Important terms used in imaging

1. Important terms used in imaging X-ray radiography Radio opacity:A structure which appeare on radiograph is radio opaque.It is because of more attenuations of x-rays by that structure. Radio lucency:An area or structure which appear more black copared to adjacent structures is called lucent.It is because of morretrnsmission of x-rays through that structure. Ultrasound.

2. A structure which appear on white ultrasound is echogenic and this is because of attenuation of sound waves through that area. Hypo echoic. Any part or tissue in the body whiich appear more black on ultrasound is hypo ecoic and it is because of through transmission of sound waves through t5hat part of the body CT scan Hyperdense .CT image is described in term of densities.a white area in the image is hyperdense. Hypodense:a black area appeare is hypodense Any abnormal area in a structure which has same grey scale appearance is isodense MRI MRI image is described in term of intensities.white area in the mri image is hyper tense. A black area in the image is hypointense An abnormal area of the same color is iso intense Nuclear medicine.These images are described in term of uptake More uptake in an area is hot less uptake in an area is called cold.Or we called these areas are of high uptake or low uptake

3. Normal X-Ray chest 1:Request form: Check name age gender of tpatient. Check date and time of examination Check if any previous x-ray Check clinical information 2:Technical aspect: Projection PA or AP Position: Upright or supine Orientation. check side marker as there May be congenital anomaly like Dextrocardia. Centering and rotation. Medial end of the calvicle should be equidistance from the spinous process Penetration. Vertebral bodies and disc spaces should just be visible through the cardiac shadow.

4. Portable (AP or Antero-posterior) FILM 007

5. PA (Postero-anterior) FILM 008

6. Projection PA AP 009

7. Low Lung Volumes 010

8. Proper Exposure Over Exposure 011

9. 9 012

10. 013

11. Clinical and x-ray manisfestations • Seropositiverh factor is present in blood • Gointpain,fever,weight loss etc • Soft tissue swellings spindle shape of interphalengeal joints • Osteoporosis • Joint space changes and alignment deformities • Periostitis • Erosions • Secondry osteoarthritis

12. Exposure factors: If the vertebrae and disc spaces are clearly visible then over exposure If they can not be seen it means the film is under expose. Over expose film will appear black and under expose film will appear white. Inspiratoryefforts:Count the number of ribs above the diaphragm.

13. *If 10 posterior rib is above the diaphragm---------adequate *If 6 anterior rib is above the diaphragm ----------adequate *If more ribs are visible above the diaphragm-----Hyperexpanded lungs *If less ribs-----------------------------------------------poor inspiratory efforts Look angles clear or not ,lungs bases clear or not. 3:Review of anatomy: 1.look at the heart.Asses the outline.Apex is directed to the left or right.Look at the size.It should be 50% of the thorax in adult and 60% in children

14. 016

15. 017

16. RUL (Right Upper Lung) 018

17. RML (Right Middle Lung) 019

18. RLL (Right Lower Lung) 020

19. Right Sided Fissures 021

20. LUL (Left Upper Lung) 022

21. LLL (Left Lower Lung) Al-Yami 023

22. Left Side Fissure LUL LLL 024

23. Border of the heart:Right border---RT atrium Left border ---Lt ventricle Front ----Rt ventricle Base Lt atrium Apex Lt ventricle Look at the cardiophrenic angles Look at the mediastinum.It should form one third of the thoracic diameter. Look at the hila.The left hilum is about 2.5cm higher than the right. The hila should be of equal density and size.They should be concave in shape. Look at the lungs field. Examine the lung fields zone by zone and compre the two sides.Look also for the fissure and lobe. There are three lobs and two fissure on the right. The fissures are horizontal and oblique. There is only one fissure and two lobe on the left.

24. Look at the diaphragms.The right is higher than the left .It is because the heart apex is directed to the left.The difference between the two side is 1,5cm if it is more than this it is abnormal.Costerphrenic angles should be clear and sharp. In a good inspiratory film, the diaphragm should be at the level of 10th posterior rib 6th anterior rib Look at the trachea.It should be cebtral with slight deviation to the right. It divide at the level of T4/T5 in to rt and lt main bronchus.Thert bronchus is shorter and wider than the left.The left is longer and narrower.Tracheal division is called carina.The angle of carina is 65 to 70 degree. Look at the bones.The density of bones should be similar on both sides Look at the soft tissue of the chest wall Look at the hidden areas. They are clearly in the LA view. The hidden areas are Retrocardiac,retrosternal,costopherinic and cardiopherenic angles apices,lung bases and hila and domes of diphragm

25. Rhumatoid arthritis • Autoimmune inflamatory disease • Occre in adults • Multisystemic disorder • Seropositive arthritis • Mainly affect the small joints of the hands and feets • Cervical spine and rarly large joints are also affected,speciallyatlantoaxial and shoulder joint

26. Invistigations • X-ray • Ultrasound • CT • Radionuclide studies • MRI

27. Psoriasiatic arthritis • Seronegative arthritis • Affect the small jpints of hands and feet • Nail changes and skin • Affect and distal interphalangealgoints • Affect the spine with syndesmophyte formation • Sacroillitis

28. Reiters disease • Syndrome of arthritis,urethritis and conjunctivitis • Affect the feet more than the hands • Painfull erosion of calcaneus with spur formation • Sacroillitis

29. Ankylosingspondylitis • Seronegative arthritis • HLA –B27 is positive • Affect young adults • Mainly affect the spine with chacteristic changes • Squaring of vertebral bodies and bamboo spine • Sacroillitis is bilateral and symetrical.sacroillic joints are assesed with prone view of sacroilliac joints

30. Gout • A metabolic disease with abnormality of uric acid • Affect the great toe of feet • Bone erosions • Osteoporosis • Tophi formation

31. Osteoarthritis • Degenerative disease • Affect mainly the weight bearing joints • Primary when no cause is known • Secondry when the goint is abnormal • Mainly affect old people • Main complain of patient is pain and stiffness • More common in over wight people

32. X-ray appearences • Joint space narrowing • Increase bone density • Osteophyte formation • Loose body • Cyst formation • Vacuum phenomenon in the intervertebral spaces

33. Invistigations • X-ray • CT scan

34. Spondylolisthesis • When there is slip of one vertebra over another • Usually occure due to stress fracture in the parse • Four grades • 25% • 50% • 75% AND TOTAL

35. OSTEOPOROSIS • Due to decrease bone mass • Decrease bone mass result in increase incidence of fracture • Senile osteoporosis occue in old people.there is loss of cortical and trabecularbone.Fractureoccure more commonly in femoral neck and humerous • Postmenopausal osteoporosis.occure in womenabove 50 years of age.vertebral fractures are more common

36. Rickets • Vitamin D defficency disease • Occure in childern • There is lack of mimeralisation of bones • Lack of vitamin D • Lack of calcium • The above defficiency may be either nutritional or disease process

37. X-ray appearences • Loss of normal zone of proviosnal calcification • Fraying of growth plate • Splaying cupping of metaphysis • Osteoporosis • Pigeon chest • Rickety rosy

38. Osteomalacia • Vitamin defficency disease occure in addults • More common in females • Bone become soft so bowing occure • Looser zones bilateral and symetrical • Compression of vertebrae • Cordfish vertebra

39. Tumors of bones • Classification • Two groups 1:primary 2: Secondary tumors. Primary are divided in to a) benign and malignant • Primary bone tumors • A: Benign 1.bony island 2.osteoma.3.osteoid osteoma 4 osteoblastoma • B: Malignent .Osteosarcoma

40. Cartilage tumors • A. Benign 1.osteochondroma 2.chondroblastoma etc • Malignent: chondrosarcoma Tumors arising from other bone tissues and tumor like condition. • 1:Gaint cell tumors • 2 : Aneurysmal bone cyst3:hemangioma • 4:Ewing sarcoma 5:

41. Osteoidosteoma • Benign bonr forming tumor.small in size with a lucent central nidus .Give pain at night and only releived by asprine • Osteoblastoma. Same as osteoidosteoma but larger in size and pain is not releived by asprine .both these tumors occure in young adult

42. Malignent tumors of bone and cartilage • Osteosarcoma.Occure commonly in childern causing bone destruction,soft tissue and mrtastasis • Chondrosarcoma: Malignentcartilaagetumor.more common in old people cause destruction of cartilage,soft tissue mass with calcification and metastasis in advance cases.

43. Ewing sarcoma • Special bone tumor.More common in childern causing bone erosion and clinical and radiological appearences are like bone infection

44. Neuropathic or charcotgoints • Causes are DM,syphilis and other neuropathies.There is denervation of the involved goints and loss of pain sensations • X-ray appearences. Bone destruction-increased bone density-debries in joints-disorganization of joints.

45. Osteomalacia

46. Ricket

48. Charcot,s joint

49. Ricket in a child

50. Respiratory systemPulmonary tuberculosis. • It is an infectious diseas caused by mycobecterium tuberculosis. • It mainly involve the lungs,although it can affect any organ in the body. • Two groups 1:Typical 2:Atypical • Typical are Mycobecterium tuberculosis and M,bovine • Atypical are-M,aviumintracellulare.M,kansasi • And M,xenapi etc • Disease is common in poor class,alcoholics and aids patients