FUNDAMENTALS OF

DIAGNOSTIC
RADIOLOGY
 Radiology

 .emergence
 diagnostic
 Interventional
 Conventonal Diagnostic
radiology
 simple radiographic imaging

 Contrast-enhanced diagnostic
 X-RAY

Electromagnetic waves are transverse

waves, similar to water waves, that have
amplitudes, wavelengths, frequencies
and velocity
 Characteristics of
electromagnetic waves
 Amplitude is the intenisity of EMW
 Measured by Watts per sq. meter
 Square of amplitude of a wave=intensity
 Wavelength
 Velocity:all EMW travel
186,000mpersec/300,000km/sec
 Frequency=velocity/wavelength unit is Hertz
 Electromagnetic radiation
spectrum
 Radio and TV waves
 Microwaves
 Infrared waves
 Visible light waves
 Ultraviolet waves
 X-rays
 Gama rays
Creation and detection of EMW
 Oscillation of electrons: heat or alternating
current
 electromagnetic radiation hitting atoms: atoms
get vibrated, produce heat, oscillations
 Source of EMR
 Above absolute temperature
 Temperature is the measure of energy of
vibrating atoms
 The higher the temp the shorter the
wavelength and more radiation.
 Source of EMR
 Source of LONG waves-microwaves, TV and
radio waves-are from electronic devices,
alternating currents cause vibration of atoms
with appropriate frequencies.
 Source of visible light incandescent materials
 short wavelength-smashing high-energy E into
particles, such as heavy metals, x-rays are
created
 Gamma rays: nuclear reaction, atomic/nuclear
bombs, explosions on the sun and other stars.
 X-ray generations

 Bremsstrahlung: commonest, created by y

Nikola Tesla-high energy E hits or passes near
the nuclues of heavy metal change of direction
and deceleration-loss of KE—transformed into
radiation energy having the wave length of
Xrays
 K-shell emission: Bohr atomic model
 Synchrotron:. device having magnetic fields
throuh out to accelrate electrons near speed of
light.synchrotn-radiation
 Characterstics of X-ray
 Velocity, amplitude, frequency,wavelength
 Interaction with matters
 pass through many matters
 stopped by lead
 photographic effects
 ionizing atoms: absorbed, giving all its
energy to K-shell electrons—ejected out to
ionize others—leading to biological damages,
somatic and genetic effects
 Conventional Diagnostic
radiology
 Make use of x-ray photographic effect
 Process of how radiographic images are
formed and printed: X-ray beams, an X-ray film
holder, X-ray film, patient and film processing
 parameters that affect radiographic images: Kv,
ma, film processing
 Over/under-exposed, over/under penetrated,
over-developed, under-developed
 ALARA principle
 Positioning of patients

 PA, AP, lateral and oblique views, sitting, erect,

prone and supine positions
 Standard radiographic positions of human
organs
 Chest: erect and PA; SXR: prone, PA and
lateral. For sella turicica conned view with
lateral projection; abdomen erect AP;
exterimities AP, lateral and oblique; vertebrea:
AP, lateral and sometimes oblique, pelvis: AP,
but for SIJ PA, coccyx only lateral
 Contrast-enhanced convention
radiography
 To better visualize human organs: GIS, renal system ,
veins and arteries, urethra, uterus and uterine tubes
 For GI: non-absorbed, non-piosnous and easily excreted
by natural route-BaSo4 and gastrographine.;
 For others iodinated substance: urographine, iopamiro
or ultravist.
 Terms for Contrast –assisted studies: esophagogram for
esophagus; Ba-meal for stomach and C-loop of
duodenum; Ba-fol low through for SI; double contrast
Ba-enema for LB; venogram for veins and angiogram for
arteries; EU and retro/antegrade ureterogram for renal
system; urtherogram for urether; fistulogram; HSG
 Modern imaging
 MR, CT, US and PET
 CT: Sr. Godfrey Hounsfield {1972,1979}
 Basic principle: absorption coefficient of x-ray beam, x-ray
detectors, scintilation are quantified and recorded
digitally, fed to computers to produce out different
readings in the form numerical, in an analogue as 2D
display of matrix, overall result CT digital images
 HU: water 0,white matter 20, grey matter 40, congeal bld.
50-70, calcification and bones 80-100, fat -100 and air -1000.
 Images of CT are taken axial views but can be changed to
multiplanes.
 Advantages and disadvantages
 MR
 in nineteen nineties
 Basic principle: RF and MF
 Parts of MR: gantry, table, computer, imaging processing
unit
 Orthognal images.
 Adjustable parameters : T1 and T2 are features of the 3D
biological enviroment surrounding the proton of hydrogen
atoms
 T1 is the ability how h-atom interact with the envi.{ time of
excitation/magnatzation.
 T2 time to release RF.
 TR and TE
 rules 0f MR CONTRAST SOFT
TISSUE
 T1WI
Short T1 /high signal long T2 /low signal
 T2WI
Long T1/ low sign short T2/ high signal
 Free fluid long T1 short T2
 Protienaceuous fluid short T1 and T2:complcated cysts,
abscess, necrotic area in tumors, pathological fluids
 Soft tissue: predominant intracellular fluid shortens T1 more
than T2-liver, pancreas, adrenals, muscles intermediate signals
 Oedema: long T1 and T2
 Neoplastic: increase in ICF-low signal on T1WI and high signal
on T2WI
 TABLE 1.2 MR of Tissues and Body Fluids
Tissue/Body Fluid Examples T1WI Signal T2WI Signal
Gas Air in lung, gas in bowel Absent Absent
Mineral-rich tissue Cortical bone, calculi Absent Absent
Collagenous tissue Ligaments, tendons, Low Low
fibrocartilage, scar tissue
Fat Adipose tissue, fatty bone High Intermediate to high
marrow
High bound water tissue Liver, pancreas, adrenal, muscle, Low Low to intermediate
hyaline cartilage
High free water tissue Kidney, testes, prostate, seminal Low High
vesicles, ovary, thyroid, spleen,
penis, simple cysts, bladder,
gallbladder, edema, urine, bile,
CSF
Proteinaceous fluid Complicated cysts, abscess, Intermediate High
synovial fluid, nucleus pulposis

Modified from Mitchell DG, Burk DL Jr, Vinitski S, Rifkin MD. The biophysical basis of
tissue contrast in extracranial MR imaging. AJR Am J Roentgenol 1987;149:831–837.
 TABLE 1.3 MR of Hemorrhage
Age Dominant Component T1WI Signal T2WI Signal
Hyperacute (<1 day)

   Arterial Free water + oxyhemoglobin Low High

   Venous Free water + deoxyhemoglobin Low Less bright than arterial

hemorrhage
Acute (1–6 days) Deoxyhemoglobin Low Low

Chronic (>7 days) Methemoglobin

   Intracellular High Low

   Extracellular High High

Scar Hemosiderin Low Low

 Contrast media shortens T1T2
 Gadolinuim
 contraindication: pt. with
electricaly,magneticaly,mechanically activated
implants eg. Cardiac pace makers, insulin
pumps, cochlear implants, nuerotransmiters,
bone growth stimulaters, implantable drug
infusion pumps.
 Advantages: better visualization of ST, free of ionization
radiation and images are orthognal
 Disadvantages: poor visualization of bones, longer time of
scanning, expensive

 Ultrasound make use 0f sound frequencies 2.5Mz-10Mz.

 Probe has the ability to produce and detect echo-
peizoelecric effect.

 Image-formation is done by the computer portion of US

 The lesswer the frequency the higher the penetration
power and the opposite is true.
 Anatomy and Pathologies that can
be identified by simple radiograph
 Chest X-ray films
 techniques: PA, straight, deep inspiration,
well-exposed well-penetrated and well-developed
developed
 anatomy:
 Most important pathologies:
 B:acterial pneumonie aa: pneumonic
exudates found in the alveoli are traingular-shaped
and homogeneous interspacedby bronchgrams.
Dense at the periphery. Cavities are thick-walled
with irregular inside wall.
 Pulmonary effusion
 Aetiologies

 Small it obliterates the CPA.

 Large: positive meniscus sign; may push

mediastinum to the opposite
 Lung collapse
 Ae: intinsic -congenital tracheal atresia, narrowing of
trachea by intinsic causes-croup, fibrosing alveolits,
sarcoidosis:extrinsic causes-lymphnodes neoplasms and
medistinal fibrosis.

 Direct signs: BVM and ribs will crowd together,

displacement of fissures, collapsed lung part of the lung
will get opacified, total hemi-lung collapse will retaract
the collapsed lung toward the mediastinum
 Indirect signs: elevation of hemidiaphragm, medistinum
shift towards the collapsed lung, compensatory
hyperinflation of the contralateral lung.
 Miliary TBc

 Milate sized soft tissue density micro-nodules

through out both lungs
 Non-miliary Tbc: may be represented as
tubecular nodules with different sizes,
reticulonodular opacities,as cavities{ thick-
walled with smooth inner outline,
tuberculomas, and if chronic enough with
fibrosis
 Malignancies n

 Usually are solitary nodules and peripherally

based, fuzzy outlines, radiating speckles.
 Lack calcification
 Grows fast and hence periodical check-up
 metastasis
 peumothorax

 Free air in the pleural space

 Causes: trauma, pathologies, and spontaneous
transradiant air is seen without BVM, visceral
plura is seen as thin thread retarcted towards
the epsilateral mediastinum, and the lunge
tissue retarcts towards the mediastinum.
 Pneumoperitoneum
 Thin strip of air is seen under rt.
hemidiaphragm
 Lateral CXR
For mediastinum
Superior mediastinum, anterior mediastinum, middle
mediastinum, posterior mediastinum
Anterior medistinum: behind the sternum and anterior to
the heart and great chest vessels . Important structures:
lymph nodes and thymus.
Middle mediastinum comprises the pericardium, aortic arch
proximal great vessels, trachea, major bronchi
Posterior med: found behind the pericardium and consists of
descending aorta, esophagus, azygose and hemi-azygose
veins and intercostal and autonomous nervous system.
 Pathologies of mediastinum
 Anterior mediastinum: superoirly thyroid tumors,
lymphnodes and tortuous inominate arteries
 Middle: teratomas and thymomas
 Inferiror: aneurysms and morgani hernias
 Middle mediastinum: lymphnodes(paratrcheal,
carinal trachiobronchial, bronchial and
bronchopulmonary)
 Posterior med.: neurogenic tumors, anterior
meningocele, paravertebral masses, calcified and
aneurysmic aorta and enteric cysts.

 Abdominal X-ray films
 Technique: erect AP
 Pathologies: pneumoperitonuim, radiopaque stones,
intestinalobstruction
 Pneumoperitonium: of perforation of hollow abdominal
organs
 Renal stones are 95% radiopaque
 Intestinal obsraction:
 small bowel or large bowel
 Small bowel obstruction: dilated loops at the center,
multiple air-fluid level and coiled spring appearance.
 Large bowel: dilated colon at the periphery, haustral
marking, absence of air in the rectum.
 Skull xay
 Technique
 Antomy
 Skull vault fractures and increased ICP
 ICP in adults: seen at the pitutary-erosion of dorsum sellae, erosion of
anterior and posterio cleinoid processes. If mass is in pitituary –expansion
of PF. Calcification may be seen and irosion of the inner vault.commonest
tumors are Craniopharingioma, pitituary adenoma and anuerysms
 In children: below age 2-sutural diastasis and above 2 increased
convolusional markings(copper beaten appearance)
 Hair-on-end appearance: hemolytic and sickle cell anemia, thalasemia and
meningioma.
 Petrous bone erosion: acoustic neuroma. Mastoid air-cells sclerosis in
chronic otitis media. Metastasis-multiple lytic lesions over the skull
without sclerotic margins. Generalized increase in bone density: pagets,
florosis, acromegally.
 Periostial reaction
 Elevation of periostuim
 Solitary and localized, unilateral or bilateral,
contininuos or inturrpted.
 Solitary and lovalized: osteomylitis and tumors
 Bilateral and symmetrical: hypertrophicostioarthropathy
and florosis.
 Causes for HOA: pulmonary causes are-carcinoma of
bronchus, lymphoma, bronchoectasis
 pleural cause: pleural fibroma and mesetheloma
 Sites: metaphysis and diaphisis of radius, ulna, tibia and
fibula, less commonly over the bones of hands and feet.
Contrast-enhanced pathologies
 Esophagogram:is used for detection of aethiologies causing
problems in swallowing: achalsia,tumors, neuromuscular disorders
 Baruim meal:tumors ulcers, GOO and pancreatic head tomors
 Barium follow through: malabsorption syndroms, SB-obstruction
 Barium enema: colonic masses, intussusption
 EU:obstructive uropathies demonstrate anatomical malformations,
exretion abilty of kidnys, MASSES
 Venography : DVT
 Angiography to demonstrate ailments of arteries-stenossi aneurysm
 HSG: patent of fallopian tubes and uterine masses and
malformations
 urethrogram: strictures of the urethers
 Retrograde/antegrade ureterogram: for pathologies of ureters
 CT-detectable pathologies
 Brain pathologies: hydrocepalus, neoplasms, hematomas and
infectious processes
 Cross sectional anatomy is very important
 Contrast-enhancing methods may applied
 Hydrocephalus: CSF
 increased amount of CSF
 Communicating and non-communicating
 Communicating the ventricular system is in continuity with
subarachnoid spaces(subarachnoid hemmorhage and meneigitis}
 Non-communicating: dilatation of the ventricular system but not the
cysterns and gyri(aqueduct stenosis}
 Cella-media-index: -line is drawn verticall along the tips of the
anterior horns of the LV(A) and another line through the mid portion
of the lateral ventricle(B) A/B if greater than 4 no hydrocephalus
 Vascular lesions
 Bleeding can occur: brain parenchyma, subdural and epidural spaces, ventricular
system and subarachnoid spaces
 1/3 of ICH are caused by hypertension
 Common sites:basal ganglia(60%}, pontine(20%) the rest over frontal, parietal and
temporal lobes.
 CT-appaerance: hyperdense HU value 50-90
 Subarachnoid bleeding 1/3 of ICB. Cause are: trauma, aneurysmal bleeding of
small brain arteries, anticoagulant therapy, blood dyscariasis and bleeding tumors.
 Common in coarctation of aorta and pcd
 Rare below twenty, common bettween 35-65, commoner in females, 2% of
population
 Common arteries: ANT. COMMUNICATING ARTERIES, JNX OF POST COM
AND ICA, FIRST BIFERCATION OF MCA, BRANCHING OF ICA INTO MCA
AND ACA.
 Sites of bleeding tell which artery has bled: at the medial aspect of frontal lobes,
corpus callosum and septum pellicudum-anterior cerebral artery; in the sylvian
fissuresat-middle cerebral arteries; basal brain structures-PCA
 If pt. survive four vessels angiography(caroitid and vertebral arteries)
 History tells for the cause of other forms of SAB.
 Subdural hematomas
 In between dura and epidural layers
 Venous bleedings. Pressure build-up is slow
 Acute-two WKs, subacute-se2---4WKs, chronic-
beyond 4WKs.
 CT-picture of acute-hyperdense, the convexity
towards the brain tissue; subacute-similar to
brain{isodense contrast is given}; chronic-
hypodense
 Complication: brain herniation syndrom
 Subphalcine, transtentorial uncal herniation
 , cerebral tonsilar herniation thru FM
 Effects: vascular-ischemia and if two carotids are affected
brain death.
 tearing of the arterials of basilar artery-midbrain
bleeding(Durrets hemorrhage)
 Cranial nerves dysfunction
 Medullary compression-dysfunction of respiratory
center and cvs, leading to brain death.
 CT sign: effacement of basal cisterns(quadrigeminate
cisrens)
 Epidural
 Cause
 Ct appearane
 Pressure build-up rapid
 Immediate surgical compression
 neoplasms
 supratratentorial (ST) and infratentorial(IT)
 ST: intracerebral(IC) and suprasellar(SS); IT: intracerebellar and extracerebellar-
 STIC: Gliomas-astrocytoma, gloiblastoma multiformis, oligodendrogloima,
epindymoma
 pinealoma
 intraventricular: colloid cysts, papylomas, meningioma
 STSS: common-pituitary adenoma, craniopharingioma, anuerysm, meningioma.
 rare tumors: optic chiasma glioma, hypothalamic tumors arachanoid cyst,
metastasis
 Infratentorial: intracerebellar,(astrocytoma and medulloblastoma) and
brainstem(glioma)
 extracerebra-acoustic neuroma



 Supratentorial intracerebral
neoplasms
 Gliomas:- precontrast image: ill-defined hypodense area anywhere over the
cerebrum; hypo/hyperdense patchy areas; well-defined hypodense areas or
calcified areas.
 Post-contrast: almost all gliomas get enhanced
 50% of gliomas do calcify
 ICSS:- representative-pituitar adenoma
 Endochronolically active{cuases minor efects over sella turica}, inactive tumors
usually chromophob adenoma with visual effects
 CT-appearnces: enlargement of P.fossa; extra sellar extension downwards to the
basisphenoid, forwards to orbits, posterolaterrarly to the middle cranial fossa,
upwards to the third ventircles, in which case hydrocephalus; enhance
homogeneously
 DD: craniopharyngioma, meningioma and anuerysms.


 Infratentorial T
 Difference between intracerebellar and brain stem tumors: brain stem
tumors are found anterior to the fourth ventricle and intracerebellar
posteriorly.
 Brain stem glioma similar to others.
 Cerebellar tumors: astrosytoma-common in young males, have low
attenuation or mixed areas in one or the other cerebellum, 2/3 enhances
and hydrocephalus is common.
 Medulloblastoma: in young males, arise in the region of medullary
velum infront of vermis(midline). Are hyperdnse and do enhance.
 Exracerebelar tumors: meningioma arises from CPA, over the cerebral
convexities, undersurface of tentoruim. Are hyperdense and ehances
highly; femakes above forty.
 acoustic neuroma: by far commonst of CPA
tumors, grows within IAM, resulting in its expansion, tip of petrous
bone erods, grow out to the CPG, are identifeied by contrast.
 Abdominal CT
 Abdominal cavity is devided retro nad intraperitoneal
spaces
 Retroperitoneal space: anteriorly by posterior parietal
peritoneum and transverse facialis posteriorly
 Subdivisions: anterior pararenal spaces, perirenal space,
posterior pararenal spaces
 CT-detects in the retroperitonial sudvisions:localization of
pathological fluids, understanding of direction of spread of
infections and new growth, vascular anuerysm
 Tumors can be recognized either by their mass effects or
displacement. Spread beyond organs obliterate fascials
planes. Bone destruction and hydronephrosisi may be seen.
 kidneys
 HU 30-50
 Renal mass: contour abnormalities, density
differences, mass effects over the renal
structures
 Enhances with contrast(not cysts}
 Suprarenal masses can be diagnosed
 liver
 Anatomy
 Pathology: obstructive and non-obstructive
jaundice, fat infiltrations, neoplasms, cysts,
hemangiomas and abcesses. Diffuse hepatic
diseases may noe be detected by CT
 chest
 Roles: demonsrations of anatomy;
identification of segmental and subsugmental
pulm diseases; identification of occult diseases-
nodular infiltrates, ILD, pleural based diseases,
pulm nodules
 Evavluation of mediastinal masses, evaluation
of great vessels.
 CT-angiography
 Evaluation of chest wall
 Evaluation of breasts.
 ULTRASOUND
 SOUND: REFLECTED, ABSORBED,
REFRACTED AND SCATTERED
 ULTRASOUND
 ULTRASOUND MACHINE: PROBE, IMAGE
PROCESSIG UNIT, DESPLAY
 PEIZOELECTRIC EFFECT:
 TYPICAL APEARANCES OF NORMAL TISSUESB:
 SKIN SMOOTH AND BRIGHT-HYPERECHOIC
AND HYPERRFLECTIVE
 SUBCUT: DARK
 MUSCLES: MIXED
 TENDONS: HYPERECHOIC
 ABD. ORGANS:
KIDNEYS<LIVER<PANCREAS<SPLEEN;AORTA
AND IVC: ANECHOIC
 BONES VERY BRIGHT AND CURVILINEAR
 COMMON PATHOLOGIES
 LIVER: HEPATOMEGALLY
 METASTASIS: BULL’S EYE LESION,ECHOPENIC, ECHOGENIC{GI TOMOURS},SIEVE APEARANCE-
DIFFUSELY ECHOGENIC
 HCC: HYPOECHOIC WITH DIFFUSE LIVER PATHOLOGY
 BENIGN TUMOR: HEMANGIOMA
 CYSTS ARE ECHOPENIC WITH SMOOTH OUTLINE
 ECHINICOCCAL CYSTS: DOUBLE LAYERS, DAUGHTER CYSTS, COLLAPSED CYSTS WITHIN
PARENT CYST{WATER LILLY APPEARANCE}
 GALL BLADDER AND BILIARY TREES
 CBD

 PANCREAES: ANATOMY
 PATHOLOGIES: pancreatitis pancreatic tumor
 Acute pancreatitis
 Chronic pancreatitis
 Pancreatic tumor

 KIDNEYS: STONES, HYDRONEPHROSIS, TUMORS

 INTRAABDOMINAL FLUID COLLECTIONS: MORRISONS POUCH, SUBHEPATIC, SUBDIAPHRAGM
RIGH PARACOLIC GUTTER
 Doppler and color flow image
mapping
 Doppler and CFIM are used to study vessels
 Doppler is presented in spectral wave forms
 CFIM as blood moves in vessels
 Both are done to diagnose arterial/veins
stenosis/occlusions
 Doppler uses pattern of blood flow and velocities of
blood
 Frequently requested exam: internal carotid
stenosis, renal artery stenosis, portal veins HTN,
aortic aneurysm, pseudo aneurysm, gyn/obs patho.
Breast path.