Cerebellum Revision Course
Radiology
Dr. Zainab Vora
GENERAL RADIOLOGY
MOA of Ionizing Radiation
1)
2)
Effects of Radiation
STOCHASTIC DETERMINISTIC
No threshold Threshold exists
Probability increases with dose Severity increases with dose
Delayed Immediate
Cancer, Genetic mutations Skin erythema (MC), Cataracts, Epilation
“All or none”
IONISING RADIATION
RAYS PARTICLES
MODALITIES USING IONISING RADIATION
NON-IONISING IONISING : X-RAYS IONISING: GAMMA RAYS
Radiation Units
Entity SI Unit Conventional Unit
Radioactivity
(1Ci=3.7 X 1010 Bq)
Exposure
Absorbed dose
Air Kerma
ABG RAD (1Gy=100Rad)
Equivalent dose
(1Sv=100Rem)
Effective dose
MAXIMUM PERMISSIBLE DOSE
Occupational Exposure Public Exposure
• mSv/ year averaged over 5-year mSv/y
Overall
consecutive
• mSv in any single year
mSv/y mSv/y
Lens
mSv/y mSv/y
Skin, Extremities
mSv/y mSv/y
Pregnant female
mSv/y mSv/y
Fetus
➤ AIR
THUMB RULES-X-RAY
➤ FAT
➤ SOFT
EMERGENCIES-AIR TISSUE=FLUID
MSK FOREIGN BODY LINES AND TUBES
➤ BONE
➤ METAL/CONTRAST
THUMB RULES-CT
ACUTE
CALCIUM BONE FOREIGN BODY HEMORRHAGE AIR
APPROACH TO FOREIGN BODY
INITIAL-
IOC-
CI-
CT-THUMB RULES
-IOC for head, spine trauma (Q) • Lung Tumors • Aortic dissection
-IOC for acute SAH (Q) • Renal Tumors • Aortic aneurysm
-IOC for intracranial calcification (Q) • Pancreatic Carcinoma • Pulmonary embolism
-IOC for renal calculi • Liver Tumors • Mesenteric ischemia
-IOC FOR IOFB • Mediastinal Masses • Sequestration
-IOC for bone cortex • Acute Pancreatitis
-Initial Investigation in stroke (Q)
MRI SEQUENCES
MRI SEQUENCES
THUMB RULES-MRI
CNS SPINE NERVES BM EDEMA LIGAMENTS
CARTILAGE
SOFT TISSUE
USG PROBES
FREQUENCY
RESOLUTION
DEPTH
USE
DOPPLER WAVEFORMS
NORMAL VEIN DVT
COMPRESSIBILITY
FLOW
THUMB RULES-USG
GALL BLADDER FLUID PREGNANCY DVT ARTERIAL
CYST VARICOSE VEINS DISEASES
CONTRAST MEDIA
Contrast Modality Route Pre- Complication
media requisite
IODINATED
CONTRAST
GADOLINIUM
SONOVUE
BARIUM
SULFATE
GI RADIOLOGY
IMPORTANT BARIUM SIGNS
• DIAGNOSIS:
• TYPES:
• C/F:
• MOST IMPORTANT PROGNOSTIC FACTOR:
• INITIAL MX:
• CI:
• DIAGNOSIS:
• AGE:
• C/F:
• MC TYPE:
• INITIAL:
• IOC/GOLD STANDARD:
• C/F:
• DIAGNOSIS:
• MOST SENSITIVE XRAY:
• MOST SENSITIVE IX:
• NEXT STEP:
APPROACH TO INTESTINAL OBSTRUCTION
Pain abdomen + Obstipation + Abdominal distension + Vomiting
SBO LBO
MC Cause
Distribution
Diameter
Valvulae conniventes
String of pearls sign
Haustra
Mx
Sigmoid volvulus Cecal volvulus
Direction
Predisposing factors
Starting from/Base
Apex
Number of loops
Associated bowel loop dilation
Haustrations in volvulus
Mx
eFAST
• Full form:
• Sensitivity:
• Limitations:
Blunt trauma abdomen
Unstable Stable
HBP RADIOLOGY
GB PATHOLOGIES
APPROACH TO OBSTRUCTIVE JAUNDICE
C/F:
INITIAL:
IOC:
GOLD STANDARD:
APPROACH TO SUSPECTED BILE LEAK
C/F:
INITIAL:
BEST:
MOST SENSITIVE:
GU RADIOLOGY
IVP SIGNS
ADDER HEAD SIGN
WEIGERT-MEYER LAW
IVP:
RENAL CYSTS
RENAL MASSES
Q. A 13-year-old boy presents to trauma center after
skid injury, and he is unable to pass urine with blood at
meatus. What is the next step?
A) SPC
B) Foley’s catheterization
C) MCU
D) Wait and watch
Q. A 13-year-old boy presents to trauma center after
skid injury, and he is unable to pass urine with blood at
meatus. What is the next step?
A) SPC
B) Foley’s catheterization
C) Wait and watch
D) RGU
Q. A 13-year-old boy presents to trauma center after
skid injury, with lower abdominal pain and blood at
meatus. The bladder is not palpable. What is the next
step?
A) SPC
B) Foley’s catheterization
C) Wait and watch
D) CECT
Q. A 13-year-old boy presents to trauma center after
skid injury, with lower abdominal pain and blood at
meatus. The bladder is not palpable. What is the next
step?
A) SPC
B) Foley’s catheterization
C) Wait and watch
D) RGU`
IOC FOR BLADDER TRAUMA:
TYPE: TYPE:
MX: MX:
WOMEN’S IMAGING
TWINS USG
SIGN: SIGN:
INTERTWIN MEMBRANE: INTERTWIN MEMBRANE:
TYPE: TYPE:
• DIAGNOSIS:
• SIGN:
• EARLIEST ANOMALY TO BE DETECTED:
• PREVENTION:
B/L ENLARGED OVARIES-APPROACH
• DIAGNOSIS:
• SIGN:
• MX:
RESPIRATORY RADIOLOGY
• DIAGNOSIS:
• SIGN:
• EARLIEST FINDING:
• MEDIASTINAL SHIFT:
• MOST SENSITIVE IX:
• MOST SENSITIVE XRAY:
• DIAGNOSIS:
• MEDIASTINAL SHIFT:
• MOST SENSITIVE IX:
• MOST SENSITIVE XRAY:
• MX:
UNSTABLE STABLE
HRCT PATHOLOGIES-APPROACH
Q. 28-year-old male with HIV and CD4 count of 120
cells/mm3 and non-productive cough. Diagnosis?
A. TB
B. Pneumococcus
C. Invasive aspergillosis
D. Pneumocystis carinii
PEDIATRIC INFECTIONS
IMPORTANT PYQs
Q. A 30-year man post-RTA with flank ecchymoses with
stable vitals. Which of the following investigations is
the best to localize the site of bleed?
A) Xray
b) CECT
c) USG
d) RGU
Q. A 35 year old male with RTA with BP 90/60mm Hg.
What is the next appropriate investigation?
a) eFAST
b) CECT
c) MRI
d) DPL
Q. 39 year old male with recurrent episodes of
pain abdomen and jaundice. MRCP is shown
here. Likely diagnosis?
• a) Primary biliary cirrhosis
• b) Primary sclerosing cholangitis
• c) Oriental cholangitis
• d) Caroli disease
Q. 35 year old male with severe pain abdomen since 2
hrs. He recently had a radius fracture for which he’s
been taking lot of painkillers. CXR is shown here. What
is the next step?
• a) Advise him to stop painkillers
• b) eFAST
• c) Barium meal
• d) Exploratory laparotomy
Q. Identify the technique
a) Myelography
b) MCU
c) Vertebroplasty
d) Vesseloplasty
A 35 yr-old male with history of trauma patient
presenting to emergency with breathlessness. What
is the most likely diagnosis?
• a) Pneumothorax
• b) Hydropneumothorax
• c) Emphysema
• d) Diaphragmatic hernia
Q. Division occurs at what time
in the visualized twins?
• a) 0-4days
• b) 4-8days
• c) 8-12days
• d) >12days
Q. Sequential arrangement of order of appearance
1-Yolk sac 2-Embryo 3-Double decidual sign 4 Cardiac activity
• a) 1-2-3-4
• b) 3-1-2-4
• c) 3-1-4-2
• d) 3-2-1-4
Q. Identify the true statement
a) Left heart border silhouette sign negative
b) Location in Left lower lobe
c) Location in Lingula
d) Location cannot be commented without CT
Q. While doing USG of a neonate who has
difficulty in urinating, this appearance is
noted in the lower abdomen. What is the
gold standard investigation to confirm the
diagnosis?
• a) IVP
• b) RGU
• c) MCU
• d) RGP
Q. A 8 month old child after vaccination presents to
the emergency with incessant crying and legs
drawn up. X-ray abdomen is normal with no signs
of free air. USG is done next which shows the
following. What will you do next?
a) Plan for urgent surgical exploration
b) Air enema
c) CT scan
d) MRI
Identify the structure marked by the arrow?
• A) Right 3rd anterior Rib
• B) Right 3rd Posterior Rib
• C) Right 4th anterior Rib
• D) Right 4th Posterior Rib
Q. After a delivery via Caesarean
section, a term neonate presents with
respiratory distress. CXR is shown.
Likely diagnosis?
a) Hyaline membrane disease
b) Transient tachypnea of newborn
c) Diaphragmatic hernia
d) Meconium aspiration
Q. A newborn baby presents with respiratory
distress. Diagnosis based on image
• A) Congenital diaphragmatic hernia
• B) Hiatal hernia
• C) RDS
• D) TTNB
Q. A 35 year old female presented with fever, expectoration and difficulty
breathing. HRCT of chest was performed and shown. What is the likely diagnosis?
a. Mediastinal mass
b. Pleural effusion
c. Diaphragmatic hernia
d. Consolidation with air bronchogram
Q. 45 year old male had RTA. Patient is stable but
complaining of mild chest pain and dyspnea. CXR
is shown below. What is the diagnosis?
a) Hemothorax
b) Pneumothorax
c) Lung contusion
d) Diaphragm tear
Q. What is the least useful investigation to confirm
the diagnosis of the patient with following
condition?
a) Timed barium swallow
b) UGIE
c) Manometry
d) 24-hr pH monitoring
Q. Identify the sign shown in the image
• A) Saw tooth sign
• B) Apple core sign
• C) Corkscrew appearance
• D) String sign
Q. A 30 year old female presenting with sterile
pyuria. Radiograph is shown identify the
diagnosis?
A) Nephrocalcinosis
B) Putty kidney
C) Staghorn calculus
D) Psoas Calcification
Q. A child presents with cyanosis. Xray of the
patient is given below identify the diagnosis?
A) Cottage loaf, truncus arteriosus
B) Snowman sign, Supracardiac TAPVC
C) Egg on side, TGA
D) Boot shaped heart, TOF
Q. A 35 year old female presents to you with history of nausea and
vomiting. She is undergoing IVF treatment. What is the likely
diagnosis?
a) PCOD
b) Theca-Lutein cyst
c) OHSS
d) Mucinous cystadenoma
Q. What does the following X ray depict?
a. Pleural effusion
b. Tension pneumothorax
c. Emphysema
d. Bronchiectasis
Q. A 55 year old male patient with chronic
cough. Likely diagnosis
• a) Silicosis
• b) Sacroidosis
• c) Lymphangitic carcinomatosis
• d) Both a and b
Q. Classification describing risk of malignancy
in renal cysts
• a) KIRADS
• b) RC-RADS
• c) Bosniak
• d) Ravine
Q. Identify the correct pair
• a) Sitting duck-Tricuspid atresia
• b) Goose neck deformity-VSD
• c) Hilar dance-ASD
• d) Egg on string-PTA
Q. Identify the MRI sequence
a) SWI
b) Proton density
c) ADC
d) Gradient echo
CVS RADIOLOGY
CARDIOGENIC PULMONARY EDEMA
PCWP FINDINGS
CONGENITAL HEART DISEASES
DIAGNOSI
S
SIGN
COMPONE
NT
OLIGEMIA/
• DIAGNOSIS:
• MC R/F:
• C/F:
• IOC STABLE:
• IOC UNSTABLE:
• MANAGEMENT:
• DIAGNOSIS:
• MC R/F:
• C/F:
• INITIAL IX:
• IOC :
• INDICATIONS OF MX:
• DIAGNOSIS:
• C/F:
• IOC :
NEURORADIOLOGY
HEAD TRAUMA
• INITIAL INVESTIGATION:
• IOC:
• DIAGNOSIS:
• MCC:
• C/F:
• MC SITE OF BERRY ANEURYSM:
• INITIAL IX:
• IOC:
• GOLD STANDARD:
Q. A 34-year-old woman landed up in AIIMS emergency after
a road traffic accident with GCS of 3. She was intubated and
sent for NCCT which was found to be normal. What is the
most likely diagnosis?
A. SAH
B. EDH
C. Cerebral contusion
D. DAI
• DIAGNOSIS:
• C/F:
• NCCT:
• IOC :
STROKE
• INITIAL INVESTIGATION OF CHOICE:
• MOST SENSITIVE INVESTIGATION FOR INFARCT:
• ALGORITHM:
• DIAGNOSIS:
• MC SITE:
• MC R/F:
• VESSEL:
BRAIN TUMORS IN ADULTS-PATTERN APPROACH
BRAIN TUMORS IN CHILDREN-PATTERN
APPROACH
CNS INFECTIONS
CNS INFECTIONS-HIV/AIDS
SKULL XRAYS-PATTERN APPROACH
SKULL XRAYS-PATTERN APPROACH
PNS X-RAY VIEWS
PNS
IOC:
GOLD STANDARD:
LARGEST :
ANTERIOR-MOST :
POSTERIOR-MOST:
INFRAORBITAL:
PNEUMATISED MIDDLE TURBINATE:
PNS ANATOMY AND VARIANTS
MSK RADIOLOGY
• DIAGNOSIS:
• AGE:
• HLA:
• C/F:
• DIAGNOSIS:
• SIGN:
• BIOCHEMICAL:
• IOC:
• SCORE:
SPINE XRAYS-APPROACH
NUCLEAR MEDICINE
Scan Use
Tc99m-DMSA
Tc99m-DTPA
Tc99m-MAG3
Diuretic renography
Captopril
renography
Radioisotope Test
Tc99m-MDP
(methylene
diphosphonate)
Tc99m-HIDA
Tc99m Sestamibi
Tc99m Sulphur colloid
scan
Tc99m pertechnate
Tc99m labelled RBC
Tc99m tetrofosmin,
Sestamibi, Th-201
Tc99m pyrophosphate
RADIOTHERAPY
Types of Radiotherapy
Agents for Radiotherapy
Dose-Depth curve
Dose
Depth
Fractionated RT – 5Rs
• Repopulation
• Reoxygenation
• Repair
• Redistribution
• Radiosensitivity
Inverse Square Law
Element HALF LIFE
18-FDG
Tc 99
I-123
I-124
I-125
I-131
P-32
Ir-192
Co-60 (Q)
Cs-137
Au-198, Yt-90
Radium-226
Important one-liners
• Most common side effect of RT-
• MC RT-induced malignancy-
• MC brain tumor after cranio-spinal RT-
• MC RT-induced thyroid carcinoma-
• MC bone cancer after RT-
Type Most sensitive Least sensitive
Cell Type
Organ
Blood cell
Cell cycle phase
Tissue
Structure of eye
Tumors
Acute radiation
syndrome
RADIOLOGICAL ANATOMY
IMPORTANT PYQs
Q. A 26 year old male with back ache, morning
stiffness and reddening of eyes. X- ray of the
patient is given below, Identify the diagnosis of
this patient?
A) Rheumatoid arthritis
B) Psoriatic arthritis
C) Ankylosing spondylitis
D) Paget’s disease
Q. A 34-year-old woman landed up in AIIMS
emergency after a road traffic accident with GCS
of 3. She was intubated and sent for NCCT which
was found to be normal. What is the most likely
diagnosis?
• A. SAH
• B. EDH
• C. Cerebral contusion
• D. DAI
Q. Identify the view given in the X-ray?
a. Towne view
b. Water’s view
c. Coldwell view
d. Basal view
Identify the structure marked with the arrow
• a) Sequestrum
• b) Involucrum
• c) Cloaca
• d) Osteoid osteoma
Q. A 5 year old boy with inability to pronate
and supinate. What is the likely diagnosis?
• a) Radial head dislocation
• b) Monteggia fracture
• c) Galleazi fracture
• d) Radioulnar synostosis
Q. Which of the following is most likely to be seen due to rupture of saccular
aneurysm in brain?
a. Subdural Haemorrhage
b. Subarachnoid Haemorrhage
c. Hydrocephalous
d. Intracerebral Haemorrhage
Q. A 10-year-old boy
presented with seizure and
then fell unconscious. Imaging
was done which is shown here.
What is the likely diagnosis?
• a) Glioblastoma multiforme
• b) Abscess
• c) TB
• d) NCC
Q. A 35 year old male with lower limb pain.
What is the likely diagnosis?
• a) GCT
• b) Chondroblastoma
• C) ABC
• D) NOF
Q. Identify the correct pair
A-Coronoid fossa
B-Trochlea
C-Olecranon process A.
D-Lateral epicondyle D.
B.
C.
Q. A 45-year-old male presents to the trauma centre post-RTA.
HE is conscious, talking and vitals are stable. CXR is shown.
Which of the following procedures is contraindicated?
A. NG tube
B. Log roll
C. ICD tube drainage
D. Epidural anaesthesia
Q. Most radiosensitive bone tumor
• A) Enchondroma
• B) Osteosarcoma
• C) Ewing sarcoma
• D) Osteochondroma
Q. 36 year old male underwent a road traffic
accident. NCCT was performed. What is the likely
diagnosis?
a) EDH
b) SDH
c) SAH
d) Cerebral contusion
Thank you
