basic radiology points for homeo pathy
TRANSCRIPT
Ideal diagnostics
Tip of Iceberg
Ideal diagnostics
Diagnostic Investigations
Is investigations necessary ?
Only Clinical Evaluation = Management Is it Possible ?
Ideal diagnostics
TEAM EFFORT {Diagnostician & Therapeutician}
CONFIRMATORY DIAGNOSIS { INVESTIGATIONS}
TREATMENTMANAGEMENT
CLINICAL DIAGNOSIS{ PROVISIONAL DIAGNOSIS}
Ideal diagnostics
Diagnostic Need ??
DIAGNOSTICIAN{ RADIOLOGY / LABORATORY/
DOCTOR
PATIENT
NATUROPATHY
UNANIAYURVEDA
& SIDDHA
HOMEO
ALLOPATHY
FINALFINALDIAGNOSISDIAGNOSIS
Ideal diagnostics
Ideal diagnostics
Central Point
RADIOLOGY/ OTHER INVESTIGATIONS
ModernMedicine Ayush Naturopathy
Ideal diagnostics
Importance of Confirmatory Diagnosis
To Choose / Plan Appropriate method of Management
To initiate Early Treatment
To avoid late Complications
For Medico-legal Overcome
For Future Follow-up
Ideal diagnostics
Investigations
Radiology Lab Tests / Pathology - For all Systems Cardiac – ECG / Treadmill/ ECHO/ ANGIO Neuro- EEG/ ENMG Audiogram - ENT Bone densitometer- BONE Spirometry – Lung Capacity Endoscopy – Any Luminal Structure
Today ours focus is 1] What investigations to do ?
2] How to Write test ? View …
3] How to Read the Reports & Images ?
4] What to do Next ?
5] Follow-up tests needed or not ?
What investigations required for?
Headache : Skull X-Ray ; PNS ; CT Scan Giddiness : Audiometry ; C.Spine x-ray;
Carotid doppler Sinusitis : X-Ray PNS; CT Scan Stridor & URI in Children: X-ray adenoid Cough ; LRI : Chest X-Ray Dyspnea: ECG; PFT Dysphagia: Barium Swallow x-ray
Tests needed are Breast Swelling : USG Breast; X-Ray breast Neck Pain: C-Spine x-ray Shoulder Pain: C-Spine X-Ray & X-Ray
shoulder Restricted shoulder movements: X-Ray &
USG Scan Abd Pain; Dyspepsia;Vomiting;Bowel
disturbances : USG Scan; Barium; endoscopy
Nedded tests are Colicky pain abd: USG Scan; Urine R/E; Menstrual complaints: USG Scan; Male Infertility: Doppler Scrotum; Semen
test Femal Infertility: USG Scan;Follicular study;
HSG Erectile Dysfunction: Penile Doppler Leg swelling & Pain: Doppler limbs Numbness legs; DM : Limb arterial doppler
Symptoms based tests: Fits : EEG ; CT Scan; MRI Scan Backache: USG abd; X-Ray SPINE;MRI Occupational dyspnea: PFT Cancer Work-Up : PET Scan Neck Swelling : TFT ; USG Thyroid
RADIOLOGY
NUCLEARMEDICINE
RADIO-THERAPY
RADIO-DIAGNOSIS
Ideal diagnostics
Radiology Sub-divisions { RADIO-DIAGNOSIS}
X-Ray - Head; Neck; Chest ; Bones & Joints Ultrasound Scan - Abdomen; Pelvis;
Scrotum;Breast;Thyroid;Soft tissue lesions Colour Doppler Scan – Vascular Study CT Scan- Head; Neck; Chest;Spine& Joints MRI Scan- Brain;Spine;Joints PET Scan-{ Anatomy & Physiology} Neoplasms Workup INTERVENTIONAL Radiology – Vascular & Non-vascular
Chocolate Cyst Ovary
TB LUNGS
Meningioma
Radiology
Ideal diagnostics
Case Scenario : 1 40 yrs old male with acute onset of Pain Lt
shoulder with restricted movements following history of fall…
Could it be fracture ? Muscle tear ?? First to R/O Serious one fracture.. X-Ray Lt Shoulder what view? AP View… Normal What next?
X-Ray Left Shoulder AP View
Look for Bony Parts
Joint Space
Dislocation
Fracture
ULTRASOUND LT SHOULDER Muscular / Tendinous
Tear { Complete / Partial}
Tendinitis
Joint Effusion
Soft tissue swelling
MRI SCAN LEFT SHOULDER Confirmation of earlier
findings
Articular Cartilage / Ligamentous injury
Soft tissue details
Case Scenario : 2 Elderly male { 75 yrs } with C/O Chronic
Cough; Weight loss & Hemoptysis TB ? Neoplastic ?? Without diagnosis Symptomatic management
??? Advised Cheap & easily available test Chest X-Ray ; Which view PA View
Chest X-Ray PA View Right Lung Opacity Vessel ? LN?? Mass?
CT SCAN CHEST { HRCT} Mediastinal Window /
Lung Window
With or Without Contrast
Imagingwise looks like mass lesion
PET CT { Whole body} To Know the lesion
either as active / inactive
Spread to rest of the lung & rest of the body
Costlier & harmful
Ideal diagnostics
How to Write tests:
Positional Views
A P view
P A view
LATERAL view OBLIQUE view SPECIAL views { water’s view, axial view,lordotic
view ,skyline view, OPG, Mammogram}
Views The body Part closer to Cassette is area of
interest – denominated as second letter PA Means : “A”{ANTERIOR} Close to
Casette ; Area of Interest
How to read reports & Images
RADIOLOGY X-Ray { Conventional & Contrast } USG Scan Doppler Scan CT Scan MRI Scan PET Scan
Ideal diagnostics
X- Ray History X-Ray is Electromagnetic Ionic Radiation X-Ray is Produced from “X-Ray tube” First Invented by Wilhelm Roentgen in nov 8th
1895 X-Rays Captured by Photoelectric Plates / CR
Plates Images Developed by Darkroom Technique / CR
Technique X-Ray energy emission measured as mSv/ mGy
Ideal diagnostics
Formation of X-Rays
Ideal diagnostics
X-Ray Taking
Ideal diagnostics
Analogue CR X-ray
Ideal diagnostics
Significance of CR X-rays Digital form- Images so easily transferable
No Chemical used
Better Resolution- better image
Storage for longer time
Costlier
How to read Reports & Images:
X- Ray Terminology
Radio-opaque ; Opacity Radio-lucent Hyperlucency / Hypolucency Osteopenia / Osteoporosis Hyperostosis Spondylosis / Spondylolisthesis / Spondylitis Cartilage / Articular Surface
Ideal diagnostics
Ultrasound Terminology Echogenicity: [a] Iso-echoic = Same echoes as
Comparative structure [b] Hypo-echoic = Low-echoic = Sonolucent =
Sonopoor= echopoor [c] Hyper-echoic= Echogenic=echodense [d] Mixed echoic [e] Post-acoustic shadow / Post-acoustic
enhancement [f] Anechoic = echo-dropout [g] Valsalva manoeure [h] Compressibility
CT SCAN TERMINOLOGY
Hounsfield units ; Bone –Higher HU Density { iso ; hypo & Hyper} Plain { NECT} & Contrast { CECT} Contrast Dye : Ionic { Urovideo} Non-ionic { Iohexol}
Ideal diagnostics
X-Ray Bones
Bone Mineralization
Length & Width
Fracture
Tumour
Ideal diagnostics
osteopenia
Senility
Vit.D Deficiency
Hypo-parathyroidism
Hypocalcemia & Hypophosphatasia
HYPEROSTOSIS1. HYPERCALCEMIA STATE2. FLUOROSIS
Ideal diagnostics
LYTIC AREAS1. INFECTIVE2. PROLIFERATIVE DISORDER3. NEOPLASTIC
Ideal diagnostics
BLASTIC LESIONS
1. BENIGN OSTEOMA
2. NEOPLASTIC
3. SECONDARIES
Ideal diagnostics
FRACTURE Complete / Greenstick
With / without Displacement
Ideal diagnostics
X-Ray Skull
AP View Lateral View
X-Ray Skull
Ideal diagnostics
Ideal diagnostics
sella
mastoid
Ideal diagnostics
X-Ray Neck – Soft tissues
PNS
Ideal diagnostics
Ideal diagnostics
x-ray Nasopharynx
Ideal diagnostics
XX--RAY CHESTRAY CHEST
NUTSHELLNUTSHELL::
The Only Diagnostic Investigation nearly The Only Diagnostic Investigation nearly
Needed by all the Medical PractitionersNeeded by all the Medical Practitioners
{ { All Medical SubAll Medical Sub--specialitiesspecialities & Surgical & Surgical SpecialitiesSpecialities as Preas Pre--Operative Operative WorkWork--up} up}
Ideal diagnostics
Ideal diagnostics
Why CXR Important
Two Vital Organs Heart and LungsTwo Vital Organs Heart and Lungs
Ideal diagnostics
Indications for AP View
1.1. Pediatric age GroupPediatric age Group2.2. Bed ridden PatientsBed ridden Patients3.3. Bony [rib] FractureBony [rib] Fracture
Decubitus View for Minimal Pleural Decubitus View for Minimal Pleural effusionseffusions
Ideal diagnostics
X-RAY REPORTING
1.1. TRACHEATRACHEA2.2. CARDIAC CARDIAC
SHILHOUTTESHILHOUTTE3.3. CTRCTR4.4. HILAR REGIONSHILAR REGIONS5.5. COSTO-COSTO-
PHRENIC PHRENIC ANGLESANGLES
6.6. LUNG FIELDSLUNG FIELDS7.7. CHEST WALLCHEST WALL
Ideal diagnostics
Ideal diagnostics
Ideal X-Ray
1.1. Vertebral Column Should be Vertebral Column Should be VisibleVisible
2.2. Equal Sterno-Clavicular distanceEqual Sterno-Clavicular distance
Ideal diagnostics
2 Vital Organs
Ideal diagnostics
Ideal diagnostics
Physiological Variations
Ideal diagnostics
AGE RELATED CHANGES
AORTIC KNUCKLEAORTIC KNUCKLE COSTO-CHONDRAL CALCIFICATIONSCOSTO-CHONDRAL CALCIFICATIONS THYMIC SHADOWTHYMIC SHADOW
Ideal diagnostics
Aortic Knuckle
Ideal diagnostics
Thymus
Ideal diagnostics
Rib Calcifications
Ideal diagnostics
LOBAR & SEGMENTAL ANATOMY
RIGHT LUNGLOBES
[1] UPPER LOBE [a] APICAL [b] ANTERIOR [c] POSTERIOR [2] MIDDLE LOBE [a] MEDIAL [b] LATERAL [3] LOWER [BASAL] LOBE [a] APICAL [b] MEDIAL [c] ANTERIOR [d] LATERAL [e] POSTERIOR FISSURES MAJOR [OBLIQUE] MINOR [ HORIZONTAL]
LEFT LUNGLOBES
[1] UPPER LOBE [a] APICO-POSTERIOR [ b] ANTERIOR [c] SUPERIOR LINGULAR [d] INFERIOR LINGULAR [2] LOWER LOBE [a] APICAL [b] ANTERIOR [c] LATERAL [d] POSTERIOR FISSURES MAJOR FISSURE
Lung Segments
Ideal diagnostics
Appearance of Pathologies
Ideal diagnostics
Lt Pleural Effusion
PLEURAL EFFUSION
Ideal diagnostics
Ideal diagnostics
Raised Diaphragm
Ideal diagnostics
CTR
CARDIAC SHILHOUTTE
BORDERAPEX
Cardiomegaly
Ideal diagnostics
Lung Parenchyma
FOCAL LESIONSCOLLAPSE
CONSOLIDATIONMASS LESIONS
DIFFUSE LESIONSILD
Ideal diagnostics
FOCAL MASS LESIONS
BENIGN CYSTIC LESIONBENIGN SOLID LESION
MALIGNANT
Ideal diagnostics
COLLAPSE
FINDINGS VOLUME REDUCTION AIR REPLACEMENT TYPES ACTIVE [External Communication
Patent] PASSIVE
Ideal diagnostics
CONSOLIDATION
AIR REPLACEMENT BY FLUIDPRESERVATION OF VOLUME
PATENT BRONCHI
Ideal diagnostics
Ideal diagnostics
DIFFUSE LUNG LESIONS
• BRONCHO-PULMONARY :
MULTIPLE FOCAL LESIONS
• INTERSTITIAL LUNG OPACITY :
Ideal diagnostics
MULTI-FOCAL LESIONS
> PATCHY > PATCHY CONSOLIDATIOCONSOLIDATIONSNS
> MILIARY TB> MILIARY TB
> METASTASES> METASTASES
Ideal diagnostics
MASS LESION
MEDIASTINAL / PULMONARYCENTRAL / PERIPHERAL
EXTRA-PULMONARYPLEURAL / CHEST WALL
Lung Mass
Ideal diagnostics
PLEURAL PATHOLOGIESEFFUSION
PNEUMOTHORAXMASS LESION
Ideal diagnostics
Rt Pleural Effusion
Hydro-Pneumothorax
Ideal diagnostics
Ideal diagnostics
CONCLUSION
= PRACTICALLY WE ARE GETTING MIXED OF THE ABOVE SAID FINDINGS
= CHEST X-RAY IS THE ONE DIFFICULT TO INTERPRET IN COMPARED TO CT CHEST
= WE AS RADIOLOGISTS READY TO HELP YOU ATLEAST IN SMALL WAY
Ideal diagnostics
ABDOMEN X- RAY
Supine AP
Erect AP
KUB
ABDOMEN X-RAY
Ideal diagnostics
LEFT RENAL CALCULUS
Ideal diagnostics
LEFT RENAL CALCULUS
Pelvic X- Ray
Ideal diagnostics
Ideal diagnostics
Spinous Pathology
Lumbar Spine Cervical Spine Sacral Spine Dorsal Spine Whole Spine
Ideal diagnostics
Parts of Vertebra
Body Endplates Pedicles Lamina Transverse Process Spinous Process
Ideal diagnostics
Spinal Internal Joints
Facet Joints Disco-vertebral joints
Ideal diagnostics
External Joints
Atlanto-Occipital Joint Costo-vertebral joints Sacro-iliac joints
Ideal diagnostics
Cervical Spine
Typical Vertebrae- Body ; Pedicle; [Vertebral foramen +] Neural arch & Spinous Process
. Atypical Vertebrae- 1. Atlas 2. Axis 3. Long Spinous Process C 7
Ideal diagnostics
Dorsal Spine
12 pairs of ribs Costo-Vertebral Joints Relative Immobility
Ideal diagnostics
Spinal Measurements
Measurements: Vertebral Height Disc space width Spinal Canal diameter Inter-pedicular distance [ Lumbar]
Ideal diagnostics
Sacral Pieces
S1 – S5 C1- C3 [ C 5]
Ideal diagnostics
Normal Cervical Spine
Short Neck Long Neck
Ideal diagnostics
Spondylosis
Ideal diagnostics
Cervical to CoccyxSpinal Curvatures : Lordosis Scoliosis
Ideal diagnostics
Lumbar Spondylosis
Narrow Disc Space Marginal Osteophytes
Ideal diagnostics
LS Spine – AP View Pedicles Inter-Pedicular Distance
Ideal diagnostics
EXTREMITIES { APPENDAGES}
SHOULDER & ARM ELBOW & FOREARM WRIST & HAND HIP JOINT & THIGH KNEE JOINT & LEG ANKLE JOINT & FOOT
Ideal diagnostics
X-Ray Shoulder
Arthritis
Ideal diagnostics
Shoulder Dislocation
Ideal diagnostics
X-Ray Knee Joint
Ideal diagnostics
OA KNEE
Ideal diagnostics
Patellar Fracture
Ideal diagnostics
OA KNEE
Ideal diagnostics
ARTHRITIS KNEE
Ideal diagnostics
Is it Harmful ? X-Ray ; CT Scan & PET CT are harmful “Ionic Radiation” 1 Chest X-Ray Producing 0.01 – 0.15 mGy 1 CT Scan = 10- 20 mGy Accepted Background Radiation is 2.4 mGy/y { 1 dental x-ray = 1 day BG Radiation 1 CXR = 10 days BG Radiation 1 Chest/ AB CT = 2-3 yrs BG Radiation}
Usefulness > harmness
Prior Preparations
For Abdomen & X-Ray KUB Prior 2 days Bowel laxative with empty
Stomach. For Contrast Studies Empty Stomach
ULTRASOUND { USG SCAN} Being used Since 1950 Sound Frequency : 20- 20,000 Hz Ultrasound Probes { Convex; TVS; High
Frequency ; 4 D Probe; endocavitary} B-Mode; M-Mode;CFI;Spectral doppler Piezo-electric Crystals Harmless; easily availability; Cheaper;
Portable ALARA { As low as reasonable acceptable}
Ideal diagnostics
Ultrasound Terminology Echogenicity: [a] Iso-echoic = Same echoes as
Comparative structure [b] Hypo-echoic = Low-echoic = Sonolucent =
Sonopoor= echopoor [c] Hyper-echoic= Echogenic=echodense [d] Mixed echoic [e] Post-acoustic shadow / Post-acoustic
enhancement [f] Anechoic = echo-dropout [g] Valsalva manoeure [h] Compressibility
Ideal diagnostics
ULTRASOUND MACHINE
Ideal diagnostics
Portable USG Machine
Ideal diagnostics
ULTRASOUND PROBES
Ideal diagnostics
Cirrhosis Liver
Ideal diagnostics
Liver Hemangioma
Ideal diagnostics
Liver Abscess
Cholelithiases
Ideal diagnostics
RENAL CALCULUS
Ideal diagnostics
Vesical Calculus
Ideal diagnostics
Intra-vesical Ureterocele
Ideal diagnostics
PROSTATOMEGALY
BPH Vs CA
Ideal diagnostics
Catheter in Bladder
Ideal diagnostics
USG SCAN
Appendicitis
UTERINE FIBROIDS
Ideal diagnostics
Endometrial Hyperplasia
PCOD
Ovarian Cyst
Ideal diagnostics
Worm Infestation
Small Parts Scan Thyroid Pathologies Thyroiditis Solitary Nodule MNG Mass Lesion
Small Parts ScanBREAST { Sono-mammogram} Fibro-adenosis Fibro-adenoma Abscess Malignancy
Breast Malignancy
Small Parts Scan Scrotum: Hydrocele Varicocele Torsion Epididymo-Orchitis Mass lesion
Ideal diagnostics
Scrotal Varicocele
Valsalva Resting
Doppler Scan To Find-out Vascular Pathology { either
arterial / Venous} Color Flow Imaging / Spectral Doppler PSV ; EDV ; STENOSIS % DVT Varicose Veins
Arterial Stenosis
3 D/ 4 D SCAN
Prior Preparation
Overnight Fasting
Full Bladder
Menses – not a contraindication for scanning
Lower limb doppler – Concerned dresses
Ideal diagnostics
1. SPIRAL CT SCAN2. MULTI- SLICE CT { single, 4 slice, 16 slice, 64
slice, 128 slice }3. CARDIAC CT4. MAIN USEFULNESS IN HEAD: NECK:
CHEST: ABDOMEN: EATREMITIES
CT SCAN HISTORY
CT SCAN TERMINOLOGY
Hounsfield units Density { iso ; hypo & Hyper} Plain { NECT} & Contrast { CECT} Contrast Dye : Ionic { Urovideo} Non-ionic { Iohexol}
Ideal diagnostics
CT SCAN CONSOLE
Ideal diagnostics
CT SCAN HEAD { Brain}
Ideal diagnostics
CT BRAIN { Plain }
Ideal diagnostics
CT { Plain & Contrast } NECT & CECT
Ideal diagnostics
X-RAY Vs CT
• EXPOSURE• TIMING• PREPARATION• AVIALABILITY• MOBILITY• BASIC INVESTIGATION IN
RADILOGY
Ideal diagnostics
MRI TERMINOLOGY
Intensity { iso ; hyper & hypo}MAGNETS { Superconducting}TESLA UNITS { 0.2 – 3.0 T}
COILSCLAUSTROPHOBIA
PACEMAKER; IMPLANTS INCOMPATIBLECOSTLIER
MRA ; MRS ; FUNCTIONAL MRI
Ideal diagnostics
MRI SCAN
MRI SCAN MAGNETS: Superconducting magnet Units : Tesla { 0.2 to 3.0 T} T1 ; T2 ; FLAIR ; MRS ; MRA ; f MRI Contraindicated : Pacemaker ; Cochlear
implants Claustrophobia
Ideal diagnostics
MRI BRAIN { Plain & Contrast }
MRI Spine
Ideal diagnostics
PET CT SCAN
Combined CT Scan & SPECT Scan
Functional characters assessed
Costlier
Mainly used in Cancer Follow-ups
Ideal diagnostics
PET SCAN BRAIN
Ideal diagnostics
Wholebody Pet Scan
Ideal diagnostics
PET BRAIN
Therapeutic Radiology Drainage of Abscess or collection Guided FNAC Selective Reduction in Twins Angioplasty with Stent Coiling or Glue apply in Aneurysm
Ideal diagnostics
60 yrs old Post menopausal woman with C/O Bleeding PV
Clinical exam; Speculum examination Next ..
Ideal diagnostics
Case Scenario : 3
Ultrasound Scan Pelvis Bulky Uterus Fibroid with
Endometrial Thickening
Post menopausal EM- > 4 mm
HPE
Ideal diagnostics
MRI PELVIS Extent of EM
EM- Myometrial distinction
Parametrial invasion
Local MetastasesIdeal diagnostics
Case Scenario : 4 30 yrs female with Colicky abdominal Pain in
Right sided abdomen ? Ureteric Colic ? Appendix ? Ovarian ?? Cholelithiases Symptomatic Tx.
Ideal diagnostics
USG ABDOMEN Renal
Hydronephrosis Ureter is dilated Not traceable
Ideal diagnostics
X-Ray KUB Size & Site of
Calculus Number of Calculus Radiolucent ?
Ideal diagnostics
SPIRAL CT SCAN KUB Exact size & site Asso. Complications
Ideal diagnostics
Case Scenario: 5 Middle aged male with fever; Chronic
Cough; loss of appetite ; loss of weight High ESR ; Raised Lymphocytes
Ideal diagnostics
CHEST X-RAY PA VIEW
Ideal diagnostics
Ideal diagnostics
Topic Specific
PCOD
Enlarged Ovaries Peripherally arranged
Small cystic structures Central cyst free
stroma
EM Thickening
Fibroid Uterus Common in Middle
aged females Nulliparous 3 Types SM –type = Bleeding Major decision upto
Menopause
Ovarian Cyst
Benign Vs Malignant
Functional
Fibro-adenoma Breast
Fibroadenosis Vs Fibroadenoma Vs Ca Quadrants Clock Positions Sonomammogram Vs X-Ray mammogram
Follicular Study { Ovulation } Basal Scan on 2nd Day
of menses Next Scan On 10th day Follicle matures at a
rate of 1-2 mm / day Maximum size
expectation 20-25 mm Size reduction with FF
& em thickening HSG Next
Calculous Disease Urolithiases :
4 Types calculi
Common sites of Ureteric narrowings – PU Jn; iliac vessel crossing; Pelvic brim;VU Jn
GB Calculi
2 Types:
Mobile / fixed
Obstructed / Non obstructed
Asso. Cholecystitis
Thyroid
Thyroiditis
Solitary nodule MNG
CA Thyroid
FNAC
Feedback 1] Common Chest X-Ray View ?
2] Term used in CT & MRI ?
3] USG Scan harmful ?
4] Koch’s Preferred site in Lung ?
5] Shoulder pain next to X-Ray what ?
Takehome message… Please use Diagnostic modalities to arrive at a
Proper diagnosis before Start of treatment Common X-Rays are: Chest X-Ray PA View X-Ray PNS for Sinuses X-Ray Spine AP & Lateral Views for Backache
. USG Scan abdomen for Renal Calculus / Uterine Fibroids
Takehome message… HRCT Scan for Head & Chest HFU Scan for Thyroid ; Breast ; Scrotum and
any swelling MRI Scan for Head; Neck ; Spine & Joints PET Scan for Activity of the lesion and whole
body Spread If any doubt, please don’t hesitate to call me 94472 77746
Significance of RADIOLOGY Ever expanding , Fascinating diagnostic
Modality Proper & Judicious use of Radiology for
arrive at a diagnosis DON’T Lag behind your allopathic
Colleagues Keep update yourself