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Library of Congress Cataloging-in-Publication Data
Names: Chowdhury, Rajat, author. | Wilson, Iain D. C. (Iain David Cooper),
1975- author. | Rofe, Christopher J. (Christopher James), 1977- author. |
Lloyd-Jones, Graham, author.
Title: Radiology at a glance / by Rajat Chowdhury, Iain D.C. Wilson,
Christopher J. Rofe, Graham Lloyd-Jones.
Description: Second edition. | Hoboken, NJ : Wiley, 2017. | Series: At a
glance series | Preceded by Radiology at a glance / Rajat Chowdhury ...
[et al.]. 2010. | Includes index. |
Identifiers: LCCN 2017017189 (print) | LCCN 2017018823 (ebook) | ISBN
9781118914793 (pdf) | ISBN 9781118914786 (epub) | ISBN 9781118914779 (pbk.)
Subjects: | MESH: Diagnostic Imaging | Handbooks
Classification: LCC RC78.7.D53 (ebook) | LCC RC78.7.D53 (print) | NLM WN 39 |
DDC 616.07/54–dc23
LC record available at https://lccn.loc.gov/2017017189
Cover image: © arnitorfason/Gettyimages
‘Radiology at a Glance’ – it won’t take most readers very long to realise that radiological images, like those in this book, deserve more than just a glance – in the old adage, ‘a picture is worth a thousand words’. Over the past 120 years since the discovery of X-rays, medical imaging has assumed an ever more central role in patient management. A familiarity with modern medical imaging techniques is an essential prerequisite for the practice of almost all branches of medicine. The past 40 years in particular have been dubbed the Golden Age of Radiology with the arrival on a regular basis of new techniques and modalities depicting human anatomy and disease processes in previously unthinkable detail. Ultrasound, computed tomography (CT), magnetic resonance imaging (MRI) and most recently positron emission tomography (PET) have all helped to shed light on structures and processes within the living human body which previously could only be imagined. The growth of interventional radiology has allowed the replacement of complex surgical procedures with minimally invasive techniques, often avoiding the need for anaesthesia and even hospital admission.
The authors of this excellent book, Rajat Chowdhury, Iain Wilson, Christopher Rofe and Graham Lloyd-Jones, have revised and expanded the bank of images displayed in this second edition to provide an even more comprehensive overview whilst retaining the clarity of presentation which characterised the first edition. New sections have been included on breast imaging, cardiac MRI and CT, CT colonography, and interventional oncology, representing some of the new frontiers in radiological practice. Further chapters on interventional radiology have also been added as well as new opportunities for self-assessment in the form of OSCE.
Medical students, junior doctors and healthcare practitioners from a wide range of backgrounds will find material here relevant to their learning and their daily practice and my hope is that it will fire their enthusiasm for medical imaging. The story of radiology does not end with the exquisite images of the beating heart which you will find in this volume. Functional imaging is with us already and new modalities are coming along in the near future which will enable us to move from imaging of gross anatomy to imaging at the cellular and molecular level and will support the key role that radiology plays in the era of personalised medicine.
Dr Giles Maskell
President of The Royal College of Radiologists (2013–2016)
Following the success of the first edition of Radiology at a Glance, we have implemented the feedback, updated and expanded the book, and maintained the classic at a Glance style to help teach the basics of radiology in a simple and clear fashion. We develop the reader from radiological anatomy through to classic pathological conditions that regularly appear in medical school exams. ‘Classic cases’ are found in separate chapters allowing easy access for doctors on the wards. The companion website now includes practice material for exam preparation.
We have written this book not only with medical students and junior doctors in mind, but trust that it will be a useful aid to students of radiography, nursing and physiotherapy, as well as other health professionals. We therefore hope it will be a valuable tool in gaining an understanding of the essentials of clinical radiology.
We would like to express our gratitude to all our colleagues and teachers for their inspiration, meticulous teaching and expert guidance. We extend warm thanks to Dr Giles Maskell for giving the second edition his prestigious seal of approval. We would also like to thank our publishers for all their enthusiasm and support in developing the renewed concept for the second edition. We would like to dedicate this book to our families who continue to support us along the at a Glance journey, and finally, we thank all our readers for taking the time to read this book, and in return we hope you feel it was time well spent.
Rajat Chowdhury
Iain D. C. Wilson
Christopher J. Rofe
Graham Lloyd-Jones
# | fracture |
AAA | abdominal aortic aneurysm |
ACL | anterior cruciate ligament |
ADC | apparent diffusion coefficient |
AIIS | anterior inferior iliac spine |
ALARA | as low as reasonably achievable |
AP | anterior to posterior |
APTT | activated partial thromboplastin time |
ARDS | acute respiratory distress syndrome |
ARSAC | Administration of Radioactive Substances Advisory Committee |
ASD | atrial septal defect |
ASIS | anterior superior iliac spine |
ATLS | Advanced Trauma Life Support |
AVN | avascular necrosis |
AXR | abdominal X-ray |
Ba | barium |
CAD | coronary artery disease |
CAMG | coronary artery bypass grafting |
CBD | common bile duct |
CC | craniocaudal |
CIN | contrast-induced nephropathy |
COPD | chronic obstructive pulmonary disease |
CPPD | calcium pyrophosphate dehydrate |
CR | computed radiography |
CSF | cerebrospinal fluid |
C-spine | cervical spine |
CT | computed tomography |
CTA | computed tomographic angiography |
CTCA | computed tomographic coronary angiography |
CTKUB | computed tomography of kidneys, ureters and bladder |
CTPA | computed tomographic pulmonary angiography |
CTSI | computed tomography severity index |
CXR | chest X-ray |
DCS | ductal carcinoma in situ |
DDH | developmental dysplasia of the hip |
DEXA | dual energy X-ray absorptiometry |
DIC | disseminated intravascular coagulation |
DIPJ | distal interphalangeal joint |
DMSA | dimercaptosuccinic acid |
DOB | date of birth |
DP | dorsal to plantar |
DR | digital radiography |
DRUJ | distal radioulnar joint |
DTPA | diethylene triamine pentaacetic acid |
DVT | deep vein thrombosis |
DWI | diffusion-weighted (magnetic resonance) imaging |
Echo | echocardiography |
EDH | extradural haemorrhage/haematoma |
EDV | end diastolic volume |
EF | ejection fraction |
eGFR | estimated glomerular filtration rate |
EndoUS | endoultrasound |
ERCP | endoscopic retrograde cholangiopancreatography |
ESV | end systolic volume |
EVAR | endovascular aneurysm repair |
FB | foreign body |
FDG | fluorodeoxyglucose |
FEV1 | forced expiratory volume in 1st second |
FLAIR | fluid attenuated inversion recovery |
FNAC | fine-needle aspiration cytology |
FOB | faecal occult blood |
FVC | forced vital capacity |
GI | gastrointestinal |
GORD | gastro-oesophageal reflux disease |
HIV | human immunodeficiency virus |
HOC | hypertrophic obstructive cardiomyopathy |
HRCT | high resolution computed tomography |
HSE | Health and Safety Executive |
IBD | inflammatory bowel disease |
ICD | implantable cardioverter defibrillator |
ICH | intracerebral haemorrhage |
ICP | intracranial pressure |
ID | identification details |
INR | international normalised ratio |
IR | interventional radiology |
IR(ME)R 2000 | Ionising Radiation (Medical Exposure) Regulations 2000 |
IRR99 | Ionising Radiation Regulations 1999 |
IV | intravenous |
IVC | inferior vena cava |
IVU | intravenous urography |
KUB | kidneys, ureters, bladder |
LBO | large bowel obstruction |
LLL | left lower lobe |
LOS | lower oesophageal sphincter |
LRTI | lower respiratory tract infection |
LUL | left upper lobe |
LUQ | left upper quadrant |
LV | left ventricle |
LVF | left ventricular failure |
MAA | macroaggregated albumin |
MAG3 | mercaptoacetyl triglycine |
MARS | Medicines (Administration of Radioactive Substances) Regulations |
MCPJ | metacarpophalangeal joint |
MDP | methylene diphosphonate |
MEN | multiple endocrine neoplasia |
MLO | mediolateral oblique |
MR(I) | magnetic resonance (imaging) |
MRA | magnetic resonance angiography |
MRCP | magnetic resonance cholangiopancreatography |
MTPJ | metatarsophalangeal joint |
MUGA | multi-gated acquisition |
NBM | nil by mouth |
Neuro | neurological |
NGT | nasogastric tube |
NHS BSCP | NHS Bowel Cancer Screening Programme |
NHS BSP | NHS Breast Screening Programme |
NM | nuclear medicine |
NOFF | neck of femur fracture |
NSAID | non-steroidal anti-inflammatory drug |
NSF | nephrogenic systemic fibrosis |
N-STEMI | non-ST elevation myocardial infarction |
OGD | oesophagogastroduodenoscopy |
OM | occipitomental view |
OPG | orthopantomogram |
OSCE | Objective Structured Clinical Examination |
PA | posterior to anterior |
PACS | picture archiving and communications system |
PCA | percutaneous coronary angioplasty |
PCI | percutaneous coronary intervention |
PCL | posterior cruciate ligament |
PCNL | percutaneous nephrolithotomy |
PCS | pelvicalyceal system |
PD | proton density |
PE | pulmonary embolus |
PET | positron emission tomography |
PET-CT | combined positron emission tomography with computed tomography |
PICC | peripherally inserted central catheter |
PIPJ | proximal interphalangeal joint |
PT | prothrombin time |
PTC | percutaneous transhepatic cholangiography |
PUD | peptic ulcer disease |
RA | right atrium |
RCR | Royal College of Radiologists |
RF | radiofrequency |
RFA | radiofrequency ablation |
RLL | right lower lobe |
(R)ML | (right) middle lobe |
RUL | right upper lobe |
RUQ | right upper quadrant |
RV | right ventricle |
RWMA | Regional myocardial wall motion |
SAH | subarachnoid haemorrhage |
SBO | small bowel obstruction |
SDH | subdural haemorrhage/haematoma |
SIJ | sacroiliac joint |
SOL | space occupying lesion |
SPECT | single photon emission computed tomography |
STEMI | ST elevation myocardial infarction |
STIR | short tau inversion recovery |
SUFE | slipped upper femoral epiphysis |
SV | stroke volume |
SVC | superior vena cava |
TACE | transcatheter arterial chemoembolisation |
TARE | transcatheter arterial radioembolisation |
TB | tuberculosis |
Tc-99m | metastable technetium-99 |
TFCC | triangulofibrocartilage complex |
TIA | transient ischaemic attack |
TIPS | transjugular intrahepatic portosystemic shunt |
TNM | tumour, nodes, metastases |
UC | ulcerative colitis |
UGI | upper gastrointestinal |
US | ultrasound |
V/Q | ventilation-perfusion |
Attenuation | Gradual loss in intensity of beams and waves including X-rays and ultrasound waves. May also be used synonymously with ‘density’ to describe appearances on CT imaging (areas of high attenuation are bright whereas areas of low attenuation are dark). |
Density | Used synonymously with ‘attenuation’ to describe appearances on CT imaging (areas of high density are bright whereas areas of low density are dark). |
Echogenicity | Used synonymously with ‘reflectivity’ to describe appearances on ultrasound imaging (hyperechoic areas are bright whereas hypoechoic areas are dark). |
Hotspot/coldspot | Used to describe the uptake of radiopharamaceutical agents by tissues in nuclear medicine imaging (increased uptake results in a hotspot whereas reduced uptake results in a coldspot). |
PACS | The ‘picture archiving and communication systems’ are computer networks that store, retrieve, distribute and present medical images electronically. This permits images to be viewed and manipulated digitally on screen with remote and instant access by multiple users simultaneously and has therefore almost replaced the use of hard-copy films in the UK. |
Reflectivity | Used synonymously with ‘echogenicity’ to describe appearances on ultrasound imaging (hyperreflective areas are bright whereas hyporeflective areas are dark). |
Signal | Used to describe appearances on MRI (areas of high signal are bright whereas areas of low signal are dark). |
Don’t forget to visit the companion website for this book:
http://www.ataglanceseries.com/chowdhury/radiology/
There you will find valuable material designed to enhance your learning, including:
- Radiology OSCE, case studies and questions
- Flash cards
- Figures from the book in PowerPoint format, to download
On 8 November 1895, the German physicist Wilhelm Conrad Röentgen discovered the X-ray, a form of electromagnetic radiation which travels in straight lines at approximately the speed of light. X-rays therefore share the same properties as other forms of electromagnetic radiation and demonstrate characteristics of both waves and particles. X-rays are produced by interactions between accelerated electrons and atoms. When an accelerated electron collides with an atom two outcomes are possible:
The resultant beam of X-ray photons (X-rays) interacts with the body in a number of ways:
Most modern radiographic machines use electron guns to generate a stream of high energy electrons, which is achieved by heating a filament. The high energy electrons are accelerated towards a target anode. The electrons hit the anode, thereby generating X-rays as described above. This process is very inefficient with 99% of this energy transferred into heat at 60 kV. The dissipation of heat is therefore a key design feature of these machines to sustain their use and maintain their longevity. The material for the target anode is selected depending on the chosen task and the energy of the X-ray beam can be modified by filtration to produce beams of uniform energy.
Most modern radiology departments now employ digital imaging techniques and there are two principal methods in everyday use: computed radiography (CR) and digital radiography (DR). CR uses an exposure plate to create a latent image, which is read by a laser stimulating luminescence, before being read by a digital detector. DR systems convert the X-ray image into visible light, which is then captured by a photo-voltage sensor that converts the light into electricity, and thus a digital image. The final digital images are stored in medical imaging formats and displayed on computer terminals.
The clarity of the image can be expressed as ‘unsharpness’. This can be classified into:
Newer digital imaging systems now allow the postprocessing of data to enhance various aspects of the image.
The contrast of an image is dependent on the variation of beam attenuation within the subject. There are five principal densities that can be seen on a plain radiographic image.
The contrast may be increased by lowering the energy of the X-ray beam. However, this has negative impact on image quality and increases the dose of radiation.
Contrast agents are often used to enhance anatomical detail. A desirable contrast agent is one that has high photoelectric absorption at the energy of the X-ray beam. The contrast agents most commonly used in plain X-ray imaging are barium, gastrografin (water soluble) and iodinated compounds. Precautions in the use of iodinated contrast agents are discussed in Chapter 6.
Fluoroscopy allows dynamic real-time imaging of the patient, which can provide information regarding the movement of anatomical structures or devices within the patient. Fluoroscopy is based on X-ray imaging and the physical principles are similar to the plain X-ray imaging chain from X-ray beam generation to image display (see Chapter 1). However, the procedure is performed using a specifically designed X-ray machine and uses low dose real-time acquisition techniques and hardware.
There are two main types of fluoroscopy machines:
Fluoroscopy machines are designed specifically to manage the heat generated from the repeated exposure in fluoroscopic imaging. They also use lower beam energies and exposures compared with plain X-ray imaging techniques and thus image intensifiers are employed to enhance the image. These convert the X-rays to electrons to amplify the signal several thousand-fold and then convert the electron beams again into visible light. This light image is then transmitted onto a screen.
Static images, which are similar to plain X-ray images, can be acquired. These provide increased contrast and spatial resolution compared to standard fluoroscopy images, but at the cost of increased patient dose.
When using image intensifiers, several factors must be
considered:
For the majority of fluoroscopic imaging, contrast agent enhancement is used. Fluoroscopy gives the ability to make real-time adjustments to the patient’s position and image orientation, which often reveals invaluable information to help differentiate the diagnosis. This is most evident when using contrast-enhanced imaging of the bowel.