Radiology killer!

Modalities:

1. X-ray
2. Computed Tomography (CT)
3. Magnetic Resonance Imaging (MRI)
4. Ultrasound (US)
5. Nuclear Medicine (NM)
6. Positron Emission Tomography (PET)

Contrast agents:

1. X-ray/CT: iodinated contrast
2. MRI: gadolinium-based contrast
3. US: microbubble contrast agents
4. NM/PET: radiotracers

Basic Principles of Radiological Interpretation

Systematic approach:

• Be consistent in your approach
• Evaluate all aspects of the image
• Compare with previous studies (if available)

ABCDE mnemonic for interpretation:

•  Alignment
•  Bones
•  Cartilage (joints)
•  Density (soft tissue, air, fluid)
•  Everything else (foreign bodies, devices, etc.)

 X-ray Interpretation

Chest X-ray:

•  Assess the quality of the image (inspiration, rotation, penetration)
•  Systematic approach (e.g., A - airway, B - bones, C - cardiac silhouette, D - diaphragm, E - effusions, F - fields [lung fields], G - gastric bubble, H - hila, I - impression)

 Abdominal X-ray:

•  Evaluate bowel gas pattern and distribution
•  Look for free air (pneumoperitoneum)
•  Assess bony structures and soft tissues
•  Identify calcifications or foreign bodies

Extremity X-ray:

•  Evaluate bone alignment and joint spaces
•  Assess for fractures, dislocations, or subluxations 3. Examine soft tissues for swelling, gas, or foreign bodies

 CT Scan Interpretation

Head CT:

•  Evaluate for intracranial hemorrhage, masses, or infarcts
•  Assess ventricular size and midline shift
•  Examine skull and facial bones

 Chest CT:

•  Assess lung parenchyma, mediastinum, and pleural spaces
•  Evaluate for pulmonary nodules, masses, or infiltrates
•  Inspect the heart, great vessels, and lymph nodes

 Abdominal and Pelvic CT:

•  Evaluate liver, spleen, kidneys, and pancreas for masses, cysts, or inflammation
•  Assess bowel and mesentery for obstruction, inflammation, or ischemia
•  Examine the urinary system for stones or hydronephrosis
•  Evaluate pelvic organs, vasculature, and lymph nodes

 MRI Interpretation

Brain MRI:

•  Assess gray and white matter for abnormalities (e.g., tumors, demyelination, infarction)
•  Evaluate ventricular size and midline shift
•  Examine vasculature and sinuses

 Spine MRI:

•  Assess spinal alignment, vertebral bodies, and discs
•  Evaluate spinal canal and neural foramina for stenosis or compression
•  Examine spinal cord
•  inspect paraspinal soft tissues and ligaments 

 Musculoskeletal MRI:

• Evaluate bones for fractures, stress reactions, or marrow infiltration
• Assess joint spaces, cartilage, and ligaments
• Examine muscles and tendons for injury or inflammation
• Inspect surrounding soft tissues for masses or fluid collections

 Ultrasound Interpretation A. Abdominal Ultrasound:

•  Assess liver, spleen, kidneys, and pancreas for masses, cysts, or inflammation
•  Evaluate gallbladder for stones, sludge, or wall thickening
•  Examine abdominal aorta for aneurysm or dissection

 Pelvic Ultrasound:

•  Evaluate the uterus, ovaries, and adnexa in females
•  Assess the prostate and seminal vesicles in males
•  Examine the urinary bladder for stones, masses, or wall thickening

 Vascular Ultrasound:

•  Evaluate arterial and venous blood flow
•  Assess for stenosis, occlusion, or thrombosis
•  Measure vessel diameter and intima-media thickness

Musculoskeletal Ultrasound:

•  Evaluate muscles, tendons, and ligaments for injury or inflammation
•  Assess joint spaces and synovial fluid
•  Identify soft tissue masses or fluid collections

Nuclear Medicine and PET Interpretation

 Bone Scan:

• Assess for areas of increased or decreased radiotracer uptake
• Evaluate for fractures, infections, or metastatic disease

Thyroid Scan:

•  Assess thyroid size, shape, and position
•  Identify areas of increased or decreased radiotracer uptake (hot or cold nodules)

PET Scan:

•  Evaluate for areas of increased radiotracer uptake (e.g., tumors, infection, inflammation)
•  Assess treatment response and monitor disease progression

High-Yield Summary

•  A consistent, systematic approach is essential for accurate radiological interpretation.
•  Familiarize yourself with the different imaging modalities and their respective indications.
• Compare current imaging with previous studies when available to identify changes or trends.
• Practice interpreting a wide variety of cases to improve pattern recognition and diagnostic accuracy.