Radiology Secrets Plus, 3e
Cover
Title Page
Copyright 9780323067942
Dedication
Preface
Acknowledgment
Contributors
Top 100 Secrets
I - Introduction to Imaging Modalities
1. Introduction to Plain Film Radiography & Fluoroscopy
Plain Film Radiography
How do diagnostic x-rays differ from other kinds of electromagnetic radiation?
What are the components of an x-ray tube?
How are diagnostic x-rays produced?
What happens to most of the energy entering the x-ray tube?
What are the key parameters that can be manipulated on an x-ray generator?
What happens if kV is increased?
What happens if mAs is increased?
How are plain film radiographs generated?
What are collimators, grids & screens? Where are they?
What is the inverse square law?
What are the advantages & disadvantages of a small focal spot?
What are the five basic densities seen on an x-ray? How do they appear?
How does computed radiography differ from film screen radiography?
How do mammography film screen combinations differ from combinations used for chest & abdominal examinations?
What is the difference between a posteroanterior (PA) & an anteroposterior (AP) film?
Mammography
How does mammographic technique (kV & mA) selection differ from that selected for chest & abdominal examinations?
What are the two standard views obtained in mammography?
Can any other views be obtained?
How are spot compression & magnification views used in diagnostic mammography?
How are women with breast implants imaged with mammography?
What are the two main tissue types in the breast? How do they appear on a mammogram?
Why are single screens (rather than dual screens) usually used in mammography?
Fluoroscopy
What is fluoroscopy? How are fluoroscopic images obtained?
Why are image intensifiers used?
How do fluoroscopic conventions differ from radiographic conventions?
Discuss the contrast agents used in fluoroscopic studies of the upper & lower gastrointestinal (GI) tract
Why is it important to obtain a scout film before administering a contrast agent in a fluoroscopic study?
Name four types of fluoroscopic studies & a possible clinical indication for each
What is digital subtraction angiography?
2. Introduction to Ultrasound, CT & MRI
Ultrasound
How is an ultrasound (US) image created?
Why is the gel used?
What makes something bright or dark on US?
What are some things that are hyperechoic?
What are some things that are hypoechoic?
What transducer should I choose for the examination?
What kinds of specialized transducers exist?
Why are patients asked to come with a full bladder for a pelvic US?
What is the difference between posterior acoustic enhancement & posterior acoustic shadowing?
What is Doppler US?
Computed Tomography
How is a computed tomography (CT) image created?
What makes something bright or dark on CT?
What is the difference between serial CT & helical (or spiral) CT?
In helical CT, what is pitch?
What is the difference between single detector row & multidetector row scanners?
What is the Hounsfield scale?
What are window & level?
What is the difference between a pixel & a voxel?
What is field of view?
What is the matrix?
What is the difference between spatial resolution & contrast resolution?
Magnetic Resonance Imaging
How is the MR image created?
What are the three basic planes used in imaging?
What is the difference between T1 & T2?
What are T1-weighted & T2-weighted images?
What is a pulse sequence?
What are TR & TE?
What is a spin-echo (SE) pulse sequence?
What is the difference between SE imaging & fast spin-echo (FSE) imaging?
How can I tell the difference between T1 & T2 by looking at the TR & TE?
How can I tell the difference between T1 & T2 by looking at an image?
What kinds of things tend to be bright on T1-weighted images?
I see something dark on T1-weighted & T2-weighted images. What kinds of things do that?
How strong is 1.5 Tesla (T)?
Are low-magnetic-field open scanners as good as high-field scanners?
What is the difference between SE images & gradient-echo (GE) images?
What kinds of images are acquired before & after gadolinium chelate administration?
Why is it important that the precontrast image & the postcontrast image have the same imaging parameters?
What are contraindications to MRI?
Who should not receive gadolinium chelates?
3. Introduction to Nuclear Medicine
How is a nuclear medicine test performed?
What is the difference between the x-rays used in plain films & computed tomography (CT) & the gamma rays used in nuclear medicine?
How does nuclear medicine differ from other imaging modalities used in radiology, such as plain film, ultrasound (US), CT & magnetic resonance imaging (MRI)?
List some common clinical indications for performing nuclear medicine imaging
What radiopharmaceutical agents are used in a V./Q. scan?
How is a V./Q. scan performed?
How are the results of a V./Q. scan interpreted?
What radiopharmaceutical agent is used in HIDA scan?
How is HIDA scan performed?
How are the results of HIDA scan interpreted?
What radiopharmaceutical agents are used for GI bleeding scan?
How do you tell whether the results of the bleeding scan are positive?
What are some indications for performing a renal scan?
What are the four major renal functions that can be evaluated with radionuclide imaging?
What are the main radiopharmaceutical agents used in renal scans? How do they differ?
What three main factors should be examined when interpreting a renal scan?
What radiopharmaceutical agents are used in thyroid imaging?
Describe the appearance of Graves disease, thyroiditis & tumor on a nuclear imaging study
What radiopharmaceutical agents are used in bone scanning?
What are the two types of bone scans that can be performed & what are the indications for each?
If you are concerned about an infection outside the skeletal system, what nuclear imaging studies can you perform?
What is a PET scan?
What radiopharmaceutical agent is used in PET? What type of pathologic conditions can it detect?
What is SUV?
What types of cancer are best detected on PET?
Should PET/CT be done with or without an intravenous contrast agent?
Bibliography
4. Computers in Radiology
What is PACS?
How are PACS images stored?
What is a RAID?
What is image compression?
What is the difference between “lossy” & “lossless” compression?
What is RIS?
What is HIS?
What is DICOM?
What determines image storage size?
How large are these studies?
What is teleradiology?
What is IHE?
What is HL7?
How are conventional radiographs integrated into an all-digital PACS?
What is three-dimensional (3D) reconstruction?
What is voice recognition (or speech recognition)?
What are the advantages & disadvantages of voice or speech recognition relative to conventional dictation/transcription?
What is structured reporting?
What is RadLex?
Bibliography
II - Breast Imaging
5. Screening Mammography
What is a screening mammogram?
When should an average woman start getting mammograms?
Are there instances when screening should start earlier than 40?
How many views are obtained for a routine mammogram?
Which view visualizes the most breast tissue?
Which portion of the breast is better visualized on CC view than on MLO view?
How should a film screen mammogram be hung?
How old should the comparison films be?
What if there are comparison films elsewhere? Do we need to get them?
What is the incidence of screening-detected breast cancer?
What is the reported sensitivity of screening mammography?
What is the difference between a screening mammogram & a diagnostic mammogram?
Are there other types of breast cancer screening modalities? Which modalities are used in everyday clinical practice?
Is digital mammography better than film screen mammography in detecting breast cancer?
Is there an age at which breast cancer screening should stop?
What is batch reading of screening mammograms?
What are some risk factors for developing breast cancer?
True or false: Most breast cancers occur in women with a family history of breast cancer.
True or false: With increased use of breast cancer screening, the incidence of breast cancer has been declining
It has been said that one in eight women has a risk of developing breast cancer. Does a 40-year-old woman have the s
What are BRCA1 & BRCA2? What is the risk of getting breast cancer by age 70 in a patient who is a BRCA1 gene ...
How much radiation does a woman receive from a routine screening mammogram?
How is a patient who has undergone screening informed of her test results?
What happens if additional imaging evaluation is needed based on findings on the screening mammogram?
What is the call-back rate? What should the call-back rate be for a radiologist?
Is the breast a modified skin gland, fatty tissue, muscle, or lymphatic structure?
How does accessory breast tissue form? Where is it most commonly located?
Bibliography
6. Diagnostic Mammography
What are the indications for a diagnostic mammogram?
What views are performed for diagnostic mammography? How are patients who have undergone diagnostic mammography in ...
What is BI-RADS?
What types of mammographic changes may be seen after breast conservation?
Does mammography have a very high sensitivity in detecting recurrent breast cancer after breast conservation?
What is the incidence of recurrent breast cancer in a patient after breast conservation?
True or false: In patients who develop recurrence after breast conservation, survival rates are about the same as for patients who had a mastectomy as the initial treatment
What are contraindications to breast conservation?
In a patient who is planning to have breast conservation, when is it necessary to obtain a postbiopsy mammogram shortly after a successful excisional biopsy?
True or false: In a patient with a history of breast cancer, it is beneficial to geta mammogram more frequently than once a year
How do you hang a mammogram of a patient who has had a mastectomy?
What is a 6-month follow-up? How long is the follow-up performed for BI-RADS category 3 lesions?
How is the mastectomy bed evaluated?
What types of surgical reconstruction are available after a mastectomy?
True or false: After a benign breast biopsy, significant residual changes are usually visible on a mammogram
For all breast biopsies, approximately what percentage of the pathology results should be malignant?
A 47-year-old woman presents with a newly palpable breast mass & has a negative mammogram. What should be done next?
If US results are negative, what should be done next? What percentage of the time can a cancer be missed on US & mammography?
What types of nipple discharge are considered suspicious & warrant additional imaging evaluation? What imaging work-up is recommended for suspicious nipple discharge?
What types of nipple discharge are associated with benign etiologies?
In a patient with a suspicious type of nipple discharge, what is the likelihood that the discharge is due to cancer?
What is the most common etiology for bloody nipple discharge?
What are the most common histologic types of breast cancer?
Is lobular carcinoma in situ (LCIS) a form of cancer? What is the significance of LCIS?
What is the differential diagnosis for a red swollen breast?
Is there such a thing as a mammographic emergency?
How many views are obtained in a patient with breast augmentation?
Where can the implants be placed in the breast?
What types of implants are available?
What is the most sensitive imaging evaluation for implant rupture?
A man presents with a breast lump. How should the patient be imaged? What is the most common etiology for a breast lump in a man?
What is the etiology of gynecomastia?
Do men get breast cancer? What is the frequency?
True or false: Breast cancer can manifest in the following ways: calcifications, masses, architectural distortion & density.
The following terms are commonly used to describe calcifications. Classify the terms as describing benign, indeterminate, or malignant calcifications
Figs. 6-4 through 6-9 sho
w images of calcifications. Classify them as benign or malignant calcifications
What is a triple-negative breast cancer? What is the significance of a triple-negative cancer?
A patient presents with a palpable breast mass & a stable mammogram. The mass in Fig. 6-10 is seen on US. What shou ld be the radiologist’s recommendation?
Bibliography
7. Breast Ultrasound & Breast Procedures
What are the labeled structures on the ultrasound (US) image in Fig. 7-1
?
What type of transducer should be used to perform breast US?
List the indications for breast US after a mammographic evaluation
In what situations would you not perform a mammogram but go directly to breast US in evaluating patients with palpable breast
What are some suspicious lesion features on US?
What are some benign lesion features on US?
What types of biopsy procedures may be performed to evaluate breast lesions?
What are the relative disadvantages of FNA, core needle biopsy & needle localization/excision?
After core biopsy, how can one be certain that the lesion of interest was actually what was sampled?
What is stereotaxis?
In what circumstances would stereotactic biopsy be difficult to perform?
In what circumstances would a US-guided biopsy be difficult to perform?
What is discordance in relation to percutaneous biopsies?
In what situations or histologic diagnosis should an excisional biopsy be recommended after a percutaneous breast biopsy?
Bibliography
8. Breast MRI
Breast MRI Technique
How is breast magnetic resonance imaging (MRI) performed?
What pulse sequences are required for breast MRI?
Is 3-Tesla (T) imaging superior to 1.5-T imaging for breast cancer detection?
Can MRS complement MRI for identifying malignant breast lesions?
Normal Anatomy on Breast MRI
What are the components of the female breast?
What is the normal appearance of the breast on MRI?
Indications for Breast MRI
What are the indications for diagnostic breast MRI?
What are the indications for screening breast MRI?
What is the appearance of (invasive) breast cancer on MRI? Do all breast cancers appear as focal enhancing masses?
Do all enhancing abnormalities in the breast represent cancer?
Does an irregular or spiculated margin in an enhancing lesion always represent breast cancer?
Do malignant lesions enhance more strongly & more rapidly than benign lesions?
How are breast lesion kinetic patterns categorized?
Do all breast cancers show early rapid enhancement, followed by washout (type III enhancement)?
How can biopsy specimens of suspicious lesions that are identified only on breast MRI be obtained?
Implant Evaluation By MRI
What are the components of a breast prosthesis?
How does one distinguish between silicone & saline implants on MRI?
What is the normal MRI appearance of a breast implant?
What are the different types of implant rupture?
What is gel bleed?
Describe the appearance of a contained implant rupture
What are the MRI findings of extracapsular rupture?
Bibliography
III - Cardiac & Noninvasive Vascular Imaging
9. Cardiac Imaging: X-Ray & MRI
What forms the borders of the heart on the frontal posteroanterior (PA) or anteroposterior (AP) chest radiograph?
What forms the borders of the heart on the lateral chest radiograph?
What are signs of left atrial enlargement on the chest radiograph?
What are signs of right ventricular enlargement on the chest radiograph?
What are common causes of an intra-atrial mass?
What are the types of atrial septal defect (ASD)? Which chambers & vessels become enlarged with an ASD?
What are the types of ventricular septal defects (VSDs)? Which chambers & vessels become enlarged with a VSD?
What is a patent ductus arteriosus (PDA)? Which chambers & vessels become enlarged with a PDA?
What is the most sensitive imaging technique for the detection of myocardial infarction?
How long after myocardial infarction does a ventricular aneurysm develop?
How long after myocardial infarction does a ventricular pseudoaneurysm develop?
What are some imaging findings of chronic (constrictive) pericarditis?
In a patient with an abnormal electrocardiogram (ECG) finding & a family history of sudden death, cardiac MRI shows a dilated right ventricle with abnormal wall motion & a normal left ventricle. What is the most likely diagnosis?
How is bright blood MRI accomplished? Why is it used?
How is dark blood MRI accomplished? Why is it used?
How is cine imaging accomplished?
Why is cine imaging used?
Which congenital coronary artery anomalies can cause sudden death?
What are the standard planes for cross-sectional cine cardiac imaging?
What is the most common malignancy of the heart & pericardium?
What are some causes of dilated cardiomyopathy & restrictive cardiomyopathy?
How can cardiac MRI distinguish between ischemic heart disease & nonischemic diseases such as cardiomyopathies?
What is Eisenmenger syndrome?
What are some noninvasive methods of coronary artery imaging?
What are some diseases that affect valvular function? How can they be diagnosed with imaging?
What is the differential diagnosis of a regional wall motion abnormality?
What portions of the heart are supplied by the right coronary, left anterior descending & circumflex arteries?
Bibliography
10. CT Angiography & MRA of the Aorta
How do aneurysms & pseudoaneurysms differ?
What is a mycotic aneurysm? Which imaging findings help suggest the diagnosis?
What is an inflammatory aneurysm?
How is aortic dissection different from aortic transection?
In the setting of blunt trauma, where do aortic injuries most commonly occur?
How are traumatic aortic injuries diagnosed?
Name the chest x-ray findings of a thoracic aortic pathologic condition.
What are the two classification schemes for aortic dissection?
How are dissections that involve the ascending aorta managed differently from dissections that involve the descending aorta only?
Which lumen is usually larger in aortic dissection—the true or false lumen?
Describe other acute aortic syndromes that are often called variants of aortic dissection.
What is the best imaging modality for diagnosing each of these conditions?
How can these conditions be distinguished on axial MR or CT images?
What is the utility of precontrast imaging when performing CT angiography or MRA of the aorta?
How large must the thoracic & abdominal aortas be to be called aneurysmal?
When is an abdominal aortic aneurysm usually repaired?
What is Laplace’s law? How is it relevant to aortic aneurysms?
Can the overall size of an aortic aneurysm be determined by catheter angiography?
How is the size of the aorta most accurately measured on CT or MRI?
Name two methods of repairing aneurysms & compare their advantages & disadvantages.
What criteria are used to determine whether an aortic aneurysm can be treated by endovascular technique?
Why is follow-up imaging of stent-grafts needed?
What are endoleaks? What imaging technique is used to find them?
What other types of aortic procedures can be performed through an endovascular approach?
How do aortic coarctation & pseudocoarctation differ?
What is a bovine aortic arch?
Bibliography
11. Coronary CT Angiography
What is coronary CT angiography & how does it differ from regular chest computed tomography (CT)?
What is multidetector image acquisition? Are more slices always better?
How long does a cardiac CT acquisition take?
What is gating?
Can coronary CT be performed at any heart rate?
Can I use nitroglycerin to dilate the coronary arteries & get better images?
How much radiation exposure is there for a patient undergoing coronary CT angiography?
What are the advantages & disadvantages of coronary CT angiography versus catheter angiography?
Which patients can benefit from coronary CT angiography?
Can I use coronary CT angiography as a single study for a patient with chest pain to rule out cardiac ischemia, aortic dissection & pulmonary embolus?
Are there uses for cardiac CT other than coronary artery evaluation?
Is coronary CT the same as coronary artery calcium (CAC) scoring?
Does CAC scoring have a role in chest pain evaluation?
How is a coronary CT angiography examination reviewed?
How are coronary artery stenoses reported?
What is “myocardial bridging”? Is it important?
Have trials shown an advantage to using coronary CT angiography in place of catheter angiograms or nuclear stress tests?
Will the patient’s insurance pay for coronary CT angiography? What do NCD, LCD & CED mean?
12. CT Angiography of the Pulmonary Vasculature
What are the primary methods for imaging for pulmonary embolus (PE)?
What plain film findings may suggest PE?
What are the advantages of CT angiography over other methods in the evaluation of PE?
How do you perform a CT angiography examination for PE?
What are the direct CT angiography findings of PE?
What are the indirect findings of PE?
How can acute PE be distinguished from chronic PE on CT angiography?
What are other uses for CT in PE?
What is a pulmonary arteriovenous malformation (AVM) & what symptoms can it cause?
What is orthodeoxia?
What pulmonary AVMs are associated with what hereditary disorder?
You are asked to start a peripheral intravenous line in a patient with a known pulmonary AVM. What special precautions should you take?
What are the imaging characteristics of a pulmonary AVM on plain film & CT?
What is partial anomalous pulmonary venous return (PAPVR)?
What is scimitar syndrome & what are its associated imaging findings?
What is the most common primary tumor of the pulmonary artery?
13. CT Angiography & MRA of the Peripheral & Visceral Vasculature
What are computed tomography (CT) angiography & magnetic resonance angiography (MRA)?
When is peak contrast enhancement?
How do we know the time of peak contrast enhancement?
What images are obtained during a CT angiography or MRA study?
When should one choose MRA versus CT angiography for a runoff examination?
What do intravascular stents look like on MRA & CT angiography?
What is the definition of a hemodynamically significant artery stenosis?
What is the best way to measure the degree of a stenosis?
What is the distribution of peripheral vascular disease in different age groups?
What is meant by “single-, two-, or three-vessel” runoff?
What structures separate the superficial femoral from the popliteal artery & the external iliac from the common femoral artery?
On an anterior projection, which thigh vessel takes a more medial course—the superficial femoral artery or the deep femoral artery?
Why are angiographic studies performed on potential renal donors?
What is the prevalence of accessory renal arteries in the general population?
What is the most common left renal vein anatomic variant?
What are the secondary imaging signs of renal artery stenosis?
Can fibromuscular dysplasia (FMD) be diagnosed using MRA or CT angiography?
What are the collateral pathways between the superior mesenteric artery (SMA) & inferior mesenteric artery (IMA) & the celiac artery & the SMA?
Can ostial SMA or celiac artery occlusion result in mesenteric ischemia?
Identify each of the vessels shown in Fig. 13-7
What is the median arcuate ligament? What is its significance?
What is nephrogenic systemic fibrosis?
How does this nephrogenic systemic fibrosis affect which patients should receive MRA versus CT angiography?
Website
Bibliography
IV - Gastrointestinal Tract
14. Plain Radiographs of the Abdomen
What is a flat plate of the abdomen?
What structures are visible on a plain radiograph?
What is an anteroposterior radiograph?
What is a lateral decubitus radiograph?
What is the purpose of an image obtained with the patient in a lateral decubitus or erect position?
List indications for a plain radiograph of the abdomen
What are the advantages & disadvantages of a plain abdominal radiograph versus a computed tomography (CT) scan?
In the era of fast CT scanners, what is the role of a plain radiograph?
Why is the term free air a misnomer?
What are the best patient positions to detect free intraperitoneal gas on a plain radiograph?
What percentage of supine radiographs shows free intraperitoneal gas?
What is the Rigler sign?
In what quadrant is free intraperitoneal gas best detected?
A coned-down image of the right upper quadrant is presented in Fig. 14-6. What structure is outlined by gas? Where is the gas lo
cated?
What is the most common noniatrogenic cause of pneumobilia?
What is Rigler triad?
What does the linear form of pneumatosis imply?
In what portions of the GI tract is normal gas located when the patient is radiographed in a supine position?
What does the term ileus mean?
Which study is superior in diagnosing small bowel obstruction: plain radiograph or CT?
What are the pitfalls of plain radiograph diagnosis of small bowel obstruction?
What modality is able to diagnose an obstruction complicated by ischemia?
Can CT show adhesions?
In what situations are barium studies most helpful for the diagnosis of small bowel obstruction?
What is the most common form of colonic volvulus?
What patient groups have a greater incidence of sigmoid volvulus?
In what quadrant of the abdomen does the cecum lie in a patient with cecal volvulus?
What percentage of gallstones are calcified?
A plain radiograph of the abdomen is obtained in a patient who has a palpable abdominal mass (Fig. 14-15). What is your diagnosis?
A coned-down view of the upper abdomen (Fig. 14-16) is obtained in a man with chronic abdominal pain. What is your diagnosis?
A patient has a palpable abdominal mass (Fig. 14-18). What organ is enlarged?
A 45-year-old man has recently received a liver transplant. Identify the type & location of the two tubular structures below the diaphragm in Fig. 14-19A. What has the radiologist done in Fig. 14-19B & C?
A 38-year-old man complains of nausea & vomiting. What type of tube has been placed in Fig. 14-20A?
Bibliography
15. Upper Gastrointestinal Tract
What organs are studied during an upper gastrointestinal (GI) series?
What organs are studied during a pharyngoesophagogram?
What organ is shown in Fig. 15-1?
What organs are shown in Fig. 15-2? Ident
ify the numbered parts of the organs as labeled
What curvatures do the black & open arrows in Fig. 15-2 identify?
Why does the gastric fundus appear white in Fig. 15-2, whereas the antrum appears gray?
Two images of the esophagus are presented in Fig. 15-3. What is your diagnosis?
What does single contrast mean?
What does double contrast mean?
What are clinical indications for performing an upper GI study?
What are clinical indications for performing a video/DVD pharyngoesophagogram?
Describe the preparation for an upper GI study or pharyngoesophagogram
What are contraindications to a barium study of the upper GI tract?
What type of contrast agent should be requested first in patients with suspected upper GI perforation?
When is a single-contrast upper GI series performed?
What portion of the GI tract is shown in?
What portion of the GI tract is shown in?
What are the indications for a small bowel follow-through?
Fig. 15-8 is an overhead image obtained from what type of study? What organ is being imaged?
What layers of the bowel wall comprise the valvulae conniventes?
What are the indications for enteroclysis (small bowel enema)?
What is the preparation for enteroclysis?
Fig. 15-9 is a spot radiograph of the terminal ileum in a young man with chronic diarrhea. What disease does this patient have?
Fig. 15-10 is from a double-contrast esophagogram performed in an immunocompromised patient with acute odynophagia. What is your diagnosis?
Fig. 15-11 is an imag e performed during an esophagogram while the patient lies prone & rapidly drinks thin barium. This patient had long-standing dysphagia for solids & chronic heartburn. What is your diagnosis?
Fig. 15-12 shows two images of the lesser curvature of the stomach from a double-contrast upper GI series performed ...
Fig. 15-13 is an image of the gastric antrum from a double-contrast upper GI series performed in a 52-year-old woman with anemia. What is your diagnosis?
Fig. 15-14 is a close-up of the distal greater curvature of the stomach obtained during a double-contrast upper GI series performed in a patient with abdominal pain & rheumatoid arthritis. What is your diagnosis? ...
A coned-down image of the gastric fundus obtained during a double-contrast upper GI series is shown in Fig. 15-15. What is yo
A coned-down image of the gastric fundus obtained during a double-contrast upper GI series in shown in Fig. 15-16. What is your diagnosis?
Fig. 15-17 is an image of the gastric antrum from a double-contrast upper GI series performed in a 43-year-old man with anemia. What is your diagnosis?
An elderly man complains of early satiety. A spot radiograph of the stomach from a double-contrast upper GI series is provided (Fig. 15-18). What is your diagnosis?.
Fig. 15-19 is a spot radiograph of the lower stomach obtained from a double-contrast upper GI series in a man who has had 4 months of abdominal discomfort. What is your differential diagnosis?
A young man complains of acute right upper quadrant pain. Fig. 15-20 is a spot radiograph from a double-contrast upper GI series. What is your diagnosis?.
Fig. 15-21A is a coned-down image of the mid-small intestine obtained in a man with unexplained heme-positive stool. Fig. 15-21B is an axial image from a CT scan that was performed several days later. What is your differential diagnosis?
A young man complains of increasing abdominal distention & subacute right lower quadrant pain. Two images from a CT scan are presented (Fig. 15-23). Although a specific diagnosis is not possible, describe what is happening
A young man complains of diarrhea for 4 weeks. Fig. 15-24 is a spot image of the terminal ileum from a small bowel follow-through. What is your diagnosis?
A patient with known Crohn disease comes to the emergency department with abdominal pain. What radiologic test should be performed first?
A middle-aged woman has peripheral lymphadenopathy & heme-positive stool. Fig. 15-26 is an image of the terminal ileum & ileocecal valve from the single-contrast phase of a small bowel enema. What are the diagnostic possibilities?
A middle-aged woman has foul-smelling yellow stools. Fig. 15-27 is a spot image of the proximal jejunum obtained during enteroclysis. The double arrows represent 1 inch. What is your diagnosis?
A 35-year-old woman has right lower quadrant pain & diarrhea. The results of the CT scan were normal. Fig. 15-28 is a spot radiograph of the distal ileum from a small bowel follow-through. What is your diagnosis?
A 44-year-old man had surgery for a persistent duodenal ulcer (Fig. 15-29). What operation was performed?
What are the physiologic sequelae of gastric operations?
A 62-year-old man complains of abdominal pain 20 years after an antrectomy with gastroduodenostomy was performed for intractable duodenal ulcer disease (Fig. 15-30). What is your differential diagnosis?
A 45-year-old woman complains of vomiting. She had surgery for morbid obesity 2 years previously (Fig. 15-31). What operation did this patient have? Why is she vomiting?.
A 42-year-old woman has undergone surgery for morbid obesity (Fig. 15-32). What operation was performed?
A 41-year-old woman had undergone surgery for morbid obesity (Fig. 15-33). What operation was performed?
A 27-year-old woman underwent surgery for morbid obesity & now presents with left upper quadrant pain & regurgitation. Fig. 15-34A is a spot radiograph from a study performed 14 months before the image in Fig. 15-34B. What has happened?
Bibliography
16. Colon: Contrast Enema & CT
Anatomy
Identify the parts of the colon (numbers 1 through 8) in Fig. 16-1. What structures are identified by the open ...
What are haustra?
Technique
Fig. 16-4 is from what type of examination?
In what position is the patient lying tabletop of the fluoroscope in Fig.16-1?
What type of patient is capable of undergoing a double-contrast barium enema?
Fig. 16-5 is an image from what type of examination?
What are the indications for a double-contrast barium enema?
What are the indications for a single-contrast barium enema?
What is your hospital’s preparation for a barium enema?
What patients may require more than the standard barium enema preparation?
List the contraindications for a barium enema
What are the contraindications for the use of intravenous glucagon?
What patients should be scheduled early in the day?
What are the complications of a barium enema?
Is antibiotic prophylaxis needed before administration of a barium enema?
What patients need a preparation for a CT scan?
What is the most important radiographic predictor of malignancy arising in a polyp?
What does fine lobulation of the surface of a polyp mean?
What percentage of colonic cancers is out of reach of the flexible sigmoidoscope?
Which of the following morphologic shapes is the most common form of symptomatic colonic carcinoma: polypoid, carpet, plaquelike, or annular?
What is the most common cause of colonic intussusception in adults?
Hyperplastic polyps are found most commonly in what part of the colon?
Fig. 16-10 is an image from a CT scan through the mid-abdomen. What is your diagnosis?
What tumors commonly spread to the intraperitoneal space?
What is the most common finding of intraperitoneal metastasis on CT?
What are the differences in distribution between ulcerative colitis & Crohn disease?
Aphthoid ulcers are characteristic of which chronic inflammatory bowel disease?
What is the first radiographic study that should be performed in symptomatic patients with Crohn disease?
What is the most common form of colitis in an outpatient older than 50 years?
A woman with a history of cervical cancer now has rectal bleeding (Fig. 16-18). What is the most likely diagnosis?
What form of colitis is sometimes detected when CT is performed to exclude an intra-abdominal abscess in hospitalized patients with fever & leukocytosis?
Neutropenic colitis (typhlitis) most commonly involves what part of the colon?
What are colonic diverticula?
Describe the distribution of diverticula
What is the primary muscle abnormality in diverticular disease?
An elderly patient presents with acute left lower abdominal pain. The clinical concern is diverticulitis. What examination should be performed?
Fig. 16-22 is an image from a CT scan in a patient with acute left lower quadrant abdominal pain is presented. What is your diagnosis?
A young woman complains of left lower quadrant pain (Fig. 16-24). What is your diagnosis?
What is defecography?
What types of symptoms are indications for defecography?
What happens to a patient during defecography?
What abnormalities are detected during defecography that are not identified during endoscopy or barium enema?
What study has been performed in Fig. 16-27? What is the diagnosis?
What are the advantages & disadvantages of virtual colonography?
What are the indications for a water-soluble contrast enema?
A water-soluble contrast enema is performed in a patient with a hand-sewn end-to-end colorectal anastomosis, after re ...A water-soluble contrast enema is performed in a patient with a hand-sewn end-to-end colorectal anastomosis, after resection of a c
Bibliography
17. CT & MRI of the Liver & Biliary Tract
What sequences should be obtained when performing magnetic resonance imaging (MRI) of the liver?
Why does the liver have high signal intensity on T1-weighted images?
Can T1-weighted MR images characterize focal liver lesions as hepatocellular in origin?
What is the most commonly depicted benign hepatocellular lesion?
What are the imaging findings of FNH?
What is the second most common benign hepatocellular mass?
How does one distinguish between hepatic adenoma & FNH at imaging?
What are the two most commonly encountered benign liver lesions?
What are the CT & MRI features of hepatic cysts?
How are hemangiomas differentiated from cysts on MRI & CT?
Are there atypical patterns of hemangioma enhancement on CT & MRI?
What is nonalcoholic fatty liver disease (NAFLD)?
What are the imaging features of steatosis?
What are the imaging features of liver cirrhosis?
What are the imaging features of HCC?
Describe the CT & MRI appearances of metastatic disease
What MRI techniques are used to perform magnetic resonance cholangiopancreatography (MRCP)?
What are the advantages & disadvantages of MRCP compared with endoscopic retrograde cholangiopancreatography (ERCP)?
Bibliography
18. CT & MRI of the Spleen
What are the magnetic resonance imaging (MRI) signal characteristics of the normal spleen?
What is the difference between white pulp & red pulp?
Why does the normal spleen look so bizarre in the arterial phase?
What is an accessory spleen?
What is the differential diagnosis of splenomegaly?
What is the most common cause of a small spleen?
What does splenic iron deposition look like on MRI?
What are causes of splenic calcifications?
What is the appearance of splenic segmental infarction on CT & MRI?
What abdominal organ is most commonly injured in blunt trauma to the abdomen?
What is a splenic cleft & how can it be differentiated from a splenic laceration?
What are some nontraumatic causes of splenic rupture?
What is the most common CT appearance of lymphoma involving the spleen?
What is the role of imaging in the staging & management of Hodgkin disease & lymphoma?
What is the differential diagnosis of a cystic lesion within the spleen?
What is the differential diagnosis of a noncystic lesion within the spleen?
Can CT or MRI reliably differentiate these noncystic splenic lesions from one another?
What is polysplenia?
What is asplenia?
Bibliography
19. CT & MRI of the Pancreas
How does a pancreatic protocol computed tomography (CT) scan differ from a routine enhanced abdominal CT study?
What is the normal morphology of the pancreas on CT & magnetic resonance imaging (MRI)?
What blood vessels are found near the pancreas?
What is the normal CT attenuation & MRI signal intensity of the pancreas?
What is magnetic resonance cholangiopancreatography (MRCP) & how does it compare with endoscopic retrograde cholangiopancreatography(ERCP)?
When is MRI/MRCP of the pancreas indicated?
What normal or normal variant structures may be seen in the portocaval space?
What are the roles of CT in assessment of acute pancreatitis?
Is there an optimal time to perform the initial contrast-enhanced CT scan for assessment of complications of acute pancreatitis?
What are imaging findings of chronic pancreatitis?
True or false: Pancreatic adenocarcinoma enhances to a greater degree than normal surrounding pancreas during the arterial phase
What CT & MRI findings determine unresectability of pancreatic adenocarcinoma?
Why is the “double duct” sign important?
What are the three most common types of islet cell tumors?
How does an islet cell tumor typically enhance on CT & MRI?
How do imaging findings at presentation differ for functioning versus nonfunctioning islet cell tumors?
What is the differential diagnosis of a solid pancreatic mass?
What causes diffuse fatty replacement of the pancreas?
True or false: The pseudocyst is the most common cystic lesion of the pancreas
What imaging features favor the diagnosis of serous cystadenoma versus a mucinous cystic neoplasm?
What is the most common congenital anomaly of the pancreas?
What genetic disorder results in “bronze diabetes”?
What are characteristic MRI findings in primary hemochromatosis?
Which pancreatic lesions are associated with von Hippel-Lindau disease?
Pancreatic epithelial cysts may be found in association with which three underlying diseases?
Which portions of the pancreas are most commonly injured in blunt trauma & why?
What are CT imaging findings of pancreatic injury?
What is an IPMT?
Bibliography
20. CT of the Acute Abdomen & Pelvis
Why is computed tomography (CT) commonly used for diagnostic purposes in patients with an acute abdomen or pelvis?
How does CT work?
When are oral & intravenous contrast materials for CT administered to patients with an acute abdomen?
What is the major differential diagnosis for acute abdominopelvic conditions diagnosable on CT?
What is an abscess? What is its CT appearance?
What is acute appendicitis?
Describe the CT findings related to acute appendicitis
What is acute large bowel diverticulitis? What are the CT findings?
Describe acute mesenteric lymphadenitis & the associated CT findings
What is neutropenic enterocolitis (typhlitis)? What are the CT findings?
Describe primary epiploic appendagitis (PEA) & segmental omental infarction. What are the CT findings?
What is acute cholecystitis?
List the CT findings related to acute cholecystitis
What is gangrenous cholecystitis & what are the CT findings?
Describe emphysematous cholecystitis & its CT findings
What is the treatment for acute, gangrenous, or emphysematous cholecystitis?
What is acute pancreatitis?
Describe the CT findings related to acute pancreatitis
What is the CT grading system for acute pancreatitis?
Describe the normal phases of renal enhancement seen on CT
What is acute pyelonephritis & what are the CT findings?
What is emphysematous pyelonephritis? What is the CT appearance?
Describe the CT findings of urolithiasis along with its associated complications
What is pelvic inflammatory disease (PID) & what are the CT findings?
List the major causes of bowel obstruction
Describe the CT findings associated with bowel obstruction
Describe the CT findings associated with bowel ischemia
List the major causes of bowel ischemia
What is a closed loop bowel obstruction & what are the CT findings?
List the major causes of bowel perforation
What are the CT findings associated with bowel perforation?
Describe the CT appearance of hemorrhage & active arterial hemorrhage
Describe the CT findings related to AAA rupture & impending rupture
What are the CT findings associated with shock & what should one do on seeing these findings?
List the major CT findings associated with solid organ traumatic injury
Describe the major CT findings related to hollow organ traumatic injury
What are the major CT findings associated with vascular traumatic injury?
What is Fournier gangrene? What is its CT appearance?
Bibliography
V - Genitourinary Tract
21. Intravenous Urography
What is an intravenous urogram (IVU)?
In what clinical situations is IVU useful?
The patient I am seeing in the clinic has gross hematuria. Can I send him to the radiology department for IVU today?
What preprocedural preparations are necessary for IVU?
When is IVU contraindicated?
What radiographic contrast agents are used for IVU?
What is the sequence of radiographs for IVU?
How should a patient with hematuria be evaluated?
What should be done if IVU suggests the presence of a renal mass?
My patient has presented with diffuse lung metastases & gross hematuria. Should I evaluate him with IVU to look for ...
Why is IVU necessary in patients with TCC of the urinary bladder?
What does TCC look like on radiographic studies?
What do stones look like on IVU?
Is a filling defect in the collecting system diagnostic of TCC?
How do I distinguish between these different pathologic conditions?
My patient has severe flank pain after hiking all day in 100° F weather. What study should I order to exclude renal c ...
What abnormalities are seen on IVU in a patient with acute renal colic?
Because CT detects all stones, when is IVU necessary in patients with urinary tract stones?
My patient is 2 days postsurgery for an abdominal tumor & the surgical drains are putting out a lot of yellow flui ...
Is there a role for IVU in evaluating patients with abdominal masses?
What is the role of IVU in a patient with suspected urinary tract obstruction?
Is IVU useful in patients with UTIs?
Bibliography
22. Genitourinary Fluoroscopic Examinations
What are genitourinary fluoroscopic examinations?
How are retrograde pyelograms & intravenous urograms (IVUs) different? Do they provide the same information?
What is the difference between a cystogram & VCUG?
What are the indications for cystogram & VCUG?
Is a cystogram sensitive in excluding a leak from the bladder?
A patient is brought to the emergency department with blunt abdominal trauma & pelvic fractures. Does this patient need both an abdominopelvic computed tomography (CT) scan & a fluoroscopic cystogram?
Why is VUR important? How is it shown?
What is RUG?
How is the female urethra evaluated?
What is a loopogram?
What is a hysterosalpingogram?
Does magnetic resonance imaging (MRI) or ultrasound (US) examination of the pelvis provide the same information as hysterosalpingogram?
If I have a female patient with a pelvic mass, what study would be helpful in further evaluation?
What about a postmenopausal patient with vaginal bleeding? Would hysterosalpingogram be helpful in evaluating the endometrium in this patient?
Bibliography
23. CT & MRI of the Kidney
What computed tomography (CT) protocol should be used to characterize a focal renal mass?
What magnetic resonance imaging (MRI) protocol should be used to characterize a focal renal mass?
What is the normal enhancement pattern of the kidneys on CT & MRI?
What are the expected CT & MRI findings of renal cell carcinoma (RCC)?
What are risk factors for RCC?
What is the Bosniak system for cystic renal lesions?
What if I cannot tell whether a septation is thin or thick, or if the mural calcification is fine or bulky?
Is CT or MRI better for characterizing cystic renal lesions?
What is an angiomyolipoma?
What syndrome is associated with angiomyolipomas?
How are angiomyolipomas treated?
I see an enhancing renal mass that does not have fat attenuation on CT & that does not have fat signal on MRI. What is the differential diagnosis?
How is RCC staged by CT & MRI?
What does renal infarction look like on CT or MRI?
What does renal laceration look like on CT?
What findings on a trauma CT scan indicate that a kidney would need to be surgically repaired?
What is autosomal dominant polycystic kidney disease (ADPKD)? Is it associated with RCC?
What is autosomal recessive polycystic kidney disease (ARPKD)? Is it associated with RCC?
What are two genetically inherited syndromes that are associated with RCC?
What is acquired cystic renal disease? Is it associated with RCC?
Should patients on dialysis be screened for RCC?
What are some features that suggest oncocytoma on CT & MRI?
What are the findings of pyelonephritis on CT or MRI?
A multiloculated cystic lesion looks like it has herniated into the renal collecting system. What could this be?
Are CT & MRI useful in imaging TCC?
What are the MRI signal characteristics typical of TCC?
What does renal lymphoma look like on CT & MRI?
Does metastatic disease go to the kidneys? What does it look like on CT & MRI?
What protocol should be used for performing CT or MRI on a patient who is a potential renal donor?
What kinds of things should be included in the CT or MRI report on a patient who is a potential renal donor?
I have an emergency department patient with flank pain. What is the best radiologic test to find renal & ureteral calculi?
What is post-transplant lymphoproliferative disorder (PTLD)?
Other than PTLD, what are some things that can go wrong with a renal transplant?
What is a horseshoe kidney?
For what diseases are individuals with horseshoe kidneys at increased risk?
What is CT urography & how is it performed?
What is MRU? What are the relative strengths & weakness of CT urography & MRU?
Bibliography
24. CT & MRI of the Adrenal Glands
Where are the adrenal glands located?
What do normal adrenal glands look like on computed tomography (CT) & magnetic resonance imaging (MRI)?
What is the differential diagnosis of an adrenal lesion seen on CT or MRI?
What is chemical shift imaging?
How can I tell which is the out-of-phase image?
How can MRI be used to show that an adrenal lesion is an adenoma?
How can unenhanced CT be used to show that an adrenal lesion is an adenoma?
Are there any malignant adrenal lesions that can contain intracytoplasmic lipid?
How can enhanced CT be used to show that an adrenal lesion is an adrenal cortical adenoma?
Which is better for imaging the adrenal glands, CT or MRI?
What is the difference between a functioning & a nonfunctioning adenoma? Can CT or MRI differentiate these?
What is a myelolipoma & how can CT & MRI be used to show that an adrenal lesion is a myelolipoma?
On MRI, I see an adrenal lesion that does not lose signal on chemical shift imaging. Could it still be an adenoma?
What is a collision tumor?
How commonly do malignancies spread to the adrenal glands?
How do adrenal cysts form & what do they look like on CT & MRI?
What causes adrenal hemorrhage?
How can CT or MRI be used to tell the difference between adrenal hemorrhage & an adrenal mass?
What does pheochromocytoma look like on CT?
What is the differential diagnosis of T2-hyperintense adrenal lesions on MRI?
My patient has an elevated urine catecholamine level & hypertension, but there is no adrenal lesion on CT (or MRI). Where else should I look for a pheochromocytoma?
What is the pheochromocytoma “rule of tens”?
My patient has lung cancer. What are the odds that there would be an adrenal lesion at time of presentation?
How can I tell whether a lesion is in the adrenal gland or in the upper pole of the kidney?
Where do the adrenal arteries arise?
Where do the adrenal veins drain?
On CT & MRI, I see an adrenal mass that extends into the left renal vein. Does that help narrow the differential diagnosis?
What are the causes of Conn syndrome?
What are the causes of Cushing syndrome?
Both adrenal glands look thick, but I do not see a focal mass. What does this mean?
Which of the multiple endocrine neoplasia (MEN) syndromes involve the adrenal glands?
Bibliography
25. Ultrasound of the Female Pelvis
What are the main indications to perform an ultrasound (US) examination of the female pelvis?
How is a pelvic US performed?
What is the normal US appearance of the uterus?
How is the endometrial stripe routinely measured?
What is the normal thickness of the endometrium?
What is the name of the simple cysts identified within the cervix? What is their clinical significance?
What is the most common tumor of the uterus?
What are the most common causes of vaginal bleeding in a postmenopausal woman?
What are the US findings related to endometrial carcinoma?
How can US help differentiate an endometrial polyp from other causes of endometrial thickening?
What is the US appearance of endometrial hyperplasia?
Describe the major congenital uterine anomalies.
What is the role of US in the diagnosis of uterine anomalies?
What are the findings associated with adenomyosis on US?
What is the normal US appearance of the ovary in a premenopausal woman?
Describe the management of simple ovarian cysts in premenopausal women
What are the US findings associated with a hemorrhagic cyst?
What features of an ovarian mass suggest a benign versus malignant etiology?
If a woman presents with a palpable mass in the pelvis, but no abnormality is identified on US, which lesion should be considered? (Hint: This is the most common ovarian neoplasm to occur in women younger than 50 years old.)
What findings are associated with pelvic inflammatory disease on US?
What is the imaging modality of choice in a patient with suspected endometriosis?
If a woman presents with infertility, hirsutism & oligomenorrhea & pelvic US displays large ovaries with multiple, peripherally based follicles, what is the diagnosis?
What are the US findings associated with ovarian torsion?
Bibliography
26. MRI of the Female Pelvis
Describe the normal location & normal magnetic resonance imaging (MRI) appearance of the ovaries.
How can uncomplicated functional cysts be distinguished from cystic ovarian malignancy?
What is the significance of a papillary projection with a cystic ovarian structure?
What are four benign masses of the ovary that exhibit characteristic MRI features?
Describe the content of mature teratomas that gives them a characteristic MRI appearance.
What imaging characteristics does a hemorrhagic ovarian cyst share with a dermoid?
Can MRI be used to distinguish between hemorrhagic cysts & endometriomas?
How can MRI aid with the diagnosis of ovarian torsion?
From what cell types can primary ovarian tumors originate? What are some collective features of ovarian malignancy?
What is the role of MRI in pregnancy?
What is the MRI appearance of the normal uterus?
Describe the types of congenital uterine abnormalities & the role of MRI in detecting them.
Name two benign diseases of the uterine myometrium.
What degree of junctional zone thickness is indicative of adenomyosis?
If focal adenomyosis & leiomyomas are both of low-signal intensity on T1 & T2 images, how are they distinguished?
Name three malignant uterine neoplasms.
What is the role of MRI in endometrial carcinoma?
What is the normal appearance of the uterine cervix on MRI?
Describe the role of MRI in the evaluation of cervical cancer.
What term is given to the cystic outpouchings of the anterior urethra into the vaginal canal? How do these outpouchings appear on MRI?
What is the difference between the MRI appearance of Bartholin cysts & Gartner duct cyst?
What is the most common primary vaginal malignancy?
When is MRI of the female pelvis performed with & without the patient engaging in the Valsalva maneuver?
Bibliography
27. MRI & Ultrasound of the Male Pelvis
What is the anatomy of the prostate gland?
What is the normal size of the prostate gland?
What values of prostate-specific antigen (PSA) are considered normal & abnormal?
Other than prostate cancer, what can elevate PSA?
Where does BPH usually occur? What does it typically look like on magnetic resonance imaging (MRI) & ultrasound (US)?
What is the distribution of prostate cancer within the gland?
What is the primary role of US & MRI in the evaluation of prostate cancer?
What is the typical imaging appearance of prostate cancer on transrectal US & MRI?
When should MRI be performed after biopsy? How is postbiopsy hemorrhage differentiated from tumor in the peripheral zone?
How is prostate cancer staged? How does the cancer stage affect patient management?
What signs of nonsurgical (stage C or D) disease can be seen on MRI?
Where does capsular penetration most commonly occur?
What is hematospermia? What causes it?
Where do the testicular arteries arise?
Describe the normal appearance of the testis & epididymis on US
How does the testicle appear on MRI?
What is cryptorchidism? What does a cryptorchid testicle look like?
What are complications of cryptorchidism?
What is testicular microlithiasis? Name diseases commonly associated with microlithiasis
What is the most important question to consider when imaging a palpable scrotal abnormality? Why?
What is the most common cause of a scrotal mass?
Do cysts occur in the testicle? Is there anything else in the differential diagnosis?
What is the differential diagnosis of a solid testicular mass? Can these be distinguished on US & MRI?
Name the different types of malignant testicular lesions
What are the most common types of tumors in young adults (20 to 34 years old), children & older adults (>50 years old)?
Which category of testicular tumors is most common overall?
Germ cell tumors are generally classified according to whether they are seminomatous or nonseminomatous. Why is this distinction important? Describe the general differences between the tumors in these two categories.
List the stages of primary testicular tumor
Describe the spread of primary testicular tumors
Which germ cell tumor has a tendency for early hematogenous metastases?
What types of testicular tumors are hormonally active? Which of these is most common?
What is the differential diagnosis for multiple intratesticular masses?
What is an epidermoid inclusion cyst? Is it malignant?
What does an epidermoid inclusion cyst look like?
Name several structures that may herniate through the inguinal canal into the scrotal sac
What is a varicocele & how is it diagnosed? Is it more common on the left or the right?
What are complications of a varicocele?
Under what circumstances is a varicocele concerning? Why?
What is a hydrocele?
Name the common causes of a hydrocele
What is the clinical differential diagnosis for an acutely painful scrotum? How is this usually evaluated with imaging?
What are the most common types of testicular torsion? Why does it occur?
What is the key criterion in diagnosing testicular torsion?
Why is the sensitivity of US for torsion only about 90%?
What is the imaging appearance of acute epididymitis?
What are the complications of epididymitis?
What is a cause of isolated diffuse hyperemia of the testicle (orchitis without epididymitis)?
What else may cause hyperemia of the testicle & epididymis?
What are the possible US findings after testicular trauma?
Describe the normal appearance of the penis on MRI
Describe the physiologic factors behind erection
What congenital abnormality of the penis is associated with bladder exstrophy?
The penile meatus is located more ventrally & proximally than expected. What is this congenital malformation called? What is an associated finding?
What is the most common cancer of the penis in an adult? What are the risk factors?
Where is the cancer most commonly located?
A patient with known prostate or bladder cancer presents with priapism. What must be considered?
What is Cowper duct syringocele? What does it look like on MRI?
A patient has a clinical history of painful deviated erections. What disease does the clinician suspect? What should one look for on MRI or US?
Describe the characteristic clinical history or physical examination findings associated with penile fracture. What are the findings on MRI?
A patient presents with a history of impotence. What can one look for on US to evaluate for potential causes?
Bibliography
VI - Interventional Radiology
28. Patient Sedation & Pain Management
What is the purpose of sedation & pain management during an interventional radiology procedure?
What is the difference between analgesia & anesthesia?
What is the difference between anxiolysis & amnesia?
What capabilities should the patient maintain during conscious sedation?
Describe the levels of patient sedation.
List the details that should be included in the presedation evaluation of a patient.
How long should a patient typically fast before undergoing conscious sedation?
The physical status of a patient is often quantitated on a 5-point scale, known as the American Society of Anesthesiologists Physical Assessment Status. Describe this scale.
Commonly, conscious sedation is administered by the provider (e.g., interventional radiologist) with patient monitoring provided by a qualified nurse. What patient factors should influence a provider to consider consulting an anesthesiologist to adminis
What patient factors must be monitored during conscious sedation?
What equipment must be present when administering conscious sedation to a patient?
What pharmacologic agents are commonly used for patients undergoing conscious sedation? What is their reversal agent?
What are the usual effects of benzodiazepines?
What pharmacologic agents are commonly used for pain control? What is their reversal agent?
What are the typical effects of opiates?
What pharmacologic agent used for pain control is contraindicated in patients taking a monoamine oxidase (MAO) inhibi ...
What are the strategies for dealing with a patient who has a known hypersensitivity to iodinated contrast agents?
List possible options for the management of an acute vasovagal reaction.
What are the ABCs of patient resuscitation?
Describe the management of acute hypotension.
List possible options for the management of an acute hypertensive crisis.
How can acute pulmonary edema be managed?
Describe the immediate options for management of an anaphylactic reaction.
Describe the immediate options for management of acute laryngeal edema.
Describe the immediate options for management of bronchospasm.
What are possible options for the management of generalized urticaria?
Website
Bibliography
29. Equipment, Terms & Techniques in Interventional Radiology
What are the characteristics of a diagnostic catheter?
What is the difference between a Cobra 1 & a Cobra 2 catheter?
What is a French? What is a gauge?
What are the two general categories of stents? How do they differ?
How is a balloon-expandable stent deployed?
What two materials are used to make self-expanding stents?
How do woven Elgiloy & nitinol self-expanding stents differ?
What is nitinol?
What do the terms hoop strength & radial force mean?
What is a sheath?
What is a guiding catheter?
What is an up-and-over sheath?
Explain the Trojan horse technique.
What are the defining characteristics of guidewires?
What is an exchange-length wire? How long does it have to be?
What is a Cope loop?
What is the origin of the term stent?
What does it mean to “Dotter” a lesion?
What is a micropuncture set?
What is the difference between the single-wall & the double-wall technique?
What are the advantages & disadvantages of a single-wall puncture?
What is a snare?
What is a reverse curve catheter?
What are the different ways to form a Simmons catheter?
What is a Waltman loop?
What is a “road map”?
How do you select the proper injection rate for an arteriogram?
What is meant by an injection of “20 for 40”?
What is a rate rise?
What is a Hickman catheter?
What is a PermaCath?
What is a Medcomp?
Bibliography
30. Inferior Vena Cava Filters
What is an inferior vena cava (IVC) filter?
What are some common indications for IVC filter placement?
List relative indications for IVC filter placement
What is a prophylactic IVC filter?
What is Virchow triad?
What are absolute contraindications to IVC filter placement?
What are relative contraindications to IVC filter placement?
How many PE originate from the lower extremities?
When would a superior vena cava (SVC) filter be placed?
Why is a venacavogram performed before IVC filter placement?
How is a venacavogram performed before IVC filter placement?
What do the renal veins look like on a cavogram?
Can a cavogram be performed if the patient is allergic to iodinated contrast agent or has an elevated creatinine level?
What common venous anomalies are seen on a cavogram?
How common is IVC duplication? What does it look like on a cavogram?
What should be done in a patient with duplicated IVC who needs an IVC filter?
What are the characteristics of a left-sided IVC?
What are characteristics of a circumaortic left renal vein? How common are they?
Where should a filter be placed in a patient with a circumaortic left renal vein?
List the IVC filters that are currently approved by the U.S. Food & Drug Administration (FDA)
What is a nonpermanent IVC filter?
What patients could benefit from a nonpermanent IVC filter?
Which of the currently FDA-approved filters can be used as a retrievable filter?
Can patients with an IVC filter still get PE?
Where in the IVC should the filter be placed & why?
What complications are related to IVC filter placement?
How often does IVC occlusion occur after IVC filter placement?
Bibliography
31. Advanced Procedures in Interventional Radiology
Aortic Aneurysm Stent Grafts
What is the basic composition of a stent graft?
What are the prevalence, incidence, demographics & risk factors for abdominal aortic aneurysms (AAAs)?
What is the natural history of AAA & when is intervention indicated?
How are most AAAs detected & what is the role of screening programs?
In general, when is endovascular aneurysm repair (EVAR) favored over open repair?
Describe briefly the traditional open surgical repair of AAA.
Name some findings on preprocedure imaging of AAA that would preclude a patient from EVAR.
What is an endoleak? What are the different types of endoleak & how are they treated?
What kind of follow-up imaging do patients treated with EVAR undergo?
What are some of the complications related to EVAR?
What are the major studies that have looked at the outcomes of EVAR?
What are the results of the major EVAR studies?
What devices are currently commercially available in the United States for EVAR & how do they differ?
What advantages will future generations of stent grafts have over ones that are currently available?
What are advantages of EVAR over traditional surgical repair?
Transarterial Chemoembolization
What is meant by transarterial chemoembolization (TACE)?
What types of hepatic malignancies can be treated with TACE?
What is a typical mixture used to perform TACE?
What is the purpose of ethiodized oil (Ethiodol) in the TACE mixture?
What types of patients should be considered candidates for TACE?
How are patients followed after TACE & when is retreatment indicated?
What is the typical imaging & work-up required before TACE?
What is postembolization syndrome?
What medications are patients typically treated with after TACE?
What is the major risk factor for hepatic abscess formation secondary to TACE?
What tumor markers are used to follow HCC? What about metastatic colon cancer?
What laboratory values should be checked when determining candidacy for TACE?
How can the liver tolerate embolization of the hepatic artery without undergoing infarction?
What does one look for on follow-up imaging to evaluate the success of a TACE procedure?
What is radiofrequency ablation (RFA) & how does it work?
What characteristics of hepatic lesions are considered treatable by RFA? What are the characteristics of renal lesions treatable by RFA?
What are the imaging characteristics on MRI & CT of a lesion successfully treated with RFA?
How are patients followed after RFA procedures?
What subset of patients is best treated with RFA of renal lesions?
What are complications of RFA?
Uterine Fibroid Embolization
What are typical symptoms of uterine fibroids?
What clinical work-up is required before undergoing uterine fibroid embolization (UFE)?
What imaging is required before UFE?
How is a patient followed after undergoing UFE?
What are the risks associated with UFE?
What are the alternatives to UFE?
How do symptoms typically respond to UFE?
Are there any other indications for UFE other than fibroids?
What type of embolic is typically used?
Is there a correlation between postprocedure pain & clinical outcomes?
What is a typical analgesia protocol for patients undergoing UFE?
What are the indications for discharge from the hospital after UFE?
Describe the vascular anatomy relevant to UFE.
What is the risk of premature menopause related to UFE?
Is pregnancy possible after UFE?
Bibliography
32. Peripheral Vascular Disease
What is the appropriate landmark for a femoral artery puncture?
What is Cope’s law of vascular access?
If the femoral artery cannot be accessed, what are other options for obtaining access for an arteriogram?
If a brachial approach must be used, is the right or left arm used?
What are some complications unique to brachial access?
What is claudication?
What are the risk factors for PAD (Peripheral arterial disease)?
Does the location of leg pain suggest the location of arterial stenosis?
What is Legs For Life?
Why is it important to identify patients with claudication?
What is the Fontaine classification?
What is the Rutherford-Becker classification system?
What are the clinical categories of leg ischemia?
What is the ankle-brachial index (ABI)?
How is the ABI interpreted?
What can cause a falsely elevated ABI?
What is meant by the terms inflow & outflow?
What are the basic steps in performing an angioplasty?
What constitutes a technically successful angioplasty?
What are the complications of angioplasty?
What are the indications for stenting?
What constitutes a hemodynamically significant arterial stenosis?
What is the kissing balloon technique?
What are the basic principles in performing a thrombolysis procedure?
In general, how is a thrombolysis procedure performed?
What is the guidewire traversal test?
List the contraindications to thrombolysis.
What is a PVR examination?
What is Leriche syndrome?
What is an ACT measurement?
How are groin pseudoaneurysms managed?
What are the major pathways of collateral circulation to supply the lower extremities in a patient with known aortic occlusion?
Website
Bibliography
33. Embolization Techniques & Applications
Describe embolotherapy & some of its indications
What materials are most commonly used for embolization?
What is Gelfoam & how is it used?
How does Gelfoam work? When is it used?
What are metallic coils?
When are coils preferred?
What happens when coils are the wrong size?
When are PVA particles used?
When performing an embolization procedure, why is it recommended always to place a vascular sheath at the access site?
What is postembolization syndrome?
How can nontarget embolization be minimized?
When performing an embolization procedure for an upper GI bleed, what information from the endoscopy report is essential?
Can a lower GI bleed be treated with empiric embolization?
In the setting of pelvic trauma or peripartum hemorrhage in a patient with an unstable condition, is superselective embolization always indicated?
Name some clinical indications for angiography in patients with pelvic trauma
Is empiric embolization indicated in pelvic trauma?
In bronchial artery embolization for hemoptysis, vigilance for which vessels is imperative?
Why should coils not be used in the bronchial arteries?
Why is it necessary to embolize both sides of a pseudoaneurysm, aneurysm, or arteriovenous fistula?
What should always be placed when absolute ethanol is being used for renal artery sclerosis?
How is chemoembolization theorized to work?
What happens when the cystic artery is embolized during hepatic lesion embolization/chemoembolization?
What happens if the left or right gastric artery is embolized during hepatic chemoembolization?
What is the significance of gas in the target organ postembolization?
What findings suggest that postembolization gas is due to infection?
When is uterine artery embolization used in a nonemergent setting?
Bibliography
34. Hepatobiliary & Portal Venous Interventions
What are the indications for percutaneous transhepatic biliary drainage?
List the causes of benign & malignant biliary obstruction
What is the most commonly encountered biliary ductal anatomy?
Describe the basic steps required to perform diagnostic percutaneous transhepatic cholangiography
Describe the basic steps required to perform percutaneous transhepatic biliary drainage
What is the difference between an external biliary drainage catheter & an internal/external biliary drainage catheter?
When should an internal/external drain be capped? When should this drain be uncapped?
A patient begins to leak bile around an indwelling biliary drain. Why does this happen? What can be done?
What are the potential complications associated with percutaneous transhepatic biliary drainage?
After an initial drainage procedure, what additional management measures may be performed to treat benign biliary obstruction?
What can be done to manage the treatment of malignant biliary obstruction after initial drainage?
What does the term isolated ducts mean? What is its significance?
How does stricture morphology help differentiate between benign & malignant disease?
If a histologic diagnosis is required, what methods may be used to obtain a biopsy specimen of the bile ducts?
When is percutaneous cholecystostomy indicated?
Name the basic steps involved in performing percutaneous cholecystostomy
What are potential complications associated with percutaneous cholecystostomy?
How long must a percutaneous cholecystostomy catheter remain within the gallbladder before it can be removed?
Should the cholecystostomy catheter be placed to external drainage indefinitely?
When is transjugular liver biopsy indicated & preferred over percutaneous liver biopsy?
How is transjugular liver biopsy performed?
What are the clinical signs & symptoms associated with portal hypertension?
How can one indirectly estimate portal venous pressure to confirm the diagnosis of portal hypertension?
What are the indications for creating a transjugular intrahepatic portosystemic shunt (TIPS)?
What are the contraindications to TIPS creation?
Describe the steps of the TIPS procedure
What are the potential complications of TIPS creation?
What are the short-term & long-term goals of TIPS creation?
Bibliography
35. Genitourinary & Gastrointestinal Interventional Radiology
List the indications for a percutaneous nephrostomy (PCN)
What is the indication for an emergent PCN?
What are important technical factors to consider when performing a PCN?
What is the most common method of visualizing the collecting system for a PCN?
What are alternative means other than fluoroscopy of visualizing the collection system for a PCN?
Should access for a PCN be obtained through the renal parenchyma or directly into the renal pelvis?
From what approach should a PCN be performed?
Aside from decreasing the chance of bleeding, what are the other benefits of performing a PCN through Brödel line?
What imaging modalities can be used to perform a percutaneous drainage of renal or perinephric abscesses?
What are possible complications resulting from percutaneous drainage of renal or perinephric abscesses?
When is percutaneous management of urinary tract calculi preferred over extracorporeal shock wave lithotripsy (ESWL)?
What is the role of PCN in percutaneous treatment of urinary tract calculi?
How are calculi removed during percutaneous treatment of the urinary tract?
What are indications for ureteral stenting?
Describe the difference between a double-J ureteral stent & a nephroureteral stent
How does a ureteral stent work?
What are indications for esophageal stenting?
What technical complications are associated with esophageal stenting?
What factors should be considered when selecting the puncture site for a percutaneous gastrostomy?
What is the difference between a G tube, G-J tube & J tube?
When are feeding G tubes not the tube of choice?
When are small bowel feeding tubes indicated?
Websites
Bibliography
VII - Musculoskeletal Radiology
36. Extremity Plain Films & Trauma
How are fractures evaluated with plain films?
Define the following terms: dislocation, subluxation, closed fracture, open fracture, intra-articular fracture, pathologic fracture & occult fracture.
What is an avulsion fracture?
What is a comminuted fracture?
What is an os acromiale?
Describe types I, II & III acromioclavicular (AC) separation.
What is a “Y” view?
What are the radiographic features of anterior shoulder dislocation on an anteroposterior view?
What are Hill-Sachs fractures & Bankart fractures?
What is pseudosubluxation of the humerus?
What are the “posterior fat pad” sign & the “sail” sign in the elbow?
Describe Monteggia fracture & its associated finding.
Describe Galeazzi fracture & its associated finding.
Name all eight carpal bones.
Which carpal bone gets fractured the most often?
What is the “Terry Thomas” sign?
Define dorsal intercalated segmental instability (DISI) & volar intercalated segmental instability (VISI).
Match the following fractures with the radiographic images in Fig. 36-3:
Which is more common, anterior or posterior dislocation of the hip?
What is a bipartite patella?
What is a Segond fracture & what is its clinical implication?
What is a tibial plafond fracture?
Match the following fractures with their radiographic images in Fig. 36-4:
Bibliography
37. Plain Film Examination of Spinal Trauma
Describe a standard cervical spine radiograph examination
Describe how to interpret a lateral cervical spine film
What is a swimmer’s view?
Describe Jefferson fracture & its mechanism of injury
Describe three different types of odontoid process (also known as dens) fractures
What is os odontoideum?
What is a hangman’s fracture?
What is a flexion teardrop fracture? What is its prognostic significance?
What is a clay shoveler’s fracture?
What is the difference between unilateral & bilateral interfacetal dislocations?
What is the “hamburger” sign?
What is the difference between compression & burst fractures?
What is a Chance fracture?
What is a “Scotty dog”?
What is spondylolysis?
Describe spondylolisthesis & its grading method
Bibliography
38. Nontraumatic Spine Plain Films & Degenerative Disease
Define scoliosis & name the most common cause.
Describe the three subgroups of idiopathic scoliosis.
Although idiopathic scoliosis is the most common type of scoliosis, what other etiologic factors should be considered before making this diagnosis?
What is a limbus vertebra?
What is a butterfly vertebra, hemivertebra & block vertebra?
List important descriptors when reporting scoliosis.
How is the Cobb angle measured?
What is the Risser classification & why is it significant in scoliosis?
List the radiographic signs of degenerative disc disease.
What is a Schmorl node?
What is the best way to image degenerative disc disease?
What are Modic changes of the vertebral end plates?
What terms are used to describe the different types of disc extension beyond the vertebral body margin?
Other than degenerative disc pathology, what other factors commonly contribute to neural foraminal narrowing & central canal stenosis?
What nerve root exits the C3-C4 neural foramen; C7-T1; T3-T4; L3-L4?
What nerve root may be compressed by a right posterior disc protrusion at L3-L4?
What is failed back syndrome? What is the best way to evaluate affected patients?
What is spondylolisthesis? Name the two major causes.
What is the “inverted Napoleon hat” sign?
What is OPLL?
What is DISH?
What are three radiographic criteria for the diagnosis of DISH?
.What is the difference between an osteophyte & a syndesmophyte?
What is Scheuermann disease?
What is the radiographic appearance of Kümmell disease?
Bibliography
39. Osteoporosis
What is osteoporosis? How does it differ from osteomalacia & osteopenia?
What are potential causes for generalized osteoporosis?
What are some causes for regional or localized osteoporosis?
In what demographic groups is generalized osteoporosis most prevalent?
Are conventional radiographs sensitive enough to diagnose osteoporosis?
What radiographic features are useful in diagnosing osteoporosis?
Is computed tomography (CT) more sensitive than conventional radiographs for evaluating bone mineral density (BMD)?
What are other quantitative methods of measuring BMD?
What are the units of measurement of BMD?
What sites of the skeleton are routinely assessed on a DXA scan?
How can large osteophytes & sclerotic changes in a patient with lumbar degenerative disease affect bone densitometry assessment?
What are the World Health Organization criteria for the diagnoses of normal BMD, osteopenia & osteoporosis?
What are t & z scores?
Bibliography
40. Osteoarthritis & Inflammatory Arthritis
What imaging modality is best for diagnosis & follow-up of arthritic diseases?
What is the difference between an inflammatory arthritis & a degenerative arthritis?
Which joints are most often affected in RA?
What portion of the spine does RA most commonly affect?
Can RA affect nonarticular structures?
How do inflammatory arthritides affect cartilage?
What finding, which is common in osteoarthritis, is virtually never seen with RA?
What additional joint findings are seen with RA?
Where are the swan neck & boutonnière deformities located?
When can RA be confused with other arthritides?
What joints are typically affected by osteoarthritis?
Where are Heberden & Bouchard nodes located?
Which joints are rarely involved in primary osteoarthritis?
What are the hallmarks of osteoarthritic change in a joint?
What is erosive osteoarthritis?
Name the seronegative spondyloarthropathies.
What mnemonic can be used to remember the triad of symptoms seen with reactive arthritis (also known as Reiter syndro ...
What are the different presentations of psoriatic arthritis?
What is the “pencil-in-cup” deformity?
Does AS have a specific pattern of joint involvement?
What does the term bamboo spine describe?
What is the radiologic appearance of gout?
What is pseudogout?
What are the differences between pyrophosphate arthropathy & CPPD crystal deposition disease?
Bibliography
41. Osteomyelitis
What are the initial plain film findings in osteomyelitis?
What is meant by periosteal reaction? Does it occur only in osteomyelitis?
How long does it take before the initial skeletal findings of osteomyelitis are seen on a plain film?
Define sequestrum, involucrum, cloaca & sinus tract
What is Brodie abscess?
Name the two imaging modalities that may be used to diagnose acute osteomyelitis if plain films show negative or equivocal results
What is the appearance of acute osteomyelitis on MRI?
Are the MRI findings of osteomyelitis specific?
Diabetic patients are at increased risk of osteomyelitis, in particular in their feet. Is there a best imaging test for evaluation?
List the three classes of radiotracers used predominantly to diagnose osteomyelitis
Name the three phases of a three-phase bone scan & describe the timing of each
How can the diagnosis of osteomyelitis be differentiated from cellulitis on a three-phase bone scan?
List the four main routes through which osteomyelitis (and septic arthritis) may be acquired
Which organism is accountable for most cases of hematogenous osteomyelitis & septic arthritis?
Which disease is associated with an increased incidence of Salmonella osteomyelitis?
How does the vascular anatomy of tubular bones affect the location of infection in infants, children & adults?
What are the plain film findings of chronic sclerosing osteomyelitis?
Is malignancy a potential complication of osteomyelitis?
Describe the plain film & MRI findings in septic arthritis
Name the joints most commonly infected in infants & children, adults & intravenous drug abusers
How is a definitive diagnosis of septic arthritis made in a child?
List the differential diagnoses for unilateral sacroiliac joint disease
Describe the radiographic findings of infectious spondylitis (infection of the spine)
Can infection of the intervertebral disc (discitis) occur without involvement of the adjacent vertebral bodies?
How does infectious spondylitis appear on MRI?
What is the Phemister triad?
What is Pott disease?
What plain film findings suggest an infection of a metallic prosthesis?
What is a ring sequestrum?
Bibliography
42. Bone Tumors
What radiographic features should be considered when evaluating a suspected bone tumor?
How do cartilage tumor matrix & neoplastic bone matrix differ?
Which imaging study is most useful in arriving at an accurate differential diagnosis for a bone tumor?
What is the role of magnetic resonance imaging (MRI) & computed tomography (CT) in the evaluation of musculoskeletal tumors?
What are some tumor features evaluated with MRI? Can MRI be used to distinguish between benign & malignant tumors?
What is the role of intravenous gadolinium contrast enhancement in MRI of musculoskeletal tumors?
What is the staging system adopted by the Musculoskeletal Tumor Society & what three features form the basis of this staging system?
Which primary bone tumors tend to involve the epiphysis most commonly?
What is the difference between a nonossifying fibroma & a fibrous cortical defect?
What is the most common malignant tumor involving the skeleton?
What is the most common primary malignant bone tumor in adults?
If the diagnosis of multiple myeloma is suspected, what radiographic evaluation should be performed?
What are the most common primary neoplasms that metastasize to bone?
Which tumors can give rise to lytic, expansile, “blown-out” metastases of bone?
What is the second most common primary bone tumor after multiple myeloma?
Which type of tumor can manifest with bone pain, swelling, tenderness, fever & increased sedimentation rate, mimicking an infection?
Where do sarcomas most commonly metastasize?
What is the most common benign skeletal neoplasm?
Which clinical & radiographic features suggest malignant degeneration of an osteochondroma?
What is the most common benign bone tumor of the hand? Where else may these lesions occur & what are the features of malignanttransformation?
Which primary bone tumor has the characteristic history of pain at night that is relieved by aspirin?
What is fibrous dysplasia?
Which of the following has an increased incidence of skeletal malignancy: high-dose radiation therapy, bone infarction, Paget disease, or chronic osteomyelitis?
What is a bone island?
What is the most common location for a skeletal hemangioma?
Bibliography
43. Shoulder MRI
What magnetic resonance imaging (MRI) planes are used for evaluating the shoulder?
Name the four muscles of the rotator cuff
What is impingement syndrome?
In what age group do rotator cuff tears most commonly occur?
What is the typical MRI appearance of a rotator cuff tear?
Which tendon of the rotator cuff is most commonly torn?
What MRI features indicate that a rotator cuff tear is chronic?
What are Hill-Sachs & Bankart deformities?
What other shoulder abnormalities can be diagnosed on routine shoulder MRI?
What is a SLAP lesion?
Which is better for the detection of calcific tendinitis, radiographs or MRI?
What is meant by glenohumeral instability?
Bibliography
44. MRI of the Elbow & Wrist
Name the bones & articulations of the elbow
Name the muscles that cross or surround the elbow joint
Name the labeled structures on the MR images in
Describe the anatomy of the medial & lateral collateral ligament complexes
What pattern of injury is seen with a valgus injury? Whom does it most commonly affect?
What is the LUCL? Explain its significance in instability of the elbow joint
What are golfer’s elbow & tennis elbow? Which is more common?
What muscle groups do medial & lateral epicondylitis involve?
What causes the anterior & posterior fat pad signs in conventional radiographs? What is the significance of these signs?
What role does MRI play in the evaluation of patients with anterior & posterior fat pad signs?
Which patients most commonly present with biceps tendon rupture? Describe the MRI appearance of complete rupture
What are the boundaries & contents of the cubital tunnel?
The presence of which anomalous muscle is a rare cause of symptoms related to the cubital tunnel?
What is Panner disease?
Where does the pseudodefect of the capitellum occur compared with osteochondritis dissecans in the capitellum?
What is the differential diagnosis for olecranon bursitis? Describe its appearance on MRI
Name the labeled structures in
What is the role of MRI in evaluation of scaphoid fractures?
What is the appearance of AVN of the proximal pole?
Define negative, neutral & positive variance. Which of these is related to Kienböck malacia?
Name the contents of the carpal tunnel. What are classic signs & symptoms of carpal tunnel syndrome (CTS)?
Describe the MRI appearance of CTS
What is the role of MRI in CTS?
What are the two most common causes of recurrent symptoms in patients who have had surgical release of the carpal tunnel?
What are the boundaries & contents of Guyon canal?
What situations can cause neuropathy related to Guyon canal?
What is de Quervain tenosynovitis? Describe its MRI appearance
What ligament is injured in gamekeeper’s thumb or skier’s thumb?
What is a Stener lesion? Describe its significance
What is the most commonly injured intrinsic ligament of the wrist? With what form of instability is this injury associated?
Describe typical patients who experience traumatic versus degenerative tears of the triangular fibrocartilage
What mass in the wrist has been called the “King James lesion”? Where does it most commonly occur?
Bibliography
45. MRI of the Hip
What is the first radiologic examination for the evaluation of hip pain?
When should magnetic resonance imaging (MRI) of the hip be performed?
Which modality is best for the evaluation of suspected osteoarthritis (degenerative changes) of the hip?
Does an MRI examination of the hip usually include one or both hips?
Is intravenous contrast agent helpful for an MRI evaluation of the hip?
What is avascular necrosis of the hip?
What is the natural history of osteonecrosis? Why is the articular location so critical?
What is the blood supply to the femoral head?
Is osteonecrosis a unilateral or bilateral process?
Which is more common, unilateral or bilateral osteonecrosis?
What is an idiopathic cause of osteonecrosis in children?
How is MRI useful in the treatment of osteonecrosis?
What are the MRI characteristics of osteonecrosis?
What are radiographically occult hip fractures?
Why is MRI a useful modality for the detection of radiographically occult hip fractures?
What are the MRI signal characteristics of an acute fracture?
There is clinical suspicion of an occult fracture related to trauma, but plain radiography displays normal results & MRI reveals only diffuse edema without any sign of a dark fracture line. Does this scenario exclude a fracture?
How many types of stress fractures are there?
In the hip, where do stress fractures usually occur?
How are stress fractures of the hip usually treated?
When a stress fracture or other occult fracture of the hip is diagnosed, which modality is best for follow-up?
Which individuals are prone to fatigue stress fracture?
Who is most prone to insufficiency stress fracture?
Does diffuse marrow edema without a fracture line always indicate a bone contusion or microfracture?
What is transient osteoporosis of the hip?
46. MRI of the Knee
What sequences should be included in a standard magnetic resonance imaging (MRI) knee protocol?
What structures in the knee are best evaluated in each plane?
Identify the following labeled normal structures of the knee on
What is a Baker (popliteal) cyst, where is it located & what is its significance?
What tendons compose the pes anserinus?
Describe the clinical presentation of meniscal injury. Which portions of the menisci are more likely to be involved in injury?
What is the appearance of a normal meniscus & a torn meniscus on MRI?
What are the criteria for diagnosis of meniscal tear on MRI?
What common meniscal variant is associated with tears of the lateral meniscus & what is the appearance on MRI?
How can traumatic meniscal tears be differentiated from degenerative meniscal tears?
What is a bucket-handle tear? Describe the findings on MRI.
What are the sensitivity & specificity of MRI in the detection of meniscal tears?
What are meniscal cysts & what is their significance?
What are the points of attachment for the cruciate ligaments?
Which is more commonly injured, ACL or PCL?
What is the MRI appearance of a torn ACL?
What are the sensitivity & specificity of MRI for the detection of complete ACL & PCL tears?
What are the components of the medial collateral ligament & lateral collateral ligament complex?
What structures are important stabilizers at the posterolateral corner of the knee & why are they important?
What is O’Donoghue’s “unhappy triad”?
What is the grading system for medial collateral ligament injury?
List the signs of lateral patellar dislocation.
What is jumper’s knee?
What is meant by the term osteochondral lesion?
What is OCD?
Why is OCD graded?
How is OCD graded?
Describe the MRI appearances of subchondral insufficiency fracture of the knee.
Bibliography
47. MRI of the Foot & Ankle
What are the four compartments around the ankle & what do they contain?
What is the most commonly injured ankle tendon?
Describe the magnetic resonance imaging (MRI) appearance of Achilles tendon tears
Which of the flexor or medial tendons is most commonly torn?
Name the three ligaments that form the lateral collateral ligament
Which of these three ligaments tends to tear first?
Which bones form the hindfoot, midfoot & forefoot?
What are the articulations of the subtalar joint?
Describe the tarsal canal & the sinus tarsi
Which ligament around the ankle is least likely to tear?
What are the three plantar compartments & why are they important?
What is tarsal coalition?
What are common sites for stress fractures of the foot?
Which part of the dome of the talus is typically injured in repetitive trauma? What part of the talar dome is typically involved if there is a single bad traumatic event?
MRI & magnetic resonance arthrography of the ankle may be useful in evaluating the different types of osteochondral injuries. How are osteochondral injuries classified?
Describe characteristics used to differentiate between osteomyelitis & neuropathic arthropathy?
What MRI findings are related to plantar fasciitis?
What is plantar fibromatosis?
What are Morton neuromas?
What characterizes the tarsal tunnel?
What is tarsal tunnel syndrome?
What is sinus tarsi syndrome & what does it look like on MRI?
Of the bones of the foot & ankle, which is the most likely to develop avascular necrosis? What is the typical cause of this?
Bibliography
VIII - Neuroradiology
48. Brain: Anatomy, Trauma & Tumors
Identify the parts of the brain labeled 1 through 6 in
What are the two primary imaging modalities used to image the brain?
What are the clinical indications for obtaining CT & MRI of the brain?
What are contraindications for performing MRI of the brain?
Define the terms intra-axial & extra-axial, which are commonly used to localize intracranial pathologic conditions
What is nephrogenic systemic fibrosis (NSF) & who is at risk for developing this complication?
Is gadodiamide the only MRI contrast agent available?
What is the imaging modality of choice for imaging acute head trauma?
How does one differentiate a subdural hematoma from an epidural hematoma?
What is the CT appearance of traumatic SAH?
What is the Glasgow Coma Scale? How is it used?
What are the advantages & drawbacks of MRI in assessing a trauma patient?
Define penetrating injury to the brain & identify common causes
What are the five patterns of brain herniation & herniation syndromes?
What is the imaging manifestation of a brain contusion?
What are the imaging manifestations of diffuse axonal injury?
Primary brain tumors in adults usually arise from what cell line?
What is the most common benign extra-axial tumor in adults?
What are the most common neoplasms arising in the corpus callosum?
What are the most common systemic neoplasms to metastasize to the brain?
What are the most common primary brain tumors that calcify?
What is the imaging appearance of leptomeningeal carcinomatosis or subarachnoid seeding? What are the most common tumors producing it in adults?
What are the most common tumors producing subarachnoid seeding in adults?
Why would a mass appear hyperdense on unenhanced CT scan of the head?
What is the most common tumor in the cerebellopontine angle cistern?
What is the most common clinical presentation of a vestibular schwannoma?
Define transtentorial herniation
What is the most common posterior fossa/infratentorial mass in adults?
What are the three parts of the anterior lobe of the pituitary gland?
Name newer imaging techniques that help diagnose brain tumors
Pineal region masses are associated with what visual disturbance?
Bibliography
49. Brain: Inflammatory, Infectious,and Vascular DiseaseS
How is multiple sclerosis (MS) diagnosed?
What is the differential diagnosis of MS based on imaging findings?
What are the causes of intracranial abscesses?
What is the imaging differential diagnosis of a ring-enhancing lesion in the brain?
What advanced MRI techniques may be useful in distinguishing brain abscess from neoplasm?
What anatomic location in the brain is preferentially involved by herpes simplex encephalitis?
What is the differential diagnosis of an intracranial mass in a patient with human immunodeficiency virus (HIV) infection?
What is a stroke?
What are the common causes of stroke that one must consider in children & young adults?
What are the imaging manifestations of ischemic stroke in the acute stage?
How can one differentiate acute from chronic stroke on imaging?
What are watershed infarctions?
What are lacunar infarctions?
What are the risk factors for venous sinus thrombosis & venous infarction?
What is the most common cause of nontraumatic subarachnoid hemorrhage (SAH)?
What is the work-up of a patient presenting with SAH?
If multiple aneurysms are seen on catheter angiography in a patient with SAH, which one most likely bled?
What are common locations for hypertensive intraparenchymal hemorrhages?
What is amyloid angiopathy?
Review the MRI signal characteristics of intracranial hemorrhage.
What are the imaging features of cerebral hypoxia/anoxia?
Bibliography
50. Advanced Imaging of the Spine
Identify parts of the spine labeled in
What imaging modalities are most often used in the evaluation of spine pathology?
Describe the strengths, weaknesses & most appropriate uses of CT in spinal imaging
Describe the strengths & drawbacks of MRI
In patients with contraindications to MRI, what radiologic study can be used to assess the contents within the spinal canal?
What is discography & when is it used?
What is the primary role of catheter angiography of the spine?
What is spinal dysraphia?
Differentiate open & occult forms of spinal dysraphia
What are the clinical findings & imaging features of a tethered spinal cord?
List & describe caudal spinal anomalies
What are the split notochord syndromes?
What is the most common disorder of the spine affecting adults?
Discuss the MRI findings of degenerative disease affecting the spine
What are the most common lumbar & cervical spine levels to be affected by degenerative disease?
What is the natural history of most disc extensions beyond the vertebral body end plate?
Define Baastrup disease
How can residual & recurrent disc abnormalities be differentiated from scar tissue?
What is arachnoiditis?
Review the epidemiologic factors of spinal trauma
What are the appropriate indications for obtaining imaging of the spine in the setting of blunt trauma?
Name the most common mechanisms of cervical spine injury
Describe the most common fractures associated with each of the mechanisms of injury in
What is the role of MRI in spinal trauma?
What additional structures may be injured in association with cervical spinal trauma that may not be detected on radiographs or CT scans?
Name the most common sites of infection in the spine
What patient populations are particularly prone to the development of infectious spondylodiscitis?
What is the most common infectious agent responsible for spondylodiscitis?
What is the typical clinical presentation of discitis?
What are the typical imaging findings of spondylodiscitis on plain film radiographs & CT?
Describe the imaging appearance of spondylodiscitis caused by atypical organisms, such as tuberculosis
List noninfectious disorders that can have imaging findings similar to infectious spondylodiscitis
What is the most common inflammatory disorder that affects the spinal cord?
What are the classic imaging findings of multiple sclerosis that affect the spinal cord?
What is the typical MRI appearance of sarcoidosis? How can its appearance, combined with the clinical history, distinguish it from other inflammatory disorders?
What is the typical time course for the development of radiation myelitis after irradiation for treatment of tumor?
What portion of the spinal cord is typically involved with syphilis?
Name the two most common vascular disorders of the spinal cord
What is the arterial vascular supply to the spinal cord?
What are the typical clinical characteristics & imaging findings of spinal cord infarcts?
List the four types of spinal vascular malformations & describe their clinical & imaging characteristics
How are spinal tumors classified anatomically?
What is the most common epidural spinal tumor in adults?
What is the most common benign osseous lesion involving the spine?
What is the differential diagnosis for an intradural-extramedullary tumor?
What neoplasms are associated with leptomeningeal seeding of tumor?
List the most common intramedullary spinal tumors
Describe the distinguishing clinical & imaging features of intramedullary spinal tumors
Bibliography
51. Head & Neck: Part I
The hyoid bone divides the neck into two distinct regions. Name them.
What imaging modalities are used to evaluate lesions in the two regions of the neck?
What are the three subdivisions of the pharynx?
What are the boundaries of the nasopharynx?
What structures are part of the oropharynx?
What structures are part of the hypopharynx?
What structures are part of the oral cavity?
Name the three anatomic subsites of the larynx.
What are the boundaries of the supraglottis?
What structures compose the glottis?
Where is the subglottis located?
Name & identify the extramucosal spaces of the head & neck in.
Describe how displacement of the fat in the PPS helps to localize lesions or masses to their correct anatomic subsite in the extramucosal compartment.
Displacement of the longus colli/longus capitis prevertebral muscle complex helps differentiate masses in what two extramucosal spaces?
Displacement of the cervical internal carotid artery helps differentiate masses in what two extramucosal spaces?
What are the imaging criteria for diagnosis of a pathologic lymph node?
What is the best cross-sectional imaging study to identify pathologic nodes?
What is the most common cause of a calcified cervical lymph node?
What is the most common cause of a cystic mass in the lateral neck of an adult?
What are the most common causes of cervical lymph node metastases in an adult?
In patients with head & neck cancer, how does the presence of metastatic adenopathy affect prognosis?
What is the role of the radiologist in the evaluation & staging of head & neck cancer?
Describe the most common neck masses in a child.
Bibliography
52. Head & Neck: Part II
Paranasal Sinuses
Through what structure do the maxillary, frontal & anterior ethmoid air cells drain?
In which paranasal sinus does malignancy most commonly arise?
On an unenhanced CT scan, what are common causes of hyperdense tissue within the paranasal sinuses?
What classic radiologic finding supports the diagnosis of acute sinusitis in the appropriate clinical setting?
Name the three major salivary glands & the ducts that drain them
What salivary gland has the highest incidence of calculi/stones & why?
Which salivary gland contains lymphoid tissue? What is the significance of this tissue?
What is the most common benign tumor of the salivary glands?
What are the most common malignancies of the salivary glands?
How is the size of the salivary gland related to the likelihood of a mass in the gland being malignant?
What imaging features distinguish a benign thyroid mass from a malignant thyroid mass?
What is the most common cause of proptosis in an adult?
Which metastatic lesion to the orbit is classically associated with enophthalmos?
What is the most common primary ocular malignancy in a child & in an adult?
What key clinical & imaging features distinguish an optic nerve glioma from an optic nerve meningioma?
Hearing loss is classified into what two major subtypes?
How is tinnitus clinically subcategorized?
Cholesteatoma is commonly noted to be a “pearly white” mass seen in the middle ear on otoscopic examination. What is a cholesteatoma?
What neoplasms occur in the jugular foramen?
Unilateral middle air fluid in an adult should trigger the search for what lesion?
Bibliography
IX - Nuclear Radiology
53. Positron Emission Tomography
What instructions do patients need to prepare for positron emission tomography (PET) scan with fluorodeoxyglucose (FDG)?
Is bowel activity normal on the FDG PET scan in
What structures in the head & neck normally take up FDG? Is the neck uptake normal in
Is the lung nodule in the right upper lobe benign or malignant in
Is the patient in Fig. 53-3 a good surgical candidate?
How can FDG PET change the management of patients with lung cancer?
What are potential confounding diseases that can mimic lung cancer?
How is dual time point imaging used?
How important prognostically is FDG PET scan with negative results after treatment for lymphoma?
What are the current indications for FDG PET in patients with lymphoma?
How useful is PET in the evaluation of colon cancer?
How does correlation with anatomic imaging help in detecting cancer accurately?
How does PET help with patient planning for radiation therapy?
Is FDG PET useful for evaluating peritoneal seeding?
How useful is FDG PET in the evaluation of osteomyelitis?
How is PET used in the interictal evaluation of patients with seizure disorders?
What are the most common areas for seizure foci & what are the implications for finding multiple abnormal areas?
How useful is FDG PET for the evaluation of primary brain tumors or new metastatic disease?
What are the sensitivity & specificity for differentiating tumor recurrence from radiation necrosis in patients with brain cancer?
What are the characteristic features of Alzheimer disease on FDG PET in
What is the typical metabolic pattern in the PET study of a patient with depression
How is cardiac PET used clinically?
Bibliography
54. Bone Scans
What should a patient know about a bone scan?
What are the normal structures observed on a bone scan? Describe the typical nonmalignant findings in asymptomatic patients.
Why is a “superscan” associated with a negative prognosis in the patient with prostate cancer shown in Fig. 54-2?
Is there a way to treat successfully a patient with bone pain associated with multiple osteoblastic metastases?
Fig. 54-3 shows a scan of a patient complaining of swelling & pain in the distal arm after a recent traumatic event. What is the diagnosis?
What causes a bone scan that does not show the bones clearly?
Is a bone scan an appropriate study for a 65-year-old patient with multiple myeloma?
Does a bone scan that shows a worsened condition after chemotherapy portend a bad prognosis?
What are the most common findings on a bone scan that suggest metastatic disease?
What are the causes of “cold,” or photopenic, defects on bone scans?
Are three-phase bone scans alone useful for the diagnosis of osteomyelitis?
What other scans can be used to improve diagnostic accuracy?
Is lung uptake normal on a bone scan?
Can Paget disease be distinguished from cancer in the bones?
What is the “Mickey Mouse” sign?
Intense activity on a bone scan in multiple joints can be the result of which disorders?
Can shin splints be differentiated from stress fractures on a bone scan?
Is a prostate-specific antigen (PSA) level relevant to bone scan findings in patients with prostate cancer?
What is the significance of a single rib lesion in a patient being evaluated for metastatic disease from a known primary cancer?
Which benign bone tumors have increased uptake on a bone scan?
Do bone scans have a role in the evaluation of child abuse?
Are planar bone scans sufficient for the evaluation of spondylolysis?
Is increased uptake in the kidneys a clinically relevant finding on a bone scan?
What are the causes of liver uptake on a bone scan?
What can cause uptake in the muscles on the scan in Fig. 54-7?
Bibliography
55. Ventilation-Perfusion V /Q Scans
How would you prepare a patient for a ventilation-perfusion V˙/Q˙ scan?
In what order should radiographic studies be obtained in the work-up of a patient with acute shortness of breath?
How do aerosols compare with xenon (Xe)-133 for ventilation scans?
What are normal findings on V˙/Q˙ scan?
What findings are necessary to classify V˙/Q˙ scan as “high probability” for PE?
What are the causes of gas trapping on V˙/Q˙ scan?
How does a quantitative V˙/Q˙ scan assist in preparing patients for lung surgery?
What is the significance of a “triple match” on V /Q scan & chest x-ray?
What can cause liver & splenic uptake on Xe-133 ventilation scan?
If the clinical suspicion for PE is high & V /Q scan result is low probability, what is the patient’s actual probability for having PE?
Name the causes of mismatched perfusion defects on V˙/Q˙ scan
How can V˙/Q˙ scans be used in the evaluation of chronic PE?
Why is a1-antitrypsin deficiency the most likely cause of the perfusion scan findings in Fig. 55-4?
Can idiopathic pulmonary fibrosis (IPF) be easily distinguished from PE?
Does the severe airway disease depicted in Fig. 55-6 prevent adequate interpretation of V˙/Q˙ scans?
Could the V˙/Q˙ scan in Fig. 55-7 result from a lung tumor?
Can V˙/Q˙ scans be performed in pregnant women?
What does activity in the brain or kidneys imply on V˙/Q˙ scan?
How quickly do perfusion defects associated with PE resolve?
How are V˙/Q˙ scans used in patients who have had lung transplants?
What is a “stripe” sign & what does it signify on V /Q scan?
What are the causes of matched ventilation & perfusion defects?
What are possible causes of unilateral decreases in lung perfusion with relatively preserved ventilation as shown in?
Bibliography
56. Thyroid Scintigraphy
What patient preparation is required before thyroid scanning?
Which isotopes can be used for imaging the thyroid & how do they compare physiologically?
What are normal thyroid scan & iodine uptake results?
Can a patient with normal I-123 uptake still have Graves disease?
What are possible outcomes after I-131 therapy for Graves disease?
How is a patient with a hot nodule treated for hyperthyroidism?
Why is a patient with a hot nodule more likely to end up euthyroid?
What are the typical radiation safety precautions that patients must follow after I-131 therapy?
When should a patient with multinodular goiter be treated with I-131?
What factors affect the likelihood that a cold nodule represents thyroid cancer?
Why can I-131 be used to treat thyroid cancer if the original nodule is cold?
What foods should be avoided as part of a low-iodine diet?
What is the general management plan for patients diagnosed with thyroid cancer?
What does “stunning” mean with regard to I-131 scanning?
What range of doses of I-131 is typically recommended for therapy for thyroid cancer in patients with the scans in?
How does a recombinant human thyrotropin alfa (Thyrogen) scan work?
What are possible causes of a thyroid scan in which there is no uptake or minimal uptake by the thyroid?
How is fluorodeoxyglucose positron emission tomography (FDG PET) useful in the management of thyroid cancer?
Bibliography
57. Gastrointestinal & Genitourinary Scintigraphy
What should patients know about a renal scan & what preparation should they be given?
What are the normal findings in a renal scan?
What are causes of focal areas of decreased flow within a kidney?
An increase in size of one or both kidneys may be associated with what processes?
List the causes of a unilateral small kidney on the renal scan
Describe potential causes of nonvisualization of a kidney
How do processes that decrease the activity in both kidneys differ from processes that affect a single kidney?
How is a captopril renal scan used to evaluate for renal artery stenosis?
Why are renal scans obtained 1 day after transplant?
How is ATN differentiated from rejection in transplant patients?
What type of renal scan is used to evaluate for cortical scarring related to pyelonephritis or vesicoureteral reflux? How does it work?
What are the current uses of a liver/spleen scan?
What conditions result in a hot quadrate lobe & a hot caudate lobe on a liver/spleen scan?
What is the diagnostic pattern of activity on a red blood cell (RBC) scan in a patient with a hemangioma in the liver?
What is the best test for the detection of splenic tissue?
What functions of the hepatobiliary system can be evaluated using iminodiacetic acid tracers?
When should cholecystokinin (CCK) or morphine sulfate be used in relation to a hepatobiliary scan?
What can a gallbladder ejection fraction study show?
What are the causes of nonvisualization of the gallbladder on a hepatobiliary scan?
Discuss the causes of a false-negative scan (i.e., visualization of the gallbladder in the presence of acute cholecystitis)
What is the “rim” sign & what does it imply?
When a biliary leak occurs, where are the possible sites to observe the leak?
How is biliary atresia differentiated from neonatal hepatitis on a hepatobiliary scan?
What are the typical findings of a positive gastrointestinal (GI) bleed?
Contrast the differences between the sulfur colloid scan & the tagged RBC scan for detecting GI bleeding
How does a gastric emptying study work?
What are the normal rates for gastric emptying?
What physiologic factors normally affect gastric emptying?
Bibliography
58. Nuclear Cardiology
How do you prepare a patient for a nuclear medicine stress test?
What are the different types of radiopharmaceutical agents available for stress testing?
What are the three types of stress tests?
What are contraindications for an exercise stress test?
What are the contraindications for pharmacologic stress tests?
Should patients taking medications that can affect the heart be given stress tests?
List the conditions under which an exercise stress test should be stopped.
Which territories are supplied by which coronary arteries?
What is the implication of a “fixed” defect?
What methods are available to correct for attenuation artifact?
How do stress imaging studies compare with routine stress ECG studies in the evaluation of coronary artery disease (CAD)?
What is the implication of a reversible defect?
Why is transient left ventricular cavity dilation a poor prognostic sign?
How might a left bundle-branch block (LBBB) on ECG affect imaging findings?
How is a thallium resting-redistribution scan performed & how are the results of a resting-redistribution scan used clinically?
What is the difference between hibernating & stunned myocardium?
How is a multiple-gated acquisition (MUGA) scan performed?
How is MUGA scan used clinically?
How does FDG PET scan of the heart as shown in Fig. 58-6 help evaluate myocardial viability?
Bibliography
X - Pediatric Radiology
59. Pediatric Thoracic Radiology
What is the embryologic relationship between the lungs & the gastrointestinal tract?
Describe the histologic stages of lung development.
What is surfactant & why is it important?
Describe the pertinent findings on a normal neonatal chest radiograph.
What is neonatal respiratory distress syndrome (RDS)?
How does RDS appear radiographically?
How is RDS treated? What are the potential consequences?
In addition to RDS, what are other neonatal diffuse lung diseases?
How might other neonatal diffuse lung diseases be differentiated clinically?
What is the mechanism behind meconium aspiration & how does it appear radiographically?
What is TTN?
How does TTN appear on a chest radiograph?
Name the major causes of CHF in a newborn.
What is the role of the radiologist in assessing suspected congenital heart disease (CHD)?
What are the most common acyanotic CHDs?
How does assessment of pulmonary blood flow aid in the diagnoses of cyanotic CHD?
Which CHDs appear with cyanosis & increased pulmonary blood flow?
What is the importance of a right-sided aortic arch?
What are the major surgical diseases of the neonatal chest?
What is the most common cause of a neonatal pleural effusion?
Describe the two main types of vascular rings.
How does a pulmonary sling cause symptoms?
How do heterotaxia syndromes manifest in the lungs?
Describe how chlamydial pneumonia manifests clinically & radiographically.
What are the pulmonary & extrapulmonary manifestations of cystic fibrosis?
What are the findings of primary tuberculosis of the lungs in a pediatric patient?
Whom does acute chest syndrome affect?
What is lymphocytic interstitial pneumonia?
How should a suspected aspirated foreign body be evaluated?
What is Swyer-James syndrome?
What are important structures to identify on a lateral view of the neck?
Bibliography
60. Pediatric Gastrointestinal Radiology
What are the most common causes of small bowel obstruction in a child?
What is intussusception?
What causes intussusception?
Describe the clinical signs of intussusception
How is intussusception diagnosed radiologically?
How is an intussusception treated?
How can one tell that an intussusception has been successfully reduced?
Describe the “double bubble” sign & name the conditions in which it is found
. What is malrotation of the intestines?
. What are Ladd bands?
How does a midgut volvulus occur & why is this an emergency?
Does a patient with malrotation always present with clinical symptoms
What is the clinical presentation of malrotation?
Which study is the gold standard for diagnosing malrotation?
List other anomalies that are associated with malrotation
Describe the clinical presentation of pyloric stenosis
If the “olive” cannot be palpated, how can pyloric stenosis be diagnosed with radiologic studies?
What is Meckel diverticulum?
How is Meckel diverticulum diagnosed?
What are the most common causes of GI bleeding in children?
What causes necrotizing enterocolitis (NEC)?
Who develops NEC?
What findings of NEC can be seen on plain x-ray film & what is the role of the radiologist?
What are other causes of pneumoperitoneum in infants & children?
What is Hirschsprung disease?
What are the plain x-ray film findings of Hirschsprung disease?
Is Hirschsprung disease diagnosed definitively by imaging?
Name the types of tracheoesophageal fistulas (TEF). How common is each type?
What are the plain film findings in TEF?
How can a plain film help to differentiate a coin in the esophagus from a coin in the trachea?
Bibliography
61. Pediatric Uroradiology
What is the role of the radiologist in pediatric urinary tract infections (UTI)?
What conditions can be detected radiologically that impair normal urinary flow?
Which imaging tests should be used to diagnose these conditions?
Why is renal & bladder US used?
When should renal & bladder US be performed?
How is VCUG performed?
How is VCUG modified in infants?
When should VCUG be performed?
What are the pros & cons of a radionuclide cystogram compared with fluoroscopic VCUG?
What is primary VUR?
What is secondary VUR?
How is primary reflux graded?
What is dysfunctional voiding?
What diagnostic tests are useful for the detection of acute & chronic pyelonephritis in children?
What are the findings on a renal nuclear scan in acute & chronic infection?
What are the CT findings associated with pyelonephritis?
How useful is renal US in the work-up of suspected pyelonephritis?
List the most common forms of congenital hydronephrosis.
When should a postnatal renal & bladder US examination be obtained in a patient with congenital hydronephrosis?
What are the roles of nuclear medicine, VCUG, intravenous urography & magnetic resonance imaging (MRI) in congenital hydronephrosis?
What are posterior urethral valves?
How are posterior urethral valves detected?
What is primary megaureter?
What are common forms of a duplex kidney?
What is the Weigert-Meyer rule?
Are the collecting systems & ureters dilated in a duplicated system?
What is the most common cause of a scrotal mass?
What are the main differential considerations of a painful scrotum?
If epididymitis is present in an infant, what should be suspected as the etiologic factor?
What is the most common testicular tumor in children?
What are the most common testicular tumors in adolescents?
What urinary problems occur in children with spina bifida?
Name the specific problems in spina bifida that are related to neurogenic bladder.
Discuss the goals of therapy for urinary tract dysfunction in a patient with spina bifida.
What is the triad of prune-belly syndrome?
What urinary tract abnormalities are associated with prune-belly syndrome?
What is a basic classification for cystic kidney diseases affecting infants, children & adolescents?
What is the most common US appearance of MCDK?
List the other forms of nongenetic cystic renal disease.
Name the genetic forms of cystic renal disease.
Does “adult-type” ADPCKD occur in infants & young children?
What imaging findings may help distinguish ADPCKD from ARPCKD in an infant or young child
Name five hereditary syndromes associated with renal cysts.
What conditions cause echogenic renal pyramids in infants?
What is the most common solid renal mass in infants?
What is the role of imaging in infants with ambiguous genitalia?
What is nephroblastomatosis?
What are the two major types of nephroblastomatosis?
How can nephroblastomatosis be distinguished from Wilms tumor?
What is Mayer-Rokitansky-Küster-Hauser syndrome?
How is pelvic US used in the evaluation of a child with precocious puberty?
Bibliography
62. Pediatric Neuroradiology
How does myelinated brain differ from nonmyelinated brain on an infant magnetic resonance imaging (MRI) examination? Where do you expect to see myelinization occur first?
What are migrational anomalies of the central nervous system (CNS)?
Name the three kinds of holoprosencephaly
What is the differential diagnosis for what appears to be massively dilated ventricles on a prenatal ultrasound (US) examination?
Describe the classification of germinal matrix hemorrhage
How does the premature brain respond to ischemic injury?
Describe the three main types of Chiari malformation
How does the corpus callosum develop & why is this important?
What entity does not follow the normal rule of corpus callosum development?
What are TORCH infections?
How do TORCH infections appear radiographically?
Discuss the CNS manifestations of neurofibromatosis type 1 (NF1)
How is neurofibromatosis type 2 (NF2) different from NF1?
What is tuberous sclerosis?
Describe the manifestations of Sturge-Weber syndrome
What are the most common brain tumors in infants?
Name the major posterior fossa tumors in children
Describe the typical tumors that occur in the suprasellar region of a child
Why is thickening of the pituitary stalk an important finding?
What is the differential diagnosis for a pediatric cystic neck mass?
What is the differential diagnosis for leukocoria?
What is meant by trilateral retinoblastoma?
What is fibromatosis colli? Describe its imaging characteristics
Where do cholesteatomas typically arise & what is the role of the radiologist in their evaluation?
What is the role of the radiologist in the evaluation of sacrococcygeal teratoma?
Bibliography
63. Pediatric Musculoskeletal Radiology
How does growing bone respond to trauma & how is this different from mature bone?
What is the significance of fractures of the physis?
How are fractures of the physis classified?
What are secondary ossification centers?
Why are secondary ossification centers particularly important to understand in the setting of elbow trauma?
How may subtle supracondylar fractures of the elbow be diagnosed?
Describe nursemaid’s elbow
List risk factors for developmental dysplasia of the hip (DDH)
When is DDH suspected clinically?
Name the potential complications of untreated DDH
How is DDH diagnosed radiographically?
How is DDH diagnosed on ultrasound (US)?
What is Legg-Calvé-Perthes disease?
Describe slipped capital femoral epiphysis (SCFE)
How is SCFE treated?
What are coxa vara & coxa valga?
Describe Blount disease
What is Osgood-Schlatter disease?
What is the difference between a triplane fracture & a juvenile Tillaux fracture of the ankle?
What is Freiberg infraction?
What are craniosynostoses?
Give the differential diagnosis for vertebra plana
When & where do pediatric primary tumors of bone occur?
How should a suspected osteoid osteoma be evaluated?
What is rickets?
How does rickets appear radiographically?
Describe the bony changes of sickle cell anemia
What is the most common type of dwarfism & what are its manifestations?
What is the differential diagnosis for dense metaphyseal bands? How does one know when they are abnormally dense?
Bibliography
64. Imaging of Child Abuse
What are key history & physical examination findings that may raise suspicionof the possibility of nonaccidental trauma (NAT)?
What diagnostic algorithm might the clinician & radiologist apply if skeletal injury from child abuse is suspected?
Describe shaken infant syndrome
What are metaphyseal corner fractures?
Name other pediatric fractures with high specificity for child abuse
What fractures have low specificity for child abuse?
What features of skull fractures increase the likelihood of NAT?
What features of a fracture are useful in estimating its age?
Summarize common findings of head trauma in shaken infant syndrome
What is the most common cause of death in a patient who has sustained NAT?
How should imaging of the brain be applied in the setting of suspected abuse?
How is the age of intracranial blood determined on MRI examinations?
Describe possible bowel findings in cases of abuse
What is the most common cause of pediatric pancreatitis?
Describe radiologic manifestations of pediatric pancreatitis
Are multiple bruises & skeletal injuries always diagnostic of child abuse?
How does congenital syphilis mimic child abuse?
What is the differential diagnosis of periosteal reaction in a newborn?
When does physiologic periosteal new bone formation occur?
Can a metaphyseal corner fracture look like a metaphyseal lucent band?
What is the legal responsibility of any U.S. physician who suspects child abuse?
Bibliography
XI - Thoracic Radiology
65. Solitary & Multiple Pulmonary Nodules
What is a solitary pulmonary nodule (SPN)?
List some causes of pulmonary nodules
What is the general approach to the evaluation of SPN?
What further diagnostic steps may be implemented in the work-up of indeterminate pulmonary nodules?
What are some potential blind spots on chest radiography & CT when trying to detect pulmonary nodules?
List some morphologic imaging features of nodules assessed on chest radiography & CT
Describe morphologic imaging findings that are suggestive of a benign SPN
Describe morphologic imaging findings that are suggestive of a malignant SPN
How does measurement of the doubling time of nodules aid in the determination of a benign SPN?
How does the degree of enhancement of pulmonary nodules on CT aid in the determination of benignancy?
How does FDG PET aid in the differentiation of benign & malignant lung nodules?
Describe some clinical features that suggest whether SPN is more likely to be malignant & whether it is more likely to be due to lung carcinoma or a pulmonary metastasis if there is a history of extrapulmonary primary malignancy
What minimally invasive procedures may be used to obtain tissue samples from SPN?
What are potential complications of transthoracic needle biopsy?
How important is lung carcinoma as a public health issue?
What are the major histologic types & subtypes of lung carcinoma?
Summarize some of the differing features of the various histologic types & subtypes of lung carcinoma
What is a superior sulcus tumor?
Describe the major imaging findings related to lung carcinoma
Summarize the tumor node metastasis (TNM) staging system for NSCLC
When is NSCLC generally considered unresectable?
Are there any reliable screening tests for lung carcinoma? What is the National Lung Screening Trial (NLST)?
Name some treatment options for lung carcinoma
Describe the imaging findings of pulmonary metastases
What is lymphangitic carcinomatosis?
What are pulmonary carcinoid tumors?
What is a pulmonary hamartoma?
What is congenital bronchial atresia?
Bibliography
66. Interstitial Lung Disease
What radiographic features distinguish interstitial diseases from air space diseases?
What factors influence the likelihood of one interstitial disease over another interstitial disease?
What is the most common interstitial abnormality identified on chest radiography?
Name the most common interstitial abnormalities other than interstitial pulmonary edema.
What radiographic characteristics help determine the diagnosis of interstitial disorders?
What is the appearance of a nodular interstitial pattern on chest radiography?
What disorders cause nodular interstitial diseases?
Discuss granulomatous lung diseases that cause nodular interstitial disease.
Discuss pneumoconioses & tumors that lead to nodular interstitial lung disease.
What is the chest radiographic staging system for sarcoidosis & what is the clinical significance?
Give some examples of hypersensitivity pneumonitis (extrinsic allergic alveolitis).
Why do intravenous drug abusers get talcosis?
What radiographic feature of nodular pneumoconioses is most strongly associated with respiratory deficits?
What are the radiographic characteristics of the peripheral reticular pattern?
Which diseases cause the peripheral reticular pattern?
What demographic features can help distinguish the cause of the peripheral reticular pattern?
Which connective tissue disorders can result in interstitial disease?
Are there any imaging features that can help distinguish the cause of the peripheral reticular pattern?
Describe the imaging characteristics of the linear pattern on chest radiography.
What disorders cause the linear pattern of interstitial disease?
Are there any imaging clues that may help to distinguish the cause of the linear interstitial pattern?
What are the imaging characteristics of the cystic pattern of interstitial lung disease?
What disorders produce the cystic interstitial pattern?
What disorders cause diffuse bronchiectasis?
Are there any imaging features that help to distinguish the cause of the cystic pattern?
When is computed tomography (CT) scanning indicated for the evaluation of interstitial lung disease?
What type of CT scan is indicated for the evaluation of interstitial lung disease?
Bibliography
67. Mediastinal Diseases
Describe the anatomy of the mediastinum
What are the three compartments of the mediastinum?
List the differential diagnosis of major anterior mediastinal lesions
List the differential diagnosis of major middle mediastinal lesions
List the differential diagnosis of major posterior mediastinal lesions
List the differential diagnosis of fat-containing mediastinal lesions
List the differential diagnosis of cystic mediastinal lesions
Name different collections that may occur within the mediastinum
What clinical symptoms & signs can be associated with mediastinal lesions?
What is a thymoma?
Describe the clinical presentation of a thymoma
Describe the imaging findings of a thymoma
What is thymic carcinoma?
What is thymic carcinoid?
What is thymolipoma?
What is a mediastinal germ cell tumor?
What is a mediastinal teratoma?
Name a rare but highly specific clinical presentation of mediastinal teratoma
What is mediastinal thyroid goiter?
Define mediastinal lipoma & mediastinal lipomatosis
What is Hodgkin lymphoma?
What is non-Hodgkin lymphoma?
What are the most common causes of mediastinal lymphadenopathy?
Which vascular disorders can appear as mediastinal masses?
Describe the congenital foregut cysts
What is a mediastinal pancreatic pseudocyst?
What is pneumomediastinum?
What is a mediastinal abscess?
What is fibrosing mediastinitis?
What are neurogenic tumors?
Describe the imaging appearance of neurogenic tumors
What is an intrathoracic meningocele?
How do osseous tumors & infection within the posterior mediastinum differ on imaging?
What is extramedullary hematopoiesis?
Bibliography
68. Pleural Diseases
Describe the normal pleural anatomy & physiologic features.
List the major tumors that may affect the pleura.
What are the major substances that may collect within the pleural space?
What is the differential diagnosis of major causes of pleural effusion?
List the major mechanisms of pleural effusion formation.
What are the two major types of pleural effusion?
What are the major imaging findings of simple nonloculated pleural effusions on erect chest radiography?
Describe the major imaging findings related to simple nonloculated pleural effusions on portable supine, semierect chest radiography & computed tomography (CT).
What are the major imaging findings associated with complex loculated pleural effusions?
List the differential diagnosis of major causes of hemothorax.
What is pneumothorax?
What are the radiographic imaging findings of pneumothorax?
How much air in a pneumothorax is required for radiographic visualization?
What radiographic maneuvers can be performed to show a subtle pneumothorax?
What is a tension pneumothorax?
What is the differential diagnosis of major causes of pneumothorax?
When should treatment of a patient with a pneumothorax be considered?
How is the diagnosis of an empyema obtained?
When is empyema usually treated?
What is empyema necessitatis?
List causes of pleural calcification.
What are pleural plaques?
What is malignant mesothelioma?
What are risk factors for the development of malignant pleural mesothelioma?
Describe symptoms & signs of malignant pleural mesothelioma.
What are the imaging findings of malignant pleural mesothelioma?
What diagnostic tests may be used in the diagnosis or staging of malignant pleural mesothelioma?
What is the prognosis for malignant pleural mesothelioma?
Describe the general treatment approach to malignant pleural mesothelioma.
What is localized fibrous tumor of the pleura?
Name clinical presentations of localized fibrous tumor of the pleura.
What are the imaging features of localized fibrous tumor of the pleura?
What is the treatment for localized fibrous tumor of the pleura?
Bibliography
69. Tubes, Lines & Catheters
What is the radiographic appearance of an endotracheal tube (ETT) & where is it optimally placed?
Describe how an ETT may be malpositioned; list other potential complications of ETT placement.
What is the optimal positioning of a tracheostomy tube?
Name potential complications after tracheostomy tube placement.
What is the radiographic appearance & ideal positioning of a nasogastric tube (NGT) or orogastric tube?
Describe the radiographic appearance & optimal location of an enteral feeding tube.
Discuss ways in which NGT, orogastric tube, or feeding tube may be malpositioned, including other potential complications.
If NGT, orogastric tube, or feeding tube is misplaced within the tracheobronchial tree, what should one do before removing the tube?
When is a thoracostomy tube generally used?
What is the radiographic appearance of a thoracostomy tube & where should its tip be located?
Discuss potential complications of thoracostomy tube placement.
How can I decrease the chance of injury to an intercostal artery or vein during thoracostomy tube placement?
Describe the basic normal venous anatomy of the chest.
What is the radiographic appearance & optimal location of a central venous line (CVL) & a peripherally inserted central catheter (PICC)?
What are potential complications of CVL or PICC placement?
List locations where a CVL or PICC may be malpositioned when inserted through a vein.
Name some clues of inadvertent arterial puncture with CVL, PICC, or Swan-Ganz catheter (SGC).
What should one consider in the differential diagnosis for rapid development of an ipsilateral pleural effusion or mediastinal widening after CVL, PICC, or SGC placement?
If air embolism is suspected during catheter placement, what should one do to treat the patient?
How do I prevent air embolism during catheter placement in the first place?
Describe the radiographic appearance of SGC & its optimal location.
What are potential complications of SGC placement?
Why can pulmonary infarction occur as a complication of SGC placement?
How does an intra-aortic counterpulsation balloon (IACB) work?
What are the major indications & contraindications for placement of IACB?
Describe the radiographic appearance of an IACB & its optimal position.
What are the potential complications of IACB?
What is the radiographic appearance of a transvenous pacemaker or automatic implantable cardioverter defibrillator (AICD)?
Where should the leads of a transvenous pacemaker or AICD be located?
What are potential complications of transvenous pacemaker/AICD placement?
What is twiddler’s syndrome?
Bibliography
XII - Ultrasonography
70. Obstetric Ultrasound: First-Trimester Imaging
Should a first-trimester pelvic ultrasound (US) examination be performed transabdominally or transvaginally?
What are the indications for first-trimester US?
List seven causes of vaginal bleeding in the first trimester
Name three possible causes of a positive serum b-HCG level & an empty uterus on US
During a routine first-trimester US examination, what sonographic features should be documented?
When should a gestational sac be seen with transabdominal & transvaginal US?
Describe the US features of a normal gestational sac
What constitutes the “double decidual sac” sign?
When should a yolk sac & an embryo be seen with transabdominal & transvaginal US?
At what point should embryonic cardiac activity be detected on US?
Describe the US features & significance of an abnormal gestational sac
What are the US findings of an abnormal yolk sac?
Name six types of early pregnancy complications & describe their US appearances
What is an ectopic pregnancy?
Who is at increased risk for an ectopic pregnancy?
What is the classic clinical presentation of an ectopic pregnancy?
List four possible US findings associated with an ectopic pregnancy
What is a pseudogestational sac?
What is a heterotopic pregnancy?
How common are heterotopic pregnancies?
What is a molar pregnancy?
What is the US appearance of a molar pregnancy?
Bibliography
71. Obstetric Ultrasound: Second-Trimester Imaging
What are the components of the basic (level 1) second-trimester ultrasound (US) examination?
How is the normal amniotic fluid volume estimated?
What are the major causes of polyhydramnios?
What is the dreaded complication of oligohydramnios?
If the placenta appears to be covering the internal os, what entity may be present?
A pregnant woman presents with vaginal bleeding, pelvic pain & tenderness over the uterus. What entity must be considered
What is an “hourglass” deformity of the cervix?
Can the presence of a single umbilical artery be normal?
What is the most accurate measurement to assess gestational age in the second trimester?
How is the abdominal circumference obtained & why is it used?
What is the difference between symmetric & asymmetric intrauterine growth retardation (IUGR)?
What percentage of cardiac anomalies can be detected by the four-chamber view alone?
Describe the classic US features of fetal hydrops
What is the most common intrathoracic/extracardiac fetal anomaly?
Name the four types of anterior abdominal wall defects. Which are most common?
Which abdominal wall defect is covered by a membrane?
How can the abdominal cord insertion (ACI) help in the diagnosis of anterior abdominal wall defects?
Which has a worse prognosis, omphalocele or gastroschisis?
Why might the urinary bladder not be visualized?
A markedly distended bladder & ureters with bilateral hydronephrosis are visualized during a routine second-trimester US of a male fetus. What abnormality may be present?
Name the four patterns of limb shortening seen with skeletal dysplasias
What would produce an enlarged cisterna magna on US?
What is the significance of the nuchal skin?
Which open neural tube defect contains elements of spinal cord?
When an open neural tube defect is discovered, what else should be evaluated?
Bibliography
72. Vascular Ultrasound
What is the incidence of deep venous thrombosis (DVT)?
How do patients with lower extremity DVT present clinically?
List the risk factors associated with the development of DVT
Describe how to perform an ultrasound (US) examination of the lower extremity when looking for DVT
How do the US findings of acute & chronic DVT differ?
How accurate is US in establishing the diagnosis of DVT?
Discuss treatment options for patients with DVT
List the US findings of a pseudoaneurysm
How may a pseudoaneurysm be treated nonsurgically?
Summarize the differential diagnoses for a perivascular mass seen on gray-scale imaging
What are the characteristic findings of an arteriovenous fistula (AVF) on US?
Where in the femoral vasculature do AVFs most commonly occur?
Identify common indications for performing a carotid US examination
Name the three components of a carotid US examination
What spectral analysis findings are indicative of stenosis?
What parameters are used to grade the degree of carotid artery stenosis?
What degree of carotid stenosis is considered clinically significant in symptomatic & asymptomatic patients?
In an area of critical stenosis, what is the significance of showing a “string” sign?
Name several potential pitfalls of carotid US
Can US be used to diagnose subclavian steal syndrome?
What does a parvus tardus waveform indicate?
What is the role of US in establishing the diagnosis of renovascular hypertension?
What are the most common causes of renovascular hypertension?
What parameters are used to make the diagnosis of renovascular hypertension on US?
How does US compare with other modalities in establishing the diagnosis of renovascular hypertension?
Bibliography
73. Abdominal Ultrasound
What anatomic landmarks can be used to determine in which hepatic segment an abnormality is located?
What is the normal echogenicity of the liver?
Can one differentiate between hepatic & portal veins on ultrasound (US)?
Name the common benign & malignant focal hepatic lesions.
What is the significance of a target lesion?
What are the possible growth patterns of hepatocellular carcinoma; when should one highly consider the diagnosis?
What are the US findings of cirrhosis?
In addition to location, what imaging features help to differentiate focal fatty infiltration from a mass lesion?
Describe the US appearance of gallstones.
What is meant by the “WES” sign?
How does the US appearance of gallstones differ from that of other intraluminal abnormalities?
What is the normal gallbladder wall thickness & what diseases can produce gallbladder wall thickening?
Describe the US signs of early or uncomplicated acute cholecystitis.
What are additional findings in advanced or complicated cholecystitis?
Describe the US appearances of gallbladder carcinoma & tell which is the most common.
What malignancy has the highest propensity to metastasize to the gallbladder?
What is the normal measurement of the common duct?
Name three causes of extrahepatic biliary dilation.
Does a normal-appearing pancreas exclude the diagnosis of pancreatitis?
Because the pancreas may appear normal in pancreatitis, what is the role of US in patients suspected to have pancreatitis?
What is the differential diagnosis of a hypoechoic pancreatic mass lesion?
What are the two major types of cystic pancreatic neoplasm?
What genetic diseases are associated with pancreatic cysts?
Describe the normal US appearance of a kidney.
What is the main function of US in the setting of acute renal failure?
What are the US findings of obstruction?
Describe the US appearance of renal calculi.
What is the most common renal mass lesion?
Are any diseases associated with renal cysts?
What is the most common solid renal mass?
Describe the imaging features of renal cell carcinoma.
Discuss the differential diagnosis for a markedly echogenic renal mass.
Does pyelonephritis have a characteristic appearance on US?
What is meant by renal parenchymal disease?
Bibliography
XIII - Diagnostic Radiology as a Profession
74. Training Pathways in Diagnostic Imaging
What is the usual training pathway to become a radiologist in the United States?
Do I have to match for a separate preliminary year?
Is it difficult to get a residency position in diagnostic radiology?
What can I do to help my chances of matching in radiology?
What information should my personal statement contain?
Does it matter who writes my letters of recommendation?
Do I need letters of recommendation from radiologists?
Are radiology positions offered outside of the National Resident Matching Program (NRMP) match?
To how many residency programs should I apply?
To what kind of residency programs should I apply?
How do I become board-certified in diagnostic radiology?
I am an international medical graduate. What must I do to apply for a diagnostic radiology residency position in the United States?
What is a research track residency position?
Do I have to complete a fellowship after residency?
In what subspecialties is fellowship training offered?
What is the training pathway for nuclear medicine?
How do I become board-certified in nuclear medicine?
What is a certificate of added qualification (CAQ)?
Websites
75. Medicolegal Issues in Diagnostic Imaging
Define medical negligence
What must be proven for a physician to be found liable for malpractice?
Outline the history behind current malpractice law. What is unique about the legal determination of medical negligence in the united States?
List factors that have been responsible for the expansion of medical litigation in the United States
There can be no malpractice without established practice. Who sets the established practice & who determines whether the established practice has been breached?
Would a general radiologist who misses a lesion on a brain magnetic resonance imaging (MRI) study be held to the standard of a neuroradiologist?
The average plaintiff award in the United States is $3.5 million. What is the aim of the award & what are the types of damage awarded by the jury? ...
Can an exculpatory waiver signed by a patient shield the physician of a certain degree of liability?
A radiologist in an outpatient facility reads radiographs without ever meeting the patients. Does he or she still form a physician-patient relationship?
It is estimated that in any given year a lawsuit may be brought against 1 in 10 radiologists. What are the most common reasons radiologists get sued?
What are the groundbreaking findings of the Institute of Medicine’s report To Err is Human: Building a Safer Health System?
Radiology has its unique set of errors. What is the most common radiologic error & how often is this error estimated to occur?
What is hindsight bias & why is it important medicolegally?
List ways to minimize the occurrence of perceptual errors
In 1997, the Wisconsin Court of Appeals issued a decision that has had a positive effect for radiologists sued for perceptual errors. Outline the decision
What is the “Aunt Minnie” approach to film interpretation & how may this approach lead to errors in judgment?
How may errors in judgment be minimized?
Explain the following terms in the medicolegal context: proximate cause, law of intervening cause & joint & several liabilities.
Explain the following terms in the medicolegal context: vicarious liability & respondeat superior.
Who is responsible for the negligent action of a technologist?
What is meant by the term res ipsa loquitur? Give some examples
A radiologist renders a report on an intensive care unit portable chest x-ray that reads, “Endotracheal tube in the right main bronchus should be withdrawn by 2 inches to lie within distal trachea; left lower lobe atelectasis; otherwise normal.” What
A radiologist renders a report on a posteroanterior chest x-ray of a 60-year-old man with dyspnea that reads, “Infiltrate in the right lower lobe, likely pneumonia, clinical correlation is advised.” Is this report adequate?
A radiologist renders a report on a barium enema that reads, “Filling defect in the splenic flexure with abrupt shelflike margins, cannot rule out malignancy; colonoscopy may be of help if clinically indicated.” What is wrong with this report?
A patient develops anaphylactic shock from iodinated contrast material for excretory urography performed to rule out renal calculi. This older examination (rather than the current standard—a noncontrast helical computed tomography [CT] scan) was perfo
A radiologist reports that a case of trauma to the lateral cervical spine is “normal except for straightening, which could be positional.” Later the patient has weakness in the legs & a CT scan shows “fracture-dislocation” at C7/T1—an area not cove
A patient develops anaphylactic shock from iodinated contrast material for excretory urography performed to rule out renal calculi. This older examination (rather than the current standard—a noncontrast helical computed tomography [CT] scan) was perfo
Failure to diagnose breast cancer is the number one cause for litigation in radiology. Summarize how may one practice safe mammography
Only 2% of medical negligence injuries result in claims & only 17% of claims apparently involve negligent injuries. About 60 cents of every malpractice dollar is taken by administrative & legal costs. The current tort system is inefficient. What
A 45-year-old man with uncontrollable hypertension is referred for “magnetic resonance angiography with contrast” to exclude renal artery stenosis by his cardiologist. His glomerular filtration rate is 25 mL/min/1.73 m2. He is not on dialysis. What sh
A report states “History—suspected pulmonary embolus…. Technique—CT scan of the chest was performed….” If all reports in this radiology practice were of similar disposition, why would this practice expect to hemorrhage money?
Bibliography
76. Radiology Organizations
What is the Radiological Society of North America (RSNA)?
What is the American Roentgen Ray Society (ARRS)?
What is the Association of University Radiologists (AUR)?
What is the American Board of Radiology?
What is the American College of Radiology (ACR)?
What is the American Council of Graduate Medical Education (ACGME)?
What are the major subspecialty societies in radiology?
What are the leading academic journals within diagnostic radiology?
What is the NIBIB?
Index
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B
C
E
F
G
H
I
J
K
L
M
N
O
P
R
S
T
U
V
W
X
Y
Z