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Manual of Chest Radiology 1st Edition Hariqbal Singh
M.D. Digital Instant Download
Author(s): Hariqbal Singh M.D.
ISBN(s): 9782031708919, 8184489064
Edition: 1
File Details: PDF, 13.61 MB
Year: 2010
Language: english
 Manual of
Chest Radiology
 Manual of
Chest Radiology

Hariqbal Singh MD DMRD

Professor and Head
Smt Kashibai Navale Medical College
Pune, Maharashtra, India
Sushil Kachewar MD DNB
Assistant Professor
Smt Kashibai Navale Medical College
Pune, Maharashtra, India

JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD

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Manual of Chest Radiology

© 2010 Hariqbal Singh, Sushil Kachewar

All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or
transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or
otherwise, without the prior written permission of the authors and the publisher.

This book has been published in good faith that the material provided by authors is original.
Every effort is made to ensure accuracy of material, but the publisher, printer and authors will
not be held responsible for any inadvertent error (s). In case of any dispute, all legal matters are
to be settled under Delhi jurisdiction only.

First Edition: 2010

ISBN 978-81-8448-906-4

Typeset at JPBMP typesetting unit

Printed at Ajanta Offsetand Packagings Ltd., New Delhi.

 Dedicated
to
Our dear wives
Arvind Babbal Hariqbal
Smita Sankaye Kachewar
 Preface

Manual of Chest Radiology is a concise, comprehensive, brief

and a small-sized book meant for students preparing for
Postgraduate Medical Admission Tests, who are always
short of time and have wide curriculum. It is a handy manual
for the resident and the practitioner providing useful
information.
Chapter on “Must Remember Before Proceeding to MCQs”
must be remembered in totality by the student appearing
for the competitive examination. Multiple choice questions
being the culture of the day have been put together for the
best advantage. These MCQ’s have been picked up from
various competitive examination papers.
We thank Prof MN Navale, Founder President, Sinhgad
Technical Educational Society and Dr Arvind V Bhore, Dean,
Smt Kashibai Navale Medical College for their kind
permission in this endeavor.
Dr Anand Kamat, Prashant Naik, Abhijit Pawar, Anubhav
Khandelwal, Sheetal Dhote and Mrunalini Shah have helped
in compiling the images. Dr Sachin Patil, Smita Kachewar
and Nimeesh have been generous to allow the use of images
from their collection for this educational entity.
We are greateful to GOD and mankind who have allowed
us to have this wonderful experience.

Hariqbal Singh
Sushil Kachewar
 Contents

1. Introduction ............................................................... 01
2. Normal Radiograph of Chest .................................. 09
3. Consolidation ............................................................ 13
4. Pulmonary Tuberculosis (TB) ................................. 17
5. Miliary Tuberculosis ................................................. 21
6. Collapse ...................................................................... 25
7. Pulmonary Sequestration ........................................ 29
8. Coin Lesion (Pulmonary/Lung Nodule) .............. 31
9. Lung Metastases ........................................................ 35
10. Pulmonary Hamartoma ........................................... 39
11. Interstitial Lung Disease .......................................... 41
12. Cavitary Lung Lesion ............................................... 45
13. Fibrosis ....................................................................... 49
14. Bronchiectasis ............................................................ 51
15. Chronic Obstructive Pulmonary
Disease (COPD) ......................................................... 55
16. Drug-induced Lung Diseases .................................. 59
17. Pleural Disorders ...................................................... 61
18. Pulmonary Embolism ............................................... 69
19. Trauma ....................................................................... 73
20. Hilar Enlargement .................................................... 81
21. Heterotaxy Syndrome .............................................. 85
22. Heart ........................................................................... 87
23. Mitral Stenosis ........................................................... 93
24. Pericardial Effusion .................................................. 97
25. Mediastinal Widening .............................................. 99
26. Aortic Imaging ........................................................ 105
27. Diaphragm ............................................................... 107
28. Rib Abnormality ..................................................... 113
29. Lung Amyloidosis .................................................. 115
30. Sternal Abnormality ............................................... 117
x Manual of Chest Radiology

31. Thymus ..................................................................... 119

32. Kerley Lines ............................................................. 121
33. Trachea ..................................................................... 123
34. Chest Wall ................................................................ 125
35. Must Remember Before Proceeding to MCQs .... 129
36. MCQs for Practice ................................................... 135
Index .......................................................................... 153
1

Introduction
2 Manual of Chest Radiology

X-rays are electromagnetic radiations having wavelength

of 0.1-1 Å and speed is same as that of light (3 x 108 m/sec).
They behave as waves as well as particles and are considered
as a form of modified electrons.
Modern X-ray tubes are based on hot cathode tube
principle invented by Coolidge in 1913 which enables
excellent control of kVp (kilovolt peak) and mAs
(milliampere second). kVp is responsible for penetration of
X-ray beam, low kVp gives high contrast. mAs is responsible
for the film blackening. The radiation intensity on the
cathode side of the X-ray tube is higher than on the anode
side and this principle is called as the Heel effect. The heat
generated in the tube is dissipated in three ways: conduction,
convection and radiation. Diagnostic X-ray machine uses
voltage upto 150 kV whereas machines used for
radiotherapy use high voltage > 200 kV.
In diagnostic radiology about 85% of X-rays arise from
Bremsstrahlung radiation and 15% from characteristic
radiation.
X-ray tube is a diode consisting of tungsten filament
cathode and a rotating anode target of tungsten held in an
evacuated glass. Tungsten anode is inclined at an angle so
that it works on line-focus principle.
Tungsten (atomic number 74) is used as target material
for X-ray production. Molybdenum (atomic number 42) is
used as the target in mammography. X-rays are produced
when the electron beam strikes the anode made of tungsten
or molybdenum.
X-ray filter made of aluminum absorbs low energy
radiation and decreases unnecessary patient exposure and
thus improves film contrast. Grid made of parallel lead lines
with intervening radiolucent material absorbs scattered
 Introduction 3

radiation. Cones and collimators restrict field size and

decrease scatter.
Distance from X-ray tube to the radiograph is called focus
film distance (FFD). It is 100 cm for usual radiographs of
extremities, abdomen and skull. However, for standing
radiograph of chest it is 180 cm (6 ft) so as to reduce the
magnification.
Ultrasonography (USG) works on piezoelectric effect of
crystals made from lead zirconate titanate. Here the sound
waves having frequency more than 20,000 hertz are
generated by piezoelectric crystals and are used in forming
images by using pulse echo principle. Quartz is the naturally
occurring piezoelectric crystal. Gray scale (B) mode is used
in general imaging. Motion (M) mode is used for
echocardiography.
Color Doppler ultrasound is used for imaging of vessels.
Christian Doppler put forth the principle of doppler.
Computed tomography (CT scan) was developed by
Godfrey Hounsfield and he was awarded Nobel prize in
1979. It works on the principle of linear attenuation of
X-rays. The density of a structure on CT scan is measured in
terms of Hounsfield unit (HU). One of the most important
uses of multislice CT is in cardiac applications, i.e. coronary
angiography.
Magnetic resonance imaging (MRI) scan was introduced
by Lauterbur and Mansfield and they were awarded Nobel
prize in 2003. The theory of nuclear magnetic resonance was
put forth by Felix Block and Edward Purcell. Patient is not
exposed to any ionizing radiation in MRI Scan. Hydrogen
protons in the body are used for imaging in MRI. The images
are obtained using gyromagnetic properties of hydrogen
proton under high magnetic field of field strength ranging
4 Manual of Chest Radiology

from 0.2-3.0 Tesla. To prevent MRI room from external

electromagnetic radiations, a cage made of copper is used
which is called as Faraday's cage.
MRI is better than CT scan for imaging brain, spine and
soft tissues. CT scan is better than MRI for assessing bones,
small calcifications and fresh bleed.
Radioisotope imaging is done using Tc99m (Technetium)
and Gamma camera. Single photon emission computerized
tomography (SPECT), images the distribution of
radiopharmaceutical which emits photon on decay in the
body. Whereas positron emission tomography (PET scan),
shows the distribution of positron emitting nuclides in
patients.
Dual energy X-ray absorptiometry (DXA scan) is used
for measuring bone mineral density and it is the gold
standard for assessing osteoporosis.
Radiographic film has 2 parts: The base (polyester/
cellulose triacetate) and the emulsion (silver halide crystals-
photosensitive layer). The cassette is the rigid holder that
contains the intensifying screen and film. Intensifying screen
made of phosphor converts and amplifies the energy of X-
ray beam into light photons so that good radiographic
contrast can be obtained at lower dose of X-ray. Latent image
on the exposed film is converted into a visible image by
processing the film in developer solution made of metol and
hydroquinone and fixing it in a fixer solution made of
sodium or ammonium thiosulphate.
Radiography has now become 'film less' due to the
availability of digital radiography (DR), which uses
photostimulable phosphor plate. This is also called as
computerized radiography (CR).
Picture archiving and communication system (PACS) has
become possible only due to the advent of digital
radiography.
 Introduction 5

Newer units are used now for measuring radiation. Curie,

which was the unit of measuring radiation activity earlier,
has now been replaced by Becquerel (Bq).
One Bq means one radiation disintegration per second.
Roentgen which was the unit of radiation exposure earlier
is now replaced by Coulomb/kg.
Gray (Gy) replaced Rad as the unit of absorbed radiation
dose.
One Gray is equal to 100 rads.
Sievert has replaced Rem as the unit of dose equivalent.
One Sievert is equal to 100 rem.
Radiation exposure is measured in units of sieverts. On
one X-ray chest the patient receives around 0.2 milli Sieverts
(mSv) of radiation. One CT scan of chest gives 8 mSv
radiation to patient.
Thermoluminiscent dosimeter (TLD) is used to measure
exposure of radiation workers. TLD contains calcium sul-
phate as the thermoluminescent material, which is activated
with disprosium.
In radiology department, lead apron is used for protec-
tion against radiations. Recommended thickness of lead in
the apron is 0.5 mm.
Methods to decrease scattered radiations include
reduction in beam size by using collimator, cone, grid,
intensifying screen and film cassette.
ALARA principle emphasizes that the radiation should
be kept as low as reasonably achievable (ALARA). Children
are 10 times more sensitive for hazards of radiations than
adults. Hence high kV and low mAs technique is
recommended in children.
Inverse square law states that intensity of radiation at a
given distance from the source of radiation is inversely
proportional to the square of distance.
6 Manual of Chest Radiology

Fig. 1.1: TLD Badge

Acute radiation at doses in excess of 100 Gy to the total

body, usually result in death within 24 to 48 hrs from
neurological and cardiovascular failure. This is known as
the cerebrovascular syndrome.
Chronic radiation causes radiation pneumonitis and even
permanent scarring that results in respiratory compromise.
Preconception maternal irradiation in therapeutic doses
gives rise to defects in 1 out of 10 exposed children. Non-
urgent radiological testing should not be done between
8-17 weeks of gestation, which is the most sensitive period
for organogenesis.
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 Data Science - Student Handbook
Fall 2024 - Program

Prepared by: Professor Johnson

Date: August 12, 2025

Results 1: Ethical considerations and implications

Learning Objective 1: Key terms and definitions
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Learning Objective 2: Theoretical framework and methodology
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Learning Objective 3: Learning outcomes and objectives
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Learning Objective 4: Research findings and conclusions
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Learning Objective 5: Literature review and discussion
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Study tips and learning strategies
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Example 6: Study tips and learning strategies
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Research findings and conclusions
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 8: Statistical analysis and interpretation
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 9: Diagram/Chart/Graph]
Key Concept: Learning outcomes and objectives
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 10: Diagram/Chart/Graph]
Part 2: Current trends and future directions
Example 10: Case studies and real-world applications
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Study tips and learning strategies
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Key Concept: Problem-solving strategies and techniques
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Ethical considerations and implications
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Theoretical framework and methodology
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Fundamental concepts and principles
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Note: Current trends and future directions
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Fundamental concepts and principles
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 18: Diagram/Chart/Graph]
Definition: Problem-solving strategies and techniques
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 19: Interdisciplinary approaches
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Introduction 3: Experimental procedures and results
Definition: Literature review and discussion
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 21: Diagram/Chart/Graph]
Practice Problem 21: Research findings and conclusions
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Definition: Current trends and future directions
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Fundamental concepts and principles
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 24: Learning outcomes and objectives
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 25: Practical applications and examples
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Definition: Comparative analysis and synthesis
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Learning outcomes and objectives
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Interdisciplinary approaches
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 29: Experimental procedures and results
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Quiz 4: Learning outcomes and objectives
Remember: Study tips and learning strategies
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 31: Research findings and conclusions
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Example 32: Practical applications and examples
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Comparative analysis and synthesis
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 34: Diagram/Chart/Graph]
Note: Comparative analysis and synthesis
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Best practices and recommendations
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 36: Diagram/Chart/Graph]
Example 36: Experimental procedures and results
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Note: Theoretical framework and methodology
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 38: Theoretical framework and methodology
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Remember: Critical analysis and evaluation
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Abstract 5: Theoretical framework and methodology
Practice Problem 40: Learning outcomes and objectives
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Fundamental concepts and principles
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Ethical considerations and implications
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 43: Practical applications and examples
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Definition: Best practices and recommendations
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Interdisciplinary approaches
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 46: Ethical considerations and implications
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Important: Current trends and future directions
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 48: Statistical analysis and interpretation
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 49: Theoretical framework and methodology
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 50: Diagram/Chart/Graph]
Part 6: Fundamental concepts and principles
Example 50: Current trends and future directions
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Case studies and real-world applications
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Theoretical framework and methodology
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Practice Problem 53: Experimental procedures and results
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Key terms and definitions
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Note: Case studies and real-world applications
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 56: Diagram/Chart/Graph]
Example 56: Theoretical framework and methodology
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Statistical analysis and interpretation
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Historical development and evolution
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Ethical considerations and implications
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Lesson 7: Learning outcomes and objectives
Practice Problem 60: Key terms and definitions
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Definition: Literature review and discussion
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Remember: Problem-solving strategies and techniques
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 63: Ethical considerations and implications
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Key Concept: Current trends and future directions
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Assessment criteria and rubrics
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Historical development and evolution
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 67: Diagram/Chart/Graph]
Note: Research findings and conclusions
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 68: Diagram/Chart/Graph]
Key Concept: Fundamental concepts and principles
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 69: Diagram/Chart/Graph]
Note: Comparative analysis and synthesis
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
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