badge
• Personal dosimeter
• CaSO4 + Dysprosium(India
• LiF (best)
• 3 monthly reading Lead apron
MC : 0.5mm
Min : 0.25mm
Gamma rays
Tc99 scintigraphy + CT
+
SPECT(Single Photon Emmision CT)
Sestamibi
3D localisation
Radioisotope Test [Link]

Tc99m-MDP (methylene diphosphonate) Hot spots : mets/bone tumours/fracture/

Bone scan metabolic bone disease
Cold spot : Multiple myeloma
Tc99m-HIDA EHBA - Rule out Acute cholecystitis (most accurate)
Gold std : cholangiography Most sn to localise bile leaks
Tc99m Sestamibi PTH adenoma

Tc99m Sulphur colloid scan Kupffer cells(Fibronodular Hyperplasia)

Tc99m pertechnate
Meckel’s diverticulum
Warthin tumour

Tc99m DMSA
Static/Morphology scar in kidney

Tc99m DTPA / MAG3 Functional/Dynamic investigation for

kidney obstruction
Normal Super scan
Metastasis - Hot spots
Used in metabolic bone
disease & metastasis
 [Link]

Warburg effect

IOC for metastasis

PET CT scan
Uses 18FDG False +ve : TB
False -ve : typical carcinoid
Radioisotope Test
18-FDG PET Metastasis
NaF PET Bone mets IOC
Choline PET, PMSA PET Prostate Cancer
DOPA-PET Pheochromocytoma
DOTANOC PET NET
C11 Pittsburg compound b PET Alzeihmer’s disease
 Brachytherapy
Teletherapy Gamma knife
Reduces surrounding organ damage
LINAC Stereotactic radio surgery
Remote after loading
Linear accelerator Leksell frame(x,y,z)
X-rays/electrons Co60 - gamma rays
MC mode of RT Vestibular schwannoma
Pituitary adenoma
Ca Lung(cyber knife - no
frame, LINAC)
Cyclotron: Protons
Braggs peak: Protons
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Type Most sensitive Least sensitive
Cell Type Undifferentiated/rapidly Quiescent/non-dividing
Bergonie law dividing cells cells
Organ Gonads Vagina
Blood cell Lymphocyte Platelet
Cell cycle phase G2-M S phase
Tissue Haematopoetic cells CNS/Neurons
Structure of eye Lens Sclera
Tumors Ewing sarcoma Osteosarcoma
Acute radiation Haematopoetic GI CVS-CNS
syndrome ~1Gy ~10Gy ~100Gy
Inverse square law Intensity is inversely proportional to the
square of distance from source of radiation