Radiology

tadio Physics & Nuclear Medicim

1. X-ray are extranuclear in origin.
2. All electromagnetic waves have same velocity and frequency
3. PACS is acronym for picture archiving & communication System
4. The amount of radiation absorbed is measured by RAD in conv. Unit/ Gray in
SI unit.
5. Most radiosensitive phase of cell cycle is G2m
6. Ionization radiation acts on tissue leading to excitation of electron from
orbit
7. Functional basis of ionizing radiation depends on removal of orbital electron
8. X-ray are produced when electron beam strikes the anode
9. Most common used rays for radiotherapy is X- rays
10. Whole body electron therapy is used in the treatment of Mycosis fungoides
11. 1 Gray equals 100 rad
12. Curie is unit of Radioactivity
13. Contrasts used in USG is sonoview
14. USG uses Piezoelectric crystals
15. Acoustic shadow in USG is due to reflection
16. USG frequency used for diagnostic purpose is 1-20 MHz
The intensity of color in Doppler is determined by velocity of flow
17. Color Doppler is used in diagnosis of peripheral vascular disease and deep
vein thrombosis
18. The ultrasound probe is made up of PZT
19. Ultrasound is the most practical technique to detect retinal detachment
20. The method of choice to determine thyroid size accurately is USG
21. Most sensitive test for Ductal carcinoma in situ is MRI
22. Ultrasound waves are poorly transmitted through lungs
23. Bile is not echogenic on USG
24. In case of stenotic valvular lesions the outflow tract pressure gradient can
be best estimated by Doppler ultrasonography
25. Duplex ultrasonography combines B-mode imaging and pulse-wave Doppler
examination
26. On USG diffuse thickening of gall bladder with hyperechoic shadow at neck
and 'comet tailing is seen in adenomyomatosis
27. The procedure of choice to confirm the presence of perirenal collections of
urine, blood, or lymph in a transplanted kidney is USG
28. Ultrasound is investigation of choice for CHPS
29. Hounsfield Unit depends on Linear Attenuation coefficient
30. Coronal CT sections can be most useful for assessing Sinonasal diseases
31. Calcification of posterior spinal ligament is best diagnosed by CT
32. Thin - One mm slices are taken in HRCT
33. Noncontrast spiral CT is investigation of choice for Hangman's fracture
34. Solitary pulmonary nodule can be seen with HRCT
35. Investigation of choice for interstitial lung disease is HRCT
36. Best investigation to detect intra-articular osteochondral fracture fragments
is MRI
37. The most sensitive investigation to detect obscure fractures of cervical
spine is the Helical CT
38. HRCT can be extremely useful in determining the integrity of ossicular chain
39. CT scan is least accurate in the diagnosis of stone in common bile duct
40. CT scan room is shielded by lead
41. Fine Bone abnormalities are best seen with CT
42. Investigation of choice for fractures involving sacroiliac joints is CT
43. Attenuation value of <0 on CT is seen in Fat, Air
44. High resolution CT of lung is a specialized CT technique for greater detail of
lung parenchyma and it utilizes bone algorithm for image reconstruction
45. Slice of tissue x ray is tomography
46. HRCT is ideal modality for evaluating interstitial lung disease
47. Single most important advantage of MRI is high contrast resolution
48. MRI is vastly superior to CT in evaluating intracranial posterior fossa tumors
as CT scanning is frequently hampered by Beam-hardening artifacts
49. MRI is contraindicated in patients with metallic foreign body in eye
50. CSF on MRI scan appears hypointense on T1 weighted image and
hyperintense on T2 weighted image
51. Cardiac pacemaker is a contraindication for MRI
52. Contrast agent used for MRI is GD DTPA
53. Mucocele are bright on Tl-MRI and T2-MRI
54. NMR is based on principle of proton beam
55. In MRI images are produced due to H+
56. In MRI the field used is 0.2-3 tesla
57. Metallic foreign body in eye can be detected by X-ray
58. MRI is better than CT scan to detect lesions located in extremity
59. In cerebral angiography the dye is injected through femoral artery
60. Inferior mesenteric artery is dissected most frequently following
arteriography by femoral route
61. Gadolinium is non iodinated
62. Osmolar contrast agents may be ionic or non ionic
63. Contrast media of choice for myelogram is lohexoi
64. Most common complication of myelography is Headache.
65. Lower osmolar contrast is preferred in a patient with decreased renal
function to avoid contrast nephropathy
66. Motor mechanism of gall bladder is not required for visualization of gall
bladder in OCG.
67. Maximum dose of radiation per year in a human which is safe is 5 rad
68. Maximum permissible radiation dose in pregnancy is 0.5 rad
69. Most sensitive tissue to radiation is Bone marrow
70. The cell most sensitive to RT is lymphocyte
71. The radiation tolerance of whole liver is 40 Gy
72. Most sensitive structure in cell for radiotherapy is DNA
73. Cartilage is radioresistant
74. Hypoxia cause cell to become more radioresistant
75. Radiation therapy to hypoxia tissue may be potentiated by the treatment
with metronidazole
76. Radio protective drug is Amifostine
77. Most common hormone deficiency seen after intracranial radiation therapy
is Growth hormone
78. MC cancer due to radiation is Leukemia
79. Most common presentation of radiation carditis is pericardial effusion
80. Most common skin manifestation seen after 2 days of RT is erythema
81. Gamma camera in nuclear medicine is used for measuring the radioactivity
82. Tc-99 is derived from Mo-99
83. In radionuclide imaging the most useful radiopharmaceutical for skeletal
imaging is Tc 99 MDP
84. Best investigation for bone metastasis is bone scan
85. Double density sign is osteoid osteoma
86. Distribution of functional renal tissue is seen by DMSA
87. Impaired renal function is assessed by MAG3Tc99
88. Renal GFR is best measured by Tc99 DTPA
89. Best imaging modality for neuroendocrine tumors is radionuclide scan
90. Sestamibi scan is used in parathyroid adenoma
91. Investigation of choice for locating parathyroid adenoma is Tc thallium
subtraction scan
92. Isotope for thyroid scanning is 1123, Tc 99
93. Amount of 1311 used for thyroid scan is 50 microcurie
94. Hot spot in acute Ml is seen in Tc 99 strontium pyrophosphate
95. Thallium scan is performed to detect reversible myocardial ischemia
96. Multiple gated radionuclide cardiac MUGA scan is used for testing
ventricular function
97. Acute myocardial infarct scintigraphy is done with Tc stannous
pyrophosphate
98. To visualize vascular sling causing tracheal/external airway compression
MRI would be preferred.
99. Drug used to perform stress echo is Dobutamine
100. The most recent advance in noninvasive cardiac output monitoring is use of
electrical impedance cardiography technology
101. Tc labeled RBC are used for splenic disease
102. In pancreatic scanning radioisotope used is Se 75
103. Commonly used agent for liver nuclear scan is 99mtc-sulfur colloid
104. Gastroparesis is most commonly diagnosed with Scintigraphic scan
105. Agent of choice for Meckel's diverticulum is 99mtc-Pertechnate
106. Hampton hump is a feature of pulmonary embolism
107. Best method to diagnose pulmonary embolism is CT Pulmonary.
Angiography.
108. Gold standard for diagnosing pulmonary embolism is angiography
109. PET is best for differentiating recurrence of brain tumour from radiation
necrosis
110. Transfemoral route is the most preferred route to perform cerebral
angiography
111. Warthin tumour adenolymphoma shows a hot spot on pertechnetate scan
112. Panda sign is seen in Sarcoidosis on Gallium scan
113. Nuclear agent used for sarcoidosis is Gallium 67

CNS

1. Hyperintense corticospinal tracts on T2 W MRI is seen in Amyotrophic

lateral sclerosis
2. The MR imaging in multiple sclerosis will show lesions in White matter
3. Extensive involvement of deep white matter with bilateral hyperdense
thalamus on noncontrast CT scan of brain is virtually diagnostic of Krabbe's
disease
4. Investigation that should not be done in patient with brain tumours, is
lumber puncture
5. "Face of giant panda" sign on MRI brain is seen in Wilson's disease
6. Eye of tiger" sign on brain MRI is characteristic of Hallervorden-Spatz
Disease
7. Basal exudates, infarcts and hydrocephalus on computed tomography are
seen in Tuberculous meningitis
8. Abnormal signals in bilateral thalami on MRI brain is seen in Japanese
encephalitis
9. Meningioma shows calcification on CT scan
10. Periventricular calcification is often due to Cytomegalic infection
11. Intracranial calcification with cystic lesion in plain x-ray skull is seen in
Craniopharyngioma
12. Suprasellar calcification is characteristic of Craniopharyngioma
13. Commonest calcifying brain tumour in child is Craniopharyngioma
14. Tumour associated with extracranial spread is medulloblastoma
15. Pituitary adenoma is highly vascular in nature
16. "Ice-cream cone" sign on MRI brain is seen in acoustic neuroma
17. Corpus callosum lesions are characteristically seen in the Butterfly
conditions
18. Epidermoid can be differentiated from arachnoid cyst on MRI by restricted
diffusion on DWI
19. Wide neural foramina is associated with neurofibromatosis 1
20. MRI/CT appearance of lateral meningocele is widened neural foramen
21. Mesencephalon-oculo-facial- angiomatosis is seen in Wyburn Masson
syndrome
22. Tram track appearance on CT scan of head is seen in Sturge Weber
syndrome
23. IOC for temporal bone injury is CT
24. Subdural hematoma most commonly results from injury to cortical bridging
veins
25. Characteristic of subdural hematoma is concavo-convex hyper density
26. Crescent shaped hyperdense lesion is a classical CT appearance of acute
subdural hematoma
27. IOC for diagnosis of acute sub arachnoid hemorrhage is CT scan
28. Hyper dense biconvex appearance on cranial CT scan is seen in EDH
29. The 1st IOC in patient with suspected SAH should be NCCT
30. Best test to determine etiology of SAH is Intra-arterial digital subtraction
angiography
31. Investigation of choice for diffuse axonal injury is MRI
32. 'Tear-drop' appearance on PNS x-ray is seen in fracture floor of the orbit
33. The 'Light-bulb' sign on DWMRI is hyperacute stroke
34. The most definitive test for identifying intracranial aneurysms is Cerebral
angiography
35. Premature closure of coronal, sagittal, and lambdoid sutures results in
Oxycephaly
36. Raised intracranial tension in adults is seen as erosion of dorsum sella
37. MRI finding of cavernous angioma is Popcorn like pattern

Chest

1. In Chest X-ray 40% lung tissue is obscured by bony structure and

mediastinum
2. Lt sided cardiac bulge on chest x-ray is due to enlargement of left atrial
appendage
3. Structure forming right border of heart is SVC,IVC. RA
4. Base of heart is formed by RA+LA
5. Middle lobe collapse is best seen in Lordotic view of chest x-ray
6. All show miliary shadow on CX ray except Staphylococcal pneumonia.
7. Bulging fissure in lungs is seen in Klebsiella pneumonia
8. Hyperinflation of lung in CX ray is seen in congenital lobar emphysema
9. Linear air fluid level is a feature of hydropneumothorax
10. Deep sulcus sign is a feature of pneumothorax
11. Minimal amount of fluid which is required for detection on chest x-ray is
150 - 200ml
12. Stratosphere sign on M mode USG is seen in pneumothorax
13. Floating water lily sign is a feature of lung hydatid
14. Water lily sign is seen in chest x-ray of Echinococcus
15. Extensive pleural thickening and calcification especially involving the
diaphragmatic pleura are classical features of Asbestosis
16. Obliteration of left cardiac shadow on PA view is due to lingular lesion
17. If the right cardiac silhouette is obliterated, it means the pathology involves
Rt middle lobe

Cardiology

1. Left ventricular enlargement is more specific of MR than MS

2. Posterior marking on Ba column in Ba swallow study is caused by aberrant
right subclavian artery
3. CXR picture in CCF are Cardiomegaly, Thick interlobar septum
4. Pruning of pulmonary arteries is seen in pulmonary hypertension
5. Earliest feature of pulmonary venous hypertension is upper lobe diversion
of vessels
6. Characteristic X-ray finding in ASD is pulmonary plethora
7. X-ray picture of VSD are dilated Lt atrium and dilated pulmonary veins
8. Calcification of ascending aorta is virtually diagnostic of aortitis on chest
X-ray

Sign in Cardio Respiration Diseases

1. Kerly B lines seen in mitral stenosis and lymphangitis carcinomatosa

2. Popcorn calcification is characteristically seen in pulmonary hamartoma
3. Spring water cyst is another name for pleuro-pericardial cyst
4. Coarctation of aorta causes rib notching on chest radiograph
5. Inferior rib notching is seen in coarctation of aorta (LQ)
6. In Tetralogy of Fallot, there is a coeur en sabot shape of heart is seen
7. Snowman appearance is seen in supra cardiactotal anomalous pulmonary
venous connection
8. Egg on side appearance is seen in uncorrected TGA
 Breast

1. Areas of spiculated microcalcifications on mammogram would suggest

malignancy
2. The sensitivity of mammography is low in young females because young
breast has dense tissue
3. Triple assessment for carcinoma breast includes clinical examination,
mammography and biopsy /cytology
4. The most sensitive investigation for DCIS of breast is MRI
5. BIRADS stand for Breast imaging reporting and data system
6. Screening modality of choice in lactating mother is USG

GIT

1. 'Cork-screw' esophagus is seen in diffuse esophageal spasm

2. Investigation of choice in diffuse esophageal spasm is barium examination
showing tertiary contractions
3. Gold standard investigation for GERD is 24-hour intragastric pH monitoring
4. Barium swallow is the investigation of choice for Zenker diverticulum
5. Investigation of choice for trachea-oesophagal fistula is X-ray
6. Bird beak appearance is seen in Aclasia cardia
7. Early gastric cancer generally indicates gastric adenocarcinoma confined to
the mucosa and submucosa
8. Gold standard investigation for recurrent gastrointestinal stromal tumour is
PET
9. Investigation of choice for small intestinal tumor is CT scan with contrast
10. In Crohn's disease, enteroenteric fistulas are commonly seen
11. Pneumoperitoneum can be best diagnosed by CT scan
12. Double bubble sign seen in duodenal atresia
13. Mucosal granularity is the earliest sign of ulcerative colitis on double contrast
barium enema (DCBE)
14. An important screening test for functional anorectal dysfunction is balloon
expulsion test
 15. Pudendal nerve terminal motor latency (PNTML) can best evaluate the
extent of the injury to the sphincter muscles in patients with incontinence
16. The most common facial abnormality in Gardner's syndrome is Multiple
osteomas
17. The best investigation to diagnose Hirschsprung's disease is rectal biopsy

Liver & Gall Bladder

1. Central dot' sign is Caroli's disease
2. Hyperechoic hepatic metastasis on USG is seen in Ca colon
3. Focal nodular hyperplasia can be diagnosed with high accuracy by using
nuclear imaging/ triphasic CT
4. Porcelain Gall bladder may be detected on the plain abdominal film and is a
premalignant condition
5. Thickened gall bladder in USG seen in acute cholecystitis.

Pancreas
1. Most worth investigation for detection of suspected pancreaticobiliary
worms is ERCP
2. Most sensitive investigation for identification of Insulinoma is intraoperative
ultrasound
3. The modality of choice for localizing both primary NETs and their metastases
is Somatostatin receptor scintigraphy
4. Investigation of choice to detect ruptured spleen is CT scan
5. Adrenals should always be imaged in a suspected case of bronchogenic
carcinoma
6. Sentinel loop sign is seen in acute pancreatitis
7. Colon cutoff sign is seen in acute pancreatitis
8. Widening of C loop of duodenum is a feature of pancreatic head growth
9. ERCP in pancreatitis is done to know about pancreatic divisum
 Abdominal Trauma

1. Investigation of choice for detecting minimal ascites is ultrasound

2. Investigation of choice for detecting minimal intraperitoneal free air is CT
scan

Sign & Facts GIT

1. Double bubble sign is seen in duodenal atresia
2. X ray feature of pyloric stenosis is single bubble appearance
3. Radiological sign of Crohn's disease is Cobblestone appearance
4. Lead pipe appearance is seen in ulcerative colitis
5. String of Kantor is seen in Crohn's disease
6. Soap bubble appearance is seen in meconium ileus
7. Radiological sign of ischemic colitis is thumb print appearance
8. String sign is suggestive of hypertrophic pyloric stenosis
9. Feathery appearance in jejunum is due to valvulae conniventes
10. X-ray appearance of CBD stone on cholangiography is meniscus
appearance
11. Chain of lake appearance in ERCP is seen in Chronic pancreatitis
12. Central dot sign is seen in Caroli's disease
13. Spongy appearance with central sunburst calcification is seen in serous
cystadenoma
14. Rim sign in IVP is seen in Hydronephrosis
15. Cobra head IS characteristic of. Ureterocele
16. B/L spider leg sign on IVP suggests Polycystic kidney disease

GUT
1. Rapid sequence excretory urography is used in suspected renovascular
hypertension
2. Non-visualization of kidney in excretory urogram is seen in renal vein
thrombosis
3. A dense nephrogram is obtained by rapid (bolus) injection of dye
4. In Nephro graphic phase of IVP, contrast is PCT
5. Hydronephrosis may be absent on ultrasound when obstruction is
associated with Staghorn calculi
6. 90 percent of urological stones are radiopaque
7. The Most Sensitive Imaging Modality for Diagnosing Ureteric Stones in A
Patient with Acute Renal Colic is non Contrast CT Scan of Abdomen
8. For renal stone, diagnosis is not done by MRI
9. Calcification is best detected by CT scan
10. IOC for bladder calculus is CT scan
11. Filarial dance sign is seen with Ultrasonography
12. Medullary cystic disease (MCD) can be best diagnosed by renal biopsy
13. Persistent fetal lobulation of kidney is because of normal variant
14. Most important investigation for posterior urethral valve is MCU
15. The posterior urethra is best visualized by Voiding cystogram
16. The most common sign of renal cell carcinoma on IV is polar enlargement
17. IOC for Carcinoma of Urinary Bladder is CECT
18. Lymphatic spread commonly occurs in carcinoma of prostate
19. Rim sign on nuclear imaging is a feature of testicular torsion
20. IOC for testicular torsion is Doppler USG

OBG
1. Earliest ANC diagnosis on USG is done for anencephaly
2. To detect gestational sac on transabdominal ultrasonography, it should be
minimum of size 20-30 mm
3. Oligohydramnios is commonly associated with renal agenesis
4. Nuchal edema is an ultrasound marker, associated with greatest increased
risk for Trisomy 21 in fetus
5. Color Doppler finding suggestive of impending fetal death is reversal of flow
in umbilical arteries
6. "Ring of fire" appearance in ectopic pregnancy is due to vascularity
7. USG can detect gestation sac earliest at 5-6 weeks of gestation on
transabdominal sonography.
8. Earliest sign of fetal life is best detected by Real time USG
9. Parameters used to estimate gestational age in last trimester is femur length
10. USG done at 18-20 weeks mainly to detect fetal abnormality.
11. Anencephaly can be diagnosed by USG at 10-12 weeks of gestation
12. Best for unruptured ectopic pregnancy is Trans vaginal USG
13. Most accurate assessment of gestational age by USG is done by crown rump
length
14. Ectopic pregnancy, characteristic findings in USG is absence of gestational
sac in uterus
15. On USG findings of cystic hygroma in fetus in suggestive of Turner syndrome
16. Missed IUD (IUCD) is recognized by USG
17. Radiological investigation of female of reproductive age group is restricted
to first 10 days of menstrual cycle

Musculoskeletal System
1. Acro-osteolysis is seen in Pycnodysostosis
2. Metacarpal sign is positive in Turner's syndrome
3. 'Chevron sign' is seen in achondroplasia
4. On X-ray, typical appearance of burning candle with slippage of wax around
is seen in Melorheostosis
5. Absent lateral third of clavicle is seen in Cleidocranial dysostosis
6. "Champagne glass" pelvis is seen in Achondroplasia
7. Most common radiological abnormality predisposing to developmental
dysplasia of the hip is Developmental Acetabular dysplasia
8. Heberden's nodes are found in DIP joint in osteoarthritis
9. Tufting of distal phalanx is characteristically seen in Psoriatic arthropathy
10. Chondrocalcinosis is seen with Pseudogout
11. Calcification of IVD is seen in Non rheumatic ankylosis
12. Calcification of IVD is seen in Alkaptonuria.
13. Calcification around the joint is seen in Pseudogout
14. Bone erosion is a recognized X ray feature of RA
15. Terminal phalangeal sclerosis is associated with rheumatoid arthritis
16. Calcification of meniscal cartilage is a characteristic feature of pseudogout
17. Earliest evidence of healing in rickets is provided by radiological
examination of growing bone ends
18. Radiological features of rickets include cupping of metaphysis
19. Splaying and cupping of metaphysis is seen in rickets
20. Looser's zone is seen in osteomalacia
21. Flaring of anterior end of the ribs is characteristically seen in Rickets
22. Brown tumors are seen in Hyperparathyroidism
23. Osteofluorosis is best characterized by calcification of ligaments and
tendons
24. "Rugger-jersey" spine seen in chronic renal failure patients is mainly due to
Secondary hyperparathyroidism
25. Radiological feature of osteosarcoma is sunray appearance
26. Dense calcification is seen in Chondrosarcoma
27. Expansile pulsating secondary metastasis is a feature of RCC
28. All the statements are true about exostosis, except Growth Continues After
Skeletal Maturity
29. Most common lesion of hand is enchondroma
30. Ollier's disease is Multiple Enchondromatosis
31. Bone tumor that typically affects the epiphysis of a long bone is
Chondroblastoma
32. Secondary tumor in osteochondroma is chondrosarcoma
33. Expansile lytic lesion of sacrum with specks of calcification is suggestive of
chordoma
34. Most common site of osteogenic sarcoma is the upper end of humerus
35. A classical expansile lytic lesion in the transverse process of a vertebra is
seen in aneurysmal bone cyst
36. Ground glass appearance is an X ray feature of fibrous dysplasia
37. Bohler's angle is lost in fracture of calcaneum
38. Radiological sign of spondylolisthesis is the ’Scottish dog with collar’ sign
39. Cl C2 best seen in Odontoid view
40. Clay choveller fracture involves the spinous process of C7
41. Epiphyseal enlargement is seen in Juvenile rheumatoid arthritis
42. Dense metaphyseal band is seen on Hypervitaminosis
43. Windswept deformity is seen in Rheumatoid arthritis and Rickets
44. Trident hand is seen in Achondroplasia
45. Champagne glass pelvis is seen in Achondroplasia
46. Bone within bone appearance is seen in Osteopetrosis
47. X-ray view of choice for lumbar spondylosis is the lateral view
48. Scottish terrier sign is seen in the oblique view
49. Beheaded Scottish terrier sign is Spondylolisthesis
50. In spondylolisthesis, Napoleon sign is seen
51. Pseudo fracture of loser's zone is seen in Osteomalacia
52. Radiographic appearance of Pindborgtumour is Driven snow appearance
53. Sunray appearance on X-rays is suggestive of an osteogenic sarcoma
54. Sunray appearance is seen in Osteosarcoma

Hematology
1. Hair on end appearance is seen in Thalassemia
2. Wide diploic space of skull with brush border (hair on end) appearance is
characteristic of Congenital hemolytic anemia
3. H shaped vertebral body is a feature of sickle cell anemia
4. Autonephrectomy is a feature of Tuberculosis
5. In sickle cell anemia, Salmonella is the major causative organism causing
osteomyelitis
6. Bone infarcts are characteristically seen in sickle cell anemia
7. Hypertelorism is a feature of Thalassemia
8. Widened intercondylar notch is seen in Hemophilia

Pediatrics
1. Invertogram is done in a new born after 6 hrs
2. First sign of hydrocephalus in children is sutural diastasis
3. William's syndrome is associated with congenital supravalvular aortic
stenosis
4. Steeple sign is a feature of croup
5. Thumb sign is a feature of epiglottitis
6. White cerebellum sign is a feature of hypoxic ischemic encephalopathy
 Endocrine
1. For the imaging of adrenal glands in neonates, the modality of choice is
ultrasound
2. DOPA - PETscan is most sensitive for evaluation of extra adrenal
pheochromocytoma
3. Light bulb appearance on MRI is seen in Pheochromocytoma
4. Post irradiation thyroid tumour is Papillary CA
5. Radioiodine is used in treatment of Follicular ca thyroid

Investigation of Choice
1. Investigation of choice for juvenile naso angiofibroma is CECT
2. The procedure of choice for evaluation of an aneurysm is Arteriography
3. The best investigation to diagnose a case of acoustic neuroma is Gd
enhanced MRI
4. MRI is the best choice to evaluate radiologically a posterior fossa tumour
5. Ideal imaging method for diagnosis of hydrocephalus in infants is USG
6. Parameningeal rhabdomyosarcoma is best diagnosed by MRI
7. The best x-ray view for minimal pleural effusion is lateral decubitus
8. Decubitus view is useful in diagnosing pleural effusion, Pleural effusion
with dependent hemithorax
9. Best view for Rt pleural effusion in X-raychest is right lateral decubitus
10. Interlobar pleural effusion can be detected in the best way in Reverse
lordotic position
11. Basal skull view (submentovertical) X-ray is best to visualize Sphenoid
sinus
12. In a down's syndrome patient posted for surgery, the necessary
preoperative investigation to be done is echocardiography
13. IOC for aortic dissection is CT scan in stable patient.
14. IOC for pericardial effusion is echocardiography
15. The most accurate investigation for assessing ventricular function is MRI.
16. Cardiotoxicity caused by radiotherapy and chemotherapy is best detected
by Endomyocardial biopsy
17. IOC for detection and characterization of interstitial lung disease is HRCT
18. IOC in bronchiectasis is Bronchography
19. Best diagnostic aid for bronchiectasis is CT scan
20. Most sensitive investigation for air embolism is Doppler USG
21. In patient with high clinical suspicion of pulmonary thromboembolism,
best investigation would be Catheter angiography
22. IOC for pulmonary embolism is CECT
23. Pulmonary embolism is best diagnosed by CT scan
24. Best method for detecting minimal bronchiectasis is CT scan
25. Best view to diagnose pneumothorax is PA view in full expiration
26. In renal cell carcinoma, investigation of choice to evaluate IVC and renal
vein for thrombus is Colour Doppler
27. Functional analysis of kidney is best done by Radionuclide scanning
28. IOC for studying renal cortical mass is Tc 99 DMSAlT
29. IOC in diffuse oesophageal spasm is manometry
30. Gastro - oesophagal reflux is best detected by endoscopy
31. IOC for gall stone is USG
32. Investigation of choice in obstructive jaundice is USG
33. Most common investigation for obstructive jaundice is USG
34. Minimal ascites can be best detected by USG
35. The IOC for acute cholecystitis is HIDA scan
36. Best radiographic view for fracture C1,C2 vertebrae is Odontoid view
37. Best investigation for traumatic paraplegia is MRI
38. The gold standard for assessing bone mineral density and diagnosis of
osteoporosis is Dual Energy X ray absorptiometry
39. Judet view is done for acetabular fracture
40. Neural tube defect best detected by amniocentesis
41. Earliest congenital malformation that may be detected on USG is
Anencephaly

Radiotherapy
1. Inverse square law means radiation from any source increases in intensity
as a function of the square of the distance from the source.
2. Maximum damage to skin is caused by Orthovoltage x-ray therapy
3. Linear accelerator is used to provide electrons and x-rays
4. A positively charged radiation is alpha particle
5. Linear accelerator employs electrons and X -rays
6. Very effective in reducing pain of bone cancer is strontium 89
7. Phosphorous-32 emits beta Particles
8. In the treatment of papillary carcinoma thyroid, radioiodine destroys the
neoplastic cells predominantly by beta rays
9. Electron beam therapy may be used in treatment of Mycosis fungoides
10. Systemic radiation therapy, by using Iodine-131, Phosphorous-32
11. For shield (mould) in eye tumors, Phosphorous-32 is preferred
12. Isotopes used for teleradiotherapy are Cobalt-60
13. In colon malignancy postoperative radiotherapy is minimally used
14. For Prostate malignancy, intensity modulated radiotherapy is the most
suitable
15. Radiotherapy is treatment of choice for Nasopharyngeal CA T3N1
16. cobalt 60 is commonly used as external beam radiotherapy in treatment of
cancer patients
17. Conventional dose per fraction in external radiotherapy is 225-250 cGy
18. Mantle Irradiation is used in Hodgkin's disease
19. Dose of radiotherapy given at point b in carcinoma cervix is 5000 rads
20. The most commonly used form of radiation therapy is teletherapy
21. Stereotactic radiosurgery is a form of radiotherapy
22. Gamma-knife is very useful in the treatment of cerebral metastasis
23. Stereotactic radiotherapy used for CA lung stage 1 single lesion
24. Ibritumomab is drug of choice for NHL
25. RFA is used in treatment of hepatoma
26. Prophylactic craniospinal irradiation is used as treatment modality for
small cell carcinoma lung
27. Radiotherapy can be used with best results to treat Medulloblastoma
28. Testicular tumor most sensitive to radiation is seminoma
29. Seminoma responds best to radiotherapy
30. The most radiosensitive lung cancer is squamous cell carcinoma
31. Poorly differentiated carcinoma responds best to radiation
32. Benign condition that can be treated by radiotherapy is pituitary adenoma
33. Osteosarcoma is radioresistant
34. First sign after radiation treatment is erythema
 Miscellaneous

HISTORICAL ASPECT
1. JJ. Thompson - Discovered electrons
2. W.K. Roentgen - discovered X-rays in 1895.
3. Henry Becquerel -- discovered radioactivity in 1896.
4. Madam Marie Curie -- discovered radioactive substances
radium, Uranium, etc.
5. Chadwick -- discovered neutron.
6. Maxwell -- discovered electromagnetic waves
(invented- by Hertz)

Characteristic appearances
a. Spondylolysis- scotty dog wearing a collar app
b. Spondylolisthesis- Scotty dog with separated neck
c. Scottish terrier sign- in oblique view
d. Soap bubble appearance in abd x-ray- Meconium ileus
e. Soap bubble appearance in head CT - Cryptococcal meningitis
f. Soap bubble calcification in x-ray - Osteoclastoma
g. Puffed rice appearance on CT-Scan head -neurocysticercosis
h. Soap bubble cerebral calcification in head CT- Toxoplasmosis
(Congenital)

Important Point
1. Investigation of choice in traumatic paraplegia - MRI
2. Intra-osseous skeletal tumours are best diagnosed by- MRI
3. In fibromuscular dysplasia string of beads appearance on angiography
4. Trethowan sign in Slipped capital femoral epiphysis
5. Trachea lies behind LA so in left atrial enlargement there is widening of
tracheal bifurcation angle. Enlargement is best seen in penetrated chest x-
ray PA view. Descending aorta is displaced to the left by LA enlargement
(Bedford's sign) &in LA enlargement esophagus is displaced towards right
& posteriorly1
6. Amt. of air needed to create pnuemo peritoneum ---------800 ml
7. Amt. of air needed to produce death in air embolism--------- 200 ml
8. Echo cardiography can detect pericardial effusion as little as --------- 15 ml
9. X-ray can detect pericardial effusion as little as—......... 250 ml
10. Minimum amt. of ascitic fluid required to elicit puddle sign ---------- 50 ml
11. Lateral view chest X-ray can detect pleural effusion as little as- 75 ml
12. Lateral decubitus chest-X ray detect pleural effusion as little as—-10-15 ml

Some Imp. Negative points

1. On PA view X-ray chest cardiac silhouette is NOT increased in-------- TOF
2. NOT a Radiosensitizer substance ---------- Cyclophosphamide
3. NOT a Radiosensitive tumour --------- Osteosarcoma
4. Miliary mottling is NOT seen in ------------ Staph, aureus pneumonia on chest
X-ray PA view Rt heart border is NOT formed by ------- RV
5. NOT related to development of bladder cancer ---------- TB
6. Skin tumours, which is NOT radiosensitive --------- Malignant melanoma
7. MCV is NOT indicated for---------- Suspected renaltumours/mass
8. Solitary pulmonary nodule is NOT seen in ----------------- Neurofibromatosis/
neurofibroma
9. Air in biliary tract is NOT seen in------------------ Sclerosing cholangitis B/L
calcification of lung NOT occur in -------- Klebsiella pneumonia.

HALF LIFE OF IMPORTANT RADIONUCLIDES

NUCLIDE HALF-LIFE
1132 2.3 hours
C06O 5.2 years
Tc99m 6 hours
P32 14 days
Thallium 3 days
Gallium 3 days
Irl92 74 days
Carbon-ll 20.3 min
Cesium-137 30 yr
Chromium-51 27.8 day
Cobalt-57 270 day
Cobalt-58 71.3 day
 Cobalt-60 5.26 yr
Fluorine-18 109min
Gadolinium-1 53 240 day
Gallium-67 78.1 hr
Indium-Ill 67 hr
lodine-l 23 13 hr
lodine-l 25 60 day
Iodine-131 8 days
Krypton-81m 13 see
Moiybdenum-99 66.7 hr
Nitrogen-13 IO min
Oxygen-IS 124 see
Phosphorus-32 14.3 day
Rhenium-1 86 90 hr
Rubidium-82 1.3 min

RADIOSURGERY
a. y-knife radiosurgery
Focused radiation for limited brain metastasis
b. Cyber knife
Combines robotics and advanced image guidance to deliver radiation to
tumour along spinal cord/other critical location.

Respiratory System

1. Hydatid cyst of lung

a. Meniscus / Moon/ Air crescent / Double arch sign
b. Combo sign
c. Water Lilly / Camalotte sign
d. Serpent sign / Rising sun sign
e. Empty cyst sign
2. Hamartoma &Mediastinal nodes of histoplasmosis
a. Popcorn calcification
3. Pulmonary thrombo-embolism
a. Westermark sign b. Hapton's hump
c. Palla sign d. Fleishner lines

e. Felson's sign
4. Thymic enlargement b. Muivay Wave sign c. Notch sign
a. Sail sign
5. Rounded atelectasis
a. Comet tail sign
6. RUL collapse secondary to a central mass
a. Golden S sign
7. LUL collapse
a. Luftsichel sign
8. LLL collapse
a. Broncho lobar sign
9. Pneumo-mediastinum
a. Ring around artery sign b. Continuous diaphragm sign c.
Tubular artery sign d. Double bronchial wall sign
e. V sign of Naclerio f. Spinnaker sail sign
10. Pneumothorax
a. Deep sulcus sign
b. Visceral pleural line
11. Epiglottitis
a. Thumb sign
12.
Croup
a. Steeple sign
13. Aspergilloma
a. Air crescent sign b. Monod sign
14. Klebsiella pneumonia
a. Bulging fissure sign
15. Pulmonary edema on CXR
a. Batwing sign
16. Diaphragmatic rupture
a. Collar sign b. Dependant viscera sign
17. Pulmonary septic emboli
a. Feeding vessel sign
18. ABPA
a. Finger in glove sign
19. Aspergillosis
a. Halo sign
20. Subacute hypersensitivity pneumonitis
a. Head cheese sign
21. RUL atelectasis
a. Juxta phrenic peak sign
22. Cryptogenic organized pneumonia a.
Reversed halo sign
23. COPD
a. Saber sheath trachea
24. Alveolar microlithiasis a. Sandstorm
lungs
25. Bronchiectasis
a. Signet ring sign
26. RLL atelectasis
a. Superior triangle sign
27. Empyema
a. Split pleura sign
28. Endobronchial spread in TB a. Tree in
bud sign on HRCT

Metastasis in Lung
Calcifying lung metastasis Cavitating lung
metastasis Hemorrhagic
lung
metastasis
with ill
defined
nodules
a. Osteosarcoma/chondro a. SqCC, Sarcoma
sarcoma b. Colon 1.
b. Mucinous adeno Ca.+ c. Transitional cell Choriocarcin
d. Cx under CT oma
c. Lung metastasis following
(Chemotherapy) 2. RCC
RT/CT
3. Melanoma
4. Thyroid Ca
 Calcification in Lungs & Pleura
Calcification in Lungs Pleural calcification
a. B/LTB a. Old empyema
b. B/L Histoplasma b. Old Hemothorax
c. B/L coccidiomycosis c. Asbestosis
d. Silicosis
e. Talc exposure

Miliary shadows on CXR

1. CWP & silicosis,
2. MS sarcoidosis,
3. Hyperparathyroidism,
4. Eosinophilic granuloma (Histiocytosis X),
5. Blastomycosis, coccidiomycosis, histoplasmosis,
6. streptococcal pneumonitis, VZV (But not staph).
7. Hemosiderosis in Mitral stenosis

THORAX
THE SILHOUETTE SIGN

Silhouette sign is used mainly for localizing intrathoracic lesion.

SIGN LESION OF
Obscured right heart border — Right middle lobe lesion,
Obscured left heart border --- Lingular lobe /left lower lobe.
Hemidiaphragm — Relative lower lobe.
Aortic knuckle ™ Apico-posterior segment of left
Ascending aorta upper lobe.
Descending aorta — Ant. segment of right upper lobe.
— Sup. &postero basal segment of
left lower lobe.

Pneumomediastinum Hamman's sign +ve

1. Lung tear
2. Asthma
3. Artificial ventilation
4. Esophageal perforation
5. Spontaneous rupture of emphysematous bullae(MC cause)
6. Diabetic ketoacidosis
7. Histiocytosis
8. Respiratory distress syndrome

Neonatal Cyanosis
With Oligemia + With Oligemia But With Pleonemia (Plethora)
Cardiomegaly No Cardiomegaly
(All have an ASD) (Sign appear usually Cyanosis + CCF
a. PS after 1 wk) TAPVC
b. Pulm atresia •TOF a. Hypoplastic LV
c. Ebstein • Pulm atresia with b. Interrupted aortic
anomaly VSD* arch
d. Tricuspid atresia • Tricuspid atresia C. TGA
d. Truncus arteriosus
e. Hypercyanotic
spells & e. Treat CCF & Rashkind
polycythemia atrial
may develop septostomy is done in these
T/t palliative patients as an emergency
shunt surgery measure to decompress LA

Cardiac Calcification
Intracardiac Myocardial Pericardial
a. Atrial a. Mainly in LV - a. Mainly in right chambers
myxoma apex b. (RV) & A-V groove
b. Valve b. Post-myocarditis c. Constrictive pericarditis
thrombu c. Hydatid ds d. Post-traumatic
s d. Aneurysms e. Uremia/CRF
e. Infarct f. Asbestosis

GIT
Gasless abdomen on X-ray
a. Acute pancreatitis
b. Bowel malrotation
c. Cong. Diaphragm. Hernia
 d. Duo-atresia
e. Annular pancreas
f. Cog. Hypertrophic PS
g. Duo. Atresia
h. Infraction (Mesenteric)

Skeletal System
GROSSLY EXPANSILE LUCENT BONE LESIONS
i. Aneurysmal cyst
ii. Enchondroma
iii. Sarcoma
iv. Plasmacytoma
v. Giant cell tumor
vi. Brown tumour (PTH)
vii. Fibrous dysplasia
viii. Hemophilia

Moth eaten appearance of bone is seen in

1. MM
2. Lymphoma
3. Sarcoma
4. Osteomyelitis
5. Leukemia
5. Histiocytosis-x

Extra Edge
1. Epiphyseal dysgenesis is characteristic of hypothyroidism.
2. Enlargement of Epiphysis is characteristic of JRA.
3. Epiphyseal widening is seen in rickets.
4. Epiphyseal loss of density is seen in scurvy.
Osteolytic Bone Metastasis
a. Neuroblastoma d. Thyroid cancer
b. Lung cancer e. Kidney
c. Breast cancer f. Colon

Osteoblastic Bone Metastasis

a. Prostate cancer d. Bronchus
b. Breast cancer e. Bladder
c. Brain (Medulloblastoma) f. Buie (carcinoid)
g- Lymphoma

QUICK SPECIFICS - BREAST AND OBGY

Breast implant rupture
Stepladder sign
Linguine sign
Spalding sign Intrauterine fetal demise
Robert sign
Snowstorm pattern Molar pregnancy
Rosary sign Adenomyomatosis
Pearl necklace sign
Interstitial line sign Ectopic pregnancy
Double decidua sign Early normal intrauterine gestation
Breast in a breast Fibroadenolipoma

Guide to the Relative Radiosensitivity of Normal Tissue

1. Radiosensitive
a. Lymphocytes Bone marrow Gonads b. Embryonic tissue
2. Moderately sensitive
a. Skin, Small blood vessels Lens of the eye Growing tissues Lung tissue
Salivary glands
3. Moderately resistant
a. Skin b. Thyroid gland c. Nerve cells
4. Radio resistant
a. Muscle b. Bone c. Connective tissue d. platelet
Guide to the Relative Radiosensitivity of Tumours

1. Radiosensitive tumours
a. Embryonic tumours b. ReticulosisAnaplastic, carcinomas
2. Limited sensitivity
a. Epithelial tumours b. Adenocarcinomas
3. Radioresistant
a. Soft-tissue sarcomas b. Osteosarcomas c. Melanomas

Some important views

VIEW USED FOR
. Lordotic For apex, lingual lobe (rt middle
. Reverse lordotic lobe) of lung
. Oblique To detect interlobar effusion
. Von Rosen Spondylolisthesis, #scaphoid
. Skyline CDH
. Stryker's view # patella
. Lateral skull view Recurrent subluxation / dislocation
of shoulder
For sella turcica

Views for study of PNS / Orbit

View Used to visualize Comments

1. Water's view Maxillary sinus & antrum Not ideal for frontal
[Occipitomental (best) Floor of orbit sinus
view] Frontal sinuses
2. Caldwell's view Ethmoidal sinus Maxillary antra are not
[Occipitofrontal For sphenoid sinus (best) well seen
view]
3. Lateral view
 Imp. Findings of Skull
Geographical skull _____________________________________________
(lytic lesions + beveled edges) ----- Eosinophilic granuloma ______________
Punched out lesions in skull -- Multiple myeloma______________________
Brush border skull (TRU cut app.) - Cong. Hemolytic anemia esp. thalassemia
Chicken-wire calcification -— Chondroblastoma (Codman's tumour)
Silver beaten appearance ----- Raised ICT ____________________________ _
Salt peeper skull ----- Hyperparathyroidism ______ ____________________
Sun ray appearance------ Meningioma

Calcification of Imp. Structures

Basal ganglia calcification Calcification of pinna
a. Hypoparathyroidism (2nd MC) a. Ochronosis
b. Idiopathic with age (MC) b. Frost bite
c. Lead & CO poisoning c. Gout
d. Wilson's disease d. Addison's disease
e. Cysticercosis e. Cockayne's synd.

Radionuclide Imaging
o Tc 99m (99 is mass and m is metastable) is most commonly used. It is
administered IV and is pure 'Y rays emitter. It has Short half life (6 hrs).
Uses -______ __ ____________________ _ _____________________
m
Tc 99 labeled serum albumin _______________ -To detect pulmonary emboli
Tc 99m labeled RBCs _______________________- For spleen imaging ____
Tc 99m labeled DMSA -is taken up by renal cortical cells, is used for renal
structure, scarring ________ ____________________________________ _
Tc 99m labeled DTPA _______ -Measures GFR _______________
m
Tc 99 MAG3 - Diagnostic of transplant rejection./renal function _________
Tc 99m labeled HIDA/PIPIDA-To study the functions of hepatobiliary tree
Thallium 201 chloride-For cardiac imaging (cold spots in myocardial ______
perfusion studies), reversibility of myocardial ischemia _________________
Ga-67 nitrate-To detect tumours, inflammation and abscess cavities.
 Investigation Of Choice
CT SCAN (BEST FOR) MRI US6
a. Bronchiectasis a. For pituitary & Pregnancy
b. Pancreas hypothalamic & optic mass
c. Adrenal chiasma lesion Gall stones
d. Acute SAH cavernous sinus invasion
b. Brain abscess
c. For spinal lesions
d. Prolapse IVD
e. ICSOL (esp. post. Fossa
mass lesions)
1, ECHO - is investigation of choice for minimal pericardial effusion, MS
2. Angiography - is investigation of choice for sequestration lung

Radiotherapy

RADIOSENSITIZERS RADIOPROTECTIVE RADIATION

AGENTS POTENTIATOR
Chemotherapeutic agents Chemotherapeutic They have been reported
which enhances radiation agents which protect to cause flare-up of
effect by sensitizing the cell the cell dermatitis/esophagitis in
(radio -mimetic) from radiation areas previously treated
a. Cisplatin injury with radiation therapy
b. 5- FU Amifostine (radiation recall reactions)
c. Hydroxyurea Sodium butyrate Doxorubicin
d. Vincristine Dactinomycin
e. Metronidazole
f. Bleomycin (but NOT-
cyclophosphamide)

1. Amifostine reduces cisplatin-induced nephrotoxicity &also reduces

xerostomia in patient with head &neck Ca.
2. Sodium butyrate when given topically improves the symptom of radiation
proctitis
 Radiation Units
Radiation exposure - Coulombs
Radiation absorbed dose - Gray & Rad
(Remember Red & Gray Color) [ 1 Gy = 100 Rads]
Radioactivity - Becquerel,
Radiation effectiveness Curie
public health measure of radiation) - Rem, Sievert
Tissue penetration" capability y-ray
> X-ray > P-ray> a-ray
(50cm) (15-30cm) (.06-4mm) (0.5 mm)

Radiosensitivity
Most Least sensitive or radioresistant
radiosensitive
1. Stage of cell G2M S phase
cycle Ovary, testis Vagina (bone CNS, cartilage, muscle)
2. Organ Bone marrow, Nervous tissue (bone, CNS, cartilage,
3. Tissue gonads muscle)
4. Cell type Rapidly Quiescent
5. Blood cells dividing Platelet
Lymphocyte

Extra Edge
1. Most common mucosal surface affected is intestinal mucosa
2. Most common organ affected is skin and presents as erythema
3. For Chemotherapy &radiotherapy induced cardiotoxicity investigation of
choice is endomyocardial biopsy
4. Most sensitive
Testicular tumour Seminoma
Ovarian tumour Dysgerminoma
Brain tumour Medulloblastoma
Lung tumour Small cell carcinoma
Basal cell cancer
Skin cancer
Ewing's sarcoma (multiple myeloma)
Bone tumours
 Radiotherapy
1. Maximum Half-life is of uranium 701 x 108yrs >Ra (1622 yrs.)
2. Important radioisotopes
a. Gadolinium Paramagnetic contrast dye used in NMR (MRI)
b. Xenon For regional cerebral blood flow (CBF) studies
c. m
Tc" labeled RBCs Imaging of spleen, GIT bleeding,
Ventriculography
d. Tc"MAG3 Gallium Diagnostic of transplant rejection Isotope
e. abscess cavity Tc9Sm selectively concentrated in
(technetium)
Used for infarct avid imaging Standard
Pyrophosphate isotope
g- Thallium (Tl201) for "Hot spot" imaging in Ml
h. studies Agent used for myocardial perfusion

Imaging agent of choice to assess

myocardial viability Shows "Cold spot" in
Ml on perfusion scan (in Non avid infarct
imaging) Evaluation of radioactive Iodine
Iodine -123 uptake, (RAID)
For detection of thyroid cancer For Red
j- Iodine-131 cell survival studies.
k. Cr52 Most frequently used moiety in PET is 2-
FDG
l.
[I8F] fluro-2-deoxy-D-glucose

Radioactive P32 is useful in

1. Diagnosis of Eye cancers, Esophageal cancers
2. Rx of Sq CC, Ca esophagus, CML, MM, bone secondaries, Ca breast, Ca
prostate, Polycythemia vera
3. Malignant ascites, Mycosis fungoides, Senile keratosis, Superficial
angiomas
 Recent & High Yield Updated LMRPs

1. Myelography uses a real-time form of x-ray called fluoroscopy and an

injection of contrast material to evaluate the spinal cord, nerve roots and
spinal lining (meninges)
2. Empty thecal sac sign on MRI seen inArachnoiditis
3. M.R.I is the tests does not include ionizing radiations.
4. Giant cell tumour is the condition having a soap bubble appearance seen
in radial bone
5. Water soluble contrast islohexol
6. Allergic fungal sinusitis shows double density appearance on CT scan.
7. Gasless abdomen:Acute pancreatitis
8. Boot shaped heart cause: Right ventricular hypertrophy
9. Doppler waveform in peripheral arterial disease in severe stenosis is
monophasic.
10. Rigler triad seen in gall stone ileus has 3 components-pneumobilia, small
bowel obstruction, ectopic gall stone.
Imaging techniques which are not used in Uterus anomalies is CT guided
11.
HSG
Salt and Pepper pot appearance of skull seen in Hyperparathyroidism
12.
Bragg peak effect pronounced in proton
13.
Contrast of choice used in diagnosis of esophageal perforation is lohexol.
14.
After radical resection of chondroma, best radiotherapy is Proton.
15.
FDG pet negative tumour is typical carcinoid.
16.