Residents Review Session Slides

7/30/2019 Residents Review Session Slides

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De artment of Radiolo ,

Vancouver General Hospital

..

Director of ER/Trauma RadiologyDirector of ER/Trauma Radiology

[email protected]@vch.ca


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Note: NO NEW SLIDES! All Review


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Lecture 1- Introduction to Imaging Modalities


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Overview of imaging modalities

X-ray systems

Radiography (plain films, fluoroscopy, angiography)

ompu e omograp y

Nuclear Medicine NM / Positron Emission Tomo ra h PET


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Radiography

5 major densities are found on

radiographs, and aredemonstrated on this ima e

Air - fat - water - bone - metal Soft t issue

Lower Higher fat

Note that THICK structuresattenuate more radiation thanTHIN structures of the same bone

ai r

metal


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Fluoroscopy

Continuous low dose radiography used to monitorpart of the body in real-time

Often used in conjunction with contrast, can behelpful to evaluate motion such as

Used less commonly in

NB: Contrast is anexogenous agent used to

structure

Barium Swallow


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CT Views

x a

Coronal

CT Sagittal


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Hounsfield Unit (HU)

ColonGall bladder

-1000 HU6 HU

LiverFat -120

Air -1000; fat -100; water 0; blood 30 ; bone 500+ HU


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MRI Images

T1 weighted T2 Weighted


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Ultrasound (US)

1 2Anechoic

3Echogenic

Shadow

Hypo-echoic

Longitudinal cross section of the gall bladder. Fluid in bladder shows noreflections (1) whereas calcified stones (2) show strong reflections withdecrease of signal beyond (3)


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Nuclear Medicine - Bone Scan

show higher retention of radio-

labelled bone seekin a ent

Hot spot


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Nuclear Medicine Positron Emission Topography (PET)

Positron Emission Tomo ra hPET uses fluorine-18 which is a

positron emitter. Positron emissionproduce photons that can beimaged. CT

Fluorine-18 can be incorporatedinto biologically active moleculessuch as fluoro-18-deoxyglucose

PET


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Lecture 2- Imaging of the Spine


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Radiograph Views of the Spine

Anterior-Posterior (AP) Lateral


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Lateral View of Cervical Spine

Dens

Anterior arch of CI

Posterior arch of CI

CII Vertebral Body Pedicle(best seen on oblique image)

Superior Articular ProcessCIII

CIVCIII-IV Vertebral Disc

CVIIntervertebral Foramen

Transverse Process

Spinous Processes

CVII

TI

(best seen on oblique image)


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AP View

From the AP view, thoracic and lumbar vertebrae create an owl appearance:

Eyes are pedicles

Beak is spinous process

Face is vertebral body

Ears are transverse processes

CVII Vertebral Body

Right Pediclesof CVII & TI

Spinous Processes


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Ri ht IntervertebralPedicle

Foramen (CIII nerve)

CIV Vertebral Body

Spinous ProcessesInferior Articular Process

Superior Articular Process

Oblique


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Radiographical Views: X-ray

Odontoid

Dens and body of CII centre

Lateral masses of CI right and left


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CT Images

DensAnterior archDensAnterior arch

Foramentransversarium

Right lateralmass Left lateral mass

Right lateralmass

Left lateralmass

Posterior arch

This is CI (Atlas)


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Anteriorarch CI

Dens

ver e rabody

S inalcanal

SpinousProcesses

Intervertebraldisc space


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S inous

S inal Cord

Process

(dark on MR)

CSF surrounding thecord li ht on MR

Vertebral Body

Intervertebral Disc

(cannot differentiateannulus from nucleusdue to age related


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Thoracic Lateral

Vertebral Bodies

Intervertebral disc spaces

Intervertebral foramen

Inferior Articular Process

Superior Articular Process


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CT Sagittal

Vertebral bodies

Inferior articular

foramen

Intervertebral disc spaces

Pedicles Superior

process

Pars

interarticularis


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X-ray Lumbar AP

12th rib

TransverseProcessesSpinous

rocesses

Intervertebral

Sacrum


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Lecture 3- Imaging of the Shoulder


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AP View 1. Clavicle acromial end2. Clavicle- sternal end

3. Acromion4. Coracoid process

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2


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5. Glenoid cavity6. Humerus greater

tuberosit

AP View

7. Humerus lessertuberosity

8. Head of humerus

67

85


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9. Surgical neck ofhumerus

AP View

.humerus

11. Supraglenoidtubercle

. n rag eno tu erc e11

10

9

12


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1 borders of thescapula indicated

by the yellow

3

arrows

1. Lateral border2. Superior border

3 B) What are the

.

scapula indicatedby the green

arrows?

1 1. Superior angle2. Inferior angle3. Lateral angle

2


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Lateral View 1

23

7

4.

2. Acromion

3. Coracoid process

5

4. Spine of scapula

5. Head of humerus

6

6. Humerus

7. Superior angle of scapula

.

8


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Axillary View

1. Humerus

2. Coracoid Process3. Clavicle

5. Greater tuberosity6. Lesser tuberosity7. Intertubercular sulcus

9. Anatomical neck10. Surgical neck11. Acromion

. eno cav y 8. Head of humerus

5

1

3

8

6

9 4


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Radiograph Views of the Elbow


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Radiograph Views of the Elbow

AP View Lateral View


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Lateral View of Elbow


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Lateral View of Elbow1. Shaft of Humerus2. Trochlea

. ecranon4. Coronoid Process5. Head of Radius6. Radial Tuberosit7. Tuberosity of Ulna

1

25

46

Trochlear Notch

37


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Lecture 5- Cross Sectional Imaging of the Chest


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Full size axial CT with contrast

7

8

1

23 4

5

6

.

2. Trachea

3. Brachiocephalic Artery

.

6. Right Subclavian Vein

7. Right Internal Jugular Vein

Artery and Right Subclavian Artery)

4. Left Common Carotid Artery

.

9. Left Subclavian Vein


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3

1

2

(4)

1. Esophagus

2. Descending Thoracic Aorta

3. Inferior Vena Cava

(4. Liver)

Full size coronal CT with contrast


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1

5

6

7 8

4

3

(9)

(10)

1. Trachea

2. Pulmonary Trunk

6. Superior Vena Cava

7. Right Brachiocephalic Vein

.

4. Aortic Sinus


.

(9. Right Atrium)

(10. Left Ventricle)



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1

4

5

3

6 7

8

1. Trachea2. Pulmonary Trunk

6. Right Brachiocephalic Vein7. Left Brachiocephalic Vein

.


5. Left Common Carotid Artery

.

9. Inferior Vena Cava



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12

3

4

5

6

1. Esophagus 5. Right Pulmonary Artery

.

3. Aortic Arch

4. Left Subclavian Artery

.


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1

2

1. Esophagus 2. Descending Thoracic Aorta


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Lecture 6- Imaging of The Cardiac Anatomy

Heart borders (anterior)


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Superior vena cava

ort c root u monary artery

Right atrium

Right ventricle

Heart borders (right lateral)


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Aortic root

Right atrium

Right atrial appendage

Right ventricle


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Radiology Anatomy of the ThoraxAxial View


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Right Atrium

pulmonary vein

Descending Aorta



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Ri ht ventricle

Tricuspid Valve

coronary sinus



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ModeratorBand

LeftVentricle

Valvular Anatomy: Pulmonary Valve


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Tricuspid + Mitral valves


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Radiology Anatomy of the ThoraxCoronal View


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Aorta

Pulmonary ArteryAscending

Aorta

Left Ventricle

Right Ventricle


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Volume rendered heart (anterior)


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ort c root

Left anterior descending

coronar arter


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Volume rendered - Left lateral


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Left Circumflex

LAD coronary artery


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Left coronary artery branches


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Circumflex artery


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Lecture 7- Imaging of CXR


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SternumSternum

bodiesbodies

abuttingabuttingretrosternal spaceretrosternal space

Left AtriumLeft Atrium

Posterior margin ofPosterior margin of

LT ventricleLT ventricle

Normal Lateral Chest


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Pneumothorax - Air in Pleural Space


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pleura

pleura


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Right Upper, Middle and Lower Lobes


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RUL

RUL

RLL

RML

RML

RLL

Left Lower and Upper Lobes


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LUL

LLL

LLL


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Lecture 8 Imaging of Abdominal X-Ray

GASTROINTESTINAL SYSTEMInterpreting the Abdominal Radiograph


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Routine 3 Views:

Supine AP abdomen Erect AP abdomen Erect chest x-ray


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LiverSpleen

Stomach


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Left kidneypedicle

Hepatic

flexure

Left psoas

margin

p nous process

Left sacroiliacjoint

Left hi oint

Symphisis pubis

Soft Tissue

LiverSpleen

Stomach


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Left kidne

Hepaticflexure

Left psoas

Bone


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Spinous

Pedicle

Right iliaccrest

Left

Right

acetabulum sacroiliac

joint

Right femoral

head

Bowel Gas


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Bowel Gas


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Lecture 9 Cross Sectional Imaging of the Abdomen

Upper abdomen axial viewlevel of the pancreas and L1

1212


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1212

4

2

4

5

5

2

13

7

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9

10

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11 11

1. Liver

2. Stomach3. Pancreas

8. Abdominal aorta

9. Inferior vena cava10.Right crus

.5. Large intestine6. Intra-abdominal fat

7. Spleen

.12. Rectus abdominus

Mid-abdomen axial viewlevel of kidneys and L3

10


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10103 2 3

78

6 99

8

7 454 1

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1. Liver2. Ascending colon3. Transverse colon

7. Abdominal aorta8. Inferior vena cava9. Psoas muscle

4. Descending colon5. Small intestine6. Left kidney

10.Rectus Abdominus

Lower abdomen - axial viewlevel of L5

4


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4

10

19

8

8 233

10

55766

7

1. Transversus abdominusmuscle 6. Quadratus lumborum muscle7. Lumbar vertebral body.

3. External oblique muscle

4. Rectus abdominus

5. Psoas muscle

.9. Descending Colon

10.Small Intestine

Mid-Sagittal view


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21. Abdominal aorta2. Liver

2

13. Small intestine1

3

3

Right Para-Sagittal view


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64. R Kidney5. Quadratus

46

5

lumborum muscle6. Liver

5

Left Para-Sagittal view


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7 64. L Kidney5. Quadratus

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44

lumborum muscle6. Stomach

7. Spleen

5

Vascular Review

.

2. Left CommonIliac Artery

3 Ri ht C


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3. Right CommonIliac Artery

4. Left External

Iliac Artery.

Iliac Artery6. Inferior Vena

Cava

1

6

2

3

4

5

Coronal view

1 31 3


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31 3

42

2

4

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5

7

6 6

1. Liver2. Gallbladder

5. Descending colon6. Rectum

. omac

4. Small intestine

. scen ng co on

Coronal view

14 1


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2

55

6

. un us o s omac2. Body of stomach

3. Pyloric antrum of stomach

. ar a no c5. Psoas muscles

6. Iliacus muscle

Coronal view

1 2


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1

3

4

3

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1. Liver2. Spleen

3. Left kidne

5. Gluteal muscles6. Rectum

4. Psoas muscle

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