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DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER TWO Dental And Breast Pattern CRT04211 · Image Pattern Recognition START READING NOTES Study Dental And Breast Pattern using the sections below. Use the topic navigation to continue through Image Pattern Recognition. Contents of This Topic Dental And Breast Pattern Learning objectives BREAST ANATOMICAL STRUCTURES Key Anatomical Structures: Areola: The circular area of pigmented skin surrounding the nipple. Muscle: Relations Arterial supply Venous drainage INDICATIONS FOR BREAST (MAMMOGRAPHY) RADIOGRAPHY Follow-up of previous breast surgery or biopsy Mammography (Breast X-Ray) Preparation Clothing Choice: Wear a two-piece outfit so you only need to remove your top during the exam. TOOTH TYPES Dental Anatomical Structures Enamel Gingiva (Gums) Cementum Dental radiography indications include Trauma to teeth or jaws Dental Radiography (Dental X-Ray) Preparation NORMAL DENTAL RADIOGRAPHIC FINDINGS Terminologies Tooth Structures Enamel: Highly mineralized outer layer; appears as the most radiopaque (white) outer layer, indicating a healthy tooth Periodontal Structures Maxillary Anatomical Landmarks Normal anatomical landmarks of the maxilla and surrounding structures. Mandibular Anatomical Landmarks Normal anatomical landmarks of the mandible and surrounding structures. Cancellous and Cortical Bone ABNORMAL DENTAL RADIOGRAPHIC FINDINGS Dental Caries (Tooth Decay) Radiographic findings of dental caries Occlusal Caries (Chewing Surface) In summary, Radiographic Detection of Dental Caries Dental Trauma Radiographic findings of dental trauma Alveolar Bone Fractures Summarized Radiographic Signs of dental trauma Clinical Correlation – Trauma Neoplasms Ameloblastomas Radiographic Findings of ameloblastoma Odontomas Radiographic findings of odontomas: Non-Odontogenic & Malignant Neoplasms Clinical Correlation – Neoplasms Oral Cancer Radiographic findings/features Dental Cysts Radiographic findings of a dental cyst Expansion and Thinning of Cortical Bone Salivary Duct Calcifications (Sialoliths) Radiographic Findings of Sialothis Clinical History of Sialothis: Differential – Soft Tissue Calcifications Clinical Correlation – Sialolithiasis NOTE: Periodontal Disease Category DENTAL AND BREAST RADIOGRAPHY Apply image pattern recognition steps in identifying abnormalities in dental radiographs Dental And Breast Pattern Radiographic imaging plays a vital role in the early detection, diagnosis, and monitoring of diseases affecting both the oral cavity and the breast. Dental radiographs are essential for identifying pathologies such as dental caries, periodontal disease, cysts, and jaw fractures, while breast radiographs (mammograms) are crucial for the detection of abnormalities like breast masses, calcifications, and early signs of breast cancer. Learning objectives Describe breast and dental anatomical structures Outline indications for breast and dental radiography Explain preparation procedures for breast and dental radiography Describe normal dental radiographic findings Describe abnormal dental radiographic findings (dental carries, trauma, neoplasm, salivary ducts calcifications) Correlate patient clinical history with findings of dental radiography BREAST ANATOMICAL STRUCTURES The breast is a glandular organ located on the anterior chest wall. The breast is an apocrine gland found in both males and females. However, in females, it has a specific function – the production of milk for neonatal nutrition and immune function. The breast has an inhomogeneous structure that is predominantly composed of adipose tissue and glandular tissue. In addition, there are also suspensory Cooper's ligaments and connective tissue such as collagen and elastin. An apocrine gland is a type of exocrine gland that releases its secretions by "decapitation," where part of the cell membrane pinches off along with the secreted product Dental And Breast Pattern The adult breast has nearly 14-18 lactiferous lobes. Each lobe is made up of several lobules, and each lobule is made up of several acini. Each acinus drains into a branching duct that converges into a single lactiferous duct in each lobe, which subsequently drains at the nipple-areola complex. The breast parenchyma comprises glandular structures, namely acini and ductal tissue. Meanwhile, the breast stroma consists of fat and fibrous tissue. Dental And Breast Pattern The glandular parenchyma is estrogen-dependent. During adolescence, the growing breast becomes increasingly glandular. During pregnancy and lactation, the number of acini increases. When lactation stops, the gland becomes even less glandular when compared to before pregnancy. Thus, the breast of a parous woman is less glandular when compared to a nulliparous woman of the same age. Breast parenchyma starts to atrophy in adulthood and accelerated in menopause with an increasing amount of fat. Key Anatomical Structures: Lobes: Each breast contains 14-20 lobes, arranged like the petals of a daisy. These lobes are the major milk-producing glands. Lobules: Smaller sacs within the lobes, these are where milk is produced. Ducts: Tubes that carry milk from the lobules to the nipple. Nipple: The central projection of the breast, containing muscle fibres that allow it to become erect. The nipple is the small, raised part at the centre of the breast. It has 10–20 tiny openings for milk ducts, allowing milk to exit during breastfeeding. It contains smooth muscle, which makes it erect when stimulated. Areola: The circular area of pigmented skin surrounding the nipple. or The areola is the circular, darker skin surrounding the nipple. It contains small glands (Montgomery’s glands) that keep the area moist and protected. The areola helps guide the baby to the nipple during breastfeeding. Ligaments: Connective tissue bands that support the breast and attach it to the chest wall. Fatty and Connective Tissue: Surrounds and fills the spaces between the lobes and ducts, providing structure and volume to the breast. Blood Vessels: Supply the breast with oxygen and nutrients, as well as remove waste products. Adipose Tissue Fat that surrounds and cushions the breast. Connective Tissue Provides structure and support to the glandular tissue Nerve Supply The nipple is richly supplied with nerves, making it sensitive to touch. Muscle: There are no muscles within the breast tissue itself, but muscles like the pectoralis major and pectoralis minor lie underneath the breast. Lymphatic Drainage: Lymph vessels from the breast tissue drain into lymph nodes, primarily in the axillary (armpit) region, but also in the parasternal (along the breastbone) and supraclavicular (above the collarbone) areas. The lymphatic drainage is significant for clinical reasons, particularly in cancer metastasis. Lymph fluid drains into axillary nodes (75%), parasternal nodes (20%), and posterior intercostal nodes (5%). This drainage system plays a critical role in immune response and cancer spread. Nerve Supply:

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER TWO Documenting Radiological Reports CRT04211 · Image Pattern Recognition START READING NOTES Study Documenting Radiological Reports using the sections below. Use the topic navigation to continue through Image Pattern Recognition. Contents of This Topic Introduction Report Components Clinical History / Indication Imaging Technique Description of Findings Conclusion / Impression Suggestions (Recommendations) Name, Signature & Date Summary Sample Skeleton of a Chest X‑Ray Report: Impression: Communicate Findings Documenting Radiological Reports Apply image pattern recognition steps in documenting radiological image Introduction Applying Image‑Pattern Recognition in Radiology Reporting Objective: Enhance speed, consistency, and clarity by structuring reports around standard components: clinical history, technique, findings, conclusions, recommendations, and sign-off, while leveraging AI-powered pattern recognition for image interpretation. Report Components Clinical History / Indication Techniques used Description of findings Conclusion / Impression Suggestions / Recommendations Name , Signature & Date Clinical History / Indication A concise summary of why the exam was performed, symptoms, medical background, suspected diagnosis. Patient demographics: age, sex, hospital ID Chief complaint / symptoms: e.g., "Shortness of breath for 3 days" Relevant medical background: e.g., "History of COPD, recent fever, elevated WBC count" Image pattern recognition is used to flag anatomy regions or pathology based on history (e.g., lung zones in dyspnea) Missing history should be noted. Imaging Technique Modality and views performed (e.g., PA & lateral chest X‑ray) Technical parameters and equipment used Contrast type/dose if relevant Quality remarks (e.g., limited inspiration, motion artifact) Comparison Mention review of prior relevant studies, with dates If none exist, note absence of prior imaging Description of Findings Systematic, structured description using recognized imaging patterns (e.g., ground-glass opacities, consolidation). Pattern‑based observations: Normal structures: bronchi, vessels Abnormal findings: For example, “Patchy ground‑glass opacities in bilateral lower lobes” “Tree‑in‑bud nodularity in right middle lobe” Negative observations: e.g., "no pleural effusion or lymphadenopathy Use of standard descriptors: size, distribution, location, density Pattern‐ recognition helps identify and classify lung findings (e.g., consolidation vs. interstitial) Findings (Description of Findings) Systematic, organ‑based breakdown (e.g., bones, lungs, mediastinum) Use precise language—dimensions, densities, margins Describe both abnormalities and relevant negatives Identify any incidental findings Reference previous exams for comparison Conclusion / Impression Concise synthesis interpreting image patterns with reference to history, providing diagnoses or differential. Summarize key findings: Example: “Findings of bilateral peripheral GGOs are highly suggestive of viral pneumonia (e.g., COVID‑19); consider differential of organizing pneumonia.”(differential dx) Most critical section, directs clinical action and decision-making Pattern matches guide diagnostic confidence and differential. Impression / Conclusion Brief summary of the most significant findings Provide a definitive diagnosis or ranked differential Directly address the clinical question Include incidental findings of importance Suggestions (Recommendations) Advice for next steps, follow-up imaging, clinical correlation, further testing. Further imaging: e.g. “Recommend high‑resolution CT in 4–6 weeks for follow‑up.” Clinical correlation: “Correlate with COVID‑19 PCR and inflammatory markers.” Management advice: “Consider antibiotics if bacterial infection cannot be excluded.” Suggest targeted follow‑up driven by pattern severity and distribution. Improves patient care and minimizes unnecessary procedures Suggestions / Recommendations Advise further imaging, referral, or follow-up timing if needed Ensure recommendations align with clinical benefit and avoid unnecessary testing Name, Signature & Date Essential details: Name and credentials: Miss, Gloria Nathaniel, BScMIR (Radiology scientist) Signature: Typed or digital signature Date of report/interpretation: June 23, 2025 Contact info (if applicable): “For questions, call Radiology Dept at XXX‑XXXX.” Ensures legal integrity, accountability, and follow-up availability. Summary Structured reports ensure clarity and consistency. Pattern recognition assists with discovery and description. Radiologist/radiology scientist judgment remains essential for final interpretation and management guidance. Balanced synergy enables efficient, accurate, and clinically valuable reporting. Sample Skeleton of a Chest X‑Ray Report: Patient: Jane Doe • DOB: 01-Jan-1970 • ID: 123456 Date/Time: 22-Jun-2025, 10:15 • Facility: Mwanza Regional Hospital Clinical History: 55 y/o female with acute chest pain and shortness of breath; possible pneumonia vs. pulmonary edema. Technique: PA and lateral chest X‑rays obtained; no contrast. Comparison: No prior imaging available. Findings: Bones/Soft Tissue: No rib fractures. Clavicles symmetrical. Lungs & Pleura: Patchy consolidation in the right lower lobe with air bronchograms; no pleural effusion or pneumothorax. Mediastinum/Heart: Heart size within normal limits; mediastinal contours normal. Impression: Right lower lobe consolidation suggestive of pneumonia. No evidence of pleural effusion, pneumothorax, or bone injury. Recommendations: Recommend clinical correlation and a follow-up chest X‑ray in 4–6 weeks if symptoms persist. Reported by: Dr. John Smith, Consultant Signature/Date: 22‑Jun‑2025, 11:00 Is anything missing Communicate Findings In the “Communicate Findings (hard copy, RIS/DICOM/PACS)” section of an image pattern recognition report, ensure that each described lesion or pattern is clearly linked to specific image(s) ideally annotated within PACS for visual confirmation Use a structured reporting format—such as DICOM Structured Reports (SR) or RIS-integrated templates to encode descriptions with standardized terminology and coded elements which supports semantic interoperability and efficient downstream use. Whether distributing via hard copy or electronically through RIS/PACS, maintain consistency, clarity, and metadata integrity (patient info, modality, technique) This approach ensures findings are unequivocally communicated and actionable, enhancing clinician trust, workflow efficiency, and facilitating downstream tasks like follow-up, data mining, and quantitative analysis Documenting Radiological Reports QN:”A 60‑year‑old patient presents with progressive dyspnea. The upright posteroanterior chest X‑ray above demonstrates right-sided blunting of the costophrenic angle with a concave meniscus and homogenous opacity in the lower lung zone. The left lung field is clear. Documenting Radiological Reports Using the image provided, compose a structured chest X‑ray report focused on suspected pleural effusion. Your report should include the following sections: Clinical History & Indication. Technique & Quality – Comment on image projection (PA upright), adequacy of inspiration, exposure, and positioning. Findings – Describe radiographic sign(s) of pleural effusion estimated volume, location, and any mass effect or shift. Comparison – State if previous imaging is available and, if missing, note that explicitly. Impression Recommendations THANK YOU ← PREVIOUS TOPICNEXT TOPIC →VIEW ALL MODULE NOTESVIEW SEMESTER NOTESVIEW ALL LEVEL NOTESALL DIAGNOSTIC RADIOLOGY NOTES Need These Notes as PDF? Need a clean, well-formatted PDF copy for offline study, revision or printing? Request the complete notes directly through WhatsApp.

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER TWO Genitourinary System: Normal Imaging Patterns CRT04211 · Image Pattern Recognition START READING NOTES Study Genitourinary System: Normal Imaging Patterns using the sections below. Use the topic navigation to continue through Image Pattern Recognition. Contents of This Topic Presentation outlines Genitourinary system Introduction…… Functions of Urinary System organs: Reproductive System: Female: Anatomical organs of the genital urinary system to be investigated with contrast Male Reproductive System: Female Reproductive System: Contrast types for genital urinary system investigation Positive Contrast Agents: Negative Contrast Agents: Contrast Imaging Procedures and indications of each procedure 1: PLAIN URINANARY TRACT RADIOGRAPHY(KUB) Renal stones 2:Intravenous Urography( IVU)/ Excretory Urogram (EU) Indications of IVU/EU Contraindications 3:RETROGRADE PYELOGRAPHY AND CYSTOGRAPHY Retrograde Pyelography: Cystography (including VCUG): 4:URETHROGRAPHY Types cont.….. Indications of urethrography 5. HYSTEROSALPINGOGRAM (HSG) Indications for hysterosalpingogram: Kidneys Ureters: Urinary Bladder: Urethra: NOTE: The male urethra is divided into three parts: the prostatic urethra, the membranous urethra, and the penile urethra. Uterus and Fallopian Tubes: Organ/System Example of Congenital anomalies of the urinary sytem Kidney Anomalies Renal Agenesis Summary in Renal Agenesis findings Diagnosis: Horseshoe Kidney: HORSE SHOES Genitourinary System: Normal Imaging Patterns Renal hypoplasia Renal Ectopia (Simple & Crossed) Renal Malrotation Summary Collecting System Anomalies Hydronephrosis Megacalycosis Duplex Collecting System Ureteropelvic Junction (UPJ) Obstruction Ureter Anomalies Megaureter Ectopic Ureter Intravenous urography (IVU) Ureterocele Fluoroscopy Vesicoureteral Reflux (VUR): Bladder and Urethra Anomalies Posterior Urethral Valves (PUV) Common congenital anomalies of genital system Uterine Anomalies 4. Septate uterus Fallopian Tube Anomalies Traumatic Injuries of Genitourinary system 3. Ureteral Trauma 5. Testicular / Penile Trauma Infertility pathologies Tubal Pathologies and their radiographic findings Tubular obstruction RADIOGRAPHIC FEATURES IN THE HSG Radiographic findings Corkscrew or Beaded Appearance Tubal Spasm Hydrosalpinx Salpingitis isthmica nodosa Pathology Nephrolithiasis & Ureterolithiasis (Kidney/Ureter Stones) Urolithiasis refers to the presence of calculi anywhere along the course of the urinary tracts. The more common composition of stones include (more detail below): Radiographic features Lucent stones include: Renal (Urinary) Stone Disease 1. Renal/Ureteral Stones (Urolithiasis) 2. Nephrocalcinosis 3. Genitourinary Tuberculosis 4. Urinary Tract Schistosomiasis 4. Renal Fungal Infections (e.g. Candidiasis/Mycetoma) 5. Renal Abscess & Emphysematous Infections 1. Renal Cell Carcinoma (RCC) 2. Transitional (Urothelial) Cell Carcinoma (TCC) 3. Wilms Tumor (Nephroblastoma) 4. Rhabdomyosarcoma (Genitourinary Tract) 5. Bladder Carcinoma – Squamous Cell Type (Subtype of bladder carcinoma) References Genital urinary system Presentation outlines Introduction to the genital urinary system Genital urinary system anatomical organs(general) Genital urinary system anatomical organs to be investigated with contrast Types of contrast media Indications of contrasted imaging procedures of the genital urinary system Genitourinary system The genitourinary system includes organs of both the urinary and reproductive systems. The urinary system consists of the kidneys, ureters, bladder, and urethra. The reproductive system includes the testes, vas deferens, seminal vesicles, prostate gland, penis (in males), and ovaries, fallopian tubes, uterus, cervix, and vagina (in females) Introduction…… Urinary tract is the system consisting of kidney, ureters, Urinary bladder and urethra which is responsible for excretion of waste products in form of urine . Upper urinary tract is made up of two kidneys and two ureters Lower urinary tract is made up of Urinary bladder and urethra Functions of Urinary System organs: Kidneys: Filter waste from the blood and produce urine. Ureters: Tubes that carry urine from the kidneys to the bladder. Bladder: Stores urine until it is eliminated from the body. Urethra: Tube that carries urine from the bladder to the outside of the body. Reproductive System: Male: Testes: Produce sperm and hormones. Vas Deferens: Tube that carries sperm from the testes. Seminal Vesicles: Produce a fluid that nourishes and supports sperm. Prostate Gland: Produces fluid that is part of semen. Penis: Organ of sexual intercourse. Female: Ovaries: Produce eggs and hormones. Fallopian Tubes: Carry eggs from the ovaries to the uterus. Uterus: Where a fetus develops during pregnancy. Cervix: Lower, narrow part of the uterus. Vagina: Canal that connects the cervix to the outside of the body. Anatomical organs of the genital urinary system to be investigated with contrast Urinary System: Kidneys: These are the primary organs for filtering blood and producing urine. Imaging with contrast can help visualize kidney size, shape, and identify abnormalities like tumors or blockages. Ureters: These tubes carry urine from the kidneys to the bladder. Contrast imaging can help assess for blockages or narrowing of the ureters. Bladder: This organ stores urine. Contrast imaging can help evaluate the bladder's shape, size, and capacity, as well as identify any abnormalities like tumors or diverticula. Urethra: This tube carries urine from the bladder out of the body. Contrast imaging can help assess for blockages, strictures, or other abnormalities in the urethra. Male Reproductive System: Prostate: This gland surrounds the urethra and produces fluid that is part of semen. Contrast imaging can help assess its size, shape, and identify any abnormalities like tumors or enlargement. Seminal Vesicles: These glands produce a fluid that makes up a portion of semen. Contrast imaging can help assess their size and shape and identify any abnormalities. Female Reproductive System: Uterus: This organ is where a fetus develops during pregnancy. Contrast imaging can help visualize the uterus's shape and identify abnormalities like fibroids or polyps. Fallopian Tubes: These tubes connect the ovaries to the uterus. Contrast imaging can help assess for blockages or other abnormalities. Contrast media Contrast types for genital urinary system investigation For imaging the genitourinary system, contrast agents are used to enhance visualization of the kidneys, ureters, bladder, and urethra. These agents can be broadly categorized as positive and negative contrast, with positive contrast being further divided into water-soluble iodinated contrast and barium. Positive Contrast Agents: Water-soluble iodinated contrast media: These are the most common type used for intravenous urography (IVU) and CT urograms. They are injected intravenously and allow visualization of the kidneys, ureters, and bladder as they are excreted. Ionic vs. Non-ionic: Ionic contrast agents have a higher incidence of side effects due to their hypertonicity but are becoming less common due to the availability of non-ionic

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER TWO Pattern Of GIT System Pathologies CRT04211 · Image Pattern Recognition START READING NOTES Study Pattern Of GIT System Pathologies using the sections below. Use the topic navigation to continue through Image Pattern Recognition. Contents of This Topic CONGENITAL AND HEREDITARYANOMALIES Associations Subtypes Pattern Of GIT System Pathologies Radiographic findings on Plain radiograph Fluoroscopy PresentationNot tolerating feeds Patient data:Newborn Case Discussion Congenital tracheo-esophageal fistula As such, the types of esophageal atresia / tracheo-esophageal fistula can be divided into: Radiographic features on Plain radiograph Direct Communication: Discuss on HYPERTROPHIC PYLORIC STENOSIS Clinical presentation Affected infants often become dehydrated and fail to gain weight. Radiographic findings of HPS This is often accompanied by increased gastric peristaltic waves, which may be visualized as the "caterpillar sign“ The pylorus indents the contrast-filled antrum (shoulder sign) and (tit sign) or base of the duodenal bulb (mushroom sign) Presentation: Non-bilious projectile vomitingPatient Data -Age: 4 weeks & Gender: Male NOTE: Sonography has become the standard and highly accurate method for diagnosing HPS without the need for radiation exposure. DUODENAL ATRESIA Radiographic features PresentationA newborn presented with vomiting. He was born with Down syndrome.Patient Data: Age: 10 hours & Gender: Male Barium study Summary How the Barium Study/fluoroscopy study Helps: ANNULAR PANCREAS Types Radiographic Findings Pancreatic Tissue Ring: HIRSCHSPRUNG DISEASE (CONGENITALAGANGLIONIC MEGACOLON) 4. Empty Rectum: FLOUROSCOPY Microcolon: BOWEL ATRESIA Paucity of air distally: Radiographic features in barium studies Absence of Distal Gas: DIVERTICULUM Epiphrenic diverticulum arises in the distal esophagus just superior to the lower esophageal sphincter (LES). MECKEL DIVERTICULUM Diagnosis of Meckel diverticulum is difficult, as it may not be visible on a radiograph of the small bowel. X-rays can reveal findings suggestive of Meckel's diverticulum complications Barium studies (enteroclysis): Intestinal malrotation Terminology Diagnosis Although not a specific criterion of malrotation, the jejunum will be commonly located to the right of the spine. Midgut volvulus Tapering or beaking of the bowel in complete obstruction. Bowel Perforation Plain X-ray Findings: Barium Study Findings: Mesenteric Injury Bowel Wall Hematoma Radiographic findings in plain radiograph Barium Studies: Bowel Ischemia PNEUMOPERITONUM Pathology The causes and, hence, the corresponding severity of accompanying illness, are variable: postoperative free intraperitoneal gas Radiographic features in plain radiograph Leaping Dolphin Sign Cupola Sign Abdominal radiograph ​​Double wall sign (Rigler sign) Telltale triangle sign Peritoneal ligament-related signs right upper quadrant signs Peptic Ulcer disease(PUD) Causes of peptic ulcers Peptic Ulcer disease Gastric ulcers Radiographic features of gastric Ulcer in fluoroscopy study bull's eye sign PresentationEpigastric pain: Unwilling to undergo endoscopy.Patient Data , Age: 70 years Gender: Male Duodenal ulcers Crohn’s disease Radiographic features in crohn’s disease include Ulcerative colitis Radiographic features of UC include Hiatal hernia Presentation: Dysphagia Differential diagnosis Achalasia Symptoms: Gastro esophageal Reflux Disease: Findings associated with gastro-esophageal reflux disease include: Ileocecal tuberculosis Radiographic findings in ileocecal TB (barium meal follow through) Esophagus Cancer Colon cancer Radiographic features may include Apple core sign Adenocarcinoma Common Metabolic Diseases and Radiographic Findings: Strictures: Colonic diverticulosis Abnormal radiological findings of GIT system CONGENITAL AND HEREDITARYANOMALIES Esophageal Atresia Esophageal atresia is a rare congenital anomaly in which the esophagus fails to develop at some past some point, resulting in discontinuation of the esophagus. The absence in the continuity of the esophagus is due to an inappropriate division of the primitive foregut into the trachea and esophagus. This is the most common congenital anomaly of the esophagus. Associations Esophageal atresias are frequently associated with various other anomalies (50-75% of cases).They include: Other intestinal atresias Duodenal atresia Jejunoileal atresia Anal atresia Annular pancreas Pyloric stenosis Subtypes It is frequently associated with a tracheo-esophageal fistula(TEF). As such, the types of esophageal atresia / tracheo-esophageal fistula can be divided into: Proximal atresia with distal fistula: 85% Isolated esophageal atresia: 8-9% Isolated fistula (h-type): 4-6% Double fistula with intervening atresia: 1-2% Proximal fistula with distal atresia: 1% Pattern Of GIT System Pathologies The symptoms of esophageal atresia are visible soon after birth and include excessive salivation, choking, gagging, dyspnea, and cyanosis. Diagnosis of this congenital anomaly may be established by inability to inability to swallow saliva or milk, aspiration during early feedings, or failure to pass a nasogastric tube(NG tube) into the stomach successfully. Pattern Of GIT System Pathologies If a radiopaque NG tube is used, the terminal end of the pouch may be demonstrated radiographically with a chest radiograph without the use of a contrast agent. Radiographic findings on Plain radiograph Chest/abdominal radiograph may show: Dilated Proximal Esophageal Pouch: A radiolucent, blind-ended pouch in the upper esophagus is a hallmark finding (A dilated pharyngeal pouch) Gasless Abdomen (without TEF): If there is no fistula, the abdomen will likely be gasless as air cannot pass through the atresia and absence of gastric bubble. Bowel Gas (with TEF): The presence of air in the stomach and/or bowel loops suggests the presence of a distal fistula (TEF) NG Tube Placement: If an esophagogastric (feeding) tube insertion has been attempted this may show the tube blind looping and turning back at the upper thoracic part of the esophagus or heading into the trachea and/or bronchial tree Fluoroscopy Contrast swallow may show contrast blindly ending and pooling in an esophageal stump and/or may show evidence of the tracheo-esophageal fistula. Fluoroscopy is particularly useful in demonstrating H-type fistula. PresentationNot tolerating feeds Patient DataAge: NeonateGender: Male Naso / orogastric tube is curled in the upper mediastinum. The abdomen is completely gas-less and no gastic air bubble is visible Patient data:Newborn Case Discussion A newborn with esophageal atresia associated with trachea-oesophagal fistula. Gas in the stomach and small bowel mean that there must be an associated tracheo-esophageal fistula. Pattern Of GIT System Pathologies Presentation : Inability to swallow milk, aspiration during feedings. Failure to pass orogastric tube to stomach.Patient Data : Age: 2 days & Gender: Male Plain film shows orogastric tube not passing to the stomach, instead it is turning back superiorly. After injection of non-ionic water soluble contrast material in the orogastric tube, there is no evidence of passage

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER TWO Contrast Studies of the Gastrointestinal Tract: Normal Patterns CRT04211 · Image Pattern Recognition START READING NOTES Study Contrast Studies of the Gastrointestinal Tract: Normal Patterns using the sections below. Use the topic navigation to continue through Image Pattern Recognition. Contents of This Topic 1. Esophagram (Barium Swallow or Upper GI Contrast Study) OESOPHAGUS The cervical esophagus begins at the upper esophageal sphincter, which is formed by the cricopharyngeus muscle. Phrenic ampulla, A and B-rings Three normal narrow esophageal segments (oesophageal constrictions) should not be confused with pathology: Radiological features of Esophagus Extrinsic Indentations: There are three normal anatomical indentations where the esophagus is compressed by: 2. Upper GI Series (Stomach and Duodenum) STOMACH Contrast Studies of the Gastrointestinal Tract: Normal Patterns Small Bowel Follow-Through (SBFT) / Enteroclysis Small Bowel (Duodenum, Jejunum, Ileum) 4. Barium Enema (Lower GI Study) LARGE BOWEL Large Bowel (Colon) Rectum and Anus General Indications for Any GIT Contrast Study GIT CONTRASTED NORMAL PATTERN 1. Esophagram (Barium Swallow or Upper GI Contrast Study) A contrast-enhanced examination of the gastrointestinal tract (GIT) is performed to evaluate structural and functional abnormalities. Indications: Dysphagia (difficulty swallowing) Odynophagia (painful swallowing) Suspected esophageal stricture or web Gastroesophageal reflux disease (GERD) Hiatal hernia Esophageal motility disorders (e.g., achalasia) Esophageal perforation (use water-soluble contrast) Foreign body localization Pre/post-operative evaluation OESOPHAGUS ANATOMY OF THE OESOPHAGUS The oesophagus (plural: oesophagi or oesophaguses) is a muscular tube that conveys food and fluids from the pharynx to the stomach. It forms part of the upper gastrointestinal tract. The esophagus is 23-37 cm long with a diameter of 1-2 cm and is divided into three parts: cervical: continuous with the hypopharynx, commences at the lower border of cricoid cartilage (at level of C5/6) or cricopharyngeus muscle thoracic: from superior thoracic aperture (T1) to the esophageal hiatus (T10) in the diaphragm which covers the inferior thoracic aperture abdominal: from esophageal hiatus and is continuous with the cardia of the stomach at the gastro-esophageal junction RELATION The cervical esophagus begins at the upper esophageal sphincter, which is formed by the cricopharyngeus muscle. The esophagus then descends to the left of the midline through the neck and superior mediastinum, returning to the midline at T5, before coursing to the left of the midline once more, in the posterior mediastinum. The distal thoracic esophagus then curves anteriorly to pass through the diaphragm into the abdominal cavity. The lower esophageal sphincter, a specialized region of the circular muscle of the distal esophagus, manifests itself radiographically as the phrenic ampulla (a.k.a. esophageal vestibule), a 2-4 cm long dilatation between the A-ring and B-ring. phrenic ampulla is seen radiographically as a globular structure above the diaphragm and below the tubular oesophagus. Phrenic ampulla, A and B-rings The phrenic ampulla (also known as the esophageal vestibule) is the region between the A-ring and B-ring of the distal esophagus. The gastro-esophageal junction is below the ampulla (and gastric folds should not enter the region of the ampulla) The ampulla is more prominent in some patients than in others, but it is a normal finding and should not be confused with a sliding hiatal hernia or an esophageal web. Three normal narrow esophageal segments (oesophageal constrictions) should not be confused with pathology: The narrowest segment is at C5/C6 at the level of the cricoid cartilage Due to the aortic arch at the T4/5 level At the esophageal hiatus at the T10/11 level Radiological features of Esophagus Appearance: A smooth, narrow, tubular structure from the pharynx to the stomach. On Barium Swallow: Shows a uniform/symmetrical, smooth mucosal outline. The cervical esophagus is slightly wider. Normal peristalsis moves contrast smoothly. The gastroesophageal junction (GEJ) appears as a Z-line(A zig-zag mucosal border where the oesophageal mucosa transitions to the gastric mucosa). Extrinsic Indentations: There are three normal anatomical indentations where the esophagus is compressed by: The aortic arch The left main bronchus The left atrium Forming notch or a deep recesses 2. Upper GI Series (Stomach and Duodenum) Indications: Epigastric pain Suspected peptic ulcer disease Gastric outlet obstruction Vomiting of unknown cause Gastrointestinal bleeding (when endoscopy is unavailable) Mal-rotation or volvulus (especially in pediatrics) Suspected mass or tumor Evaluation of post-surgical anatomy Stomach STOMACH One common radiologic procedure of the GI tract is an “upper GI,” in which barium sulfate flows from the esophagus and into the stomach and small bowel. Once the barium reaches the stomach, the evaluation of the stomach contour, position, and rugae and the peristaltic changes occurring as the stomach fills and empties. Contrast Studies of the Gastrointestinal Tract: Normal Patterns In many instances, a gas-producing substance (carbon dioxide crystals) is used with barium sulfate to produce a double-contrast examination. The purpose is to expand the stomach and promote coating of the stomach mucosa. Stomach Appearance: A J-shaped or crescentic organ with a rugal fold pattern. On Barium Meal: Fundus: Fills first and appears as a rounded area under the left hemidiaphragm. Body and Antrum: Display smooth peristaltic waves. Rugae (mucosal folds) are longitudinal and prominent folds, especially in the body. Pyloric canal appears as a narrow outflow tract into the duodenum. Small Bowel Follow-Through (SBFT) / Enteroclysis Indications: Chronic diarrhea Malabsorption syndromes Inflammatory bowel disease (e.g., Crohn’s disease) Obscure gastrointestinal bleeding Suspected small bowel obstruction or stricture Evaluation of fistulas Post-surgical complications (e.g., adhesions) Small intestine Small Bowel (Duodenum, Jejunum, Ileum) On Small Bowel Follow-Through: Duodenum: C-shaped loop surrounding the pancreatic head; smooth mucosa with a fixed position. Jejunum: Located in the left upper quadrant; displays a “feathery” or “stacked coin” appearance due to prominent valvulae conniventes. Ileum: In the lower abdomen/pelvis, has smoother and thinner folds compared to jejunum. 4. Barium Enema (Lower GI Study) Indications: Chronic constipation Rectal bleeding Change in bowel habits Suspected colonic obstruction (water-soluble contrast if perforation is suspected) Evaluation of colonic masses or polyps Inflammatory bowel disease (e.g., ulcerative colitis) LARGE BOWEL The lower GI tract is examined by administering a barium enema through the rectum. This examination demonstrate abnormalities of

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER TWO Plain Abdominal X-ray Pattern Recognition CRT04211 · Image Pattern Recognition START READING NOTES Study Plain Abdominal X-ray Pattern Recognition using the sections below. Use the topic navigation to continue through Image Pattern Recognition. Contents of This Topic Normal Plain and contrasted radiographic GIT INTRODUCTION NINE ANATOMICAL REGIONS ABDOMINAL QUADRANTS ABDOMINAL ORGANS GASTROINTESTINAL SYSTEM ORGANS IMAGING CONSIDERATIONS Anteroposterior (AP) projections of the abdomen are generally taken in the supine position. As with other body areas, evaluation of the abdomen should be done systematically. Radiographic findings Plain Abdominal X-ray Pattern Recognition AIR-FLUID LEVEL BOWEL GAS(FREE AIR) Note: In Gastrointestinal System, Some contents of the abdomen can be seen without contrast media. Small bowel on plain x-ray Large bowel Other soft tissues seen on a plain films CONTRASTED INVESTIGATION OF THE GIT ORGAN TO BE INVESTIGATED STOMACH SMALL BOWEL CONGENITAL AND HEREDITARY BOWEL ATRESIA HYPERTROPHIC PYLORIC STENOSIS Abdominal radiography may show gastric distention with HPS. Sonography has become the standard and highly accurate method for diagnosing HPS without the need for radiation exposure. HIRSCHSPRUNG DISEASE (CONGENITAL MECKEL DIVERTICULUM Normal Plain and contrasted radiographic GIT Pattern Recognition INTRODUCTION The abdomen is composed of the abdominal and pelvic cavities and is often divided into nine anatomic regions. NINE ANATOMICAL REGIONS Right hypochondriac Epigastric Left hypochondriac Right lumbar Umbilical Left lumbar Right iliac Hypogastric Left iliac ABDOMINAL QUADRANTS It may also be described in terms of quadrants: Right-upper quadrant (RUQ) Right-lower quadrant (RLQ) Left-upper quadrant (LUQ) Left-lower quadrant (LLQ) ABDOMINAL ORGANS The abdominal cavity contains organs of the digestive system (stomach and intestines), the hepatobiliary system (liver, gallbladder, and pancreas), the urinary system (kidneys and ureters), and the circulatory system (spleen). The pelvic cavity contains the bladder, portions of the intestines,and the reproductive organs. GASTROINTESTINAL SYSTEM ORGANS A major portion of the gastrointestinal (GI) system is the alimentary tract, which serves to digest and absorb food. Extend from the mouth to Anus the alimentary tract consists of the mouth, pharynx, esophagus, stomach, small bowel, large bowel, and rectum. IMAGING CONSIDERATIONS Radiography Abdominal radiography is often performed for survey purposes, without contrast agents. The usual starting point is a supine radiograph taken to include the kidneys, ureters, and bladder (“KUB”). The frequency of abnormal findings on a conventional abdominal radiograph is fairly low and nonspecific, but it is of most value for patients complaining of severe abdominal tenderness and to rule out bowel obstructions and perforations Anteroposterior (AP) projections of the abdomen are generally taken in the supine position. An AP radiograph allows examination of air distribution within the bowels and of the size of the viscera, serves to evaluate vascular and other types of calcifications and body or soft tissue trauma, and, finally, serves as a preliminary radiograph for other procedures. As with other body areas, evaluation of the abdomen should be done systematically. This should include inspection of the renal outlines, ureters, psoas muscles, spleen, liver, gallbladder, and peritoneal fat stripes. Radiographic findings In a normal abdomen, varying amounts of gas and fecal material are always present in an unprepared patient. The liver,kidney, spleen, and psoas muscle shadows are variably outlined because of the lucent layer of fat surrounding them. Properitoneal fat stripes are visible as radiolucencies extending laterally from the costal margins down to the iliac crests. Plain Abdominal X-ray Pattern Recognition The aorta and pancreas are not normally seen unless they are calcified, as might be expected in an older patient in the case of the aorta or in a patient with chronic calcific pancreatitis. AIR-FLUID LEVEL Few, if any, air–fluid levels are present in the normal patient who is radiographed in the erect position. Limited fluid levels in the small bowel and large bowel, however, may be considered normal. Fluid levels are abnormal when they are seen in dilated bowel loops or when they are numerous. In infants and children,gas may be scattered throughout the bowel,but in adults gas is normally seen only in the stomach and colon. BOWEL GAS(FREE AIR) Small bowel gas in an adult, therefore, may indicate a pathologic process. In some patients, gas may be recognizable only on erect radiographs because of the presence of intraluminal fluid. Free air should not be visible in the peritoneal cavity and is indicative of a bowel perforation or other pathologic entities that introduce air into the peritoneum. Plain Abdominal X-ray Pattern Recognition Erect abdominal radiographs must include the diaphragm to assess for free air, and in instances in which the patient is unable to stand, a left lateral decubitus abdomen should be obtained. Note: In Gastrointestinal System, Some contents of the abdomen can be seen without contrast media. However, most of the GI tract cannot be examined directly. Small bowel on plain x-ray The small bowel lies centrally. There should be no more than 3 short air-fluid levels on an erect film. There should only be small amounts of gas in the small bowel. After being swallowed, air reaches the colon within 30 minutes. The jejunum is recognised by valvulae conniventes, folds which traverse the full width of the bowel. The distal ileum is smoother in appearance. Large bowel The large bowel lies peripherally. There may be longer fluid levels and the maximum diameter is variable. The large bowel often contains faeces & has a speckled appearance due to gas trapped in the faeces. The haustra may be outlined by gas. It is quite common to see gas outlining much of the large bowel normally. The haustra can be recognised by the fact that they do not cross the full width of the bowel and they are not regular. Other soft tissues seen on a plain films The bladder may be seen as a soft tissue density arising from the pelvic floor. The stomach is normally outlined with air below the left hemidiaphragm. CONTRASTED INVESTIGATION OF THE GIT Radiographic investigation of the GI system is commonly a combination of fluoroscopy and radiography. Fluoroscopic examination of the GI system requires positive and

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER TWO Hand Fractures And Dislocation CRT04211 · Image Pattern Recognition START READING NOTES Study Hand Fractures And Dislocation using the sections below. Use the topic navigation to continue through Image Pattern Recognition. Contents of This Topic Hand Anatomy Imaging First Metacarpal Fractures Bennett fracture Plain radiographic features • Dorsal and radial dislocation (force from abductor pollicis longus) Rolando fracture BOXER'S FRACTURE Fracture of phalanges Hand Fractures And Dislocation Proximal Phalanx Primer of Diagnostic Imaging fifth edition – Weissleder, hand fractures and dislocations Hand Anatomy Metacarpals Phalanges: distal, medial, proximal Joints: distal interphalangeal (DIP), proximal interphalangeal (PIP) and metacarpophalangeal (MCP) Hand Anatomy Imaging Plain radiographs: multiple views are necessary: AP / PA Lateral Oblique CT Scan First Metacarpal Fractures Bennett and Rolando fractures are intra-articular MCP fracture-dislocations of the thumb. These fractures must be distinguished from extraarticular fractures located distal to the carpometacarpal (CMC) joint because the former may require open reduction. Bennett fracture A Bennett fracture is a fracture of the base of the thumb resulting from forced abduction of the first metacarpal. It is defined as an intra-articular two-part fracture of the base of the first metacarpal bone. Plain radiographic features Two-piece fracture of the base of the thumb metacarpal Fracture line (radiolucent line) Intra-articular extension Dorsolateral displacement A small fragment of the 1st metacarpal, attached to the anterior oblique ligament, continues to articulate with the trapezium. Lateral retraction of the first metacarpal shaft by the abductor pollicis longus When an intra-articular fracture of the 1st metacarpal is comminuted, producing at least three parts, it is referred to as a Rolando fracture which has a worse prognosis • Dorsal and radial dislocation (force from abductor pollicis longus) Small fragment maintains articulation with trapezium. Rolando fracture Is a three-part or comminuted intra-articular fracture-dislocation of the base of the thumb (proximal first metacarpal). It can be thought of as a comminuted Bennett fracture. Rolando Fracture Comminuted Bennett fracture; the fracture line may have a Y, V, or T configuration. BOXER'S FRACTURE Fracture of the MCP neck (most commonly fifth MCP) with volar angulation and often external rotation of the distal fragment Fracture of the 3rd, 4th, and 5th MCP, with angulation and external rotation of distal fragment 4th and 5th metacarpal fracture Fracture of phalanges Mechanism of Injury: Stepped on (direct force) Hit on the tip of finger Twisting/torsion Hand Fractures And Dislocation Mallet Finger. A small avulsion injury is noted at the base of the distal phalanx, which is where the extensor digitorum tendon inserts. This is termed a mallet finger or baseball finger because it is often caused by a baseball striking the distal phalanx and causing the avulsion MALLET FINGER Proximal Phalanx More common than middle phalanx fractures. May result in a great deal of disability. Dorsal or palmar angulation may occur with these fractures. Primer of Diagnostic Imaging fifth edition – Weissleder, Radiopedia professional website Imaging of Othopaedic- Springer 2007 ← PREVIOUS TOPICNEXT TOPIC →VIEW ALL MODULE NOTESVIEW SEMESTER NOTESVIEW ALL LEVEL NOTESALL DIAGNOSTIC RADIOLOGY NOTES Need These Notes as PDF? Need a clean, well-formatted PDF copy for offline study, revision or printing? Request the complete notes directly through WhatsApp. GET WELL-FORMATTED PDF NOTES

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER TWO Skeletal System CRT04211 · Image Pattern Recognition START READING NOTES Study Skeletal System using the sections below. Use the topic navigation to continue through Image Pattern Recognition. Contents of This Topic Introduction Skeletal System Bone is a specialized connective tissue made primarily of collagen and calcium phosphate, which provides strength and flexibility. Osteoblasts are specialized bone-forming cells that play a crucial role in the formation of new bone tissue. Osteoclasts a bone cell that breaks down bone tissue to help with bone repair and mineral balance. Axial and Appendicular skeleton radiographic landmarks SKULL Facial Bones: Sutures: VERTEBRAL COLUMN Thoracic Vertebrae(T1-T12) Lumber vertebrae Sacrum Thoracic Cage: Ribs Appendicular Skeleton Radiographic Landmarks Upper Limb: Clavicle Scapula Arm Forearm Hand Lower Limb: Thigh Leg Foot NORMAL RADIOGRAPHIC PATTERNS OF THE AXIAL AND APPENDICULAR SYSTEM 4.Sella turcica is intact with normal size. Cervical Spine (C1–C7) 3.Intervertebral disc spaces are equal and maintained. Thoracic Spine (T1–T12) 3.Spinous processes well-aligned. Lumbar Spine (L1–L5) & Lumbosacral Junction (L5-S1) 3.Intervertebral disc spaces are well-preserved. Sacrum & Coccyx 3.Sacroiliac (SI) joints are symmetrical Shoulder Joint 3. Smooth Humeral Head and Glenoid Cavity Elbow Joint 3. Clear Anterior and Posterior Fat Pads Wrist Joint Hip Joint 3.Equal Joint Spaces Knee Joint 3.No Tibial Plateau Fractures Ankle Joint 3.No Soft Tissue Swelling Importance of Normal Radiographic Appearance ABNORMAL RADIOGRAPHIC FINDINGS IN THE AXIAL AND APPENDICULAR SYSTEM CONGENITAL DISORDERS 1. Osteogenesis imperfecta (OI) Clinical presentation Radiological Features of OI Bone Deformities 2. Osteopetrosis Radiological Findings of osteopetrosis Bone-within-bone 3. Diaphyseal Aclasis (Hereditary Multiple Exostoses/Osteochondromatosis) Radiological findings 4. Scoliosis ACQUIRED DISORDERS 1.Osteoporosis Radiological features 2. Osteomyelitis Sequestrum 4. Tuberculosis of the Spine/ spondylitis (Pott's Disease) 5. Paget’s disease The most frequent sites of involvement are: Plain radiographic features Spine Pelvis Long bones 6. Spondylolisthesis Pathology Radiographic Findings Consider the following on Plain Radiographic features 7. Rickets 8. Ankylosing Spondylitis Radiographic features On the Spine 9. Rheumatoid Arthritis (RA) The radiographic hallmarks of rheumatoid arthritis are: 10.Gout In plain radiograph Bone Surrounding soft tissues DEGENERATIVE DISORDERS 1. Osteoarthritis(OA) The Kellgren and Lawrence system is a common method of classifying the severity of osteoarthritis (OA) using five grades Risk factors Subchondral Cysts 2. Degenerative Disc Disease(DDD) Irregular Vertebral Alignment: Traumatic disorders Acute traumatic fractures are classified as: Descriptive terms used to indicate the shape or pattern of an acute fracture in the adult are: Dislocations Fractures in children Radiographic diagnosis of fractures 1. Vertebral Fractures Findings Bone Fragmentation 2. Pelvic Fractures 3.Clavicle Fracture 3. Colles' Fracture Fractures of the forearm Distal radio-ulnar fracture-dislocation (Galeazzi fracture) 4. Femoral Neck Fracture 5. Tibial Plateau Fracture Type II Type V 6.Ankle fractures Ankle fractures are classified using the Weber classification Type C Dislocation of the shoulder Anterior dislocation Posterior dislocation COMMUNICATING AXIAL AND APPENDICULAR RADIOGRAPHIC FINDINGS Ankylosing Spondylitis (SI Joints) Appendicular Skeleton (Limbs, Joints) Colles’ Fracture (Wrist) Type B Salter-Harris classification Types of Salter-Harris Fractures: Application of Radiological Pathology in Identifying Abnormalities of the Axial and Appendicular Skeleton Introduction The skeletal system is composed of 206 separate bones and is responsible for body support, protection, movement, and blood cell production. It contains more than 98% of the body’s total calcium and up to 75% of its total phosphorus. Skeletal System The system is commonly divided into the axial skeleton, which contains 80 bones, and the appendicular skeleton, which contains 126 bones. Bone is a specialized connective tissue made primarily of collagen and calcium phosphate, which provides strength and flexibility. The construction of bone classifies tissue as either compact or spongy. The outer portion of bone is composed of compact bone, and the inner portion, termed the medullary canal, is made up of cancellous bone. Osteoblasts are specialized bone-forming cells that play a crucial role in the formation of new bone tissue. They are responsible for bone growth , repair, and remodelling throughout a person's life. Osteoclasts a bone cell that breaks down bone tissue to help with bone repair and mineral balance. They break down bone tissue, releasing minerals such as calcium and phosphate into the bloodstream. Osteoclasts work in balance with osteoblasts (bone-forming cells) to maintain bone health and homeostasis. Axial and Appendicular skeleton radiographic landmarks The axial skeleton consists of 80 bones that form the central axis of the body, including the skull, vertebral column, and thoracic cage. Key radiographic landmarks include SKULL Cranial Bones: Frontal, parietal, occipital, temporal, sphenoid, and ethmoid bones. Facial Bones: Radiographic landmarks Maxillae. zygomas. nasal bones, lacrimal bones and palatine bones. Sutures: Radiographic landmarks Coronal suture. Sagittal suture. Lambdoid suture. squamosal suture. VERTEBRAL COLUMN Cervical Vertebrae (C1-C7): Radiographic Landmarks Atlas (C1). axis (C2). typical cervical vertebrae (C3-C7). Thoracic Vertebrae(T1-T12) Radiographic landmarks Vertebral Bodies. Costovertebral Joints. Spinous Processes. Pedicles. Intervertebral Foramina. Lumber vertebrae Radiographic landmarks Vertebral Bodies. Spinous Processes. Pedicles. Intervertebral Foramina. Sacrum Radiographic landmarks Sacral Promontory. Sacral Foramina. Sacroiliac Joints (SI Joints). Sacral Curvature. Thoracic Cage: Sternum Radiographic landmarks Manubrium. Body. xiphoid process. Ribs Radiographic landmarks True ribs (1-7). false ribs (8-10). floating ribs (11-12). Appendicular Skeleton Radiographic Landmarks The appendicular skeleton includes 126 bones that form the limbs and their girdles. Key radiographic landmarks include: Upper Limb: Pectoral Girdle Radiographic landmarks Clavicle. scapula. Clavicle Radiographic landmarks Sternal end. acromial end. Scapula Radiographic landmarks Acromion. coracoid process. glenoid cavity. Arm Radiographic landmarks Head of humerus. greater and lesser tubercles. olecranon fossa. Forearm Radiographic landmarks Radius and ulna. olecranon process. radial head. Hand Radiographic landmarks Carpals. Metacarpals. phalanges. Lower Limb: Pelvic Girdle Radiographic landmarks Ilium. Ischium. Symphysis pubis. acetabulum. Thigh Radiographic landmarks Femur with head. Greater and lesser trochanters. Condyles. Leg Radiographic landmark Tibia. Fibula. Tibial tuberosity. Fibular head. Foot Radiographic landmark Tarsals. Metatarsals. Phalanges. NORMAL RADIOGRAPHIC PATTERNS OF THE AXIAL AND APPENDICULAR SYSTEM A normal radiographic pattern refers to the standard appearance of bones and joints in a healthy individual. Below is an overview of the axial and appendicular skeleton normal radiographic pattern. Skull Radiographic pattern 1.Smooth, well-defined outer and inner cortices. The bone structure should be without fractures, tumors, or

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER TWO Degenerative Disorders Cxr CRT04211 · Image Pattern Recognition START READING NOTES Study Degenerative Disorders Cxr using the sections below. Use the topic navigation to continue through Image Pattern Recognition. Contents of This Topic OVERVIEW Introduction to COPDs Causes and risk factors of COPDs There are however a number of other less common risk factors/etiologies, each with their own demographics. They include: Clinical presentation : Symptoms of COPD include: 1. Chronic bronchitis Radiological findings of chronic bronchitis. 2. Emphysema Radiological findings of emphysema Hyperlucency (Increased translucency): The lungs appear more black than usual due to the presence of air. Pulmonary fibrosis Radiological features/findings CHRONIC OBSTRUCTIVE PULMONARY DISEASES(COPDs) OVERVIEW Introduction to COPDs Types/components of COPDs Radiographic features Introduction to COPDs Refers to a group of disorders that cause chronic airways obstruction and breathing difficulties. Represents a spectrum of obstructive airway diseases. Includes two key components Chronic bronchitis(small air way disease) Emphysema Causes and risk factors of COPDs The most common cause has historically been (and unfortunately continues to be) cigarette smoking It takes many years of smoking to develop COPD and as such typically patients are older adults. There are however a number of other less common risk factors/etiologies, each with their own demographics. They include: Industrial exposure (e.G. Mining) Cystic fibrosis Alpha-1 antitrypsin deficiency Intravenous drug use (IVDU) Immune deficiency syndromes Vasculitides and connective tissue disorders Clinical presentation : Symptoms of COPD include: Dyspnea on exertion Wheezing Productive cough Pursed-lip breathing and use of accessory respiratory muscle (shortness of breath) 1. Chronic bronchitis This is the long-term inflammation of the bronchial tubes often due to the smoking or air pollution. The pollutants irritate the mucous lining of the bronchial tree and increase the susceptibility to both bronchial and virus infections. NOTE: Chronic exposure to these respiratory irritants leads to hyperplasia of mucous glands hypertrophy of the smooth muscles, thickening of the bronchial wall. Radiological findings of chronic bronchitis. Findings of chronic bronchitis are non specific on chest radiography and includes: Increased bronchovascular markings. pulmonary vessels and bronchial wall(thicker) may appear larger than normal(prominent). Cardiomegaly a)Cardiomegaly b)Lung marking 2. Emphysema This is the condition in which the lungs alveoli(air sacs) become distended, usually from loss of the elasticity ,it characterized by an increase in the air spaces distal to the terminals of the bronchioles with the destruction of alveolar walls. Radiological findings of emphysema Lung Hyperinflation(lung enlargement): The lungs appears over- inflated with increased (lucency). Flattened diaphragms :The diaphragms may appear lower than normal due to the hyperinflation of the lungs. Blunting of the costophrenic angles , the sharp between the diaphragm and the rib cage is lost which is the hallmark of the emphysema. Hyperlucency (Increased translucency): The lungs appear more black than usual due to the presence of air. Small heart: The heart shadow may appear smaller than normal due to the large amount of air in the lungs. Bullous changes: Air- filled pockets(bullae) may be visible in the lungs. Barrel shape(increased in AP diameter): The chest appears wider from front to back, resembling a barrel on the lateral radiograph. Emphysema Bullous changes Pulmonary fibrosis Pulmonary fibrosis is the preferred general term for the permanent replacement of lung parenchyma by connective tissue and is typically associated with functional impairment. A variety of insults cause focal or diffuse lung injury (mechanical, infectious, inflammatory, and iatrogenic). Lung repair culminates in fibrosis with volume loss and architectural distortion. Radiological features/findings In a chest X-ray, pulmonary fibrosis often presents with: Reticular opacities: Small, irregular, and often seen as a network of lines. These reticular patterns tend to be more pronounced at the lung bases, particularly in the subpleural regions. Volume loss Traction bronchiectasis Honeycombing may also be observed These are the most common finding, appearing as a network of lines within the lung tissue Pulmonary fibrosis ← PREVIOUS TOPICNEXT TOPIC →VIEW ALL MODULE NOTESVIEW SEMESTER NOTESVIEW ALL LEVEL NOTESALL DIAGNOSTIC RADIOLOGY NOTES Need These Notes as PDF? Need a clean, well-formatted PDF copy for offline study, revision or printing? Request the complete notes directly through WhatsApp. GET WELL-FORMATTED PDF NOTES

DIAGNOSTIC RADIOGRAPHY · NTA LEVEL 4 · SEMESTER TWO Bronchial Carcinoma,Pneumothorax & Pulmonary Edema CRT04211 · Image Pattern Recognition START READING NOTES Study Bronchial Carcinoma,Pneumothorax & Pulmonary Edema using the sections below. Use the topic navigation to continue through Image Pattern Recognition. Contents of This Topic OVERVIEW Introduction to Bronchial carcinoma Bronchial Carcinoma,Pneumothorax & Pulmonary Edema Causes and risk factors CXR FINDINGS OF BRONCHIAL CARCINOMA. Pleural effusion: Fluids accumulation in the pleural spaces , often seen in the advanced cases/stages. TUMOR WILL HIDE. Below the horizon of each dome of the diaphragm. Golden’s S sign Pulmonary metastases Atypical features include consolidation, cavitation, cystic change, calcification, ossification, haemorrhage, and Introduction to pneumothorax 1. Spontaneous Pneumothorax Caused by the chest injuries such as PATHOLOGIC Open / sucking pneumothorax Tension pneumothorax. CLINICALS FEATURES. SYMPTOMS RADIOLOGICAL FINDINGS OF PNEUMOTHORAX 3: Increase in radiolucency 4: Flattened Diaphragm 6. Deep sulcus sign Note these radiographic features: PULMONARY EDEMA Causes/Etiology non-cardiogenic pulmonary edema Phases/types of pulmonary edema Radiographic features Features of pulmonary interstitial oedema: Features of pulmonary alveolar edema: General radiographic features of pulmonary edema BRONCHIAL CARCINOMA. OVERVIEW Introduction to bronchial carcinoma Types of bronchial carcinoma Radiographic features/findings Introduction to Bronchial carcinoma Also known as bronchogenic carcinoma,refers to the lung cancer originating from the bronchi (the large airways of the lungs). The most common types of lung cancer can be classified into two main categories histologically as follows: Bronchial Carcinoma,Pneumothorax & Pulmonary Edema 1: Non–small cell lung cancer(NSCLC): The most common type of lung cancer, accounting for approximately 85% of all lung cancers. It's characterized by abnormal cells in the lungs reproducing rapidly and uncontrollably. Include 3 types Adenocarcinoma Squamous cell carcinoma Large cell 2: Small cell lung carcinoma(SCLC) Oat cell carcinoma is a faster-growing cancer that often spreads early. Histological types Causes and risk factors Smoking( primary causes) Exposure to random gas Air pollution and harzadous chemicals. Genetic predisposition Symptoms Persistent cough Chest pain Coughing up blood Unexplained weight loss CXR FINDINGS OF BRONCHIAL CARCINOMA. Irregular mass (tumour): A solitary or multiple lung masses, often with edges. (lung consolidation) Hilar enlargement: Due to the tumour growth near the bronchi. Lung collapse ( Atelectasis): If the tumour obstructs a bronchus, leading to segmental or lobar collapse. Golden S sign Cavitations: 15% of peripheral primary carcinomas cavitate. Most of these are squamous cell carcinomas that may show central necrosis with cavitation. Pleural effusion: Fluids accumulation in the pleural spaces , often seen in the advanced cases/stages. Note: Most cancers ( more than 70%) occurs in the upper lobes. Many bronchial carcinomas are easy to detect usually as conspicous mass. BRONCHOGENIC CARCINOMA. Lung cancer. Left hilum bronchogenic carcinoma TUMOR WILL HIDE. Some of carcinomas are difficult to detect because of their position or because they are overlapped by normal structures. To locate a hidden mass you need to inspect four areas very carefully. Superimposed on the heart. Make sure that the density on the heart on both side of the supine is equal. Bronchial Carcinoma,Pneumothorax & Pulmonary Edema The lung apices. Some tumor begin as flat lesion and the CXR appearance may be dismissed as simple pleural thickness ,A flat apices carcinoma can mimic a apical pleural cap Below the horizon of each dome of the diaphragm. A large part of each lower lobe lies below the horizon of each dome of the diaphragm ,even so if a lung mass is surrounded by air it is usually detectable on frontal CXR. Bronchial Carcinoma,Pneumothorax & Pulmonary Edema Around the hila: This does not refer to hilar enlargement. It refers to the lung parenchyma around, behind and in front of a hilum. Overlap by vessels entering or leaving the hilum can cause a nearby lung lesion to be overlooked. Golden’s S sign A collapsed right upper lobe with a mass at the hilum results in a reverse S configuration. The reversed S is made up of an elevated horizontal fissure and a bulky tumour at the hilum. Golden S sign Pulmonary metastases Refer to distant tumour spread from a variety of primary tumours to the lungs via the blood or lymphatics. Radiographic features Pulmonary metastases typically appear as multiple, peripheral, rounded nodules scattered throughout both lungs. Larger nodules and masses may be termed cannonball metastases. Atypical features include consolidation, cavitation, cystic change, calcification, ossification, haemorrhage, and secondary pneumothorax(post–primary). Cannonball PNEUMOTHORAX OVERVIEW Introduction to Pneumothorax. Clinical types. Radiological findings. Introduction to pneumothorax Pneumothorax refers to the presence of air in the pleural spaces/ refers to the presence of gas in the pleural space which allows the parietal and visceral pleura to separate and the lung to collapse. Occurs when the air enter in the pleural spaces( the area between the lung and the chest wall), causing the lungs to collapse partially or completely. There are several types of the pneumothorax,classified based on their causes and severity: 1. Spontaneous Pneumothorax Occurs without trauma and is further divided into: Primary spontaneous pneumothorax : happens in young healthy individuals without underlying lung disease. often due to ruptured lung blebs(sub pleural blebs). Secondary spontaneous pneumothorax: occurs in people with underlying lung diseases like COPD, asthma or cyst fibrosis. Caused by the chest injuries such as Blunt trauma: Ribs fractures puncturing the lung the lung. Penetrating trauma: stab wound, gunshot injuries or medical procedures like lung biopsies. Traumatic pneumothorax Bronchial Carcinoma,Pneumothorax & Pulmonary Edema Occurs when the air enter in the pleural spaces but can not escape and increasing pressure in the chest and progressive lungs collapse, this can compress the heart and the major blood vessels cause cardiovascular instability. Iatrogenic pneumothorax Occurs due to the medical procedures such as; Mechanical ventilation ,Excessive pressure causing lung rupture. Tension pneumothorax: PATHOLOGIC Simple/ closed pneumothorax: The opening in lung is very small and hence ,it heals rapidly. There is no continuous communication between the lung and pleural cavity. This means that pleural pressure is less than atmospheric pressure. Open / sucking pneumothorax The rupture site remains open and there is a communication between the pleural cavity and the