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Radiodiagnosis, Nuclear Medicine, Radiotherapy and Radiation Oncology
Bipin Valchandji Daga, Vaibhav Ramesh Shah, Sachin Valchandji Daga
SECTION 1: RADIODIAGNOSIS
CHAPTER 1:
General Radiology and Radiology Physics
BRIEF HISTORICAL REVIEW: THE DISCOVERY OF X-RAYS
Types of Radiations and their Uses
VARIOUS MODALITIES FOR IMAGING
CONVENTIONAL RADIOGRAPHY
X-ray Production
Properties of X-rays
X-ray Tube
The Five Basic Ways that an X-ray Photon can Interact with Atom/Matter
Photoelectric Interaction
Compton Scattering
X-ray Film
Films Used in Medical Imaging
CHEMICAL PROCESSING OF An X-RAY FILM
Intensifying Screens
DIGITAL OR COMPUTED OR FILMLESS RADIOGRAPHY OR PHOSPHOR PLATE TECHNOLOGY
Types
Major Advantages of CRS
PICTURE ARCHIVING AND COMMUNICATION SYSTEM
Types of PACS
Advantages of PACS
Disadvantages of PACS
CONTRAST RADIOGRAPHY
Definition
BARIUM STUDIES
NONBARIUM STUDIES
SIALOGRAPHY
MYELOGRAPHY
EXCRETORY UROGRAPHY (INTRAVENOUS UROGRAPHY, IVU, IVP)
Indications
Contraindications
Patient Preparation
Contrast Administration
Film Sequencing
Tailoring
Modifications in IVU Include
Abnormal Nephrogram
URETHROGRAPHY
Retrograde Urethrography/Ascending Urethrography
Voiding Cystourethrography/Micturating Cystourethrography/Descending Urethrography
Indications
HYSTEROSALPINGOGRAPHY
Definition
Ideal Time to Perform HSG
Indications for HSG
Contraindications for HSG
Complications of HSG
Genital Tuberculosis and HSG
Tuberculous Salpingitis
HSG
XERORADIOGRAPHY
MAMMOGRAPHY
Indications for Mammography
ORTHOPANTOMOGRAPHY OR PANORAMIC RADIOGRAPHY
ULTRASONOGRAPHY/ULTRASOUND STUDY
Theoretic Safety Risks from Ultrasound
Transrectal Ultrasonography
COLOR DOPPLER IMAGING/STUDY
ECHOCARDIOGRAPHY
TRANSESOPHAGEAL ECHOCARDIOGRAPHY
Common Indications
COMPUTED TOMOGRAPHY
CT Number/HU Value
SPECIAL APPLICATION OF MULTISLICE CT
High Resolution Computed Tomography
Basic Principles
Clinical Applications
Safety Aspect of Computed Tomography
Advantages
Disadvantages
MAGNETIC RESONANCE IMAGING
Principle of MR Imaging
Advantages
Disadvantages
Contraindications to MRI
RADIONUCLIDE IMAGING
EMISSION COMPUTED TOMOGRAPHY
Single Photon Emission Computed Tomography
Positron Emission Tomography/18-FDG-PET Scan
Advantages
Clinical Applications
BONE DENSITOMETRY
EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY
Endoscopic Retrograde Cholangiopancreaticography
Advantages
Disadvantage
Recent Advances
CHAPTER 2:
Radiological Contrast Agents/Media
CONTRAST MEDIA FOR BARIUM PROCEDURES
Barium Sulfate
CONTRAST MEDIA FOR NONBARIUM PROCEDURES
Basic Uses of Iodinated Water Soluble Contrast Media
Adverse Effects of Iodinated Contrast Media
Strategies for Preventing Contrast Induced Nephropathy
Contrast Agent Used for MRI/MR Contrast Agents
MR CONTRAST MEDIA: KEY FACTS
CHAPTER 3:
Radiation Hazards and Protection
VITAL TOPICS
INTRODUCTION
Cell Cycle and Radiation
Radiobiology
Sources of Radiation Exposure
Biologic Effects of Radiation
Somatic/Acute/Deterministic/Nonstochastic Effects
Genetic/Chronic/Nondeterministic/Stochastic
Total Body Irradiation—Acute Effects
Specific Nonstochastic Effects
Hematopoietic Syndrome
Gastrointestinal Syndrome
Central Nervous System
Other Acute Effects
Carcinogenesis
Radiation Effects in the Developing Embryo and Fetus
Tolerance Doses
RADIATION PROTECTION
NCRP Recommendation of Radiation Dose Limits
ICRP Recommendations for the Dose Limits
Regulatory Limits for Occupational Exposure
Declared Pregnant Workers and Minors
Nonradiation Workers and the Public
How We Protect Ourselves from Radiation? [Radiation Protection]
PRIMARY AND SECONDARY BARRIERS FOR RADIATION
Materials for Radiation Protection
Lead Aprons
Radiation Dosimetry
Thermoluminescence Dosimeter
RADIATION UNITS
Absorbed Dose
Dose Equivalent
Effective Dose
CHAPTER 4:
Pulmonary Radiology
GENERAL ASPECT
Bronchopulmonary Segments
Acquiring a Chest X-ray (CXR)
Special Chest Radiographic Views
Normal Chest Radiograph
Hila
Mediastinal Outline
Trachea
COMMON ABNORMALITIES NOTED ON CXR
Localized Rib Expansion
Differential Diagnosis of Unilateral Hypertranslucent of Lung
Differential Diagnosis of Opaque Hemithorax
Differential Diagnosis of Miliary Mottling
Differential Diagnosis of Calcific Foci in Lungs
Differential Diagnosis of Cavitating Pulmonary Lesions
Differential Diagnosis of Honeycombing of Lungs
Patterns of Interstitial Lung Diseases (ILD)
Differential Diagnosis of Bilateral Upper Lobe Fibrosis
Airbronchogram Sign
Differential Diagnosis of Airbronchogram Sign
Silhouette Sign
ROLE OF CXR IN THORACIC TRAUMA
Emphysema
Types of Emphysema
CXR in Emphysema
PEDIATRIC CHEST
CONGENITAL LESIONS
Transient Tachypnea of the Newborn (TTN or Neonatal Wet Lung Disease)
Respiratory Distress Syndrome (Hyaline Membrane Disease)
Pulmonary Sequestration
Extralobar Sequestration
Intralobar Sequestration
Congenital Diaphragmatic Hernia
Congenital Cystic Adenomatoid Lung Malformation
Congenital Lobar Emphysema (CLE)
McLeod's (Swyer-James) Syndrome/Unilateral Hyperlucent Lung Syndrome
Foregut Duplication Cysts
Bronchogenic Cysts
Esophageal Duplication Cyst
Neuroenteric Cyst
FOREIGN BODY ASPIRATION
PULMONARY INFECTIONS
Staphylococcal Pneumonia
Klebsiella Pneumoniae
Mycoplasma Pneumoniae
Pulmonary Tuberculosis
Mycobacterium Tuberculosis Infection
Mycobacterium Avium Intracellular Complex (MAC) Infection: CXR
Pneumocystis Carinii Pneumonia
CXR Feature of Pneumocystis Carinii Infection
Hydatid Disease of Lung
Radiological Signs
Allergic Bronchopulmonary Aspergillosis
Primary Diagnostic Criteria for Allergic Bronchopulmonary Aspergillosis (ABPA)
Secondary Diagnostic Criteria (Less Common)
Candida Albicans Pneumonia
LUNG COLLAPSE
Pleural Diseases
Pleural Effusion
Loculated Pleural Effusion
Pneumothorax
CXR
BRONCHIECTASIS, INDUSTRIAL AND INTERSTITIAL LUNG DISEASES
Radiographic Features of Bronchiectasis
Silicosis
Asbestosis
Pleural Changes
Pulmonary Changes
Lymphangiitis Carcinomatosa
Lymphangioleiomyomatosis
Caplan's Syndrome
Wegener's Granulomatosis
Sjögren's Syndrome
Sarcoidosis
Lymphadenopathy
Parenchymal Changes
Complications of Fibrosing Stage
Hypersensitivity Pneumonitis
NEOPLASMS
Solitary Pulmonary Nodule
Characterization of SPN
Pulmonary Hamartomas
Lung Carcinoma
AJCC-UICC Classification of regional lymph nodes
TNM Staging for Lung Cancer
Pancoast Tumor
Bronchial Artery Embolization
MEDIASTINUM
Pneumomediastinum
Signs of Pneumomediastinum on CXR
Mediastinal Masses
Characterization of Mediastinal Node in Various Diseases
Hilum Overlay Sign
Cervicothoracic Sign
CHAPTER 5:
Cardiovascular Radiology
HEART
Cardiac Monitoring
Noninvasive Cardiac Output Monitoring Techniques
Cardiovascular Monitoring Techniques
Cardiac Borders on Chest X-rays
Signs of Enlarged Right Ventricle on CXR
Signs of Left Atrial Enlargement on CXR
CXR Features of CCF
Generalized oligemia may be a feature
Cardiomegaly : Cardiac enlargement
CXR Features of Mitral Stenosis
Pulmonary Plethora is Pulmonary Overcirculation
Specific Cardiac Configurations and Signs
CONGENITAL ANOMALIES
Syndromic Association of Few Cardiac Lesions
CXR Features Atrial Septal Defect
CXR Signs of VSD
CXR Signs of Eisenmenger Syndrome
Tetralogy of Fallot
Tricuspid Atresia
Total Anomalous Pulmonary Venous Connection/Drainage
Types of APVC
Classification Based on Obstruction
Classification Based on Severity
Classification Based on Anatomy
PULMONARY EDEMA
Causes of Pulmonary Edema with Cardiomegaly
Causes of Pulmonary Edema without Cardiomegaly
Features of Interstitial Pulmonary Edema
KERLEY LINES
Pulmonary Venous Hypertension (PVH)
PULMONARY EMBOLISM
Modalities Used
V-P (Ventilation-perfusion) Scan (Second Line Investigation for Pulmonary Embolism)
Pericardium
Calcification within Heart
PERICARDIAL EFFUSION
Radiographic Features
Other Characteristic Features of Pericardial Effusion include
PERICARDIAL TUMORS
AORTA
Torus Aorticus
Coarctation of the Aorta
Causes of Inferior Rib Notching
Causes of Superior Margin Rib Notching
Dissection of Aorta
Etiology
Types
Location
Radiological Investigations
Dissecting Aneurysm
Aortic Trauma
Carotid Imaging
Carotid Body Tumors (Potato Tumor/Chemodectoma)
Thoracic Outlet Syndrome (a Clinical Diagnosis; Doppler may Aid in Diagnosis)
Etiology of Thoracic Outlet Syndrome
Subtypes of Thoracic Outlet Syndrome
Role of Imaging
Subclavian Steal Syndrome
Imaging of Extracranial Vertebral Artery
Investigations for Aneurysms in General
IMAGING IN PERIPHERAL ARTERIAL DISEASE
Thromboangiitis Obliterans (Buerger's Disease)
Takayasu's Aortoarteritis (Pulseless Disease/Nonspecific Aortoarteritis)
Deep Venous Thrombosis
VASCULAR RINGS
Double Aortic Arch
DYSPHAGIA LUSORIA
Right-sided Aortic Arch
Fogarty Catheter
CHAPTER 6:
Abdominal Imaging
MODALITIES AVAILABLE FOR ABDOMINAL PATHOLOGIES
IMPORTANT PRELIMINARY CLINICORADIOLOGICALLY TERMS
PNEUMOPERITONEUM
ASCITES
SPLEEN
Calcification in Spleen
Splenic Trauma
Splenic Vein Thrombosis
Hyposplenism
Hypersplenism
Neoplasms of Spleen
ESOPHAGUS
Barium Swallow Study
Barium Study Feature of Few Esophageal Diseases
Tracheoesophageal Fistula
Esophageal Varices
Endoscopic Grading of Esophageal Varices
Hiatus Hernia
Esophageal Motility Disorders
Diffuse Esophageal Spasm
Nutcracker Esophagus
Achalasia Cardia
Features
Dysphagia Lusoria
Benign Esophageal Tumors
Carcinoma Esophagus
Predisposing Factors Associated with Esophageal Malignancy
Radiological Features
STOMACH
Congenital Hypertrophic Pyloric Stenosis (CHPS)
Upper GI Imaging (Barium Study)
Ultrasound (Investigation of Choice)
D/D
Peptic Ulcer Disease
“Pseudokidney” Sign
Gastric Volvulus
Gastric Diverticulum
Gastric Polyps
Gastric Leiomyomas and Leiomyosarcomas
Gastric Lymphoma
Gastric Carcinoma
Differential Diagnosis of Linitis Plastica
SMALL INTESTINAL
Small Intestinal Imaging
Malrotation of Gut
Malabsorption
Parasitic Infestation
Strongyloides Stercoralis
Ascaris Lumbricoides
Ankylostoma Duodenale
Trichuriasis
Neonatal GI Obstruction
Small Bowel Obstruction
Strangulating Obstruction
Intussusception
Abdominal Tuberculosis/TB
Intestinal TB
Barium Enema Features of Ileocecal Tuberculosis
Tubercular Peritonitis
SMALL INTESTINAL NEOPLASMS
Carcinoid Tumor
APPENDIX
Acute Appendicitis
COLON AND RECTUM
Hirschsprung's Disease
Imaging Features
Abdominal Radiograph
Water Soluble Contrast Medium/Barium Enema
Anorectal Malformations
Necrotizing Enterocolitis
Solitary Rectal Ulcer Syndrome (Most Common an Anterior Wall of Rectum)
Colitis Cystica Profunda
Ischemic Colitis
Crohn's Disease (Regional Ileitis)
Ulcerative Colitis
Diverticulosis of Colon
Sigmoid Volvulus
The Plain Radiographic Features
Carcinoma Colon
Ca Rectum
Villous Adenomas
Neoplasms of the Anal Canal
Gastrointestinal Bleeding
BLUNT TRAUMA ABDOMEN
Focused Abdominal Sonogram for Trauma
HEPATOBILIARY SYSTEM
Segmental Liver Anatomy
Budd-Chiari Syndrome (Hepatic Veno-occlusive Disease)
Classifications
Clinical Features
FOCAL HEPATIC LESIONS
Simple Hepatic Cysts
D/D of Cystic Lesion in Liver
Cavernous Hemangiomas of Liver
Focal Nodular Hyperplasia
Fibrolamellar Carcinoma (FLC)
Hepatic Adenoma
Hepatocellular Carcinoma
Liver Metastasis
Liver Tumors in Children
GALLBLADDER AND BILIARY APPARATUS
IMAGING IN OBSTRUCTIVE JAUNDICE
USG
CECT
Percutaneous Transhepatic Cholangiography
MRCP
ERCP (Gold Standard Study)
Hepatic Iminodiacetic Acid Scan (HIDA Scan) is a Biliary Scintigraphic Scan
Applications and Indications
Oral Cholecystography
RADIOLOGY OF GALLBLADDER AND BILIARY SYSTEM PATHOLOGIES
Gallstone Ileus
Radiological Signs of Gallstone Ileus
Rigler's Triad of Gallstone Ileus: a+b+c
Acute Cholecystitis
Features of Cholecystitis on USG
Primary Sclerosing Cholangitis
AIDS-related Cholangiopathy
Stricture in Bile Duct
Carcinoma Gallbladder
Risk Factors for Carcinoma Gallbladder
EHBA
Caroli's Disease
PANCREAS
Radiographic Sign of Acute Pancreatitis
Predict Severe Acute Pancreatitis
Acute Pancreatitis
Carcinoma Head of Pancreas
Periampullary Carcinoma
Ampullary Carcinoma
Pancreatic Cystadenomas (MC Benign Tumor of Pancreas)
TUMOR LOCALIZATION OF GI NETs (CARCINOIDS AND PANCREATIC ENDOCRINE TUMORS)
CHAPTER 7:
Genitourinary Radiology
IMAGING KEYS
Intravenous Urography
Main Current Indications
Main Contraindications
KIDNEYS AND URETERS
Congenital Diseases
Normal Variants of Kidney
Multicystic Dysplastic Kidney
Nephronophthisis (Medullary Cystic Disease of Kidneys)
Medullary Sponge Kidney
Autosomal Dominant Polycystic Kidney Disease
Horseshoe Kidneys
Vesicoureteral Reflux
Megacalycosis
CALCULUS DISEASE OF KIDNEY
Nephrolithiasis
Opacities on Plain X-ray, which way be Confused with Renal Calculus
Nephrocalcinosis
FEATURES OF HYDRONEPHROSIS ON IVU
PAPILLARY NECROSIS ON IVU
RENOVASCULAR HYPERTENSION
Imaging in Renovascular Hypertension
RENAL INFECTIONS
Renal TB
IVP is Abnormal in 85 to 90 Percent Cases. Distinctive Features of Renal TB (IVU)
Pathognomonic Features of Renal TB
Xanthogranulomatous Pyelonephritis
RENAL TUMORS
Wilms' Tumor (Nephroblastomas)
Staging
WILMS' TUMOR VERSUS NEUROBLASTOMA
ANGIOMYOLIPOMA (HAMARTOMA)
Renal Cell Carcinoma
Robson Staging of RCC
RENAL INJURIES
Incidence
Indication
BLADDER AND URETHRA
Bladder Diverticuli
‘Tear Drop’ Bladder
Ureterocele
Types
Urethral Strictures
Posterior Urethral Valves
Type I
Type II
Type III
Extraperitoneal Bladder Rupture
PROSTATE AND TESTES
Benign Prostatic Hypertrophy—Radiological Features
Carcinoma Prostate
Classic Imaging Appearance
TESTICULAR TUMOR
SEMINAL VESICLE
PENILE IMAGING
CHAPTER 8:
Musculoskeletal Radiology
IMAGING PROTOCOLS
MUSCULOSKELETAL RADIOLOGY: DIFFERENTIAL DIAGNOSIS
Delayed Bone Age/Retarded Skeletal Maturity
Diffuse Osteosclerosis (Increased Bone Density)
Patchy Sclerosis of Skeleton
Lytic Bone Lesion Surrounded by Marked Sclerosis
Causes of Multilocular Expansile Osteolytic Lesion of Bone
Causes of Multiple Lytic Lesions in Bone
Multiple Osteolytic Lesions in Children
Osteoblastic Bone Lesions
Mixed Sclerotic and Lytic Lesions
Expansile Lytic (Bubbly) Osseous Metastases
Causes of Lucent Metaphyseal Lines
Causes of Dense Metaphyseal Bands
Causes of Cortical Lesions (Especially Lytic) on CT/X-ray
Causes of Lesions with Blood-fluid Levels on MRI
CONGENITAL SKELETAL ANOMALIES and SKELETAL DYSPLASIAS
Osteopetrosis/Albers Schonberg Disease/Marble Done Disease
Osteogenesis Imperfecta
Radiological Features
Battered Baby Syndrome
Radiographic Findings
Melorheostosis (Candle Bone Disease)
Cleidocranial Dysplasia/Dysostosis (CCD)
Radiological Features of CCD
Multiple Epiphyseal Dysplasia
Achondroplasia
Hands, Feet and Limbs
Skull and Face
Pelvis
Skull
Chest
Nail-patella Syndrome (Hereditary Osteo-onychodysplasia or Fong's Syndrome)
Turner's Syndrome
Skeletal Features of Down's Syndrome
Klippel-Feil Syndrome
Mucopolysaccharidosis
Mucopolysaccharidosis Type I (Hurler Syndrome; Gargoylism)
Mucopolysaccharidosis Type IV (Morquio-Brailsford Syndrome)
Marfan Syndrome
Differential Diagnosis
METABOLIC BONE DISORDERS
Rickets
Radiological Features
Causes of Cupped and Frayed Metaphyses
Lead Poisoning
Radiological Features of Scurvy
Imaging Feature of Osteoporosis
Osteomalacia
Looser's Zones/Looser Lines/Pseudofractures/Osteoid Seams/ Increment Fracture/Milkman Syndrome/Umbau Zones
Hyperparathyroidism
Gout
Clinical Stages
Radiographic Picture of Fluorosis
Paget's Disease of Bones
BONE INFECTIONS
Osteomyelitis
Sclerosing Osteomyelitis of Garre
Brodie's Abscess
Skeletal Tuberculosis
Congenital Syphilis
SKELETAL TRAUMA
Epiphyseal Injuries
Epiphyseal Injuries Commonly Occur at the Zone of Cartilage Hypertrophy
Fatigue Stress Fracture
Insufficiency Stress Fracture
Bohler's, Kite's and Hibb's Angle
MISCELLANEOUS MUSCULOSKELETAL RADIOLOGY DISEASES
Pigmented Villonodular Synovitis
SPONDYLOLISTHESIS
OSTEONECROSIS/OSTEOCHONDRITIS
Osteochondritis Dissecans
Spontaneous Aseptic Bone Necrosis
DIFFERENTIAL DIAGNOSIS OF HIP PAIN IN CHILDREN
Perthes Disease (Osteochondritis of Femoral Capital Epiphysis/Waldenstrom Legg Calve Perthes Disease/Coxa Plana)
Catterall Stages of Perthes Disease
Radiographic Features
CT Features
MRI Features
Radionuclide Scan (RNS) Features
Transient Synovitis (Toxic Synovitis) of the Hip
DISORDERS OF LYMPHORETICULAR AND HEMOPOIETIC SYSTEM
Radiological Features of Hemophilia
Acute Hemarthrosis
Radiological Features of Sickle Cell Anemia (SCA)
Multiple Myeloma
Bone Scan Features
Radiological Changes in Leukemia in Childhood
Histiocytosis X
Types of Histiocytosis X
BONE TUMORS AND TUMOR-LIKE CONDITIONS
MRI (NMR) in Bone Tumors
Skeletal Metastasis
Secondaries in Bone
Patterns of Bone Destruction (Lodwick's Classification)
Primary Bone Tumors
Cartilaginous Benign Tumors
Cartilaginous Malignant Tumors
Osseous Malignant Tumor Malignant Tumors
Bone Lesions According to their Predominant/Primary Site of Occurrence/Origin
Pearls
Nonossifying Fibroma
Fibrous Dysplasia/FD (Jaffe-Lichtenstein Disease)
Unicameral Bone Cyst, Simple/Solitary/Juvenile Bone Cyst
Osteoblastoma
Exostosis (Osteochondroma)
Multiple Exostoses (Diaphyseal Aclasis)
Enchondromatosis/Multiple Enchondromas/Dyschondroplasia (Ollier's Disease)
Enchondromatosis with Hemangiomas (Maffucci's Syndrome)
Osteoid Osteoma
Chondroblastoma (Codman's Tumor)
Chondromyxoid Fibroma
Aneurysmal Bone Cyst
Giant Cell Tumor
Chondrosarcoma
Osteosarcoma
Location
Radiographic Features
CT Features
MR (Preferred Modality)
Radionuclide Bone Scan (NUC)
Ewing's Sarcoma
Radiological Features
Chordoma
Ameloblastoma
Dentigerous/Follicular Cyst
Adamantinoma of Long Bone
Radiological Features
JOINT DISEASES
Radiological Features of Osteoarthritis/Degenerative Arthritis
Osteoarthritis in Hands
Juvenile Rheumatoid Arthritis (JRA)/Juvenile Chronic Polyarthritis/ Still's Disease
Radiological Features
The Plain X-ray Film Joint Changes of RA include
Psoriatic Arthritis
Radiological Features
Ankylosing Spondylitis (Marie-Strumpell Disease or Bechterew Disease)
Diffuse Idiopathic Skeletal Hypertrophy (DISH)/ Forestier's Disease/Senile Ankylosing Spondylitis
Ossified Posterior Longitudinal Ligament
Charcot's Joint
5 D's of Charcot's Joint
Causes of Charcot's Joint
Developmental Dysplasia of the Hip (DDH)/Developmental Hip Dysplasia; DDH; Congenital Dysplasia of the Hip; Congenital Dislocation of the Hip; CDH
Causes, Incidence, and Risk Factors
Treatment
Crystal-Deposition Arthropathies and Periarthropathies
SOFT TISSUES
Causes of Soft-tissue Calcifications
Soft Tissue Tumors
CHAPTER 9:
Endocrine Imaging
THYROID
Childhood Hypothyroidism (Cretinism) is Characterized by
Adulthood Hypothyroidism
Tumors of Thyroid
ADRENALS
Imaging of Adrenals
Ultrasound
Computed Tomography
Radioisotope Scanning
Magnetic Resonance Imaging
Cushing's Disease (Radiology)
Adrenal Adenomas
Adrenal Carcinomas
Adrenal Metastases
Pheochromocytoma
Intra-adrenal Pheochromocytoma
Extra-adrenal Pheochromocytoma
Neoplasms of Neuroendocrine Origin
CHAPTER 10:
Head, Neck and Spine Imaging
GENERAL ASPECT AND SKULL RADIOGRAPH
Variations of Normal Sella
Radiographic Signs of Increased Intracranial Tension
In Infants and Children
In Adults
Differential Diagnosis of Calvarial Thickening
Wormian Bones
Craniosynostosis
Platybasia
Pathology of the Craniovertebral Junction
Physiological Intracranial Calcification
Basal Ganglia Calcification
Intracranial Calcification (Causes)
RADIOLOGICAL INVESTIGATIONS
Neurosonography
Computed Tomography
Key Facts
Indications for Cranial and Spinal CT
Hypodense Brain Lesions on CT
Hyperdense Brain Lesions
Ring-enhancing Lesions in Brain on CT Scan
Gyriform Enhancement on CT Scan Brain
Cerebral Angiography
Magnetic Resonance Imaging
MRI
Some Common Intensities on T1- and T2-weighted MRI Sequences
Technical Advantages
Positron Emission Tomography
CONGENITAL MALFORMATIONS OF BRAIN
Hydrocephalus
Vein of Galen Malformation
Arnold Chiari I Malformation
Chiari I Malformation (Cerebellar Ectopia and Seen in Adulthood)
Chiari II Malformation (Childhood)
Dandy-Walker Malformation: Features
Skull and Dura
Ventricles and CSF Spaces
Cerebellum, Vermis, Brainstem
Associated CNS Anomalies
Lissencephaly
Nonlissencephalic Cortical Dysplasia
Heterotopias
Schizencephaly
Unilateral Megalencephaly
Holoprosencephaly
Arhinencephaly
NEUROCUTANEOUS SYNDROMES (PHAKOMATOSES)
Neurofibromatosis
Clinical Features
Radiological Features
Sturge-Weber Syndrome (Encephalotrigeminal Syndrome/Meningofacial Angiomatosis)
Tuberous Sclerosis (Bourneville's Disease/EPILOIA)
CNS Lesion
Non-CNS Lesions
von Hippel-Lindau Disease (Cerebelloretinal Hemangioblastomatosis)
Ataxia-Telangiectasia (Louis-Bar Syndrome)
IMAGING IN DEMENTIA
STROKE AND VASCULAR DISORDERS
Brain Stroke
Diffusion MR (DWMRI)
Hyperacute Stroke
Acute Stroke
Subacute Stroke
Chronic/Old Stroke
Lacunar Infarcts
Hypertensive Hemorrhage
Germinal Matrix Hemorrhage (Most Common Site of IC Hemorrhage in Neonates)
Subarachnoid Hemorrhage
Cerebral Aneurysms
Berry Aneurysms
Arteriovenous Malformations (AVMs)
Hypertensive Encephalopathy (Posterior Reversible Encephalopathy Syndrome)
INTRACRANIAL INFECTIONS
Leptomeningitis and Meningoencephalitis
Cerebritis and Cerebral Abscess
Subdural and Epidural Empyemas
Cryptococcosis
Tubercular Meningitis
Toxoplasmosis
Herpes Simplex Encephalitis (HSE)
Neurocysticercosis
Japanese Encephalitis
DISEASES OF DEMYELINATION (ACQUIRED)
Amyotrophic Lateral Sclerosis
Multiple Sclerosis
MR Imaging in Wilson's Disease
PRION Disease
MESIAL TEMPORAL LOBE EPILEPSY SYNDROME
PML
BRAIN TUMORS
Intracranial Metastases
Medulloblastoma
Craniopharyngioma
Oligodendroglioma
Meningioma (Extra-axial Brain Tumor)
Location
Imaging Features
Spinal Meningioma
Vestibular Schwannoma (Acoustic Neuroma)
Pituitary Tumor
PITUITARY IMAGING
Lipoma of Corpus Callosum
HEAD TRAUMA
Skull Fractures
Transtentorial Herniation
Diffuse Axonal Injury
CT Diagnostic Criteria of Diffuse Axonal Injury
Traumatic Facial Nerve Palsy/Facial Nerve Trauma
ENT RADIOLOGY
Anatomy of Nose
Lateral Nasal Wall
CT PNS (Multislice Machine and Coronal Sections)
Adenoid (Lymphoid) Tissue Hypertrophy
Thornwaldt Cyst
Juvenile Nasopharyngeal Angiofibroma
Nasopharyngeal Carcinomas
OPHTHALMIC RADIOLOGY
Optic Nerve Enlargement
Tubular Type
Fusiform Type
Escrescent Type
Enlargement of One or More Extraocular Muscles
Neoplastic
Non-neoplastic
Inflammatory Orbital Pseudotumor
Vascular Intraorbital Tumors
Optic Nerve Gliomas
Retinoblastoma
NECK IMAGING
Suprahyoid Neck Spaces
Infrahyoid Neck Spaces
Cystic Lymphangiectasis/Lymphangioma/Cystic Hygroma
Branchial Cyst
Parasympathetic Paragangliomas (Chemodectomas, Glomus Tumor)
Salivary Gland Tumors
Pathological Classification
Benign
Malignant
Pleomorphic Adenoma
Warthin's Tumor (Papillary Cystadenoma) (Also known as Adenolymphoma)
Malignant Salivary Tumors
Sialosis (Asymptomatic Parotid Enlargement)
SPINE RADIOLOGY
Imaging modalities
Plain Radiography
Computed Tomography
Magnetic Resonance Imaging
Myelography
Angiography
Discography
Vertebral Lesions
D/D of Intervertebral Disk Calcification
Normal Variant
Curvatures/Curves of Spine
Congenital Anomalies of the Vertebral Bodies
‘H' Shaped Vertebra
Striated (Vertical Striations)/Corduroy/Accordion/Honey Comb Vertebra
Vertebra Plana/Wafer Thin Vertebra/Dollar Vertebra (Pneumonic → FETISH)
Ivory Vertebra
“Picture Frame” Vertebra
“Square-shaped” Vertebra
Limbus Vertebra
“Sandwich”/”Hamburger” Vertebrae (Sclerotic End plates Alternate with Radiolucent Mid Bodies)
“Bullet Shaped” Vertebra
“Fish Mouth”/Biconcave Vertebra
“Beak-shaped” Vertebra
“Wedge-shaped” Vertebra
“Pancake” Vertebra
Ghost (Bone within Bone) Vertebra
“Winking-owl” Eye Sign
Anterior Scalloping of Vertebra
Posterior Scalloping of Vertebra
Cervical Spine Trauma/Injury
Hyperflexion Injury (Most Common Mechanism of Injury)
Hypertension Injury
Flexion Rotation Injury
Vertical Compression
Fractures of First Cervical Vertebra, i.e. Atlas
Fractures of Second Cervical Vertebra, i.e. Axis
Tubercular Spondylitis or Pott's Spine
Radiological Features
Complications of Pott's Spine
CHAPTER 11:
Obstetrics and Gynecological Radiology
ULTRASONOGRAPHY IN PREGNANCY
TRANSVAGINAL USG
Ideal Time for US
Parameters for Estimation of Fetal Age by Ultrasound
Variability Associated with Fetal Age: Estimates Derived from Anatomic Parameters
Umbilical Cord
Human Placenta
PATHOLOGICAL CONSIDERATION IN OBSTETRICS USG
Complications of Early Pregnancy
Polyhydramnios
Intrauterine Growth Retardation
Intrauterine Fetal Death (IUD)
Immune Hydrops Fetalis (Erythroblastosis Fetalis): Features
Cystic Hygroma
Posterior Urethral Valve
Ultrasound Marker is Associated with Greatest Increased Risk for Trisomy 21 in Fetus
Hydrocephalus
Neural Tube Defects
Anencephaly
Ectopic Pregnancy
Molar Pregnancy
Gestational Trophoblastic Neoplasms
GYNECOLOGY
Modalities for Detection of Gynecologic Lesions
USG
CT
MRI
CEMRI
Imaging of Carcinoma Cervix
OVARIAN NEOPLASMS
Histological Types of Ovarian Malignancies
Incidence of Malignant Ovarian Neoplasms
Omental Caking
Dermoid Cyst or Mature Cystic Teratoma
Plain Film (Diagnostic in 40 Percent Cases)
USG (77–87 Percent Sensitivity)
Specific Features
CT
CHAPTER 12:
Breast Imaging
DIAGNOSTIC MAMMOGRAPHY VERSUS SCREENING MAMMOGRAPHY
Indications for Mammography
Mammographic Findings in Various Breast Diseases
Mammographic Features of Breast Cancer
Ultrasound Features of Breast Cancer
MRI Breast
Breast MRI–Key Indications
Important Differential Diagnosis in Breast Diseases
Differential Diagnosis of Fat Containing Breast Lesions
Mixed Fat and Water-density Lesion
Breast Lesion with ‘Halo Sign’
Differential Diagnosis of Radiolucent Lesions
Differential Diagnosis of Mixed Density Lesions
Calcification in Few Breast Diseases, on Mammography
SECTION 2: NUCLEAR MEDICINE
CHAPTER 13:
Radioactivity and Basics of Nuclear Medicine
WHAT IS RADIOACTIVITY?
What causes Radioactivity?
How is Radioactivity Measured?
What is Radioactive Half-life?
What is a Radioactive Decay Chain?
How can Radioactivity be caused Artificially?
WHAT IS AN ELEMENT?
What are Atomic Number and Atomic Weight?
What is Atomic Number?
What is Atomic Weight?
What are Isotopes?
USEFUL TERMINOLOGIES
How can Different Isotopes of an Element be Produced?
BASIC ISOTOPE NOTATION
INSTRUMENTATION
Gamma Scintillation Camera
Collimator
RADIONUCLIDES
Unsealed Radionuclides used for Therapy
Photon-emitting Radionuclides for Imaging
Half-life of Important Radionuclides
NUCLEAR STABILITY AND RADIOACTIVE DECAY
Alpha-particle Emission
Beta-particle Emission
Electron Capture
Isomeric Transition
RADIONUCLIDE PRODUCTION
RADIOACTIVE DECAY
Technetium-99m
67Ga Imaging
RADIOACTIVE ISOTOPES
DIAGNOSTIC USES
CHAPTER 14:
Nuclear Scans
RADIONUCLIDE SCANS
SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY
BRAIN SCAN
Brain Tumors
Epilepsy
Cerebrospinal Fluid Imaging
SALIVARY GLAND SCAN
THYROID SCAN
PARATHYROID SCAN
V/Q SCAN
MYOCARDIAL SCAN
MYOCARDIAL PERFUSION STUDIES
MULTIPLE GATED ACQUISITION SCAN
Advantages of MUGA Scan
Disadvantages of MUGA Scan
LIVER SCAN
Applications of Hepatobiliary Scintigraphy in Liver Diseases
BILIARY SCINTIGRAPHIC SCAN
Others
MECKEL'S DIVERTICULUM IMAGING
GASTROINTESTINAL BLEEDING STUDIES
RENAL SCAN
131I 01H (Orthoiodohippurate)
99mTc DTPA (Diethylene Triamine Penta-acetic Acid)
99mTc DMSA (Dimercoptosuccinic Acid)
99mTc Mercaptoacetyltriglycine (MAG3)
ACE Inhibitor Scintigraphy
ADRENAL SCAN
TESTICULAR SCAN
BONE SCAN
Radionuclides Considered for Bone Scanning
Common Indications for Bone Scans
SCINTIGRAPHIC SCAN FOR NEUROENDOCRINE TUMORS
MISCELLANEOUS
THERAPEUTIC USES
Role of Radionuclides in Radiotherapy
Precursors
More Example of Therapeutic Uses
SECTION 3: RADIOTHERAPY AND RADIATION ONCOLOGY
CHAPTER 15:
Radiation Oncology
AN OVERVIEW
WHAT ARE ELECTROMAGNETIC RAYS?
WHAT IS IONIZING RADIATION?
What is Radiation?
What is Ionization?
How is Ionizing Radiation Measured?
What are the Basic Types of Ionizing Radiation?
How does Radiation Affect Humans?
What Effect can Ionizing Radiation have on DNA?
What Immediate Effects can Ionizing Radiation have on Living Cells?
What Long-term Effects can Radiation have?
How can Ionizing Radiation cause Cancer?
How can Ionizing Radiation Produce Genetic Mutations?
CANCER BIOLOGY
Cell Cycle (G1, S, G2 and M)
PRINCIPLES OF RADIATION THERAPY
General Considerations
Physical Considerations
Biological Considerations
Simplified Medical Physics
Basic Radiobiology
Law of Radiobiology
Molecular Mechanism of Action of Ionizing Radiations
RADIOSENSITIZER AND RADIOPROTECTOR
Radiosensitizers/Radiomimetics
Radioprotectors
Amifostine
Radiopotentiators (Radiation Recall Reactions)
CHAPTER 16:
Radiotherapy
SCHEDULE OF RADIOTHERAPY
Fractionation Schedules
Fractionation Radiotherapy
Hyperfractionation
Continuous Hyperfractionated Accelerated Radiotherapy (CHART)
MODES OF RADIOTHERAPY
Brachytherapy
Remote and Manual Afterloading Machines
Manual Afterloading Machines
Remote Afterloading Machines
Advantages of Remote over Manual
Teletherapy
External Beam Therapy Machines (Teletherapy Machines)
Beams Commonly used for External Radiotherapy
Forms of X-ray Therapy
Cobalt-6o
Teletherapy: Clinical, e.g. Cervical Cancer
Steps Of Radiotherapy
Step-1: Patient Selection
Step-2: Tumor Volume Delineation
Step-3: Simulation
Step-4: Immobilization
Step-5: Dose calculation (Dosimetry and Optimization)
Step-6: Treatment Verification
Step-7: Actual Treatment
TYPES OF RADIOTHERAPY TREATMENT
Radical Radiotherapy [Organ Preservation, Function Preservation Techniques]
Palliative Radiotherapy
Bone Metastases
Brain Metastases
Adjuvant Radiotherapy
Concurrent Chemoradiotherapy
Intraoperative Radiotherapy
Preoperative Radiotherapy
Advantages
Disadvantages
Postoperative Radiotherapy
Indications
Application in
Combined Modality Approach
Multimodal (Holistic) Approach
High Dose Rate and Pulsed Dose Rate Brachytherapy
HDR Brachytherapy
LDR Brachytherapy
Endocavitary Radiotherapy
Intracoronary Brachytherapy
Intraoperative Radiotherapy
Craniospinal Irradiation (Prophylactic)
RECENT ADVANCES IN RADIOTHERAPY
Conformation Therapy
What is 3D Conformal Radiotherapy?
Planning Conformal Radiotherapy
Which Types of Cancers are Treated with Conformal Radiotherapy?
What are the Side Effects of 3D Conformal Radiotherapy?
Intensity Modulated Radiotherapy
Stereotactic Radiotherapy [Gamma-knife, X-knife]
Thermoradiotherapy
Image-guided Radiation Therapy
Proton Beam Therapy
Targeted Radiotherapy (Metabolic Radiotherapy)/Immunoradiotherapy
RADIATION PORTALS
COMPLICATIONS OF RADIOTHERAPY
BENIGN DISEASES THAT CAN BE TREATED WITH RADIOTHERAPY
Radiotherapy in Graves' Disease
Tumors and their Treatments of Choice
Surgery Alone: Treatment of Choice
Radiotherapy: Treatment of Choice
Chemotherapy–Treatment of Choice
VARIOUS TUMORS AND VISCERA: DOSE LIMITS
GUIDE TO THE RELATIVE RADIOSENSITIVITY OF NORMAL TISSUE
FOLLOW-UP OF CANCER PATIENTS RECEIVING RADIOTHERAPY
SECTION 4: NEWER ADVANCES AND INTERVENTIONAL RADIOLOGY
CHAPTER 17:
Newer Advances
ADVANCES IN CT SCAN
Multidetector CT
Virtual Bronchoscopy
CARDIAC COMPUTED TOMOGRAPHY
Clinical Applications
Limitations of CT
CARDIAC MAGNETIC RESONANCE IMAGING
Clinical Applications
Computed Tomography Enteroclysis
Advantages of MDCT (Generation IV CT)
Dual-energy CT
ECHO-PLANAR MRI: ULTRAFAST MR SEQUENCE
Newer MRI Applications Principle Utility
DIFFUSION WEIGHTED MRI (DWMRI)
FUNCTIONAL MRI
MR SPECTROSCOPY (MRS)
MRS Current Applications
NEAR INFRARED SPECTROSCOPY
CHAPTER 18:
Interventional Radiology
DIGITAL SUBTRACTION ARTERIOGRAPHY
Angiography
Arteriography
CATHETER ANGIOGRAPHY
Benefits
Risks
THERAPEUTIC EMBOLIZATION
PARTICULATE EMBOLIC AGENTS
BRONCHIAL ARTERY EMBOLIZATION
INTERVENTIONAL GI RADIOLOGY
INTERVENTIONAL NEURORADIOLOGY
ABLATION
Applications of RFA
Algorithm
CAVITRON ULTRASONIC SURGICAL ASPIRATOR
Percutaneous Vertebroplasty
PERCUTANEOUS TRANSCATHETER VASCULAR OCCLUSION
Peripheral
Hemorrhage
Vascular Malformations
Varicoceles
Congenital Cardiac Defects
Organ Function Ablation
Head, Neck, and Spine
Epistaxis
Vascular Malformations
MEDICAL TUMOR ABLATION
THERAPEUTIC EFFECTS OF DEEP HEATING
HIGH-INTENSITY FOCUSED ULTRASOUND
Introduction
Mechanism
Advantages
Disadvantages
Current Applications
INDEX
TOC
Index
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