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Foreword~.

ll is a pleasure to write a foreword to this excellent book of Multiple ChoiceQuestions (MCQsl. Now that most examinations in radiology are entirely basedon MCOs, there is a need lor a large bank for learning and self testing. And, asstated in the introduction, practice will indicate where improvements in techniqueand knowledge are required.

_ The author: have done s vary good ‘ job in making the questions asunambiguous as posslble and maltlng them relevant to the practice oi modernradiology. l suspect that the book has largely arisen through the endeavours ofthe two young radiologist first authors who have recently passed the Pan l FRCRexamination. They have wisely solicited the help ofa physicist who has contributedsome very up-to-date physics questions and that of a senior radiologist withconsiderable examining experience who has kept them on the straight and narrow.This team has provided 300 first class questions. As a previous examiner, I knowiust how hard it is to compose realistic questions of the right degree of difficulty.

There is a lot of new material here with many oi the physics questionsinvolving MRI, PET and the like. It is of course difficult to maka.the anatomyquestions seem 'trendy', but even here there are some intriguing new concepts.

lt is pleasing that the answers are provide‘?! on the opposite page which makeslile so much easier than having to look them up at tlte end. There are also uselulcomments admixed with the answers which make the book a really worthwhileeducational exercise. l have certainly learnt a lot from it.

I have no doubt that the book will be well received in all countries. Thequestions are those that all radiologists should be able to answer. Thus it shouldappeal to specialist registrars and qualified radiologists alike. Of course withincreasing pressure on specialist registrars to attain their goals in each year oftraining, first year trainees will be the chiel purchasers. And it will sell well. Butmore than mere sales. l think that the material within this volume will become astandard text for trainees and trainers, And thus the authors have achieved a lot.They should be thanked and congratulated for their effons. l wish them, thepublication team and the book well.

Adrian K Dixon MDcFRCR FRCPProfessor of RadiologyUniversity of Cambridge

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cutmu4tu.‘uv1NGST0NE _ _ yMedial Division of Pearson Professional Limited

Distributed in the United States oi America by ChurchillLivingstone lnc., 650 Avenue of the Americas, NewYork. N.Y. 10011, and by associated companies,bra;-ighas and representatives throughout the world.

O Pearson Professional Limited 1996

All rights reserved. No part of this publication may bereproduced, stored in a retrieval system, or transmitted 'in any form or by any means, electronic, mechanical,photocopying, recording or otherwise, without eitherthe prior permission of the publishers [ChurchillLivingstone, Robert Stevenson House, 1-3 Ba>tter'sPlace, Leith Walk. Edinburgh EH1 3AF, UK) or a licensapermitting restricted copying in the United KingdomIssued by the Copyright Licensing Agency Ltd.B0 Tottenham Court Road. London, W18 QHE. UK. \, < '/ 9

First edition 1996 T,

ISBN 0 443 05464 9

British Library of Cataloguing in Publication Data 'A catalogue record for this book is available from theBritish Library.

Library ol Congress Cataloging in Publication DataA catalog record lor this book is available lrom theLibrary of Congress.

Medical knowledge is constantly changing. As new iniorrnatton becomesavailable, changes In treatment, procedures, equipment and the use ol drugsbecome necessary. The authors and the publishers have, as far as it ispossible. taken care to ensure that the information given in this text is accurateand up to date. However. readers are strongly advised to confirm that theinformation, especially with regard to drug usage, t:om'plies with tzttrrcntlegislation and standards oi practice. ~

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Contents

ForewordIntroductionThe FHCR part l examinationHow to use this book -,-.Answering multiple choice questionsGlossaryMultiple choice questions:

it anatomyiil techniquesiii) physics

BibliographyThe FRCR part l syllabusindex

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The FRGR part lexamination

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Candidates are permitted to sit the examination after one academicyear's preparatioqln 5'treining post which has been approved by theRoyal College of Radiol0gists._Examinations are held in June andSeptember each year. The examination has three components:

I. One multiple choide question lMCOl paper (2 hours)0 A total of 60 questions distributed equally between anatomy.» techniques, and physics li.e. 20 questions in each areal.Q Each question has a stem followed by five independent items or

statements. Each statement is either true or lalse.O There is no restriction on the number of true or false items in a

question. It is possible for all live components to be true or all fiveto be false.

O The scorind system is as follows: Wfor each item correctly indicated as true or false +1for each item incorrectly indicated -1for each item indicated "don't know" 0

0 MCQ syntax:~ The majority means more than 50% .—- The approved name of e drug is always utilised; sometimes the

proprietary name will be added in brackets. '

ll. One film viewing session (‘l hour)

O This is designed to test the candidate's knowledge of radiologicalanatomy, radiographic techniques and understanding of film faults

y, Films are displayed on viewing boxes and each candidate isrequired to answer four questions on each radiograph. There are atotal of 20 radiographs and thus a total of 80 questions.

O All the questidns are attached to the radiograph and the candidaterecords his/h“e_'r answers in a book.

I An invigilator "and several examiners are present. Candidates arenot questioned by the examiners who are present during this partof the examination. -

all ‘Q1 \(,‘) (J t" " ~w~w~w'w‘wL " ....-'-_ . §= G Q Q GF’-9~“v.a:.__- -' -1=1-?_TT"_'

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Introductiond 1

ln”'June 1993 a revised syllabus was introduced for the FRCR pan lexamination of the Royal College of Radiologists. There were three matorchanges: the written part of the eiarnination was limited to multiple choicequestions lMC(1sl; the amount of physics was reduced so as to achievethe obiectives that candidates should have a sound understanding of theprocesses which occurred once the X-rays had left the X-ray tube andthat there would be considerably less emphasis on what actuallyhappened inside the tube and generator; and finally, sortie imagingmodalities (CT and MRll were given an increased prominence.

it is intended that this book should be used during the early stages oforganised study and so assist with the written part oi the FRCR pan lexamination taking into account the new syllabus (page 208).

There are a total of 300 lVlCOs arranged into three separate sectionsreflecting the three main sections lanatomy, techniques and physical ofthe FRCR part l examination.

ACKNOWLEDGEMENTS_- or .1

The authors are greatly indebted to Dr F'.P. Dendy, Chief Physicist,Medical Physics Department, Acldenbrookes Hospital, Cambridge andMr G. Manson, Principal Physicist. Medical Physics Department, CorkUniversity Hospital, Ireland. Their helpful comments and suggestions onthe physics section ot this book have been invaluable. The Royal Collegeof Radiologists has ttindly given permission to the authors to include thepresent FRCR l syllabus in this book.

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I. Two oral examinations (20 minutes each) “0 All candidates proceed to the oral examinations.O Each candidate is examined by two pairs of examiners. One pair

consists of a physicist and a clinical radiologist who examine in

‘\)"-.

.3.“physics. The second pair consists of two clinical radiologists who ..--i - jexamine in anatomy and techniques.

1 .

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..»0 The MCCls are grouped together under three sections:

— anatomy i—- techniques—- physics. _, _b .

0 Each section comprises 100 questions.0 Each question has a stem, followed by five independent statements0 The correct answers are indicated on the right-hand page opposite

each question. in many instances the answers include a snortexplanation.

0 A glossary of abbreviations» is provided on page xiv.0 A bibliography containing a list oi the texts which have been used

to formulate the MCQ questions is included on page 206.0 The FHCR part I syllabus is included on pages 208-213.0 An index of all the subjects which have been included in the MCOs

is listed alphabetically on pages 215-227. "" , . _Note: some explanations given within the physics MCQ answers maybe an approximation for the purposes of illustration of a principle.

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ihswering multiple1 I 3choice questions

The majority oi candidates will have had experience oi sitting multiple“choice question (MCQl papers at undergraduate and postgraduatelevel. Therefore the most important advice is for a candidate not tochange his/her technique when it has been successful in the past.

r

Three practical tips: -" : _

1. Attempt enough questions. Answer at least 240 items out oi thetotal oi 300 (60 x 5i items in order to score enough positive marksto pass the MCQ examination.

The principle behind this advice is as follows. Assuming that acandidate has an error rate of 10%. then: '0 the candidate should pass with a clear margin if 240 questions

are attempted as the net positive score will be i92 or 64% _t ' li.e. 215 correct answers less 24 incorrect answersl.0 a marginal pass or fail would be likely when the candidate

attempts only 200 questions, as the net positive score would be160 or 53% li.e. 180 correct answers less 20 incorrect answers).

0 the candidate is likely to iaii ii only 160 questions are answeredas the net positive score would be i2B or 43% il.e. 144 correctanswers less 16 incorrect answers). 'Obviously the assumed error rate oi 10% iior all answers which

have confidently been assumed to be correct) will vary betweendilierani individuals. A candidate should thoielore assess his orhot own pursonnl error rate hy doing inst uxrimintition pnpnrs rintlcomparing the number of statements intzorrecily answered withthe total number oi questions attempted. Based on this estimatedaverage error rate, an approximation oi tire minimum number oiitems which should be answered to achieve ti clctir pass cun hodetermined by using the previous exarnpl-J as ti guide.

2. Do not guess randomly. On the other hand it is recognised thatintelligent guesses often give a net positive rather than a netnegative score. A candidate should assess his or lier ‘own personalsuccess rate on several test MCO papers by comparing scoresbefore and after additional intelligent responses. The results

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Answering multiple choice questions xv

should allow each candidate to develop the most profitableanswering stylehPractice makes perfect. Practice on test MCQ papers will indicatewhere improvements in technique and knowledge are required.

FURTHER READING l r

Anderson J. The Multiple Choice Question in Medicine, 2nd edn.London: Pitman, 1982.Holden NL. Multiple-choice questions 1 a guide to success. BrJHosp Med i993k50 .i9l: 557-569. _Robinson PJ-. Strategic marking in MCO papers (|6fl8ti- 3! J 986719’1981; 54: 538-539.

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the patella. -,..»_:_t_--r '~. C1, "5 r _the lower femoral epiphysis. l I -

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the acaphold and the lunate anlctrlnre with the distal rauliu.the scaphoid and the -lunate articulate with the head of thecapitatref /tn‘l_',.r;,,¢ ‘the pisilorm articulates with lha posterior surface oi thelriquelrum. ,theWrapezlum and trapezoid articulate with the scapltoid.the proximal pan oi the triquetrum articulates with the ulna.

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the radiocarpal lolnt communicates with the rrtitlttatpal ioint.the pisllorm is the only carpal bone to give attachment to lnuththe llexor and exlensor retinaculae.the scaphoid is the most anterior carpal bone on a true lateralradiograph.the capitate is usually ossified at birth.

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False Appears at about_ §. egs of age.True Appears at about 37 weeks gestation.False Usually the l_a§t_'§f'tljfi§[§§l bones to ossify. The

ssilication centre for the navicula_r_app3a__r_s at about- 6)/ears oi age. ‘

False Appears at about 1 yeargnd is the flr§t_9_§sification' I‘ , ' centre to be sé'én'at_the elbow. it is usually (but not

, ,;;-~alvsl.r1ys) followed by the radial head, internal‘ ' - 'epico_ndyle, trochlea, olecranon and external

‘- wt epicondyle.False Appears at about ll years of age and is the last

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BTrueTrue -‘False The platform articulates with thalemerior surface oi. .. ..-_4__'_,,,,,,,......---w-="~rthe tnquetrum. '"TrueFalse The proximal part ol the triquetrum articulates with

the triangular articular disc of the wrist joint.§ 1-

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False The proximal carpal row comprises the scaphoid, thelunate, the triquetrum and the pisiform. The distalrow comprises the trapezium, the trapezoid. thecapitate and the hamate.

False The radiocarpal joint does not communicate with themidcarpal joint in the normal wrist. The rftirjcarpaljoint communicates with the c_arpornet'acar_gaLjgQ1t.

True The lle><or'rétiriaculu'rn attaches't6'Tfi'e scaphoidtubercle and ridge of the trapezium laterally, and thepisilorm and hook of the hamate medially. Theextensor retlnaculum attaches to the radius, pisiformand triquetral bones. '-

False The pisiform is the most anterior carpal bone.False The capitate usually ossilies at about 4 months.

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4 In the normal shoulder: l .A the ioint capsule is lax intetiorly.B the normal acromiohumeral distance is greater than 7 mm. '“\

. . . . . IC the glenohumeral iornt norrnally comrnrrrrrcates with the * l

subacromial bursa.D the normal glenohrrrneral ioint space has a |It£\>ti|t'rur1't wirltn ot .

6 mm.E the rotator cuff muscles all insert into the lesser tuberosity oi

the humerus. ‘

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B True

C False

D True

E False

The joint capsule passes round the circumference of/—the glefioid fossa extending proximally to include theroot of the coracoid process and distally onto theanatomical neck of the humerus. it is strong, but isi_e_>tin_fe_riQriy and so allows a wide range ofmovemgrtt. ' ' ' ' "'” ”' 'A distance less than 5 mm suggests a rotator cuiftear. ¢""'_"The subacromical bursa does not normallycommunicate with the glenohumeral ioint However.the subscaptriar bursa‘ does communicate with thesy.-rQv'rar"ra'errr5ra'rré‘arms glenohtrmeral ioint.ll QFBEWF llléfl §5l'1liTl it is suggestive of a_ posterior -dislocation. 3Supraspirrattrs, infraspinatus and teres minor insertinto the greater ttrberosity'of the humerus.Subscaptilaris is inserted into the lesser ttrberosity.

5 in the normal shoulder joint: 5 A Falsethe long tendonyof biceps is extracapstrler.

B the capsule isattached to the articular rnargin of the ltrrrncralhead e><oa‘p_t‘ar'the inferior margin.

C the subacrfimifil bursa extends inwards under the acromion; when theffam-'t'Is abducted.D the "rotat0r.;c'rlifi" comprises the fused teridomr of

' subscapularts, supraspinatus, infrasrrirtnttrs anti teres rnajur.the articular’.§urface oi the humeral head is four times the area

cm.’_- ',~-wt-. l ~1 . ’ -, H’ W’ _ lb‘t

.Flegarding the arterial supply to the upper limb:t A the deep palmar arch is formed from the corttirttration of the

- radial artery.‘ B the axillary artery lies lateral to the axillary vein.

, 5C the axillary artery becomes the hrachial artery at the lower' =- border of teres minor.

" D the axillary artery is divided into three parts by the pectoralis' - minor muscle. '

.. V [E the attillary artery commences at the r1ter_.l_ial border of the first - r\‘~*1'r|b' -f 7!“; pr”, I‘, tr.

alt. l‘ '-1'2-.:.I:'.-‘ll.-V - 1 ' ' P". ":- '-‘l . ' ». \ ‘Y -:9 . ~,-w_ _,\ .1 V '_ A in ', ,\ . -. __ _ ‘ Jr») -|l|,_tr I1 ' -fl r--~ .-r?n~t- 1 - ’ I

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E' True

it is intracapstrlar. 4 'lnieriorly, the capsule is attached to the neck oi thehumerus below the articular margin. __However, the subacromial bursa extends beyond thelateral border of the acromion with the arm aclducted.it comprises the fused tendons of subscaptrlaris,supraspinattrs, infrasprnatus and teres m_ir_i_5r. “ '

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. . . . . IC the glenohumeral iornt norrnally comrnrrrrrcates with the * l

subacromial bursa.D the normal glenohrrrneral ioint space has a |It£\>ti|t'rur1't wirltn ot .

6 mm.E the rotator cuff muscles all insert into the lesser tuberosity oi

the humerus. ‘

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B True

C False

D True

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The joint capsule passes round the circumference of/—the glefioid fossa extending proximally to include theroot of the coracoid process and distally onto theanatomical neck of the humerus. it is strong, but isi_e_>tin_fe_riQriy and so allows a wide range ofmovemgrtt. ' ' ' ' "'” ”' 'A distance less than 5 mm suggests a rotator cuiftear. ¢""'_"The subacromical bursa does not normallycommunicate with the glenohumeral ioint However.the subscaptriar bursa‘ does communicate with thesy.-rQv'rar"ra'errr5ra'rré‘arms glenohtrmeral ioint.ll QFBEWF llléfl §5l'1liTl it is suggestive of a_ posterior -dislocation. 3Supraspirrattrs, infraspinatus and teres minor insertinto the greater ttrberosity'of the humerus.Subscaptilaris is inserted into the lesser ttrberosity.

5 in the normal shoulder joint: 5 A Falsethe long tendonyof biceps is extracapstrler.

B the capsule isattached to the articular rnargin of the ltrrrncralhead e><oa‘p_t‘ar'the inferior margin.

C the subacrfimifil bursa extends inwards under the acromion; when theffam-'t'Is abducted.D the "rotat0r.;c'rlifi" comprises the fused teridomr of

' subscapularts, supraspinatus, infrasrrirtnttrs anti teres rnajur.the articular’.§urface oi the humeral head is four times the area

cm.’_- ',~-wt-. l ~1 . ’ -, H’ W’ _ lb‘t

.Flegarding the arterial supply to the upper limb:t A the deep palmar arch is formed from the corttirttration of the

- radial artery.‘ B the axillary artery lies lateral to the axillary vein.

, 5C the axillary artery becomes the hrachial artery at the lower' =- border of teres minor.

" D the axillary artery is divided into three parts by the pectoralis' - minor muscle. '

.. V [E the attillary artery commences at the r1ter_.l_ial border of the first - r\‘~*1'r|b' -f 7!“; pr”, I‘, tr.

alt. l‘ '-1'2-.:.I:'.-‘ll.-V - 1 ' ' P". ":- '-‘l . ' ». \ ‘Y -:9 . ~,-w_ _,\ .1 V '_ A in ', ,\ . -. __ _ ‘ Jr») -|l|,_tr I1 ' -fl r--~ .-r?n~t- 1 - ’ I

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C True

D False

E' True

it is intracapstrlar. 4 'lnieriorly, the capsule is attached to the neck oi thehumerus below the articular margin. __However, the subacromial bursa extends beyond thelateral border of the acromion with the arm aclducted.it comprises the fused tendons of subscaptrlaris,supraspinattrs, infrasprnatus and teres m_ir_i_5r. “ '

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6 A True

TrueB.

' C False

D True

E False

The deep’ paln_1§i_r arch is formed from the terminal ' 5 -'branch of the ragia|__grte_ry anastomosing with thedeep branch of the ulnar artery.‘ The supe__riit:ial arch ____ _is_ formed from the continuation of the uln_af;i@_ry_ 5; . t_/-

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The axillary artery_b comes the brachial artery at the I 'lower border ohteres major.)Tl"! firs‘ Pa" is ab°‘£§_.B§E£Q£.illS minor and has QQ_8l>1en¢h-' the Second ear! is Qeltmd. migrate minor .and has two branches; the rhirtrl R211 i§_b_el_ow . Ipectpralis minor and has three branches. IThe axillary artery commences, at the lateral bordertil the first rib. . ' ' ""' ' I " "'

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6 MCQ Tutor in Hadiology r

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_ (73 ' - condylar cavity of the knee ioint. D

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A ..the fabelia ltesirn the lateral head of the gastrocnernius musclein about 80% of the population. _ _the supero edial aspect of the patella may osstfylndependen ly and remain discrete.the posterior cruciate ligament is attached to the anteriorintercondylar area of the tibia. ‘the lateral collateral ligament is attached to the lateralmeniscus.the lateral articular surface of the patella is larger than themedial articular surface.

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t e suprepateller bursa communicates with the knee ioint.the geslrocnernius bursa may communicate with the medial

the medial meniscus of the knee joint is larger than tl.e lateralmeniscus.the collateral ligaments of the knee joint are extracapsuler.the popliteus tendon is intracapsular. - ,

t-. .;~.,_.

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%§i,"~,The'_pitellatfAB

is a sesamold bone.is bipartite in 2% oi cases.commonly has an irregular anterior margin. - ‘ -has two paired facets on its posterior surface. 'lorms an attachment lar tho cllpeule of the knee taint.

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False

True

The"fabel|a, a sesamoid bone, lies in the_laterai headoi the gastrocnemius muscle in about[22‘;i=[of thepopulation.The superolateral aspect of the patella occasionallyossifies independently and remains discTe'te. his isreferred to as a_l:Lipartit§_pitella.The posterior cruciate ligament is attached to theposterior in'tg_rg;p_ndylar area and passes anteriorly,medialiyrand superiorly to the lateral aspect of themedial femoral condyle.TiiFl§iEr—alE6ll‘a_tE1l ligament is separate from thelateral meniscus. it is attached superiorly to thelateral epicondyle of the femur and inferioriy to thehead of the fibula. However, the deep part of themedial £o_Qa_tera| ligament is attached to the medialmeniscus. Z

TrueTrueTrue

True

True

D

l

in abotrt@§_‘Z<Dof individuals.The lateral meniscus is more rounded than themedial which is more crescentic in shape.On the other hand the anterior and posterior cruciateligaments of the knee joint a"Fé intracapsirlarl butextrasynovial. “""‘~'“" ""'The p'r3pliteus tendon separates the lateral meniscus,to which it is attached. from the lateral collateralligament of the knee joint. r - .

True

t-‘

True

TrueFalse

True

A sesarnoid is a fibrous, cartilaginous or bony nodulewithin a tendon. The only consianl examples are thepatella. which is the largest, and one in each of thetw0,.tertci0ns of flegror pollicis brevis in the hand, andflexqr _hallucis_ br§yi_§’i_F\_i_lj§ roar?" W I ii.A bipartite patella occurs much more commonly inmales than females. When present, this normalvariant occurs bilaterally inr'43°/aiof cases.\'4

On the posterior surface of the patella, there arethree paired lagets for articulation with the patellarsurface of the iemur. There is also a medial feggtforarticulation, in lull ilexion, with the medial margin ofthe intercondylar notch of the femur.

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_ 8 M(_;O. Tutor in Radiology ~

10 ln the normal hip:the ischiofemoral ligament is the strongest of the three{A

l/BC

D

E

ligaments.the joint capsule attaches to the intertrachanteric crestposteriorly.thg__a_rtiy_gfthe ligamenturn teres originates from the

-.'o“bturator arteTy2-..,_.__,..,.,-the angle of inclination of the femoral neck is normally127° in adults.

about =

the ossification centre for the femoral heatl is visible at hum.. -7-—-~

‘ :,I'I\ Of Y-€4~r-'\~tAr I4)’ ‘v,-tL-\.V.) t» ti "t. ‘[ L-/‘_-', . 't‘i 7¢,.\(;uf ‘I L‘(..'\';¢,-_r$|‘ '/ _

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‘i{f1tieTtt.e~!e,@s>.t5tlet.¥.@=.=vit -.~='~l\>A is a continuation of the =2;-.:ernal iliac artery beyond the

inguinal ligament.becomes the popliteal artery after piercing adduutor magnus.lies anterior to the femoral vein in the 3(i('.itlCl0l'EgiTEi:—_—msupplies branches to the skin of the anterior ai:~t:'ominagives rise to the profunda fernoris artery in the ietnotatriangle.

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A the long saphenous vein lies anterior to the medial malleoltzs.the long saphenous vein contains less than five valves.the short saphenous vein lies with the sural nerve anterior tothe lateral malleolus.there is no communication between the short and longsaphenous veins.the long saphenous vein drains into the popliteai vein.

‘C www\I~wIt'*I'~I'w'w'w!g\g\g.g-.__w,wAnatomy 9

10 A False

B False

CD

TrueTrue

E False“-

The iiiOf@t’_fl_§J_l'§l ligament (Y-shaped ligament ofBiéelflwl _i$ the §t_rgn_gg§t ligament around the hip.The iscliigfemoral ligament is the wealtestli_gament.The pubofernoral ligament is the third ligamentaround thfi-hip?Postetiorly the ioint capsule does not extend as far asthe intertrochanteric crest. it is attached halfwayalong the femoral p__et:k. Anterioriy the joirTFEapsule isatt'ac'he'd"to_'the intertrochantaric line.

in neonates, the angle of inclination is normally i60°.The angle of atttaversion is SQ“ at birth and 8“ in adults.it appears durittg the first year of life...__ ...._-_._...

li A TrueB TrueC True

D True

E True

.y__ ~

in the femoral sheath. the femoral artery lies lateralto the femoral vein. lt changes position relative to thefemoral vein as it passes from the femoral sheathdownwards into the adductor canal.The femoral artery gives off suP6_fii__¢jgl hrancheswhich supply the anterior abdominal wall and skin ofthe external genitalia. = '

True 'FalseFalse .

12ABC

D False

. E False

T-he long saphenous vein contains at lea§t_1Q_val_ves.The short saphenous vein lies with the sural nerveposterior to the lateral malleolus.There are several channels of communicationbetween the short and long sephenous veins.The long saphenous vein drains into the femoralvein. The short saphenous vein drain§i?tto'thepopliteal vein.

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10 MCO Tutor in Radiology '

13 The clavicle: -T A ossifies in membrane. '

\ B has a secondary ossification centre at its lateral and which/ appears at 18 years and fuses at 25 years. :/ C forms a sec9_\'_t_t_1_a_[y_ca_rtila_gi[tous joint with the sternum. ’

' D has a rho'rT1boid fossa in approximately 0.5% of the population.- E may exhibit a conoid tubercle for attachment of the ..

costoclaviculer ligament.

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/1% /X the first costal cartilage to ossify is most commonly that cf thef" t rib, .ll J ,%B éptha ribs have two facets for the costovertebral joints.

C t e tubrcle of a typical rib lorms a synovial joint with the_ ? transverse process of its own vertebg,,._

- /F D cervical ribs occu in approximately ll_.59":-of people.E each rib forms a 9oEnt with its costal

cartilage. _

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15 Regarding the major airways: i* -TA the trachea blfurcates at the level oi T5. , Ii M 5-B me noimal S'Ub§:;lJ'if‘l18l’lpiii5;ppl'OXim3!'3!y 90°‘; 6 i; O)

e Hg it maln r 'nc us ts ot more vertical ;:lt longer than. ‘ the iefi. §w/ ‘T/— '. '*"

the trachea is reinforced by 15-20 incomplete liiigs o'l ftyaiinecartilage. ' '

" \ E on a lateral chest radiograph, the right upper lglie br'-':r'.-;i\-.-s isN t t ‘ visualised end on above the left main stem brtfrlclttrs. \ ,

1\

Anatomy l1

13 A True -- it has no rnedullary cavity.B False ‘* The secondary ossification centre is at the medial

end of the clavicle. FT “'7The sternoclavicular joint is a synovjgljgnt with anintra-articular fibrocartilaginous disc dividing the jointin two. The manubriosternal joint is a secondary

- cartilaginous jointT\J"""\_7—~' ‘FmD True Afrhornboid fossa occurs in @r normal clavicles.

33%» of these are bilateral. 'The conoid tubercle is for attachment of the conoidpan of the cora_c_oclavict;lar ligament. The rhomboidfossa is the site of attachment for the costoclavtcular

‘lig'a'ri'\'gtt. “'“——'

C False

‘ E False

14 A True Ossification of the first costal cartilage often starts in‘ thes e.The costal cartilages of

the lowest ri_bs ossify next and the process -l:>rver§§é.e‘s.'.uey!§td§-

B False A typical rib has two facets. The lower facet forms a ’"synovial joint with the upper costal facet of its ownvertebra and the upper facet with the lower costalfacet of thevertebra above. However, the first ri_b hasonly one costovertebral facet and articulates with T'l

'~ venebra only. i"C True The tubercle of a typical rib has two facets. The

medial facet forms a synovial joint with thetransverse process of its own vertebra. The lateralfacet is non-articular and gives attachment to the

-lateral costptransverse ligament.D True They are usually bilateral but asymmetric in size.E False They are primary cartilaginous joints. A primary

cartilaginous joint is where jyflmecartilage meet; a secondary cant aginougjointlsymphysisi is a union b5:-‘.l\.r!€§fl 5. earticular surfaces are ‘covered with a thin lamina of

- hyaline cartilage.

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15 A True It bifurcates at the lower level of\@B False "The normal subcarinal angle is 60 3: 10° standard

deviation. "" '“""'The right main bronchus is mog vertical than theleft. but §h9_rtir. The right main e'F<>?¢ms measures2.5 cm in length and the le_ft__Lr\easures Q -r

C False

D True .E True Q

0

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16 The tracheeis an immediate relation of:{A the left vagus nerve./fffi the oesophagus.

‘ cf C the isthmus of the thyroid gtand.the IhOl'8t.lC duct

% F: the left brachiocephalic vein.

11 Regarding the flsst‘iresof»=lthelung:7' 'J g all the accessory fissures comprise two layers of visceral

pleura.c.=xC4j7»l- 1i'l~_aQj4{o5 723$ MN I645 f-Tzwf‘ l9“/c5Q"Z¢//"/€’*"“‘the minor fi sure runs h rizontally on the ri'g‘lTFat the level oi

\?»°D .‘"6’;

‘WY!!! §9.§!él E1f!l!39B-on the lateral chest radiograph the left oblique fissure isusually more vertical than the right.the iflferior accesso_ry_fissure separates the la? teraljaasalsegment of the right lower lobe from the rasro the lobe.

18 At the pulmonary hilum:' the density seen on a plain chest racliograph 's mainly clue to

T lymph nodes and bronchi C Maj g l'- 5 be\~A~B'—the transverse diameterrof the basal pulmonary artery is

approximately @mm in an adult female. / T7 _. /5,, ._,/._the left pulmonary artery passes anterior to tte leaf: rnalnbronchus throughout itscourse.

/(D th hilar point is where the basal pulmonur-y artery crosses theupper lobe veln. 1'20 U fig’ /

ZF E the right hilum is higher than the left in about 5% of people -

the azygos fissure occurs in aboutjja of normal intlivldttals. Q» Y’l r I

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@7-

Anatomy 13

A

B

C

D

E

False The right vagus nerve is in contact with the trachea.The left is held at/vay from the tracheiir».,'_l;i_;y;thjelgreat»‘vessels evil.-e2oi.sav§"teh: . T’ "T TT

True The oesophagus is a direct -‘posterior relationof thetrachea“;The isthmus of the thyroid gland is an anterior"relation or the trachea.The thoracic duct passes from right;o_|3ft¢ po§eriorto the oesophagus, at the level oTt?l'5.§=

_ _v

True

False

False

'l7 A

BC

D

E

.1

;The azygoflgs fgirlayers, All the others have two" layers olrztsceral pleura:

., _lt occurs in about 1% of normal. individuals. It tsvisualised on Q,_L_°_/5_gf chest radiographs.The left oblique fissure therefore meets thediaphragm more posteriorly than the right.The inferior accessory flssu’re'separates the ntggglbasal segment of the lower lobe from the rest of thet<;b'e; It occurs in about 25°/q of individuals. making itthe most common accessory fissure. ‘

False

TrueFalse

True

False

18 A

BC

D

E

False The den_sjty__qf the normal hilum is mainly due tobl9991e§§el§-

True It measures 8ppl'0Xlfl1&I6l\j_1§_‘f1‘l__@_lQfl1_8fi.False The left pulmonary artery initially lies anterior to the

bronchus, then arches over the left main bronchus tolie posterior to it. The right pulmonary artery liestmteriwr to the tioht main bronchus-

True The hilar angle is formed by the intersection of the_ bas3l_pulr_rtQrta_ry_artery and the upper lobe vei_n_3gd

is normally about 120“. ' "'" _’ *-False The Fight hilum is higher than the left in about Q_.Q§‘f/1

of people. The hila'areat the same level in about Q‘:/9of cases. In the remaining 91% of cases the left hilumis higher than the right. ‘" “T”

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‘I4 MCO Tutor in Radiology

l‘%“e§t:r>.mm¢titt=.A*:atra'mw§at=~

...>t.<‘i:...I

the left paraspinal line is wider than the right.

ft mm.“ \W _

the maximum width of the right pgratrgcheal line is § nun.the azygos vein should not have a diameter greater than

he aortic nipple is formed te e uperior tntercostal veinarching around the aortic arch. ~

3 ZDA#2./eattttiitfiefir " t -

_/", .» 1'\ ‘ .

the left upper lobe is divided into three segments t_ '1L I |I ll A _ . )5

ti.-.'» 1' 5 ' ‘<8 the bronchial arteries all arise directly lrom the aorta. ' ',,,M) i’”5 B.1." alt \'- %l3 the lingula is divided into medial and lateral segments. 3 t

-| I '

.- -/r E_. /' . -

i2} Begardlhgvtha pulmonary vasculeture: -V 21 A

., t _, t _ _ _X./it the lower zone V9ll'\3 are more vertical than theircorresponding arteries. ""he normal mean pulmonary arterial pressure is approximately

/ '5 {Timbe-4 / ¢_C the truncus anterior arises from the right ulmcnar arte atl the hilum. f6r/'M/ /0 HM 21;/um - p Y Wm‘

gin

|_ _l»‘ K

(/9 liié Balmvn ry trunk is a posterior relation of the leit alrittflt/Q/)'ib1/at-t'l'\'3lI¢(,)“"" _ g{E in the upper lobes the veins usually lie lateral to the arteries. Q-{QV

(‘tE» . . . _ P 9the azygos vein |Oll‘lS the superior venarcava

;-/

the second costal cyttlage meets the rtfisternal met ”“D - .7 . . 'E the ltgaritertturn artertosum is situated T‘ ‘ ®Lg C

‘ DI E

t

1 Z2 At the level ol the lower border oi T4- l A Z Ath6Teft_phr.enic nerve lies adjacent to the trachee.<Ef4""‘Le‘i i"3"l'“"“"‘quL “QMthe thoracic duct lies anterior to the oeso he us. B

/-umtuttty tq

I cthe posterior |Ut'tCllOn line exte hove the suprasternal _ 1notch and com rises our e ers l’ leura _ ‘A -‘ ~"-<.Wir°%~t-»~-»w r E

Tru e

TrueFalseTrue

True

' ‘TiTherrraximum diameter of the right paraspinal line iségm, The maximum width of the left paraspinal line'€ LEEThe azygos vein has a maximum diameter gillWhereas the anterior junction line ends below/_ thesuprasternal notch. ' '_, .... .1

an acinus comprises three to five terminal bron_chi_oles..1 ~ - - r '1 + E the veins are usually anterior to the arteries.. J = elf, , >< . , T .

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Z’ '_. ' ' D

i “ i

False

False

False

False

True

s -- --

The left upper lobe comprises apicoposterior andanterior segments and the lingula comprises superiorand inferior segments. “M?There are usually three bronchial arteries, two on theleft arising directly from tlteagrta,‘ and oggogtheright arising from théitijircl right posterior intercostalrides?’ " " ‘The lingula ls divided into superior and inferiorsegments. The right middle lobe is divided intomedial and lateral segments.A secondary lobule comprises three to five terminalbronchioles. A acinus is all the lung parenchymadistal to one viii-minal bronchiple.

K

False

True

False

FalseTrue

Lower zone veins tend to be more__j1p_ri;_ontal than thearteries. In the upper zones, the veins _a_re morevetjtical than the arteries. T ' " ‘Mean pulmonary venous pressure is approximately3rnrvHe-The truncus anterior arises proximal to the hilum andpasses to supply the right upper lobe.The pulmonary trunk is an_t_e’rior to the left atrium.

False

False

TrueTrueTrue

it is separated lrom the trachea by the arch ol theaorta.The thoracic duct crosses from right to left as itascends posterior to the oesophagus at the level ofT4/T5. ""“"'- H

./-T‘\The manubrio-sternal angle lies at the level of\]_'i.)This is the remnant of the ductus arteriosus, whichconnects the left pulmonary artery to the aorta infetal lile. It lies in the aortopulmonary window.

%/ than anterior to the oesophagus at Tilt: level of T5

A §1%to~5.ly e t§29fl“6‘“$ at/\lflm,V

W ta 't\.ir to-W0"-srnr-»"t0t~-vg--1.1 ‘C‘C"@‘U'@‘@‘@@‘Q‘@‘@TiT

23 The superior vena cava: 1 / /*<QA is formed at the level oflqllrl G /9¢<B has two valves “""'

// has only one tri ary.D is an immediate relation of the right pttrenic nerve.E may be left sided. ;n 0'5 _\_d Si \m/‘wfi\,L -

/ 1” _ y 'll /asw%t=ta?.t4tzt.ttt!tt§%tttta2§.;!§tt2!==§Y§1@'F*===",_ A embryologically the azygos vein develops from the right‘/Tl /)7 twsteriot sardine! vsiri-'1

B ’ med from the union of the ascending At'/T ettts t

E the accessory hemiazygo vain receives larontzltial veins from1”’ the leit lung Er ,,5'\\/lg /V ‘AS M +-Lt, 4.,y11llr{I

/ §C it cot_nn1_en§_es at the level o@ '1I D e"hemtaz\,/gos vein crosses from left to right at the level of

to ioin the azygos vein.

t use45 .fli1%l2fIl;g?ri5lciE;duct:7§'

all com as a continuation of the cistetnzt city-ti at the levelof L-l.

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has no va ves. T»\r/\~,._;t\7\ _drains the lymph from the wllo_l§_tht_)rax;§;!'

/B passes t r.o_t.tgh the central tendon of the diaph agnt at thelflt/El Gig?’ $3) \c~\i\ q~(\C,t_tJ.<,lI3Z.t

crosses the |:psterior_rn.atliaitinum from right to left and is

_ 26 Regarding lymphaticrdrainage:

TT

‘ /<A the t'lg|"lt>l\/mphatlc duct drains into the right brachiocephalit: 'vein. \§\ '"“ “M ""-—~

V (/8 the.-thoracio'du%t“ha's“a diameter of 1042 mm.Q \/~5, /(C the thoracic duct is approximately ~l§_t:m long.

?fl the thoracic duct drains into the azygos vein.E the thoracic duct lies between the azygos vein and the

descending aorta in the lower mediastinurn.

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23 A

ITTUOUI‘

False

FalseTrueTrueTrue

lt commences be|t_irt_t:l_ the manubrittm lT3I4l andenters the right atrium.it has no valves. \ _ ..The azygos veingrains into it posteriorly attT_=l. )

in 0.3% of people.> - 1“ #5

N? ab ABC

D

E

TrueTrueFalse hit commences in front of and slightly to the right of

True

True

(_L.1,'ancl ascends to the right of the vertebral column.It passes posterior, to the oesophagus, and racuivesthe lower eight posterior intercostal veins.it also receives=sorh_e_ veins from the rnigdle third ofthe oesophagus. U 'xg .

25 AB

C

D

E

FalseFalse

False

False

False

It commences at t.l.:'~it passes between the gverlagping right and leftcrural__fiQr§s. behind the median arcuate ligament atthe level of T12.) 'There are many valves. the last of which isapproximately E} cm prgxirnal to the venous junction.lt drains the whole body below the diaphragm andthe left half above it. The right side of the thorax.head and neck drain into the right lyrnpltatic duct.It crosses the posterior mediastinum posterior to theoesophagus. T '

26 A True

B FalseC TrueD False

E True

lt drains the right side of the thorax, right arm, headand neck.The diameter of the thoracic duct isv_l_;Z_§_n_g1.The cisterna chyli is 6 gm long.The thoracic duct enférsthe point of confluence oithe left trite nal ittattlar and suhclavianysins at thelevel of_'Q7,SThe azygos vein lies to the right of the thoracic ductand the descending aorta to its left.

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7 .:_~__—— x -7. _ __ ti

27-‘l Theathymusz " ' ' I l (/_,§“”'_ A is usually situated in the anterior morliastlnurn. i bgwjl

/UIS predominantly composed oi fatty tissue in young t:liildrun.L%'\\l*('reaches its maximum weight at 2 years. . -/consists of two iobee, the right ls usually larger tlmn the lnlt.\?h"‘£'euui-.‘t== its l.tl::‘.-ti supply lrom the inlcrior thyroid and internal’

4 illOlBL.'l\.‘ arteries. - ' “"""'" " "Z>.~.~.t

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1 u ;_;t__;_.tkpurst;-ptiagtt_s:,;' C6 (V;. \.Ulllll|t§llCi':S at the cricopharyngeus muscle at C4 ‘ gr \\_P% 'B pierces the diaphragm with the right plllfllllt, nerve. \/W\_,L/"/C has striated muscle in the wall ollits upper third. and sinuotlt

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it lies anterior to the great vessels and trachea.it comprises lymphoid and epithelial cells inchildhood, which__a'r3 replaced by'i?ttVt'iEstle in adultlife. , 'it weighs ‘jQ—"l§ 'g at birth, grows for Y years and thenstopsgrgwing until‘? years‘ when it has a secondgrowth spurt,-reaching=»a maximum weight oi30--4O5g'a't?‘l'1 ye'ars.~.. '

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lt commences at the cricopharyngeus muscle at';Q§.__;ll passes through the diaphragm at the level of T1_Qaccompanied by branches of the left gastric arteryand both vaQgl§..!1_*1.T‘;{§s tleit anteriorly, righttw.ststi¢i"lvl- "This probably accounts for the fact that normalphysiological events occur more quickly in the upperoesophagus. _The distal 3 cm is retroperitoneal.The upper oetsopghagus is supplied by the inferiorthyroid artery from tlteitltyrgcervical trunk; themiddle portion by oesophageal branches of the aorta;and the lower portion by branches of the left gastricartery. ' '

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the corniculate cartilages commonly ossiiy.each pyriform fossa lies between the aryepiglgttig fttembranemedially, and the lamina of the thyraid cartilage laterally.the v§_s_ttpgle separates the true and false vocal cords.the trlttceal cartilage lies in the thyrohyoid membrane.the valleculae are paired depressions at the base of thetongue situated between the tongue and the epiglortis.

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the region of the larynx: 32the hyoid bone is situated at the level of CI}. 'lthe thyroid cartilage is situated at the level of C6.the cricoarytenoid articulations are s'yi‘;gyialTithe angle at which the thyroid laminae meet is greater inmales than females.at birth, the body of the hyoid hone is usually ossiiied.

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The blood supply is from the external carotid artery(superior thyroid branch) and from the lhyrocervicaltrunk (inferior thyroid artery).The thyroidea ima artery is present in about 3% ofcases. lt enters the lower border of the thyroidisthmus either from the brachiocephalic trunk, ordirectly from the aortic arch. ';.H_""" " _The‘superior and middle thyroid veins drain into theinternal iugular vein. The inferior thyroid vein drainsinto the irtnominate vein.

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About go"/9 of individuals have four parathyroidglands, 2.5% have fiye glands. " '

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The two layers are the fibrous and the serouspericardium. ' ' ' HOnly the part of the superior vena cava below theazygos vein insertion is enveloped by pericardium.

The transverse sinus is a pericardial recess whichmay be mistaken lor mediastinal adenopathy. Thesuperior recess or oblique sinus lies in front of theaorta.

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The lettatrigm is the Fhost posterior chamber.The crista terrninelis is e muec_:_ul_gg_ri§lga on theposterior wall of the right atrium, between thesuperior and inferior vena cava.These features characterise the right ventricle, aidingeasy recognition at angiography.The left atrium receives four pulmonary veins.The right ventricle is the most anterior chamber.

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The aortic, pulmonary and tricuspid valves each havethree cus sD _ .Tile 1[iQ_ 5 id valve is the only valve lying to the rightof the rnidline. Q‘ ~ ‘ ""__f____§___» .._.

The tricuspid valve is the most inferior of the [ourvalves. T’ i I HTlie chordae are attached to the free borders of thecusps and to papillary muscles which arise from theventricular walls.

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The right coronary artery arises from the giterioraortic sinus. The left coronary artery arises from theleft posterior aortic sinus.The sinoatrial node is supplied by the right coronaryartery in about Q9"/glgf cases. The atriovantricularnode is supplied by the right coronary artery in about90% of cases.The dominant artery is defined as that giving off theposterior inieryentricular branch. ‘The diagonal branches arise from the [git anteriordescending artery. The circumflex artery has at leftmarginal branch. .; “Ti” J _ N“The circurnfl_e>§pranch of the left coronary artery tonsin the atrioventricular grggygi pgsteriorly. The lehanterior des_;:en,din'g artery runs in the intarveniriculargroove.- T""""'“"

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The coronary sinus receives 60°/aiot the venousdrainage. '

The anteriior cardiac veins and venae cordis minimaeopen directly into the right atrium. The great cardiac,middle cardiac and small cardiac veins drain into thecoronary sinus.The great cardiac vein accompanies the left anteriordes the interve e. The einaccompanies-~the posterior _ _ “inteiventricular artery in the posterior intaivantriculargroove-. —~~~ r »~-~ ’

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The aortic opening is at the T12 level.

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It lies vvithinythg _l'1]§_SBfli8f\]. ' rThe ileum has a smaller maximum diametertapproxitttatelyigmi.They are thicker in the ieiunum. where they measureapproximately ;__r_"n_m. They may berabsent in thedistended germinal jlgum,This remnant of the Vil8i_l_Q_i[\_§Q§l_i[\ai duct is usuallylocated in the ileum within 1 m of the ileocaecalvalve. lt typically measures less than§_c_m/irtlength.The stomach receives part of its blood stipply fromthe right gastric and gastrtzguorglaljneries. Bothare branches of the common hepatic artery._ __ ..._._~. ...-an . _,—-- _}-"g§_\ _v ,,

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Pelvic peritoneum covers the upper third of therectum anterigrly and laterally, the middle th_irdanteriorlyonly and the lower third not ai ail.There are usually three lateral grescentic folds, lessthan 5 mm thick, bufthey are variable inconfiguration.The superior rectal vein drains into the portal systemwhilst the middle and inferior rectal veins drain intothe systemic venous system. The rectum thereforeiorm§_a site oi porto-caval anastomosis.it also receives blood from the rnic.ld_lt.=:_[gt;ta_lbranches» of the internal ilias armies. the inferior.rectal branches of the internal ptidendai grtgrig andthéhfledian sacral artery. ' .

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it bifurcates-at the level oi the body o/f_l.4.d)li gives rise to the superior__rneserttgric§T1' inferiormasenteric arteries at the{LTland i.3iievelsrespectively. M J H

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The interior vena cave starts at the level of L§,,"lowerthan the bifurcation of the aorta, and passes throughthe central tendon oi the diaphragm at T8 [fourvertebrae higher thanthe commencement of theabdominal aorta). -'The median sacral veins, companions to the artery,drain into the left gornrrion iliec vein in front of thebody of ts. " "' "Whereas the left adrenal and gonadal veins enter theleft ren_a_ii_ygi_n. The inferior vena cave also receivesdrainage direct from both renal \_/gins, the third andlounh lumbar veins, the hepatic veins and the-inierior phrenic veins. 'The irilerior vena cava is derived from the persistingright supracarrlinal, right subcardinal anti rightvitellirie veins.The left inferior vena cava drains the left renal vein,crosses the spine and continues cranially as a normalright-sided inferior vena cava.

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B

C

Du E

False

False

True

TrueTrue

The left branch of the ntidgllg colic artery lot thesuperior mesenteric artery) anastorhoses with abranch of the left colic artery lot the infg_ri_qr _mesenteric artery) in the region of the\§§_pitini§_jlg>_<ur§)The left hepatic artery arisesi om the superior“_—“mesenterid artery in aboutgffgaif cases.The inferior pancreaticoduodenal artery is lha_li,r_s_tbranchpf the superior mesenteric artery. itanastomoses with the superior pancreaticoduodeitalartery, a branch of the g8$L(l:£)_(_1_E.l2_qEt\__a'i_8_Q§_fy. ‘

The superior mesenteric artery passes anterior to theleft renal vein and the third part of the duodenum toenter the mesentery of the small intestine.

51ABC

D

E

FalseTrueTrue

False

True

~3~.

its long axis lies along the line of the tenth nb.r. '*~~--~_

The spleen abuts the upper pole of the left kidney.This produces a prominence on the lateral aspect ofthe kidney.The splenic artery enters the spleen via thesp_lepgrenal_1igament. which also contatnsgte splenicvein and pancreatic tail. ' TThe spleen is related anteriorly to the greater curveof the stomach and the splenic flexure of the colon.which both show splenic impressions.

A

B

T c

DE

True

True

False

TrueFalse

Pancreatic tissue is gradually replaced by lat andfibrous tissue with advancing age.The pancreatic nr.ck_lies anterior to this venousconfluence. \""""-"WThe uncinate process and part of the pancreatic headdevelop from the ventrflgut diygrticulum. Theremainder of the pancreatic head. body and taildevelop from the dorsal diverticulum.

The calibre of the main pancreatic duct increaseswith age, but in subjects younger than 60 years, itsmaximum diameter in the region of the body shouldbe no more than 2 mm.

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34 MCCJ Tutor in Radiology '

53 _The head of the pancreasfi i 53 AFA Bis more cephalad than the tall.

lies antarlor to this common blle duct. ,is drained by the main pancreatic duct of Wirsung.receives its main blood supply from branches of the splenlcartery.

v_ has an uncinate process which is crossed by the superior' mesenteric vessels. '

..;<‘>§%e.rY

.54 Ihe gall bladder;A usually has a volume of approximately 300ml.

TB is related to the hepatic llexure of the colon.FC has a spiral valve composed of smooth muscle.

D normally has a wall thickness of about 1 crn. ./(E typically lies anteromedial to the right lobe of the liver.

'FA a R_iede|'s lobe is more common in males than in females. ~"'\<-1(o-Mt.-.z\~ \"v,t7\,¢,...,,.1,t_,f F5 "en°‘-'5 d'3'"39_9 ol the qttgfilrratt-globe ts usually distinct lrorn_ (tire rest of the ltver._ C()>\1\)\¢lti/CE. Q({)~¢

C . L xthe ltgamentum teres ts a temrtant of the)umbilir:ztl vein/(D the.cat._r_date_lobe lies between thei'\i|'tletif)_t'__:{Ena cava and the

pprta hepatts. ‘ ‘F/\/E the bare area of the liver is applied directly to lite diaphragm

J

r 55 In the llver: 55

; .

Amer 35.\ /I _ D

False Jillie tail of the pancreas is highefthafi the head. KTrue‘ -~ It also lies anterior to the inferior vena cava in the

region cl the termination oi tho tonal valm.TrueFalse it receives its main blood supply from

pancreaticoduodenal arcades formed by branches ofthe ga§t_rg3_ggdefial'EFd superior mesenteric arteries.The necli, bodyhahhd tail of the_§afiEfi2‘a"s're‘CElVe theirmain blood supply from branches of the sglertlcartery. 'I-"True .,,_ A

False The volume of the gall bladder is usually about30-50 ml.

True-False The spiral valve"lof_Heisterl;n the neck of the gall

bladder is composed oi crescentic folds of mucosa.False The normal gall bladder wall thickness is about 1 mrn.True at l=m,;|7(Tn__

False A Riedel's lobe. the downward projection of thea\nterolateral aspect of the right lobe of the liver, is

. mo“re_é5'r'n'r*non in rgtgqgtég 'False The venous drainage ol_the caudate lobe is

frequently distinct from the rest of the liver, direct tothe inferior vent-1 cava. rather than into the hepaticveins. ‘

True lt runs in the free edge oi the lalciform ligamentwhich extends from the urnbilicus.

True Whereas the quadrate lobe lies irtferiorly and isbordered by the ligamentum teres and the gallbladder. Both the caudate lobe and the quadrate lobeare segments ol the left lobe of the liver.

True The bare area contains part of the inferior vena cavaand hepatic veins.

4

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55 in the hepatobiliary system; ' 55L! /\‘ A the_cystic artaryiarises from the right hepatic artery in the

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ma|or|ty of cases.the cy l,c- ct usually lies to the left of the common hepaticduct. 13¢the rig t hepatic artery crosses dorsal to the portal vein inabout 10% of cases.the right portal vein receives blood mainly from the superiormesenteric vein.the hepatic veins follow the structures of the portal triad.

AB

C

D

E

TrueFalse

True

True

False

ln aboutl90‘YQol’ cases.lt usually lies on the right of the common hepaticduct.ln the large rnaiority of cases the right hepatic arterycrosses ventral to the portal vein.Whereas thaalelt portal vain receives blood mainlyfrom the-splenic and inferior mesenteric veins.The hepaticveins are igtgrgggggal, in that theydrain portions of adiacent segments of the liver andconverge on the inferior vena cava. Each segment ofthe liver is supplied by a portal triad lhepatic artery,bile duct and portal vein).

. ll \_ _1‘ ' rs

- 57 The portal velnz’ 57 A

l/r;%TE

lies posterior to the common bile ducts 5 .is formed by the union of the splenic and interior mesentericveins.’receives the left gastric vein.receives the right colic vein.provides about 75% of the blood supply to the live

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58 Regarding the adrenal glands:a A the medial limb of the right adrenal gland is smaller than the

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lateral limb. _ 'the right adrenal gland lies cephalad to the right kidneY.the right crus of the diaphragm is a medial relation of the rightadrenal gland. “ __they receive branches from the inferior phrenic arteries. .the left adrenal vein drains directly into tlie inferior vena cava.

I

B

C

D

E

True

False

True

False

True

T' T4”; K

In the free edge of the lesser omentum the common 'y_v__-I‘, -bile duct liesvto the right. the hepatic artery to the lett " ;~'-\ ‘Iand the portal vein posteriorly. At the pona hepatis. _the arrangement is: duct, artery and vein from F, H ' Ianterior to posterior.The portal vein is formed behind the neck of thepancreas by the union of the splenic and superiormesenteric veins. with the inferior mesenteric veinjoining at or near the angle of this union.The portal vein usually also receives the right gastricvein. cystic vein and some duodenal or paficieaticveins.The right colic vein drains into the superiorrnesenteric vein. along with the right gastroepiploic.'pa'nci'eaticoduodenal. jeiunal, ileal and middle colicveins, H ' * -gs",-2, of the blood supply to the liver is provided bythe hepatic arteries.

A

B

CD

E

False

True

TrueTrue

False

The lateral limb of the right adrenal gland is thesmaller.The left adrenal gland lies anterior to the upper poleof the left kidney. -

Superior adrenal branches arise from the i_l1f_e_[jg;phreQir_:_a__rt_gries bilagrally. The adrenal glands arealsffsupplied by the migglg adrenal arteries, whichare direct branches from thgjgrtgi and the infgripradrenal arteries, which are branches of the renalarteries. ~ "'"""The left adrenal vein drains into the left renal vein.The right adrenal vein clr_ains.d\irectly ii{to—tlTa inferiorvena cava at the level of T12. '“"'_"‘

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38 MLJU lutor lll Hadtology

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=5quadrate fills tver.aorta.body of the pancreas.second part of the duodenum.epiploic foreman. B

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the renal artery liesTposterior to the ureter at the hilum.their superior poles lie closer to the median plane than theirinlerior poles.about 25% of kidneys receive their blood supply via multipleaortic branches. Aboth are related to the colon anteriorly.typically each renal artery divides into four segmental

Q branches,-5} t

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60 Regarding the l'tidn&t§§>\.i\/(A

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The right kidney?is usually smaller than the lelt.usually lies lower than the lelt. 'usually moves further during respiration than the left.is related to the duodenum.is tlrainud by the right renal vuin which is longer than lltu loftruntrl vein.

Ff!o0m>

has three narrowings along its length.is lined by transitional cell epithelium.is retroperitonaal.lles lateral lo the tips of the transverse processes of thelumbar vertebrae. rreceives pan of its blood supply from the gonadal arteries.

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Anatomy 39

ABc0

E

False The right adrenal gland is related to the bare area ofthe liver. "W

False “ The right adrenal gland is related to the infergfinacava. TH

False lhe left adrenal gland is related to the body of the' pancreas.

False The second part of the duodenum is separated fromthe right adrenal gland by the inferior van; cava.

False The inferior vena cave lies between the epiploicforaman and the right adrenal gland.

BOA

BC

D

E

x~‘-False At the renal hilum, the renal vein lies anteriorly, the

ureter posteriorly and the renal artery in between.True -True There may be two, three or four renal arteries which

enter through the renal sinus or at the superior orinferior pole of the kidney.

True Anteriorly the right and left kidneys are related to thehepatic and splentc flexures of the colon respectively.

False The renal artery typically divides into posteriQ_r_gndanterior branches, which together supfily fivesegm'éE=tfs': apical and posterior (from the posteriorbranch) and anterosuperiorj ‘anterointerior andinferior lfromthe anterior branch).

\

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True ¢ r 'True .False The left kidney moves further than the right.True The duodenum is related to the anterior surface of

the right kidney.False The lclt ronul vein is longer than tho right, crossing

the aorta nnturiorly to upon into the inluriot vumtcava superior to the right renal vein.

A

BCD

E

True These narrowings occur at the pelviureteric junction,pelvic brim and vesicoureteric iunctio'n.'“'”

True T ‘True ”False The ureters lie medial to the tips of the transverse

processes oi the lumbar vertebrae.True The ureters receive their blood supply from branches

of the renal, gonadal, common iliac and vesicalarteriesf ' " ~

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Lj?:'.vg1 F51l§=."?@| 5 anterior to t'l"t iliac vessels.

4 B posterior to the gonadal vessels./(C posterior to the ileocolic artery. '/gD inferior to the vas deferens in the male pelvis. ,A E inferior to the broad ligament in the female pelvis.

A the inferior portion of the sacroiliac joint is synovial.B the subpubic angle in the adult female is greater than that in

the male.C the symphysis pubis is a synovial joint.D the sacrum usually consists of fourfused vertebrae with five

paired anterior sacral foramina.

~ 84 Regarding the bony pelvisf

_/‘I E the adductor magnus muscle arises from the ischiopubic . _ramus and ischial tuberosity. ' _ '

_ , V l

65 The right lschiorectal fossa; " " A‘- A has part of its lateral wall formed by the obturator externus

muscle.contains the pudendal canal on its lateral wall.does not communicate with the left ischinrectal iossa.has part of its medial wall formed by the levator ani muscle.contains fat.MUOID

in adults the normal si;e_ot;J.A ’A the nujligarous uterus is approximately 4 cm >< 2 cm.B the testis is approximately 4 cm >< 2.5 cm.

the prostate is approximately 8 cm x 10 (Tm.the ovary is approximately 0.2 cm x 0.3 cm x 0.4 cm. ‘the internal cervical os is up to 6 rnm in diameter.MUD

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TrueTrueTrue

TrueTrue

The right ureter lies posterior to the ileocolic andright colic vessels, and the duodenum and the smallbowel meseotery. The left ureter lies posterior to theleft colic-vessels and the sigmoid meséfitery.

64 - AB

C

D

E

TrueTrue

False

False

True

The st_tg3ri9_[ portion of the sacroiliac ioint islfibdrgtigy‘)The subpubic angle is about 85° and 55° in the adultfemale and male palves respectively.The symphysis pubis is a secondary cartilaginousjoint. -' _'—____The sacrum usually consists of §i_g§_ fgsgg vertebraewith tour paired anterior sacral loramina.

65 A

BC

D

E

False

TrueFalse

True

True

The lateral wall of the ischiorectal fossa is formed bythe ischial tuberosity below and the gbtulatorinternus muscle above.

The fossae communicate with each other grrgugltloose rl=-sue behind the éfl.é!.E'?‘_‘E§!_BE9Yld“‘9 Hhorseshoe-shaped path for the spread of infection.The at-gal canal and levator aqj,mt'Isclas form the -medial wall of each lossa. -The ischiorectal lat pad allows for dilatation of theanal canal during défaécation and of the vaginaduring parturition. -

G’) U’: A

BC

D

E

False

TrueFalse

False

True

The non-pregnant uterus normally measuresapproximately B_crn’5<_§ cm.

The prostate is approximately 3 cm long and icmwide. T"""' W WThe normal dimensions of the adult ovary are2cm><3cm><~lcm.

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Regarding the uterus: ‘ 57the pouch of Douglas is an anterior relation.the paired round ligaments are folds of peritoneum.the arterial supply is from the lntefilliac artery.it is covered by peritoneum‘ori all but ihE'ir'1lerior surface.the isthmus is in continuity with the cervix.

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/ -mm:m|mm A each tube is approximately ll) grn long.

they communicate with the peritoneal cavity.they lie in the lnlerior border ol the broad ligament,the isthmus is the narrowest segment.the folds of mucous membrane are arranged in the mostcomplex manner in the region oi the ampulla.

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Regarding the ovaries:A

ITIUOGI

prior to ovulation follicles measure approximately 13-24 mmvenous drainage of the right ovary is to the rloht renal vein.they lie enterolateral to the uterus. “they commonly calclfy in normal individuals.they he anterior to the ureters.

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False The pouch of Douglas lrectoutgrineipouchl liesposterior to the uterus.

False -The round ligaments support the uterus andcomprise li_t_grgmu§_cul§_r bends extending from thelabium maiorum, tlirough the deep inguinal ring toattach to the uterus. The broad ligaments are folds ofperitoneum. "' K ' ' I H V

True ° “ KTrue .;True The isthmus is the lowest halfcentimetre_g§Q1§_i1ody

of the-uterus and this is 'oo'rTtiiiuous with the cervix."£~

68A TrueTrueFalse The uterine tubes lie in the superior border of the

broad ligament.True The other segments of the uterine tube are: the

uterige, arnpulla and iniungigglum. - 'True The uterine tubes are lined with mucous membrane

which is arranged in folds which are sparse in theisthmus and become increasingly complicated

_ towards the ampulla.

69 True‘ "False Venous drainage of the right ovary is to the_iQfg[i_q_r

vena cava. Venous drainage of the ‘left ovary is to theleft renal vein.

False They lie t3_9§l.E_!'Qi.&leral to the uterus. ‘False Physiological calcification is rarely visible in the

corpus albicans.True

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antenatal ultrasoundthe fetal heart is first detectable at 4 weeks gestationthe cr_o\1v_p_:rurnp length is the l:--_"-st measurenient for assessingmaturity at 642 weeks gestation.

co) In 1A -t

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" C the normal biparietal diameter 2'.’ :§t_weel:s is approximately\ "40 mm.

the lateral ventricular ratio should not exceed 35%.the gut is normally extra-abdominal at it-3 weeks. gestation.

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I 71 '.Tha.testis':,A has the epididymis as an imrnetliate posterglateral relation.

:5 surrounded by a fibrous capsule called the tunica vaglttal':;i_has its venous drainage to the internal iliac vein.contains the rggtg testis near its posterior border.usually lies within the scrotum by the seventh fetal month.

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B

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is arnbryologically derived from the W9_1_iiia_n duct,commences at the head of the epiclidymis. 'is t=.p_qr_a_p_e_ritoneal within the pelvis.at the ampulla, lies medial to the seminal vesiclesloops over the ureter as the ureter enters theblad-tier. l '

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I

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FalseTrue

TrueTrue

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It is iirst detectable attgygggs gestation.Biparietal diameter may be used to assess maturityat 1g—3O v_veeks_ femur length at l§l—Z2 weeks andfetal abdominal circumference at 30-40 weeks._’___, _._%

The lateral veiifiricular ratio is calculated by dividingthe distance from the midline to the lateral wall ofthe lateral ventricle by the distance from the mitllineto the inner table of the skull, in the coronal plane.A loop of gut extrudas into the umbilical cord as the"physiological hernia" at about the and of the sixthweek oi gestation, and returns to the abdominalcavity towards the end of the tenth week.

___..__..___ii.d4_i..~.L___

-A AB

C

E

D

TrueFalse

False

True

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The tunica vaginalis is a sergusgac covering theanterior and lateral surfaces of the testis. The tunicaalbuginea is a librouscapsule. lVéttouswdrainage of the testes is via the §_§§Q§g!§t.veins; The right testicular vein drains to the in_§g[i9__rvena gave and the lgit__ to the left__r_e_n§_l,vein.Semen drains via seminiferous tubules into the ratetestisrlrom where the vasa erlerentia pass towardsthafigpidldymis. YBy the seventh fatal month the testis lies at the deepinguinal ring. It should be in the scrotum hy birth.

' - 1

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CDE

TrueFalse

TrueTrueTrue

I A. T

Each vas deierens commences at the tail of theepttlidyntis in the scrotum. " ‘ ‘

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3 Regarding the male urethra:A the membranous urethra is the widest part.B the verumontanum is on the anterior wall oi the prostatic

urethra.C the prostatic duct openings lie |a_te_ra_l to the veruntontanumD the navicular lossa lies within the bulb of the urethra.E the penile urethra lies within the corpus spongiostrm of the

penis. '

74 Regarding the bladder:A it has a capacity of approxirnately 1.5 lg

the trlgone lies between the ureteric orifices and the urethra.the seminal vesicles are posterigr__rgla_tions in the male.the obturator internus rnuscle_is an inferolateral relation.the pubovasical ligaments support the bladder superiorly.YTIUQCU

7 5 The following hive their lymphatic drainage predontintmtly tothe external iliac lyrnph nodes:A testes. i .B bladder.

prostate.UiBl'U5.rectum.‘WOO

\/Concerning the cranial loremlna and canals:A the superior orbital fissure transmits the maxillary division of

the fifth cranial nerve.B the foramen eye]; transmits the mandibular qiyision of the

filth cranial nerve. ‘ " " 'C the loramen spirtgsgnt transmits the ntic1rll_e _trt§n_irtgea_l artery.D the superior orbital fissure lies between the greater and lesser

wings of the sphenoid.the leh jugular foramen is usually larger than the right.E

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Ctfi D

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_Fa|se MFalse

TrueFalse

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Anatomy '47-/‘E’ F V,’

The prostatic urethra is the wiilffit part.The veriumontanum is on the postQ'i,cy'_yval| Of theprostatic urethra and has the utricle and__e_jac_ulatoryduct orifices on its ventral wall. _h

The navigular lossa is a short dilated region justproximal to the external urethral meatus.

5

FHUOWP

FalseTrueTrueTrueFalse

1‘-'_—_ 77'

Capacity is about 500 ml.

The pubovesical ligaments are condensations ofpelvic fascia that support the bladder tnferrorly, alongwith puboprostatic ligaments in the male.

75A

BC

DE

False

TrueFalse

D

TrueFalse

The testes have their lymphatic drainage to thepara-aortic lymph nodes. i

The prostatehas its lymphatic drainage to theinternal iliac nodes and sacral nodes. A

The rectum has its lymphatic drainage to thepararectal, preaortic and internal |i|ac nodes.

76A

ITIUOW

False

TrueTrueTrueFalse

The loramen rotttngtrm transmits the maxillarynerve. The-superior orbital fissure transmits the QM{Dun}, and 5i_x__§h_£r§tnial nerves, and the first branfhofihe fifth cranial nerve, along with the SUpErl_Ol'ophthalrnicyein. l

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Tlae right jugular forarnen is often larger than the left.

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egarding the bones of the sl\u€|: 77the pterygoid proc§_s_ses arise lroiri the inferior surface of thebody oi‘ the splienoid bone. ' ithe occipital bone forms the posterior hall of the cliviis.the occipital condyles are situated at the posterior half at thaforarnen magnum.the jugular foramen lies lateral to the hy;-cglossai i;_an;i:_the internal jugular vein is transmitted thrcuglt the medialportion of the jugular foramen.

1

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Regarding grooves and sutures of the calvorium:A .. II

B

C

D

E

, 78the parietal star is caused by venous sinuses impressing onthe inner table of the skull.parietal foramina are usually situated close to the sagittalSUN-ll'E.the bregma is the point where the sagirtal suture meets thelambdoid suture.the asterion is the point where the lamb-doitl suture meets thesquamosal suture.sutural sclerosis becomes incite apparent with increasing age.

ABC

DE

TrueTrueFalse

TrueFalse

-

The occipital condyles lie at the antg_ri9_r_h_al§ oi theloramen magnum, their posterior poles separated bythe width of theaéoramen and their anterior poleslying closer together.

The internal jugular vein is transmitted lhrOugh thelateral portion of the jugular foramen. The n_ip_tlt.t_§h1'lT'ahTl"elevi3itth cranial nerves pass through thenlggjgj portion of the jugular foraman.

1‘I

' ' -~-t u'sn4tIv'fl‘*$t'i"~'=! tart;.,g,_..=‘»tw,..'.~.-;.~t-»_ -qy1§Vj'l1qg__5rt1lng~thefsku‘ll'inlfinfancy. and‘chTidhood'H ‘the metopic suture passes obliquely through” the occipital bone.

UJ)>

CD

E

themetopic suture usually fuses within the first 6 mo. _ ntlts ofextrauterine life.closure of the posterior fontanelle occurs at '18 mnntlts of age.at birth there are no vascular markings and no tzur-.~.-ulutiottalimpressions.the spheno-occipital synchondrusis begins to close by the ago ,of 5 years.

l lift

A

BC

D

E

False

TrueFalse

True

True

The "parietal star" is caused by veno_g§_pl_gxuseslying between theinner and outer tables of the skull.

The lambda marks the junction of the sagittal andlambdoid sutures. The bregma marks the junction ofthe sagittal and coronal's‘t'tTl'fr'és.The pt@rt'6;t matks'the point where the coronal suturemeets the sphenoid bone latera||y..Sutural sclerosis is a physiological bony bridgingprocess across the suture.

it 1; A

B

C

D

E.

False

False

False

True

False

The mepdosal sutures pass obliquely upwards andinwards from the lower part of the occipital bonebilaterally. " -The metopic suture of the frontal bone is present atbirth, disappggrs from the ninth _fl_‘l9_nth onwards andis usually fused by the end of the second year.Occasi0nally_it persists into adult life. 'Closure of the posterior fqrttanelle usually occurs at§'§ months. Closure of the anterior lgntanelle usuallyoccurs at t5_;l§ months. " ’ VThe vascular markings and convolutional impressionsappear bervv@==9__5l1s second anti thirst Years-The spheno-occipital synchondrosis begins to closeduring puberty. ' '

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K/r B '1-' 1r.it:»-I.-Tilt.-‘.tw;r*ti .t,- rs: *r_s_t;;_tg;t§tlt5t;";'&ttIa“\l€RlE”£l‘{l’5€t'i'§'tTF &W£ce. .

A the loramen spinosum.the lateral wall of the maxillarysantrum.the odontoid process ol the axis._ihe dorsum sellae. it 00¢’ -1‘the carotid canal. QM JMUOCU

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i’ St \ The following may be seen on a hall-axial (Townes) projection

“.5-rol the skull: '\"

the loramen ovale.\»§'l\/flyA .Q7 B the loramen rotundurn\.-Z)‘/C\y

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the internal auditory meatizthe superior orbital fissure. ts Fthe condyle of the rn_andibl‘e.}_

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/nf§Z§<i.’7l3'.§1iii3;*2'F;ll?i*£!.nt£§£t§!l‘3tltsa'.Pi."sat?anOccur?-ii-tt=.'\_ the pineal gland in approximately 5% of adults.

the habenular commissure./ the petroclinoid ligaments. F

l’I‘lUE'J(I7]>the lalx cerebri.the dlaphragma sellae.

83

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Regarding the branches of the aortic arch:A the common carotid artery bifurcatas at about the level ot

second cervical vertebra.B in the neck, the internal carotid artery lies medial to the

external carotid artery throughout its length.

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C the left common carotid artery arises from the innominateartery in about 27% ol cases. ‘

D an aberrant right subclavian artery occttrs in uhmjt 1% glpopulallon. t

E the left common carotid and left sulmlaviart arteries havecommon origin in about l% of cases.

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? Anatomy 51..*"?i _ , __ ,_

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True 'True The lateral wall of the maxillary antrum has an

_Sv-shaped configuration which is superimposed onthe lateral wall of the orbit; the latter appearing as astraight line.

True "lFalse The dorsurn sellae is seen on lateral and half-axial

(Towne'sl projections.True "F.-I '

A

B

C.oE

False The foramen _ol/aha is best seen on thesubntentovettical projection.The foramen ro_tur1_clum is best seen on theoccipitolrgrttal projection.

False

Tru eFalse The superior grlgjtal fissure is best seen on the

occipitofrohtal projection.True ,

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False lt occurs in__about_'/l§Q§’3)>_f_ adults.True‘ ln about 5019 of adults.True ln about 'fi%'§ol adults.True in aboutt7°/:10! adults.True

83I

A

B

C

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False The common carotid artery divides into the externaland internal carotid arteries at about the level of thefourth gervical vertebra. 4/ '

False The internal carotid artery lies p9_§t§_rior to theexternal carotid artery; initially lateral t0. and thenmedial to it. '

True Thlsis the most common normal variant affectingthe arteries arising from the aortic arch.

TrueTrue

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artery:)> 84 The following arteries arise directly tron‘. the internal carotid

r A

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the mertingohypopltyseal artery.the anterior communicating artery. Hthe callosomarginal artery.the posterior cornmunicattng artery. .,the ophthalmic artery. ~

B

CDE

DJ)? 85 Regarding the internal carotid artery:A it usually has no main branches in the neck.

on entering the cranial cavity, it becnrnes subaracltnoiil inposition.thecarotid siphon is formed by the cavernous segment only.it gives rise to the anterior choroitlal anery.ll anastomoses with both the external carotid andvertabrobasilar arterial systems. _

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. _ V __n_ ____,; _ -_-._:--.- ;-_:;_-. B41‘; T/(i tiwilig,h$a>rte§na§caot§1artgrQ§t\it;'s.riseito:~

the ascen tng pharyngeal artery,

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the inferior thyroid artery.the internal maxillary artery.the occipital artery.the posterior auricular artery. _

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84A True

False

False

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The nieningohypophyseal artery arises posgriorlywithin the cavernous sinus.The anteriorcornrnunicating artery acts as an arterialbridge between the anterior cerebral arteries. Thelaner are dirgct branches of the internal carotidarteries...The CQllQ§__Qfll_Q[Qll‘ldl artery is one of the three inainbranches of the anterior cerebral artery, distal to theanterior communicating artery. The other distalbranches of the anterior cerebral artery are thell9£!Ei:‘B°la‘ and P‘3ll§.§!l.l.°_i§§l§!.lel'ia5-The posterior comrnunicating artery arises posteriorlyfrom the distal loop of the i:ar0_tiQ_siphon__to link theinternal carotid artery with the posterior cerebralartery. M .The ophthalmic artery is usually given off just afterthe carotid artery leaves the cavernous sinus; but itsorigin is variable. W '

85

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TrueFalse

False

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True

it lies external to the dura mater within the cranialcavity and cavernous sinus, and enters thesub-arachnoid space at the level of the anterior clinoidprocess. "The carotitig siphon is formed by the cayernggs andstipraclirtoid segments of the internal carotid artery.The anterior choroidal artery arises posteriorly lrornthe carotid siphon just distal to the posteriorcommunicating artery. '

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TrueFalse

True

TrueTru e

The inferior thyroid artery arises iromfthathyrogeryicgl trunk which arises from the subclavianarféry. The superior thyroid artery is usually the firstbranch of the external carotid artery, but may arisefrom the terminal part of the common carotid artery.The internal maxillary artery is one of the terminalbranches of the external carotid artery; as is theSllpsifiéflel Pampers! answ-The external carotid artery also gives rise to thelingual and facial arteries.

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4»{,1Ql-I 87 A TrueThe vertebral artery:A usually has a wider calibre on the left titan the right.

usually enters the loramen transversarium of the seventhcervical vertebra.arises from the thyrocervical trunk in some individuals.is usually the first branch of the subclavian artery.usually gives off the posterior inleii§_cerebellar artery iustbefore entering the loramen magnum.

The left vertebral artery 1s_usually the larger, but theright is larger in about(g)_‘j4Jof cases.The vertebral artery usually passes through theforamina transversaria of the upper six cervicalvertebrae. it enters the fora en of the seventhcervical vertebra in aboutilgsof cases.

' ...B B False

CDEif T_, C 1’ True

“’ .,.D ..True- E False .

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The vepebral artery gives off the posterior inferiorcerebellar artery after entering the cranial cavity.

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-vi 1 '1 ti ‘The third, fourth and opl1_t|1§lQ;)jg__ar|d gigrillarydlvlsléiiie of the liith cranial nerves lle in tiisleteral

‘v wall of the cavernous sinus. The sixth cranial Herve' ‘ r'u?{s through the cavernous sinusTiiéTo__r_an_g‘l_ateral

to the internal carotid artery. The maFi_G_ib_uiar nervepasses ‘downwards through the fo|"arner'i__gyale intothe infrritemporal iossa. 4v .

88 The cavernous sinus: 33 A’A drains the ‘ophthalmic veins. B _ True

drains into the superior and iulerior petrosal sinuses. ' C False‘1/ contains the mandibular division oi the trigaminal nerve. "

lies lateral to the sphenold sinus and pituitary lossa.lies in the subarachnoid space.munm

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_ ., E tr"_'/(!)/ F5‘ _i'r D True

"I t’ -/1 1 ____ V E False-’, ' 1 I The cavernous‘ 'sinus lies between the layers oi the

dura mater. i '" "_ .. ..4... Q.

. ___.. — _ . _ U _ , ,_. Y

89 Regarding the cerebral veins: " 39 A False= A the septal vein and the thaiarnostriate vein join to fours the - .- ._

great cerebralvem ol Galen./L BC

D

The septal veiifahcl the thala_rn_ostriate vein join atthe»-veno-uslahgle to forrn the int_F._:_F_r1:§’l cerebral vein.The internal ggrelaral veins and basal veins ofRo%nth§l'ioin to lorm the great cetiibral vein ofGalen‘: ' M"The great cerebral vein joins the inferior sagittalsinus to form the straightsinus.The superior sagihal sinus usually becomes the righttransverggnus, the right sig_r11_gi5l sinus, then theright'intg_r_r]al jugular vein. The straight sinus drains ina sirhilar sequence on the left side.

the great cerebral vein oi Galen joins the interior sagiua! sinus 'to lorm the slgrnold sinus.the superior saglttal sinus usually drains to the righttransverse sinus.the great cerebral vein oi Galen lies in the quadrigenrinalcistern. H .the cavernous sinus cornmunicares with the veins of the face.

B Falsel

C True

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D TrueE True Via the ophthalmic veins anti pterygoid plexus.Iv ‘ _____...i--__

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MCt.1]Tutor in Radiology V V ' ' '.

’ "the interventricular forarnen connects the third ventricle withthe fourth ventricle. ' Lthey communicate with the central canal of the spinal cortlthe roof of the anterior horn of the laterat ventricle is formetlby the corpus callosum.the pineal body lies in the posterior wall of the third ventriclethe media" _aPerture ll‘0ran]£[l_gj Mggeridiel connects thefourth ventricle with the cerebellomedullary cistern.

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-r- - ._ :;.-,-" -- . ta,l e spurt ' formed by the junction of the external auditorycanal and the lateral wall of the attic.the promontory forms the roof_ _the handle pl‘ the malleus is attechetl to thu tyntpanicmembrane.the tncudornallear and incutlostapediel joints are synovial.the osstcles have the appearance of a “molar tooth“ on alateral tomogram.

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False

True

True

True

True

The interventrfzular iorarnina of Munro connect egg} _lalilél Yetttttgle to the th_irrl_ ye_ntricTe:'A mitllinechannel, the cerebral aqueduct of Sylvius connectsthe thjrd_ anq fourth_v'éfitTiEl§”§.'—" _ 'Below the fourth ventricle the central canal extendsthrough the spinal cord into the upper and of thefilum terminate.The floor of the anterior horn oi the lateral ventricle »is formed by the caudate nucleus grtgthalamus.The hagggular corrtmTs'sTt?e, pineal body andposterior cgrgrrtissure form the posterior wall of thethird\}eFitricle. The lamina tgrminalis forms theanterior wall and the tl_'t'a_lamt4s forms most of thelateral yyalls. The ‘hypothalamus forms the l9_w_grlateral yvall and most of the lloor.Whereas the Qajred lateral apertures lloramina olLuschlgal open into the pontine cistern. Throughthese three apertures. one median and two lateral,the cerebrospinel fluid escapes from the ygntrrcularsysterrt into the suharaghgd space for absorptionby the arachnoid villi: '\ _-- .

True

False

TrueTrue

True

. r ~~ i eThis is also referred to as the s§gy_m. lt forms thesuperior attachment oi the tympanic membrane.The tegrnen ryrnpani forms the roof. The ponycapsule of rhg basal turn of the _cg§__hlea is called theprornoT'itory.

The incudontellear joint lies between the head of thernalleus and the body of the incus. Theincuclostapedlal ioint lies between the long @essof ghe -incus and the hea_Q gfthg srapes. WThe “crown” of the tooth is made up of the head oithe matleus and the body of the incus. The "roots" ofthe tooth are the handle of the malleus and the tongprocess of the incus. The malleus is anterior to theincus.

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/ -.. ggfrlrigcgsgrpgglgi the facial canal lies inferior to the latemi

the carotid canal lies in the anterior wall of the middle 9the oval window lies superior to the round window anthe mastoid antrum lies posterior to the middle ear.

"nth Q _ I.‘ 9 ‘ -; sea‘iey are rudimentary in the neonatal skullB the! ' ' - _. cavflgomal 9'"“5 °P9"9 ""0 ll"! SUPEFIOF mcatus oi tlie nasalC the ma ill ‘ -

cavitv X ary,s'n"'9 Opens into the middle rrieatus of the nasalD lh ' ‘ ' . .ey are |m.ed by clllaleg lT!!!?°"5 ¢°ll'!'lIfl'ril' 8 ilhelitimE h ' ' ' ' I : p .-i e spheno-id sinus I5 usually divided imo two by a ihm

septum, .

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\ 4 in the temporomandlbular joint;A an articular disc divides the joint cavity inn; gnjeriq, aaj

Posterior compartments. ' ~ "'B the lateral ' - - _ . ' _disc p‘e"Y9°'d YT"-'$¢l6 I5 Inserted partly into the articular

C th l ' ~ - . . -H‘: fnagrisiglgs attached inferiorly to the coronoid yirocess of

g ll"! Sphenflmflndlbular ligament lies fl"l9lll3|l\ ' ' '35;Siabllliv is maximised by occlusion /' . :3.-

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the pyramid lies superior to the aditus to the antrum. H

r Anatomy 59

True

TrueTrueTrue

False

. 41 _ __ .4

The facial canal is divided into three pans. The firstpart, or genu, curves anteriorly adjacent to thecochlea and contains the geniculate ganglion. Thesecond part doubles back posteriorly to lie beneaththe lateral semicircular canal. The third part descendsvertically posterior to the external auditory canal toemerge at"the stylomastoid foramen.

t-

Thmopening into the antrum, a__clitus tothefantrum,“lies in the superomedial part of the posterior wall ofthe middle ear.The pyramid is a bony projection from the posteriorwall of the middle ear, lying below the aditus, andgiving rise to the stapedius muscle.

I 93 True

False

True

TrueTrue

The sinuses develop during childhood; the m__a_>§_illaryand ethmoid developing earlier than the frontal fidspheflnlolldnslhusee. " M 'The frontal sinus opens into the middle meatus bythe frontonasal duct. 'In addition, the sphenoid §_i_nus opens into thespheno-ethmoidal recessI‘“The anterior and middleethmoidai air cells open into the middle _i-neatus andthe posterior ethmoidal air cells into the superiormeatus._ ' ‘ ‘ " ."

False

True

False

True

True

The fibrocartilaginous articular disc divides the iointcavity into sugergr and in_f£§i_qr compartments whichallow sliding and rotational movements respectively.The lateral ptarygoid muscle passes through thecapsule of the joint to be inserted into the disc. TThe capsule is attached inleriorly to the neglt _o__f thecondylar process of the mandible.The splienomandibular ligament passes from thespine of the sphenoid to the lingula gf the mandible.The joint is less stable in the open position.

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<57 ‘J \""‘*-‘W ‘-I \I'~ \lL"\IL, ‘J '_Il' ._I ‘J J‘ \__y J; J, \_v

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as I ._ .3,'~;, , -st r - --, the normal adult has 32 teeth.

there are normally 20 decrgtrlous teem w Bme _P*?"°d°"lal membrane IS seen as a raclictiett-as lineoutlining the root of a tooth on a ra:lio_qr-ash. ‘ Cenamel ts the most radiopaque tissue in rho llC|!'\,-‘m _ ’ ’ I 7 _. . .8 permanent teeth start to erupt at about b years or agr-t_

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Each ttuatlrant has two incisors, one canine, twopremolars and "tree rt1.eLar$- "Each quadrant has two incisors, one canine and two*“9lats= '— _'The periodontal membrane is seen as a ratliolucentline Outlining the root. The lamjlta gura lies outsidethis, and__a'p'pears as a radio Taque line around theroot continuous with that ofefhe adiacent teeth.lt has a calcified inorggfjg content of 97%. Mgtaflicfillings §_g_e;_more radiopaque than enamel.The permanent teeth in each quadranv erupt frommedial tg lateral. The lower teeth erupt §-lg monthsearlier than the upper. Eruption is complete by about20 years of age. " _

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96 Regarding the paroticl gland;A the retromandibular vein passes through it.

the parottd duct opens onto the cheek opposite the seconrlupper premolar tooth.the parotld duct pierces the masseter rntrscir-1,the mastoid process is a posterior relation.

E an accessory parottd gland usually lies superficially rm thernasseter muscle.

SSA

BB

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D

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...._... _.__.,..-_-.._._ _ __

True

False

False

True

True

The retrorn§fltLihulat.yeln. the racial nerve and theextejflél-§i$l'Olid artery all pass through the parotitlgland.lt opens onto the cheek opposite the s_e@nd_uppermolar tooth. -The parotid duct passes forwards over the tttassetermuscle, turns medially at its anterior border andfJl8l'C§§ the httfitrinator.The paroticl gland is related anteriorly to the angle ofthe mandible and the muscles attached to it. Theexternal auditory meatus and temporomandibularioint lie superiorly. The styloid process lies medially,superficial to the carotid sheath.Several clucts open from an accessory gland into thetnt1tt'lpttrulttl tlttr;t. T '

Rega'dinQ noun?" d3VB|0pm6nt Of the vertebral coluntn;A rlttsion of thu posterior clfipuuls ul lltu lluttrttl ,,,-r-mu

commen§:es"earllost in the cervical region.8 f . -1: uslon of the neural arches with the cenrrum commences

_ earliest in the lumbar regior*if*'““.’-5"“

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., C Bfive secondary os_st_f|_gat|on cetttrg_§;ai"e prutient in catchvertebra at puberty? y -;;_ I»

..z - _ __the dens may have more than one ossiticattrm Cent“;‘he ama_"°" ma‘QlI\5 Qf"the thoracic Vertebral bodies may ‘appear irregular. -sf. .. . _

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Fusion ol tho neural arches posteriorly starts in thellllllll-ll l\l\|ll)ll ttt ‘T lg '5 yggtrtt utttl prttuuutla cupltttlrttlto the cervical region up t_o_]_y§gr§ of age. Fusiott inthe sacral region occurs last. ’ 'l_Fusion oi the neural arches with the cep_t_rum starts inthe cervical regigrtgg Qyears and proceeds cautlad tothe lu'rn:ba'r' region, which ossifies at 5 years of age.Fusion in the sacral region occurs last.These centres fuse at about 25 years.Thu dens may have tvyo §)[1|'][§Q>Q$5lflCZ1llOl\ centres;lractures may be simulated.There may be irregularity at the anterior andposterior margins of the thoracic vertebral bodies.representing vascular remnants and the basivertebral

it _i:£¥‘-‘H _ ~___. - ._...--I.-.-... 4 .— .._._ t_ J). _. . ., V veins. The term Hahrts fissure relates to the anterior

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-‘ B Regarding normal measurements in and around the spine:A in children thaboslerior laminar line of C2 may be up to

1 mm behind the posterior spinal line. i

the interpedlcular distance should increase from l.t to L5.

B in children the atlanto-axial distance may be up to 8 mm. il 7 C the sagittal diameter of the cervical spinal canal at the level

/O\, _ of C4 should not be less than t6 mm.' ‘ _, D ig_p\revertebral soft tissues in the adult should be less than

.-' _ t_4 rn__m}in width at the level of the nasopharynx

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~ " 1' "-1 B8“ i l't_ ~¢ T’ or a -l §'amen{sin!tl't'§‘£erv“ti:'ia"l Splfléir' ~1‘-r Armih-tr-¥nmd4:-5 H alerts -use Mn" -it" 'E gem ma lavgaere enached to the intetvenebral discs

and vertebral bodies anteriorly.B the membrane tectoria is a continuation oi the posterior

longitudinal ligament. , l.-, C the ligamentum nuchae may crtlcity. ('1 .. "

D the cruciform ligament lies immediately behind the (lens ol ithe axis. -

E‘ the apical ligament passes from the apex of the dens to theanterior edge ol the loramen magnum.

fl9°@ fifi§' TA ,space in adults.the spinal cord has its maximum diameter at thé= level of C7the caude equine is situated within the subarachrtoid spaceth ' ' ' - 'e spinal cord is supported by the denticuiate ligaments.the artery of Adltmltlawlcrls the major arterial supply to thedortroluntber spinal cord.

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\/ the spinal cord usually ends at the level of the Ll/2 disc

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Anatomy 63

True

False

False

TrueTrue

This physiological subluxation is caused by-ligementous laxity in children. _The atlanto~axial distance is less than Ii-imm lflchildren. It should measure no more than 3 mm inadults.The sagittal diameter of the cervical spinal canal atthe level of C4 may range from approximately

- 12-22 mm», 1

‘F" __ _.

99 False

True

_True

True

True

The ligamenta flava extend between adjacentlaminae. The anterior longitudinal ligamentis _

attached to thelntg_F\r_ei1elgLal discs and vertebralbodies enteriorly. iThe posterior longitudinal ligament extends posteriorto the vertebral bodies from the occipital bone to thesacrum. The membrane tgfoiia refers to that partvvhich extends from thifoccipital bone to C2.The IigamentuLn__[lllgltae is'p'a'rt of the supraspinousligament, which joins the tips of the spinousprocesses and extends from the external occipitalprotuberance to the sacrum: ' "The transverse part of the cruciform ligament passesbetween the lateral masses of the atlas and behindthe dens to form the posterior part of the medianatlanto-axial joint.

‘I00 True

False

True

True

True

t'§s“¢'giQt cords end within‘ the limits of the vertebralbodies of Li and L2,{Ij9‘9_lat the level ofllz andgfa at

<i@At lglrth, the spinal cord usually ends at_th§___QJlevel. ' 'The spioalcord has its maximum diameter at thelevel 0flC5_)The cauda equina consists of lumbar and sacral nerveroots and the iilgrn terminate. As the segmentalnerves leave the v'é£bral canal, they are invested inthe meningeal covering of the cord.The denticulate ligaments, layers of pia mater. lielaterally and are‘ attached to the arachnoid and duradown to the level of the twelfth thoracic nerve.It is an enlarged anterior radicular branch of aseginerital artery in the T8-L4 region. It is left sidedin about 60%\al cases. i "T

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I‘ 4/M}!/C the incident: f d ~ T ~ ' "ZN, if _ _ _ _ e 0 severe a verse reactions to il‘|(|'a-'E||'[ef|g]]

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infants and the elderly.poorly hydrated patients. .patients with myelomatosis.patients with a strong history of allergy?ITIUDW

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6 ‘ a a ‘Tefin‘@“9"3'iF‘€0*'@flI@r0@'@-33* it."atit‘G

AB

CD

E

Tr e

FalseFalse

False

-‘H

Viscositfat 20“C is about twice that at 37°C.Meglurnine salts have a strong diuretic effect whichtherefore reduces the urinary iodine_§_0j§9fllt8li0fl inintravenous urography. The use ofsoditim salts ispreferred. > ‘ '

The osmolality oj '|o_g;9_§_,q1Qlar contrast media is _about o_rt5t_riirg_the osmolality oi conventional ioniccontrast media, but still twice the physiologicalosmolality of plasma.Anaptxylatfioid reactions are ra@lvg__q§g-_QgQ§i1g&__I\l-Hyperosnwolar adverse reactions are dosetlepentlent.

A

B

C

D

E

False

False

True

False

False

This is a iOW'Ot?|TlOiBf _lgi;egiqic_dim_er with aniodinezparticle ratio of 6:3. it may be used forintravenous cholangiography. . u. _This is a conventional h_igi1_-vg§molar'rionic rnonomerwith an iodinetparticle ratio of 3:2. \"""""”'T"A nongic monomer has an iodinezpariicle ratio of3:1.This is a low-osmolar rnorgg-acid dimer with anioclinezparticie ratio oi 6:2.This is a low-osmolar non-ion_ic dimer with anlOaifiEZP&|'TlC|B ratio oi 6:1. ''\6¢- ‘we mo L,-_t,~,

WUDUJP

TrueTrueTrueTrueTrue

These groups are at increased rislt oi the zitlverschyperosmolar affects oi contrast media.

And also those with a history of severe contrastmedium reaction. Both groups are at increased riskof the anaphylactoid effect of contrast media.

‘L‘~“i>—-~ i}-JJF5-13__ , , ’ Dr. Zajn H_ AL“ ‘H '

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.< -~ _ Techniques 674“.__ *- _ __ I .

Regarding contrast media;

C

D

E

A the adverse reaction rate of ifllfavengug lowesmoiar Comma‘/5

B

media is about one fifth that of intravenous conventionalhigh-osmolar cdntrast media.‘he “'Q9'3Phl‘f "ephofliam 15 Produced by contrast medium inthe renal arterioles. ‘physical or emotional stress increases a patient's susceptibilityE: an adverse reaction (following intravenous lnj5c[iQn'|_

astrografin is indicated when attempting to demonstrate a"8¢l180-oasophageal fistula in an infant.lll9h*Vl5¢O$l§Y low-density barium should be used in double-contrast barium meal examinations.

- ‘\<=1l

Intravenous contrast media. -A

DE

intravenous metoclopramide shotild l‘e given for nau5ga_intravenous chlorpheniramine maleaté lPtritonl is indicated insevere generalised urticaria.intramuscular adrenaline 0.5-1 mg is a lirst-line drug to beused in the treatment of anaphylactoid shock.corticosteroid prophylaxis is mandatory in astlmiatic atierits.

. , _ Pralsmg lh_B Dalleflls f€_ELl.1as no value in contrast-iridticedhypoiension.

5\R°9aYdi"9 "19 mflrligflrnentpi possible adverse reactions to' l

V a l

’ i

l.'riy,‘.')'_UOUJ

E

ianeesth atic: IA n?Q_rnl of e 1/B solution is the maximum sale dost: in adults.

it is ellectively absorbed from mucous riierribranes.(2'0flVU'lSlOfl§ are a recognised’ complication of toxicity.t_iere_is_an increased risk of lignocaine toxicity in patients Qflcimetidine.it is contraindicated lor use in actite porphyria.

9 7 /1Mj7’_',n ' v L_A/15.?‘ m,}9,t,1 ¢;“ er‘! _;-Lu ,_,,Lé.,/if/l-,‘.L..(,. . , .+‘//U 1 I’ lu ;,,,(;( /J¢>[4u¢,¢‘/7 /r1t:'.:.‘r.’4¢& 1‘;(flr:.=//213'!/'l‘J;I/3%) .1.-.-/'

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B

CD

E

True

False

TrueFalse

False

The quoted adverse reaction rate of conventional 'high;-ssmolar contrast media is about 5.8%.The urographic nephrogram is produced by filteredcontrast medium in the lumen ofthetibules, mainlythe proximal convoluted tubules.,_.-

Gastrografin is contraindicated because it ishyperosmolar and may cause pneumonitis and/oracute pulmgijag oedema it aspirated. lt may alsocause dehydration by its hyperosmolar effect in thesmall intestine. Dilute barium or a low»osmo!arnon-ionic contrast medium should be used.Low-viscosity high-density barium should be used.

A

B

C

D

E

False

True

True

False

False

Confident reassurance alone is usually adequate.intravenous aniiemetics are rarely necessary.This is an antihistamine. Intravenous corticosteroidsshould also be given.Intravenous llgjgs, antihgtqmlnas, corticosteroids andnebtilggbeta-2-agonists may also be necessary.EC§lonitoring, oxiletw and blood pressuremonitoring should also be carried out.The value of corticosteroid prophylaxis remainsunproven and co_r@@rsia|.

' $imple manoeuvres alone may be effective invasovagal syncope.

A

BC

D

E

True

TrueTrue

True

True

The maximum safe dose of lignocaine for localanaesthesia is 200 mg.

. ‘t='t‘l’Other side effects include agitation, euphoria, nausea,pallor, sweating and respiratory depression. 'Lignocaine toxicity can also cause hypotension,bradycardia and cardiac arrest.Cimetidine in_h_iQit_§ the metabolism ofjifiocaine,thus increases il\.eri§i§2!.mi¢itv.Lignocaine may induce actite porphyrlc crises. lt isalso contraindicated in hypovolaemia and compgteheart Ulock. -""'_"' _"

i rl r . .- *1? ‘ _ ,i i l /' 1 r .

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' overdose.\1'3!-/\?('»1jb C

/ D

\lignocaine is a constiprocaine is recomme

Regarding local anaesthesia in radiology:A paraesthesiae and sweating are eariy signs oi lignotzaine 1

adrenaline should always be added to lignotzaine to prolongits local anaesthetic eifect. ct

-,1--n

tt.l__ent ofEg1la urgent.ndcd In Order to anaesthetist: the

pharynx prior to passage of tiE i3 entaroclysis. __E FBSPWBIOW depression as a result of lignocaine overdose may

be reversed by naloxone. -

\

\

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8 Regarding pharmacologiradiology: "A g_lu_c;t_gon is a more p

cal agents used in gastrointestinal

otent smooth muscle |'L1ii.1K&il'ii thanhyoscine butylbrornide iBuscopanl.

It 8 hyoscine butylbrornide l8uscopan) may cause at.-ute gnstrit;. dilatation-

C glucagon is contraindicated in tliohetic patients.g metoclopramtrlo increases small howol trtttmit limit.

with mulocloprttmitlulikely to occur in chilt

. u><tr:t|1yr.tmitl.\l :;itlo ullt':t:t:; tut; mumlion than in ntlttllzl.

* .(".),;.!,.;/1-1-11:1/,"t@r[ -iygfi -llt/ .|*/'_<': ~ , .. 1, ' i’' -- .- €,.. 1-‘/i '7) rvc_},),_('('}'.;‘g}' )i;t .» "1'¢=/1.7‘

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B jal_se

C True

D False

E False

in addi/tiofio pallgr, speech disturbance, tremor andauditory hallucinations. These may progress tocentral nervous system and cardiovasculardepression.Adrenaline, ayasoconstrictor, should not be added tolignoca_itre“*wl\er\ used as a_local anaesthetic inappendages or digits as it may produce ischaamicnecrosis. ‘ ' '”‘=':~;H-’<"'Emla cream consists of a combination of lignocaineand another locat anaesthetic agent. lt is often usedtopically in children when it should be applied to theskin untletian occlusive dressing 1-5 hours beforeany procedure. "Procaine, a local anaesthetic, is poorly ggsorbed lrommuggy; g_1_eg1;,ranes. it is of no value as a surfaceanaesthetim Ligno_t;§_'m_§_,§pray. which is _v_y_§ii_gp__§rirbedfrom mucous mernbranes. is used instead.QQQEQTEGVBISBS respiratory depression caused byopioid aQa_lg_es§cs. Respiratory depression caused oyttgnocaine overdose must be managed by spppomvemeasures as there is no specific antagonist available.

A TrueB TrueC False

D False

E‘ True

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A rare complication due to its attticltgligérgig action.Glucagon is contrainrlicated in patients with either apnaegghrornocvtoma or an irguliponia.Metoclopramidt: increaseigastrig peristalsis thusreducing small bowel transit time.Extrapyrannidal side eifetzts may occur if the doseuxcuurls 0.5 tntilkg.

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70 MCU Tutor in Radiology

\H‘.

C

intravenous luc n scontrai d ta hiintravenous glucagon I5 contraindicated in patients witphaeochromocytoma.tachycardia is a recognised side effect of intravenous ii oscine~___ Ybutylbrorfiide lBusoopanl.

? D mg (Maxolonl decreases gastric emptying time.>1 E meloclopramide lMaxolonl is contraindicated in atients with

_,,____ . . Ppltaaocitromocytoma.

-\ 4

10 Regarding contrast media in the examination of the

D

E

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on

4?l

P/-P

Vi

A.

/.r

L

\/ gastrointestinal tract:

BC

barium with a density of 250% w/v is ideal for a bariumlollow-through. _Gastrografin may be used in the treatment oi meconiurn ileus.barium may be used if aspiration is a possibility.intraperitoneal barium has a mortality rate ol approximately50%.a solution oi ]‘.§Q _r1'J of Gastrogralin in one litre oi n flavoured \ 1 ,_‘»_drink is recommended to opacity the bowel prior to a CT‘ jww ',2t~\P A \d‘1-.O

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Techniques 71

False

True

True

True

True

il"\lF§q\é8I'lOL|8 Btigggpan is contraindicated inclosgi-§5glg_glat_ig_oma due to its mydriatic action.intravenous giucagon can be safely used as analternative smooth muscle relaxant in this situation.Glucagon administration in phaeochromocytomamay cawigmggrrelease of catechglgmipes,resulting in sudden §‘ricl'FaTR€d_hTpertension. Othercontraindications to glucagon are previous -hypersensitivity reactions and known or suspectedinsuli_fiF'ii'a.TOther anticholinergic side_eh‘ects include blurring of\_/igignfilrylnouth and uri_ngry retention.This effect eFiha_nces the transit of barium during alollow-through examination.Maxoion adminstration in phaeochromocytoma mayinduce an 8C§_LyQ§__fl_§Q§ii/Q_LBSDOl'\S8.

False

True

True

True

False

Barium with a density of_ ;2$Q‘f/q__\¢)/y is suitable for adt;L1blt2_-tzgttrast barium meal, 190% w/y;barium isreco mended lor a barium follo\iv~t_hrough, and

t12_§§(:1~/v is suitable lor a barium enema.The hypertonic Gastrografinpclrawswater into theb°W@'» h@'F?lf*9 E9 dislodge the mB¢<>nium- Adiagnostic barium enema must be performed first.When contrast media is likely to enter the lungs.either barium or a low-osmolar contrast mediumshould be used. Aspiration of Gastrografin causesPU|fttQ_rtgl’yvgg_der'na. "Even with treatment, there is still a 50% mortalityrate il barium leaks into the peritoneal cavity. ll

should be used.A solution of 1_j5__giof Gastrografin in one litre isrecommended. This dilution minimises a_rt§_fa_gt§_arising from the contrast medium." "T '

4'?\Ifl

I% _t>\%§ ~iperforation is suspected, watensoluble contrast “Ti 3

ti1“

i9'\.v ‘J ‘J \,v J qr ‘J ‘J -J

t , , l1 A barium swallow: '

5;,

%

..-..GG

. 11 A True‘A provides better mucosai cletai' than does a Gastro:-ratizt

t swallow. " A B TrueB should be performed with the patient prone when ass-essirtli . ' C True

oesophageal motility. ' = ‘(QC is preferred to a Gastrograiin swallow in suspected aspiration. L\‘§D requires high-density (250% w/vl barium when a single~ T ~- "‘-i I

contrast examination is carried out. i\ W’ -E should preferably be performed using a double-contrast ~‘~

Echnique when studying motility?" '“'"'“:"’M"

D False

E False

Water-soluble contrast media. such as Gagtrggraiilt,give relatively poor tttttggsal detail.

Aspiration of Gastrografln causes a ch_e_n_'t_igalpneugnonitis and acute pulmonary oedema; it istherefore cogtraindicated in's_us'péct’ed'aspiration.Aspirated Barium is usually coughed up without anysequelae. Smaller volumes can be expactorated byphysiotherapy, but larger volumes can give rise tosevere respiratory embarrassment. Non-ionic contrastmedia can be used safely in any situation wherethere ts likely to be aspiration or extravasation.-Fur a single-contrast study, a mediurQ;_tl_e_rlsityllO0% wlyl, low-viscosity bariumiandicated.A's'i_ngle-contrast study is used when looking ioroesophgggal dysnjtotility. compression ordjsplacetnetfi. ~

____.-_:_____

N

UOC0P

12 When performing a barium meal: TrueA the patient should be advised not to smoke on the day of the T"l°

examination. ‘ FalseB complete large bowel obstruction is a cnrttrainditzation. FalseC approximately 1000 ml of gas should be procltice-;l in the

stomach for a satisfactory double contrast stutiy.D the HAO film demonstrates the lesser t2\li‘."3 en .‘:.t;e. E TlueE the prgrtg position should be atloproti when otttzttlptittg in

demonstrate the anterior wall ol this tlttudetsuln.

Smoking causes increased gastric motility.

200—~t(flml IS an adequate volume of gas.The RAO ltlm demonstrates the antrum and greatercurve. The LAO lilm demonstrates the lesser curveEH |'8C6. .

It

1- ""\\\]| metsarattrariw T3 A FttlsaA a supine patient position is optimal lor tletttorlstratittq the B Fill"

fundus of the stomach. ‘ ' "B effeg/ascent granules with good bubble |Ortttt:itirm 5hQr;l(l he

use . .. C the administration of hyoscine btrlylhrorrlitle lfiuscopanl ’

1‘ “ significantly affects the incidence of demon" rabi 1.‘ Falsest e _;astro- Coesophageal reflux. D Fair

?“ D filling of the duodenal bulb with barium occurs mnr el' d. _ . e r‘ lablywith glucagon than hyosctne butylbrolnide lfluscoparli. E FalseE the areas gastrlcae are usually best seen on an age; film_

/_.

7/

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u

0 ' "‘ .it tlulttu_n=stt:ttus thu antrum ltntl hotly oi lhu stomach.The ideal gasptoducittg agent should have ggbubglg production, adequate gas productionl20_0~400 mil, ltqn-igttetierenpe with barium coatingand rapid dissolution with no residue. it should alsobe cheap and easy to swallow.

Filling of the duodenal bulb with barium occurs moretallest! with Eiuseeeen eeseese it rBla><.ss!L==..exl%u$~They are best seen on the supine iilms. “’/"’_ j__,___.-...

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Z; (E; toxic megecolon is an absolute COntrair1dic' iif/f y.

l

' 7n urn 1 -~ :_ '1--=!~

" J!.1

‘l4 For a small bowel barium follow-through examination;A l -the patient should be advised to empty their bladder piior to

the examination.

barium has been ingested.E a pneumocolon technique is a recognised method of

producing improved visualisation of the i_ern_1_i_ria_l igum.RI)‘. \‘<‘\ t\“t\ 'K'(blQin“\ I g

.'~. ‘

.A I

B

ii WB Gastrogralin added to the barium is recognised as a means of

'@d"i"e§.resl! betas! uensit ii~-e- »C a suitab e volume of barium to give a child is l5 ml/kg body "weight.

D serial supine abdominal radiographs should be taken after the

it is contraindicated in suspected small bowel obstruction. ,to advance the catheter through the pylorus. it may be helpfulto turn the patient onto their left side.

C the catheter tip should ideally be positioned 5-10 cm beyondthe ligarnent of Treltz. = .

D barium should be infused at a rate of appr0xlmately_Z§_n1l/min“I E t'he procedure may be complicated by inducing a paralytic i

I eus.

16 Regarding a barium enema examination:A the procedure should not be performed within 4 weeks of a

lull thickness rectal biopsy.at on.B _1§% iv/v_ barium suspension is recommended for a slngle- F

contrast barium enema. ' " "D a Ha_mpto_n’s view (prone angled view of the sigmoid) is taken

with the tube angled 30° cephalad,E perforation as a complication occurs in one in 1000

examinations. '4

are/tacit-$5 EA/lg D9>

Techniques 75

14 False

True

False

False

True

_A'?iill bladder helps to raise the loops of small bowelout of the pelvis.Approximately lQ_nll _C_§§§Lrp_grafln should be added Pto the barium in order to achieve this effect.in children, 3-4 ml_/Kg body weight is a suitablevolume of barium.Prone films should be taken because the _.-Fompression of the abdomen helps to separate theloops ol small bowel. _”—n@im‘5r air from the colon into the terminal ileumwill are visualisation in many patients.

15 False

True

True

TrueTrue

Enteroclysi_s_is not contraindicated in suspected smalibowel obstruction. Barium will be diluted by the \srnell intestinal fluid thus avoiding impaction. v--/9/uwrWhen on the left side, air collects in the antrum andduodenal bulb, and may encourage the tube to movetowards the duodenum.If the tip of the tube is in the jejunum then the risk ofreflux of barium into the stomach is minimised.

Too fast an infusion of barium may distend andparalyse the iejunurn, resulting in delayed filling ofileal loops.

16 False

True

True

False

False

in general a 7 day interval after a rectal biopsy allowsthe mucosa to grow over the biopsy site and thusminimises the risk of perforation. iThe friability of the colon in toxic megacolon rendersit very susceptible to perforation.On the other hand a 12531; vy/v barium suspension isrecommended for a double~contrast enema.The tube should be angled_I§Qf_gaudally with thepatient prone. This view helps to visualise therectosigrnoid.Perforation is the commonest serious complication ofthe barium enema. Its incidence is quoted at one in12000. " '

J1 ‘ ‘

a "'1

Qc_'

J \ examination, the bariumenema should be pEl'fQfl'fi9(i First./in B a pattlertt with a prosthetic heart valve should he givena .Z ‘K. nti long MQl1i1y|axis.

. y ,

auuwwww-ww"wo=aauae!av""'f '5'-“"4%\’1J"‘<V~'\"J’-aV~J"J’-\'-ll_VJJ'~..V"..V~J‘-J“J"‘J’~iUal7<FJiJ/; \\ 17 With respect to a double-contrast barium enema examination:

r’ A if to be performed within 3 days oi a small bowel barium i

//‘l C the transverse colon is usually barium-filled in the supineposition. V

r,- D tleal reflux of_ banurn lsminimised if air insuillation isperformed with the patient supine. .

E ileal reflux_is increased when intravenous hyoscinebutylbromide lBusc0panl is used. '

I

IR

18 Regarding examination of the gastrointestinal tract in Citilrlfen;A barium investigation or a tracheo-oesoptiageal fistula should

be performed with the patient supine.reduction of an intussusception should not he attemptedradiologically if the symptoms have been present for over24 hours.the explorator grid should be removed when screening infantsunder l year of age.

t k D when examining for gastro-oesophagealbreflux the baby_ shouldbe placed in the prone oblique pQ5irjQn_ .

E for barium reduction of an intussusception the barium shouldbe raised 100 cm above the table for 5 '_ _ _ minutes. at maximumof three times.

F B

who

J9 With respect to sirtogafihy:A the catheter should be inserted to a maximum disiame of

V 3 cm into the sinus track.I B water-soluble contrast medium should be used.

C A maximum of 20 ml of contrast medium should be injected. 'D A radiopaque marker should be placed next to the opening of

the sinus.E Sinography performed during CT rareTy demonstrates a mqrg

extensive track system than is visible on conventional ifluoroscopy.

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B

C

D

E

False

True

False

False

True

The small bowel and stomach should be examined "first as they will be clear of'barium after a iew hours,and the preparation for the enema will then removethe residual barium from the colon.Transient bacteraemia may occur during a bariumenema. ,,.,.,¢On a supine film the transverse colon is usually seenin good double-contrast. On a prone lilm thetransverse colon is seen filled with barium as it isthen dependent.The ileocaecal valve is most commonly on theposteromedial wall of the caacum, and is thereforedependent in the supine position, making rellux ofbarium into the‘ ileum likely.intravenous smooth muscle relaxants increase thelikelihood oiileal reflux.

18 A

B

C

DE

False

False

True

TrueTrue

The baby should be positioned pron_e to visualisecontrast passing from the oesophagus into thetrachea. _The contraindications to radiological reduction arethe presence of peritonitis, perforation or advancedintestinal obstruction. Duration of the symptoms perseis not a contraindication.By removing the grid. the ra_g_igti9_[t dose can bereduced by as much as 511"/‘Q. Acceptable images willbe obtained as there is little scatter.Reflux is also best sought during episodes oi crying.If ait_er this the intussusception has not reduced, .ll isconsidered radiologically irreducible.

19 A.

BC

D

E

False

TrueFalse

True

False

l i '7

The catheter should be inserted as far aigossibleinto the sinus track until resistance is felt. This shouldensure optimum filling during il'i|8CIiOt‘l.

The amount ol‘ contrast medium depends on thetrack system. if there is clinical evidence of a fistula,contrast should be injected until either ijellggg occursor the fistula is shown.This allows the orifice to be identified easily on allfilms, irrespective of the angle at which the tilm istaken.

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'20 Regarding biliary contrast media;A intravenous agents are actively excreted into the bile by

hepatocytes. ‘they are concentrated in the normal gall bladder.they bind to serum albumin.an infusi9_n_1technique for intravenous agents is preferable toboiu_s intention.‘ ‘"’ 'they are contraindicated in pregnancy.

‘_8/ 2i‘\ Regarding orel cholecystographyzA

) I B./___ii,.C

/ o

‘/_,iE

it may be useful in the diagnosis of acute cholecystitis.the cystic duct and common bile duct are rarely visualised.a lat-containing meal should be taken on the evening prior tothe examination.when e single dose technique is utilised, thecholecystographic agent should be taken approximately onehour belore attempts are made to visualise the gall bladder.tomography to show the gall bladder is usually necessary.

M l22l Regarding intravenous cholangiography:_;»' A visualisation oithe biliary tree may be‘3inadequate in up to

approximately examinations in patients with normalhepatic function.it is contraindicated in patients who have had a pruviouscholacystactomy.ifltlta contrast medium ls infused ibiliary excretion may occur.intravenous glucagon may improve visualisation of thecommon bile duct.the mortality rate is approximately 1 in 5000 examinations.

oo quickly. renal rather than

20Afl‘ r .

True Oral agents are conjugated with glucuronic acid byhepatocytes to forth conjugates which are morewater-soluble. '

True iTrue =True infusion of intravenous agents, rather thanje bolus

injection, results iman optiijrtggt plggna ._concentration vxgith maximum biliary excretion andproduces fewer side effects. ’ _

Trtie They are alspficontraindicated in combined hepaticand_r§g§l__l'ailure, and when there is a history 0iodine hypersensitivity. . ‘

_____,.__.€-—i—

/ Techniques 79I

t

21A False Acute choiecystitis is a contraindication to oralcholecystography es the gall bladder will not Qpacify.Other contraindications include hepatore__n_al failure.dehydration. an lV cholangiogram within theprevious week and previous cholecystectomy.

FalseTrue This empties the gall bladder and allows better

subsequent filling.False .T-he chole\cystographic agent\s\hould be taken

'\ 14 hours prior to the appoiritme__r1.tlir‘flB- The Cofilmlfil?i;i:Fn_u§'t therefore be taken when the patient makeshisher appointment. as the gall bladder will alreadybe opaciiied when the patient arrives for theinvestigation.

False Tomography is often utilised in intravenouscholangiography.

22A

I

r

i

TrueFalse intravenous cholangiography may provide__u_§g§gl

information in post-cholecystectomy patients withrecurrent symptoms of biliary tract disease.

Trtie An infusion of Biligram 9_\f|t_e_[_§£)___t"_i_'t_l_r%§(3-4 rttlgu/‘kg/rrtinl gives optimum plasma _ _concentration with maximum biliary excretion. ll it isinfused too quickly, there is insufficient time foralbumin binding. so renal excretion may occur.

True it achieves this by three mechanisms: (ii contractionI _ ‘ of the sphincter oi Oddi, followed by relaxation;

-"'."i’ .I

O I)

"‘_ (2) increased qhglgrgsis and (3) increased hepaticblood flow. M l

True Other complications include impairment of liver andrenal function and the precipitation of abnormalparaproieins in patients with Waldenstrom's

\\

\

I"<Ir<I‘¢I‘*¢I

\/ i23 Regarding post-operative(T-tube)cholangiography; - i 23 A" A » athe examination should be performed at ehuut the tenth t'la

post-operatlvely. e “"" “ "&/a control film or the gall bladder area is rer uired. l ‘-cholangtovenous reflux of contrast medium can occur.retained calculi can be removed via the T~tube within a fewdays of post-operative cholangiograplly.percutaneous extraction of retained biliarv calculi ina be. , _ - Ycomplicated by pancreatltls.

Y

2.4 in endoscopic retrograde cholangiopancreatography lERCP); 24A K . , _ .

B

C

D

E

e rethe presence of a pancreatic pseutlocyst is a t.otltraintlicauonto the procedure.low-osmolar contrast medium with an iodine content of150 mg/ml should be used to exarnine the pancreatic duct.intravenous buscopan may allow easier identification of theam pulla of Vater.if both the biliary tree and the pancreatic duct are to beopacifled, the bile duct should be ctirinulatad first.hyperamylasaemia may occur in up to 70% of patients.

t

n

__l..

TrueTrueTrue

False

True

The biliary ducts absorb contrast medium andcholangiovenous reflux can occur with high injectionpressures.When a calculus has been identified on the T-tubecholangiog‘t=am, the patient should be dischargetlwith the T-tube clamped for atE§§t_§_gv_gel<§ to allowthe formation of a fistulous tract. The T-tube can thenbe removed, and the stone extracted through thefi$tt"Ou$ tract with a basket.Other complications of this technique include thecreation of false sinus passages, SBpliC3_E_lT‘li_d andvagal stimulationiwlth shock. *

._P.l§-—-——

True

False

TrueFalse

True

Other c,ont?aindications include acute pancreatitis,severe cardiorespiratgry disease, and any othercontraindication to endoscopy.Dilute contrast medium USE) mggmfi should be usedto examine the bile ducts to ensure calculi are notobscured. A more concentrated contrast medium(240 / l h l b f€n>_i_"’n_g_£r_w_) s ou d a used or pancreatic duct‘T minatiofl.

Due to its choloretic action.The pancr§'gtig_duct should be cannulated first, andthe iniection of contrast should be stopped as soonas the lateral branches of the pancreatic duct areseen.Asymptomatic elevation of the serum amylase iscommon and usually related to over-filling of the "pancreatic duct. '-

‘ 82 Ml.'Lt lutol in haululugy\ _ __ _

5) Regarding percutaneotrs transhepatic cholanglograplw.lPTCl5-f.A, a platelet count of less than 100 $5.103 l" is a contraindication

to the procedure. T’B a Chiba needle should be inserted through the liver via an

anterior approach.Cg the incidence of complications is primarily related to the

number of passes prior to entering e duct.D if contrast medium is seen in the intrahepatic lymphatics, the

procedure should be terminated.E internal biliary drainage is indicated if ductal calculi are

demonstrated.

ii

luulttriquua aw

A

B

C

D

E

True

False

False

False

False

Other contraindications include an e@§_t§dpr9_}_h_ro_mbin time, hydatid disease and 5E\/fifecaitftgptllffignary disease. -\% \.l.-.»-\lt'ur _The Chiba needle (22Gl is inserted in the mid-alrlllarytige in the right seventhgr eighth intercos_ta_l3p_ace. Itis therefore insefirted parallel tg the pla'r'le.Qfi_h§tj_b|cand advanced during su7sp'ei1“'cled respiration throughthe right lobe of the liver. MThe incidence of complications is not related to thenumber of passes. A maximum of ‘l0—20 passes may .be performed. The likelihood of success is directlyrelated to the degree of duct dilatation and thepurfiber of passes made.Excessive parenchymal injection may result inlymphatic opaciiication. This usually clears _spontaneously and the procedure can be continuedwith the needle in a different position.The presence of ductel calculi is a contraindication toendo rosthesis insertion.- . .1?

26 The following situations will increase the risk ol taacteraemiaM V" during percutaneous transhepatic cholangiography lPTCl:\/ A puncture of the portal venous ra_dic_les.

B overdistension of intrahepatic ducts."complete obstruction oi the common bile duct.multiple percutaneous punctures.presence of cholangitis.THUG

27 Regarding the use of contrast media in intravenous urography:A the recommended dose in adults is 300 mg oi iodine per kg oi

body weight. .B the recommended dose in children is approximately l ml of

370 contrast medium per kg of body weight.C patients with renal failure require hall the standaid amount ol

iodine. ID the density of the nephrogram is determiner! by the degree ol

hydration oi the patient.E the density of the pyelogram is greater with sodium salts than

with the equivalent meglumine salts for the same amount ofinjected iodine.

aI -v r‘

mUOUJ>

TrueTrueTrueTrueTrue

\

FTC should therefore be covered with prophylacticantibiotics. ‘ ‘ "

W

ABC

D

E

TrueTrueFalse

False

True

Patients with renal failure require at least twice thestandard amount oi iodine li.e. 600 -mg iodine/kg).Nephrogram density is determined by the contrastmed_iu_g1_dg§e, the peal§_plasma contrastconcentration and the glomeruler filtration rate. it isin-dependent oi the degree ofT15ti§?iThydration.Sodium salts produce less of an osmotic diuresisthan meglumine salts because sodium i§Téabsorbed.Sodium salts therefore produce denser pyelograms.

gm my ..

7 47 ~a'd"9-3Q\.l@it.J(I'flwgflu.$.;g.@ Q‘ ‘U <5 $ t‘

FOF in"-QVEHQUS uwgraphy, low-osrnolar contrast media are irecommended in preference to high-osrnoiar media in patientswith:A diabetes mellitus.

systerrijg lupus erythernatosussickle cell dlS8_8§é.h_cardiac failure.pulmonary emphysema.

______,,,__TNDOID

€g g _ @@"U'Ufli'd'@"J'~8'J'J'@-fliQ'@Q7'dslWJld'wl?

Ureteric compression in intravenous urography:A is a recognised cause of vasovagal symptoms.B should be applied 15 minutes after the contrast medium has

been injected.C is essential in neonates.D is acceptable even when there is an abdominal mass,

provided that the mass is not tender.E is contraindicated if there has been recent dD(iQtTtil'li'Ji surgery.

\)

The following techniques are recognised as assistingradiographic visualisation on an IVU:A the tube should be angled 15° ceigliaiag to obtain ti coiled

post~micturition bladder view.B the ingestion of a fizg d_§ii_'il_<__to aid visualisation of the kidneys.C it prone lilm to aid ureteric visualisation.D 35°__1ntei:iot Oblique renal views to improve delineation of the

renal outline.E tomography centred Onva point halfway betweenthe table top

and the anterior abdominal wall Wlii aid visualisation of therenal outlines.

mUDw)>

TrueFalseTrueTrueFalse e

gm

A

B

CD

E

True

False

FalseFalse

True

When this occurs the compression should be .released. and the patient placed in the head downposition. 4 _ll compression indicated it should be ‘applied 5-minutes pOSi-l’i]8CiiO|1.Compressio_p_is,riot used in young infants.The presence oi an abdominal mass is an absolutecontraindication to compression.Other contraindications include renal trauma andrenal obstruction.

L-J Q A

B

C

D

E

t

False

True

True

False

False

For a coned view of the bladder the tube is angled15‘ caugad. It is centred 5 cm’ab_o\_1e_ the pubicsymphysis. W 'In children a fizzy drink will produce a gas-filledstomach which acts as a window through which thekidneys can be seen.When the patient is prone the ureters are moredependent aiding visualisation. .,. .Obligue views of the kidney should be taken as 35°PQ§E§£lQ(.QD_flQ\_4a$-In general, the tomographic mid-point of the kidneyslies at one third the distance from the table top to theanterior abdo'rn'ih'al wall at the inferior costal margin.

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86 MCQ Tutor in Radiology

31 Regarding retrograde pyelography:A it is recognised as being useful in delineating a lesion

inadequately shown on intravenous urography.B contrast medium with an iodine concentration of 340 mg/ml '

should be used.C b0 ml of contrast medium is required to delineate the

pelvicalyceal system.D in the presence of ureteric obstruction, contrast rriecliurn

should be aspirated prior to withdrawal of the catheter.E pyelosinus bacldlow is usually asymptomatic.

32 Percutaneous renal puncture:A is recognised as being a useful technique in the evaluation of

renal cysts.8 is e luridamentiil pan oi the Whitaker Test.C should be directed towards the upper pole calyces for

nephrostomy tube insenion.D may be complicated by an arteriovenous fistula in

approximately 0.5% of cases.E is contraindicated in the presence ol urinary tract infection.

I

33 Reqflrdiflg mlcturating cystourethrography: 33A satiation should not bu given.B Wdler-soluble contrast medium with an iodine ,;onCEm,m;Dn or

100-150 mg/nil is recommentlecl.C to Semkfingtrate stress incontinence erect lateral views ggnggl

o _ie a_ der only should be taken at rest, straining, andduring micturition. .

D in male irifants, the urethra should be imaged in the anterioroblique position. '

E lateral views should be taken when attemptinii to denmnsrraie

"”"°°"Q.lt‘.€’! 9£.£§.¢.!9\;s§is§.l it_stiile==.- . '

Techniques 8/

True A retrograde examination is a useful adiunct to anipeionclusive lVU to help demonstrate the site, length

~~and lower limit of a lesion.False Dilute contrast medium (‘l50—200 mg iodine/ml)

should be used to ensure'¥hTiT§Fn_a'll_l'E_§i3ns are notobscured.

False Usuallyv5-10 ml of contrast is needed to delineate thepelvjcalyceaififsfem. The injection should beterminated if the patient complains of loin pain.

True This minimises the risk of development oi a chemicalpyelitis or a pyoneplirosis.

True Occasionally it may result in pain, fever and rigors.-s—~ --~- .

, 32

i .

True ll an apparently simple cyst is present together withunexplained fever, haematuria or pain, it may behelpful to drain the cyst via percutaneous renalpuncture. Double contrast images of the cavityshould then be obtained. '

True The Whitaker Test is used to distinguish between anobstructed and dilated system. A catheter is ' “'-introduced percutaneously into the renal collectingsystem, and saline infused at a rate of 10 ml/min. Arelative renal pelvis pressure (i.e. bladder pressure,-subtracted from renal pressure] less than 13 cm H20

. is normal. u """-'“""' TI"False The aim is to puncture a lower Q9l§§3|Y><' Pa55l"9

through the least depth. oi paienchyma to reach thecollecting system. This reduces the chance ofvascular damage. .

r"

TrueFalse Percutaneous renal puncture and drainage via

nephrostorny is not contraindicated in the presenceof obstruction and inlected urine; but prophylacticantibiotics should be given. " '

(4

False Young infants may need to be sedated particularlyprior to ctitheterisaiion.

TrueFalse These lateral views should include the sacrum and

the symphysis pubis. These bony landmarks are usedto assess bladder neck descent.

True ‘fhisyensures visualisation oi the long axis of theitretlira.

True ’ T "‘*."'_

t.

-1.0.,88 MCQ Tutor in Radiology " V V ‘I?

34

i

Ascending urethrograiphy;A is the examination of choice to tiemonstrate posterior urethral

valvesB should not be performed within 2 weeks of urethrai

instrumentation.C requires about g&jjQv[[\_|_in/Eiitii‘-SOilli.)lt3 contrast medium.D is the radiographic examination of choice for dernonstratin‘. Hthe prostaiig urethra. ai: is complicated by intravasation of contrast medium in

approximately 5% of cases._..__.---

as Regarding hysterosalpingography (H56);A it is‘ contraindicated if there is a history of untreated salpingitis

during the preceding 6 months.B it should be performed in the week preceding the menstrual

period.C pethidine can be helpful if given as an analgesic before the

procedure.D the procedure should be terminated if venous intravauation

OCCUFS.

E pain may persist for up to i-2 weeks after the procetltire.

.5’ ._.\‘ ‘.3 ‘y ‘i‘ .- ‘ ', J.

35‘J

Regarding G3V8|'l'i0$0gr'aphy‘A 5

- 36it is a recognised procedure for investigating male erectile .di:ife112iiPn~ ~;"~—--—

B a needle is positioned in each corpus cavernosum to ensurebilateral opacification.

C approximately/_ 20 ml of contrast medium is required to opacifythe corpora ca\T€Fn3§5.“ _7

D venous thrombosis lS a recognised complication.E it is contraindicated in the presence t>'r'aia?5~;5ii uriiiery tract

infection.

_!t

Ii

i

i.

34 A False

8 True

C TrueD False

E True

\.

Posterior urethral valves may not be demonstratedon this examination, as they only fill out and obstructd ' ' t ‘ ' M‘ ' h i 'uring mic urition. icturaiing c stouret rograp iy lS ®therefore the investi ation of choice for suspected9posterior urethral valves. The main indications forasceritiingiurethrography at suspected tirethrgltratima and the assessment gig urethral stricture:Thisisdue to the risk oi intravas ‘on of contrast“medium from the mucosal damage that may havebeen caused by recent instrumentation.

4 T" CL-T“The urethra IS well seen as far as if llportion on ascending urethrography. To demons ratethe proximal. rostatic urethra, a radiograph shouldbe taken during micturition.

ah .

35 A True

B False

C False

D False

E Trua

HSG is contraindicated until a course of antibioticshas been given and there is clinical evidence ofsuccessful treatment.HSG should be performed in the first week after themenstrual period. -Pethidine stimulates smooth muscle coriirggtign,which impedes the filling of the fallopian tubes withcontrast medium. r.Venous intravasation may occur in 8ppl'0XiiT\i:llt3iy6%9of cases. but it is of little significance wheni.vater~soluble contrast media are used.lluifi postulated that this is due to pelvic irritation.

A True

B False

C True

D True

E False

Other indications are the demonstration of the extentof P_eyronie‘s£isease and the investigation ofpriapismand penile trauma_;_ ‘The corpora gaygrnosa on both sides are opacifiedfrom a unilateral contrast injection. ,2_0 Q1! 9f Q |Qw;Q§m_olar contrast medium isrecommended.Venous thrombosis can lead to priapism with /iimi>_<1.tsnes==- ‘The only contraindication is a history of‘typérsensiiivity to_contrast media.

' _ - , t‘ '}lC|: ’ 1'4,. \_G.3i;,;,y\,."_ 'l,f_r-,». -l-—_ it ."/."1/ft‘ Jiiqvoitfi (IN "‘

A '-+l~t- e,-¢'rI'/Ic Hiiwi ctr mi» - '» -| ..iLr""f~=Yf‘:.l\ , 'tii\' -4‘ I‘I-1;“ In ‘rd’ V J \_Uty~,‘{- . TY," \>ey\lr Cf/""’5’f C:.-/ {Mr £(/ ft)’

_ -. , . ~;- ("T3 -"_ I .~,, r,-rr-r/on QHK/,P,,41!‘ f/fv /,.,iii-is r’

C_wC'iU'rQntgt"._‘,‘,“-

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i

90 MLJU ltiior lll neurology

37

tr’

ln arthrographyzjf zA control films are not usually recommended prior to the

procedure.B joint effusion is a contraindication becauso of the risk of

introducing sepsis.C negative contrast medium is absorbed from tire joint within a

few hours.D delayed films may be useful in the investigation of a

suspegtgdloose body.E adrenaline shoujd not be added to the contrast fl"|ediU[T|_

1

38

I

Regarding shoulder anhrogrdphyzA B 5"j9_|8-c_oiitrasi technique is usually recommended.8 the injection site lies at the same horizontal level as the

- coracoid process.C‘ "18 Patient lies supine with.the forearm pronated to allowD EBSY needle entry into the joint space.

T examination requires a smaller volume of positive contrastmedium.

E an axial radiograph is routinely performed following contrastlf'l|8ClfOl'l. ‘

~

39 in double-contrast knee arthrography:A the needle is introduced at a point 1 cm posroriqr [Q the

'“1Ei'E9lF!! at the Rflifillfi-_ --~————-——~€:r°'\g:[\5if_1\i OiflJO9lliV9 contrast medium ls r'at:ornme|1d9(j_j _5 ""9 0 lite, needle tip should be confirmed by

D aspiration of synovial fluid. ,.E 2:? kg;-‘eo5i‘?U|d bfi fliflfllptilated following contrast injection.

v c m on occuring in tho joint at iz hours I5 abnormal.

BC

'1j 38

s r'\

37A False

False

False

u

TrueFalse

X

Conlreléilms should elicayees tezimee EH2’ *0 "'°injeetion of contrast medium.Joint effusion is not a contraindication toarthrography. The effusion should be aspirated priorto contrast injection in order to avoid dilution ofcontrast medium and bubble formation.Negative contrast medium_j_qj;]_may take up to_{A_days to be completely absorbed from the joint space.Positive corgitrast medium is absorbed within a few_@9915“ T‘

‘£1 ‘

Adrenaline (0.1 ml of a 111000 solution) may beadded to the contrast medium in order to delay itsabsorption from the joint space. "" " H ' ""

False

False

False

TrueTrue

A double contrast study is usually performed usingabout 1t_)_ r1_w_l_gf__pg§itive contrast medium and ‘lqwmjof air.The injection site lies abo_ut,§A<,:,m infer.i9.[.§inFi 1255.8‘to the tip of the coracQid'process.The patient lies supine yyith the forear_m__§upinated - ,»_-'_and close to thé'body. This allows the long_head of ’/biceps to rotate away from the vertical path__of the

<_needle. In addition, the articuiar surface of theglenoid will face anteriorly avoiding damage to itslabrum.Up to 3 ml. '___,,¢-...--.... < I

39 True

False

False

True

False

Either via a medial or lateral approach into the patella-iemoraljgirit space. - -- .About-Q _rr'i_l\of positive contrast medium and 50 mlmof "tair are injected. Tu’Correct siting of the needle tip within the joint spaceis confirmed by a test injection qlf a srrtaiivglume ofcontrast mei:iium't]iw't'ir~§r_iitioroscopic control. Contrastmtadium should flow rapidly around the joint.This ensures even distribution of contrast mediumwithin the joint.Some discomfort may occur in the joint for up toabout 2 days. The patient should be warned aboutthis.

V

u \l/

W.nwwytw to ‘tetra ‘W “ ~' '

/‘

_- -_g \W<d‘<d»Uld@€lE@llUl‘@‘4U‘@*iU'W~"U@riy 0 to 0 0 I tI_-with U‘ 1' '0 I ‘U40 When performing myelograplty of the lumbar region;

J A e lumbar puncture within the preceding week is a contrai 'B . ndicationapproximately ]Qn1_l'9fwater-soluble contrast medium with an

-- iodine strength of 2\40 mg/ml should be used.C contrast should be ifiiéFté'd‘with the X- r ' i~>ray table tilted l5 head

down.l VJ D_ routine frontal and lateral views of the lower thoracic cord

J

\4

aremandatory. ,

E the patient should lie flat for 6 hours following the procedure

41 ln myelographyz

C

D

E

5}‘ A lateral cervical puncture should be performed when there i5 a

BI

5 nin the upper cervical damil,less dilution of contrast medium occurs if the contrast flows E

h I d‘cep a a lfl the spinal canal via a lumbar puncture than it umcontrast flows caudad via a cervical puncture.lateral cervical puncture is a recognised method of demonstratingthe upper level of a spinal block.a post—myelogram CT should be delayed for 24 hours after themyelogram in order to reduce the contrast density by dilution.prolonged headache is a more frequent complication in femalesthen in males. -

% “ s '

42 In dacrocystugraphyz LC‘ L'- 1 i:|,J_(i -‘I-. . . - I ,

amt"ID

a macroradiography technique is recornmenrted,an occipitofrontal 20° control film is taken.cannulation of the superior canaliculus is recornmendecl.Q;5—2.0 ml of ljpiodol ultrafluicl is recommended.btl'z§tEFal_raiher than unilateral examination is common practice

n

-¢¢‘> a’ T" - 7

40 A

BC

D

E

True

TrueFalse

True

False

A small amount of cerebrospinal fluid often leaks into thesubdural or extradural space after a lumbar puncture.and if a second lumbar puncture is performed within aweek of the first, the pool of leaked cerebrospinal fluidmay be tapped instead of the subarachnoid space.

__.=a-zThe table~should be tilted 15° l9_9t_g_qv_1n during theiniection to ensure poolingfif contrast in the lumbarsubarachnoid space. .ln order to excluclgunsuspected intraspinal tumourswhich can mimic a disc prolapse. H ' 'Following the procedure the patient should sit up so as topool the contrast metliurn in the lumbosacral region.The patient is then allowed to remain ambul_ant ii he/shewishes. l._;lJ/-"\’

H .¢,_ - . . .

41 A

BCD

E

False

TrueTrueFalse

True

-.- _, 'v

This is a contraindication to direct cervical puncture.Other contraindications include cerebgllartgitsillarherniation, suspected lumbar spinal dysraphism andcertain spinal deformities leadingto loss of the Cl/2interspace.

A delay is not needed between the myelogram and CT,unless the investigation is lor_§_yring_q__n1yglia, in whichcase a 24 hour delay is ideal to show the syrinx.Post-myelographic headache occurs in 20-30% ofpatients, and about 10% will have more severeprolortged headaches. particularhgfemales.

42 ABC

DE

TrueFalseFalse

TrueTrue

Thus magnifying the i__m_gg§ Qgtained.The control film"is'"an_occipitomegtgl flint.The lower canaliculus is usually cannulated preferentiallyas it is more convenient and functionally more important.

This enables comparison with the normal side, or, ifabnormalities are bilateral la common finding) thesimultaneous demonstration of the two sides.

is

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(L) ~ mi ‘ '“‘ cg)?‘ ‘J .

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94 MCQ Tutor in Radiology

43

ll

In sialograpny:A Lipiodol ultrafluid can be used as a contrast medium. 15 Pain ggyufvs _rnore readily with a water-soluble contrast

medium"than with an oil-based .-.i'ge‘at."'“'*'C aliens probe should be passed at least 2 cm into the parotld

D contrast medium should be injected into the parotid duct at 3rate of approximately 2 ml/min.

E an oc_clu§E_\l fgdlggfaph is useful in the evaluation of theparottd duct.

1 " 44

9’O

The following statements are true:A the anth_rQl29lQQlEEl_Egselinepasses from the otrt__er_§a'nlttt!§ 91

. ‘§.5Y?_E° Ll?“ EEBEEE Ql llié Qlilelllél §tI£l_I10-">1 meatus..8 '" 3 5l5"a3"'r°¢¢lPll0lrOntal projection‘tliie'beaifi'i's angled

cephalad.C in a submentovertical proiection the radiograpltic baseline

should be parallel to the fi|m_D a‘;§9l°m9@'flPhv maY be U59l""V §mPlOyed in the lateral0 lque VIBW of the lemporomandrbular joint,E the cororwlcl process of the mandible is well shown on 5

"'_"""""_ - . T >standard occipttomental pro|ectton.'~___...'—- '-—'

45

I

An appropriate radiographlc centring point tor;A a lateral view of the C8l'VlCB| spine is 2.5 cm posterior to the

angle of the mandible. —---'"““Bfl AP view of the shoulder is the acromion.a lrog lateral o_l the hips IS the lemcral heat],a PA chest radiograph is T4.a PA view of the hand ls the capitate. '"TOOK?

l

Techniques 95

43A

BC

\

D

E

A?!

True “Either a wateesoluble gontrasl medium or theoil-bas'e"d.m'edium, Lipiodol, can be used insialography.‘Oi|-based media are more viscous and, ifaccidentally iniected into the soft tissues, may remainin sltu lor many years.

True iFalse . After passing the probe about 1 cm into the parotid

duct. resistance will be met where the ductperletrates the buccinator muscle. The probe shouldnoebe» advanced any further.

False ‘Contrast medium should be iniected very slowly at arate of approximately 0.2 mllgjip.

False This view is useful in evaluatiT3 the submandibularduct; "~""' i

44A

B

C

D

E

False This is a description of the Qllilllfimeatal lorradiographicl baseline. The anthropological baselinepasses from the infragrhital point to the upper Qgrgerof the external auditory meatus. These two lines areat .=m"a'h'g|e oi about 10° to each other. ,»The beam is anQl_e_§l___c§u_g§|ly and centred in themine E1l>@v@>tl1=B,_r:>,1<1yiéit%-.11 occipital erqtruberance to r

u emerge from thef’nasion._True The beam is directedat right angles to the

Qrbitomeatal plane and centred midway betweflflllleexternal auditory rneati. T ' 'Open and closed mouth views of theteirttupoionwanvdibular joint do not employ patientmovement.

True a

False

False

ASAB

C

D

E

This is approximately the lev_el3[__Q§._lFor an AP view of the shoulder, the beam should becentred on the coracoid process. For an axial view,the centring point is the acromion.A lrog lateral view is taken of both hipssimultaneously. The hips are llexédfatiducted andlaterally rotated, and the centring point is in thenjtidline, at the level Ql_the ferggral pulse.For an AP chest radiograph the appropriate centringpoint is the sternal notch.For a PA view ol the hand, the beam should becentred on the head of the third metacarpal.

TrueFalse

False

True

False

‘av \7~~@ war‘-~—wIuI'tIIIr-u\_Ilw§ % 8 WI ‘Z Y ‘ifl % @ @ % Z-srl ‘elf T € 1 € \j if "' " ‘ '

~.v\tQ\ than with a PA projection.

a horizontal beam lateral film is essential in the case of headtnlury.in 3“ °_¢CiPli0"ff0fiI8l iQF) 20 film. the rierrotts flCiQt:5 shouldbe pro|ected at or near the superior orbital margins.laaljowne s view requires 30° cranial angulation of the central

for a submentovertical view, the radiographic baseline shouldbe parallel with the film.

46 egarding skull radiography:A the eye dose is up to 200 times greater with an AP projetrtir-.--t

W :

\5%7' HBQal'<“"9 Fadl°9l'BPl\y of the facial bones and teeth:33 A

t'..'/'{

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E

the zygomatic arches are best demonstrated on the lateralview.the central ray is angled 30° caudally for the standardoccipitomental (OM) view.whe“ Perform‘?-l9 °l'1h.°l3.?!{‘E9Fl"°9’aPhy the patient shouldgently open and close their mouth during the exposure,t/hswmaxtllary antra are best shown on the occipitomental (OM)

me 0¢§=l\1.5a.l,__Ql_ane is a horizontal plane passing through theopposing biting surfaces of the teeth.

/in 48

\ ‘>3?

C

D

E

The following statements are true: ‘Oblique views of the cervical spine are usually performed wirhthe patient supine.when taking an erect right anterior oblique view of the Cervicalspine the median sagittal plane of the head is parallel to thel m.

"1 ‘he AP.°b“q“° P"°l°°ll9". lhe cervical intervertehral lforaminae demonstrated are those on the side nearer theX-ray tube. _a right posterior oblique lRPOl view of the lumbar spine willdemonstrate the left pars interar§lgl|laris_for an oblique view ofiheiuhalqosacral junction, the patient isrotated approximately 45°. '

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46 A

B

C

D

E

True

True

False

False

True

Tneretore it is desirable to choose a PA proiectionwhenever possible.To exclude iirfllttigileyels in the cranial cavity, theventricles or the sguses.On an OF 20 radiograph, the petrous ridges shouldbe proiectedsonto the inietl9.!.2[P_l1§! §“.?.§9l"5- le*'=W"\9an unobstructed view of the bony orbits.A Towne's view is taken with the patient supine, thetube angled §Q° caudally and the beam centred onthe forarnen magnum.With the patient supine, the neck is fullyhyper-extended until the baseline is parallel to thefilm. The beam should be centred midway betweenthe angles of the mandible.

ll

47 A

B

C

O

E

False

False

False

True

True

‘Q-t

The zygomistic arches are visualised onoccipitomental projections, but an underpenetratedSMV view gives the Clearestdemqnstration. Theymay also be seen on a Townes view collimated toinclude the zygomatic arches.For a basic OM view the central ray is not angled.For an OM 30 it is angled 30° caudally. pThe patient should remain stationary. To prevent anymovement, most units utilise head clamps, a chinrest and a bite rod. *Together with the frontal sinuses and anteriorethrnoids.

er‘ .

48 A

B .

C

D

E

False

True

True

False

True

These views are most commonly performed with thepatient erect. _The median sagittal plane of the trunk is about 45° tothe film.ln a PA oblique prolection oi the cervical spine, theiritervertebral foraminae that are seen are thosenearer the film.Oblique views of the lumbar spine show the parsinterarticularis on the side to which the gallant ISturne‘rTleTg. RPO shows the right pars)._._-—'—

l

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l

V/‘B8 MCO Tutor in Radiology Techniques 99

Regarding imaging of the breeztt:compression should nor be used during mammography whencysts are suspected. Aultrasound should be performed with a low frequency l3.5MHz) transducer.the standard mammography film series comprises a crania-caudal view and a stralghtlateral view of each breast.the nipple shotrlcl_be seen tn profile in the standardmammographic views of the breast. -ductography involves theinjection of 5 ml of a water-5gl\_|b|gcontrast medium into a dilated duct.

‘J

50 Regarding lower limb -lymphography: "the internal iliac lymph nodes are usually well demonstrated.it should not be performed within 6 months of radiotherapy.right-to-left crossover ol lymphatics is more common thanvice versa. .7 ml l_|pi_odol ultratluid should be used lor each lower limb atan lfl|8CllOl1 rate of 1 mi/mm.Hepatic Oli embolism is a recognised complicatiorl.

ascending venography of the lower limb:a tourniquet applied above the ankle may occlude the nmmalanterior tibial vein.the study ts complete when the deep lemoral vein has beendemonstrated. ~""“‘“"""‘e single projection radiograph oi the deep call veins isadequate.

OP 6Q _t1_tl iolteggol 2-1Q would be o suitable contrast metlittm.at the end ol the procedure the needle should always beflushed Wllil normal saline.

1

FalseB False

l 49A

C False

D TrueE False

,4;

Ultrasound should be perlormed with a highfrequency, high resolution transducer_j5_:]Q_MliZl. _.The standard series comprises a cranio-caudal and 'oblique lateral view of each breast.“1:-'v_-:‘—..i~'."“~—-'-

0.5-1 ml of aiwater-soluble contrast medium shouldbe‘t'rij'éEtet:l into a duct slowly and the injectionterminated when the patient experiences pain.

"T-t » .

_ 50 A False4.

- B_ FalseIl

C True

D False

I E True

The internal iliac, mesenteric, retrocrural, splenic andrenal hilar nodes are not seen in this investigation.Lymphography should not be performed_within 3yv§el<_s of radiotherapy as disruption of mé“Wr?BiTnode architecture may allow oily contrast medium topass into the systemic circulatioi-llTherefore visualisation of both sides is possible ifonly the right side is injected.7 ml Lipiodol ultrafluid per lower limb should beinjected o\_/§r_g§3_ minutes by a pump injectortapproximately 0.2 ml/min). "‘This occurs?/TIh‘e'Ft"th'ere is lymphatic obstruction andlymphaticoportal venous communication.

' t

51 A True

B False

C False

D TrueE True

The absence of anterior tibial vein filling by contrastis not therefore always indicative of venousthrombosis. 'The deep femoral vein is only opacified in about_§Q%of cases when there is gloog connggion wit_hfie_superficial fe[n_c_>_ra_l_Qin, or when retrograde fillingo'ee'5;?d6'ra'ng the Valsalva manoeuvre.Harliographs of the deep calf veins should beobtained with the leg in internal and_e§t_erp_gl_rgt§tionto avoid superirnpositi5TT5i' Bones and veins.

To avoid stasis of contrast medium in the leg leadingto phlebitis.

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//’in superior vena cavography: ‘~A contrast medium injection into asirrgligledian antecubital

vein is usually adequate.B the total volume of contrast medium injected should not

exceed 30 ml.C a Valsalva manoeuvre facilitates opacificaticn.D catheterisation of both subclavian veins is rarely necessary to

obtain good opacification. ;E the normal azygos vein is often opacified.

%Regarding portal venography:A indirect portal venography is performed via a transplenic

approach.8 portal hypertension is a contraindication to the procedure.C for the transplenic approach. 50—6O nil of a low-osmolar

contrast medium (370 mg iodine/ml) should be inflected at8-10 ml/sec. T

D whenusing the transplenic approach, a larger volume ofcontrast"medium is required in patients with splenomegaly.

E after transhepatic portal venography, a plug ofgel-fuarnshould be placed in the catheter track.

54

‘I

%Regarding intravenous digital subtraction angiograpliy llVDSAl:A the basilic vein is preferred to the cephalic vein as a site of

access.B the right atrium is preferred to the superior vena cava as a

central site for the catheter tip.C abdominal compression may be useiul when imaging

abdominal vessels.D contrast medium with a lower concentration oi iodine per ml

than that used in intre-arterial USA GADSA) is recommencled,E A 15 ml volume delivered centrally at a rate oi 10 ml/sec is '

suitable for each injection of contrast medium.

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1

I

too Mcotutariiirtsuiniofl V V V “"' w V T " ' '.~.~i ._ ' ' ' ' ' ' ' "" " ' ' "T52. A

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CDE

False

False

TrueTrueTrue

Contrast medium should be iniected into a_y@n_1r1_both ar__r'Qs simultaneously in o_rder to opectly thesuperior vena cava.3i)Tn‘iTEbT\Tr'a§t_meditim should be injected into each?'.'f‘J- __4-£

53 A

B

CD

E

False

False

TrueFalse

True

indirect purtography results from iniecting contrastinto the cqeliac or superi_gL_rr_1§a_rit_eri§ arteries andobtaining déiayed films of the portal vain.Ponal venography is indicated to demonstrate theanatomy”:d'f the portal system in patients with portalhypertension. Direct percutaneous splenoportographycan be used to measure portal venouipressure.

For transplenic portal venography, there is no needto increase the volume oi contrast medium |n_splenomegaly. However. when performing indirectportography li.e. late phase coeliac or superiorrnesenteric angiographyi an increased volume of 'contrast is required in splenomegaly labout_]0 mllow-osmolar contrast medium 370 tng_it3tl|neE1“i at8 ml/sec). < 4Tl'ii_s-T§'d~uces the chance oi blood or bile leakage intothe peritoneum.I

1" .

54 A

B

C

D

E

True

True

True

False

False

lt is more difficult to negotiate a catheter through thecephalic vein in the region of the c_lavipe_t_:to_ral_ fascia-The right atrium is the optimal site for contrastinjection as it produces good mixing oi blood lromthe superior and inferior vena cavae.Subtraction errors due to bowel gas movement maybe reduced by abdominal compression and .intravenous Buscopan.l\1p_§’/_\_ uses f_ull;strength contrast medium labourQ50 rng'ip"cline/mll. l,f\D§_A gees contrast mediumdiluted to about one-third to one-h_al[ gf the normalconcentration. ' ' I5 I§§_1n1l_vglyme delivered at a rate oi 20 ml/second issuitable. “‘_"_"“""'_

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102 MCQ Tutor in Radiology

r \..i Regarding angiographlc equipment:

A the French size of e catheter is a measure of the circumferenceoi the catheter tip.

B polyethylene catheters are stifiar than polyuretha e cathetersand this provides better torque control. T“T”D

C guide wires consist of two inner straight wires with an outerwire coiled around them. -

D a typical guide wire measures 0.QI§_iE_hes (0.89 mml or0.038 inches (0.97 mmj in diameter. ' ‘ '

E a typical catheter measures 60-100 cm in length.

Regarding anglography:A the hole in the vessel wall produced by u 6 French catheter

has an area four times larger than that of a 3 French catheter.B sheaths are sized according to the largest size catheter that

they will accommodate. 'C single-wall arterial puncture requires a two-pun needle.D the catheter tip should be positioned about 5-10 cm above the

aortic bifurcation in lumbar aonography. """""'E the most reliable guide to the position oi the common lemnral

anery lor percutaneous puncture is the site of maximalpulsation.

ii S7 A low-osmoiar contrast medium with an iodine concentration ol350 mg/ml delivered at these injection volumes and rates wouldbe appropriate lor use in the following conventionalarteriographlc examinations:A lumbar aortography: approximatejy 5Q rnl yoiumra; rate

T 8:12 mllseuB superior mesenteric arteriography: approximately 59 rnl

volume; rate _6_-__1Q mijgec.C pulmonary arterlography: 6ppl‘O>:in'|£'lluly 20 ml volume; rate

8-10 ml/sec.D right coronary arteriograplty: 3D|JlOXilY\8l8iy 15 ml volume;

rate 10 ml/sec.E common carotid arteriography: approximately 12 ml volume;

hand injection.

\

tTechniques 103

55 TrueFalse

True

TrueTrue

<-

_>ri

Polyurethane catheters are stiffer than polyethylenecathetuefsiiOne inner straight wire runs the whole length of theguide wire to reduce the risk of fracturing. The otherinner wire terminates near the end of the guide wireto produce a soft flexible tip; it may be movable forvariabje stiffness of the tip.Typical length of a guide wire is ]_Q_Q—_]§Q cm.Mqgiiliagnostic angiography is performetimtivith-l French or 5 French catheters.

56 True

TrueFalse

TrueTrue _

A 3 French catheter produces a hole 1 mm ind' lameter. A Gfrench catheter prodfides a hole 2 m_rnin diamete'F.'This represents a four fold increase in 'area (rt x radiuszi. _

Double-wall arterial puncture requires a two-partneedle, which consists oi a bevelled central stiletteand an outer blunt cannula. Single~wall arterialpuncture uses a one-part needle with a central bore.This site lies at the level of L3/4.

57 TrueTrue

False

False

False

\..

Approximately the same volume and rate of contrastmedium injection for coeliac arteriography. inferiormesentg_r§E §.."!§!l9graphy requires about 15 m__i_voluFrTé at rate §-§n_1_l/_s_ec. ""'“'_'Pulmonar\'/"Z-irteriography requires 40-50 ml volumeat rate 20-25 ml/sec. "‘T-"""_Flight coFcTrT;r§7'aHeriograpl1y requires Q78 ml volumeby hand injection. Left coronary arteriogr_aph'y“requires §~_1Q__r‘nl volume QLlt_a_n§_ injection.A contrast medium iodine concentration oi 3§Q_[11g/mlis too high for common carotid arteriograp'h-y. Abouti2T“'i"°.!":"£>§F!19!§F29513525‘ ’J‘£9iE!'“ Wit" 3" “dine6E'>Fc"éiitration oi not more"ih§_q‘§Qp_ mg/ml is suitable.This should be given by hand injection.

nI‘ I

5&1,’ in pulmonary angiography: ''" A the catheter tip should be sited at the blfttrtjarign Dr me

B

“’ " “”'1vi'5’t ‘“filCffTu‘igrii?Ha‘$o|“t§5y'w W “"' W ‘” “’ 4 "" W W -0

pulmonary artery.ame}'°P0sterior and lateral projections should be obtainedroutinely.

C ptgtatl catheters are not suitable clue to risk of rupture of theright ventricular chordae tendinae on withdrawal.

D films WhlCh record the arterial, capillary and venous phasesshould be obtained.

E pulmonary hypertension is a contraindication.

vi

58 in angiocardiography:A the right side of the heart is studied via a catheter passed

retrogradely from the femoral artery.B a cine-film frequency of 15 frames per second is usually

adequate. ia pigtail catheter is suitable for left ventricttlar injection-s.

_ ihe "Qhl Bfll8rl0r Oblique pl'D]8C[lDfl will tlernonstrate the- mitral valve satisfactorily.

E B H58 in the incidence of ectopic heats otmttrs with increasingCOHUESI ll'\|8CllOfl FBIES.

,-_ cl D

. 5 . —~-~s-

60 in coronary arteriography: lA the Sones techni ue

51 8C

________________9 requires right and left co on" rtcatheters. r My a aw

D

the tip of the left J_udl<ins' cocurved than that of the right.8_jQ:'_§9ud§l;cranial view is ideal for visualisation of the left'"e!a~§sm sotsflaw artery. - -- -°°"°_'"a"V a“°Fi°9T3l3fi§/ is U5“a“Y Preceded by left ventricularangtography.

E coronary artery dissection is not usually clinically 5ignifir;an[_

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258 A

B

C

DE

False

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False

TrueFalse

The catheter tip should be sited ]-Q ant above thepul_rp_orLary_yaive, i.e. below the bil‘urcation'o'f thepulmonary artery.The anteroposterior projection is adequate. Obli uevifyvg 519* a_l§_t_>_p_e useful. A lateral projection IS of novalue life main-stem pulmonary artery inietztton dueto superimposition. -§¢Pigtail catheters are mostyggmrnonly used. insertionof the guidewire to straighten out the end of thecatheter, prior to withdrawal, avoids thiscomplication.

Pulmonary hypeitension is an indication lorpulmonary arteriography.'Ho\X/everjnthete is increasedrisk that the procedure may be complicated bycardiorespitatory failure in these circumstances.

59 A

FDUOW

False

FalseTrueTrueTrue

The rtght heart is studied via a catheter passedanterogradely into a peripheral vein. In adults, the leiheart is studied via a catheter passed retrogradelyfrom the femoral artery. in children, it is ttstrslrypossible to manipulate a_vt_:__t1gus catheter through apatent foramen ovate to examine the left heart.About 25-80 frames per second are required.. . ___-

60 A

B

CD

E

False

True

TrueTrue

False

._ ___‘ __ __ _ _.._ q-_ - ~

The Sqnes technique uses a single catheter via abtachial Brlfiliqtomy.To aid engagement of the coronary ostia by thecatheters.

Left ventricular angiography is carriec_l_ out using aright anterior oblique projection.Coronary artery dissection is usually followed bycardiac arrest.

l it

106 NICO Tutor in Radiology

M/‘" 1TWUOIIJ

ecognised complications of diagnostic artgiography include:_retroperitoneal haumorrhage following transfemcral tincture.' Pbrachial plexus iniury.

cholesterol embolisatioh.bacterial endocardttis

anerlovenous fistule formation. ‘

fl

. B

C

D

E

62 The following statements are true of vascular interventional\/ techniques: a

A prior to balloon dilatation of a leg vessel, the guitletvire mustbe removed.iliac arteries are preferably dilated antegradc-ly from a femoralpuncture on the side opposite the lesion.heparin should not be given during angioplasty due to theincreased risk of haematoma formation.following an embolisation procedure, the patient may have afever for up to 10 days. .embollc material should always be radiopaque.

63

BC

DE

The ideal radlopharmeceutlcnl shuttltlzA have a hall-life that is approximately four times the length 0|

the scintigraphic examination.emit mainly charged particle ernissionsfproduce emissions with an energy between at) key and300 kt-:-V.localise only in the area or’ interest.be mono-energetic.

K

Techniques 107

True

True

True

TrueTrue

getTransfemoral puncture may also be complicated byhaematgma formation in the femoral sheath,su§§§:ritgneal and intraperitoneal spaces, scrotumand fasciai planes of the thigl"i._w 'This may complicate axillary artery puncture. Itoccurs either due to primary nerve injury orsecondary to’ extrinsiciiompression of the brachialplexus by,haematoma. 'Other complications local to the puncture site includeanerialthrombus and spasm, subintimal dissection,sepsis, false aneurysm and perivascular dxtravasationof contrast medium.

Other complications remote from the puncture siteinclude subintimal dissection, arterial thrombosis andspasm, embolisation, catheter knotting, guide wirefracture and septicaemia.

False

False.1-V.

False

True

False

cl?‘

Dilatation should be performed with the guidewireremaining across the stenosis/occlusion until theprocedure is completed.lliac arteries are preferably dilated retrogradely via anip§_il‘a_teral puncture. '-The patient should be anticoagulated during anangioplasty procedure using 3000-5000 units ofheparin. """"_"“_ "Post-embolisation syndr0me- comprises fe\_/er, pain,leucocytosis and a general feeling of bein_g unwell. itsh_oul»_d' only be diagnosed when other treatablecauses of the patient's condition le.g. infection) havebeen excluded.Non-opaque emboli should always be iniected as asuspension in contrast medium so that they arevisible as filling defects during the injection sequence.

False

False

True

TrueTrue

The hall-life should be of a similar length to theduration of the examination. ‘Ti’The radionuclide should emit gamma rays and thereshould be no charged particle emissions li.e. aip_l1aand beta emissions} as these increase radiation dosewitlt0 uting to image quality.This ensures that the emissions penetrate tissue, butwill be stopped by the detector.

I ma MCQTUIOHHRHGIOIOQY y wvwwvwwcwwcwwcwv. ' Techniques l09

6-I Regarding isotope brain scanning: ‘r-r_:/.;.t,,.;,-it-.~£l [-~.-apt! (_2:I¢lj.‘T.’-H/1' - i .,A :"‘Tc H_MPAO does not cross the blood-brain barrier.

_"‘T° d*e5nz!2‘___._‘="""“'"B eectaaeelsesld QTEAJ is useful inclinical practice. """“C when using 99“‘Tc pertechnetate, perchlorate must be given

FY beforehand._ D imaging should be commenced 1-2 hours following injection.

E single photon emission computed tomography lSPECT) is Pmandatory when 99‘“Tr: HMPAO is used.

B

\.5/ 65 Regarding isotope bone scanning:A ist is a highly specihc investigation.B °"‘T¢ methvlene dinhvsnhonate lNiDFl remains stable for

48 hours.C 20% of the injected 59"‘Tc MDP localises in bone.D to ensure adequate counts the patient shoulrl not pass urine

between the isotope injection and imaging the static phase.E the blood pool phase should be imaged approximately

15 minutes after injection.

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99'"Tc HMPAO is a lipophilic radiopharmaceuticalwhich does cross the blood-brain barrier.The three principal radiopharrnaceuticals used for ‘brain imaging are 99“‘Tc DTEA, 99‘“Tc pertechnetateand ”":t§.se§aepmsi;. -r - ~- sPerteclineiate is the cheapest of the threetadiophatmaceuticals, but has the disadvantage thatit is the only one to accu__rfrt_tilate inthe choroidplexus, thyroid and salivary gTa_nds. Thisis preventedby the administration of perchlorltt-_;§_Q—_45 minutesbefore the investigation.The dyngpjigpltase is imaged im_t_‘t\_q_t_§ia_t_e_ly followingthe iniection 0f‘l$0lOp6. and theééaéigimages aretake“ 1-.2 hearts nest lt~is'=tl<>t\-Anato'mical_§letail is getter displayed using SPECT atany time from 2 minutes to B hours after iniection.

False

False

TrueFalse

False

The bone scan ls highly sen_§i_tiyg_ butppn-specific asany lesion in bone ie.g. fracture, infection, tumour orhealing bone) will show as'an area of increasedactivity.Preparation involves reduction of the pertechnetateion. After 5 hours this may reoxldise back to freepertechnetatewhitih would locallse in the thyroid andthe stomach and thus degrade the scan.The remain;g.iar is excreted by the kidneys.The patienfshould be encouraged to drink plenty oifluid‘and to empty the bladder regularly so as io__reduce the radiation dose to-thti blQQdB'-The blopd pool phase should be imaged l_t§_£_l'l'\ifllii§§__Q_Q§§vi[\jBC_liDfl. The bl_gg;1_Iigyy phase and the§§_5§ic_phase shoiild be imaged in the ii_r§t__1J_ secottdsand at 3l4 hours respectively. .

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110 MCO Tutor In Radiology

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56 Regarding isotope examinations of the thyroid and parathyroidglands:

sgglrgkghe most frequently used agent lor examination of the

' _l has a hall-life of 13 hours.prior use of an intravenous non~ionii: contrast medium willrfsult in poor uptake of the isotope within the thyroid gland,i iethyrorrl lmsges should be obtained with a Convergingcollimator.the parathyroids are imaged via a subtraction technique,subtracting the 2°‘Tl image from the 99'"Tc image.

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garding the iadlnpharmaceuticals used lor lung ventilation

WEB" “5l"9 13>“! B Single breath technique is e!Tlpl0yed_W?" Using Xe,_the ventilation study must be performedprior to the perfusion study.B _krypton ventilation study can be performed simultaneouslywith the perfusion study.lggealb Uslflffil EFT/Pivrg. lateral oblique views should be avoidedideaHyS69s%\1ic8D%(;2USlOfl caused by overlap oi the two lungs.

_ . _ I aerosols should not be used in patientswith chronic airways disease.

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66 A False B‘! is used mainly in the study of metastatic thyroidcagcer. lt is not used for routine thyroid imaging dueto the high radiation dose from beta-emission. The

/(Ll most frequently used agents are(‘23l and 99'_“Tcpertechnetate. "“"" ""_"‘ml has a half-life of §__days.Uptake of either 99""Tc pertechnetata or iodine isinhibited by recent high ingestion of iodine.Thi§ gives high resolution images. Ndté that this is atthe expense of increased imaging time and somedegree of image distortion.

E False 2°'Tl is taken up by the thyroid and parathyroid_9la7i'ds1“f’l1‘Ts is taken PP lit’ the thvrviq Qlflfld vulv-

Parathyroidiimages are therefore obtained bysubtracting the 99""Tc image frorri the 2°‘Tl image.

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67 A True

B False

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C True

D False

E True

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Because of the high radiation dose, a single breathtechnique is employed. images are taken in oneposition only (usually posterior). The imagesobtained are in inspiration, equilibritlh and in twowashout phases. W‘ W“When using ‘33Xe, the ventilation study must beperformed first otherwise image quality would be_compromised by scattered radiation from the higherenergy 99f“Tg gamma rays used for the perfusionscan. ‘27Xé'emits gamma raysiwith higher—energythan ‘33Xe and 99'"Tt: and so can be used to gerforma ventilation stud after a perfusion scar].lf duel energy data acquisition is performed; askrypton emits gamma rays with an energy of 180 keVand 99'“Tc emits gamma rays with an energy of140 keV.ln a krypton ventilation study, six views of the lungsshould be obtained: anterior; poster_ior; RPO; LPO;right lateral; and lelt lateral. ‘Aerosols clump and therefore cause focal areas ofincreased uptake in patients with chronic airwaysdisease

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23$ Regarding perfusion isotope lung imaging: . 68 AA * "it should be performed after a ventilation scan in Ul'CluT to

diagnose pulmonary embolism.B the patient should be imaged in the supine position to

maximise visualisation of the lung apices.C the 99'“Tc-macroaggregated albumin particles occlude less

than 0.5% of the total capillary bed of the lung. 'D the syringe should not be shaken before the injection as this

may damage the albumin macroaggregates. '1E respiratory failure may be induced in patients with pulmonary

hypertension.

\/\/59 Regarding isotope examinations oi the urinary tract:' A _59"‘Tc__Qlyl§A has specific affinity ior the proximal convoiuted

tubular tissue.99‘"Tc DTPA is excreted by glomerular liltration.99"‘Tc DMSA is never used to obtain a renogram curve.the peak of the renogram should occur alike‘ minutes.99‘“Tc MAG-3 is excreted by glomerular filtration.TTIUOCD

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A normal p_erf_gsion scan will exclude a‘d_i§gp‘g§t§ oipulmona_ry embolism. A perfusion seas shouldtherefore be;,pei'formed first. and the ventilation scanonly needs to be done if the perfusion scan isabnormal.Imaging shqpld be performed in the sitting position.The iniectionihould be given with the pati§_rit_§upine.The bronchial circulation maintains pulmonary 'nutrition so there is no irreversible tissue damage.The syringe should be shaken so asto prevent iparticles settling, as this would cause clumping onthe image. .A slow iniection srtlould be given in patients withpulrr'i6'naFy‘]1ypenension, and microspheres shouldbe used wheneder possible. Perfusion scanning ist:ontraindicated_i_n patients with tiqfit m.leit.catt1Lig hepossibility of systemic microernboli.

True

True

True

True

False

99"‘Tt: DMSA is bound to plasma proteins and iscleared from the blood by renal tybular absorption.When injected intravenously, 99'“Tc DTPA ISdistributed throughout the extracelluar space. lt isexcreted rapidly from the body by glomerularfiltration.99‘“Tt: DMSA is used only for s;ati§__@nal imaQi"Q-99‘“Tc. MAG-3 and 59"‘Tc _DTPA_a“ra thecominonestradiopharmaceuticals used to o'bt'ain' a renogram.The normal renogram comprises three phases; thevasgglar phase, th? secretgry phase §_r1_cltl1%§g§retOt_'yphase. The peak o the renogram occurs at — minutespost iniection, and it takes 10-15 minutes for theactivity to drop to lialf its peak value (the clearancehalt-time).99‘“Tc MAG-3 is excreted by tubular secretion and ‘has an extraction efficiency tfiree llfl_"tBS greater than59“‘Tc DTPA.

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70 Regarding radionuclide investigation oi the gastrointestinal tract: 70A patient preparation is not required lor a radionuclide Meckel‘s

diverticulum scan. .B gastrointestinal bleeding will only be detected if the rate of

blood loss is greelcf than approximately g§__m_l[min. "C a recent barium study may mask a bleeding site.D gastro-oesophageal reflux may be demonstrated with 99"‘Tc

$u_lel1u.§2!I9id- "E a lull bladder ls encouraged in a Meckel's scan in order to

elevate and separate small bowel loops.

// _ ,.

Techniques 115

'1 £_;_;_,'- \/71 Regarding cardiovascular radionuclide imaging investigations:A red cells are labelled with chromium ions. ‘B multiple gated acquisition (MUGAl may not be possible it the

patient is in atrial librillation.C °‘Tl is taken up by skeletal muscle.D rnethoxy isobutyl isonitrile lMlBl) is excreted via the

hepatobiliary route.E in myocardial irtfBfCl imaging with 5g'“Tc py|'QphQ5ph3te_ ~

infarcts show tracer uptake from 24 hours and'clo so for up to10 days. “

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- asNil by rnouthigr 6 hours unless it is an emergency. 'Prior administratiorfof an H2 blocker or pentagastrinis also advised so as to enhance detection byincreasing the uptake of 99:1T§_pertechnetate intogastric mucosa and inhibiting its release into thelumen of the stomach or bowel.

Barium causes significant attenuation of gammaphotons and may mask a bleeding site.ln adults; orange luice labelled with 99"‘Tc colloidniay be used to demonstrate reilux, and in youngchildren a normal milk feed may be similarly labelled.The bladder should be empty. A full bladder mayobscure the Meckel's diverticulum.

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Red cells are labelled with 99_f“Tc ertechnetete. butbe ore this they are primed with an \n|actron ofstannous ions. The stannous ions reduce thepertechnetate and allow it to bind to the red bloodcells.ll the patient has an arthythmia, the computer cannotidentify an acquisition cycle. 1Distribution of thallium is related to blood flow andmetabolism. lt is mainly taken up by muscle andthyroid, but some uptake occurs in the liver, spleenand kidney. it is used lor myocardial‘ pegfgionimaging. ' VThe gall bladder may therefore appear as an area ofincreased tracer uptake on a 99'“Tc MlBl scan. A drinkof milk or a fatty meal‘30—60 minutes alter injectionhelps to clear the radiopharmaceutical from the liverand gall bladder so that myocardial perfusion can beimaged. 'The size and intensity of myocardial uptake is relatedto infarct size.

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72

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\/ -The following statements are correct:A in “Ga scintigrsphy uptake within the bowei is often a no l

feature. y ‘ rmaE esmTc tin colloid is taken up in the liver by the hepatocytes. It. lit colloid scintlgraphy, focal liver disease may be mimicked b

overlying breast tissue. VD in normal cholescintigraphy, the gall bladder should be

visualised by 1 hour.E Trlcycllc_antlde_pressants should ‘be stopped prior to a

radlolodlne M-lodobenzylguanidlne il‘v‘llBG] scan forphaeochromocytoma. y

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73 In ultrasound of the upper abdomen:A the spiral valve of the cystic duct will frequently produce an

acoustic shadow. .. u ’B assessment of gall bladder wall thickness is preferably carried

out after a tarry meal,C reflectivity of the normal liver parench ma i 'l' h l h’

than that of the normal renal cortex. Y S S lg W lgherD ;:\a:‘f::fCOSt§_l_§pp__r'oach ls optimal lor examining the adrenal

E hepatic veins have highly reflective walls.

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DOWBI ouuvtty ta Ptuutllluru -r .-. ._ y.of the main drawbacks oi 5-[Ga imaging lorabdominal infection. Delayed imaging is essential.Radiolaiielled colloids are taken up by the l<ugfier_cells in the liver. ___.-a-‘Llhere I5 considerable variation in normal liverappearances. For example, focal abnormalities canalso be mimicked by rib impressions, hepatic veins,and the impression of the right kidney.99"'{Tc N-substituted iminodiacetic acid iHlDA) is takenup by hepatpcytes and secreted intoihe bile in thesame way asislbilirubln. By one hour the gallbladder is normally visualised.Tricyclic antidepressants block MlBG uptake, as doesreserpine, labetalol and cocaine. The thyroid shouldbe blocked before MIBG scanning with potassiumperchlorate or Lugol's iodine,

73 True

False

True

TrueFalse

This should not be mistaken for a stone in the cysticduct. -The normal gall bladder is contracted andthick-walled alter a fatty meal. These appearancescannot be distinguished from pathologicalcontraction. Therefore, gallbladder wallmeasurements should only be carried out in thelasting state, when wall thickness is normally lessthan 3 mrrjl.Reil§_cTi'vity of the normal liver parenchyma is alsoslightly higher than that of the spleen. '

Hepatic veins have poorly reflective walls. Portalveins have highly reflective walls.

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ultrasound of the a ; . l 7the pancreaflc dug 2:122: normany be visualised False The pancrleatic duct can normally be visualised inan oral fluid mad may be he|p‘uL - almost 30 /» of patients. its maximum diameter, in the

, _ region of thepancreatic body, is up to 2 rnm in:3'r;§l?i|'::1fl?r? :“f:1g$el2'e)g)t;?tri1;ly visualised with the patient patients under $0 veers of age. The calibre oi the-the normal pancreas is homngéneous with _ . . ~ pancreatic duct increases with age.meme, than or equal to may ‘h?fi\/er 3 '9 le""VllY 3 B True This produces an acoustic window through thethe maximum ameropostefl0rT£ifi_dT . 1 I stomach. This helps to visualise the Pancreati§_bBE'Vpancreatic head is 15 mm arne er o the normal A i andtail vi/hen the patient IS turned onto ll18__l_l'__1§fI_

‘ ‘ ' gldei and the Pancreatis h.?§.d and uflcifiélfi l°.l9.'=e5§vvhéh the patient is turned onto their Light sfle.

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T C TrueD True Variations in the level of reflectivity of the pancreas

probably relate to the degree of fat content; thiscommonly increases alter 60 years of age.

- E False The maximum AP diameter of the pancreatic head is25 mm. The pancreaiicjligy _has e maximum AP

‘ diameter of i5 mm..

75' Régmding Urlfl‘&i'y tract ultrasound‘ ‘A 75 A/

/'i B

C

D

E

True Due to tat sujryguggjgg the renal collecting systemand blood vessels. This reflectivity is reduced_ii'i_Qemleies. "'-"'Flenal lengths are measured by rotating the probearound the long axis of the kidney and recording itslongest lenglh.“'_'”“Mild collecting system dilatation occurs as early asV12 weeks gestation. This increases throughout{fiegnancy until term, when dilatation is usually moremarked on the right side. Following delivery, thedilatation decreases but may persist lor at least

_3 months.D True

' E True Due to the ellect of normal uf§E§ll_'~E BeFl5la|9l5-

the r|e‘nal sinus is normally ecliogenic.ren - .I 3 °"9lh5 file preferably measured in the BflteroptjstgrigrD ane lor standardisation. 5 parsemat I ‘ .- - - _Ema ¢°"_e°ll"_Q -iY$tem dilatation does not normally 0(:(:i_irbelore the third trimester of praggaiiqy‘Slag: bladder appears '9§!él1t3Li|a.lZ§l@i?_8d in transverse C Falsea ier of urine entering the bladder is commonly observed

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USZEO‘:/1:: ;°a°r:'s':1"::3e:‘fr“‘“.‘""f?~ 76 A False A high resolution transducer in the lrequencY range8 water bath is not usefeciuency is recommeiided. 1.5-‘l0 Ml-iz ls desirable. _ _‘he normal ‘ems Is hem" - I B False A water bath clears the organ being examined fromme mediasunum testis k:°Q9"E0\_J5 Ifl'_l8Xlure. I _ l near‘ field interference and ensures that the organ liesIongiwdinany seen as a thin reflective bani! lying ‘ within the focal _zorie of the transducer. _the head of me H ‘did m_s I f _ _‘ I I I C False The normal testis is acoustically homogeneous. it IS‘esliéB.‘é.r ¥i_s§‘Té_£___y i s o siiiiilar rellectiviiy to the of medium reflectivity. _ _

- W. D True it is a normal structure representing condensations ofconnective tissue within the testicular stroma.Bur the rests? the Bilididvmis is_l.e§§.s§_ll§1i\_'@ thantesticular tissue. _ ~

E True

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"‘;"'"°| neonatal ultrasound:the pancreas is markedly echogenic.t e neonatal ad - .\ .of the adum 'e"a| Qlfllld ls rngwre easily visualised than thatthe renal pyramids appear profininenta 3.5 MHz linear arra ' 'tran d _- ~the brain‘ Y s ucer IS preferred when bt.8fif'llI1Qthe tri- ‘ - . t .radme °a"“|a9e cannot be idenufled.

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ma choroid plexus is llltlhly echogonic.the corpu§_§g||95um is eghiopoor.{ha CHVUITI Sepfufn I _ ~ . _ _of fulmerm infamipfi lucldum can be visualised Ill Z1l)Q1|[ 95%a 7.5 M ‘ .Hz “"°a' “Nev transducer ls ideai

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The pancreas is, et:hopoor_1g_neonates.For several reas'oris:' th'é'T1e0nata| adrenal gland isproportionally larger; there is less neonatal perirenalfat; and higher frequency transducers are used,improving resolution. The normal adrenal cortexaplilggrs eghopogr and the medulla B.<2l10.Q.Bnic.The renal pyramids are large and echopoorcompared with fiie thin echogenic'co'rtéit'. Theseneonatal appearances alter between 2 and 6 monthsof age when the adult pattern emerges.Ag§;Z.5 MHZ sector transducer should be used.The tri-radiate cartilage is seen as an echopdgg areabetween the bony iliurn and ischium. Ultrasound ofthe neonatal hip is successfully carried out using thecartilaginous femoral head as an acoustic windowinto the acetabulurn. ' "

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The posfiarior fontanelle and temporofparietal bonecan also be used. '

The cavum septum pellucidum can be visualised inabout 50% of all full-term infants. By 6 r_no_n_tl3§ ofage, its incidence is similar to that reported in adults(15-20°/til.This letzhniquu requires a sector transducer. A lineararray transducer has a long rectangular scan headand a field of view which is unsuitable forvisualisation of the whole brain through a smallacoustic window.

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80 In endoscopic ultrasound examination of the oesophagus:A patient preparation should include drinking at least 1 l of fluid.B the heartvelves can be identified. 5

rnanorneiry is carried out as part of the procedure.pH monitoring is part of the procedure.all the layers of the oesophageal wall can be identified."IUD

Techniques 123

81 transrectal pro static ultrasound:0A the reflective peripheral zone constitutes the major part of the

normal gland.patients are examined prone.an anal stricture is a contraindication.no bowel preparation is required.the seminal vesicles era highly echogenic.MUOUJ

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Regfltdiiig lnterventlonal techniques in ultrasound:A the transducer should be sterilised by eutoclaving following8 ultraaoundpuided puncture and biopsy.

needle positionwlthin the tissues I5 demonstrated by theC highly echogenic needle shaft. _D fine-needle biopsy is safely performed on an outpatient basis.

ocal anaesthesia is necessary prior to transrectel guidedl>i0i>5v vi the prostate gland.prophylactic intravenous antibiotics are recommended prior tolransrectal guided biopsy of the prostate gland.

E

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The ultrasound probe is attached to a rubber bagcontaining water so that acoustic contact can bemaintained between the oesophageal wall and probe.identification of the heart valves helps to define localanatomy.Endoscopic ultrasound defines anatomy rather thanfunction. Manometry require'§T5'péi*fGs'éd’rnultilurnentG5ET‘ -pH monitoring requires a pH probe to be positionedin the lower oesophagus for 24-hour monitoring.

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The peripheral zone constitutes 70% of the normalgland. lt is more reflective 'th'a‘rT‘t'li'é'remainingtransitional and central zones of the gland.Patients are examined in the left lateral position.

The seminal vesicles are echopoor with fine internalechoes.

A

B

CDE

False

False

TrueFalseTrue

Ultraso_und transducers do not tolerate autoclaving.Sterility is achieved by the u$_p of sterile rubber‘coverings for the transducer or by immersion of the-equipment in cleaning fluids.A needle shalt within tissues is poorly visualisedunder ultrasound guidance. However, the needle tipis usually well visualised as a strong echo. ’

No local anaesthesia is required.Prophylactic intravenous antibiotics should be givenimmediately belore. and subsequently orally for 3days post-biopsy. "

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B3 ln Doppler ultrasound:g<|)gFglg1L?1l%L|$ Wage Doppler may be used in fetal heart detection.

w wit in the popliteal vein can be augmented bymanual calf compression. 'the portal vein isbest assessed via an anterior apprciat;h_the normal velocity waveform of the common carotid arteryshows continuous forward flow in diastole.the normal velocity waveform of the external carotid artery - -may show reversal in diastole. '

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‘-// H34 Z:/ith T5599“ I0 Doppler imaging of the leg veins;the normal venous flow signal in the legs varies withrespiration.

B compressibility of veins is one of the rnost reliable signs of,\ patency.

\ C an established collateral venous system may Simulate now iny a patent ma|or vein.

,,;é D Poppler flow studies are more reliable in detecting thrombusin the veins below the knee than in those above the knee

E thrombus may be anechoic. '

\/ ~35 1 ln' chflst computed tomography {CT}; 85\. A the vague nerves are commonly visualised.

' the mediastinal structures are best derrionstrared with anarrow window width. -

(0) g normaimediastinal lymph nodes are not visualigedthe maior fissures are demonstrated " ' ' I. . as l|'tlfl white lines imajority of cases. H the

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\Y/ C the normal pericardium is not visible.

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This manoeuvre l5 useful in examination of the deepveins of the leg where normal low velocity bloodflow may not otherwise be detected. The Valsalvamanoeuvre is also followed by a compensatorytransient irttttiease in blood flow in the deep veins ofthe leg. ‘An anterior approach to the portal vein is optimal forimaging but provides a poor beam/vessel angle forDoppler studies. ln Doppler ultrasound thebeam/vessel angle should be no greater than 60°.Therefore, the right lateral i_n_ti_ggg_§_tal approachoptimises the eat-rat/vessel angle.This is characteristic of a low resistance arterial llowpattern.This is characteristic of a high resistance arterial flowpattern.’

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B True

C TrueD Falst-tx

E True

When the patient lies supine, the venous flow signaldecreases on inspiration and increases on expiration.Direct pressure with the ultrasound probe over thevein will cause the normal vein to collapse. lfthrombus is present. this will not occur.Thus causing confusion and inaccuracy.Duplex Doppler studies have a high degree ofaccuracy in detecting occlusions in the femoral.popliteal or iliac veins. Below the knee the study isdifficult, time consuming and less reliable.Thus compression studies are important.

A Fa1seB True

C False

D False

E False

A narrow window width le.g. 300 Hounslield units)and a soft-tissue level le.g. §l_J_—_“5U'fitiit_siield unitslare optimal. """_'~The normal pericardium is visible as a thig stripe ofsoft tissue density around the heart outlined bymediastinal and epi_C_a__rgi_al fat. ""-Normal mediastinal lymph nodes may be visualised.A diameter of 1 cm is considered as the ugpe_r limitof a normal noi;lé'in‘most parts of the mediastinum.The major fissures are demonstrated as thin whitelines in only ]Q—ZQ% of CT scans. However theirposition can be interred from the relatively avascularplane of lung lying either side of each fissure.

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85

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When the thorax is examined by high-resolution CT:A

MDUW

contiguous 1 mm thick sections'are usually obtained.the mA is usually increased compared with conventional chest CT.normal interlobular septa may be visible.a soft tissue algorithm is used.motion artefact adiacent to the heart is eliminated.

87

$_

egarding percutaneous lung biopsy:AB

C

D

E

a previous contralateral pneumonectomy is a contraindication.a prieumothorax will be detectable on a chest rarlio ra h inQ Dapproximately 60% of cases.the risk oi pneumothorax is increased if the biopsy needletraverses a fissure.in the case of a large or cavitating lesion it is importairt to obtainmaterial from its margins.a CT scan is required in all cases to accurately locate the lesion.

883

IiiA

BCD

E

CT scanning ol the upper abdomen:the normal spleen enhances irregularly lollowing bolus intravenouscontrast agents.the normal gastric wall can be 10 mm thick.pancreatic examination may require a left lateral decuhitus position.zitltorlrll glands ore vistlalisctl in rl|li)lt)Xll'l1iI1UlY 10'3"}. nl rinriirriliiritrtililzr ‘llltl gull lrlritlrler wull l)l\l\LllltZt!$ rrrrirlttitily ltrllnwirig rrrtrrrvnirrrirzzt.urrtru:.t ulrlruncuriierlt.

ii?n CT oi the abdomen:A

Om

DE

dilute barium can be used to opaciiy the bowel.normal intrahepatic bile ducts are usually visible.oral contrast medium should be given 1 hour prior to theexamination to produce large bowel opacification.the diapliragrnatic crura can be rnrstrrkcri ior erilargecl lyiirph nrrtlesrmtlge interpretation is easier in thin rather than tlllctsu pant.-rils.

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Techniques 127

86 A

B

C

DE

False

True

True

FalseFalse

1 mm thick sections are usually obtained at intervalsfro_n'i‘Tiie lung apices to bases.increasing mA reduces the visible image noise andimproves scan quality.Normal centrilobular arteries may also be visible. Thecentrilobular bronchiole is not normally seen.A bony algorithm is used in high-resolution CT.

37 AB

CD

E

TrueFalse

TrueTrue

False

4-

B8C8l.l§_B a pneumothorax would be poorly tolerated.Achest radiograph demonstrates a pneumothorax in15-25% of cases. CT shows a much higher percentagelabour 60%).Thelbiopsy needle will be traversing four layers of pleura.The cells in the centre of the lesion may be necrotic andunrepresentative of its true cytological nature. A.The lesion can often be adequately detected using'biplane iluoroscopy or a C-arm.

B8 AB

C

l)E

TrueTrue

False

FrllsuTrtru

Due to variable rates oi blood flow through its pulp.The normal small bowel wall is up to 3 mm thick. Thenormal colonic wall is up to 5 mm thick.in pancreatic CT examination a right lateral decubitusposition immediately alter oial contrast medium may behulpltrl in rmzlcilying the tltrtitlontrrn.Atllt:l\£llt_]ltlllll1-Iilll:Vltilltllltiutllllillllltltilillllit)Illll\lil(lllll5.

89 AB

C

DE

TrueFalse

False

Titre'False

Barium concentrations between 1-3“/tr w/v are optimalNormal intrahepatic bile ducts are not usually visible onCT.Oral contrast medium should be given at least 4 hoursprior to the examination to produce large bowelopaciliczition. Oral contrast medirrrn should be givengradually over rt pnriotl ol 1 hour liolbie scanrrirrg ituprotlrrco small lmwul opacilicatiun.

Much ol the natural contrast in CT is provided by fat,thus making image interpretation easier in obese patients.

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128 MCQ Tutor in Radiology

ln CT of the normal pelvis:vaginal tampons should always be tcriiovetl prior to scaiir-tingto avoid confusing artefacts.the ovaries are readily identified.the paired seminal vesicles have a characteristic bowtie~shaped appearance.

D the spermatic cord is visualised in the inguinal canal.E the prostate is separated from the bladder by a fat plane.

Regarding computed tomography: -A suspended respiration is required for examination of the neckB air is seen within the oesophagus in approximately 80% oi

patients on chest CT.C filling defects may be seen in the normal superior vena cttva

during contrast enhancement.D CT pelvimetry has a much lower radiation dose than

conventional pelvimetry.E patients undergoing a pelvic examination should have tt lull

bladder.

l

92 in CT examination oi the brain:- . A most adults’ heads are adequately examined in apiiroximately

15 contiguous 10 mm thick axial sections.when SC3fll'llI'lQ‘IT18 posterior cranial iossa liony nttefact isreduced by increasing slice thickness.intravenous contrast enhancement should precede pituitarylossa examination.white matter is more dense than grey matter.the internal capsule is oi a ltlglior ttttanuation vt-iltiti than thecatidate nuclei.

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' 9 O False A vaginal tampon is indicated in pelvic scanning. Airtrapped by the tampon produces negative contrast.

False They are difficult to identify on CT.TrueTrue lt is seen as arthin-walled oval structure of lat density

V containingsmall dots representing the vas delererifiand spermatic vessels.

False V

91 False Suspended res_piration is not required. However, thepatient should be asked not to swallow during theexposure. r

True .True Filling (,i8i&Cl5'zit‘| the superior vena cava result from

incomplete mixing of opacilied and unopaciiiedblood.

True CT pelvimetry measurements are also accurate andreproducible.

True

DZ

—-——-—---e--_---_--_.__.._i____.-_~.

True i0 mm tltitzk coiitiguotts sections from the posteriorarch of the atlas to the vertex.

Ftilse When scanning the posterior cranial lossa. thinnerand more frequent sections will reduce bone ‘artclacts and improve scan quality. Alteration iiigantry angultttion may also reduce artelztct.

TYUE § T

False White mutter is less dense li.e. has a lowerllntinslieltl nuiuheri than grey matter. _

False The iuternul capsule is of at lower Zll\GllU‘tlllOl\ vtiluethan the isaudate nuclei.

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, //4In CT scanning of the orbits:A the superior ophthalmic vein cannot he distinguished separately

from the superior rectus muscle.direct coronal sections are often necessary.intravenous contrast enhancementris mandatory.axial sections are acquired parallel to the neuro-ocular plane.the prone patient position is essential when obtaining directcoronal sections.

WUOID

.y_-_‘_-When imaging the larynx: -A lateral tomograms give a better demonstration of the vocal cords

titan anteroposterlor tAPl tomograms.B phonating "ee" approximates the vocal cords.C axial CT sections of 5 mm thickness are tecltnically appropriate _D ossification of the laryngeal carttlages is more easily seen on the?

frontal radiograph than the lateral radlograplt. ' 'E soit tissue discrimination is better on it/lfil than FT.

95

\

%Dimeglumine gadopentate [Gadolinium]:A is superparamagnetic.B shortens the Tl-relaxation time.

is excreted by the kidneys.ptotltrtzes tl ttttttstent tntzretttatt in :.t.-rttttt trttn |t:vt:|s lt1ilttwt|tt_|intravenous tttjuctiun. '

E has, no severe adverse effects‘

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Techniques 131

93 AB

C

DE

False .-True

False

TrueFalse

4%

In addition to axial sections. Coronal reformats shouldbe reserved for those patients whose dental fillingsmake direct coronal sections difficult.intravenous contrast enhancement is generally givento show up space-occupying lesions in better detail orwhen there is suspicion of intracranial involvement bya lesion‘. it is not necessary in thyroid eye disease norfollowinq_t[a_tu;n,a,

Te-obtain direct coronal sections the patient usually liesprone with the chin elevated. However, if this is notpossible, then direct coronal sections may be obtainedby placing the patient supine with the neckhyperextencied. " '

94

DOW}

E

FalseTrueTrueFalse

Tru e

a

The vocal cords are best seen on AP tomograms.

Laryngeal cartilage ossification is best seen on thelateral radiograph which avoids superimposition ofcartilage over spine.in addition, the use of coronal and sagittal sections inMRI allows visualisation"bf the intrinsic laryngealmuscles.

9 5 AB

CO

E

FalseTrue

TrueTrue

False

Gadolinium is a paramagnetic contrast agent.Gadolinium leads to an increased signal onT1-weighted MR images and is therefore known as apositive contrast agent. Superparamagnetic contrastttgtmtz; ||:(it|t;t: llm T2 ttzlttxitlttnt tttnu. luntling] to utillt.2lUtI:$t.‘ti slgnztl on T2 tvuigltlutl intugus. Tlttty umknown as negative contrast agents.it has a plasma half-life of about 90 minutes.Therefore serum iron estimations may be inaccurate inthe 24 hours following intravenous injection.Gadolinium may result in art anaphyloctoid reaction.Minor reactions are seen in El-mUTT1 following injection; these include nausea, local burningsensation, urticaria and headache.

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atIx) "MearsQ.~.te.t..Qmr“l "' l" " ~" " ~' W ~' W he ‘W - ~ - iv - w w ~ - ~ -36 Regarding spin echo imaging:

A structures with a short Tl produce nigh signal intensity lfiTl-weighted images.

B structures with a short T2 produce high signal intensity inT2-weighted images.

C fat produces a higher signal intensity than muscle on aTi-weighted image.

D cerebrospinal fluid usually produces a lower signal intensity ,;than grey matte-r on a T2-weighted image.

E conical bone has a high signal intensity on Tl- andT2<weighted images.

9 Regarding MRI of the brain:A the pituitary gland enhances poorly with intravenous

Gadolinium.B mascara should be removed prior to the examination.C the parainasal sinus mucosa enhances t-vitlt intravenous

Gadolinium.D on T1-weighted images grey matter has a higher signal

intensity than white matter.E on T2-weighted images white matter has a higher signal than

grey matter.

98 A significant deflection (rotational movement as a result of theprimary field) of the following implants/devices will occur duringMRI:A Charnley total hip replacement prosthesis.B Bjork-Shiley heart valve replacement.

copper intra~uterine contraceptive device.dental amalgam.all surgical clips.ITIDO

>.

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96 True

False

TrueFalse

False

Structures with a long T1 prgdugfl lqw signalintensity on Tl-weighted images.Structures with a long T2 produce high signalintensity on T2-weighted images, Structures withshort T2 produce low signal intensity on T2~weigntedimages. »~**=‘Fat has a shorter Tl than muscle.Cerebrospinal fluid usually has a longer T2 than greymatter.Cortical bone has a low signal intensity on Tl- andT2-weighted images.

(D \-l FalseTrue

TrueFalseFalse

lt enhances strc“ngly. .- Mascara may contain ferromagnetic material andthus cause s'ignal lossi eometric distortion.9 .

The reverse is true.The reverse is true.

98 False

False

FalseFalseFalse

Most orthopaedic implants do not undergosignificant deflection and are therefore safe.Many modem prosthetic heart valves are submittedto a deflection force which is notglinically significantHowever, some prosthetic valves, including theStarr-Edwards valve, may undergo significantdeflection.

Whether a surgical clip undergoes significantdeflection or not depends on the individual type ofclip.

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134 MCQ Tutor irt Radiology lTechniques 135

I

99 The following statements regarding MRI are true: l

Gadolinium enhancement helps to disr.-riminate betweenrecurrent intervertebral disc prolapse and postoperativefibrosis.

E cardiac gating improves image quality in examination of thecervical spine.

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t 99 AI _ A the entire scanning suite is designated a controlled area. 5T / B the noise heard during scanning arises from the transmitted

radiofrequency pulses. _‘ ' C 60% w/v barium is used as a positive bowel contrast agcnt.~

D

N1

False -' The area inside the 10 Gauss line is designated ascontrolled. Any person entering the controlled areashould remove all loose ferromagnetic objectssusceptible to the missile effect, and any magneticcards. Persons with pacemakers must not enter.

False The noise which is heard during scanning arisesfrom vibration in the gradient coils due to the varyingmagnetic fields.

False Barium is used as a negative bowel contrast agent,by shortening T2 and therefore appearing figk on

"T2-weighted spin echo images. Gadolinium and fattyoils are used as positive bowel contrast agents.

True Imaging must be performed shortly after intravenousGadolinium as fibrous tissue enhances immediatelybut disc material does not enhance within 10 minutesof injection.

True Artefact produced by cerebrospinal fluid pulsation inthe cervical spine can be reduced by synchronisingdata acquisition to the cardiac cycle. '

100 In magnetic resonance imaging: 1 100A Ti-weighted spin echo (SE) images usually visualise

anatomical structures better than TI-.'-weighted SF. irnztges.the signal from fat is suppressed by short T1_~lg)yc-rsion

~§./T : ; ~- - ' ' Recovery tSTlRl sequences. 'C healthy tendons can acquire abnormally high signal on short

TE sequences if orientated at 55° to the static magnetic field.D rapidly flowing blood or cerebrospinal fluid usually has high

signal on spin echo sequences.E regarding magnetic resonance arrgtography lit/IRA}, the time

oi flight technique is more sensitive to slow iluw than thephase contrast technique

gt, .2

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True _T2_-weighted spin echo images usually demonstratepathology better than T1-weighted SE images.

True, it is particularly useful in ihe examination of tissueswith a high lat content leg. orbit, parotid gland, bonemarrowlf

True This is referred to as the magic angle phenomenonand may mimic pathological tendinous change. Theeffect is most likely to be seen in curved tendonsleg. supraspinatus tendon).

False in spin echo sequences, rapidly following blood orcerebrospinal fluid usually has low signal. Slowflowing blood usually has high signal. However ingradient echo techniques, virtually all vessels arehyperintense.

False The opposite is true. Time of flight tTOF) MRA uses agradient echo sequence with a flip angle of 30-60° tomaximise flow-related enhancement of vessels thatoccurs due to the entry phenomenon. Thus in-planeflow will produce less signal so that TOF techniquesare less sensitive to slow flow within the imagingplalle.

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1 Regarding the structure of the atom:A an electron has a unit negative charge and no mass.B the number of neutrons is the same as the number of orbital

electrons in an electrically neutral atorn.- C the atomic mass (Al of an element is always equal to or

greater than its atomic number (Z).D an electron in the K shell has a higher binding energy than an

electron in the M shell.E the nuclear forces that are called exchange forces are effective

only at very short distances.

Q_2_'mHe'gaidTng':_radloa‘qtivit_¥,r§A the maximum number of electrons in the M shell is 64,B an isobar is any nucleus which contains the same numba

protons as another given nucleus.C all isotopes achieve stability by the process of radioactive

decay.D the binding energy of an electron in a particular shell

increases with an increase in-the atomic number.E an alpha particle is four times heavier than an. electron,

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1 AB

C

D

E

FalseFalse

True

True

True

An electrffnllias a mass of 9_.l09 x 10'“ kg.in an electrically neutral atonifthe number of protonsis equal to the number of orbital electrons. ' ' 'The atoritigtgass of an element is comprised of thenumber of protflns and the number OLQQQEFDHSpresent in theflnucleus. The atomic mass will thereforealways be equal to or greater than the atomic number.The binding energy is greater lor those shells whichare closer to the nucleus.The exchange forces in the nucleus are also calledshag rar\g§'lorceS and are effective at distances oi10' m.

2 A

B

C

D

é

False

False

False

True

False

Use the 2n2 law to calculate the number of electronsallowed in any orbit. Here n is the shell number. Theshell number n starts from n = 1 for the K shell.

K shell, n = l, number of electrons = 2L shell. n = 2. number of electrons = 8M shell, n = 3. number of electrons = 18

The number oi electrons in the M shell will be l8 andnot 64.An isobar is any nucleus which has the same atomicTi tii ass un yer as another nucleug.N_oF___a!l_isotopes are radioactive, e.g. ‘ZC and “C areisotopes olf carbon but neither is radioactive.The shell radii are smaller with increasing atomicnumber and the binding energy is greater for thoseshells clos_er to the nucleus.An alpha particle is 7280 times heavier than anelectron. ~""'—_"

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138 MCO Tutor in Radiology J

3 Regarding radioactivity:A the unit of radioactivity is the Becquerel (Bql where 1 Bq is 1

disintegration per minute.B the unit of specific activity is Betzquerels per millililre (Bq/ml).C it is possible to slow the radioactive decay process by

lowering the temperature of the radioactive sample to -4°C.D stable heavy nuclei contain an increased number of neutrons

relative to the number of protons.E gamma rays exceed X-rays in their maximum possible energy.

1

i Uy 4 Regarding radioactivity:l A “C decays to “N by the pr0CeS5 of isgipgrig: transition.

Bt during positron and electron annihilation twogamma plintonsof 150 keV energy are emitted.

C during a beta decay the total energy carried by the betaparticle and the associated neutrino is constant.

D lor ionizing radiations, frequency lvl multiplied by itswavelength ti.) is always constant.

K E the quantum energy (E) associated with the iniiiviiiliml X-rayand gamma photons can be calculated by dividing l"lartt.:k'.sconstant (hi by the frequency of the radiation.

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FalseFalse

False

True

True

1 Bq is equal to 1 disintegration per second.Bgjgwl is a concentration of radioactivity and notspecific activity; the letter is expressed as Bq/kg, i.e.activity per unit mass. ’_"‘_The radioactive decay process is not affected by thetemperatgire of the sample.An increased number of neutrons reduces the extentof repulsive columbic forces between the positivelycharged protons.Gamma rays originate from unstable nuclei andX-rays originate from changes in the electron shells.The maximum amount of energy available duringnuclear transformation is much higher than thatinvolved in the electron transfers lBremsstrahlung).

Fnlae

False

D

True

True

False

isomeric transitions occur between metastable andstable states, e.g. 99'“Tc decays to 59Tc. Note that themetastable state is denoted by the letter m.An annihilation process involving a positron and anelectron produces two gamma photons of 0.511 MeVenergy. This follows the principle of mass and ‘é'ner'g'yequivalence. "During beta decay the kinetic energy is sharedbetween the beta particle and the neutrino. Thereforethe total energy carried by a beta particle and aneutrino for a specific beta transformation is alwaysconstant.The product of frequency iv) and wavelength (it) isconstant and is equal to the velocity of lightc i3 x108 m“).The electromagnetic radiations can be considered asenergy quanta or photons. The energy associatedwith the photons is given by the followingrelationship: E = h\~. The energy is a product of thefrequency (vl and Planck's constant (h) 6.63 x 1O‘3‘ Js.

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Regarding the interaction of electrons with matter:electrons travel ohiy a short distance in tissue ranging frurn efew mic w millimetresrons to a fa _ ' .

' Bremsstrahlung radiation occurs when .i low eneri electron- JVinteracts with matter. tthe average energy required to form an ion pair isapproximately 10 O00 eV.units of linear energy transfer are expressed as kezl urn“.a low atomic number material, such as perspex, is moresuitable than a high atomic niirnlier material, such as lead, forprotection against pure beta emitters.

Regarding the attenuation of X- and galntna radiation by mutter:A the linear attenuation coefficient (til is the fractional reduction

B

C

D

E

in the monoenergetic photon beam per unit mass. ithe half value thickness (HVT) is the thickness of materialwhich will reduce the intensity of the photon beam to 70% ofits original value.under narrow beam conditions. for H30 i<e\/ pliotrins, the hailvalue thickness lHVTl for \Ni.ll8i is less than the half valuethickness of lead.the mass attenuation coefficient is given by the linearattenuation coefficient divided by the d_eri_s_ity.six half value layers reduce the photonbeam intensity to 1.56% Iof its original intensity.

- , eCDE

Galahad depends on the energy of the incident photon.F6-afr'¢>a:i=y . .. .. _____ _ 8 .

A

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and suffers no loss of energy. .the energy of the Compton scattered hoton is the

'\/4£3§§5g'gsjrgr§i'g_ipe _im¢r‘a¢iia'ii"Mxrréyé‘ana‘ga"mi*m1i‘iays'with mat;Qalwrwj’ A during elastic scattering the photon is deflected from its path

_ _ P same asthat of the incident photon.the attenuation coefficient decreases with iricraasint enor ~_ _ , J El /-during elastic scattering no ionization occurs.during Compton scatter the direction of the scattered photon

Regarding the photoelectric effect:

ITIUDIII

an interacting photon disappears coriipleiely.it is an interaction between a photon and a free electron.it does not produce an ionised atom.It produces characteristic X-radiations.no further ionizations or excitations occur in the matter as thephotoelectron slows down

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TrueFalse

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Brernssiralilung radiation occurs when a ‘hiqh energyelectron is de-accelerated by interacting with theelectric field of the nucleus.The average energy required to form an ion pair is34 eV. "'

Bremsstrahltirig radiation is dependent on the atomicnumber of the interacting matter. Therefore a lowatomic number material such as perspex should beused as a shielding material for pure high energybeta ernirters. I.

6 A

8

C

DE

False

False

False

TrueTrue

The lineartattenuation coefficient is the fractionalreduction in the monoenergetic photon beam perunit length.The H\fT will reduce the intensity oi the photon beamto 50% of its original value.For a given photon energy the value of the HVT isinvergglyprgponignal to the atomic number of thematerial. Water is a low atomic number material andtherefore will have a higher value of HVT than leadwhich is a high atomic number material.This is the definition of mass attenuation coefficient.

ii

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a

B

CDE

TrueFalse

TrueTrueTrue

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The energy of the Compton scattered photon is lessthan that of the incident photon.

Very low energy photons are scattered almost .equally in all directions but as the energy increases agreater percentage is scattered in a forward direction.

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TrueFalse

False

TrueFalse

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The interaction is between a photon and a boundelectron. _A bound electron is ejected during the photoelectriceffect resulting in an ionized atom.

The photoelectron loses its energy by causing furtherionisatioiis and excitations in the matter.

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D

it is the predominant process of interaction for photons withenergies less than 1.02 Me\/. .

B the incoming photon interacts with zt free electron to producean electron-positron pair.

C it is an example of creation oi mass from energy.D during an annihilation process a positron interacts with an

electron to create_[g_u_r 0.51 Me‘! photons.E the annihilation process is an uxatnple ul Ct)flV(:tSlUlr of trr-ass

into equivalent energy.

15.’-3‘ - 10 Regarding photon Interactions in the patient during diagnosticX-ray imaging: .A they are independent oi the kv used. 'B photon interactions in the suit tissue are Ittaittly scattering

events. "C the average atomic number of soit tissue is higher than that of

bone.‘ fr D photoelectric absorption is the main BTIC-3I'ttti|lllJfi process

occuring in bone.E the pair production interaction does not take place.

Iiii“—

A all the energy oi the incident photon is trarrslc-ire.-d to theorbital electron.

B the ejected electron is usually trapped within tltt: electrontraps in the soft tissues. - -

filled by an outer shell tor valency bond) electron.u.‘ D it is the means by which alumrniurn [ilters rerrttr-.-t; lQ,\/v on ,-9‘:

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photons. ‘E it is the predomirlgtnt mechanism ot X-ray interatrtmrr with

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B False Pair production octztirsi/vhen the photon passes close

C TrueD False During an annihilation process two 0.5] MeV

photons are formed. “'°E Trtte

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photon to be more than 1.02 Mev.

to a nucleus.

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A False The nature of the interaction depends on the photon

B True Compton scatter is the predominant interaction.C False The average atomic number of soft tissue is 7.4 and

that of bone is 14.0.D TrueE True Pair production does not take place below 1.02 MeV

energy and therefore on the kV used.

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A TrueB False The eiecteti electron loses rts kinetic energy as tt

passes through matter as a result of furtherinteractions with atoms and molecules. After losingall its kinetic energy the electron populates the

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the linear attenuation tzoefiicient is tleiinetl as the ft-notionalreduction in the intensity per unit length.the mass attenuation coefficient depends on the density of theinteracting medium. “the mass attenuation coefficients of l g of ice antl 1. g of waterare the same.the higher attenuation coefficient oi muscle compared tr. thatof fat produces enhanced radiographit: contrast at low photonenergies.minimum X-ray absorption is achiei.-eti when the K edge of anabsorber is equal to the energy of the X-my l:ieui"i'i.

13 Regarding the interaction of X-rays with matter:A

B

C

D

E

attenuation in fat is predominantly clue to Comptoninteractions at 60 keV.attenuation in bone is preclomiiiaritly tlue to the pliotoelectiit:affect at 60 keV.the majority of electrons in the soft tissues may be consitleretlto be free electrons.bone gives rise to more scattered radiation than muscle perunit mass.virtually all of the photon energy is trtinsfarretl to tht-.- oietitetlelectron in a Compton interaction.

T4

BC

D

E

The linear attenuation coefficient of an X-ray beam:A is defined as the reduction in intensity per unit length.

is higher for bone than for fat at 30 ltell.is higher for fat than for bone when Compton interactionpredominates. .can be used to calculate the half value thickness (H\fl') of amaterial for a given monoenergetic photon beam.is constant for a monoenergetic beam. _

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The mass attenuation coefficient is a ratio of thelinear atteniiation coefficient and the density of theinteracting medium.The linear attenuation coefficients for water and ice aredifferent L92) 4 cm" and 0.196 cm“ respectively). Thedensities of water and ice are different ll g/cm3 and0.917 g/cm3 respectively). Therefore the massattenuation coefficient for water is0.214/1 = 0.21-l cmz/g and that for ice is0.196/0.917 = 0.214 cm7'g. TThis will result in-Fmaximum X-ray absorption, sincephotoelectric absorption is maximal when the _X-raybeam energy equals the binding energy of an innershell electron of the absorber.

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ln soft tissues Compton interaction is pr_etloi_ninant.The photoelectric interaction becomes signiiicantonly at very low energies.The attenuation in bone is predominantlv title 1°Compton scattering at 60 lteV. Photoelectricabsorption predominates at about 30 ltev anti below.

Almost all the scattered radiation at diagnosticenergies comes from Compton scatter. Musclesproclutza more Compton scatter per unit mass thanlioiiu ll) tlio lii£l(_]|ll)t3UU uiit.-rgy range. _ > ITi18J'l‘llt-:l'aCling photon retains most of its original -energy.

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The linear attenuation coefficient ‘is the fractionalredtiction in intensity per unit length (for aninfinitesimally small length).

it is higher for bone than for fat because of thedensity effect even when Compton interactionpredominates.The HVT = 0.693/linear attenuation Coefficient for agiven material and monoenergatic beamcombination. .

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[/ 15 Regarding X-ray production in diagnostic imaging:A the filament is raised to incandescence by it high filament l l

current which produces-‘a space charge of ;>_gtut_t>i1_s around the Ifilament by thermionic emission.

B the filament ls made out of tungsten because it is lf'l€X|')8l'lSl'v'l! l. and easy to replace. -

C the focusing cup of a cathode is made of a relatively poorthermionic emitter material that has a high melting point.

D the tube current is measured in milliamperes. IE over 99% of the energy carried bymelectroiis is converted .

into X~rays and less than 1% of the energy is lost as heat.

l 15 R993"-'1l"QIlle Xvray lube used in diagnostic radiography: lJ A the focusing cup oi the cathottci is designed so as to spread ,,' ‘

T the electrons over the entire stiiiace of the anode. y 'B the addition of rhenium in a tt_£t_g§ten target rnakes the target ‘

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Q1Th'e process will produce a space charge of electroris__around the filament. "—' l lThe filamentiis made of tungsten because it is agood thermionic emitter. does not vaporise easily,and can be readily drawn into a thin coiled wire.For example nickel.

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l0\'9_l1Er and less likely to crack tintler the stresses caused hy Iheating. '

C a dtial locus tube has two lilriments ol (littering size, which- enables the production of two different sizes of election loci

on the anode.D the glass envelope is filled with an inert gas stich as neon in

order to increase heat dissipation during X~ray protluiztion.E the glass envelope is metle of liorosilicme.

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17 Hegarrling X-ray production:A the filament current is the srinie as the X-my tube ctiriorit.B the mA is related to the filament current.

a compound anode is usually ntatie of co;i|inr ciiitl zinc.the electrons from the hlziment aim it.)t'.ll:}f1(lOll‘i1 tiiii,-titmaterial sticli as ltingg-;tQ|1_ _

E the niioilu tingle is~tllt.: tingle l)l;l‘fvL'L.'|l the plant: nl the t_'-‘lllllltlit |filament and the plane of the miotte, I

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The focusing cup is designed so that the electronsare concentrated on a smell pert of the anode calledthe focal spot.

The small filament is used for line locus radiography.The glass envelope of the X-ray tube is evacuated soas to allow the free movement of electrons from thefilament to the anode.

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The filament tztirrent and the X»ray tube current arenot the same. The filament current is typically of theorder of 5 A while a typical X-ray lube current isabout 200 rnA.An inizrtzaise iii filament current will result in anlll(IlCél$t3tl tlittiiiiiriitic eniissinn of electrons and thisrcsttlls in tin 'iiicicase in lllu liilit: current.The ziiiotle is ustizilly matte of copper and tungsten.

The anode angle varies between 6" and 20". Thesmaller thu anode angle, the smaller the apparent loreffective) local spot.

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the deceleration of electrons in tlte target produces X-rays,B _ theiprocessesv of Bremsstrahlung radiation and characteristic

radiation are involved. 'C the anode heel effect produces a rccliiciioit in the K-ray

Intensity for those X-rays which are emitted from the anode atnear-grazing angles to tlte face of the target.

D a tube Wliita fixed anode has better cooling cliaracteristitzstthan one with a rotating anode because more heat isproduced during anode rotation.

E the intensity of an X-ray heath tup to l'DU kevl is proporiiiyiiatto the atomic-number lZl of a thin target.

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The rotating anode tube has better coolingcharacteristics as the heat generated on the anode isspreadrfif/er a much larger area. Therefore there is agreater area available to lose heat.High atomic number elements such as tungsten(Z = 74) are ideal as target materials.

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Regarding the rating and operation of the X-ray tube:A any two X_-ray tubes used lor similar diagnostic pl'OtJl:Lii.ll'tiS

will_have identical rating charts.B Feflllfifialivn. thermal capacity of the £t(iOLlt:, and the anode

angle are selectable during the operation oi an X-ray tithe,C me F3""€.l of an X-ray tube for fine focus tlzit: is |0wt:r lhuii that

for broad tocus use.D the rating chart depends on several factors inizlutluig the ltvp

used.E a rotating anode tuha has =1 signilicantly liitilier iatiiig than it

lube which uses a stationary unode.

><2o Regarding X-ray timers:A the timer switch controls the X-ray exposure by controlling tho

filament current.B a thyratron is a gas-filled tube that functions as an electronic

switch.C mechanical timers are accurate to 0.01 seconds.D in electronic timers a resistancecapacitor circuit is used to

dotormina the length of the X-ray exposure,E ionisation chambers are not in-iltrihln lor iiuo tin X-my tirrtcru'

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Each tube has its own rating chart.These factors are not selectable hut areprecletermiiied. 'The rating oi the X-ray tube using the line focus islower titan that when using the broad locus as theelectron beam is focused onto a smaller area andthis catises a higher temparaltiru for the some ntA.The rating ol tin X~ray tuhu tlopentls on the log-31spot site, tho _k\/p, the cxpustiro tiiitu tintl lhurectification K-A rottitiiig uiiotlu has ittoro oflitziuiit htitit loss;because of the moving track the-energy is depositedover a larger area on the anode resulting in a higherrating.

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The timer switch controls the X-ray exposure bycontrolling the high voltage supplied to the X-raytube. The lilanient heats and cools relatively slowlyand therefore cannot be used to regulate theexposure times. -A thytatron is a gas-filled le.g. low pressure argon) ttriode valve. The potential on the grid is used toswitch the thyratron on. The thyratron is switched offby reducing the anode potential to nourly cathodepotential so that gas multiplication no longer takesplace.Mechanical timers are accurate to only 0.25 seconds.

ionisation chambers can be used as phototimers.They are designed to be as radiolucent as possibleso that they can be placed in front of the X-ray film.

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paIaB§r'*=\‘i5lm§ti8!l3’$$f$A a centrally peeked radiation intensity distribution gives a focal

spot with improved resolving power.B size increases with an increase in the tube current.C size increases with increasing kVp. """“D size measurement mtrst be ntarfe in the central part of the

X-ray beam.E the modulation transfer function lMTFl deteriorattrs with an

increase in the focal spot size.

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true magnification is always smaller titan geometricmagnification. .

B star test pattern irnaging demonstrates the itttgnsity P-I-b=\"“Q,%distribution of radiation égoaéltg local spot, MP0,

C a pinhole Elrameter of 0. nt is recommended formeasurement of a lO l less than 1 mm.

D star test pattern imaging is gerteruily rnr:ornmt_-ntletl lorassessing locul spot sizes lrrrqcr than 0.3 nmt.

E the actual physical size of ct loctrl spot can he directlymeasured in a star pattern imaging test. **.------—

. / 23 Regarding X-ray film:A the silver halides are sensitive in the blue part ul the vtsihie

spectrum at approximately 480 nm.B the addition of a small amount of Sllvéif iodide to sliver

bromide reduces the sensitivity of the film.C the cut-off sensitivity of an ettrtrlsion is the wot.-elengtlt

beyond which the flint is no longer sensitive.D the spectral sensitivity of silver halide is altered by adding

cenain dyes to the emulsionsE an emulsion with a wide range of grain sizes pr0ti'.1t:e:s e iilm

that has a high film contrast.

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Physics 151

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gieometric unsharpness due to asymmetricalradiation distribution is thus minimised.This effect is called blooming and is more marked atlow kVp and high mAs.The focal spot size decreases slightly with increasingk\/p.The apparent size of the focal spot changes awayfrom the.;central ray. The focal spot length is shorterwhen_rneasured at the anode _end than at thecathode end of the X-ray beitfa)Ag increase in the focal spot size increases themagnification factor which causes deterioration in theMTF.

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Magnification depends on the focal spot size.Geometric magnification is calculated assuming thatall X-rays riginate from e point source. in reality, thelocal epotilitas finite dimensions and therefore thetrue magnification is always greater than thegeometric magnification.Star test pattern imaging measures the resolvingcapacity of the focal spot. The intensity distribution ofrzttlintiort is tlernortstrzuerl hy pinhole imaging.The recommended diameter is 0.003 rnnt.S_ta_r__pat_tern imaging is recommended for focal spotsizes smaller than Q3 mm as the piflole image of a0.3 '11rn1_fQ“gal_§pot is difficult to assess withotrt'§_t;r“er:_iaiised equipment.The local spot size can be derived from the starpattern imaging test using a formula.

23 A TrueB False

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,The addition of silver iodide increases the filmsensitivity.

Such a film is sensitive to a wide range of exposures.it therefore has a high exposure latitude and a lowsfilm contrast.

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Regarding X-ray film:A the latent image is produced on the film alter exposure and

development.lhfi latent image IS rormed by partial reduction of the silverbromide crystals during the exposure.

C gelatin is used as the basis of the emulsion.D there is an excess of silver bromide -aver silver iodide in the

film emulsion. . - .->' '"——-~—--— _E thespeed of an emulsion is largely tiepentlerit on the range of

grain sizes (grain size distribution)._________,___.___

B .

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Regarding sensitometryzA the transmission ratio is the ratio of tr;-znsmittetl to incirlertt

light (i.e. ll/lo). "the opacity is the rec_ip_rot:al of the transmission ratio ti.e l,,_~'l,j_the optical density is an antilog value of the opacity. “ ithe density is linearly related to the weigltt oi the iil "lm si vet.the characteristic curve oi a tilm is a plot of optical density lDlagainst relative exposure (E). -1'"

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Regarding X-ray film:A the normal density due to the base plus log of a correctly

stored unexposed film is approximately l.B ageing oi the film decreases the overall level oi base plus log.C the base plus fog level is independent of the processor

temperature.density is proportional to the logarithm of film exposure ir the_ llinear part of the characteristic curve oi the film.

E the greater the exposure range over which the density lDlversus relative log exposure (log El is linear. than the greateris the latitude of the film.

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False The latent image is formed after exposure anti heiore

Truedevelopment.

True These are some of thejeasons why gelatin is used:when tit; silver halide +5 formed the gelatin keeps thegraittsilispersed; gelat n forms a flexible transparentlayer; gelatin protects the latent image.

True Film emulsion contains grains of silver halide -approximately 90% silver bromide and 10% silveriodide.

False The speetl of an emulsion is largely tlepettdertt onthe average_siz;a of tltggrgigts. Tlte_largoi"ilte_?@-tygfggiugrain size, The greater the speed or the.emuTsion.

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ratio. A perfectly transparent area has a transmissionratio of one.A perfectly transparent area of an image has anopacity of one. A perfectly opaque area has an >infinite opacity. The blackest part oi a racliographicimage has an opacity approaching 10 O00. _The optical density is a log value of the 0l1a¢llY-

The characteristic curve is a plot of optical density lDlagainst the log of the relative exposure llog El.

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The density due to base plus tog for these con_ditionsis approximately QL _ _The level of base plus log increases with ageing.The level of base plus log increases with art increasein the processor temperature.The average slope of the linear pan of thecharacteristic CUN8 gives the gamma of the film-The greater the film latitude, the lower the lilrrtgamma and vice versa.

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l54 M661 Tutor in Radiology _ Physics 155

ezssgtrqisseeizmmamraatmeaeiteg 2, A '7"True The inherent contrast of the film is determinedinherent contrast of the film. during the manufacture of the emulsion by the size

B development conditions of the lilin. and size distribution of the grains of silver halide.contrast of the subject. B True -viewing conditions of the film. C True Subject contrast can be influenced by several factorsbasic l09- oi which kV, scattered radiation and intensifying

5 screens are the most important.B True .»E ~True The overall effect of a high basic fog (base plus fog)

' on a normally exposed radiograph is to reduce the

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Regarding processing of X-FRY mills: False Developers have a pH range between §_.6 and 10.6.A the developer has a pH range between 11 and 13 False The lixer has a pH range between 4.2 and 4.9.B the fixer has a pH of 7. TrueC the developer precipitates the metallic; silver from the False The a""P|lfi¢3ll°fl 985" ailhieved is much hlghefi Le-

bromide, chloride and iodide salts. 109.the numerical value of the arnplilication gain achieved by the E T"-'9 ii,process of developing is 102. 41 \"' "

E the fixer contains ammonium ll1lOSlll[JllEllE. '

D

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ol the most exposed pan nl the lilm. . B False The film processor performance should be checkedB l f’ - _ _ "1“? ""1 l1f0¢E$$°' Per'icrmarit.;e should be flfifictihfltll tmct: a dai|v- '

“'\3‘3|’~'- , C True "__'_the iilm speed and the film tzuntrnst zzhuultl he Illt-Lill-iillutl llilllyi D ‘lulu’ lltili i=l uflritflllt-ll ill "Hit-'1 1" i\t¢l\lt>\'" '0l"Q'~l\|llibilllY vithe lilrn pmcussur should ln: lIlC1l‘lllOl't.'tl ul .i llJUtll(|r nine "W tE'5"l\1F-during the clay. E True

E the films which are use-ti for t1'tUtlitt)titlq iilni |;rucessn:~; Dshould be taken from a specially reserved lilrn box.

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30 Regarding silver conservation:\ Q the electrolytic method produces 50--70% pure 51h/gr_

in high current densih/electrolytic units the fixer solution iskept under constant agitation.the silver content of a fixer solution can be estimated by asimple test paper.

_ around 10-20% of the available silver is recoverable by usinga metal exchange method.

E fitting metal exchange units in tantlern improves the overall lsilver recovery efficiency.

C

v

313$?-The followipg statements are true regarding film/screen“combinations? " ‘ ' ' " '“""A after X-ray exposure, the film produces an image which

I B results from light and direct X-rays in equal p|'O[)L)l‘[iQn5_Sb/rot ihe'X-ray beam IS absorbed by the plioioelectrit; gffgrjrwithin the intensifying screen. 'during the process of fluorescence the phosphor absorbs longwavelength radiations and emits short wavelength radiations

D modern film-screen combinations have a resolution rangebetween 200 and 300 line pairs mm“.

E the speed of rare earth phosphors is inclepcrtderit of the kvp

\

32 Regarding intensifying screens:A ' t ~' ' -1 T - -in eitstfying screens redtici. the il|I\Ul|[][ gf _ct__1rm,-ed rmi|;mLm_

czilcium iungstaite protlucus liiiht wiili .ii prizilt w=ivvlcnr;ih ofC tillntit 700 ntinnrnutrmi iliitiiiti llrrrirrr;;r;t_,rrr;“_ ‘

tlioiiitiiiisic uilirziriiiizy ut lllu phniiiiliiii it. llillililltl nu ii“; |'t||,||i,.,,0| fltllil tiliuiuiizi priii.liii;uil tiur iiiiii ;iiu;i ltrlrrritrmt hm -‘)

D dpproxtiiiiiluly hull lliu tiuiiuitituil lffllll it'irii:_liii:s lliii lilin iilillthu rust is absornotl in ihu si:ri.-un.

E the inierisification factor of tho 5(Jfl!Utl is ihu rilllu of ihi- X~ ru. - ' vexposures needed to produce the same density on a film withand without the screen.

B

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The electrolytic method produces 95-98% pure silver.The agitation oi the solution brings fresh Silver ions ‘close to the surface of the cathodeand speeds up the

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rate of deposition of ineiallic silver. This allows theuse of a higher current and a smaller surface areacathode wititiinut the danger of sulphiding, which caneventually stop the plating process altogether.Sulphiding describes the decomposition of the fixerby unused current in the cathode. The products ofthis decomposition react with any silver ions presentin the fixer to form a silver sulphide precipitate,which turns the cathode deposit black.

" lThe metal exchange method is 70% efficient in[Jl'3CUCt3.

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31 A False

B TrueC False

D FalseE False

The majority l95%l of the image is produced by light.The rest of the image is formed by the direct actionof the X-rays on the film.

During the process of fluorescence the phosphorabs0rtgs_sl]ortyavelength radiations tkiflsl andemits long wavelength radiations ilighil.The resolution range is 2-18 line p§E?iitiii".The speed of rare earth phosphors depends on thekvp. The rare earth screens show maximum speed at80 kvp. Lower speeds occur at both low and highkilovgltages. a -

32A False

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intensifying screens are used to convert relativelylow tlhstilliittl X-my photons into iiiatiiy light photons.Thus iliu X i-iy ilniiu in the pzitiutit is riultitzuil whilr:zalill :illuwiiii_i .i |llll|)\l||\/ iniiiiizauil X i.iy liliii.Hill punt; vvrivuluiittili nl lliii litiltt tiiniluiauil lb uliniit-tjittriiii iiiitl hue iii tliu hliiu int|iuii Ul lliu Vltillllil§tTiit:triiiii lwtivnluiriiili i;iiii_|ti 350-5M0 iiinl.Thu iniriiitsic ullitziuitcy its tluliiind us tliu ratio oi thulight uiii;_rgy_[ili_urtituil liy ihu crystal to tho X-rtiyenergy absorbedf The intrinsic efficiency of calciumiiingstniu is ntiprnximaiely 5%.

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J3 Regarding intensifying screens:the rare earth phosphors fluoresce maximally in the pure statethe X-ray to light conversion efficiency of rare earthphosphors is the same as that of calcium tungstatc (Ct-rW0,,l.the K edges of barluf_n, lGfll_l_]_a_f‘l2Tl‘l and gadolinium correspondclosely to the mi3<'iTnum intensity of diagFi5§'tlE'$<'-rays in theprimary beam.as a result of fluorescence the terbiurtr-activated gadoliniumoxysulphide phosphor [Jt0t.lUCt25 a continuous sprzrtrrum oflight with a maximum peak at 430 iiitT'"“'_'the rare earth screens show maximum speed at about 80 kvp.

_. — : 4

the speed of the calcium tungstate screen and its ability to yrecord detail have a reciprocal relationship.the ability of phosphors to fluoresce is independent of the i

erasesasrarrtaaratarazihta§<srseaas=w- .-

J Aambient tgmprature. ‘they s ould be cleaned at regular intervals with an antistatic ;compound and a detergent applied gently with a lint-tree cloth.the film cassette should be i:heckr:tl lor goorl scrrrran-iilmcorttrtct ill regular iritcrvnls.ll1t:‘lltlfltttllllfiillltill l.ir:tui rrl i:trlr:ttrrir trrrtgsirrtrr llltiruilsili; wtllran increase in the kVp of the X-ray beam.

Regarding grids used in diagnostic radiography: lA .they are used to improve contrast.

they consist of lead loil strips separated by calcium tungstatespacers.the grid’ ratio is defined as the ratio between the total areacovered by the lead foil strips and the total area covered bythe interspacing material.the grid ratio of a crossed grid is equal to the average of theratios of the two superimposed linear grids.a linear grid allows the operator to angle the X-ray tube alongthe length of the grid without loss of primary ratliation. ~

Physics 159

33A False

False

True

False

True

The rare earth phosphors, such as gadoliniumoxysulphide, fluoresce maximally when atoms ofterbium (0.3%) are incorporated to activate thegadolinitifiw oxysulphide.The X-ray to light conversion efficiency of _CMa_\_/YO‘ isapproximatelyiyg while that of the rare earthphosphors is approximately '_'—_Baritlm K edge 37.4 keV; lanthanum K edge 38.9 keV;gadolinium K edge 50.2 keV.The spectral emission of this phosphor is due to theterbium ion. Therefore it is not a gg_Qt_inuousspectrum but is concentrated in narrow lines with astrong peak at 544 nm.

__.__-

34 TrueFalse

True

§

True

True

_ eftt;-,intensifying screens fluoresce more brilliantly atlower temperatures. A higher ambient temperaturewould require an increase in the exposure factors inorder to.produce a film with the same optical density.It is important ito keep the intensifying screens clean.Any foreign material org. the screen will block lightphotons and produce an arerr of underexposure ontltt: lilrn. Rngirlttr t:lt;.'inirti_; with llll nrrtistulic andtlrilrtrgtint rzurtiimiriitl sltnrrlrl t!llllllll;llt2 this |irul>lr:in.The cassette in which the intensifying screen ismounted holds the film in tight contact with thescreen over its entire surface. With a poor screen~iilmcontact the light produced in the intensifying screenwill diffuse before it reaches the film and result initrtiligrgfiss of the rtrtliograpltic image.High kVp X-rays are more abundantly absorbed bythe photoelectric process in calcium tungstatescreens. This results in a high intensification factor.

35 True

False

False

False

True

Gritls improve contrast by absorbing scatteredradiation before it reaches the film.A grid consists of a series of lead foil strips separatedby X~rr.|y transparent spacers. The interspaces arefilled with aluminium or an organic compound.The grid ratio is defined as the ratio between theheight of the lead strips and the distance betweenthem.-The grid ratio of a crossed grid is equal to the sum ofthe ratios of the two linear grids.

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war

‘I:

3 Regarding a grid;A ‘he Qfld ratio is defined as a ratio of th T ' '. l ~ >smps to their width. e ieignt or the lead2 ghiengeaasd srripfs are approximately 1 mm mi¢k_

‘ fire 0 primary beam traiisiiiissiori l$ user] in theD gvaitiatfion of grid perf0rmanr;e_

uc y actor is used as a measure of the ehil' ' 'femove scatter. try or the grid tous; of a grid is the most important method of improvingra lographic contrast.

37 Regarding grids used in diagnostic radiography;A thosewith a low grid ratio are more efficient in removing

Soflttered radiation than those with a high grid (amt8 primary transmission tTp) of a grid is inversely

proportional to its grid ratio.C the measured primary transmission is always I555 than ma

calculated primary transmission.D the primary transmission lTpl is the s"m " ti

of the grid. G e as ‘e Bucky factorE the Bucky factor increases with an increase in the grid ratio

\

V“]5trM'“L‘W|“l'5"n"*3mbl0'§’“'“"WW-Wwtiivtriwitirsy. ~iy=.w~lr.r~-vi.rsIurraJIiI.7VIi‘ ‘ ‘ \'|,l-D,'l\'{, , y r

l

False

FalseTrueTrue

False

Grid ratio is defined as the ratio between the heightof the strips and the distance between them.The lead strips are approximately 0.05 mm thick._,____..

The Bucky factor is the ratio of the incideiit___r_agiationfalling onrihe grid to the trai_1_smitted radiationpassing through the grid. lt is a measure ol theability of the grid to remove scatter.Contrast improvement depends on various factorssuch as kVp. field size and patier_it_tl\_icl<ness. The use ofa grid is’€?Te of theimeans of improving radiographiccontrast by reducing the scattered radiation.

1‘

False

TrueTrue

False

True

t

Grids with a higher grid ratio have relatively tellerlead strips and shorter distances between the leadstrips making them more efficient in removingscattered radiation.

The difference is mainly duo to some absorption ofthe primary radiation by the interspace material.The primary transmission lTpl indicates the amountof primary radiation absorbed by the grid while theBucky factor indicates the amount of absorption ofboth primary and secondary radiation.High-ratio grids absorb more scattered radiation andhave larger Bucky factors than low-ratio grids.

‘ or

f

162 MCO Tutor in Radiology

\/ 38 Regarding gridsiA the contrast improvement factor lKl is usually detei"mined at

70 l<Vp by utilising e small field and scatter free conditions.B the higher the Bucky factor, the greater the exposure factors

and radiation dose to the patient. y'C the contrast improvement factor (Kl remains constant for all

grids.D grid cutoff is the loss of primary radiation that occurs when

the images of lead strips are proiecteci wider than they wouldbe with ordinary magnification.

E grid cutoff caused by lateral decentring of the grid is bestidentified by close inspection of the film under a bright light.

A.-’i-

(

Regarding filtration in diagnostic radiography:A it is the process of increasing the mean energy of

polychromatic radiation by passing it tliio-igh an

dosealasorlirrr.8 the process of beam filtration does not rctluce the patient

C the inherent filtration of a typical diagnostic tube variesbetween 0._fi and 1.0 mm of leads;

D the beryllium window X-raytube designed for stilt tissueradiography has a minimum inherent filtration.

E the glass envelope alone is responsible for the inifiltration of a typical diagnostic X-ray tube. tereiit

Jr

' Physics 163

38 A Falsei

B True

C False

D TrueE False

sag‘ .

The contrast improvement factor is dependent onkVpI field size and patient or phantom thickness —these three factors determine the amount ofscattered radiation. To permit comparison betweendifferent grids, the contrast improvement factor isusually determined at i_QQ_l§_\i’p with a large field anda 20 cm ttifglg phantom: ‘ 'll the Bucky factor fora particular grid-energycombination is 3, then exposure factors and patientexposure both increase by a factor of 3 above thatwhich would be necessary for the sameexaminationwithout that grid.The contrast improvement factor increases with anincrease in the lead content of the grid.

During grid cutoff caused by lateral decentring all thelead strips cut off the same amount of primaryradiation. This results in a uniform loss oftransmitted radiation over the entire surface of thegrid and thus produces a uniformly underexposedradiograph. ‘

39 A TrueB False

C False

D TrueE False

Q

The process of beam filtration removes the lowenergy photons from the X-ray beam. The lowenergy photons do not contribute to the radiographicimage and their removal by the process of filtrationtherefore reduces the total patient radiation dose.The inherent filtration of a diagnostic X-ray tube ismeasured in aluminitim equivalent, which is thethickness of aluminium that would produce the samedegree of attenuation as the thickness of thematerial. It usually varies between 0.5 and 1.0 mm ofaluminium. ' '

The insula_tin_g_9_i_l surrounding the X~ray tube and thewindow in the tube housing, as well as the glassitrtvplpiie, ririi responsible for the inherent filtration ofa typical iliagiiostic X-ray tithe.

_ _ .___._a

MP’ W W’ ufl‘uV sat/"-<0’ <hlW'HlV 3iU'u’lV \l,‘u' .1,"-tr 4'I64/'

MCQ Tutor in RadiologykilI_i'

/0 Regarding filters used in diagnostic radiography:A copper and aluminium are the materials or choice lor added

filtration of the X-ray beam.B copper is always used in combination with aluminium as a

filter material.C in a compound filter the higher atoniic riiimher niatarial filter

faces the patient and the lower atomic number material tillerfaces the X-ray tube. i

D the characteristic radiation produced by an ulurnitiiurn filtercan give a significant radiation dose to the skin.

E an added filter of aluminium 3 mm thick is advantageous overan aluminium tilter 2 mm thick.

‘J 41 Regarding the air gap technique used in diagnostic radiography:A scattered radiation is decreased mainly as a result of filtration

caused by the air gap.B there is a strong bias for forward scattering in the diagnostic

energy range.C more scattered radiation reaches the film from the scattering

events which occur near the entry surface rather than the exitsurface of the patient.

D a larger air gap is desirable when imaging a tliicker part of thebody.

E image sharpness deteriorates with an increase in the air gapunless the focal-film distance is also increased.

V -'2

1

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¢

ti’ I 1' -.1§tI!!:Iyws's.§.I~;<JPhysics l65

40 TrueTrueFalse

False

False

See answer (Cl.See answer (Cl.Most filtration occurs in the higher atomic numbermaterial lcopperi and the purpose of the loweratomic nu_i_xi,’oer material (aluminium) is to absorb thecharacteristic ragiatign from the former. Therafor_e—ina compound filter copper (atomic number 29) alwaysfaces the X-ray tube and aluminium (atomic numberl3l faces the patient. .The characteristic radiation produced by aluminiumhas a very low energy (1.5 itgy/_l which is absorbed inthe air gap l§éHe“éri"thé"patient and the filter.An aluminium filter gfnrn thick absorbs most of thephotons with eiiergies less than 20 lteV. Increasingthe filter thickness to 3 mm of aluminium does notofier any luither advantage. The excess filtration willcause overall attenuation of the beam withoutsignificantly altering the quality of the beam.

41 False

False

False

True

True

Scattered radiation is reduced because scatteredphotons miss the film. Very small quantities ofradiation are absorbed in the air gap withoutappreciable beam hardening.No fonivard scattering bias exists. At the energiesinvolved. a photon is likely to scatter in almost anydirection equally.Most of the scattered photons reaching the film arisenear‘the exit surface of the patient due to a greateranglegf capture and less tissue attenuation. 'The ratio of scattered to primary radiation tor a giventhickness or‘ an absorber depends on the size oi theair a e t A l ' "ll d Kg p pr sen. ar a air a wi re rice th__e;_r_a_tio°l 5¢a‘!@'Ee.L9_2tim;Tr%€.fll1gtl@fl-An ’iiTc'r€ése in the focal-film distance compensatesfor the greater magnification produced by anincrease in the air gap.

H? 5'

166 MCO Tutor in Radiology l

42 The following statements are true regarding noise in imagesproduced by a film-screen combination:

the image quality of low contrast images is st;-riotisly alfectedby noise.

Physics 167

‘42 A True

images of comparable optical density contain less noise if r§tp_ B Falseearth screens BIB US8d rather thijln Calciirn t_tri1gst,3te stgreensthe noise decreases as the mean number of X<ra\,' photonsthat are utilised in the formation of the image ifiaiagea.an increase in the phosphor thickness will increase the rioiseto produce a given optical density.

E the main factor determining the noise is the number of >1-rayphotons utilised by the screen.

C True, D False

E True

43 Regarding radiographic mottle:

in ldyv contrast images the density differencebetween adjacent structures is less. An increase inthe noise can mask the difference in contrast andthus reduce image quality.Lower d ' hex osures are use wit rare earth screensand thus noise is increased.

With an inérease in the phosphor thickness the noisewill be cinchanged as the number of photons used bythe screen remain the same due to the reducedegtposure.

* 43 A True~ Bstructure mottle is caused by defects iii the iritensilyirig

screens.lilm graininess makes a significant contribution to theradiographic mottle observed in clinical radiology.quantum mottle is caused by statistical iluctuatioris iri thenumber of X-ray quanta absorbed per unit area of theintensifying screen.quantum mottle increases with an increase in the number oiX-ray quanta used.quantum mottle will be greater with at high ltvp.

False

C TrueD False

E True

4-1 Fiegarditig the radiographic image:parallax utisharpness IS seen with the use ot singlr.» omtit~_iit_iiifilm.the edge gradient is the rctiiiin oi partial illtiniinzitttin thatsu_tr_otg1ti_s the complete sliatlow. \"—-""*' ‘"—-"“*the width ol the pU['lUlT\l)l'i'il5iU5ti0llliiHfll1(l(it) tiiilu lli.-iii tinlitil tltlllitllld Sttifl.iiliziitiiatinit \l|\iilitIl||l'lt::i‘.i i:: t|it:.iii:;.l iii trli|i;t.i:i Wllll :;li.n|iutliiiis. ‘motion utislizitpnoss is iiicrutisetl with sltuttut cxiitistxre tiiiitis

Film graininess is visible only when radiographic filmis examined with a lens to produce a magnificationof >< 5 to >: 10. Under normal viewing conditions filmgraininess does not make a significant contribution tothe mottle.

Quantum mottle increases with a reduction in thenumber of Xeray quanta used. Quantum mottledecreases with an increase‘_in the number of X-rayquanta used.A high kvp will produce a higher intensificationfactor and therefore quantum mottle will be greater.

r. .

44 A False

B TrueC True

l) l'-.il:iu

E False

Parallax tinslizirpiioss l5 protliicctl by the formation oitwo images on a tluublg emulsion film where theeiniulsions are separated by the width of the filmbase.

The oriizntation of the anotlc angle prntiutzes losslmiiiiiitliiii till tliti iiiitiilu :;itltt. i'lIii: illI!ilH|llltlll ti|i:'.li.ii|ititi:;:; lli Hllltlllltil ltn tttitiiil uiiiv.il iil>|t:t:|;: l|ii:i iy|iii til tinsltnipiititts JHIHUS lrutntlii: grzitttitil ulttiitgt: iii lliu X-ray i1l)St)l|lllt)lt ticrussthe hotrtitlary.Motion unsharpness is minimised by reducingexposure tithes. Patient immobilisation and organcompression devices also help to reduce motionttnshzirpness.

w. ~_ -- -- w -1 <- -..- uw ww ur <07 sir '47 ~17 47 ~$ ‘~17 ~17 ~47 '17 ~27 -I Q7

/'45

it

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“.7 G -IS .7 ‘S .7 ‘S 3 J $ S S'Il|.UUb$H.>-Y S 1-? 3 J7

Regarding resolution: 45 AA the resolution olf a l'ilm-screen 4C(_]l11UilTa[lI.]r\ is exp,-8555-U by

the number of line pairs per millimetre.8 the line spread function (LSF) of an X-ray film exposed

' without a screen is very wide.C §i 5‘/Slem _WiIl1 hlghresolving power is able to record separate

images or small obiects placed very close together.D in a resolution test object a line pair refers to a pair of

adiacent lead strips. J ’E in a 4 li_ne_pair per mm test object the width of an lfiCliVl(Iil|ill

lead strip is 0.2; mrn.

/Li\/6

/

8

CD

E

The modulation transfer function (MTF):A is expressed as the number of line pairs per rnin.B provides an obiective measurement of resolution.C can be understood as a ratio of the infcirrnation recorded and

the information available.D is normally greater than 1.E can be calculated from the corresponding line spread fiiiiction

lt_:Fl data.

7 (A ¢¢;\\_v"¢ '/7\L4.;"\'7—;-:3’)47 Regarding modulation transfer function (MTF): ""‘5'~’L"‘_"""‘,"‘ "-.‘ ‘J

_ "g\(\i.is xx) ¢\.b ‘,;$A the MTF of a film-screen combination may he assessed hy

imaging a grating.B MTF curves can be used to compare image qualities of

competing systems.C resolving power can be considered to be a single specified

pointon the MTF curve for use in the comparison oi different "imaging systems. .

D a 30% response on the MTF curve corresponds approximatelyto the resolving power of an imaging system.

E thetotal MTF of a cascaded system is obtained liy adding theindividual MTF components.

.‘ . 1'C»4-4-"1‘:(J'df -: llL‘ ..-L [zz//’)‘("' J \

iv» -“-

TrueFalse

TrueFalse

False

The LSF is the profile of the intensity curve obtainedby collinjatittg the X-ray beam through a very narrowilit. The LSF of arfii-ray film exposedrwitfiout a ‘screen is very narrow as there is no diffusion oiX-rays iti,;,he lilni.

A line pair refers to a single lead strip and a space oinonabsorbing material.The width of the lead strip will be 0.125 mni.

45A

BCD

E

False

TrueTrueFalse

True

ii

MTF is a function expressing the ratiogjjriiiiiitiirlesoi s atial fre uency under different COLdlll0flS. lt has_ Q_} ___,_.no units. v

\-

The recorded iniorniation is normally never greaterthan the available information and therefore MTF isnormally less than l.The mathematical operation known as Fouriertransformation is used to derive the MTF from thecorresponding LSF data.

47A

BCD

E

True

TrueTrueFalse

False

Different inethotls Oi evaluating the MTF exist. Theseare based on exposures of slits or gratings tollowettby analysis using a itiicrocleiisitottietet. _

%U

l

The resolifing power of a system correspondsapproximately to the 10% response on the MTF CurveThe total MTF is a productof the individual MTFcomponents.

W‘ : -' r‘ J ‘4_8- ln an image ir_1_tansifier:Qg 48 A

t\%s Regflrdlflg image lntensillersi " \// 49 AA _ . . .

170 MCQ Tutor in Radiology 3;» Physics 171

A the fluoroscopic X ray tube is operated at zi rr.i.ic.li lower tube - Bcurrent compared with that used in conventional radiography.

B the input fluorescent phosphor is made of calciumtgrigstzite. CC the distance between the liiput screen and the photocatliocle

is about 1 cm.D the photocatitode absorbs electrons anti emits visible light. . DE the anode has a positive potential of ai:-proximately l-S00 l<V. E

TrueFalse

False

False

False

The input screen phosphor is made of caesiuml9.¢.lide- " ' "The distance between the input screen and thephotocathode is only a fraction of a millimetre. Thisproximity _is essential to minimise loss of resolution.The pltotocathode absorbs light photons and emitsplTOIO6l8Cll‘§J_;tS. ‘The anode has a positive potential of approximately25 kV. V

~___4

the Output fluorescent phosphor is rri:-ride of caesium iodideB a layer ol aluminium is coated on the iiinci surface of the ' l3

output phosphor to increase its mechariicul strength.C the aluminium layer removes spent rilcctrons from the output

phosphor screen. CD the conversion factor is the ratio ol the luminescence oi the 9

t lllQl.t[_QhOS[,)hDf' to the input exposure rate.E in general the overall brightness gain oi rnodern image E

intensiliers is between 50 and 100.

False

False

TrueFalse

False

The output fluorescent screen phosphor is made of§ilygr_ activated zinc cadmium sulphide.The thin aluminium layer prevents light fromtravelling back through the tube and reactivating thephotocathode.Thus avoitlitig a build up ol negative charge.lt is the ratio til luminescence ol the output phosphorto the input exposure rate. "The overall brightness gairi is more than 1000.

_“ .Q

50 Regarding image lntnrisillercz 50 AA output is usually viewed tliietttly by ti ielovisinii izzinit.-iti.B tlir: sup-:rior image qtinlil:/W r:.1r:sium irirliclii pliri:;pl‘iiir:: is l.il!(:

to its t ll_:itl.t.:I uckin tleitsit and liii liur UllLl__'[i'JI,' utu-iiii;nurnbér. J"P__""2" Y J ' ~“444444444“ ‘

C unequal magnification across the OUll')lll.llUO!E3St1l.-Bill screencauses an increase in brightness at the peripliery.

D the contrast ratio of an image intensifier is typically measured 5using an aluminium disc. ; C

E the image distortion of an image interisilier is assessed iisini i.1 -a rectangular grid. ‘ D

E

5..-7-4_¢_’;:_—,,./I“._'-—-3-'-""_"_’_‘_—

Tr u I:

TrueFalse

False

[rue

A television viewing system has several advantageswhich include prorliiction ol zitieuiiate light output _front the television monitor tn rillciw cone vision oiilll tltl\|)llllUl.l llll;l\_]U. It tz; iilsu .i vuiy iilliiziuitt SYZHUIHbecause it results iii minimal loss ol information, andthe video signal can be recorded giving a permanentrecord ol the investigation. '

The brightness at the periphery is reduced and socauses vigriettirig. \ .The coi'itra'st ratio oi an image intensifier is typicallyiiieusuiiiti iiiiirig .i luiiil ilisc whicli has ti ili;u'nr:ter10% llli'll ul the iinzt-t_)'tTintensilit:r. Thu contrast fl.lllO isl'lUlUll‘l|llll:ll liy iiii.-asiiiing the light output oi tliciiiii|iiiI pliiiaipliiii witlt iiiirl witliniit tlii: lixtitl (lint:|i|tii:i=il :i| tliii i:r:iitii: Hl tliii irii:ii|ii iiituitiiiliiir.

. . 44»~_*_

‘Ir: MCQ Tutor in Radiology

51 ln a TV camera:A the fluoroscopic image from the intensifier is focused on to

the Vidicon target using an electronic focusing system.B focusing and deflecting coils control the electron beam of the

Vidicon tube.C the antimony trisulpliide globules are in tlireci contact with the

signal plate.D the end plate of the anode is a wire mesh which allows the

electron beam to reach the target.E the antimony trisulphide tnatrix converts the tltioroscopic

optical image into an electrostatic iiitage.

A 52 Regarding digital subtraction angiograpliy lDSA):A the analogue—digltal converter (ADC) converts the digital

voltage output of the video camera into a range oi analoguesignals.

B the ana|ogue—digita| conversion for the entire video image is' carried out in real time.

C the subtraction process improves anatomical detail.D the video cameras which are usetl characteristically exhibit a

significant amount of lag.E Plumbicon cameras utilise lead oxide lPhO) as the target

material.

53

FL

\

Regarding subtraction techniques used in diagnosticradiography: -A an image without contrast medium is electronically adcled to

an image with contrast medium.B an image with contrast medium is known us the stihtractien

mask. "““'_“""'“C there must be almost perfect registratiori in order to obtain '

good subtraction.D pixel shifting is a form of post~processin-3 that can be used to

eliminate motion artefact.E when used in angiography the vessels filled with contrast

medium appear black on the subtracted image.

"nu.-

.-___..’-

Physics 173

False The fluoroscopic image is focused on to the Vidicontarget using an optical system.

TrueFalse The antimony trisulpliide globules are insulated from

the signal platttl-1 by a mica matrix.TrueTrue

\

I

1

False The ADC converts analogue signals. from the video. camera into acrangts oi digital numbers.

True TFalse DSA improves vascular detail by employing the

process of digital subtraction of other anatomicaldetails.

False Lag is not desirable in video cameras used in DSA. ltis important to reduce the lag so as to reduce themotion artefacts which are caused by the rapidlychanging image as the contrast bolus passes throiignthe vessels. -

True PbO exhibits low lag properties.

False An image without contrast mediunl is electronicallysubtracted from a subsequent post-contrast image.

False A'§tTbtraction mask is a pre-contrast image.True There should be perfect superimposition of structures

- between the pre- and post-contrast images. Anymovement between the two images producesregistration artefacts and degrades the resultantimage. .

True This involves moving one image either horizontallyor vertically in order to improve the alignment of twoimages prior to digital subtraction.

True I

t

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' t-»v

. i;

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L J ‘"‘i_ t

ltt

-

t

- Il,5;

l74 NICO Tutor in Radiology Physics 175

it is a high frequency and high dose techniqttee.’ ~ iB the voltage across the X-ray tube should be less than 50 kv. jC a typical dose from a single pamornographic exposure is

approximately 1 mSv.D equipment used lor intra-oral films must be fitted with at lit.-Id

defining spacer cone.E for equipment working up to 60 i;\./ the cone mttsl ensure at

minimum focus to skin distance oi 10 cm. ~

54 A False

FUUOU1

FalseFalseTrueTrue

, 7“ . _.. . ..

iii 54 Regarding dental radiography: ,A _ . Dental radiography is a high frequency but low dose

technique. --—*~The voltage across the X-ray tube is typically 70 kV.The dose is approximately 0.08 mSv. """""In order to reduce radiation*cl5§§.—ln order to reducE"iFte skin dose.

I .- '-' _‘_'_<'

¢

’€

I_§s¢aittrtaa"rtttit1=¢§‘r§i=ii§i=A a high energy X-ray spectrum is employetl in urclor to

visualise structures of low contrast. _8 the mammography unit is usually operated at 80 l<'\/p vo-l‘tac_te.C the X-ray beam used in mammography usirtg molybdenum as

a target consists almost entirely of Brenisstraltlttng radia ion.D the K-characteristic radiatirtrt ol a ntolylztdenum target lor tts

an intense band between 17.9 Lev and 19.5 kev.E a double-sided emulsion film~st.-reen combination is ttsec to

reduce radiation dose to the breast.

U’! U\ A False

B False

C False

U

D TrueE False

The connective tissue, glandular tissue. skin and tathave very similar attenuation coefficients and thusproduce little subject contrast. To visualise structuresof low contrast a low energy spectrum is used.The maximum tubé'T:tfa'gE'f5r~m?mmograplty isabout 30 kVp. 'With loT~7é'r§omic number target materials theBremsstrahlung production is less efficient Themammography X-ray tubes are operated at lowvoltages. The combination of low atomic numberanode and low tube voltage reduces the efficiency ofBremssttahlung production and characteristicradiation becomes doittinant. '._""'_'

A sin le-sided emulsion film and single screencombaination is used to maximise resolution. Asingle-siclett emulsion film eliminates parallax: andthe single screen is positioned behind the film as thiscauses slightly less loss in resolution than il placed infront ot the ltlm.

56 Regarding mammography: 55 A

M A AB

ior magntlication ntutttrttugraphy a local spot size of i-ass than0.2 mm diameter is requiredthe total permanent filtration ol the X~tay tube should not he

.lass than 2.5 mm ol ulutninittnt.(2 the window of the X-ray tube is made oi thin borosilicale

glass.D the X-ray tube voltage should be accurate to :10 it-V.E the mean glandular dose increases with the use ol a scatter

grid.

1*

True

B False

C False

D False

E True

A focal spot size in the range of 0.2-0.5 mm is usedlor standard mammography. '-The total liltration of a mammography X-ray tube _should not be less than 0.5 mm of aluminium orO O3 mm of molybdenum.The window of the X-ray tube should be made olberyllium with a maximum thickness oil ntnt.Beryllium is the material ol choice due‘-to its lowatomic number.The tube voltage lor mammograplty should beaccur-ate to 11 kV.Higher exposures will be needed with the use of ascatter grid.

or 47 tutu _t.rivitiIu t~iILu..Jr|i-UtJiuU-fly? '1-P tr I tI I P U V cw

57 Regarding linear tomography:A

BC

D

E

the X-ray tube and film are cglnectetl lay a rigid rod whichrotates about a fulcrum. 1/U‘/,1the amplitude of tube travel is measured in centimetres.the plane of interest is positioned approximately 10 cm belowthe fulcrum.the extent of blurring of_ an image point is proportional to thedistance between that point and the fulcrum plane. _the X-ray tube and film move in the same direction. '

58 Regarding linear tomography:»:~.

a~c

oE

the exposure angle and the tomographic angles are alwaysequal. 'theblurlwidth is directly proportional to the amplitude of thetube travel.the orientation of the obiect does not affect the extent ofblurring.the blur margin produced by a linear motion tomogram is lesssharp than the one produced by a circular motion tomogram.section thickness is directly proportional to the amplitude ofX-ray tube travel.

£1'l§Q.§.-,l'n, comptiiAi§d*‘t’Eli*i1'o'gFaiiihy‘the following statements are true;A . ‘ .8

C

D

./ Eill

the X ray tube is rypically operated at about 70 kvp. V D "filtered baclt projection is the most common imagereconstruction technique utilised in the most modern scanners.the average energy of the emerging beam is significantlylower than that of the incident beam.gas detectors are filled with an inert gas such as xenon at -atm9§Dheric pressure.. ‘the detectors are mass-produced in order to ensure identit.-g_lsensitivities. i P“‘

a

U €

t?-T ~ - -t ~- ‘. F c "Q" *1 3'5 ".9¢7$~I~PI‘I"D‘.’!‘I“!'§YwPasm?fi7

57 AB

C

DE

TrueFalse

False

True -False

The amplitude of tube travel is measured in degreesand is called the tomographic arc. " " "WThe plane of intere§t'T§p_d§iiioned at the same levelas the fulcrum, The plane of interest remains in locuswhile planesiflbove and below are blurred.

When the X-ray tube moves in one direction the lilmmoves in the opposite direction.

________-i_____o1.._u

Q A

B

C

D

E

False

True

False

True

False

Occasionally X-rays are not emitted during part ofthe tube travel. in‘which case the tomographic a_ngleis 9iea_E§[.ll‘fl‘_}.ll§_§.F2.Q_€HliéD9|9- "TThe blur width refers to the distance over which theimage of an object is spread out on the film,When the longitudinal axis of a long and narroworgan is orientated in the same direction as the X-raytube travel, the image is not blurred even if it is lyingoutside the focal plane. 'With linear motion tomography the entire image isuniformly blurred and fades off gradually at its edge.With circtilar motion tomography the blurred imageis not uniform and the margin appears sharper.An inverse relationship exists ibetween the sectionthickness and the amplitude of tube travel. i.e. thelarger the tomographic angle the thinner the section.

ll

S9

I

A.B

C

D

E

FalseFalse

False

False

False

qt .

The X-Pay tube is typically operated at about l2O kvp.Analytical methods have superseded iterative or backproiection methods of image reconstruction.A photon loses only a small amount of its energyduring Compton interagtigg which is predominant inthe CT energy range.The gas detectors are filled with an inert gas at ahigh pressure of about gbflatrriospheres to increasethe detector efficiency:The detectors do not need to be perfectly matched athe sensitivities are calibrated during imaging.

S

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iI|

'l

iI

l

Iit

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ii

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no |||\4vJ lull-oi HI rmdtuit.-gyun-

60 Regarding detectors’ used'iri'5cohiif5iited trirnogratfi; AA sodium iodide detectors are 60% efficient in ll1E_t2lit-Jgnostir;

\2 B

C@

_/,

D

E

X-ray range.bismuth germinate detectors are used in prefetence ti; 5Q('|iu|~niodide detectors because they are cheaper. 5the voltage between the electrodes is set high enough to ' Cproduce an avalanche effect iii gas detectors during radiation 3detection. "‘ "

i Physics 179

----..-------Q

O’! O

gas-filled detectors are more efficient than sodium iodide 'detectors. 6 Falsegas detectors have a linear response which is not affecter t. , 1the intensities used. W E

\/\/\.1

61

BC

- D

E

Regarding computed tomography:A

False _the diagnostic X-ray range.

B False

False

True

Sodium iodide detectors are almost 1_QQf4= efficient in‘

Bismuth germinate detectors are superior to sodiumiodide detectors as they have higher efficiency andno afterglow. < ' " 'Tl:ie_\/oltagé in ionisation chambers is adjusted suchthat it does not cause an avalanche but is such thatthe resultant current is proportional to the energy ofabsorbed X-rays.Gas-filled detectors are less efficient due to their lowdensity compared with that of sodium iodide detectors.

, STAa first generation CT scanner is less efficient in eliminatingscartered__radiation than a third getmranon QT 5-,_;im,,e,_9"el9Y dlscflmtnators are used to eliminate scattered iadiiitioiidetector collimation is the only method ol controlling i Bscattered radiation.detector collimators reoulate the thick ~ l tSECUOH.the long axis (cathode—anodel of the X-ray tithe is C True

D TrueE True

§

Defuendicuiar to the fan beani. ll

-_, ness o t re torziograpliic

I

62 InAH

U0

E

computed tomography:62each square element in the image inatrix is called El pi:-zel. l 5

a vowel represents a group of tour zictiaccni pixel;-:_ (3

False

False

A first generation scanner uses a pencil beamsource-detector geometry which is more efficient ineliminating scatter than is the fan beam geometrywhich is employed in third generation scanners.The CT X-ray beam is polychromatic and the photonslose a very small amount of energy due to Comptonscatter; therefore, a discriminating window would notbe useful in eliminating scattered radiation.

This arrangement eliminates the asymmetry in theX-ray output caused by the heel effect.

mu 5'“ °i 3 l’l"°' is “°""°“l’ll llv llirlerlor wlliiiicitttnthe size of a voxel is detizrrnined by the width of the X-ray Dbeam.a weighting lacigr is apniied during image recoitsiriiction so85 ‘O c°mP9"53!E lor the difference between the size andshape of the scanning beam and the pi';ttire matrix

A TrueFalseFalse

TrueE True

A typical image matrix is made tip of 256 >< 256 pixelsA voxel represents a unit volume of tissue sampled.The size of an image pixel is determined by thecuntptitci progrtiinine.

i 1I .I \.. =t_;ii..

E7 r'.-Q -My "~l£~ ~.&Vi-“Is ‘iufl-.4i4,Iiiq,l_..L,‘iJ“w ,5, 4' J J J’ J’ ‘D ya ‘U

i/

Regardingthe CT number: 'A it represents a relationship between the linear attenuation

coefficient in a pixel and that of its immediate f‘lEigi'"li)OUfS.=.2 ifszisfgésbthe linear attenu_ation coefficierrt in each pixel.

D to image matignlgisjgviiiIi:nhaigiie:EaUh)'n rciictgi (K) of moo qr more_ _ _ igher linear atteniiuiinncoefficient than bone it is necessary to utilise a higher CTnumber.

E it can represent variations of linear attenuation coefficient to 5the fourth decimal place in a pixel.J Q,-5* fj‘

Regarding computed tomography: rA the cupping effect seen at the centre of a iiiiiform density

phantom is caused by hardening nf the K-my beam,B quantum mottle is more apparent on n CT image when a with-3

window wiclth is used.C a variation of :5 Hounsfield units in the water CT ntirii'ner

obtained during routine quality control checks is acceptableD a 10% deviation from the expected slice thickness is -

acceptable during routine quality control r;m;;;i<$_E the standard deviation of the CT numbers of the pixels in rim

same region of interest used for water level calibrationrepresents the noise in the image. -'*

in cc mputod to mo grap|\y‘;""’A slaitisticul HUi$iJ riztliices iliu ctiiiirtlst l'l“30|tlllt)|\ til iliii iiii lqt:

. . . , _ " _ l _ _B statistical noisn is rt.-ducutl by an iiicreusu iii pixel ;;|¢u_increasing scanning time reduces statistical noisereducing slice thickness increases spatial resolution.reducing slice thickness increases contrast resolutionmDO

u

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53

64

A

BC

DE

A

B

C

D

E

False The linear attenuation C08ffiCiBfllS of adiacent pixelsare independent oi each other.

TrueTrue The linear attenuation coefficient of a pixel is multiplied

by a magnifying constant to give the CT number.Typical C’l"numbers with a magnification factor of T000are: bone ldensel=_;_1QQ9, intracranial soft tissue = rlt)to +50, water = 0, fat = 400, air = -1000. "T"

True '_"T "'-"'True

True As the polyenergetic X-ray beam passes through theuniform density phantom, the lower energy photonsare removed and the beam becomes harder withincreasingfdepth. As a result, the pixels near thecentre of the image will be assigned smaller valuesof linear attenuation coefficient than pixels near theperiphery. This effect is referred to as cupping.

False Quantum mottle becomes less apparent when a widewindow width is used.

True This is the maximum limit acceptable. The water CTnumber calibration is tested by scanning a region ofinterest of at least several hundred pixels oi a circularplastic phantom filled with water.

True This is the maximum limit acceptable. The slicethickness is assessed by measuring the length of theimage of an angiilateo plate within zt specialiilitiiitiiiii.

Truu u "

lili AB

C

HL‘

rluuTruu Si:ili:;tit:.il iiinzin is also iiiiliiizutl by illi illLllLItl5U in tliu

slice ihicknt.-ss. Noise is inversely proportional to slicethickness.

True increasing the mAs increases the number of photonsreaching the detectors and therefore increases the-ziiinnl in nniiin itiiin.

Ttiinliiilsu Uy iurlticiiig slicu tliicluiuss, luus uniittutl nurintu uiu

ilntc-t;it=rl tintl tliii signal to nnisu ratio is tlutzruaisutl. Thisdecreases contrast resolution. in addition, reducingslice thickness decreases partial volume effects.

is

-'\ _. .-“,4 III ltdututuyy

Physics 183Regarding helical C1? ‘A it is analogous to spiral CT. 66 A TrueB “_°P‘?”"e$ Bl 3 Slglllflfiflnlly highell l<Vp than conventional CT. B FalsaC 5l'P'""Q lB¢l1flOl0gy is employed in a helical CT scanner to

allow the gantry to be rotatetl conitntially in a given direuiionD a lull data set of 360° protections is acquired throu h the

59""? planar section as the reconstructed slice QE the pitch of a helical scan is given b tr bl y‘_ ‘ _ y ie ta e increment per

360° '°'a"°" °f ‘he X‘faY lube divicletl by the collimation.

I C True

D ‘False

t E True

67

xiii T

Helical CT operates at a similar kVp to that used inconventional CT.In a slip-ring gantry the electrical connections to theX-ray tube and detector array are achieved using acircular contact with sliding brushes. Due to thisarrangeméht the gantry can be rotated continually ina given direction.During helical scanning the patient table is advancedwhile the gantry is rotated, thus continually acquiringthe data in a helical fashion around the patient. Toreconstruct planar sections the raw helical data isinte[goh2i_tgd so as to approximate the acquisition of afull data set of 360° projections.For example. a pitch of 1 means the table incrementper 360° rotation of the X-ray tube (measured in mmlis equal to the slice thickness (measured in mm).

The following statements are]l-.lltrasound:*-- ---- we regarding diagnostic 67 A TmeA ultrasound vvaves are longitudinal waves. 3 FaiseB me Wm Of l'eQ"9n¢Y H9"? lH1l l5 "73 lIYFl@$ Der second C Fal eC Over 99% of the ultrasound beam is reflected at a soft A t S

tissue-water interface. JD ll f t' r. -bl so t_ issues the speed ol ll'6l1slIllbSl0fi of the ultrasound D False

‘ream '5 3"“ 15 009 "'"=’ll'95 Der second.i . " * , . , _ . . ._ e spee of transmission of the tlllfi3..rO'.lll(l beam lll soft E False

issues will increase /Vlllt increesiiig liecitiei-icy of thetransducer.

E

68___-__....._..__.___ _____ __ > i

I

The disturbance is in the same direction as that ofthe propagation of the wave.ll-l_g is 1;cycle per second.Less than 1% ofthe ultrasound beam is reflected at asoft tissue-water interface, dyer 99% of the ultrasoundbeam is reflected at a soft tissue~ai'r interface.ln the majority of soh tissues the speed oftransmission is jtist over 1500 metres per second.The speed of ultrasound in soft tissue is essentiallyconstant and is independent of the frequency used.

RE9a"ll"9 diagnostic ultrasound: 58 AA B pulsed wave transducer cannot be used to detem mo

Doppler shift, "B in 1 con in ~ - ~ -‘mini l tiotis wave tr,instltit.ur luvt) |)l(?/t}t;||}(;[r|4- L,\,,;,_,;5; ‘W: B Tum

False

C lll l:l ~ . . . .Ill, iiti titl vvttvti tittit_.tltit.ui lint, ti li.it;l<iiit_; wlitcli 1:; iii.tili: til tl U TH"!tt.ii:.i.- tlttttiping nmlertal. D Faise

D ""9ll$IlY tlticnys smootlily with (fl$lt‘|lltIU \Vlllllli lllt: I-it,-;;,|l;i'""° l'"JlIl llultll of tho tiltitisoiiic litiiini

E ho limit of axitil ltluiith) iesoltitioii for il stznnnm gsapproxtittately half the spatial iitilsi: Itiiititli

t- A-\ E True

_-!\‘ ' "= ‘ tt <

A continuous wave or puléed wave ultrasoundtransducer may be used in modern studies to detectthe Doppler shift.l")iii: t:ty:;t.-tl is: ii::i:t| tn lrrinsrnit tho tiltrristiiinil liiizim.uitl tlti: tillttii is. ii:-titl Iii iiit.tiivti llll) itittiittiitgi Ullllllllii.

litiensity decays smoothly with distance in theFtiitiiinlitilltir l_Ul|l: lliir lit.-ltll (Jl l|lL' tiltitisoiiic beam,wltit:lt hm; litiytintl int: finsntil mitt) (tit:-'ii' liultll. ThuFititiuiiltolltii mite consists of rt divergent main lobe.iiiil :i ittiiitlrtti tif iul;ttivt:ly wutik sitlo Iolms. Ctlllllllukintensity varialiorts result from interference effects inthe Fresnel zone immediately in front of thell’i]flSdllt.Zl;‘l.

1»irv...,~v ~ir.._wn'- vriur ‘tr '-er ~17 ~-t vi '3 my ,|y. aw yr.w..y v.7 ‘S $7 U U I ‘C P ‘T I Q

184 MCQ Tutor in Radiology

$553?R8981’diflglhe ultrasound__t_rensdueer?-1 i“ A the majority of diagnostic ultrasound machines operate at

frequencies between 1-10 MHz.the bandwidth refers to the complete range of frequenciesgenerated by the transducer.the lateral resolution is independent of the beam width.the side lobes of the ultrasound beam are occasionally .responsible for image artefacts. ' 1

. the ultrasound pulse length is kept to -"i minimum to optimisethe axial resolution of the transducer.

mUQHI

\ 70 The following statements are true regarding diagnostic

seconds. -the frequency of the transducer is also known as the pulserepetition frequency (PFtFl. ., .

C by increasing the PHF from I0 000 to 100 O00 pulses poisecond a significant improvement in the image resolution canbe achieved. y

A D the intensity (or powerl of e continuous ultrasound beam ismeasured in number of pulses per square centimetre.

E for a continuous wave transducer the intensity or power isusually measured close to the transducer surface.

1 _ ultrasound:OJ\7 A for a 2 MHz transducer a 2 cycle pulse lasts for 1 x. 10'“

7/ B

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Physics 185

TrueTrueFalse

True

True

The lateral resolution is the resolution across thebeam. This resolution depends on the effective beamwidth at-ffie depth of the target. _Image artefacts occur when highly reflectivestructures fall’ within the side lobes and return highamplitude echoes to the transducer. These are thenregistered on the screen and create artefacls.If the pulses are unduly long ll.e. of the order ofhundreds of rnicrosecondsl the ultrasound ‘ ‘equipment will He less able to determine the positionof an interface with a high degree of accuracy andthus the i3I'.l8l resolution will be reduced.

’Ct.

TrueFalse

False

False

True

The frequency with which the pulses are transmittedis termed (the pulse repetition frequeflfiv (PRFl._No significant improvement of the image quality canbe achieved beyond a certain PRF value. The generalrange of PRF is from 50_0 to l5QQ I1d8i_'S8C_C:lt1d. asThe intensity or power is measure in rni iwalmWl per square centimetre. '“""_'-Q

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186 MCO Tutor in Radiology

/1 Regarding the Doppler effect: i -P§ ihflapgrent frequency ol a signal is altered if the Sourcg of

--=--il 1"» iiivvirig with respect to the Observer'\’\e.{{("1§\Ll?HCYDfihB_ reflected tillrasound waves decreases ii

- --. ilnca I5 movinq towards the ll-ansducerC-iiil-h¢t?tq§i1ifUd_e of the increase in the frequengy is (ii,-ect|._,

§..lt1(.rufllUl‘lBi to the velocity of the moving object. lmg LFITqU8flCYd3[f)1lfT depends ori_the_sine of tiie angle between

rasoun eam and the direction of movement of theblood when used to measure blood flowa_li§§1_i1g arises when the Doppler shift frequency Exceedg hairthe pulse repetition frequency (PRF) Q! me [men-Ogalinultrasound beam. 9'

72 The following statements are triie:A ‘he angular il'9"l'-19"!-‘V Oi Drecession of a nucleus is

deiermined by ‘he p"°"“¢' °" ‘"9 9V'0IQa0[1et_ig ratio of the“ucieai BPBCFBS and the E:.\lfBfft‘di field strength “Tfor the “aid 5"9"lS"'Y9 Wliillfllly used in it/ii? imagingapplications, the proton Larmor fieqiienuy lies in the range2-80. MHz:thietgyrorragnetic ratio ol hydrogen UH) is gag MHZ,-|-_MP 5 5 °“/9' Qvrflfltagnetic ratio than those mi 13c_ 15N_ ortliia irilativit ritoriiir‘ oltiinilriiim i-.l l"(' ' ' ' -- -r ‘ . "ll liviiii l:::; 1 :i 'Hm "H. M ‘H - _; i ill i li|g|h.i _

II l _

flu : ' - -»ti "tllfltt llm -ii\giil.\i iimniuiitum oi gm ,,,,L|m,:,_.it I -. .r . _l"l"""|J "ll lllli .i|mi iil iiiip.iiii.il llllillllili mitt ||.;t;||.,it L|\)1lullti5 on tliii oihiiiil llltiilult Hi Hlti ,,.,\|¢,,,,,.

llm iiiiuliiiti :i|llH viiltm ll‘ ir, IIllrt-1;--| l if ' ’ " WHY" Hill! Hi II w|:n|ii iitiiiiliiii... . ...iii |u_ ur lliu piuciissiuii til lllU lillfiltjllb wlim, :;|;,(;mi 5,,a magnetic field.

8' ‘”“" 5 "weal Spin villufi ll) ol zero are Sltiiflhig rm Mittnucl

|l'i- . . f ii I =.;

|||lUif|H\||,, 3 ' U mi “iii

1.. ' ,il:n:l

C True

D False

u

E True

Physics 187'7

gist‘

The reflected frequency iqgrgases if the iiiteitace ismoving towards the transducer and vice versa.The shift frequency is also diregtlyprgpgrtional to theoriginal ultrasound frequency used.It depends onrthe cosine of the angle between the _ultrasound beam and tlieidirection of movement of theblood,lbeam/vessel angle, B). Therefore, the l1_l§)il_fl;l_lg_f\lDoppler frequency shift is obtained when 6_i§_O_" and socosine 6 is _l. Conversely, when 8 is 90°, then cosine 9 is0 and no Doppler signal is obtained. in clinical Dopplerexaminations, it is important to lteep 8 as low aspossible so as to ma5rimise the Doppler sigi"ial.' "There are several approaches to overcome aliasing inclinical practice. The PRF may be increased if theultrasound equipmenF pplar shiftfrequency may be reduced. The shift frequency maybe reduced by using a lower ultrasound transmissionfrequency or by increasing the beam/vessel angle (8).

72 A True

B True‘C TrueD False

E False

This is the Larmor equation. Therefore theprecessional frequency of a nucleus increases linearlywith increasing externakmagnetic field strength.

The gyromagnetic ratio of ‘3Q_iss_1_Q_;Z MHz/T. Thegyromagnetic ratio of ‘SN is Ali] Thegyromagnetic ratio of “P is 17.21 MHZ/T.The relative atomic abundaTi'r':e'ol‘T~l is 1.0 whilst therelative tttoiiiic ubiirirlaiicr: of ‘ZC is 0.19. Of all theiitiirrt nliiiriilziiii l)itllI\l.‘lH5 iii iiitiii, ‘ll liiis tho mosttiruiiiisiiiti iiiiultizii |)ll||)\!lUU5 liir Mill.

/ll /\ lruiill l'mu,

C Fulsu

D TrueE False

*

iillfi i:. iiiliiiiiiil Iii .i:. fill] hlllll iiiigiilsii _i_i_i_i_i_iiiuiiiiiiii.||\l:Z Iii iiilirtiutl ill .i:. llm uihiliil llllullfill iiiuinuiitiiiti.It 3:: :ii:tii:tl|y tzriiiststl liy this spiniiiiig| iittiltuii (if tho\Il\lllll iiiii;luii:. iiitluii tli-iii liy llllr uiiliiiiiiiiil_iiiil iiiiiliniiiii this iiiiliviiliml iiiii:liiiiii:i.The iiuclutii spin Vililll! ll) isytilwiiys zero, a multipleof l/2 Ul a wliole niimher.

Nuclei with a nuclear spin value of zero do notprecess in a magnetic lielcl. Nuclei with spin valuesol other than zero are suitable lor Mfll.

I00‘__v»._-.\_-sq--3-.wwvs-r.__vrvr<w\>r\iw.awr'7i%'I'UIWW''i\-1't.t4'iutor in Ha .iioiog--, Physics 189

i i I

74 When a t‘3Lllt)frEqt.l-‘.i‘tCy pulse is applied to a tissue slice wianA

8

C

D

E

thinMR magnet:resonance does not occur it the energy is delivered at adifferent frequency to that of the Larmor frequency of thenucleus.resonance does not occur ii the energy is delivered at anangle other than 90° to the net magnetisation vector ifNl\'lV).during the process of resonance the aligrinient oi‘ the T‘ll'\/lv ofprotons and the external magnetic field is unchaiiged.at a flip angle of 45‘ the longitudinal NMV is cornplett;-lytransformed into a transverse l\lM\/.as a result of resonance the rnagnetit; moments of the i'|tit:lGiwithin the transverse NMV move into pl‘i£ZS& with :8tIl‘l other.

75 Regarding spin echo pulse sequences:A . _ .

8C

D

E

the recovery time constant ii is the Kim: ii takes lor 50% ofthe longitudinal magnetisation to recover in the tissue.the Tl recovery is also termed the spin-lattice relaxation.during free induction decay (FIG) tne magnitude ol (lit: voltagein the receiver coil is reduced as the ntagnittide oi trrinsversernagnetisatton decreases.the repetition time (TR) of the ratlioireqtieiicy (RF) pulse has tivalueof more than S sacoritis. .the echo time (TE) is the time from opplicati-.:-ti of the Ft? pulse-.to the peak of the signal intiuced in the receiver coil.

8

CD

E

\\//£7§%ifi*?»i%1”tiiifi¥ii=?ft=$@ne'i§s.tmssitw~l!\g1!3!l= tit»A ' 0- _ I -he’; ,. V . ._ _spin spin relaxation describes thu decay or trrinsverse

magnetisation.the relaxation time constant T2 is the time it takes for 63% inthe transverse magrietisation to bu lost.T1, T2 and 12‘ rate constants descrihe exptlmential rlt1r;5-'15,the time constant T2 is always shorter than the time coilstaiitT1 in biological materials. ythe time constant T2‘ is always longer than the time iii,-i5t;,mT2 in practice. _ _.

4

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TrueTrueFalse

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As a result of resonance the NMV moves out oralignment away from the direction of the externalntagiietifi field.This only occurs when the flip anglais 90“.

4|

75 A

B

C

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' Y

lt IS The time needed for §'3_% of the longtttidtiiéilmagnetisatiori to recover. _ >The recovery oi the longitudinal magnetisation istermed T1 recovery. Ti recovery is caused by "YBresonant nuclei sharing their ext;ess_enert__|y_vvtlli’thestirrounding en_v_iro__nQ"iertt or lattice and IS térmfifilspin~ia'ttice_rr§|axation. _A 5'i'§E|_B~r"\§E'lTz.tge is only indticett IN the receivercoil it the magnctisation in the transverse r>l.tne is inphase. _The TR is measured in [[Til|_l§_§§Q_D_d_§- Tvwwl ‘/alum“long Tl"-_i_ QQQQ ins, short TR 250_—_7Q{J_ mi-Typical values: long TE 8'0 ms; short TE to-25 rns._. ‘ .

76 A

|'l"lOD'-3-'1

True

Tl LiaTrueTrueFalse

Splfl-':i[ll\ relaxation is also termed T2 decoy. Thudecay of transverse htagnetisatioti is catisetl lay theredistrihution oi excess eiiorgy among tilliut iesonatitnuclei which are rolatively less excited.

L

in practice. the time constant T2‘ is shortertliari thetime constant T2. This is because loss oi splitcoherence is iiiiluenced by other factors, such aslocztl inagnetit: field inhomogeneities. in dtl(lll|Ofl tospin-spin inter.-"ictions. The time constant T2‘ denotesthe obscweti decoy constant.

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a spinecho puise sequence: _hydrogen ih water loses trarisverse magnetisation faster thanthe hydrogen in fat. 'the Tl recovery of fat is shorter than the T1 tecove of wla_ _ _ FY ter.the T2 decay time of water IS approxiniately 5 ms Ime T2 decay time of lat is approxirnately 80 ms. I E

9 5"‘-*_"9\ 07 5'9"?" Pffldtlced in a T1-weighted imageiproportional to the amount of transverse rnagnetisatignproduced after application of the RF pulse.

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an‘tncrea_se in the field of view (FOV) decreases the signal ,to‘noise ratio. ,the signal to noise ratio increases as the square of the t'tttrl'il)eroi excitations.the signal to noise ratio is reduced in rlirect t)r0[)0r'tiQn todecrease in slice thickness.the sigrtal to noise ratio increases as the clata acquisitionbandwidth decreases. .an increase in the field of view can be useci to overcome analiasing artefact. r

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\ \[]79.§t':B95i'dih9. magnetic resonance lntaging (Matt;

B

C

D

E

a perntanent magnet has the best twith other types of magnet.a ' ' - - .l_ '9_5,'5l“’§ magnel _lS cooled using cryogenic lluitls such asiqutdiheltum and liquid nitrogen,tron-cored resistive magnets can o 't)Gl‘1i0 at fieltl st = -to 0'5 Tesial * rengths upglpmrgagttettc field requires rt homogeneity Qt 0_1 pa,-ts De,-

etnporal stability compa;-ett

in vivo spectrometry tequitcs '1 titzignct with ti Pi =|| -between 0.1 and 0.2 Tesla. Q l L‘ Sucnwh

Physics 191

77A False

True

FalseTrueTrue

_\11-Hydrogen in fat recovers more rapidly along thelongitudinal axis titan water and loses transversemagnetisation faster than water. _Therefore lat has higher signal on T1-weighted SEsequences than water. rThe T2 decay time of water is approximately 200 ms.

For example, there is more transverse magnetisationin fat than in water after the RF pulse. Fat therefore

‘has a higher signal and appears brighter than waterin a T1-weighted image.

78A False

False

TrueTrue

“U8

An increase in the FOV increases the voxel volume.Large voxels contain more spins than small voxelsand therefore have a higher signal to noise ratio.The signal to noise ratio increases as the squareledcztflof the number of excitations. The number ofexcitations refers to the number of times each valueof phase encode is repeated.Le. thin slice images are noisy.Reducing the data acquisition bandwidth results iniess noise being sampled relative to signal. However,chemical shift artefagt increases as a consequence.An aliasing artefact occurs because the imagedabject is larger than the chosen field of view.

79 False

False

TrueFalseFalse

A superconducting electromagnet has the besttemporal stability.A resistive magnet is water cooled while asuperconducting 8l8Cll’0fT\t':lQf'l8l is cooled usingctvogetttc lluitis.

The field liomogcneity needed is 10 parts per million.The field strength required is in the region of 1-2 Tesla.

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192 ~ MCQ Tutor in Radiology ‘

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80 lnA

BCD

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a MRI scanner: -the gradient coils, shim Coils and radiofrequency coils lieoutside the magnet.there are three sets of gradient coils.a gradient field is used to perform slice selection.slice thickness can be altered by changing the bandwidth ofthe applied radiofrequency pulse. 2shim coils are used to perform frequency encoding and phaseencoding. T

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sensitivity and spatial resoltitiori aie iiitleperitlerit of ez.it:li otliet.its resolution is equal to the square root oi the stint oi thest]ti.ittt:t til tliu tttlrtitstt: t_|.'tiititt;t tzriiiitliit ;liiil t:ulliitt;ilt.ii'|tlUU|tlllt)l\5. ‘-—"—-'-its siizilial resolution increases with on l(lCfl:il5U iii thecolliniator-to-object distance.it produces approximately 40 visihle light photons for eachincident M0 kev gamma photon that it detects.pulse height analysis is tisetl to select those pliotniiiiiliipliiii‘tubes tPMTsl in the detector heail which have dettictitil Llscinullatioii.

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The gradient coils, shim coils and radiofrequency coilsmust all lie within the inside diameter of the magnet.A gradient coil generates Q transient change in themagnetic field which varies lapproximatelyl linearlywith position along the axis of the magnet bore. ltthus produces a field gradient. The three sets of coils-generate field gradients in directions perpendicular toeach other. iA gradient field is superimposed on the externalmagnetic field. Protons along this gradient iietd areexposed to tlilferent magnetic field strengths andtherefore have different precession frequeiicies. Aslice _can be selectively excited by transmitting aradiofrequ.=.iicy pulse with frequencies correspondingto the precqssional frequencies of the protons in thatparticular slice. ‘Slice thickness can also be altered by modifying thesteepness oi the gradient field.Gradlentcoils are used to perform frequencyencoding and phase encoding. Shim coils are used toachieve better magnetic fielcl i\9lnQQ§|1t§ilY. Thisprocess is called shinii"r'\it"i'tj'."-T M

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its spatial resolution decreases with E.ll‘llt'1Ct_2£1St3 intltt.-‘;iilliiii:itiii tii iili|i:t:t ili:;li'iiii:n.,Tlti:i is triiii for iitll"/|it::; til i:tilliiii.i\tiiThe tleti:i;toi systeni tiiutltictis .i|iiiio.\.iiii.iti:ly -ltltlt)visible light photons for each incident gamma photonthat it detects. -Pulse lieiglit ;lthl|YSl$ is tisetl to select those pulsesgeiiurtttiztl liy the PMTS wliit;h_cut"rt:sponil ttl_t_hugaiiiinri ray eiiert til the ratlioiiuizlitle being eiiiiitcil.in principle, plli$3iGlQ|1l analysis allows tfiscrifiiinationbetween scattered and unscattered monoenergettcganiiiiai rays.

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BC

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a parallel hole collimator fc-rrnjs an image by relraciirig gainiiiarays and bringing them into focus at the sodium iodidedetector surface. ~a high resolution collimator has a low sen-siti-.~ity.a_slant_hole collimator should be used lor gated cardiacacquisitions. -a lan beam collimator helps to keep the teniperature of thegamma camera electronics low.by increasing the length and number oi the collirnr-itur liulesthe intrinsic resolution ol the gamma carriers criri be iitipru-.-etl.

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D

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B single headed gamma camera must always rotate a full 360°around the patient to register e SPECT acquisition.the most widespread mode oi toiiiograpliic acquisition is thestep-and-shoot method.a multiple headed gamma camera increases the acquisitiontime as compared _with a single headed gamma Camerabecause comparatively more gamma rays will need (Q bedetected. 'a single headed SPECT camera cati only follow a circular orelliptical orbit around the patient. 'the centregol rotation (CORJ correction is stored in the computermemory at the time of installation and is applied to allsubsequent SPECT studies. .

Physics___195

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True This ensures that the crystal has a high stoppingefficiertcy for gamma rays for a given crystal thickness.Th'€"lTigll§_t_o__itiic number favours a plioio_el_ectricinteraction which results in a light pulse that isprop'c'>'?ii'oTiEil to the gamma ray energy.

False The scintillation crystal is a sodium iodide (Nail crystaldoped with approximately 0.1% thallium (Tll. Thethalliurn increases the light output irom the crystal.

TrueTrue The Nal(Tll crystal is hygroscopic.True "However, a thicker scintillation -rysta| degrades

iritrirti_ic_;g§_c_ilution and therefore the crystal thicknessthat is chosen represents a compromise.

False A parallel hoie collimator works on the principle ofan absorptive collimation. Unlike visible light, gammarays cannot be refracted.

True increased resolution can only be achieved byreducing the overall sensitivity.

True A 15° slant hole collimator is best suited forseparating the left atrium from the left ventricle.

False A fan beam collimator refers to the arrangement oi. individual collimator septa and is used for cardiac

and cerebral SPECT imaging. Collimators do notcontrol the temperature oi the electronics.

False The intrinsic resolution of the gamma camera is afunction of the sodium iodide crystal thickness.number and shape of the photomultiplier tubes andassociated electronics. The collimator characteristicsdo not affect intrinsic resolution.

False A SPECT acquisition can be performed by a gammacamera rotating 180‘ around the patient (e.g.myocardial perfusion study: 180" rotation).

TrueFalse A multiple headed gamma camera is much faster

§i\Bfi a single headed camera because multipleprojections can be acquired simultaneously.Modern SPECT camera heads can follow an operatordefined contour around the patient. This reduces thedistance between the detector and (he gamma camerathus preventing loss of resolution.The extent of COR correction can change with time.Therefore the COR correction is assessed on a regularbasis (e g at least once a week) and then stored on the

False

False

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Regarding positron ernistilon toitiotirapliv lPETl: 35 AA a positron has a unit positive charge and no mass. BB .a neutron is convened into a positron and a proton during

positron emission.the scintillation detector is usually made of bisrntith german:-ite.the positron decay is detected by a coincident detection methodthe positron emitters that are used in PET imaging have ,longer half-lives than that of 99“‘Tc. '

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Physics 197

tIl"i‘a"ad‘ri'tinisiered activity is measured using a scintillationdetector.the performance of an isotope calibrator is independent of thesource geometry.mouth pipetting of radioactive liquids with low specificactivities is permissible provided that it is performed in a wellventilated fume cupboard.lead syringe shields are used during the dispensing ofradiopharmaceuticals.routine contamination monitoring of controlled areas isperformed using a calibrated dose rate meter.

= eg'ardin'g’;‘tha-handling of:unsealediradionurzlidasztt» t a rt U. - . ti t,A s

False

raise

True

TrueFalse

A positron has a unit positive charge and the samemass as that of an electron.During positron emission a proton is convened into anegn and a positron. A positron and a neutrino aree|ected fr00Wth§'rT_ticleus.The high atomic number of bismuth (Z = 83) and thehigh density of the crystal give a high intrinsic detectionefficiency for 5ll kev photons. These“ photo‘tTsfiFe_produced by the positron annihilation process. -

The tatlionticlides used in PET imaging have veryshort half-lives, e.g.'“C l20.5 mini. "N no mini. ‘so(2 min), '8F {H0 min). The half-life of 95"“Tc is E hours.

87 Regarding patient dose resulting from the atlministration of aradiopharmaceutical:

the dose received depends on the decay scheme of theradionuclide.the absorbed dose is directly proportional to the arneunt oiradioactivity administered.the patient dose can be decreased by retlticing the ticquisiiioritimes using El gamma camera.int Aliti/\C iiitzuitiiittmtltitl t|n:iu:t lliti nil<tt.l:vu llkliiit t;\|\|lV.|ilI|lllEUl§) ti; tilwiiyzi lusts lhiiii S tiiSv. ~the biological hall-lile does nut aileci the ahsorbutl dose.

False

False

False

True

False

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Activity is measured using a calibrated isotopeCaiil§[Q_lOf. t 'lsotopetzalibrator performance depends on the sourcegeometry. Different calibration factors are used lor thesame radionuclide presented in different geometries,i.e. 99'“Tc activities measured in a syringe and in a vialrequire the use oi different calibration factors.Mouth pipetting of radioactive liquids is not permittedunder any circumstances.The use of lead or tungsten syringe shields reducesfinger dose.A calibrated contamination monitor tnot a dose ratemeter‘ for appropriate radionticlides is used.

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TrueFalse

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the type of radiation emitted and the presence oiradioactive daughter products will influence theabsorbed radiation dose.

Patient dose is independent of the image acquisitiontimes using a gamma camera. lt depends primarilyon the amount of radiopharmaceutical administeredand other measures taken to reduce patient doseiii.t|. lltyttiifij liititikinqj tiflititlrtl.litir tixiiitiiilir, tliu tltmti tliiti iii *'“' ll itziutl llllliYUL2Llli.llil| iititigttig is lttt_)liut', Lu. Blliiitiv.A shorter biological hall-life reduces the absorbed dose

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Regarding radiation doses‘A the average total annual radiation dose to a m8rt"|bet of the

UK population is 2,5 mSv.B nuclear fall out and discharges account for the largest inan-

made contribution to the radiation burden ol the populationliving in developed countries. _ _ _

C the average effective dose from a skull radtograpu isapproximately 0.15 mSv. _ ‘

D the average effective dose from an l\/U exarntnatirm is ‘approximately 3.5 mSv. 99 _

E the average effective dose from a '"Tc MD.“ bone scan isapproximately 15 mSv.

_ _ er' 88 A True

B

®

False

True

TrueFalse

Medical irradiation contributes up to 90% of the totalman-made radiation dose.The effective dose is a measure of the combinedeffect on the whole body of the radiation doses toseveral different organs or tissues in the body.

The effective dose from a 99'“Tc MDP bone scan isapproximately 5 mSv.

The effective dose: ' - 89A is the same as the effective dose equivalent.8 of an abdominal radiograph is approximately i.-5 rnSv.C of a barium enema is equivalent to approximately 4.5 years

natural background radiation.D of a chest CT scan is equivalent to approximately 40 PA chest

films.E of a 2°lTl myocardial perfusion scan is less titan that of a

99"‘Tc methoxy isobutyl isonitrile tMlBll myocardial perfusionscan.

® Regarding the radiation monitoring film badge: y soA

True

TrueTrue

FalseD

False

The 1990 Recommendations of the internationalCommission on Radiological Protection llCRPPublication 60l now use the term effective dose,which is analogous to the term effective doseequivalent used in previous ICRP publications.

The effective dose of a barium enema isapproximately 9 mSv.The effective doses of a chest CT and a PA chest filmare approximately"8 mSv and 0.02 mSv respectively.Therefore the dose of one chest CT is equivalent tothat of 400 chest films.The effective dose ol a 2°'Tl myocardial perfusion ,tscan is approximately 20 mSv. The effective dose ofa 5'9""Tc MIBI myocardial perfusion scan isapproximately 4 mSv.

the X-ray lilm used inside the badge has a fast €£il'\Ul$ltZ2-I’! onone side and a slow emulsion on the other side.

, B the cadmium-lead filter is used to estimate the e.~.tmsi'irr: to-v t

.$.!'_i‘t‘ r ‘ ' '/

thermal neutrons. -C the photographic lilm becomes progressively less optically

dense as a result ol exposure to t'.',-nising radiations.D the use of plastic, tin anti aluminium litters tn a ltlrn laatlge

enables the _:distinction to be made between X-ray andultraviolet exposures. -'

E the lilm badges are calibrated by exposing sonic badges lrotnthe batch to e known amount of radiation. t

True

True

False

False

Tru e

ll a high exposure of radiation has occurred. the fastemulsion can be removed and an estimate of thedose can then be made from the measurements onthe slow emulsion.The neutron capture by cadmium nuclei results ingantttta emission which exposes the lilm.The photographic lilm becomes progressively moredense as a result of exposure to ionising radiations.The different filters allow the distinction to be madeas to whether the dose was the result of beta particleemission, high or low energy X-rays, or gamma rays.

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J The radiation weighting factor lqtitililv lvlllflrl is:A . . . .

.9

91 AnA

BCD

E

air equivalent wall ionisation chamber:is unsuitable for measurement of radiation at the higherkilovoltages used in diagnostic radiology.is more sensitive than a Geiger counter.can be used to measure cxpflsutfi tales-may be convened into a chamber whose response varies withphoton energy in the same way as the standard air chamber.requireshigh gas pressure inside the chamber. -

D

E

Regarding radiation protection:A the radiation weighting factors (quality factors) depend on the

\) relative biological effectiveness (RB_El Of the r8diflli0fl- I\7 B the radiation weighting factor [quality factor) for X-rays i§_Q__5__V C the annual whole body dose limit for a member of the public

is ten times less than that for a radiation worker.the average annual whole body dose per person in the UKdue to natural background radiation is 10 mSv.exposure to natural background radiation mainly arises frommen. "°K and "c.

8 greater for radiations with a low linear energy transfer., . . .DO

E

dependent on the relative biological effectiveness.

a factor determining equivalent dose.higher for all particulate radiations than it is for “Co gzininiziemission. --ctiitsitlnrtitl in hit izunstiiiit for lliii iliziiiiiiizitii: itintiu iii X rtiys.

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False

False

TrueTrue

False

An ionisation chamber is suitable lor measurementof radiation at all kilovoltages used in diagnosticradiology. iThe amount oi an electrical charge or currentreleased inati ionisation chamber is very small.Unlike the Geiger counter, the ionisation chambercannot be used to count individual radiation events.Instead the total amount of current passing throughthe chamber can he measured using an elecirometer.

By adjusting the size of the aluminium electrode andthe amount of carbon.The gas used is air at atmospheric pressure.

True

False

True

False

True

¥

The RBE oflthe radiation is a ratio of the dose fromstandard raliiation (usually 200 kvp X-raysi toproduce a given biological effect to the dose from thetest radiation to produce thesame biological effect.The radiation weighting factor for x_ffa\/5 (andgamma rays and beta particles) is l.The annual whole body dose limit for a radiationworker is§_9 mSv. The annual whole body dose limitfor a member of the public isj mSv llonisingRadiations Regulations 1985).The UK population average annual whole body dosedue to thenatural background radiation isapproximately 2.175 mSv.

. "5'

TrueFalse

TrueFalse

lrttu

lt is greater lor radiations with higher linear energytransfer.

The quality factor for electrons (except Augerelociroiis utiiiiteil from iiiiclei huiintl to ON/Xi is thosnniu as llliil lnr ““Cu gainniii niiiissintis.

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2‘o2 MCQ Tutor in Radiology

94 6Rfi¢ii=$!*!ii£I!,2§.i!119.‘l‘¢.P"$!5?ifi'iiiiiiiiti'55ii'=iBdi5§'9PW‘3""?.5@ 9‘ A7educed byzqj _ABCDE

reducing scatter with a grid.decreasing the object to fllm distance.compressing the abdomen during an lVU examination.using rare-earth phosphors in the screen.selecting the highest tube voitage consistent with acceptableimage quality.

95 Regarding diagnostic imaging: .A\/ BC

D

E

thermionic emission ls preceded by electronic excitation. 'a large proponion of the energy in the incident Xiray beam isconverted to heat energy in the tissues.gamma emissions from 99"‘Tc have a higher linear energytransler iLETl than 100 kVp X-rays.small temperature changes in irradiated gonads are thought tobe responsible lor the consequent genetic effects.dehydrated patients are at a higher risk of t8di6tiOr\<inLitit;E\ddamage.

A

U0

E

»

Smflegarding 'the?biological~.al'fects-of radiation:the severity of stochastic eflects is dose depeiitlent.Cancer induction is an example of a non-stochastic effect. yAll the somatic effects oi radiation are SiOCilc!S[iC.radiation dose levels in tliagntistic rtiiiiiilugy ant more liitely in|JlLItillLll: nun ::tticli.islit: etiutzts iiiflll LiiOt2ihi:5!I\1 t.-lltrctzz.gaiiiinu 0ll\iSSlOI\$tilOl1i ratliortticlitle iitiiigiiiiii tilt} iiiriiu lilutlylu iiititlucu llU|l'LiiUb|ir'.l!.l|iC ullucte ihiin utu X~l|lYll-

BC

D

E

Z_g;,_Ilte tollowing,;tatatjn_artts.arevtrue of the non~stochastictefft'si:'is ,;0‘ . . . 4

l/ Atndintlo_rtL_*_ Clliuie is it threshold dose below which rioii-stocliastic eilectsdo not occur.the severity of the effects is at least in part dose deperiiilent.the effects are assumed to be rton-atldilive if the lime intervalbetween tliti exposures is strllitzitrriily loiig lu iiimiiit crrrriiiletiirecovery. ‘a pleural allusion lollowing ratlioiliciepy is an \;‘K3l11t)|U oi anon~stocliastic effect.skirt erytliema is an example oi a non-stochastic effect.

Physics 203

"TUBE

False

TrueTrueTrueTrue

Agfid always absorbs some primary radiation inaddition to scattered radiation and therefore exposurefactors need to be increased when a grid is used. Thisincreases the radiation dose to the patient.

v

95ABC

' o

E

TrueTrueFalse

False

False

’€

The LET is the number of keV lost per micron of trackof ionising radiation. lt is similar for X-rays and gammarays.Temperature changes are insignificant. Geneticdamage is caused by the interactions betweert ionisingradiation and the genetic material of the germ cells.The state oi hydration is not relevant.

USA

B

C

I)E

False

False

Fiilsti

FiilsuFalse

The strut-.iity ol stochastic effects is not dosedependent. The Qrobability of the effect occurring isdose dependent without a threshold.Cancer induction in somatic tissue is a stochasticeilect oi itttiizilion. Genetic effects are also stochastic.Tlin :it)H\iliit§ nfititzts til mtiirititiii iirti hoth sioclinsticJltli HUH-5lULIi\ilSllC. _’ g __“ ___Tliii lllvtltiill i:; tiini ' 'Gamma emissions and X-rays are both equeliy likelyto produce itori-stochastic eilects. '

97A

B

CDE

True

True

TrueTrueTrim

Above the threshold dose, non-stochastic eflectsurztztii with rt high tiegrct: (Ii predictability.When the tliresltuld dose level is exceeded, theseverity ol the non-stochastic effects is proportionalto the radiation dose.

Czitarzicl (urination is unotlier exziinple of a non-stocliastic ullctzt ul iatliatioit.

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MCQ Tutor in Radiology

the POPUMET regulations (1988) are concerned with theradiation protection of radiation workers.the Radioactive Substances Act H993) does not apply tohospitals.the ARSAC issues licences to administer radioactivesubstances under the Medicines Act (1978).the Radioactive Material lfioad Tf8flSpOi‘l) Act (1991) onlyapplies to the nuclear power industry. _the ionising Fladiations Regulations H985) are designed toprotect the public as well as staff.

K;/tt. Aagardingith ,_ atutgg!raai;;i9ihg9se|i_mr_i§ lien ._1se§§,.for radiation workers"ti1”e“i:‘lo"§e‘liri"1‘i{tFior the lens oivthe eye is15 mSv per year. "the whole body annual dose limit for a trainee radiationworker aged under 18 years is the same as that for aradiation worker aged 30 years.the dose limit for the abdomen of a pregnant woman is 10mSv during the declared term of pregnancy.the whole body dose limit for a classified worker is 5 mSvper year.a radiation dose below these statutory lirnits is considered tobe free of any harm.

medically qualified persons can direct medical exposure fora diagnostic purpose without any additional training.they do not apply to the in vitro use of ionising radiation inscientific research.it ls the duty of the employer to maintain an up to dateinventory of the X~ray equipment.the core of knowledge training records of all staff who areinvolved in clinically or physically directing radiation doseare maintained by the employer.responsibility for medical exposure lies solely with theperson physically directing it. ‘

100 Regarding the ionising Radiation (POPUMET) Regulations 1988:

»ww10‘IW\I'IFW-"I-‘IIl'i'QPhysics 205

B

CD

E

Regarding radiation protection lflgislaliflnr 33 A False

False

TrueFalse

True

The POPUMET regulations H988) are concerned withthe protection of persons undergoing medicalexamination or treatment.The Radioactive Substances Act (1993) applies to allwork plac_e,s involved in the use of radioactivesubstances. V

The act equally applies to hospitals which transportradioactive materials. Note that the RadioactiveMaterial (Road Transportlifireat Britain) Regulationsbecame law in 1985.

99 AB

C

D

E

FalseFalse

True

False

False

The limit iStS8l at 150 mSv per year.The whole body dose limit for a trainee radiationworker aged under 18 years is 15 mSv per year; thisis less than the limit for a radiation worker aged over18 years (50 mSv per year).Note also that the dose limit to the abdomen of _women of reproductive capacity is set at 13 mSv inany three consecutive months.The whole body dose limit for a classified worker is50 mSv per year. ’No level of radiation dose is considered to be safe forstochastic effects. _

0 A

FHUOW

False

TrueTrueTrueFalse

According to the POPUMET Flegfilations 1988 all 'persons directing clinical or physical exposure needto be adequately trained to acquire a core oiknowledge in radiation protection matters.

The responsibility lies with the person clinicallydirecting it. The person physically directing it is requiredto keep the dose as low as reasonably practicable.

t

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l

BibliographyAdministration oi‘ Radioactive Substances Advisory Committee

(ARSAC). Notes for Guidance on the Administration oi RadioactiveSubstances to Persons lor Purposes of Diagnosis, Treatment orResearch. London: Department of Health, 1993.

Agur AMR. Grant's Atlas of Anatomy. 9th edn. Baltimore: Williams andWilkins, 1991. , '

Ansell G, Wilkins RA. Complications in Diagnostic imaging. 2nd edn.Oxford: Blackwell Scientific Publications. 1987. _

British institute oi Radiology. Assurance of Cluaiiry in the DiagnosticX-ray Department. London: BIR, 1988.

British National Formulary Number 27 lMarch 1994i. i_Ot1tlon: BritishMedical Association and the Royal Pharmaceutical Society of GreatBritain, 1994.

Bushberg J, Seiben J, Leidhoidt E, Boone J. The Essential Physics oiMedical imaging. Baltimore: Williams and Wilkins, 1994.

Cafiey J. Paediatric X-ray Diagnosis. 8th edn. Chicago: Year BookMedical Publishers, 1985.

Chapman S, Nakielny R. A Guide to Radiological Procedures. 3rd edn.London: Baiiliére Tlndaii, 1993.

Chesney D, Chesney M. Fiadiographic imaging. -ttli edn. Oxford:Blackwell Scientific Publications, 1981.

Clark KC. Positioning in Radiography. 9th atln. London: WilliamHeinemann Medical Books, 1974.

Cosgrove D, Meiru H, Dewbury K. Clinical Ultrasound: Abdoinirial antiGeneral Ultrasound. Edinburgh: Churchill Livingstone, 1992.

Curry TS, Dowdey JE, Murry RC. Christensen‘s introduction to thePhysics oi Diagnostic Radiology. 3rd edn. Philadelphia: Lea andFebiger, 1984. -

Dendy PP, Heaton B. Physics for Radiologists. Oxford: BlackwellScientific Publications, 1987. ,

Grainger RG, Allison DJ. Diagnostic Radiology. 2nd edn. Edinburgh:Churchill Livingstone, 1992.

Hornsby VPL, Winter RK. Aids to Part l FRCR. Edinburgh: ChurchillLivingstone, 1988.

Hospital Physicist's Association. The Physics oi P-adiotiiagnosis. 2ndedn. London: HPA, 1977.

institute oi Physical Sciences in Medicine. Report No. 59. TheCommissioning and Routine Testing of Mammographic X-raySystems. 2nd edn. York: lPSM, 1994. _

institute oi Physical Sciences in Medicine. Report No. 87 QualityAssurance in Dental Radiology. York: IPSM, 1994.

Johns H. Cunningham J. The Physics oi Radiology. 4th edn.Springfield, lllinois: Charles C. Thomas, 1983.

Keats TE. Atlas of Normal Roentgen Variants That May Simulate F '.

"‘ :' " '"' " "1 -' ~- 9*"---~-=~~~--=----=-~--~ wee ‘

‘___.A.___.____

uruuugiupiiy LIJI

Maisey M, Britton K‘£"Gilady D. Clinical Nuclear Medicine. 2nd edn.London! Chapman and Hall, 1991.

Martin A, Harbison S. An introduction to Radiation Protection. 3rd edn.London: Chapman and Hall, 1986.

McMinn RMH. Last‘s Anatomy. 8th edn. Edinburgh: ChurchillLivingstone, 1990.

Nleschan l. An Atlas of Normal Radiographic Anatomy_.__2_g_d edn-London: B Saunders, 1959. . N

Moores B, Henshaw E, Watkinson S, Pearcy B. Practical Guide to‘ Quality Assurance in Medical imaging. Chichester: John Wiley and

Sons, 1987. 9Moores B, Stieve F, Eriskat H, Schibiila H. The BIR Report 18. Technical

and Physical Parameters in Medical Diagnostic Radiology. London:BlR, 1989. '

RCR Working Party. Making the Best Use of a Department of ClinicalRadiology: Guidelines lor Doctors. 3rd edn. London: Royal College ofRadiologists, 1995. '

Sander RC. Clinical Sonography: A Practical Guide. 2nd edn. Boston:Little, Brown and Company, 1991.

Sharp PF, Gemmell HG, Smith FW. Practical Nuclear Medicine. Oxford:lRL Press, 1989.

Sorenson J, Phelps M. Physics in Nuclear Medicine. New York: Gruneand Stratton, 1980.

The ionising Radiation (Protection of Persons Undergoing MedicalExaminatiog or Treatment) Reguiations..,,Statutory instrument No.778. London: HMSO, 1988.

The ionising Radiations Regulations. Statutory instrument No. 1333.London: HMSO, 1985.

Welsh S. The Physics oi Motiicul imaging. Bristol: Atitim Hilgor, 1988.Weir J, Abrahams PH. An imaging Atlas of Human Anatomy. London:

Wolfe, 1992.Westacott S, Hall JRW. Key Anatomy for Radiology. Oxford:

Heinemann Medical Books, 1988.Westbrook C, Kaut C. MR1 in Practice. Oxford: Blackwell Scientific

Publications. 1993.Whitehouse GH, Worthington BS. Techniques in Diagnostic imaging.

2nd edn. Oxford: Blackwell Scientific Publications, 1990.Wiilts R. Principles of Radiological Physics. 2nd edn. Edinburgh:

Churchill Livingstone, 1987.Wotton R. Radiation Protection oi Patients. Cambridge: Cambridge

University Press, 1993.

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The FRCR part i syllabusThe Royal College of Radiologists has kindly given permission to theauthors to include the present FRCR part l syllabus in this book. itshould be noted that this book is not an official publication of theRoyal College of Radiologists, and detailed information on any aspectof the fellowship examination and the syllabus should be obtainedfrom:

The Examinations Secretary,The Royal College of Radiologists.38,'Portland Place.London W1N 4-JO.

1.0 RADIOLOGICAL ANATOMY AND TECHNIQUES

1.1 Radiological anatomy

General commentsThe candidate should be familiar not only with the basic anatomyrelevant to all the common radiological examinations but should alsobe familiar with cross-sectional anatomy In the axial. coronal, sagittaland. where appropriate, oblique planes. A knowledge or normalanatomical variations will be expected. it is expected that the formalteaching course will build on the anatomical knowledge alreadyexpected of a radiological trainee, in much the same way as theinterpretation of radiological abnormalities is built obn a soundknowledge of basic pathology. -

Candidates should know the normal appearances in the growingchild including apiphyseal ossification, but need not memorise thedates of appearance of the ossification centres.

1.1.1 The syllabus for anatomy as shown by imaging examinationsincludes the following systems:

The skull including the facial bones, mandible, teeth, lacrirnaiapparatusThe remainder of the skeletal system 'The respiratory systemThe abdomen ”The gastro-intestinal tract and biliary systemThe urinary tractThe cardiovascular systemThe lymphatic systemThe female pelvic organs, including the pregnant uterusThe anatomy and ultrasound dating of the normal foetusThe female breast

5‘‘=1Egi_.. B! IIs gt“iFfii

- The male genital tract— The brain, spinal cord and meninges— The endocrine system.

1.2 Radiological techniqupfir '

1.2.1 The candidate will be expected to show familiarity with, andexperience of, everyday investigations. A detailed knowledge is onlyrequired for those techniques which a candidate is expected to havecarried out personally and on his/her own during the first 9 months oftraining in radiology. These examinations are standard contrastexaminations of the gastro-intestinal tract, intravenous urograplty.urethrography, cystography, leg vanography, sialography.dacrocystography, hysterosalpingography, T-tube cholangiograptty.sinography and a nephrostqgram.

1.2.2 A knowledge oi the basic principles underlying the techniquesused in arteriography, interventional radiology, biliary tract imaging,_nuclear medicine, ultrasound, CT and MR1 will also be expected but inless detail. For these investigations. the candidate should know. inoutline only, the following:- The principal indications and contra-indications- Patient preparation— Radiographic apparatus-used— Contrast media (see 1.3 belowl- Outline of technique with main variations- Principal complications and their treatment.

_ ‘D

1.3 Contrast ntediafradiopharmaceuticals and drugs

1.3.1 Contrast media: The contrast media _to be studied are thosewhich relate to the practical procedures mentioned in 1.2 above. Theyinclude the contrast media in current clinical use for radiography.computed tomography and magnetic resonance imaging. For eachcontrast agent the following are expected:

— Official name '— Doses, including doses for children—~ Constitution (not the detailed formula)— Modes of administration and the clinical uses- Routes of elimination~ Relative advantages of the different types of media- Side effects and treatment of reactions—- Contra-indications to use.

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1.3.2 Fladiopharmaceuticals: The choice of iadiophzirriiaceuticals.

1.3.3 Drugs: Some knowledge is expected of those drugs commonlyused in radiological practice, including their dosage. These can beconsidered under the following headings: . i

Preparation oi the gastroilntestinal tract. including drugsmodifying bowel behaviour ‘

— Sedation before radiological procedures- Prophylaxis and treatment of reactions to contrast media

Prophylaxis and treatment of reactions to radiological proceduresother than to contrast, e.g. in phaeocliroihocytoma.

1.4 Radiography

General commentsCandidates will be expected to demonstrate a knowledge of thestandard radiographic projections relating to the regions outlined inthe radiological anatomy syllabus lsection 1.1 above). Candidatesshould, therefore. be able to comment on the positioning and titheangulation used to obtain the image and should be able to givepractical advice on improving the quality of the film. A knowledge ofinfrequently used projections will not be expected.

1.4.1 Knowledge of. and practical familiarity with, the following will beexpected:

Positioning oi patients. The use oi ll'l'll't‘lOlJlllSll1g devices andprotective devicesStandard radiographic projections and angles. Correction oferrors in centering an exposureThe specific problems of mobile radiographic techniquesThe following standard radiograpliic projections:

Basic skull views including the facial bonesAP and lateral projections of the spliiePA and lateral chest radiographErect and supine abdomenAP pelvisStandard views of the shoulder girdle, pelvic girdle andextremities.

2.0 PHYSICS

General comments-

— A basic knowledge oi physics is assumed.On the assumption that the whole of the physics syllabus can becovered in approximately 40 hours of formal teaching, the hoursindicated in hrackets are a ouide as to how these 40 hours might

The FRCR part I syllabus 211_-at

2.1

the approximate proportion of questions devoted to each topic inthe MCQ part of the examination and the depth of knowledgeexpected in the topic.The changes in content and recommended time contained in thisrevision of the syllabus,,are designed to reflect the introduction ofthe newer imaging modalities.Equipment design and construction details will not be examined,but an understanding oi the function of equipment componentsrelevant to image formation may be tested.A mathematical approach to the physics Syllabus is lnafipfoflflaieithe emphasis should be placed on a clear understanding of thephysical basis of radiological practice in 6 qualitative Sense-However, the knowledge of the approximate magnitude ofquantities encountered in daily practice will be expected, e.g.percentage transmission of X-radiation through a patient; theactivity of a radionuclide used for bone scanning.Basic electricity, magnetism and mathematics are not included inthe syllabus and questions on these subjects will not be included inthe examination.During formal teaching, all physics demonstrations/practicalsshould have a direct relevance to everyday rBCll0l09Y-Knowledge of the principles of quality assurance, contrastresolution. spatial resolution and noise is expected for all thesections listed below.

ionising radiation (5 hours)

Structure of the atom.Radioactivity and raclioniiclides: basic definition of alpha. beta andgamma radiation; principles of exponential decay, half-life, specificactivity and units of activity.Electromagnetic spectrum.General properties of X- and gamma rays: wavelength, energy,inverse square law.Interaction of X- and gamma rays with matter: coherent, Comptonand photoelectric interactions; concepts of attenuation. absorptionand scatter —- and their practical consequences.

2.2 Radiation protection (7 hours]

— Statutory responsibilities: an appreciation of relevant legislationand Codes of Practice.

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— Genetic and somatic effects of ionising radiations. 2.6 Magnetic resonance imaging (5 hours)Relative risks of ionising radiations. — Basic principles and origin of the signal.

— The principles of dose limitation. iflBlL1diflQ fl"-L various practical — Principles of basic sequences in clinical use.means of dose reduction to staff and patient with special T =2-L - -

considemuon of females and chfldflm — Concept of T1, T2, proton density and effect of motion on signal__ Staff and patient doses; magmmde and measuremem — Magnetic field hazards to patients, staff and passers by.

2'3 Pmdumion of X_rays [3 hours, 2.7 Radionuclide imaging (5 hours)

The basic principles of a rotating anode X-ray tube.Basic factors which influence X-ray output from differing types ofX-ray machinery; anode material. l<\/, rnA, focal spot size, tube rating,filtration. lDesign and construction details will not be examined.)

2.4 The X-ray image (10 hours)Geometricxfactors and magnification, effect of focal spot size,geometric movement and unsharpness.Conventional film/screen systems: basic structure; characteristiccurve; latitude; density; speed; contrast anti how to inlliicnrzc ormanipulate it.Basic principles and effects of film processing.Basic principles of image intensification. Optzratorcontrolletlvariables. -Principles of tomography, particularly CT, with emphasis onoperator-controlled variables, e.g. slice thickness, partial volumeeffect, field size and effect on resolution, data storage and display,pixelfvoxol, window width and level, and grey scale.Basic principles of digital imaging and picture archiving andcommunications systems (PACE). ~

2.5 Principles of diagnostic ultrasound l5 hours)

_The basic components of an ultrasound system.Types of transducer and the production of ultrasound withemphasis on operator-controlled variables. *The frequencies of medical ultrasound.The interaction of ultrasound with tissue, including biological effects.The basic principles of A,_B, M, real-time and duplex scanning.The basic principles of pulsed, continuous wave and colourDoppler ultrasound. - "Recognition and explanation of common artefacts.

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The function of a gamma camera.Properties of radiopharmacgeuticals.Static and dynaniii: imai_ing.Handling of radionuoiides.Introduction to single photon emission computed tomographylSPECT) and positron emission tomography lPET).

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Abdomen, CT scanning, 126-7Abdominal compression

IVDSA. 100-1radiation dose. 202-3

Acinus, 14-15Acromiohumeral distance. 4-5Acromion, 94-5Adductor magnus muscle. 40Adrenal glands. 35-7

CT scanning, 126-7neonatal ultrasound. 120-1right, 38-9ultrasound examination. 116-17

Adrenal veins. 35-1Adrenaline, 66-7, 68-9

arthrography. 90-1Air gap technique, 164-5Airways, 10-11Aliasirtg, 186-7. 190-1Alpha particle. 135-7Aluminium filter. 164-5Ammonium thiosulphatfl. 154-5Ampulla of Vater, 80-1Amylase level, ERCP. 80-1Anaesthesia, local. 6&7, 68-9Anal stricture, 122-3Anapliylactoid reactions. 64-5Angiocardiography, 10-1-5Angiography, 102-3

complications. 106-7diagnostic, 106-7digital subtraction, 172-3equipment, 102-3pulmonary, 104-5vessel appearance. 172-3

Angular momentum, 186-7Annihilation process, 139, 142-3Annual whole body dose. 200-1,

204-5Antenatal ultrasound, 44-5Anthropological baseline 94-5

Antibiotic prophylaxis. 76-7. 82-3.86-7. 122-3

Antimony trisulphide globules,172-3

Aorta, 24-5abdominal, 30-1branches to kidneys. 38-9descending, 16-17

Aortic arch, 14-15branches, 50-1

Aortic knuckle, 18-19Aortic nipple, 14-15Aortic valve, 22-3Aortogra-play, lumbar. 102-3Aortopulrnonary window, 1B-19Apical ligament. 62-3Appendix, 28-9Areae gastricae, 72-3Arrhythrnia, 114-15Arteriography

arterial puncture. 102-3contrast medium, 102-3

Arteriovenous fistula, 106-7Artery of Aclamkiewicz, 62-3Arthrography, 90-1Articular disc, 58-9Atlanto-axial distance. 62-3Atom

ionized, 140-1structure, 136-7

Atomic abundances. relative. 155-7Atrial fibrillation, 114-15Atrioventricular groove, 24-5Atrium

left, 22-3right. 22-3. 100-1

Auditory meatus, external, 94-5Auricular artery, posterior, 52-3Axillary artery, 4-5Azygos vein, 14-15,~16-17,-1'30-1 .Azygos venous system, 16-17

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Costoclavicular ligament, 10-11Cranial foramina. 46-7Cranial fossa, posterior, 126-9Cranial nenres. 46-7. 54-5Crista terminalis. 22-3Crown-rump length, 44-5Cruciate (cruciform)

ligament, 62-3posterior, 6-7

Cystic artery, 36Cystic duct, 36-7

spiral valve, 116-17Cystourethogrephy. micturatlng, 86-7

Dacrocystography, 92-3Dental amalgam. 132-3Dental radiography, 174-5Denticulate ligaments. 62-3Dentition, 60-1Devices, deflection during MR1, 132-3Diabetes mellitus, intravenous

urography. 84-5Diaphragm, 16-17,18-19,24-5 'Digital subtraction arlgiography,

172-3Dlrrieglumina gadopentata see ‘

GBdO|1fil\.ll'1'1Doppler effect. 186-7Doppler ultrasound, 124-5Double-contrast study, 72-3Ductography, 98-9Ductus arteriosus, 15Ductus nooe,"1B-'-19 '-Duodenum, 26-7. 38-9

barium meal. 72-3kidney relationship, 38-9

Ear. 58-9see also Middle ear

Echo time. 188-9Ectopic heart neat. 104-5Effective dose. 198-9

uqtnvtlluttl. 1116-7. 1'.ltl-9Elucllontt. 136-7

ejected, 142-3interaction

with matter, 140-1with photons, 140-1. 142-3

Ernlmlic rnaturial. 106-7Embolisatron. 105-7Energy disr.-rirninators. 178-9Enteroclyais, 74-5Epididymta, 4-1-5

ultrasound rellectivity. 118-19Epiploic lorarnen. 38-9ERCP see Cltolangiopancreatograpliy,

endoscopic retrograde .Erectile dysiuntion, 88-9 'Exchange forces. 136-7Eye. radiation dose, 96-7

Fabella, 6-7Facial bones, radiography. 96-7Facial canal, '18--9Fallopian tubes, ~12--3Fat

attenuation coefficient, 1411-5MRI signal. 132-3. 134-5, 190-1

Femoral artery, 8-5- rFemoral epipl1ysis,'2-3Femoral head, 8-9Femoral neck, 8-QFemoral vein, deep, 98-9

vrwwrwww-artiNDEX 219

Gas detectors, computedtomography, 176-7. $18-9

Gastro-oesopltageal reflux, 6-7,114-15

Gastrografin, 66, 70-1, 72-3, 74-5Gastrointestinal radiology -7"

pharmacological agents. 68-9radionuclide investigation, 114-15

Gastrointestinal tract. see also Bowel;Gut; Oesophagus; Stomach

Geiger counter, 200-1Gel-loam, 100-1Gelatin. 152-3 VGlenohumeral joint. -1-5Glucagon, 68-9. 78-9

barium meal. 72-3Gonadal arteries, 36-9 1Gonadal veins, 30-1Grey matter. 128-9. 132-3Grid

contrast improvement factor.Fetal hean, 44-5, 124-5 ‘ -|52_3Film viewing session, xiFine-needle biopsy, 122-3Focal spot, 150-1Fontanelle

anterior, 120-1posterior, 48-El

Foramen trattsvrarszirinm. 54--5FRCR pert l

examination, xi-xiiisyllabus, 208-13

Free induction decay, 186-9Frontal sinus, 56 -9

“Ga scintigraplty, 116-17Ga<l(rl1t‘\1t|tt1, 13i)—1

adverse efincts, 130-1ntagneltc rertonance imaging,

1 132-3, 13-1-5Gilll liidtltiut, .3-1-5

Clllilrttail inertia, 711-9C1 -scrinning. 126-7w.1li lhttsittnztia. 116 ~17

cutoff, 162-3diagnostic radiography, 160-1linear, 158-9primary transmission, 158-9. 160-1ratio. 158-'3. 160-1

Guide wire. 102-3Gut

divarticutum, 32-3fatal, 44-5see also Gastrointestinal

radiology 0Gyromagnenc ratio. 186-7

'1-i telattve atomic abundance, 185-7Hall value thickness. 140-1Hand, radiograpnic centring point.

94-5lluuzztru. 28 -9lli:.ul injury. 96-7|1t:tlk1tlChU, post-rttyologrzlpltrc. £12-lllli:;1r|_ 21! -Ti

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192-3 '. . l\t: l. -14-5tlulllmtitor, 194-b b IDo 1 Jlur Uilfdtafltliili 121-‘

Ir.:s0lt|li0l"l, 182-3 Vmvu‘ E224 w.4__5 ' ' J"““'?’“u “’s°|“l'°“* ]9’j'5 i:||¢lt>:scopr<: ultrnsnunrl nlrlurlnplu ltuntlutl. 1214-b ,,Um,U|,_,,“,5 122 .3scintillation crystal, 194-5_ ~ 1 - , 132-'3

1 snmtnl rESOl1lllC1ll, 192--3 y vu::Jpu:c,f,r§|TS‘ G 2_,_5SPECTimaging,19~1-5 , 1. - . ‘.9 'llerniazygos vein 16-17

G.\l'l1t11&l rays. 138-:1 '1lrmlrillittllttrlgut. 24-1»

Heparin. 106-7Hepatic aneries. 36-7Hepatic oil embolism, 98-9Hepatic veins, 35

ultrasound examination. 116-171-lepatobiliary system. 36-7Hilar angle, 12-13Hip, 8-9

' joint capsule. 8-9neonatal, ultrasound scanning.

120-1prosthesis. 132-,3radiograpttic centring point, 84-5

Humarus, 4-5Hyoid bone, 20-1Hyoscine butylbromide. 68-9, 70-1

barium meal. 72-3Hyperosmolar adverse eflects ol

contrast media, 64-5Hysterosalpirtgography. 68-B

f“1. 110-11-"1. no-ttlleal rellux. 76-7lliac artery

dilatation. 106-7internal, 42-3

lliat: lymph nodesexternal, 46-7internal, 98-9

lliolernoral ligament. 9Image inteffsifier, 170-1

contrast ratio. 170-1TV camera viewing system, 170-1.

172-3Implants. dellection during MR1. _

132-3lncudomaliear ioints, 56-7lncurlostapediat joint. 56

. lttctts. 56-7lnlurinr vunn cava. 25. 30-1. 35llttorvortlrrctrlat i-rtury. 2+l|\|()|Vu(lQl)|'i1I inrnrtunzm, curvrrzal.

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angiography tlVDSAl. 100-1lntussuscuption, ‘I6-7lutlntu. 1.12-3.1113 l

concentration tor artenograplty.102-3

lohexol. 98-9Inn tnnr. 141.1-1

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216 INDEX

Bacteraemiabarium enema. 76-7percuraneous transhepatlc

cholangiography, 82-3Bacterial endocarditis, 106-7Barium

bowelcontrast agent, 134-5

.CT scanning. 126-7enema, 74-5

double-contrast, 76-7 'effective dose. 198-9 ,

antaroclylla, 74-5follow-througn, 70-1gastrointestinal tract radionuclide

investigation. 114-15investigation in children, 76-7meal, 72-3

double contrast. 66-7, 72-3gas production. 72-3

swallow. 72-3Basilic'vein. 100-1Beam filtration, 162-3Beta decay, 138-9Beta emitters, 1-10-1Bile duct, intrahepatic, 126-7Biliary calculi, 80-1. 82-3Biliary contrast media, 78-9Biliary tree, 80-1

visualisation, 78-9, 126-7Biparietal diameter. letal, 4-1-5Bismuth germinate detectors, 178-9Blood. MR1. 134-5Blooming, 151Bone

isotope scanning, 108-9occipital. -18-9spin echo imaging of conical,

132-3X-ray attenuation, 144-5

Bowel"Ga scintigraphy, 116-17MR1 contrast agent, 134-5

Brachial plexus injury, 106-7Brachiocephalic vein, right, 16-17Brain

CT examination. 128-9internal capsule. 128-9isotope lctlnrting, 108-9tnugllultc rusnnoncu imaging,

132-3neonatal ultrasound, 120-1ventricles, 56-7

radiography technique, 174-5ultrasound scanning, 120-1

Bregma, -18-9Bremsstrahlung radiation, 1-10-1,

148-9. 174-5Bronchial artery, 14»-15

left. 18-19Bronchus. 10-11

left main, 18-19Bucky factor, 160-1, 162-3Buscopan. B0-1

"C relative atomicabundattce, 186-7Cadmium-lead filter, 198-9Caosium iodide, 170-1Calcillcatlon, intracranlal, S0-1Calcium tungstate, 156-7, 158-9

intensification factor, 158-9Cali.-uli, biliary, 80-1, 82-3Call veins. deep, 98-9Cailosomarginal artery, 52-3Calvarium, 48-9Carinaliculus, 92-3Capitate, 2-3Capitulum. 2-3Cardiac failure, intravenous

urography, 84-5Cardiac gating in MR1, 134-5Cardiac veins, 2-1-5Cardiovascular radionuclide

investigations, 114-15Caroti_d artery

common. 50-1artarlography, 102-3normal velocity waveform,

124-5external. 52-3

normal velocity waveform,124-5

internal, 50-1, 52-3Carotid canal, 58-9Carotid sheath. 20-1Carotid siphon, 52-3Lartilaginous joints, 10-11Catheter ~

French size, 102-3guitle wire, 102-3. 106-7Jt|clkin's coronary artery, 104-5tttritnriztl. I02-3rlitytnil, 104-5 ‘~sltcutli, 102--3

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Cavum septum peliucidurn, 120-1Centre of rotation correction, 194-5Cerebellar artery, posterior inferior,

54-5Cerebral vein of Galen. great. 54-5Cerebral veins. 54-5Cerebrospinal fluid, MR1, 132-3,‘,

» 134-5Cervical os, internal. 40-1 -Cervical spine

MR1. 134-5 Qnormal ligaments. 62-3oblique view. 96-7radiographic cenrring point, 94-5

Chest CT scan, 124-5. 126-7effective dose. 198-9

Chest radiograph centring point. 94-5Chiba needle, 82-3Ciilorpheiramine maleate. 66-7 -Cholangiography

intravenous. 78-9percutaneous transnepatic, 82-3postoperative (T-luDé1. 80-1

energy discriminators, 178-9filtered back proiection, 176-7 -first generation scanners, 178-9gas detectors, 176-7, 178-9helical, 182-3

pitch. 182slip-ring technology, 182-3

larynx, 130-1 _noise. 180-1number, 180-1orbit, 130-1pelvis. 128-9quantum mottle, 180-1slice thickness. 180-1third generation scanners, 178-9upper abdomen, 126-7water calibration number, 180-1weighting factor, 178-9X-ray tube, 176-7

alignment, 178-9see also Single photon emission

computed tomographylSPECTl _

Cholangiopancreatography, Contamination monitor, calibrated,endoscopic retrograde, 80-1 196-7

Cholecystitis. acute. 78-9 Contrast improvement factor. 162-3,Cholecystographts oral. 78-9 Contras"i medium, 66-7Cholescintigraphy, 116-17Cholesterol embolisation. 106-7Chordae tendinae. 22-3Choroid plexus. neonatal ultrasound,. 120-1Choroidal artery, anterior. 52-3Cimetidine. 66-7 .Circumflex artery, 2-1-5Cisterna chyli, 16-17Clavicle, 10-11

rhomboid fossa, 10-11_ Co gamma emission, 200-1Colic vein, right. 36-7Collateral ligaments of knee. 6-7Collitnator, 194-5

converging, 110-11high resolution. 194-5

60

Communicating arteries. 52-3 C

aneriography. 102-3arthrography.'90-1cholangiopancreatography, 80-1cholangiovenous reflux, B0-1CT scanning, 126-7gastrointestinal tract examination,

70-1nigh-osmolar, 64-5. 66-7intravenous

adverse reactions, 66-7urography, 82-3. 84-5

low-osmolar. 64-5, 66-7adverse reactions, 66-7

myelography, 92-3paramagnetic, 130-1retrograde pyelography, 86-7superior vena cavography, 100-1

opper filter, 164-5Compton interaction, 144-5 , Coronary arteriography, 104-15Compton scattered photon, 140-1 right, 102-3Computed tomography, 178-9 Coronary artery, 24-5 _

abdomen, 126-7humn t:nur(|y, 176--7

dissection, 104-5 ,vintiaiisntion. 104-5

11111111. 1211-9 Cutonrny sinus, 24-5cltusl, 124-5 Corpus cullosuttt. 120-l

Calida equina. 62-3 ‘contrast resolution. 180-1 Corpus cavernosum, 88-9B19351 11-3 ca‘"~‘~"\°‘5"11"\0h\i, 33-9 cupping effects 180-1 Corticosteroids, 65-7

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220 INDEX

lonisarion chamber, 148-9air equivalent wall, 200-1gas pressure, 200-1

ionising Radiation (POPUMET)Regulations 119881. 204-5

ionising Radiations Fiegulzit|on5(19851. 204-5

loparriidol, 64-5 il‘oihalamatg,>§-gmlotrolari, 64»-5lrradiation, medical, 198-9lscniolemoral ligament, 8-9lschiorectal fat pad, 40-1lschiorectal fossa. right, 40-1isomeric transition, 138-9isotope scanning

bone. 108-9brain. 108-9

' lung perfusion. 112-13‘parathyroid, 110-11thyroid. 110-11

lsotopelsl. 135-7calibrator, 196-7

Jeiunum, ZB-9Joint effusion, 90-1Jugtilar loramen. 46-7, -18-9Jugular vein, internal, 48-9

Kidney, 38-9left. 32-3 'radiographir: visualisation on 1\/U

84-5 'see also Nephrogram; Fienogram

Knee, 6-7arthrography, 90-1collateral ligaments, 6-7manipulation lollowing contrast

iniecilon. 90-1Krypton ventilation siirtly, 110-11

Lambtloitl iitrture, 48-9Llmlnnr llne. posterior. 62-3Large bowel. 28-9Larmor equation. 186-7Larmor frequency, 196-7, 188-9Laryngeal cartilage. ossification.

130-1Larynx, 20-1 -

CT scanning, 130-1 'Lateral ventricular ratio. letal. 44-5Lead oxide. 172-3

Levator arii muscles, -10-1Ligaments of Cooper, 22-3Ligarnentum aneriosum, 14-15,

18-19Ligamentum ilavum, 62-3Ligamentum nuchae, 62-3Ligamenturn teres, 35Lignocaine. 66-7 ,

overdose, 68-9 J 'Linear attenuation coefficient, 140-1,

1-14-5Linear energy iransler. 202-3Linear toinograpliy, 175-7Lingula, 14-15Lipiodol

artrzrocyslography, 92-3lower limb lympnography, 913--9sialography, 92-3

Liver, 34-5caudate lobe, 35colloid sciritigraphy. 116-17duclal calculi, 82-3quatlraie lobe, 35, 38rarliolaliclltztl tzolloitl upitiltu.

118-17ulirasoilntl rellutllvliy. 116--ll

Lower limbasctmiling vuiiogrcipliy, 98-9Doppler imaging of veins, 1'2-1 5lyriipliograpliy, 98-9veins, 8-9

Lumbar aortograpliy, 102-3Lirmhar puncture, 92-3Lumbosacral joint, obliqtro view. 95-7Lung, 14 -15

fissures, 12-13, 124-5, 126-7high r8501\.l110l'1 CT, 126-7pertzutaneouis biopsy, 125-7periusion isotope imaging, 112-13vonlilntion studies, 110-11

Lymphatic drainage, 16, 17Lyriiplinrrrtiplty, lowur liitilr, 989

Manic tingle plicnornunon, J34Miignetic resonance Blifliflgfilplly,

13-1-5Magnetic resonance imaging, 198-_9.

213 'aliasing, 190-1brain, 132-3cnntrollétl area, 134-5 V

' dellection of irnplanislduvices, 'I32-3' <

iieltl ol view, 190-1 '

--i 1lI

1I

INDEX 221

Magnetic resonance imaging lcontdlGidfllifllum, 130-1. 132-3gradient coil, 192-3gradient field. 192-3larynx, 130-1magnet temporal stabilitfif 190-1magnetic field, 190-1noise. 134-5radioliequency coils. 192-3relaxation time, 188-9resistive magnet, 190-111821111101’, 192-3shim coils, 192-3 Vsignal to noise ratio. 190-1slice thickness. 19?.-3 'spin echo images. 132-3, 13-1-5split-spiii relaxation. 1118-9T1 weigtiteu. 130-1. 132-I1. 13-1-5,

188-9. 190-1T2 weighted. 131. 132-3. 134-5.

188-9. 190-1time constant. 188-9

Magnetic resonance magnet. 188-9.< 190-1

Mrillutis, 56lv1u|niiiograp1\y.9B-9. 174-5

scatter grid. 174-5 _Niill1lliJllUSl1:l|1i1l101111, 11, 14-15Mtiaitziiin. 132 -3Muss iI.lllOl1UJllL)l\LZU\3iiiClU|11. 1-10-1,

144-5Mastoid antrum. 58-9Mlistoitl prouuss. 50:1lvlnxillary tintra. 58-9. 915-7Maxillary artery, internal, 52-3Maxillary sinus, 58-9, 95-7Mecltel‘s tliverticulum. 213-9

rutlioiincliuo scan. 11-1-15Motliastinum, posterior, 16-17Mutliiziiius Act 119781, 20-1-5Mtrglirminu srilis, 6-1-5Mirriilirirria luclurlu. 152-3Mirritlns-'11 izirtirru, -19Moiiiiiguliypopliysuul urluiy, 52--3Muiiisuutl. riiutliul, G-7Mi:-rseiiteric artery, inlerior. 30-1, :12-Musoiitorir: vus-sols. superior. 25-7,

. ' 34-5Mctocloprziinitlo. 68-9. 70-1Motoplc suture, 48-9MIBG scan. 116-17Mitltllu uzir, 56-7Mitral valve. 22-_3. 104-5Modulation transfer lunction, 150-1,

168-9 7

Molybdenum target. 17 4-5Multiple choice question

answering, xii-xiiierror rate. xii—xiiiguesses, xiinumber answered. X11-X111paper, xi .practice, xiiisyntax, xi

Multiple gated acquisition, 114-15Muscle attenuation coelficterit.

144-5Myelography

cervical puncture. 92-3lumbar, 92-3

Myelomatosis, 6-1-5Myocardial infarct imaging, 11-1-15

Naloxone, 68-9Navicular. 2-3Navicular lossa, -16-7Neclt‘-, CT scanning. 128-9Needle. twp-part. 102-3Needle shaft. irltrasound, 122Neonates. tilirasounu scaiiiiiiig,

120-1Nopnrogrom. 66-7. B2-3Nuplirustoiny tuuu llltrufllklll. 116-7Nut inugiiutrstitioii vector lN1\r1V1,

1138-9Neural arches. 60-1N(.tui!1flD, T39, 196-7Neutrons, 136-7. 138-9. 1156-7. 196-7

capture. 198-9Nipple, 98-9Nuclear spin value. 186-7Nucleus. angular rnomenitirn.

186-7

Oliosity, 126-7Oizcipiial rirtury, 52-3Otztzipitul hone, 111-11Occipiiul condylus, 411-9

3 Oosophageal hiatus. 2-1-5Ousoplinguel rnotiliiy, 72-3Oesopliagus, 12-13, 18-19, 22-3

CT scanning, 128-9endoscopic ultrasound, 122-3pH monitoring, 122-3

Opliihalrnii; artery, 52-3Ophthalmic vein. 5-1-5Optical density, 152-3Oral examinations. xii

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221 INDEX, [.14 -.-4

Orbit lCT scanning, 130-1 'intravenous contrast enhancement

130-1ultrasound scanning, 120-1

Orbital angular momentum, 186-7Orbital fissure, superior, 46-7Orthopantomography, 96-7Ossification

at birth, 2-3centres of vertebral column, 60-1clavicle, 10-11 -costal cartilage, 10-11hyoid bone, 20-1laryngeal cartilage. 20-1, 130-1

Ovary, 40-1, 42-3calcification, 42-3CT scanning, 128-9venous drainage, 42-3

I

Pain, hysterosalpingography, 88-9Pair production. 142-3Palmer arch, deep, 4-5 'Pancreas, 32-3, 38-9

CT scanning, 126-7head. 34-S Aneonatal ultrasound, 120-1reflectivity, 111!-19ttltrnsutttttf, 113-19

Partcrcuttc unct. 32-3, B0-1ucccssory,26-7ultrasound examination, 118-19ulWirsut1g. 34-5

Pancreatic pseudncyst. 80-1Partcreaticorlnutlenul urturtes, 31-1.

34-5Patucolic gutter, 26-7Paratfuotlonal lossa, 26-7Paralytic ileus, 74-5Paranasal sinus, 58-9

mucosa, 132-3Paraspinttl line, 14-15Parathyroid glands, 20-1

isotope exantinatton, 110-11P3f’31IfiC|1BB| line, 14-15_Parietal loramina, 48-9Parietal star, 48-9 'Parotid duct, 60-1

sialography, 92-3Parotid gland. 60-1Pate11a,2-3. 6-7

bipartite, 6-7facets, 6-7knee anhrograplty. 90-1

Pelvicalyceal system, 86-7Pelvis "

bony, 40-1 -'computed tomography, 128-9

Perchlorate, 108-9Perlcardiurn, 22-3. 124-5Peritoneal spaces, 26-7

lesser sac, 26-7Pethidine, B8-9Petrous ridges, 96-7Phaeochromocytoma scan, 116-17Pharyngeal artery. ascending, 52-3Phosphor, 156-7, 158-9. 170-1

fluorescence ability, 158-9output fluorescent, 170-1thickness and noise, 166-7

Photoelectric effects. 1411-1, 142-3Photoelectron, 1/10-1Photomultiplier tubes. 192-3Photons, 138-9, 140-1, 142-3

energy, 144-5, 200-1interaction with electrons. 140-1

142-3' in screen and noise, 166-7Phrenic artery, inferior. 36-7Pnrenic nerve

lefl. 14right, 16-17

Pttrotticocolit; ltg<1tt1L't'11. 32 -3Pinttrtl lmrly, 56-7P1511\'Jfll\13H)Ilf!, 2-Piltttlttty 10551:. —Pixel, 178-9

linmjr ultutttttttitzn coullioiurtt,1110-1 '

5ltillirttJ_ 172-3Plrttttzids constant, 130-»9Plutttnl ufltrsiurt, 202- 3l-‘lurnhirzon ctrmura, 172-3f"rtt:un-tucnlnu tecltnittuta, 74-5i‘tteutttotltnr:tx, 126-7Punlitttttl artery, 8-9Popliteal vein, 0-9. 124-5Pupliletts torttfon, 6-7POPIJMET regulations, 204-5.Portal ltypurtentttou, 100-1

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-a , mot-sx 223

Procaine, 68-9 ‘haProfitnda femoris artery, 8-9Prostate, 40-1

CT scanning, 128-9lytnphatit: drainage, 48-7transrectal ultrasound, 122-3

Prostatic duct, 46-7Protons, 186-7 vPTC see Cholangiography,

tpercutaneous transhepaticPterygoid muscle, lateral, 58-9Pterygoid processes. 48-9Pubovesical ligaments. 46-7Pulmonary angiography. 104-5

monitoring film badge, 198-9non-stochastic effects, 202-3protection, 200-1. 211-12

legislation, 204-5scattered, 164-5somatic effects, 203statutory close limits, 204-5stochastic effects, 202-3weighting factor, 200-1

Radioactive decay, 136-7, 138-9Radioactive liquids, mouth pipetting,

196-7Radioactive Material lRoad Transport)

Act (19911, 204-5Pulmonary arterial/‘venous pressure, Radioactive Substances Act 11993).

14-15Pulmonary arteries, 12-13, 14-15Pulmonary arteriography, 102-3Pulmonary embolism, 112-13

204-5 'Radioactivity, 136-7, 138-9Radiofrequency pulse, 188-9

transverse 'n-tagnetisation, 190-1Pulmonary emphysema, intravenous Fiadiographic baseline. 94-5

urography, 84-5Pulmonary hllum. 12-13Pulmonary hypertension, 104-5

Fladiographic centring point, 94-5Radiographic image, 166-7Radiographic mottle, 166-7

perfusion isotope lung imaging, Radiography, 209112-13

Pulmonary trunk, 1-8-15Pulrttonnry valve, 22-3 1Pttlttttattatty vrtsfittltttuiu, 14- I5Pttltttnttttry veins, 1.1-15. 22-3i’ul:.utt:t1rtlt|it1ttftt:t|tu:||t:y,

ttlttztsntttttl, llrl-1-5l’yt.-lt1t_)rntn tit.-rttttly, 5'2--3Pvttlugrnplty, retrograde. 85-6|’yulm;t|1us' llaultllow. 86-7l’yt.ttttrrlft:ttt1,58 1]l’ytilottttlt1sso.20-l

L)u;||\lUtt'tt:l1t.'tt_)y, 138-9Ouztnttutt mottle, 166-7, 180-1

ltatliztl artery, 4--5Hnrfintion

backgrourtd, 200-1_ biological ulfeots. 202-3

P°””' "elm 36‘, = clinical direction of exposure,0097"“ u"'as°u"d' 12475 204-5 Flare earth screens, 158-9, 202-3

P°n,a| Venograph‘/' 100-1 - dose, 198-9, 202-3 Rectovesical fistula, 86-7P°5{"°"' 19§_7_ abdominal compression, 202-3 Rectum, 30-1Positron emission tomography lF‘ETl, grid‘ 202_3 wmphatic drainage‘ 45_7

195“? , _ limits, 204-5 Recurrent laryngeal nerve. 20-1Post-cmboltsatton syndrome, 106-7 equivayem dose‘ 2004 ‘eh. 1849Pouch of Douglas. 42-3 mnisin 211 99'"q' ‘Red cells. , Tc penechnate Jab Ilin'°"°°‘="“- 88'“ ,, _..,.,_,.-,_.2

dental. 174-5diagnostic

an gap technique, 164-5filturs, 16-l 5_fillrattott, 162-3 ‘gunutu: rltttttttgtu, 202 -3 .ttrttis, 1511-0, 160-1ltyntauun state of notiuttt, 202-3rnamrttography, 174-5radiation dose. 202-3~:tti)trut:1int1tucltttittttus, 172-3visualisation of low cotttrast

sttucltnus, 17-I-5Rat1iomrt:litlel:;)

ltantlling unsealed. 196-7imaging. 213

Rautopharntaceuticals, 106-7, 210absorbed dose. 196-7biological half-life, 196-7effective dose equivalent, 196-7emissions, 106-7lung ventilation studies, 110-11patient dose, 196-7

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224 i INDEX

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Relative biological effectiveness,200-1

Henal aneries, 38-9Renal cysts, 86-7Flenal failure, 64-5

intravenous urography, 82-3Renal length. 118-19Renal puncture. percutaneous, 85-7Renal pyramid, neonatal ultrasound.

_ 120-1Renal sinus, 118-19Renal vein, 38-9

leh. 30-1.. 32-3Flenogram, radiopharrnaceuticals,

112-13Repetition time. 188-9Resonance, 188-9Rate tntla, 44-5Retromandibular vein, 60-1Rhenium. 1-16-7Ribs, 10-11Fliedel‘s lobe lliverl. 34-5Rotator cuff. 4-5Rutherford Morison's pouch, 26-7

Sacroiliac joint. -10-1Sacrum, ‘40-1Sagittril sinus, 54-5 iSalivary glands. ultrasound scanning,

120-1Salpingitis, 88-9Sapnenous vein, 8-9Scaphoid bone, 2-3Scintillation crystal, 194-5Scintillation detector, 196-7Scrotum, 44-5Seminal vesicles

CT scanning, 128-9echogenicity. 122-3

Sesamoid. 6-7Shimming. 192-3Shoulder, 4-5

arthrography, 90-1axial radiograph, 90-1CT examination, 90-1joint capsule, it-5

Sialography, 94-5Sickle cell disease, intravenous

urography, 84-5Signal

Doppler irequency. 186-7intensity of fat. 132-3to noise ratio, 190-1

Silver halides, 150-1, 152-3

‘5TV§@iY 81Qt §i

Single photon emission computed Superior rnesenterii: artery, 28-9,tomography lSPECT). 108-9, 32-3194-5 _ Superior mesenteric vein. 37

centre of rotation correction, 194-S Superior vena cava. 16-17, 22-3Sirioatrial node, 24-5 i filling detects. 128-9 iSinography, 76-7 Superior vena cavography:'1i'J0-1Skull = Surgical clips, 132-3

bones, 518-9 = Sutural sclerosis, 48-9half-axial proiection, 50-1 Symphysis pubis, -10-1 ‘racliographic baseline, 95-7 Syringe shields, lead.1ungsten, 196-7submentovertical projection, 50-1 5‘/$180119 lupus EFYlil8mi1l0$uS.sutures, -18-9

Skull radiography, 95-7Small bowel obstruction, 74-5

intravenous urograpliy, 84-5V

Smoking, 72-3 Taeniae coll, 28-9Sodium iodide, 194-5 ”'“T¢

detectors, 178-9Sodium ioxaglate, 64Sones technique, 104-5Spe 'matic cord, 128-9Spheno-occipital synchondrosis, =18-9Sphenoid sinus. 58-9Sphenomandihular ligament, 58-9Spin angular momentum, 186-7Spin echo images, 132-3, 134-5Spin echo pulse sequences, 188-9.

190-1 .free inductlgn decay, 188-9

Spinal canal. cervical sagiiialdiameter, 62-3

Splfli-ll cord, 56-7, 62-3Spine measurements, 62-3Spiral valve of Heister, 34-5Spleen, 32-3

CT scanning, 126-7Splenic anery, 32-3Spleriic vein, 36-7Stapes. 55-7Star test partern imaging. 150-1Sternoclavicular ioinr, 10-11Stomach

blood supply, 28-9double-contrast barium meal, 72-3greater ctirve. 32-3

' wall thickness, 126-7Stress incontinence, 86-7Subacromial bursa, 4-5Subcarinal angle, 10-11Suoclavian artery

anorrant right, 18-19, 50-1lelt, 50-1

Subclavian vein, 18-17, 100-1Subtraction mask. 172-3Superior mesenteric aneriograpriy,

102-3

1

OMSA urinary tract examination,112-13

DTPA, 108-9aerosol, 110-11urinary tract examination, 112-13

gamma emissions. 202-3HMPAO. 108-9MAG-3 urinary tract examination,

112-13metlioxy isobutyl isonitrile scan,

114-15methylene diphospnonate. 108-9M181 myocardial perfusion scan,

198-9pertecltiietaie. 108-9, 110-11, 115

red cell labelling, 115pyrophosphate. 134-15sulphur colloid. 114-15tin colloid, 116-17

9""'Tc~macroaggregated albuminpanicles, 112-13

teem, 60-1occlusal plane. 96-7

Temporomaridibular joint, 58-9articular disc. 58-9

Tendon MRI, 134-<3Teroium ion, 158-9Testes. 40-1. 44-5

lymphatic drainage, 45-7ultrasound scanning, 118-19

Thoracic artery. lateral, 22-3Thoracic duct. 12-13, 14-15, 15-17Thorax, computed tomography, "

124-5. 126-7. 198-9Tliromliiis, Doppler imaging of veins,

124-5Thymus, 1B-19Thyratron, 148-9 (1Thyrocervical trunit. 18-19

Thyroid, 20-1angle of laminae. 20-1cartilage, 20-1interior artery, 52-3isotope examination, 110-11isthmus, 12-13ultrasound scanning, 120-1veins, 20-1 ‘

Thyroidea ima eneiy. 20-1Tibial vein, anterior. 95-9Time of llight magnetic resonancemm angtogrephy,134 5

image. 110-11myocardial perfusion scan. 198-9uptake. 114-15

Tomography, 78-9Toxic mega-colon, 74-5Trechea, 10-11, 12-13Tracheo-oesophagual lisiuia, 66-7,

78-7Transfemoral puncture, 106-7Transmission ratio, 152-3Transrectal guided biopsy, 122-3Transverse sinus, 22-3Tri-radiate cartilage. 120-1Tricuspid valve, 23Tricyclic antidepressants, 116-17Triquetrum, 2-3Triticeel canilage, 20Tunica vagiitalis, -t-l-5

13

Ultrasound7.5 MHZ frequency transducer,

120-1antenatal, 44-5axial resolution limit. 182-3beam

Frauenhofier tone. 182Fresnel zone. 182

1 intensity, 184-5reflection, 182-3side lobes, 184-5transmission speed, 182-3

diagnostic, 182-3, 184-5. 212Doppler eflect, 188-7endoscopic cl oesophagus, 122-3interventional techniques. 122-3

~ neonates. 120-1pancreas. 118-19pulse

duration, 184-5length. 184-5repetition lrequency, 184-5

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Ultrasound lr:cnra1 -pulsed wave transducer, 182-Llreflected wave frequericy,.l86-7testes. 118-19transducer, 184-5 , ’

cleaning, 122-3transrectal prostatic, 122-3upper abdomen, 116-17 ,urinary tract. 118-19waves, 182-3see also Doppler ultrasound

Upper aodornenCT scanning, 126-7ultrasound. 116-17

Upper limb arterial supply, 4-5 _Uroteric compression, intravenous

urography, 84-5Ureieric obstruction, B6-7Ureteric peristalsis. 118-19Ureteis. 38-9, -10-1 ‘Urethography, ascending, 88-9Urethra '

imaging, 86-7male. 46-7

penile, 46-7prostatic. 88-9

Urethral valves. posterior, 88-9Urinary bladder. J6-7Urinary tract

infection, 86-7, 88-9isctope examinations. 112-13ultrasound, 118-19

Urination, isotope bone scaniiiiig,108-9

Urine, collecting system dilatation.118-19

Urographyintravenous, 62-3. 84-5

. l "TVenous ll\|'Ol1\bO5l$. 88-9ventricle. rightllelt. 22-3Vertebral artery, 54-5Vertebral canal, 62-3Vertebral column, 60--1Veruii"-oniifnuili. 46-7Vesicovaginal fistula. 86-7Vidicon tube, 172-3Vocal cords. 20-1, 130-1Voxel. 178-9

volume. 191

Water, spin echo pulse sequence.190-1

Whitaker test, 86-7White matter, 121!-9. 132-3Whole hody annual tlose limit, 20

204-5Wrist bones, 2-3

X-ray, 138‘-T9"absorption, 144-5base plus fog, 152-3. 154-5beam

filtration. 162-3linear attenuation coefficient

lit--5Cllagnostit: lfl1(lQll1Q, 1-12-'3, 146

160-1. Z02-3emulsion, 150--1, 152-3equipineiit inventory, 20-1-5film, 150-1, 15?. 3

cassette. 158-9characteristic curve, 152-3density, 152-3developer. 154-5

radiographit: visualisation. 84-5 fixer, 1541-5Urticaria, 66-7 graininess, 166-7Uterus. 40-1, 42-3

lymphatic drainage. 46-7

Vaginal tampon. 128-9Vague nerve, 12-13

computed tomography. 124-6left. 18-19 '

Valleculae. 20-lValsalva manoeuvre, 100-1, 124-5Valvulae conniventes, 25-7, 28-9Vas deferens, 45

inherent Contrast. 15-1-5inii-;i-oral, 174-5line spread function, 168-9processing, 154-5processor monitoring, 154-6

_.;_

spend, 154-5 '"fllm-screen comhliiatioii, 156;}

double-sided, 174-5modulation transfer function

168-9noise in images, 166-7resolution, 168-9

Vascular iriiervetttional techniques. " single-sided, 175105-7

Vasovnoal svitttnue. E5-7filter material, 164-5local lilm distance, 164-5

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lNDEX 227

'\ X -ray lcoiirdl _.-erfocal spot, 150-1glass envelope, 145-7, 162-3grids, 158-9, 160-1, 162-3

diagnostic radiography, 16011image, 212

absorption unsharpness, 166-7intensifier, 170-1latent. 152-3 ...motion unsharpness. 166-7penumbra, 166-7 '

intensifying screen, 156-7, 158-9interaction with i0dinated‘c0ntrast

agents, 142-3intarnigtion with matter, 144-5intrinsic efficiency of phosphor, "

156-7line pair. 168-9optical tlensity of image. 166-7parallax unsltarpness, 166-7production. Z12

anode, 146-7, 148-9 \diagnostic imaging. 146-7electron deceleration. 148-9energy loss, 145-7filament, 146-7

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target, 148-9quanta used, 166-7radiographic contrast, 154-5, 160-1rare earth screens, 158-9, 202-3resolution, 168-9sensitcimetry, 152-3silver conservation, 156-7spacer cone, 174-5 .timers, 148-9tube, 146-7

beryllium window, 162-3computed tomography, 176-7glass envelope. 146-7, 162-3inherent filtration. 162-3linear tomography, 176-7 _mammography, 174-5rating, 148-9 ' -travel, 176-7 ~ ‘ \voltage, 174-5, 202-3

‘nXe vtirltilatiutt study, 110-11.‘"xi-;- ventilation study, 110-11

Zinc cadmium sulphide, silveractivated, 170-1 .

Zygomatir: arch, 96-7

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