Rapid Revision Reignite Radiology: Question-Answer Format

Cardiovascular System

Big Question 1: How are the heart borders and chambers identified on imaging, and what are the key radiological signs of chamber enlargement and mediastinal anatomy?

Broad Answer: On X-ray, the right heart border shows the right atrium; the left shows the left ventricle and aortic arch. On CT, the right ventricle is anterior, and the left atrium is posterior. LAE shows signs like the walking man and double density. Use 'SAAP' to identify mediastinal structures.

Detailed Questions

Q1.1: What anatomical structures form the right and left heart borders on a chest X-ray?

Answer:

Right Heart Border

Left Heart Border

Q 1.2: What are the anatomical positions of the heart chambers as seen on a CT scan?

Answer:

• Anteriormost chamber of the heart: Right ventricle
• Posterior-most chamber of the heart: Left atrium
• Chamber On the left: Right atrium
• Chamber on the right: Left ventricle

Q 1.3: What are the key mediastinal structures seen on imaging?

Answer:

• From right to left: Mnemonic - 'SAAP'
  • S- Superior vena cava
  • AA- Ascending Aorta- anteriorly, Descending Aorta- posteriorly
  • P- Pulmonary artery

Neuroradiology

Big Question 2: Describe the fundamental principles and key radiological findings of neuroradiology, focusing on the differentiation of imaging modalities and sequences.

Broad Answer:

• In neuroradiology, CT scans are identified by a "bone white" appearance.
• MRI sequences are distinguished by the appearance of water:
  • T2-weighted
  • T1-weighted
  • FLAIR
• Advanced MRI techniques include DWI for acute infarcts (restricted diffusion), SWI for haemorrhages and calcification (blooming).
• MR Tractography for white matter tracts
• BOLD/fMRI for functional areas of the brain
• MR Spectroscopy, which provides a graph of metabolites to differentiate normal brain (NAA peak), tumours (Choline peak), and TB (Lipid peak).
• Myelography involves injecting contrast into the subarachnoid space to visualise the spinal cord.

Detailed Questions

Q2.1: How can a CT scan be differentiated from an MRI scan?

Answer:

• A CT scan shows a "bone white" appearance.
• An MRI scan shows a "bone cortex black."

Q2.2: How can you identify T1, T2, and FLAIR MRI sequences?

Answer:

• T1-weighted MRI shows white matter as white and grey matter as grey. (Image A)
• T2-weighted MRI shows water as white. (Image C)
• FLAIR (Fluid Attenuated Inversion Recovery) shows all fluid, including CSF and white matter, as black. (Image B)

Q2.3: What is DWI (Diffusion Weighted Imaging) based on, and what does it show in an acute infarct?

Answer:

• ADC (Apparent diffusion coefficient) is based on the Brownian movement of protons (protons move freely like CSF ® Facilitated diffusion).
• An acute infarct shows restricted diffusion.

Q2.4: What is SWI (Susceptibility Weighted Imaging) used for, and how do haemorrhages and calcifications appear on it?

Answer:

• SWI is used for identifying haemorrhages and calcification based on magnetic susceptibility.
• These appear as black areas of blooming.

Q2.5: What is the purpose of MR Tractography/DTI and BOLD/fMRI?

Answer:

• MR Tractography/DTI is done to visualise white matter tracts and is based on the anisotropy of these tracts.
• BOLD/fMRI (Blood Oxygen Level-Dependent) is useful for locating the functional/eloquent areas of the brain (e.g., visual cortex, speech area) to aid in neurosurgery planning.

Respiratory Radiology

Big Question 3: Describe the radiological features of foreign body pathologies.

Broad Answer:

• Coin in Trachea vs Oesophagus
• Button Battery
  • On AP view: Double ring appearance
  • On lateral view: Sloping/ Bevelled edge

Coin in Trachea 

Coin in Esophagus

Detailed Questions

Q3.1: How can you differentiate a foreign body in the trachea from one in the oesophagus on an X-ray?

Answer: A foreign body in the trachea appears as a slit in the AP view and a circle in the lateral view. A foreign body in the oesophagus appears as a circle in the AP view and a slit in the lateral view.

Q3.2: What are the characteristic signs of a button battery on an X-ray, and what is its clinical significance?

Answer:

• On an AP view, it shows a double-ring appearance.
• On a lateral view, it shows a sloping/bevelled edge.
• A button battery is corrosive and must be removed even if the patient is asymptomatic.

Q3.3: What is a "white out hemithorax," and what are its causes, with emphasis on the direction of tracheal shift?

Answer:

No tracheal shift

Shift to the same side

Shift to the opposite side

Q3.4: What is a "blackout hemithorax," and what conditions can cause it?

Answer:

Pneumothorax Emphysema

Post mastectomy Poland syndrome

Pulmonary embolism (Westermark sign)

Head and Neck

Big Question 4: What are the key radiological views and findings in Paranasal Sinus (PNS) and orbital imaging?

Broad Answer: Different X-ray views (like Water's, Caldwell's, Rhese, and Towne's) are used to visualize specific sinuses and orbital structures—e.g., Water's view for the maxillary sinus and These views for the optic canal. CT PNS, especially HRCT, is the investigation of choice before FESS.

Detailed Questions

Q 4.1: What are the different X-ray views used in PNS and orbital imaging, and which anatomical structures can be visualized in each?

Answer:

Q 4.2: In which X-ray views can the sphenoid sinus be visualized?

Answer:

● With an open mouth, the sphenoid sinus can also be visualized.

● Other views where the sphenoid sinus can be visualized: Basal view and Submentovertical view

Q 4.3: What is the investigation of choice before performing Functional Endoscopic Sinus Surgery (FESS)?

Answer: HRCT

Q 4.4: What is the HRCT finding of PNS?

Answer:

1. Concha bullosa (Pneumatization of middle turbinate)

2. Onodi cell

3. Haller cell: Infraorbital air cell

4. Agger nasi: Anterior-most ethmoidal cell

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