Radiology

Question 1

Chest radiograph summary

Answer 1

• Introduction
  
  • patient identification
  • date of radiograph
  • old radiographs
• Comment on quality of film
  
  • Rotation
  • Inspiration
  • Projection
  • Exposure
• ABCDE
• Review areas and silhouette signs

Question 2

rotation on X-ray

Answer 2

central trachea and equal distance between medial end of clavicle and midline

Question 3

projection on CXR

Answer 3

• Usually PA not AP (heart may look magnified)

Question 4

Exposure

Answer 4

can you see vertebrae behind heart

Question 5

ABCDE approach to CXRAY

Answer 5

Airway

Breathing

Circulation

Diaphragm

Everything else

Question 5

ABCDE approach to CXRAY

Answer 5

Airway

breathing

circulation

diaphragm

Question 6

Airway

Answer 6

tracheal central?

Question 7

breathing

Answer 7

• Lung fields (opacification)
  
  • Upper
  • Middle
  • Lower
  • Costophrenic angles
  • Compare left lung to right lung

Question 8

circulation

Answer 8

• Aortic knuckles
• L and right hilar region
• Heart size
  
  • Cardiothoracic ratio
  • Cardio phrenic angle

Question 9

Diaphragm

Answer 9

compare both sides

• Tented?
• Flattened?
  
  • Pneumoperitoneum?
    
    • Gas in stomach normal

Question 10

Everything else for CXRAY

Answer 10

bones

soft tissue

Question 11

review areas for CXRAY

Answer 11

• Apices
  
  • Mass
  • Pneumothorax
• Hilar
  
  • Unilateral- cancer
  • Bilateral- sarcoidosis
• Heart
  
  • Look through the heart to the lungs
• Lung hidden by diaphragm
  
  • Look through the heart

Question 12

silhouette signs

Answer 12

if you lose a key silhouette sign the atelectasis or consolidation is in a specific place

Question 13

lost left hemidiaphragm

Answer 13

atelectasis or consolidation in the left lower lung (LLL)

Question 14

lost right hemidiaphragm

Answer 14

atelectasis or consolidation in the RLL

Question 15

lost right heart border

Answer 15

atelectasis or consolidation in the rright middle lobe

Question 16

lost left heart border

Answer 16

atelectasis or consolidation in the lingula

Question 17

lost upper border of the horizontal fissure

Answer 17

right upper longer

Question 18

diagnose

Answer 18

C - lung metastases

• ‘Canon ball mets’
• Older patients
• Primary sites: bowel, renal cell, pancreatic and breast cancer

Question 19

diagnose

Answer 19

C- right pneumothorax

Question 20

diagnosed

Answer 20

B- bilateral hilar lymphadenopathy

e.g. sarcoidosis

Question 21

diagnosed

Answer 21

C- right upper lobe collapse

• Atelectasis- mediastinum pulled towards collapse

Question 22

diagnose

Answer 22

D- left lung

Question 23

diagnose

Answer 23

B- pneumoperitoneum

Question 24

diagnose

Answer 24

C- right pleural effusion

Question 25

Abdominal radiograph summary

Answer 25

* **Introduction** * patient and identification * date of radiograph * previous radiograph * **Comment on quality of film** * Supine or erect (AP) * erect may distinguish an air fluid level * Exposure- diaphragm → pubic symphysis in frame * Penetration- soft tissue differences * **BBC** * bowel gas pattern * bones * calcified artefacts * **Review areas** * lung bases

Question 26

general approach

Answer 26

* follow the bowel up from the rectum looking for air * liver on right and spleen on left * split abdomen into 4 * look for the course of the ureters

Question 27

BBC

Answer 27

* Bowel gas pattern * Bones * Calcified artefacts * E.g. renal calculi/phleboliths

Question 28

large bowel vs small bowel

Answer 28

Question 29

diagnose

Answer 29

B- Small bowel obstruction * Plica circularis * Central

Question 30

diagnose

Answer 30

* C- sigmoid volvulus * Coffee bean sign

Question 31

diagnose

Answer 31

* E- Perforation * Rigler sign – when bowel wall becomes very defined

Question 32

Musculoskeletal approach

Answer 32

* Introduction * Patient identification * date of radiograph * Body part (side) * Are there x2 views (lateral and AP) * comparison to previous imaging * ABCS * alignment * bone texture * cortices * soft tissue *

Question 33

A- MSK xray

Answer 33

* Alignment of bones and joint spaces- dislocation

Question 34

B- MSK XRAY

Answer 34

bone texture e.g. osteoporosis

Question 35

C-MSK XRAY

Answer 35

Cortices * any breaks int he cortex - trace finger around looking for ‘step’

Question 36

S- MSK XRAY

Answer 36

soft tissue- joint effusion or soft tissue swelling

Question 37

RA XRAY

Answer 37

Question 38

example of disruption of normal bone texture/trabeculae

Answer 38

Question 39

example of disruption of the cortex

Answer 39

Question 40

pelvic x-ray joint space/aligment

Answer 40

Question 41

example of cortex on pelvic x-ray

Answer 41

remember: **SHENTONS LINE$**

Question 42

diagnose