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27-RADIOLOGY, RADIOTHERAPY

Angiographycatheter for coronary angiography Amplatz, Judkins, Sones

a dissection-string a/c mesenteric ischem-string of sausage Buerger ds-corkscrew a carotid body tm-Lyre intramed tm-candle grease dripping, trouser leg Moya Moya ds(change in cerebral part of ICA)-puff of smoke renal OncOcytOma-spOke wheel v hemangioMa brain-Medusa head

Barium examination achalasia cardia-bird beak, pencil tip, rat tail, sigmoid esoph, cucumber esoph ADPKD-Swiss cheese nephrogram ARPKD-striated nephrogram, sunray ca colon-apple core ca esoph-rat tail, shouldering, apple core ca PAncr-PAd ca stom-Carman meniscus, Carman Kirklin complex, irregular nodular radiat fold, irregular ulcer margin c/c duod ulcer-trifoliate duod CHPS-string, double track, shoulder, mushroom CrOhn ds-aphthoid ulcer(earliest), rose thorn, string sign of Kantor, COmb diffuse esoph spasm-cork screw esoph, rosary esoph diverticulosis-saw tooth gastric CROHN-Ram HORN, pseudobilroth gastric ulcer-spoke wheel, outpouching hiatus hernia-GE jn elevated ileal atresia-microcolon intussusception-coiled spring, claw, meniscus ischemic colitis-thumbprint jejunum-valvulae conniventes, feathery midgut volvulus-corkscrew duod periampulary ca-reverse3, frostberg pOlypOsis-Mexican hat, bOwler hat Schatzki ring-Ba Swallow sigmoi volvulus-coffee bean, bird of prey TB GIT-string, pulled up caecum, inverted umbrella, Fleishner, goose neck ileum ulcerative colitis-mucosa granularity(1st sign), collar button ulcer, lead pipe/pipe stem colon Zenker diverticulum-outpouching

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bead cystogram stress incontinence

Bone scan fibrous dysplasia-hot met-hot multiple myeLOma-cOLd

colour doppler type of colour-direction of bld flow Red, Orange, Yellow(ROY)-TOwards transducer(ROYTO) blue, green-away from transducer

CTGodfrey Hounsfield, 1972, England, Nobel prize-1979 conventional CT-brain spiral CT-trunk, 30s, lth=30cm multislice/director CT-CVS-middiastole ECG gating, cone shaped beam min size lesion Dx by CT=10mm Hounsfield scale of attenuation bone, Ca=+1000=white brain=+60-+70 hge=+20-+40 water=0=dark fat=–100 air=–1000=black

contrast material(CT, IVP, angiography)-I2 contrast ionic-urograffin/gastrograffin(Na/miglumine ditriazoate)

high osmolar-I2:particle=3:2, osmol=1400-1600mosmol/l, →idiosyncratic(anaphylactoid nonIgE complement activat histam release), dose

related nephropathy low osmolar-I2:particle=3:1, osmol=300mosmol/l, iodixanol

nonionic-iohexol, ioversal, iopamidol↓ prophylactic hemodialysis in ren failure does not risk contrast mediated nephrotox,

↓it by hemofiltration radiat CT=8mSv=250-400×CXR 1rad=1rem=0.01mSv

appear/sign A/c Appendicitis-Arrow head adrenal adenoma-low attenuation, homogenous density, well defined border, no calcific alveolar Microlithiasis-sandstorM alveolar Proteinosis-crazy Pavement ANgiofibroma-ANtral/HollmAN Miller asbestos pseudotm(round atelectasis)-comet tail atherosclerosis plaque asympt-Ca deposit in a bronchiectasis-signet ring bronchiolitis obliterans-patchy hypertranslucency

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bronchoalveolar ca, adenoCIS-pseudocavitation, CT angiogram CAROLi ds-CentRAL dOt cerebral infarct a/c-hypodense lesion, ventricle dilatation cryptogenic organising pneum-reverse halo, Atoll Dandy Walker malformation-vermis absent diffuse axonal inj-compression basal cistern, multiple small hge empyema-split pleura endoBronchial ds-tree in Bud epidural hge-hyperdense biconvex, not cross suture line Follicular bronchitis-Fine reticulate Hallevorden SpaTz ds(Fe deposition globus pallidus)-eye of Tiger holoprosencephaly(Patau synd)-pancake, horseshoe ventricle HSV encephalitis-temp lobe hypodensity Huntington Chorea(Caudate nucleus)-box Car, butterfly ventricle hydatid cyst liver-serpent, crumpled memb Krabbe ds-hyperdense basal ganglia, hypodensity white matter MCA infarct-dense MCA pituitary macroadenoma-8shape Pneumocystis pneum-tree in bud POrtaL v thrOmbosis-POLOmint PSP(Midbrain atrophy)-Mickey Mouse pulm aspergillosis-halo renal oncocytoma-central stellate scar SAH-sulci appear white sarcoidosis-galaxy Serous cystadenoma pancr-Sunburst silicosis-crazy paving sporadic CJD(basal ganglia, Cortex)-Cortical ribbon subdural hge a/c-hyperdense concavo convex, cross suture line subependymal giant cell astrocytoma-enhancing lesion at foramen Monroe, periventricular calcific sup saggital sinus thrombosis-empty delta tuberous sclerosis-subependymal calcif VariantCJD/madcow/bovine spongiform encephalopathy(pulVinar)-hockey stick vert hemangioma-polka dot Wolman ds-adrenal cortex calcific

Diffuse tensor imaging isotropic, anisotropic diffusion

Echocardiography MS-hockey Stick pulm embolism-McConnel

Endoscopy otosclerosis-cartwheel TB kidney-golfhole ureter

ERCP endoscopic

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C/c pancreatitis-Chain of lake Intraductal Papillary Mucinous Neoplasm(IPMN)-fishmouth

Functional MRI BOLD(Bld O2 Level Dependent) sequence localise motor&speech area

HSG D5-15(10), dye-urograffin60(Na&meglumine ditriazoate), Leech Wilkinson I2 soln 10ml

arcuate uterus-dip at level of fundus Asherman synd-loculated dye hydrosalpinx-thick dilated FT norm-b/l free spill

⅔ salpingitis isthmica nodosa-nodularity prox FT⅓ TB genit-nodularity distal FT

invertogram best done after 24h, earliest-6h

IVP ADPKD-sPiDer leg BPH-fish hook/J shape ureter duplication of ureter with upper pole nonfnal-drooping lily horseshoe kid-flowervase, hand joining/shaking hydronephrosis-rim, crescent idiopath retroperitoneal fibrosis-maiden waist multicystic dysplastic kidn-not visualised neuroblastoma-drooping lily neurogenic UB-christmas/pine tree papillary necrosis-golf ball on T, lobster claw, egg in cup partial duplication ureter-Yo Yo reflux schistosomiasis-fetal skull like UB TB kidn-irregular calyx(1st sign), moth eaten calyx, putty kidn, cement kidn TB UB-thimble UB ureterocoele-adder/cobra head

Mammography single coat film target material-Molybdenum(Mo) CC-CranioCaudal, MLO-MedioLat Oblique rad deliver=0.1cGy >40y-annual mamography screen for DCIS breast cluster of calcific>5↓ mortality by 33%

ca breast-ill def margin, irreg stellate speculat, comettail, high density, widehalo, heterogenous, microcalcif, architectural distortion fibROadenoma breast-popcORn

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MR angiography/venography time of flight sequence

MRCP noninvasive, heavy T2wtI

MRI absolute c/i-claustrophobia, orthopedic implant, cardiac pacemaker(Larmour freq) mag field=0.2-0.7Tesla routine=1.5Tesla Faraday Cage-Cu T1wt image CSF, water-dark(hypointense) fat-white white matter-white cortic bone, calcif, air, tendon, lig, flowing bld, hemosiderin-dark

T2wt image CSF, water-white(hyperintense) fat-less white white matter-dark cortic bone, calcif, air, tendon, lig, flowing bld, hemosiderin-dark

T2wt image with FLAIR(FLuid Attenuated Inversion Recovery) dark CSF with T2wt image-vasogenic edema STIR(Short Tau Inversion Recovery) seq-musculoskeletal(bonemarrow edema) dye-Gd(lanthanide, paramagnetic)-Gd DTPA-c/i CRF, preg

arachnoid cyst-dark(CSF) Arnold Chiari malformat(type2)-banana, lemon, spina bifida brain hge(DD-BD-BB-DD)-a/c(deoxyHb<48h)-DD, early suba/c(methHb=3-7 d)-BD, late suba/c(methHg=7-14d)-BB, c/c(hemosiderin>14d)-DD breast implant rupture-Linguire cavernous hemangioma brain-popcorn Chiari malformation type1-tonsillar herniation with syringomyelia CoRpus callosum agenesis-racing CaR epidermoid cyst-T1-hypointense,vT2-hyperintense Friedrich ataxia-spinal cord atrophy Halloverden Spatz ds(pantothenate kinase degenerat)-eye of tiger hemangioma liver-light bulb HOloprosencephaly-pancake brain, HOrseshoe ventricle HSV1 encephalitis-temporal lobe hyperintensity Joubert synd(vermian dysgenesis)-molar tooth lissencephaly-no sulci,gyri medial meniscus bucket handle tear-double PCL medulloblastoma-sugar coating melanoma met-T1-high, T2-low signal meningioma-dural tail mesial temp sclerosis-atrophy of mammilary body, fornix, hippocampus metachromatic LEukodystrophy-tigroid, LEopard skin multipl sclero-Dawson finger, open ring

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multisystem atrophy type C/olivopontocerebellar atrophy-hotcross bun pons neurocysticercosis(VDCN) Vesicular stage(Viable)-cystic with scolex Dying stage-min edema Colloidal stage-vasogenic edema Nodular stage-calcified

NF1-bare orbit, ribbon rib norm pressure hydrocephalus-enlarged lat ventricle Parkinson ds-swallow tail(substantia nigra) absent pheochromocytoma-light bulb, hyperintense(T1), isointense(T2) pituit macroadenoma-fig8 PSP(Steel Richardson Olszewski synd)-Mickey mouse(axial), penguin, humming bird(sagittal) ring enhancing lesion-neurocysticercosis, TBoma, toxoplasmosis, brain abscess, met Wilson ds-face of giantpanda(midbrain) vasc tm-salt&pepper vasc tm brain-mother-in-law vein of Galen malform-hyperintense vestib schwannoma-icecream cone

MR/proton spectroscopy biochemical evaluation brain Choline(Cell memb)< creatine(energy storehouse brain)< N-acetyl aspartate(Neuron)

↑ CaNAvAn ds- NAA↑ ↓ ↓ glioma- choline, creatine, NAA

MYelography dye-MYodil

NMR H+ beam

Nuclear/isotope/radionuclide/scintigraphy Tc99m, metastable isomer-t½=6h, γray=140keV Tc99m ligand, γ/Anger camera-scintillating detector(NaI+thallium) TcMAG3-excret by both tubular secretion&GF TcDTPA-excret by GF-Physiology kidn TcDMSA-Struct of kidn Tc99mMDP-bonescan myocard perfusion scintigraphy-Thalium, Tcsestamibi, TcpyroP, Tctetrofosmium, Rubidium82 TcRBC MUGA(MultiUptake Gated Acquisition)-ventr fn, low GI hge(0.1ml/min), hep hemangioma, residual spleen Tcsestamibi-parathy adenoma Iridium111-brain Se75-digestive enzyme selenomethionine-pancr GA67-sArcoidosis

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sarcoidosis-panda, lambda thyroid gld hypofn area(cyst, tm, suppressed ts, deQuervain thyroiditis, Hashimoto thyroiditis, iatrogenic thyrotoxicosis, hamburger thyrotoxicosis)-cold hyperfn area(Graves ds, toxic nodular goitre, toxic adenoma, amiodarone, I2, struma ovarii, H mole)-hot

PET(Positron Emission Tomography) 18F(cyclotron)-t½=110min electron(e–)+antimatter(e+)= annhilation=2γ=511keV

→ 18F+deoxyglu 18FDG(nonmetabolisable glu analogue) heart-metab-FDG, perfusion-NH3,H2O,Rubidium scar-FDG–, NH3– ischemic but viable-NH3–, FDG++

RGU UB inj-flame, pear

SPECT(Single Photon Emission CT) Tc99m, γcamera

USG piezoelectric effect, quartz, Pb zirconate titanium

→ wavelth=2×thickn crystal, small crystal higher freq routine abd USG freq=3-5MHz TVS=5-7MHz superf organ, thy, breast=7-12MHz hard-hyperechoic-white soft-hypoechoic-grey cyst-anechoic-black acoustic impedance=density×velocity of sound in organ acoustic Shadow-Stone, bone, air acoustic enhanCem-Cyst, fluid fill Cavity↑ ↑ echogeniciTy- chance of Tm/malign↑ ↑ SonolucenCY- chance of CYSt

→ → ↑ sonovist, echovist, levovist microbubble reflection USG ts harmonic imaging-US elastograph-hardn of ts-guide Bx FAST(Focussed Assessm with Sonography in Trauma) 2.5-3.5MHz rt hypochondria-(perihepatic& hepatoren space) lt lower chest-(perisplenic) hypogastrium-(pelvis) epigastrium-(pericardium) 1-2min, hemiperitoneum(200ml/min)

Saline infusion sonography/sonohysterography D5-D10 polyp, fibroid, abnorm uterine bld, adhesion, not for adenomyosis c/i-preg, recur pelvic inf

a/c hepatitis-starry sky

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adenomyomatosis GB-diff wall thicken, hyperechoic nodule at neck, comet tail artefact anencephaly-frog eye biliary atresia-triangular cord, ghost GB ca prostate-hypoechoic ca thy-hypoechoic, incomplete periph halo, irregular margin, microcalcific CBD obstruction-double barrel CHPS-target, cx, antral nipple ectopic preg-ring of fire emphysemat cholecystitis-ringdown, comet tail endometrium-periovulatory-triple layer, Secretory-hyperechoic(bright),Single,thick layer endometrioma(chocolate cyst ovary)-ground glass GB stone-hyperechoic h mole-snowstorm, grapelike vesicle hgic cyst ovary-fish net hydatid cyst lung-cart wheel, rising sun intussusception-double target, doughnut, pseudokidn monoamniotic twin-T multicystic dysplast kidn-soap bubble

↑ nonimmune hydrops- skin thickn>5mm(1st sign) obstructive jaundice-double barrel partial mole-focal cystic space in placenta post urethral valve antenatal-keyhole twin peak/lambda(10>10-14w)-dichorionicity ureterocele-cyst within cyst

Xray→ → Brehmstalang radiation-cathod tungston filament tungston target

Rotating anode(tungston+10%Rhenium) photosensitive material-AgBr+AgI

↑ → ↑ ↓ kVP(kilovolt Peak)- kVP Penetrating power(intensity), contrast↑ → MAS(milliampere s)-rad dose received, MAS blackening of film

→ photoelectrIc effect-lIght scatter of Inner shell e→ COmptOn effect-Xray scatter of Outer shell e

rad dose monitor-thermoluminescent dosimetry(quarterly-3mth) CXR radiat delivered=2.5-6rad=0.6mSev

→ prim radiat-cathode anode of Xr tube sec(scattered) radiat-emitted by any matter irradiat with Xr digital radiography-photostimulable phosphorus

ABPA-gloved fing app of Simon, fleeting a/c croup-Steeple, church top, pencil tip a/c epiglottitis-thumb a/c osteomyelitis-soft ts swelling/blurring of ts plane(1st sign) a/c pancreatitis-colon cutoff, sentinel(jejunal) loop, gasless abd, renal halo AC polyp-column of air b/n soft ts mass&post pharyng wall aCHondroplasia-CHampagne glass pelvis acromegaly-heal pad thickening(>21mm) alkaptonuria-IVD calcific

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aNgiOfibrOmA-HONdOusA ankylosing spondylitis, Bechtrewer ds-haziness, widening SI jt(1st sign), bamboo spine, shiny corner, Romana, squaring vert, dagger, Anderson, tiger annular pancr-double bubble aortitis-calcific ascend aorta asbestosis-ground glass, Holly leaf aspergillosis-air crescent, Monod battered baby synd-multiple #metaphysis Brodie abscess-small lytic lesion with surrounding sclerosis bronchiolitis obliterans-hyperlucency, patchy infiltrate bronchiectasis/cystic fibrosis-bunch of grape, tramtrack, string of bead bronchogenic ca-atelectasis, reverse S ca lung-solitary lung nodule without calcif c/c osteomyelitis-sequestrum(dead bone), moth eaten Charcot jt-bag of bone, tumbling block, jigsaw vert chemical peritonitis(perforated DU)-Blumberg, Rigler

→ → → → CHF-cephalisation of bld flow Kerley B(Base) A(hilum) C(meshwork) →D(retrosternal) fluffy shadow,batwing

CHondroblastoma-CHicken wire, patchy calcific ChorioCa-Cannon ball, snowstorm CHPS-single bubble COA-fig3 cong CMV-periVentricular calcific, Celery stalk long bone cong rubella-celery stalk cong Syphilis-Wimberger, Saber tibia, hotcross bun skull, celery stalk longbone cong toxoplasm-scatter brain calcific constricti pericarditis-egg in cup heart cretinism-epiphyseal dysgenesis CrOhns ds-CObble stone COlOn cryptogenic organising pneum-reverse halo, attenuation diaphyseal aclasia(multiple exostosis)-bony spur growing away fr jt, trumpet shape projection metaphysis DISH(Diffuse Idiopath Skeletal Hyperosteosis)/Forrestier ds-flowing wax ossificat of ant spinal lig dislocation LunATE-spiLLed TEAcup duod atresia-double bubble duod ulcer-trapped air Ebstein anomaly-box shaped heart endocardial cushion defect-goose neck Ewing sarcoma-onion skin fat embolism-snowstorm fibrous dysplasia-ground glass, shephard crook, cotton wool GI perforation/pneumoperitoneum-gas under diaph, football, Rigler, cupola, telltale triangle hamartoma-exploded popcorn hemangioma bone-spoke wheel calcific, osteolytic lesion hemophilia-deep intercondylar notch, squaring of patella, enlarged epiphysis histiocytosis-geographic skull, vertebra plana, silver dollar vert, button sequestrum hydatid cyst lung-air cresent, cumbo, onion peel, water lily, camelote, serpent, crumpled memb, floating memb

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hyperparathy-salt pepper skull, floating teeth, loss of lamina dura↑ ICP-suture diastasis(1st sign child), Cu beaten, erosion dorsum sella(1st sign adult),

J shaped sella, pineal displacem>3mm fr midline IVD prolapse-Schmorl node ischemic colitis-thumbprint, sawtooth irregularity IUD-Robert, Spalding jejunal atresia-triple bubble Klebsiella pneumonia-bulging fissure LA enlarg-post displacem esoph(1st sign), Bedford, widening carinal angle, elevat lt bronchus, double shadow rt bord LeprosY-Licked candY LeUkEmia-LUcEnt metaphyseal band lipoma(periCAllosal)-brACket CAlcific lissencephaly(no gyri)-fig8 brain LUL collapse-LUftsichel(German airbag) lung abscess-bulging fissure m cyscticercosis-rice grain MeLorrheostosis-MoLten wax mesenteric thrombus-stack of coin midgut volvulus-gasless abd MPS-bullet shape(tapered) MC, radius&ulna towards each other, J shape sella multiple myeloma-punched out, lytic nasal polyp-Dodd, crescent optic glioma-J shape sella osteoarthritis knee-reduct jt space(1st) osteoclastoma-soap bubble osteogenesis imperfecta-multiple# diaphysis osteomaLacia-Looser zone/miLkman#/pseudo#/osteoid seams, triradiate pelvis, milkman line/umbauzonen osteopetrosis-marble bone, bone within bone osteosarcoma-Codman triangle, sunray Paget ds-Picture frame vert, osteoporosis circumscripta, cotton wool skull, helmet skull, blade of grass, ivory veteb, brim PAPVC-Turkish sword, Schmitar pericardial effusion-moneybag heart persistent truncus arteriosus-sitting duck heart Perthes ds-crescent(subchondral lucency-1st sign), gaze, sagging rope, flat fem epiphysis phantom/vanishing tm-golden S PinDborg tm-Driven snow pintrack inf-ring sequestrum pleural effusion-Ellis curve, decubitus≥25ml pleural effusion loculat-obtuse angle with mediast, unsharp margin, do not confirm segmental distribut pneumomediastinum-continuous diaphr, thymic Spinnaker sail, Naclerio V, ring around the a, extrapleural air pneumothorax-stratosphere post disloc hip-light bulb post disloc shoulder-light bulb Pott spine-earliest-rarefaction of vert endplate> disc space narrowing,

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healing-sharpening of fuzzy paradiscal margin pseudohyparathy-short 4th&5th MC psoriatic arthritis(arthritis mutilans)-pencil in cup hand/foot, ivory phalanx pulm edema-batwing pulm embolism-Westermark, Hampton hump, Palla pulm HTN-jug handle heart, oreo cookie, pruning of pulm a pulm plethora-diam descend rt pulm a>16mm pyloric atresia-single bubble RA-soft ts swelling(1st sign), juxta articular osteopenia, bone erosion renal osteodystrophy-Rugger jersey spine, sandwich spine ren papillary necrosis-track&horn, egg in cup, ring shadow resp distress neonat-sunray RHD(earliest)-straight lt heart border rickets-loss of provisional zone of ossific(earliest), growth plate widening, cupping, flaying, splaying, white line of calcific(healing rickets), flaring of ant end of rib, moth eaten epiphysis rt upper lobe collapse with bronchogenic ca -golden S rt middle lobe path-Felson, silhouette, rt heart border obscure RVH-lift up heart apex sarcoidosis-1-2-3, garland, panda(face), lambda(chest) scapholunate dislocat-Terry Thomas/David Latterman Schizencephaly-Split brain scurvy-pencil thin cortex, white line Frenkel, Wimberger ring, Trummerfeld zone, Pelkan spur, osteoporosis sigmoi volvulus-inner bent tube, omega SiLicosis-egg SheLL calcific, Snowstorm simple bone cyst-fallen leaf/fragment slipped capital fem epiphysis-Trethowan spina ventusa/TB phalang-ballooning/lytic metaphys phalang spondylolisthesis-inverted napolean hat(APview), behead Scotty dog(oblique view) spondylolysis-Scotty dog with collar TAPVC-fig8 heart, cottage loaf heart, snowman TB arthritis-osteoporosis+erosion+jt space narrowing TB hip-osteoporosis(earliest), wandering acetabulum TB knee-synovium TB osteomyelitis-osteoporosis+no new bone formation TB shoulder-caries sicca tetralogy of Fallot-boot shaped heart(cor en sabot), shoeman TGA(uncorrected)-egg on side/string heart thymus-sail, wave of Muvley transient tachypnoea neonat-prominent interlobar fissure Turner synd-short 4th MC UB inj-ground glass undisplace #supracondylar humerus-fatpad unstable pelvis-post sacroiliac complex displacem>1cm, avulsion# sacral/ischial end of sacrospinous lig, avulsion# L5 transv proc, disrupt pubic symphysis, gap in post pelvic ring vert hemangioma-Coduroy cloth, linear striation vert met-pedicle erosion, winkling owl(1st sign) Weg granulomatosis-fleeting opacities

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air bronchogram-pneum, pulm edema, HMD, bronchoalv ca air crescent Ek-Echinococcus P-Pus in cavity C-Clot in cavity At-Aspergilloma Table-Tm in cavity

egg shell calcific mediast LN-Ranke(calcified Ghon) complex, silicosis, sarcoid, histoplasmosis, blastomycosis, postRT lymphoma honey coomb lung R-RA P-Pneumoconiosis Singh-Scleroderma HIT-HIsTiocytosis Six-Sarcoidosis

inf rib notching/Roesler/Dock sign(vascular)-COA, aortic thrombus/obstruction, aortitis, Taussig-Blalock operation, subclav a obstruction, SVC obstruction, pulm oligemia/atresia, NF Kerley B line(ca met) Certain-Cx Ca-Colon Spread-Stom By-Breast Plugging-Pancr The-Thy Lymphatic-Larynx

miliary mottling lung-miliary TB, sarcoid, histoplasm, met, long standing MS, alveolar microlithiasis, pneumoconiosis, varicella, fat embolism sup rib notch-poliomyelitis, osteogenesis imperfecta, RLD, Marfan synd, connective ts ds(RA,SLE,scleroderma), hyperparathy, NF

silhouette-contact with lung up rt heart bord/ascending aorta-ant seg RUL rt heart bord-RML up lt heart bord-ant seg LUL lt heart bord-lingula aortic knob-apicopost seg LUL hemidiaphragm-basal seg LL

physiologic airfluid level abd Xray≤2

Xray view-struct/lesion baSal(submentovertical)-S Caldwell(occipitoFrontal)-F Judet-#acetabulum Lateral-seLLa turcica Law, Schuller-mastoid antrum lt lat-aortopulm window Lordotic-Lung apex

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Mortice-ankle inj oblique-#scaphoid Peg odontoid-C1,2 Rheese-optic foRamen Stryker notCH-Hill SaCH lesion sunset-patellofem dysplasia von Rosen-DDH Waters(occipitomental)-M, orbital floor(blow out#) West point axillary-Bankart

brain calcific-ds basal ganglia calcific-hypoparathy, FAHRS, Cockayne synd bracket calcific-corpus callosum lipoma diffuse nodular calcific-toxoplasmosis periVentric Calcific-CMV inf rice grain calcific brain-neurocysticercosis sunray calcific+spicule brain-meningioma suprasellar calcific-craniopharyngioma, meningioma tramtrack/railroad calcific-Sturge Weber synd

Brain tm CAlcified brain tm(CA COME) Craniopharyngioma Astrocytoma Choroid plexus papilloma Oligodendrogioma Meningioma Ependymoma

Glioma-astrocytoma, ependymoma, oligodendroglioma, glioblastoma Neuronal tm-gangliocytoma, neurocytoma, L'Hermitte Duclos tm(cerebellar gangliocytoma) CSF spread-medulloblastoma, germinoma, glioblastoma multiforme, CNS lymphoma, ependymoma

RADIOTHERAPYteletherapy-ext beam therapy

→ Co machine(highV)-Co60 Ni60+γray→ → LINAC(LowV) Xr orthV, megV, superV

brachytherapy-contact, substance, cavity fractionat-once daily, weekend off hyperfract-non SmCC lung-CHART(Continuous Hyperfract Accelerated RT) prophylact cranial radiation-SmCC lung, ALL IMRT(Intensity Modulated RT)↑ →↑ intensity thickn-ca prostate 6mV

IGRT(Image Guided RT) γknife-brain-vest schwannoma, pit adenoma, meningioma, AV malform, CNV neuralgia cyber knife-whole body H+ beam therapy-Bragg peak(deposit energy only at target) whole body electron therapy-mycosis fungoides

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→intraoperative RT-electron photon therapy RT-ionisation of molecule O2 effective-just before starting RT

radioisotope-t½ 18F=110min Tc99=6h I123=13h-fn scan(RAIU) Au198=2.7d Radon=3.8d I131=8d-unsealed TRT ca thy P32=14.3d(β) albumin=21d Co60=5.2y(TRT>BRT) tritium=12y Cs137=30y-BRT Ra226=1600y(α) U238=4.5bil y

I125-RIA, BRT(γ) I124-PET I127-stable iridium192-HDR BRT

max biologic effect-γ→Radium daughter element in gas form

radiation—unit—SI unit(RC BARGERS) Radioactivity-Curie-Becquerel(RCB) Absorption-RAd-GrAy(ARG) EQuivalent-REm-SEvErt(EQRS) exposure-Roentgen-C/kg 1Ci=3.7×10^10Bq(3.7GBq)

max permisible dose International Commision of Radiologic Protection(ICRP)-5rem preg≥0.5rad(therap abortion)

radiosensitivity MRS bld cell-lymphocyte LRS bld cell-PLT>RBC MRS bone tm-Ewing sarcoma>multiple myeloma MRS brain tm-Medulloblastoma MRS eye struct-lens LRS eye struct-sclera MRS kidn tm-Wilms tm MRS lung tm-SmCC MRS mucosa-intest mucosa MRS organ-skin LRS organ-vag

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MRS ovary tm-dysgerminoma>teratoma MRS retina layer-LRC LRS retina layer-GCL MRS phase-G2M>G2>M>G1>early S>late S LRS phase-late S MRS testis tm-seminoma MRS ts-bone marrow LRS ts-nervous ts MRS tm-WESMiLe Wilms tm(within 10d of Sx) Ewings sarcoma Seminoma Multiple myeloma Lymphoma

LRS tm-ca pancr, malign melanoma, osteosarcoma

high dose RT>12Gy/hlow dose RT=0.4-2Gy/hHodgkin lymph=20-30Gy

isotope temporary-iridium, caesium Permanent(PGI)-Palladium, Gold, I125 bone tm-Strontium, P(β), RAdium223(Alp), Yttrium, Samarium(γ), Rhenium(γ)

ds-radiat absorpt hema2logic synd-2-8Gy(death-2-4w after exposure) perm sterility>6Gy brain can tolerate=6Gy GI red synd=6-10Gy neurovasc synd=10Gy fatal time full body exposure 5Gy=1-2mth

organ-tolerance dose(TD50) fetus=400 bone marrow=450 liver=2000-4000 kidn, lung=2500 brain=6000

radiation recall phenom severe skin rxn develop when CT given after RT-actinomycinD, doxorubicin, mtx, 5FU, hydroxyurea, paclitaxel, As trioxide

radiation carditis-pericard effusion

radioprotector-SH grp-amifostine radiosensitiz-hydroxyurea, hyperbaric O2 radiomimetic-busulfan, N2 mustard simulator-duplicat geometry of therapy machine

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fetus sensitive-w8-15

radioisotope/radiation-use craniospinal-medulloblastoma e–-ca skin P32-Polycythemia

Abbreviations a-artery, AA-amino acid, abtc-antibiotic, AI-autoimmune bef-before, bel-below, b/l-bilateral, bld-blood, b/n-between, bn-benign, br-branch, Bx-biopsy ca-carcinoma, carb-carbohydrate, c/i-contraindication, c/l-contralateral, conc-concentration, cong-congenital, Cx-cervix d-day, def-deficient, ds-disease, d/t-due to, Dx-diagnosis E-estrogen fem-female, fr-from gld-gland, glu-glucose h-hormone idiop-idiopathic, i/l-ipsilateral, inf-infection, inj-injury lig-ligament, LL-lower limb, l/t-leading to m-muscle, maj-major, mal-male, MC-most common, met-metastasis, min-minor, mtx-methotrexate, Mx-management n-nerve, norm-normal P-progesterone, pl-plasma, prot-protein, pt-patient Rx-treatment SCC-squamous cell carcinoma, sr-serum, Sx-surgery, sz-seizure tm-tumour, ts-tissue UL-upper limb, u/l-unilateral vag-vagina, VC-vocal cord, vel-velocity, vert-vertebra, vit-vitamin, vol-volume w-week, wt-weight Xr-X ray y-year #-fracture °-degree

THESE NOTES ARE ONLY FOR THE PURPOSE OF GUIDANCE AND HELP TO PG ASPIRANTS, NOT FOR COMMERCIAL OR OTHER PURPOSE. REFERENCE HAS BEEN TAKEN FROM VARIOUS STANDARD TEXTBOOKS.

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