5

=-4,, ._-

' ,_ -.-i--

Foreword

J
r

_=r

~.

.-l

ll is a pleasure to write a foreword to this excellent book of Multiple Choice

Questions (MCQsl. Now that most examinations in radiology are entirely based

on MCOs, there is a need lor a large bank for learning and self testing. And, as
stated in the introduction, practice will indicate where improvements in technique
and knowledge are required.

_ The author: have done s vary good job in making the questions as

5)

unambiguous as posslble and maltlng them relevant to the practice oi modern

l

radiology. l suspect that the book has largely arisen through the endeavours of
the two young radiologist first authors who have recently passed the Pan l FRCR
examination. They have wisely solicited the help ofa physicist who has contributed
some very up-to-date physics questions and that of a senior radiologist with
considerable examining experience who has kept them on the straight and narrow.
This team has provided 300 first class questions. As a previous examiner, I know
iust how hard it is to compose realistic questions of the right degree of difficulty.
There is a lot of new material here with many oi the physics questions

involving MRI, PET and the like. It is of course difficult to maka.the anatomy

questions seem 'trendy', but even here there are some intriguing new concepts.
lt is pleasing that the answers are provide?! on the opposite page which makes

lile so much easier than having to look them up at tlte end. There are also uselul

comments admixed with the answers which make the book a really worthwhile

educational exercise. l have certainly learnt a lot from it.

,6

I have no doubt that the book will be well received in all countries. The
questions are those that all radiologists should be able to answer. Thus it should
appeal to specialist registrars and qualified radiologists alike. Of course with
increasing pressure on specialist registrars to attain their goals in each year of
training, rst year trainees will be the chiel purchasers. And it will sell well. But
more than mere sales. l think that the material within this volume will become a
standard text for trainees and trainers, And thus the authors have achieved a lot.
They should be thanked and congratulated for their effons. l wish them, the

publication team and the book well.

Adrian K Dixon MDcFRCR FRCP

Professor of Radiology
University of Cambridge

W W W av W we w w w in in we

,
_

..

cutmu4tu.uv1NGST0NE

_ y

\
__

1-

Contents

Medial Division of Pearson Professional Limited

Distributed in the United States oi America by Churchill

Livingstone lnc., 650 Avenue of the Americas, New

York. N.Y. 10011, and by associated companies,

I
\

bra;-ighas and representatives throughout the world.

O Pearson Professional Limited 1996

All rights reserved. No part of this publication may be

reproduced, stored in a retrieval system, or transmitted '
in any form or by any means, electronic, mechanical,
photocopying, recording or otherwise, without either
Livingstone, Robert Stevenson House, 1-3 Ba>tter's
Place, Leith Walk. Edinburgh EH1 3AF, UK) or a licensa
permitting restricted copying in the United Kingdom
Issued by the Copyright Licensing Agency Ltd.

7\i

B0 Tottenham Court Road. London, W18 QHE. UK.

\, < '/ 9
T,

Hf

First edition 1996

ISBN 0 443 05464 9

British Library of Cataloguing in Publication Data

A catalogue record for this book is available from the

British Library.

vii
ix

Foreword

the prior permission of the publishers [Churchill

'

Introduction
The FHCR part l examination
How to use this book
-,-.
Answering multiple choice questions
Glossary
Multiple choice questions:
it anatomy
iil techniques
iii) physics
Bibliography

xi

xiii
itiv

xvi

2
64
136
206
208
215

The FRCR part l syllabus

index

Library ol Congress Cataloging in Publication Data

A catalog record lor this book is available lrom the

>\""":L

Library of Congress.

\ ~>~
\'
\\'

.s<"*"/9

5r
G
*\{<

r
#1

\/

-4" t,\ i

.;""3
:6

/'

'

Medical knowledge is constantly changing. As new iniorrnatton becomes

Ll

/\
L/.

available, changes In treatment, procedures, equipment and the use ol drugs

become necessary. The authors and the publishers have, as far as it is
possible. taken care to ensure that the information given in this text is accurate
and up to date. However. readers are strongly advised to confirm that the
information, especially with regard to drug usage, t:om'plies with tzttrrcnt

legislation and standards oi practice.

Tie
pdsrwt
ptiq s in wt

pap-Itromh-sun-d

lrurn uuuirunh lo-"nu

Produced by Longmari Singapore Publishers lPtel Ltd.

Prlntd in Singapore .

i
.1

The FRGR part l

examination
u
-4

-r

hie

'0-

"l<\

Candidates are permitted to sit the examination after one academic

year's preparatioqln 5'treining post which has been approved by the
Royal College of Radiol0gists._Examinations are held in June and
September each year. The examination has three components:
I. One multiple choide question lMCOl paper (2 hours)
0 A total of 60 questions distributed equally between anatomy.
techniques, and physics li.e. 20 questions in each areal.

Q Each question has a stem followed by five independent items or

statements. Each statement is either true or lalse.

O There is no restriction on the number of true or false items in a

question. It is possible for all live components to be true or all five

to be false.

O The scorind system is as follows:

W
for each item correctly indicated as true or false

for each item incorrectly indicated

for each item indicated "don't know"

+1

-1

0 MCQ syntax:
~ The majority means more than 50%
.
- The approved name of e drug is always utilised; sometimes the
proprietary name will be added in brackets.
'
ll. One film viewing session (l hour)

O This is designed to test the candidate's knowledge of radiological

anatomy, radiographic techniques and understanding of film faults
y, Films are displayed on viewing boxes and each candidate is
required to answer four questions on each radiograph. There are a

total of 20 radiographs and thus a total of 80 questions.

O All the questidns are attached to the radiograph and the candidate
records his/he_'r answers in a book.

I An invigilator "and several examiners are present. Candidates are

not questioned by the examiners who are present during this part
of the examination.
-

all

Q1

" ....-'-_
F-9~v.a:.__=1-?_TT"_'

"\(,) "(J

~w~w~w'ww

Introduction
d

-'

-1
._ ,_.-

- _ _ _ ., _ .-

ln'June 1993 a revised syllabus was introduced for the FRCR pan l
examination of the Royal College of Radiologists. There were three mator

IF

changes: the written part of the eiarnination was limited to multiple choice
questions lMC(1sl; the amount of physics was reduced so as to achieve

the obiectives that candidates should have a sound understanding of the

processes which occurred once the X-rays had left the X-ray tube and
that there would be considerably less emphasis on what actually
happened inside the tube and generator; and finally, sortie imaging
modalities (CT and MRll were given an increased prominence.
it is intended that this book should be used during the early stages of
organised study and so assist with the written part oi the FRCR pan l
examination taking into account the new syllabus (page 208).

There are a total of 300 lVlCOs arranged into three separate sections
reflecting the three main sections lanatomy, techniques and physical of
the FRCR part l examination.
ACKNOWLEDGEMENTS
_-

or

The authors are greatly indebted to Dr F'.P. Dendy, Chief Physicist,

Medical Physics Department, Acldenbrookes Hospital, Cambridge and
Mr G. Manson, Principal Physicist. Medical Physics Department, Cork

University Hospital, Ireland. Their helpful comments and suggestions on

the physics section ot this book have been invaluable. The Royal College

of Radiologists has ttindly given permission to the authors to include the

present FRCR l syllabus in this book.

it

t
l

NCQTutorinRadtol0gy

--

._ _. t:

W W W W W W W O W W 6) v8 {J J '3 W ll '3 W Q W Q C U CF Q-';"

_.:K_.

I. Two oral examinations (20 minutes each)

0 All candidates proceed to the oral examinations.

\
)"-.

.3.

O Each candidate is examined by two pairs of examiners. One pair

consists of a physicist and a clinical radiologist who examine in

physics. The second pair consists of two clinical radiologists who

-_

examine in anatomy and techniques.

..--i

- j
I
r'

_. .
..

0 The MCCls are grouped together under three sections:

anatomy
- techniques
- physics.

".0,

"I.

:1:-

it' 54'

_, _b .

0 Each section comprises 100 questions.

0 Each question has a stem, followed by five independent statements

0 The correct answers are indicated on the right-hand page opposite

each question. in many instances the answers include a snort

explanation.

0 A glossary of abbreviations is provided on page xiv.

0 A bibliography containing a list oi the texts which have been used
to formulate the MCQ questions is included on page 206.

0 The FHCR part I syllabus is included on pages 208-213.

0 An index of all the subjects which have been included in the MCOs
is listed alphabetically on pages 215-227.
"" ,
. _

:1

Note: some explanations given within the physics MCQ answers may
be an approximation for the purposes of illustration of a principle.
1

-\
In-

-1
if

t
1
l
1

"-

If-4

Pv
t
i

__,__

__

_______________..

. ..;

____ __<'

-~

V~ ~

-~~-\\-~~--*" ~~"- "'

"

'

'

Answering multiple choice questions

'1 =-..

_. _:,:\
7-

-'

xv

should allow each candidate to develop the most profitable

ihswering multiple
1

answering styleh

choice questions

Practice makes perfect. Practice on test MCQ papers will indicate

where improvements in technique and knowledge are required.

FURTHER READING

Anderson J. The Multiple Choice Question in Medicine, 2nd edn.

London: Pitman, 1982.

Holden NL. Multiple-choice questions 1 a guide to success. BrJ
Hosp Med i993k50 .i9l: 557-569.
_
Robinson PJ-. Strategic marking in MCO papers (|68ti- 3! J 986719

The majority oi candidates will have had experience oi sitting multiple

choice question (MCQl papers at undergraduate and postgraduate
level. Therefore the most important advice is for a candidate not to
change his/her technique when it has been successful in the past.

1981; 54: 538-539.

Three practical tips:

1.

-"

Attempt enough questions. Answer at least 240 items out oi the

total oi 300 (60 x 5i items in order to score enough positive marks

to pass the MCQ examination.
The principle behind this advice is as follows. Assuming that a
candidate has an error rate of 10%. then:
'
0 the candidate should pass with a clear margin if 240 questions
are attempted as the net positive score will be i92 or 64%
_
t ' li.e. 215 correct answers less 24 incorrect answersl.
0 a marginal pass or fail would be likely when the candidate
attempts only 200 questions, as the net positive score would be
160 or 53% li.e. 180 correct answers less 20 incorrect answers).

no
U

0 the candidate is likely to iaii ii only 160 questions are answered

as the net positive score would be i2B or 43% il.e. 144 correct
answers less 16 incorrect answers).

'

Obviously the assumed error rate oi 10% iior all answers which

have confidently been assumed to be correct) will vary between

dilierani individuals. A candidate should thoielore assess his or
hot own pursonnl error rate hy doing inst uxrimintition pnpnrs rintl
comparing the number of statements intzorrecily answered with
the total number oi questions attempted. Based on this estimated
average error rate, an approximation oi tire minimum number oi

lr
4

items which should be answered to achieve ti clctir pass cun ho

determined by using the previous exarnpl-J as ti guide.

2.

Do not guess randomly. On the other hand it is recognised that

intelligent guesses often give a net positive rather than a net

negative score. A candidate should assess his or lier own personal

success rate on several test MCO papers by comparing scores
before and after additional intelligent responses. The results

..

ff;/.

'80Z'Anatom\"/* . T
I,,rt,wt,t]r-ttit>,;tttt\ur'tM_q\-,,;t~t><>sstFi\r~lE\al'ltO\~

/_

, ,/.\ -

ta-

.,/ . 4/

v:~L

the aamiltfm.

"1

,,,

\/~

r.-T

"*'

_= I

rv M '

" -

>

I_ #1
-

I l ._ . . .

..~.-

Q\< '

if/(5 -,1

'\_

"l;/

i."5 '-'3 7' ti.-,

I}

V),

-J
./ll

-- i
I Ii

if./-_"\

Ii

It

the scaphoid and the -lunate articulate with the head of the

t
I

2A

.t

"\".|l

' -~~\.s+ '' __*_-. _ _. _\E'21-.

\_-

hf

all

)\\

1.

---.

.1

*'

. I .i

'

'

'-

False

The platform
articulates with thalemerior
surface oi
.
.. ..-_4__'_,,,,,,,......---w-="~r

True
False

The proximal part ol the triquetrum articulates with

the tnquetrum.

False

False

True

False
False

'"

the triangular articular disc of the wrist joint.

D
E

1-

The proximal carpal row comprises the scaphoid, the

lunate, the triquetrum and the pisiform. The distal
row comprises the trapezium, the trapezoid. the
capitate and the hamate.
The radiocarpal joint does not communicate with the
midcarpal joint in the normal wrist. The rftirjcarpal
joint communicates with the c_arpornet'acar_gaLjgQ1t.
The lle><or'rtiriaculu'rn attaches't6'T'e scaphoid
tubercle and ridge of the trapezium laterally, and the
pisilorm and hook of the hamate medially. The
extensor retlnaculum attaches to the radius, pisiform

and triquetral bones.

'-

The pisiform is the most anterior carpal bone.

The capitate usually ossilies at about 4 months.

iy

<.

. ,;_.>*._ -.333
'-'-"-~':.' I'-t_-4-_~r_*;_,. _

J
\

\
'\$

Ex.PRT

.-'1

-I

Min

_.
(J

Appears at about 37 weeks gestation.

Usually the l_at_'f'tlj[l bones to ossify. The

True
True

I1

the radiocarpal lolnt communicates with the rrtitlttatpal ioint.

/,1-.f'

I"-L

il

-' . .-

..I=.--i

"

(-

.\

7"
I I t

alt

ta-wtttiq
.
the lr true rurn lies l the distal carpal row.
,,._.._--3.

'

l. .

t':m>,;,' the pisllorm is the only carpal bone to give attachment to lnuth
the llexor and exlensor retinaculae.
D the scaphoid is the most anterior carpal bone on a true lateral
radiograph.
E the capitate is usually ossified at birth.

Hi

capitatref
/tnl_',.r;,,
C the pisilorm articulates with lha posterior surface oi the
lriquelrum.
,
D theWrapezlum and trapezoid articulate with the scapltoid.
E the proximal pan oi the triquetrum articulates with \the ulna.

'

II

13'

,lt the acaphold and the lunate anlctrlnre with the distal rauliu.

K.

'

'1 4

ln the normalwrlst:
B

:"

V >

my

ssilication centre for the navicula_r_app3a__r_s at about

- 6)/ears oi age.

False
Appears at about 1 yeargnd is the flrt_9_sification

ml cc
jg,

1|!

Appears at about_ . egs of age.

True
False

' ,

-H

centre to be s'n'at_the elbow. it is usually (but not

, ,;;-~alvsl.r1ys) followed by the radial head, internal
' - 'epico_ndyle, trochlea, olecranon and external
1H,, hlr
- wt
epicondyle.
/'t'
5--1

,.r
it,-'_
.'\
~'..:\
Appears at about ll years of age and is the last
E False
_:'.'- l' ii
1"),-'-'/"-'-,5:-J
carpal bone to 5ssify. U V

False

B
C

..

l I

it

,1

K_

f~"'L""J
-.

.,.;,| _-;..-,,u'r .-t

the lower femoral epiphysis.

thrfnavicular.
.
f\
moom> the pisilorm. .

- 'I
l
t

'

1;.

A
16",)

./ ,,.I ,
,.
F

,~,

_....---

the patella. -,.._:_t_--r '~. C1, "5 r

..

g,ltr-- :41!

L.

t_
t___
$t\&'1

-'.'

.7 5/

-,_':_f.

E?

.1

'i<~'

Q-51.2%! Tt4&7,r~#.'-rrlrd=.lw7;,_--U W tw

W W I-.l-I
iw U "I) - I_|' *0 vs.: tr \~.I to -Q
-f
..
I
_
,

In the normal shoulder:

l
A the ioint capsule is lax intetiorly.
B the normal acromiohumeral
distance is greater
than
. .
.
. 7. mm.
C the glenohumeral iornt norrnally comrnrrrrrcates with the

the humerus.

,4

/ __._
/_ \_,;__1

\
y

\ an

.-......

t
".
\,

- <..,~.r.=:r

~4Y

) 2

True

False

tear.
""'_"
The subacromical bursa does not normally
communicate with the glenohumeral ioint However.

the subscaptriar bursa does communicate with the

sy.-rQv'rar"ra'errr5ra'rrarms glenohtrmeral ioint.
ll QFBEWF lllfl 5l'1liTl it is suggestive of a_ posterior -

True

False

dislocation. 3

Supraspirrattrs, infraspinatus and teres minor insert

into the greater ttrberosity'of the humerus.
Subscaptilaris is inserted into the lesser ttrberosity.

"1

B .

in the normal shoulder joint:

the long tendonyof biceps is extracapstrler.
B the capsule isattached to the articular rnargin of the ltrrrncral
head e><oap_tar'the inferior margin.
C the subacrmil bursa extends inwards under the acromion

'

cm.

True

True

it is intracapstrlar.
4 '
lnieriorly, the capsule is attached to the neck oi the
humerus below the articular margin.
__
However, the subacromial bursa extends beyond the

False

it comprises the fused tendons of subscaptrlaris,

the "rotat0r.;c'rli" comprises the fused teridomr of

subscapularts, supraspinatus, infrasrrirtnttrs anti teres rnajur.

t
.Flegarding the arterial supply to the upper limb:
l

~1

-,

H W

False

lateral border of the acromion with the arm aclducted.

supraspinattrs, infrasprnatus and teres m_ir_i_5r.

E' True

B
5C
=-

i
~

lb

6 A True

'

radial artery.
the axillary artery lies lateral to the axillary vein.
the axillary artery becomes the hrachial artery at the lower
border of teres minor.

V [E

the attillary artery commences at the r1ter_.l_ial border of the rst

\~*1'r|b'
. alt.
\
\
.

'

ft .

7!;

in

.-fl

, 1 r--~_ .-r?n~t\\

l
Y
-.

A _. .__ )f

-f

'-1'2-.:.I:'.-ll.-V
-:9
. ~,-w_
_,\
__
_

-.

1 .1

Qi-\\- ,_

. /'= ls;'\:"c*'l-}'ErvuQ_
xx

_\

O"

,- ...E_.1.'trrrt>itt...~;.r

. . .N C;1 ,-oyt-_~_;t''" ol-t\n

'
uvn c..*~

. ~.__.
5'1

___

\'u)-T:-I;-\-.5|t:p=( ~ Q

_ r,

!"

I,

'-l
V ' ' '_ P". ":A
in ', ,
Jr) -|l|,_tr
I

J ='~' ~"
,.(;

.'|

___ .

;".'I.';:

'

A ' .

/ ~-.-

\r F \I -:- l<

"

H l

'

'7 Q 3.
__

- ;lct>;4~tr-i"-=t--9
ll ""

I "..'..Yl'..~.*',*'(~""' 77""

r_

~--4

_
l

Q\\=.

_r

[L

-i

,.

ll

,
'

..

l,

r"

'

.1

1
l'

____ _
5; . t_/t

True
False

The axillary artery_b comes the brachial artery at the

True

Tl"! rs Pa" is ab_.BEQ.illS minor and has QQ_8

l>1enh-' the Second ear! is Qeltmd. migrate minor

False

til the first rib.

' ' ""' '

I " "'

_.i tr. ft).

r

~\'

K, \t-

.1

rl F~

- 1 l r - \-r

"1 f/r- *
<

_|.,l_

t.

'

._r

lf;~["l -

\._(Qr lg

*'u"l\" '\

,"~-lr-.

, --

.1

.-r I-rt-1) tgrrl

'1~

\"-""\ Q)"-J ts

|',,.r-~~fll

"

<\-1-,.1k-\/\__t

@_Q_l)CIul

6..

"l-

H W
'

--.-'*
*4
2' '<-
_. _.
Z4./
:%_- K_

"'

5'
I".'
-7. ..,_' . t__~_._
_/_.,_.-: _ .\_..,-,_-"
.__.

" i'l'=1

' tr

__b_\__ _Q fob"/Q
\

I '

. I

'Y_;1'1(,l_,\/\l'>u

.l

and has two branches; the rhirtrl R211 i_b_el_ow

pectpralis minor and has three branches.
The axillary artery commences, at the lateral border

,\
_*,

lower border ohteres major.)

l
t

' 5 -'

@-

The deep paln_1i_r arch is formed from the terminal

branch of the ragia|__grte_ry anastomosing with the
deep branch of the ulnar artery. The supe__riit:ial arch
is_ formed from the continuation of the uln_af;i@_ry_

ll

"'._
|:

4'.
_.

tr.

_/
"'

6L .'

'

'

' '..i r ..'- .

t_,>r -.

-6A~.,;'rI};i_$$ ~r-hr) l/n )

1- r-a~,-v<rc'-z"'w~

pr,

.'

" D the axillary artery is divided into three parts by the pectoralis
' minor muscle.
'

..

r..

B.

'

A the deep palmar arch is formed from the corttirttration of the

'

- B

when theffam-'t'Is abducted.

_- ',~-wt-.

the articular.urface
oi the humeral head
is four times the area
_
.,_
.
of the glengg.
.

i_e_>tin_fe_riQriy and so allows a wide range of

movemgrtt.
' ' ' ' "' '
'
A distance less than 5 mm suggests a rotator cuif

t
I
l

"

anatomical neck of the humerus. it is strong, but is

.r ..

"_.,--

The joint capsule passes round the circumference of/

the gleoid fossa extending proximally to include the
root of the coracoid process and distally onto the

A True

"at:-"l.-.'

._/ "'.,,--

Z"

4
* l

Q Q 9 Q S Q 1! aw.-t.vt-1,-Y"'

'\

5 6 7 11

.1-I-'1 -

subacromial bursa.
the normal glenohrrrneral ioint space has a |It\>ti|t'rur1't wirltn ot
6 mm.
the rotator cuff muscles all insert into the lesser tuberosity oi

__r. A

I I

K-

J
.

t
I\l|OL\J||ly

MCQ Tutor in Hadiology r

A
--

..

.\)

The superolateral aspect of the patella occasionally

False

lndependen ly and remain discrete.

C the posterior cruciate ligament is attached to the anterior

\9

The"fabel|a, a sesamoid bone, lies in the_laterai head

oi the gastrocnemius muscle in about[22;i=[of the
population.

False

the fabelia ltesirn the lateral head of the gastrocnernius muscle

in about 80% of the population.
_ _
the supero edial aspect of the patella may osstfy

ossies independently and remains discTe'te. his is

referred to as a_l:Lipartit_pitella.
The posterior cruciate ligament is attached to the
posterior in'tg_rg;p_ndylar area and passes anteriorly,
medialiyrand superiorly to the lateral aspect of the
medial femoral condyle.

False

intercondylar area of the tibia.

the lateral collateral ligament is attached to the lateral

meniscus.

TiiFliEralE6lla_tE1l ligament is separate from the

False

the lateral articular surface of the patella is larger than the

lateral meniscus. it is attached superiorly to the

lateral epicondyle of the femur and inferioriy to the

medial articular surface.

it

!\}\.~.\

'-

1.

Q-.2_"cl,
1 .~v -_,

_ (73 ' -

2;

.
>7

head of the fibula. However, the deep part of the

l' ta

5L

~\

-.. _

(1 !\U" Y
_

ck

L A

t-.

True

/
I

5'

:~

True

in abotrt@_Z<Dof individuals.
The lateral meniscus is more rounded than the
which is more crescentic in shape.
C True medial
On
the
other hand the anterior and posterior cruciate
D
D
ligaments of the knee joint a"F intracapsirlarl but
l extrasynovial.
""~'"
""'

8 Q True

.'rr,-'
-Y

True

t e suprepateller bursa communicates with the knee ioint.

the geslrocnernius bursa may communicate with the medial
condylar cavity of the knee ioint.
the medial meniscus of the knee joint is larger than tl.e lateral
meniscus.
D the collateral ligaments of the knee joint are extracapsuler.
the popliteus tendon is intracapsular.
,
t-. .,_..;~

"

medial o_Qa_tera| ligament is attached to the medial

meniscus.
Z

i,

%i,"~,The'_pitellatf
A is a sesamold bone.
B is bipartite in 2% oi cases.
commonly has an irregular anterior margin. - has two paired facets on its posterior surface.
'
lorms an attachment lar tho cllpeule of the knee taint.
MUG

The p'r3pliteus tendon separates the lateral meniscus,

True

to which it is attached. from the lateral collateral

ligament of the knee joint.

. ll

- .

A sesarnoid is a fibrous, cartilaginous or bony nodule

True
.

\,

._,_/
\

within a tendon. The only consianl examples are the

t-

True
True
False

patella. which is the largest, and one in each of the

tw0,.tertci0ns of flegror pollicis brevis in the hand, and
flexqr _hallucis_ bryi_i_F\_i_lj roar?" W I ii.
A bipartite patella occurs much more commonly in
males than females. When present, this normal
variant occurs bilaterally inr'43/aiof
cases.
\'4
On the posterior surface of the patella, there are
three paired lagets for articulation with the patellar
surface of the iemur. There is also a medial feggtfor
articulation, in lull ilexion, with the medial margin of
the intercondylar notch of the femur.

True

Vwwww Wwtwvviwwwwilwwt
_ 8

M(_;O. Tutor in Radiology

10

www\I~wIt '*I'~I'w'w'w!g\g\g.g-.__w,w
Anatomy

10

The iscliigfemoral ligament is the wealtestli_gament.

The pubofernoral ligament is the third ligament
around th-hip?

posteriorly.

thg__a_rtiy_gfthe ligamenturn teres originates from the

-.'obturator
arteTy2
-..,_.__,..,.,about =
D the angle of inclination of the femoral neck is normally
127 in adults.
heatl is visible at hum.
E the ossification centre for . the femoral-7--~

:,I'I\ Of

Y-4~r-'\~tAr

I \ ' I

"t.
L(..'\';,-_r$|
'1

L-/_-', .
'/

-- -

i{f1tieTtt.e~!e,@s>.t5tlet..@=.=vit

'ti 7

_
'

-.~='~l\>

the long saphenous vein lies anterior to the medial malleoltzs.

the long saphenous vein contains less than five valves.
the short saphenous vein lies with the sural nerve anterior to

the lateral malleolus.

there is no communication between the short and long

saphenous veins.

in neonates, the angle of inclination is normally i60.

False

it appears durittg the first

of life.
..__ year
...._-_._...

True

The angle of atttaversion is SQ at birth and 8 in adults.

B
C

True
True

True

True

12A
B

True

in the femoral sheath. the femoral artery lies lateral

to the femoral vein. lt changes position relative to the
femoral vein as it passes from the femoral sheath
downwards into the adductor canal.
The femoral artery gives off suP6_fii__jgl hranches

which supply the anterior abdominal wall and skin of

the external genitalia.
=
'

'

T-he long saphenous vein contains at leat_1Q_val_ves.

False
False . The short saphenous vein lies with the sural nerve

False

False

posterior to the lateral malleolus.

There are several channels of communication
between the short and long sephenous veins.

The long saphenous vein drains into the femoral

vein. The short saphenous vein draini?tto'the

the long saphenous vein drains into the popliteai vein.

True
True

t
t

B
C

C
D

triangle.

popliteal vein.
Q

1 a1./tr,-,7 I

r in t.
I =7/J(i

\\

l,.,/' .
t

hie. _ _.

li..'

__

, .
t
\

..

.'-;:t ""9 -I
I

,'4\i
l:_-J

",{I_

along the femoral p__et:k. Anterioriy the joirTFEapsule is

.y__

li

supplies branches to the skin of the anterior ai:~t:'omina i

gives rise to the profunda fernoris artery in the ietnota

"TODD?

Postetiorly the ioint capsule does not extend as far as

the intertrochanteric crest. it is attached halfway

False

is a continuation of the =2;-.:ernal iliac artery beyond the

inguinal ligament.
becomes the popliteal artery after piercing adduutor magnus.
lies anterior to the femoral vein in the 3(i('.itlCl0l'EgiTEi:_m
l wait.

"vi:

att'ac'he'd"to_'the intertrochantaric line.

I4) v,-tL-\.

V.) t ti
,.\(;uf I

".1

The iiiOf@t__J_l'l ligament (Y-shaped ligament of

Bielwl _i$ the t_rgn_ggt ligament around the hip.

False

the ischiofemoral ligament is the strongest of the three

ligaments.
the joint capsule attaches to the intertrachanteric crest

l/B

7"

ln the normal hip:

{A

1
\

10

MCO Tutor in Radiology

13 The clavicle:

'

has a secondary ossication centre at its lateral and which

C
D
E

forms a sec9_\'_t_t_1_a_[y_ca_rtila_gi[tous joint with the sternum.

has a rho'rT1boid fossa in approximately 0.5% of the population.
may exhibit a conoid tubercle for attachment of the

appears at 18 years and fuses at 25 years.

..

D True

E False

' Y i""'~= - '"~-"*~"-'3 ~"='-"i

_ .

14

A True

/X the first costal cartilage to ossify is most commonly that cf the

f" t rib .
,%B ptha ribs have two facets for the costovertebral joints.
C t e tubrcle of a typical rib lorms a synovial joint with the

._,_.

V.

-4..'lr~.:
B

False

? transverse process of its own vertebg,,._

/F D cervical ribs occu in approximately ll_.59":-of people.
E

each rib forms a

C
~
l\'

"M

._".'

'-

'~
True

If

r
'

.f.~

'

"I3

D
E

1.1!."

,~

15

*
i

Regarding the major airways:

-TA the trachea blfurcates at the level oi T5.

M 5-B me noimal S'Ub:;lJ'ifl18llpiii5;ppl'OXim3!'3!y 90;

"

15

, I
6 i; O)

e Hg it maln r 'nc us ts ot more vertical ;:lt longer than

the ie. w/
T/ '.
'*"

the trachea is reinforced by 15-20 incomplete liiigs o'l ftyaiine

N t

33% of these are bilateral.

'
The conoid tubercle is for attachment of the conoid

pan of the cora_c_oclavict;lar ligament. The rhomboid

Ossification of the first costal cartilage often starts in

the s
e. The costal cartilages of
the lowest ri_bs ossify next and the process -

l:>rver.es.'.uey!td-

A typical rib has two facets. The lower facet forms a

synovial joint with the upper costal facet of its own
facet of thevertebra above. However, the first ri_b has
only one costovertebral facet and articulates with T'l
venebra only.
i"
The tubercle of a typical rib has two facets. The
medial facet forms a synovial joint with the
transverse process of its own vertebra. The lateral

facet is non-articular and gives attachment to the

t
i

Afrhornboid fossa occurs in @r normal clavicles.

vertebra and the upper facet with the lower costal

9oEnt with its costal

cartilage.

in two. The manubriosternal joint is a secondary

cartilaginous jointT\J"""\_7~'
Fm

fossa is the site of attachment for the costoclavtcular

lig'a'ri'\'gtt.
''

'

141 Regarding the ribs:

/1%
,
ll J

intra-articular fibrocartilaginous disc dividing the joint

LA

-"1 C

costoclaviculer ligament.

l1

A True
-- it has no rnedullary cavity.
B False * The secondary ossification centre is at the medial
end of the clavicle.
FT '7
The sternoclavicular joint is a synovjgljgnt with an
C False

'

uH-A.irC. r I/1' ' I5 Yna. (' /use /r"-

13

A ossies in membrane.

Anatomy

'

cartilage.
' '
on a lateral chest radiograph, the right upper lglie br'-':r'.-;i\-.-s is
visualised end on above the left main stem brtfrlclttrs.
\

-lateral costptransverse ligament.

True
They are usually bilateral but asymmetric in size.
False
They are primary cartilaginous joints. A primary
cartilaginous joint is where jyme
cartilage meet; a secondary cant aginougjoint
lsymphysisi is a union b5:-.l\.r!fl 5. e
articular surfaces are covered with a thin lamina of
- hyaline cartilage.

A True
B

False

False

D True
E True
,

It bifurcates at the lower level of\@

The normal subcarinal angle is 60 " 3: 10 standard
deviation.
"" '""'

The right main bronchus is mog vertical than the

left. but h9_rtir. The right main e'F<>?ms measures

2.5 cm in length and the le_ft__Lr\easures Q

.
Q

-r

"

w~:*Jtene.vitt2.twatY4i>ut43v"W""*"-"'l!*""""vvvvvc!-g;y=~~-=- -Anatomy

16 The tracheeis an immediate relation of:

{A
/ff
cf C

the
the
the
the

left vagus nerve.

oesophagus.
isthmus of the thyroid gtand.
IhOl'8t.lC duct

"- ts

False

True

True

False

False

F: the left brachiocephalic vein.

@7-

11 Regarding the sstiresof=lthelung:7' '

J g all the accessory ssures comprise two layers of visceral
pleura.c.=xC4j7l- 1i'l~_aQj4{o5 723$ MN I645 f-Tzwf l9/c5Q"Z//"/*"

'l7

the minor fi sure runs h rizontally on the ri'glTFat the level oi

WY!!! 9.!l E1f!l!39B-

the azygos fissure occurs in aboutjja of normal intlivldttals. Q

\?D . on
the lateral chest radiograph the left oblique fissure is
"6;

Yl r

usually more vertical than the right.

the iflferior accesso_ry_fissure separates the la?teraljaasal

18

the density seen on a plain chest racliograph 's mainly clue to

T lymph nodes and bronchi C Maj
g
l
\~A~B'the transverse diameterrof the basal pulmonary artery is
approximately @mm in an adult female. / T7 _. /5,, ._,/._

be

the left pulmonary artery passes anterior to tte leaf: rnaln

bronchus throughout itscourse.
/(D th hilar point is where the basal pulmonur-y artery crosses the
ZF E

upper lobe veln.

1'20 U g

the right hilum is higher than the left in about 5% of people

vessels evil.-e2oi.sav"teh: .

T "T TT

The oesophagus is a direct -posterior relationof the

trachea;

The isthmus of the thyroid gland is an anterior

"relation or the trachea.
The thoracic duct passes from right;o_|3ft poerior
to _the oesophagus,
at the level oTt?l'5.=
_
v

False

B
C

True
False

True

False

;The azygogs fgirlayers, All the others have two

" layers olrztsceral pleura:

., _
lt occurs in about 1% of normal. individuals. It ts
visualised on Q,_L__/5_gf chest radiographs.
The left oblique fissure therefore meets the
diaphragm more posteriorly than the right.
The inferior accessory ssure'separates the ntgggl
basal segment of the lower lobe from the rest of the
t<;b'e; It occurs in about 25/q of individuals. making it
the most common accessory fissure.

18 At the pulmonary hilum:

'- 5

The right vagus nerve is in contact with the trachea.

The left is held at/vay from the tracheiir.,'_l;i_;y;thjelgreat

.1

segment of the right lower lobe from the rasro the lobe.

'

13

/
s

False

The den_sjty__qf the normal hilum is mainly due to

B
C

True
False

The left pulmonary artery initially lies anterior to the

True
_

False

bl9991eelIt measures 8ppl'0Xl1&I6l\j_1_f1l__@_lQ1_8.

bronchus, then arches over the left main bronchus to

lie posterior to it. The right pulmonary artery lies

tmteriwr to the tioht main bronchus-

The hilar angle is formed by the intersection of the

bas3l_pulr_rtQrta_ry_artery and the upper lobe vei_n_3gd

is normally about 120. '

"'
" _ *The Fight hilum is higher than the left in about Q_.Qf/1

of people. The hila'areat the same level in about Q:/9

of cases. In the remaining 91% of cases the left hilum

is higher than the right.

~i

" T

I4

MCO Tutor in Radiology

/-umtuttty

%et:r>.mmtitt=.A*:atra'mwat=~
the left paraspinal line is wider than the right.

Tru e

the maximum width of the right pgratrgcheal line is nun.

the azygos vein should not have a diameter greater than

ft mm.
\W
_

-<.Wir%~t-~-w r

. >t.<i:. I

the posterior |Ut'tCllOn line exte

hove the suprasternal
notch and com rises our e ers l leura _
he aortic nipple is formed
te e uperior tntercostal vein

arching around the aortic arch.

1
-

~"

True
False
True
True

'

tq

Ti

Therrraximum diameter of the right paraspinal line is

gm, The maximum width of the left paraspinal line

' LEE
The azygos vein has a maximum diameter gill
Whereas the anterior junction line ends below/_ the
suprasternal
notch.
' '
_,
....
.1

s -- --

#2./eattttiiter
" t the left upper lobe is divided into three segments
3

|I

ll

ti.-.' 1' 5 ' <8

.1." alt \'- %l3

the bronchial arteries all arise directly lrom the aorta.

'
the lingula is divided into medial and lateral segments. 3
an acinus comprises three to five terminal bron_chi_oles.
the veins are usually anterior to the arteries.

. J = elf, , ><

.1 ~ - - r '1 + E

' g-l

-L

la
Z '_.

i _/",

.l

'

-|i

1'

_ .

y
'

ZDA

_ .

'

_ l

'

'

..- 1- t

, T

'

.-

-/r

_. /'

2} Begardlhgvtha pulmonary vasculeture:

.,

_, t

t_ '1

-V

tt

',,,M) i5

)5

False
False

21

'5 {Timbe-

the hilum. f6r/'M/ /0 HM 21;/um - p

(/9

False

True

False

Lower zone veins tend to be more__j1p_ri;_ontal than the

True

vetjtical than the arteries.

T ' "
Mean pulmonary venous pressure is approximately

False

at

Wm

lii Balmvn ry trunk is a posterior relation of the leit alrittt/Q/)'ib1/at-t'l'\'3lI(,)"" _

{E in the upper lobes the veins usually lie lateral to the arteries. Q-{QV
1 Z2 At the level ol the lower border oi T4-

(t
gin

E
D

;-/

th6Teft_phr.enic nerve lies adjacent to the trachee.<Ef4""Lei i"3"l'""quL

the thoracic duct lies anterior to the oeso he us.

. . .

P 9

the azygos vein |OlllS the superior venarcava

. . '
the second costal cyttlage
meets the
rtsternal .7met
the ltgaritertturn artertosum is situated T

|_

False
True

False

into superior and inferior

segments. The right middle lobe is divided into
medial and lateral segments.
A secondary lobule comprises three to five terminal
bronchioles. A acinus is all the lung parenchyma
distal to one viii-minal bronchiple.
K

arteries. In the upper zones, the veins _a_re more

3rnrvHe-

The truncus anterior arises proximal to the hilum and

passes to supply the right upper lobe.
The pulmonary trunk is an_t_erior to the left atrium.

it is separated lrom the trachea by the arch ol the

aorta.
The thoracic duct crosses from right to left as it

ascends posterior to the oesophagus at the level of

T4/T5.
True
D True
E True

Lg

Z A False
QM

_l

""

False

""

/ _C the truncus anterior arises from the right ulmcnar arte

rides?
The lingula ls divided

he normal mean pulmonary arterial pressure is approximately

There are usually three bronchial arteries, two on the

left arising directly from tlteagrta, and oggogthe
right arising from thitijircl right posterior intercostal

X./it the lower zone V9ll'\3 are more vertical than their
corresponding arteries.

The left upper lobe comprises apicoposterior and

anterior segments and the lingula comprises superior
and inferior segments.
M?

"""'- H

./-T\

The manubrio-sternal angle lies at the level of\]_'i.)

This is the remnant of the ductus arteriosus, which

connects the left pulmonary artery to the aorta in
fetal lile. It lies in the aortopulmonary window.

ta 't\.ir to-W0"-srnr-"t0t~-vg--1.1
23

CC"@U'@@@@Q@@TiT

The superior vena cava:

TT __w

23

/ /*<

A False

QA is formed at the level oflqllrl G /9

<B

//

False
True

has two valves ""'

has only one tri ary.

D is an immediate relation of the right pttrenic nerve.
E may be left sided. ;n 0'5 _\_d Si \m/w\,L -

/ 1

True

'

N? ab

from the union of the ascending A

ettts
t

it cot_nn1_en_es at the level o@

45

use

.fli1%l2fIl;g?ri5lciE;duct:7'
all

/B

com
of L-l.

as a continuation of the cistetnzt city-ti at the level

lt/El Gig? $3) \c~\i\

has no va ves. T\r/\~,._;t\7\

than anterior to the oesophagus at Tilt: level of T5

/\X
myg

V
5,

q~(\C,t_tJ.<,lI3Z.t

drains the lymph from the wllo_l_tht_)rax;;!'

crosses the |:psterior_rn.atliaitinum from right to left and is

(kl
%/

25

1 579

passes t r.o_t.tgh the central tendon of the diaph agnt at the

/\.

O \J(((

'1

A
B
C

True
True

True

True

False

e"hemtaz\,/gos vein crosses from left to right at the level of

to ioin the azygos vein.
the accessory hemiazygo vain receives larontzltial veins from
the leit lung
Er ,,5'\\/lg
/V AS
M +-Lt, 4.,y11llr{I

E
1

26

_ 26 Regarding lymphaticrdrainage:
/<A the t'lg|"lt>l\/mphatlc duct drains into the right brachiocephalit:
(/8
/(C
?
E

\\

'

'" M ""-~

the.-thoracio'du%tha'sa diameter of 1042 mm.Q \/~

the thoracic duct is approximately ~l_t:m long.
the thoracic duct drains into the azygos vein.
the thoracic duct lies between the azygos vein and the
descending aorta in the lower mediastinurn.

t"" _-.

.,

The azygos veingrains into it posteriorly attT_=l. )

.1

ilk l

,\
%
>_,- If

hit commences in front of and slightly to the right of

( _L.1,'ancl ascends to the right of the vertebral column.
It passes posterior, to the oesophagus, and racuives

the lower eight posterior intercostal veins.

it also receives=sorh_e_ veins from the rnigdle third of
the oesophagus.
U
'
xg .

It commences at t.l.:'~

False

False

False

the left half above it. The right side of the thorax.
head and neck drain into the right lyrnpltatic duct.
It crosses the posterior mediastinum posterior to the

A True

lt drains the right side of the thorax, right arm, head

The diameter of the thoracic duct isv_l_;Z__n_g1.

#5

False
False

False

C True
D False

rnvvx

l=

in 0.3% of people.

A
B

1%to~5.ly e t29fl6$ at/\lm,V

vein.

lt commences be|t_irt_t:l_ the manubrittm lT3I4l and

enters the right atrium.
it has no valves. \
_ ..

> - 1

/Tl /)7B twsteriot

sardine! vsiri-'1
med
'/T

True

ITTUOUI

248
ll /asw%t=ta?.t4tzt.ttt!tt%tttta2.;!tt2!==Y1@'
F
*==="
,_
A embryologically the azygos vein develops from the right
t

TC

True

it passes between the gverlagping right and left

crural__fiQrs. behind the median arcuate ligament at

the level of T12.)

'
There are many valves. the last of which is

approximately E} cm prgxirnal to the venous junction.

lt drains the whole body below the diaphragm and

oesophagus.

'

and neck.

The cisterna chyli is 6 gm long.

The thoracic duct enfrsthe point of confluence oi

the left trite nal ittattlar and suhclavianysins at the

level of_'Q7,S
The azygos vein lies to the right of the thoracic duct

and the descending aorta to its left.

in

|v|t_t.t tulut lll hautulugy

7

.:_~__

27-l Theathymusz " '

'

-7.

_ __

ti

l (/_,'

_ A is usually situated in the anterior morliastlnurn.

i
bgwjl
IS predominantly composed oi fatty tissue in young t:liildrun.L%'\\l*('

reaches its maximum weight at 2 years.

Z>.~.~.t

-/

consists of two iobee, the right ls usually larger tlmn the lnlt.\?h"'
euui-.t== its l.tl::.-ti supply lrom the inlcrior thyroid and internal

illOlBL.'l\. arteries.

' """'"

"

la\<ta)

/U

7.

\\

._'

.3lj'_llfhl!$f]f__3;$j_t_lj7gib{Llrl1th6sapr1-opulmonan/> window; a
the ductus node.

the left recurrent laryngeal nerve.

the left bronchial artery.

l
3

I
.

the left vagus nerve.

28

r.>?.f /\.;:=<

the ligamentum arteriosum.

1 u ;_;t__;_.tkpurst;-ptiagtt_s:,;'
C6
(V
;. \.Ulllll|tllCi':S at the cricopharyngeus muscle at C4
gr \\_P%
B pierces the diaphragm with the right pllllllt, nerve.
\/W\_,L/"/
C has striated muscle in the wall ollits upper third. and sinuotlt
' . \
muscle in the wall more distally.
3///< D H is retropeliloneal in Its intra-abrloniinal portion
_

(E

'

29

receives part of ll5 blood supply from l|te,lh"t0t:urvtcal trunl-

Art TAG
Ven BAG

QB

"1

QC

O)

_b llw hlmqln bronchus as lt passes |.}olsTerit;r to the

"

'
l

'

'

,,

30

'

posterior" impression:
CP MARS

'

growth spurt,-reaching=a maximum weight oi

30--4O5g'a't?l'1 ye'ars.~..
'
.3; __-_'

True

True
True

A
B

False
Falie

lt commences at the cricopharyngeus muscle at';Q.__;

ll passes through the diaphragm at the level of T1_Q
accompanied by branches of the left gastric artery
and both vaQgl..!1_*1.T;{s tleit anteriorly, right

True

This probably accounts for the fact that normal

physiological events occur more quickly in the upper
oesophagus.
_
The distal 3 cm is retroperitoneal.
The upper oetsopghagus is supplied by the inferior
thyroid artery from tlteitltyrgcervical trunk; the
middle portion by oesophageal branches of the aorta;
and the lower portion by branches of the left gastric
artery.
'
'

True

False
False
mm

l\l\vF>\ClElYlJrl flavltsubclavlan artery causes an anterior

[J
E

life.

True
True

A
8

'Li,5;/'13

19

A
B
C

pliarym. cause a poaterlgr impression.

The post cticnitl venous plexus causes a post.'=rinr in1;sre:=sirJn.
The aortic ttirtwua at tltu mt/at ol rs? anterior

it weighs jQ"l 'g at birth, grows for Y years and then

stopsgrgwing until? years when it has a second

D True
E True

t/-E_'/<
.'t;-!;~,#tt;!l9t:3tttsttl,'
ttt2u:::ettt*s.tet9:rrr.t%'t*9"" it? ''*ff
A The low-.~r fibres ol the tnlortor constrictor muscle I the

Anatomy

_7

False

tr

it lies anterior to the great vessels and trachea.

it comprises lymphoid and epithelial cells in
childhood, which__a'r3 replaced by'i?ttVt'iEstle in adult

D True
E True

-2

True

L,

..>\False

"

1- _

False

False

All these are situated in the aortopulmonary window,

along with lat.

tw.ststii"lvl- "

This is the cijgopharyngeus muscle.

This vartotisplextis commonly causes anterior
impressions at _;,
Tl I e ElOfllt..
\ " k nuc kl' e may cause a le it sided int ression
at l T4 : I
"
' '

rm; left main bronchus indr.-nts the oesophagus as it

passes in_ front ol it.

An aberrant right sluhclavtan artery causes a posterjgr
impression.
"'__
I

'>
.1

._/.

VI

-J1! 4'49tL.td'tul?i t'\'..iWbtti"'T

a '~'@ ii

ta C Q

-T P T

in the larynx:
A the corniculate cartilages commonly ossiiy.
B each pyriform fossa lies between the aryepiglgttig fttembrane

Q Q

31

medially, and the lamina of the thyraid cartilage laterally.

C the v_s_ttpgle separates the true and false vocal cords.
D the trlttceal cartilage lies in the thyrohyoid membrane.
E the valleculae are paired depressions at the base of the
tongue situated between the tongue and the epiglortis.

D .,:

B
C

In the region of the larynx:

A the hyoid bone is situated at the level of CI}. 'l
B the thyroid cartilage is situated at the level of C6.

32
\:

\7

at birth, the body of the hyoid hone is usually ossiiied.

Regarding the thyroid gland:

'
A it receives all of its blood supply from the external carotid
artery.
the thyroidea ima artery is present i1 abotft 50% of cases.
the inferior thyroid veins drain into the internal jugular vein.

33

32

the cricoarytenoid articulations are s'yi;gyialTi

the angle at which the thyroid laminae meet is greater in
males than females.

DO

l
l

the carotid sheath is a posterolaterat relation.

the recurrent laryngeal nerve is a pcisteromerlial relation

THUFEUJ

CCrUCUUQCiIU'UUAngQ
False

True
False

D
E

True
True

A
B

True

C
D

True
False

True

False

False

False

D
E

True
True

False

B
C

True
False

D
E

True
True

False

34

With respect to the parathyroid glands:

T
A they are variable in number in the majority of individuals,
B the superior glands are more constant in position than the
inferior glands.
T
C the inferior glands arise from the fourth pharyngeal pouch,
D they receive most of their blood supply front the inferior
thyroid artery.
y ,

normal parathyroid tissue may be located in the itiperior

rnedlasttnum.

E
I

1 ,t..r_tIt.t , .

'1'

'

,1!

',\

"

L"\

1:

,,(tr

/21/. H-'

ti

,.1-..

l-,.;ri.-..--

__,,(,._ 5-.,.~tf .-F-;_-

'

'

it :1 I

The corniculate and cuneiform cartilagas, and the

**Pi9'Fi5 ate iietesease and enot essiiv The

thyroid, cricoid and arytnoidcartilages are liyalilte

cartilage and commonly ossify
T
The laryngeal ventricle separates the true and false

cords. " _'

The thyroid cartiiage is at C4; the cricoid cartilage is

at CZ

The cricothyroid articulation is also synovial.

The |arpina'e' meet at an angle of approximately Q_
in males and 120 in females, i.e. males have at

greater laryngeal prominence.

The body and greater horn of the hyoid ossiiy at

birth. The lesser horn ossifies during adolescence.

The blood supply is from the external carotid artery

(superior thyroid branch) and from the lhyrocervical

trunk (inferior thyroid artery).
The thyroidea ima artery is present in about 3% of

cases. lt enters the lower border of the thyroid

isthmus either from the brachiocephalic trunk, or
directly from the aortic arch.

';.H_""" "

Thesuperior and middle thyroid veins drain into the

internal iugular vein. The inferior thyroid vein drains
into the irtnominate vein.

About go"/9 of individuals have four parathyroid

glands, 2.5% have fiye glands.
" '
The inferior parathyroid glands arise from the third
pharyngeal pouch. The superior parathyroid glands
arise from the fourth pharyngeal pouch.

it

T-*-U
.._ \___

_~

.'..]

iii\..~..t

35

_ l
-u__~

tutu!

in Ila-|\JI\.'el\-JU

Hllatulliy

The female breast:

4'-T
superficial
fascia.
True _A
True
These ligaments are tibrpus tissue strands.
False
The breast has about\'15 h-lain ducts, each of which

A lies on the deep fgspig pf the anterior chest wall between the
second and sixth ribs.
4
is supported by the ligamentsof Cooper-_
has about 50 main ducts.
'
"
has its exocrine tissue replaced by lat with increasing age
TWUOW obtains its entire blood supply from the lateral thoracic a
rtery.

5:4-5:-ii

__

'i

~'

/T

True
False
at

it

TA it t=Ojp_rlses two layers between which is a potential space

containing gg-25 ml serous lluid.

it extends to surround the entire length of the superior vena

cave. //1i.Z4t1rl/ i/id-n4 (at/4

it is normally 1-2 mm thick.

True

'

False

'

True

True

xiii

the transverse Sinus lies behind the ascendinq aorta.

the oesophagus is en immediate posterior relation,

True
lrnt h a h euro;
...37.l't
:
l
V2 tLie right atrium isthe most posterior cliarnt;-erL_Qri~

- N4V
,//

'

il"

. l

'.._..,|

the,leh_ ventricle is characterised by a muscular conus to

'"l'~'"dlblJlUtTli and trabeculae carnae.
the left atrium receives twovptilntona ry veins.
'
/h/rind/14.?
/
the left ventricle is the most anterior chamber.
PM t Vm/MS

(
E
I

Fake

True

1 e criste termlnelis separates the right alriurn from its-

appendage.

< l2_i~ \/L2

oi?
_;

l 33/ <.1

True

The competence of the afbventricular valves is reinforced by

The blood supply to the breast is derived mainly

from the lateral thoracic artery, but it also receives
branchesrirom the internal mammary and intercostal
arteries.
1
,

The two layers are the fibrous and the serous

pericardium.
' ' '
H
Only the part of the superior vena cava below the
azygos vein insertion is enveloped by pericardium.

The transverse sinus is a pericardial recess which

may be mistaken lor mediastinal adenopathy. The

superior recess or oblique sinus lies in front of the
aorta.

The lettatrigm is the Fhost posterior chamber.

The crista terrninelis is e muec_:_ul_gg_rilga on the
posterior wall of the right atrium, between the
superior and inferior vena cava.
These features characterise the right ventricle, aiding

easy recognition at angiography.

The left atrium receives four pulmonary veins.

The right ventricle is the most anterior chamber.
The aortic, pulmonary and tricuspid valves each have
.
three cus D s _
Tile 1[iQ_ 5 id valve is the only valve lying to the right
of the rnidline. Q

__f_______

.._.

""

The tricuspid valve is the most inferior of the [our

valves. T
i I H
Tlie chordae are attached to the free borders of the

cusps and to papillary muscles which arise from the

ventricular walls.

chordae tendinee.

It

True

True
False

False

False

on the frontal projection the 8Q_[1l-6V-B-l-vg is the Qn|V varve mt

lies to the right of the midline.
In the lalterellproiection the pulmonary valve is the mos;
anterior ol the valves. o_<\,;4;.,.A;,.~gt,,r>,r,tr%
I" he laleral Pll9ll0rl the mitra valve is re most inferior of
the valves. L/V; CW>Q\9">"

rvl

False

38

in the normal individual, the mitral valve is the only bicus id

valve.

False

) .

33" R99Brding therheart valves: F I

A

drains a lobe of the breast, and opens onto the nipple.

ty. ,_

Ii=r=eardlneahe;parteardium:_
';B

1.0

IJ'-1~wv.vwwtv
'"'
- .r
..
.
24 M_CQTutorinRadiologwWw0 " 0' " r@@WWii9\\IUl@i~I It-I I I 0 I I Q I any
stir-9
Anatomy
25
39 Regarding the coronary aneriesv

h i
' - from the right
._, . - @011;
coronary artery arises
po.~..r=riQr
A tskeuigght

_
I

False

the sinoatrial nodais usually supplied by the tight coronary

artery.
-r )

'

True '

/c alliltoximately 30% of individuals show right coronary artery

i
dominance.
"
'

. go
its

The right coronary artery arises from the giterior

aortic sinus. The left coronary artery arises from the

left posterior aortic sinus.

The sinoatrial node is supplied by the right coronary

True

Y B i8 Bf_1_flOVr_deiEendlt1g artery runs in the atrioventricular

groove.

-- ~
_

False

-I\i'~#\/vvt./\9\( LO Q3

D
False

artery in about Q9"/glgf cases. The atriovantricular

node is supplied by the right coronary artery in about
The dominant artery is dened as that giving off the
posterior inieryentricular branch.
The diagonal branches arise from the [git anterior

descending artery. The circumflex artery has at left

marginal branch. .;
Ti
J _ N
The circurnfl_e>pranch of the left coronary artery tons

ta

-b /

With respect to the venous drainage of the heart; V

ii! e coronary sinus receives about 90/., of the \,e,,5us drainage 6
th a coronary sinus lies in the posterior atrioventricular groove
A
C
~
.'
_-st'_
gt)
me coronary
sinus drains
directly
into
the- right
alrlvtllf

;_
I
L
,..._

\~.

Li_

l-r

:~_

. _,

"__-

/
-

- J!.

1
_

.-L ?_
~-._-

41

A _>

I.

1,,

_,,_-U,_
\I

_.~.

W . t

4.

._.

,i,.L;

\. r.
_

i
}

3-.
.
i
.'
.-

(_

'

.
'2

#55

till.

--

False

The coronary sinus receives 60/aiot the venous

drainage.

'

The anteriior cardiac veins and venae cordis minimae

open directly into the right atrium. The great cardiac,

middle cardiac and small cardiac veins drain into the

coronary sinus.
The great cardiac vein accompanies the left anterior
des the interve e. The

ein accompanies-~the posterior _ _

inteiventricular artery in the posterior intaivantricular

groove-. ~~~ r

_
-,

the oesgphageal hiatus passes through the ca

l . - . i "
the me ial arcuate ligament is a thickening ofiiitrig pigiioiagfg
the aorta passes posterior to the median arcuate itgiiaaii i i
accompanied by the thoracic duct and azygos vein
/EU I/'4:-2124/r,'o /Ac?

S{'v-'

r
i__

Regarding t-he diaphr.agm;_r

A the left crus is longer than the right.
the left hemidiaphragm is usually higher than the right

3} 5

False

B True
' ii-\'\/t=>zi( True
e anterior cardiac veins drain into the coronary sini_iax:***("
False
the great cardiac vein accompanies the posterior
l Q lnwbw _>CLq(
7'

T""""'"

40

intervantricular artery.

in the atrioventricular grggygi pgsteriorly. The leh

anterior des_;:en,din'g artery runs in the intarveniricular

groove.-

J3

90% of cases.

the cigzumflex artery has several diagonal branches.

I

wwwqi

41 A

False

False

(git) C
4 = (4,/[ '

False

L , '

~-~

Ti\\l'l_Q_i1l_i_iO[\Q_l:._ii aggches to L]-3 whereas the

ielfattaches Toll agd Lg ggly...

Tliehrhentidiaphragm is L_-2.5 cm higher than

the left in 99% of cases.
'~
The oesophageal hiatus passes through the guir_a_nf

the diaphragm at the level of T10. The hiatus for the

inferior vena cava is through the central tentign tlevcl

'T8l
True

True

The aortic opening is at the T12 level.

ag e.L?\j_S rt/2/in

i
.

"it

~-

--Iv.

lulul

Ill tluululuuy

Anatomy

LI

3
' 4
'-AI "I

'ur\>"

__ 11.1

2 _C"=eflI19 the peritoneal spaces:

'<
A th
' Paracoltc
- gutter conununlcales
. the right
.
suZl:lQl1.l
directly
with

.- y

epettc space.
,{< B ii"? Eh Paracolic gutter communicates directly with the left
subphrenlc space.
KC

True

'

Rutherford Morison's pouch ls the most dependent part of the

right paravertebral groove in a supine palie-nt_

4 tihe esser sac is related posteriorly to the right kidney.

_
H: ._

'

t e esser sac is related antenorly to the 5[Qmgr_;h_

False

True

The right paracolic gutter also communicates with

the right subphrenic space.
This communication is prevented by the
phrgrtigggolic ligament extending from the splenic
exure of the colon to the left hemidiaphra;mT""
Rutherford Morisons pouch, the hepatorgngl fossa, is

False

Tlwe lesser sac is related posteriorly to the leflfilnfy,

True
*

'Z~#3;'
4'.-2 -3'
eff"T:
l

duodenum
tip
(r A the first part begins to the left oi

L 4.09 t

u{'

f/B
/C

the first pert is completely retroperitoneal

the accessory pancreatic duct opens into the second

distal to the duodenal papilla.

//

\ g

False

_
p

;"_?"fE'l_5_1?r.QQ.Dnlyentes.are absent l the lourth part.

I /K

6 Its, part may be indented by the gall bladder.

(y;(,,,g.l ,-,;1-tt(.-.,2/I)
L
t
our-J-'I"'.

\|

C1\_,'t.'/-I

C/:.\'u/.'-.,
'\'-

<>\1\\':

4':/{(2
- j
'

":n';-l-

True

Ba
C. True
False

erlor to t 9 93 | bl a d der and the quadratc_

yobe 0' ha "van

the second part lies anterior to the left kidney.

_
the third part lies anterior to the superior mesenteric vessels
,
h
to theyle of the fourth pan of the
I
gueoggaudntlodenal
lossa lies

"l?CD

\)\,,_T< lcyyw,/c

V 1-mi \)Q*'
-~ _ 5""
._ -

'~

';-_,-_-

"\'l|I.
y-,1-.'.."-s
, .

\~\

(|l' -

it

-> =-

False

short mesentery.

the duodenal papilla.

""""""

Valvulae connivedtes begin in the seg[]l__pa_rtwof the

duodenum, becoming m_ore prominent distally.
E.
#4

lt also lies anterior to the common bile duct.-'

The second pan of the duodenum lies anterior to the
hilum of the right kidney and renal vessels. It lies
p'6st'e'rior'to theiransverse mesocolon.
The third part is crossd'5rit_e\riQrly by the superior
mesenteric vese'ls"a'rTthe root of the small bowel

mesentery. lt passes to the left anterior to the inferior

vena cava and abdominal aorta at the level of L3.

. _-ft. *0
True

=>

1
X \-O:
39H-)i"_
_ |."
U:;>"~-
~'

The duodenum begins at the_ ylorus which lies

The accessory pancreatic duct lies anterosuperior to

True

it 1:1: 2:2: 2:: :22: :::i"-'

Tomentum, stomach and greater omentum.

False

4_4 H@QB"ll"9 the duodenum:

The lesser sac is related

anterlorly to the lesser
.

False

False

;:|n'I1;I!'t/"A:

left adrenal. pancreas and, |efth1i.=1l@Ph'55m

"I

about Z gm to the right of;l_lJl)t ends at the

duodenojeiunal flexure which lies to the left of L2.
The firstlgggf the first part of the duodenum _h__a a_

'

art

the iweterior eztensiqn Q! the rlehl subhepette sbace

The paraduodenal lossa is a recess of perit6Fu'r

beneath the most cephalad part of the inferior
rnesenterio vein.

/" "

/Z?

L-)

-|~.

..;_ _

rizlzlzij-'1:
:1-..._r.

'

Q~

~__-; _ _._

41- \y

2e

P
Q6
5 9. 65 II5E. E6O (Q Y Wwwwwwevww-uwwravwwa
t

K ('3 O

(1:

//'\ 7

"aaw'i"~'i','.'_'gt't1t...,tt

4/tlliietfolloW5"9=$etemen@ii*Bti:%
- _W~m two W

3 the superior mesenteric artery retrnperitoneal. it ylts *3

t C he Ilurium has a maximum diameter of appm;-:in1ately 1cm.

the valvulae conniventes are about 1 mm thick in the middle

45 A True
F3155
3
C

True

True

True

and distal ileum.

*'.\31};
>

a Meckels diverticulum is present in about 2% of people.

the stomach receives branches from the common hepatic
artery.
.

-Q

as

It lies vvithinythg _l'1]_SBi8f\]. '

r
The ileum has a smaller maximum diameter
tapproxitttatelyigmi.
They are thicker in the ieiunum. where they measure
approximately ;__r_"n_m. They may berabsent in the
distended germinal jlgum,
This remnant of the Vil8i_l_Q_i[\_Ql_i[\ai duct is usually
located in the ileum within 1 m of the ileocaecal
valve. lt typically measures less than_c_m/irtlength.
The stomach receives part of its blood stipply from
the right gastric and gastrtzguorglaljneries. Both
are branches
of the common
hepatic artery.
_
__ ..._._~. ...-an
. _,-- _}-"g_\ _v ,,
ll

_.. -4

\t
=

5 in the large
boirvel?
,

4A the appendix is retrocaecal in the majority of cases. .

-/\/3
</C

,3

_&),,Q

True

46 1: True

there is a sigmoid mesentery.

r;,,,_ey
the ileocaecal valve lies anteromedially in the rnajgmy of @175 A_/

False

C3565.

3; D the taeniae coll converge on the ileocaecal valve. Q'o\E-10i Qv\ 4,2,, Q45 _e X ,
i * lH\\
o1 False
/{E
..
.
.
S i vgigpl) ,t,(
the h_austre are more clearly denned
in
the ascending
colon
_
_ than in the descending colon.

tor-ec
V ,7;/""r

__________U
-

,-

'

True

it is retrocaecal in approximately<-K9901 cases.

The mesenter'y'5t8rtS at_the rectosigmoid jtinctiori.

usually at the level ot/$3?)

"""_"

it "B5 P0SlBfQF!i_!ly approximately 90% of cases.

in line with the first complete transverse haustral
cleft of the proximal colon.

The taeniae coll, one anterior, one posteromedial and

one posterolateral, convergeon the base of the

The haustral sacculations arise between the three

9
l
l

appendix.

rows of taeniae, with clefts at the points of circular

muscle fusion. In the Tiriiiimal colon the haustra are

xed, whereas they result from active contraction of

the taeniae from the mid-transverse colon onwards.
When smooth muscle relaxents are given during a

douple~contrast barium enema, the left colon ohe_n'

shows no haustration.
I

,0
A

l
"I

30

MCO Tutor in Radiology"

47 The rectum: '

A

</B

/\c

<4:

/(E

t'

is lled. by air during a double contrast barium enema when

the patient lies prone.

is covered by the peritoneum enteriorly and laterally in its
upper two thirds.

has lateral crescenllc folds. lpliqee semilunaresl which consist

ofmucosa and submucosa. ~\\1)"leS rrj \1.o~.-;-;&=n
has venous drainage to the portal system only.
;ec;l\\,res its main blood supply from the inferior mesentarir;
'

A\ A

i>

f77\_.~_.\",---/

/\g gives rise to the inferior phrenic arteries.

/<

False

The superior rectal vein drains into the portal system

True

is crossed anteriorly by the left renal vein at the level of i_2_

than 5 mm thick, bufthey are variable in

conguration.

whilst the middle and inferior rectal veins drain into

the systemic venous system. The rectum therefore
iorm_a site oi porto-caval anastomosis.
it also receives blood from the rnic.ld_lt.=:_[gt;ta_l

branches of the internal ilias armies. the inferior.

rectal branches of the internal ptidendai grtgrig and

thhedian sacral artery.
'
.

False
True

of Tl2.

gives rise to iour paired lumbar aneries.

Pelvic peritoneum covers the upper third of the

rectum anterigrly and laterally, the middle th_ird

anteriorlyonly and the lower third not ai ail.

There are usually three lateral grescentic folds, less

'

31

True

tbilurcaies at the level of L5.

9' gives
_ rise
_ to the coeliac
' axis' at the lovel

/(C

True
False

True

if i-r\! t--a\ lg,\'l( irtiy Q-iii

Thi:abtgrti_ii"t_,:g('ay3i:.?

/i

47A

-r Q C} ,Q

"57-"*1 --->\.r,;.iit tltii-\-to-.~i

1' 5.-all-1 iiit/'\-4; A-ii, '

Anatomy

True

it bifurcates-at the level oi the body o/f_l.4.d)

li gives rise to the superior__rneserttgricT1' inferior
masenteric arteries at the{LTland i.3iievels
respectively.
M
J
H
The aorta also gives rise to paired visceral branches:
the adrenal. renal and gonadal arteries. The median

sacral artery also arises from its posi'rii:iFsuri-ace at

True

H ...-..-.

-___.
e-lhferT't:>F:7i"ie|;:li0l,{l

/.

'

is longer than the aorta within the abdomen.

.;\

True

drains the median sacral veins. i,e,Q\ U,-$'\Q

_drains the right adrenal arid gonadal veins directly.
is partly derived from the right su;;raca_rdinal vein,
is leit sided in approximately O.S%'ol @1555,

False

;i/\-:.~.:.=i i2

Trtie

True

True

the bifurcation.

..kl

------\

The interior vena cave starts at the level of L,,"lower

than the bifurcation of the aorta, and passes through
the central tendon oi the diaphragm at T8 [four
vertebrae higher thanthe commencement of the
abdominal aorta).
-'
The median sacral veins, companions to the artery,

drain into the left gornrrion iliec vein in front of the

body of ts.

" "' "

Whereas the left adrenal and gonadal veins enter the

left ren_a_ii_ygi_n. The inferior vena cave also receives
drainage direct from both renal \_/gins, the third and
lounh lumbar veins, the hepatic veins and theinierior phrenic veins.
'

The irilerior vena cava is derived from the persisting

right supracarrlinal, right subcardinal anti right

vitellirie veins.
The left inferior vena cava drains the left renal vein,
crosses the spine and continues cranially as a normal
right-sided inferior vena cava.

urrw w'-~w'~w"w-~*aata; vs av ta 0 "ta a a 0 iv w w aw w ya, w w Q T

The superior m esanteric artery:
r

/$2

//A.

/to

False

EDA

anastorrtoses with the inferior mesertteric artery at the hggac

exure.

supplies the left lobe of the liver in about 40% of cases.

gives (I56 to the inferior pancreaticoduotlenal artery.
lies tothe left of the superior mesenteric vein.
passes anterior to the left renal vein.

False

True

D
E

True
True

The left branch of the ntidgllg colic artery lot the

superior mesenteric artery) anastorhoses with a

branch of the left colic artery lot the infg_ri_qr

_
mesenteric artery) in the region of the\_pitini_jlg>_<ur)
The left hepatic artery arisesi om the superior_
mesenterid artery in aboutgffgaif cases.
The inferior pancreaticoduodenal artery is lha_li,r_s_t
branchpf the superior mesenteric artery. it
anastomoses with the superior pancreaticoduodeital
artery, a branch of the g8$L(l:)_(_1_E.l2_qEt\__a'i_8_Q_fy.

\\
u

The superior mesenteric artery passes anterior to the

left renal vein and the third part of the duodenum to
enter the mesentery of the small intestine.
~3~.

</J) The spleat1;/

.'t~(

M 5.
./\

F,

51A
B
C

lies along the line of the eighth rib.

lies on the phrenicocolic ligament.

ts directly related to the left kidney.
receives ll$ blood supply via the gastrosplettic ligament
may normally indent the greater curve of the stomach.-

False
True

True

its long axis lies along the line

of the tenth
nb.
r.
'*~~--~_
The spleen abuts the upper pole of the left kidney.

This produces a prominence on the lateral aspect of

the kidney.
The splenic artery enters the spleen via the
sp_lepgrenal_1igament. which also contatnsgte splenic
vein and pancreatic tail.
'
T

False

True

The spleen is related anteriorly to the greater curve

of the stomach and the splenic flexure of the colon.
which both show splenic impressions.

True

Pancreatic tissue is gradually replaced by lat and

brous tissue with advancing age.

True

, .
J,\5,2' The pancreasi
.
decreases in size with advancing age.
lies anterior to the conlluence of llta stlpBri0l' tnesentertc anti
splenlc veins.
originates entirely from the dorsal gut diverticulttrn.
IS retroperttoneal.
_
has a main duct which measures approximately 5 mm in
diameter.

Wmfota

.- , ~;.
/>_'/7 5,,
8/
_ J/Y )_
. 5
4 ;{",_.rJ', -up
': \ "t'
)
p F
'1 '

17/ , r

it

U )1 )1

tr/
It

'

T c

False

D
E

True
False

The pancreatic nr.ck_lies anterior to this venous

confluence. \""""-"W

The uncinate process and part of the pancreatic head

develop from the ventrgut diygrticulum. The
remainder of the pancreatic head. body and tail
develop from the dorsal diverticulum.

The calibre of the main pancreatic duct increases

with age, but in subjects younger than 60 years, its

maximum diameter in the region of the body should

be no more than 2 mm.

head 3
body 2

34

MCCJ Tutor in Radiology

53 _The head of the pancreas

FA

lies antarlor to this common blle duct.

,
is drained by the main pancreatic duct of Wirsung.
receives its main blood supply from branches of the splenlc
artery.

True
False

'

Y
<
\-t
5

.54 Ihe gall bladder;

A
TB
FC
D
/(E

usually has a volume of approximately 300ml.

is related to the hepatic llexure of the colon.
has a spiral valve composed of smooth muscle.
normally has a wall thickness of about 1 crn.
.
typically lies anteromedial to the right lobe of the liver.

f
_

region cl the termination oi tho tonal valm.

it receives its main blood supply from

pancreaticoduodenal arcades formed by branches of
the gat_rg3_ggdeal'EFd superior mesenteric arteries.
The necli, bodyhahhd tail of the_aE2a"s'reCElVe their
main blood supply from branches of the sglertlc

artery.

'

I-"

False

The volume of the gall bladder is usually about

.,,_ A

False

False
True
False

False

True

True

Amer 35

30-50 ml.

55 In the llver:
55
'FA a R_iede|'s lobe is more common in males than in females. ~"'\<-1(o-Mt.-.z\~ \"v,t7\,,...,,.1,t_,
F5 "en-'5 d'3'"39_9 ol the qttglrratt-globe ts usually distinct lrorn
(tire rest of the ltver._ C()>\1\)\lti/CE. Q({)~
.
L
x
C the ltgamentum teres ts a temrtant of the)umbilir:ztl vein

/(D the.cat._r_date_lobe lies between thei'\i|'tletif)_t'__:{Ena cava and the

pprta hepatts.
F
/\/E the bare area of the liver is applied directly to lite diaphragm

True

True-

??
r

/I _

Jillie tail of the pancreas is higheftha the head. K

True -~ It also lies anterior to the inferior vena cava in the

v_ has an uncinate process which is crossed by the superior

mesenteric vessels.

.\

53 A False

is more cephalad than the tall.

. ;<>%e.r
'

'

True

The spiral valve"lof_Heisterl;n the neck of the gall

bladder is composed oi crescentic folds of mucosa.
The normal gall bladder wall thickness is about 1 mrn.
at l=m,;|7(Tn__
A Riedel's lobe. the downward projection of the
a\nterolateral aspect of the right lobe of the liver, is

more_5'r'n'r*non in rgtgqgtg

'

The venous drainage ol_the caudate lobe is

frequently distinct from the rest of the liver, direct to
the inferior vent-1 cava. rather than into the hepatic
veins.

lt runs in the free edge oi the lalciform ligament

which extends from the urnbilicus.

Whereas the quadrate lobe lies irtferiorly and is
bordered by the ligamentum teres and the gall
bladder. Both the caudate lobe and the quadrate lobe
are segments ol the left lobe of the liver.

The bare area contains part of the inferior vena cava

and hepatic veins.

Tl

-"*1 "~v"~'v
wt
qivtk~'q :tet,.wr~.~a
ri~Jv"F*U"F'WW'WW'W-WWWw~fWwwtw~wUUIIWII
55 in the hepatobiliary system;
'
L! /\ A the_cystic artaryiarises from the right hepatic artery in the
\
ma|or|ty of cases.

55

"T

TAHLQQK/t

A
B

True
False

ln aboutl90YQol cases.

e the cy l,c- ct usually lies to the left of the common hepatic

True

the rig t hepatic artery crosses dorsal to the portal vein in

True

the right portal vein receives blood mainly from the superior
mesenteric vein.
the hepatic veins follow the structures of the portal triad.

False

ln the large rnaiority of cases the right hepatic artery

crosses ventral to the portal vein.
Whereas thaalelt portal vain receives blood mainly
from the-splenic and inferior mesenteric veins.

duct.

/\o
at/E

13

about 10% of cases.

The hepaticveins are igtgrgggggal, in that they

drain portions of adiacent segments of the liver and

the liver is supplied by a portal triad lhepatic artery,

57 The portal velnz

l/r;

TE

57

is formed by the union of the splenic and interior mesenteric

veins.
receives the left gastric vein.
receives the right colic vein.
provides about 75% of the blood supply to the live

V
.

A True

ll
T'

S)~
B?

True

_Ct

\.

58 Regarding the adrenal glands:

a A the medial limb of the right adrenal gland is smaller than the
lateral limb.
_
'
the right adrenal gland lies cephalad to the right kidne Y.
the right crus of the diaphragm is a medial relation of the right
adrenal gland.

__
they receive branches from the inferior phrenic arteries.
.
the left adrenal vein drains directly into tlie inferior vena cava.

'y_v__-I,

'

rs

bile duct liesvto the right. the hepatic artery to the lett
" ;~'-\ I
and the portal vein posteriorly. At the pona hepatis. _
the arrangement is: duct, artery and vein from
F, H ' I
anterior to posterior.
The portal vein is formed behind the neck of the
pancreas by the union of the splenic and superior

joining at or near the angle of this union.

The portal vein usually also receives the right gastric

vein. cystic vein and some duodenal or pacieatic

The right colic vein drains into the superior

False

True

False

The lateral limb of the right adrenal gland is the

True

C
D

True
True

The left adrenal gland lies anterior to the upper pole

of the left kidney.
-

'

$1:
m"

In the free edge of the lesser omentum the common

\_

T4

veins.

=._

mesenteric veins. with the inferior mesenteric vein

q_M~7

,,_J |

False

ci"~
C

KY-'
-\-" \L

duct.

lt usually lies on the right of the common hepatic

bile duct and portal vein).

lies posterior to the common bile ducts

converge on the inferior vena cava. Each segment of

/<.?;\*:,\'

rnesenteric vein. along with the right gastroepiploic.

'pa'nci'eaticoduodenal. jeiunal, ileal and middle colic

veins, H

' *

gs",-2, of the blood supply to the liver is provided by

the hepatic arteries.

smaller.

Superior adrenal branches arise from the i_l1f_e_[jg;

phreQir_:_a__rt_gries bilagrally. The adrenal glands are
alsffsupplied by the migglg adrenal arteries, which
are direct branches from thgjgrtgi and the infgripr

adrenal arteries, which are branches of the renal

False

arteries.

"'"""

The left adrenal vein drains into the left renal vein.

The right adrenal vein clr_ains.d\irectly ii{totlTa inferior

vena cava at the level of T12.

'"'_"

38

MLJU lutor lll Hadtology

Anatomy
right adrenal gland
=5

quadrate

lls tver.

aorta.

body of the pancreas.

second part of the duodenum.

RTUCUGI

/Q<\

epiploic foreman.

\>\ Mt "'

.
60

, _ M
\\
\7~

__

Regarding the l'tidn&t>\.i

\/(A
. B

/K

XE
Q

BOA

the renal artery liesTposterior to the ureter at the hilum.

their superior poles lie closer to the median plane than their
inlerior poles.
about 25% of kidneys receive their blood supply via multiple
aortic branches.
A
typically each renal artery divides into four segmental
branches,-5}

False

The right adrenal gland is related to the bare area of

the liver.
"W
False The right adrenal gland is related to the infergna
cava.
TH
False
lhe left adrenal gland is related to the body of the
' pancreas.
False
The second part of the duodenum is separated from
the right adrenal gland by the inferior van; cava.
False
The inferior vena cave lies between the epiploic
foraman and the right adrenal gland.
-

False

B True
C True

both are related to the colon anteriorly.

t

True

False

x~

At the renal hilum, the renal vein lies anteriorly, the

ureter posteriorly and the renal artery in between.
There may be two, three or four renal arteries which
enter through the renal sinus or at the superior or
inferior pole of the kidney.
Anteriorly the right and left kidneys are related to the
hepatic and splentc flexures of the colon respectively.
The renal artery typically divides into posteriQ_r_gnd
anterior branches, which together suply five
segm'E=tfs': apical and posterior (from the posterior
branch) and anterosuperiorj anterointerior and
inferior lfromthe anterior branch).

The right kidney?

is usually smaller than the lelt.
usually lies lower than the lelt.
<
OI

E.
'

usually moves further during respiration than the left.

is related to the duodenum.
is tlrainud by the right renal vuin which is longer than lltu loft

1;.2,*;,Z.?:'.* runtrl vein.

Ff!
o0m>

True
True
False
oom True
E

False

has three narrowings along its length.

True

lles lateral lo the tips of the transverse processes of the

lumbar vertebrae.
r

B
C
D

True
False

True

is lined by transitional cell epithelium.

is retroperitonaal.

receives pan of its blood supply from the gonadal arteries.

True

'
.
The left kidney moves further than the right.
The duodenum is related to the anterior surface of
the right kidney.
The lclt ronul vein is longer than tho right, crossing
the aorta nnturiorly to upon into the inluriot vumt
cava superior to the right renal vein.
These narrowings occur at the pelviureteric junction,
pelvic brim and vesicoureteric iunctio'n.''
T

The ureters lie medial to the tips of the transverse

processes oi the lumbar vertebrae.
The ureters receive their blood supply from branches
of the renal, gonadal, common iliac and vesical

arteriesf

~$

,\

39

'

"

f8*d"vW--'~J<iWlr&l|F~!B'@~0'4V cvovavw aw aa40

MCQ Tutor in Radiology

Lj?:'.vg
1
| 5
4 B
/(C
/gD
A E

84

to

7--t'1?

F51
l=."?@

Regarding the bony pelvisf

A the inferior portion of the sacroiliac joint is synovial.

as

UF..LS

D
E

True

64 - A
B

True
True

the male.
the symphysis pubis is a synovial joint.
the sacrum usually consists of fourfused vertebrae with five
paired anterior sacral foramina.

the adductor magnus muscle arises from the ischiopubic

ramus and ischial tuberosity.

._

65

muscle.

contains the pudendal canal on its lateral wall.

does not communicate with the left ischinrectal iossa.

has part of its medial wall formed by the levator ani muscle.
contains fat.

in adults the normal si;e_ot;J.A

A the nujligarous uterus is approximately 4 cm >< 2 cm.

the testis is approximately 4 cm >< 2.5 cm.

MUD

the ovary is approximately 0.2 cm x 0.3 cm x 0.4 cm.

the internal cervical os is up to 6 rnm in diameter.

the prostate is approximately 8 cm x 10 (Tm.

CY

Anatomy

II

-H

The right ureter lies posterior to the ileocolic and

right colic vessels, and the duodenum and the small

True

False

False

True

False

B
C

True
False

The st_tg3ri9_[ portion of the sacroiliac ioint islfibdrgtigy)

The subpubic angle is about 85 and 55 in the adult
female and male palves respectively.
The symphysis pubis is a secondary cartilaginous
joint.
-'
_'____
The sacrum usually consists of i_g_ fgsgg vertebrae

with tour paired anterior sacral loramina.

G) U:

The lateral wall of the ischiorectal fossa is formed by

the ischial tuberosity below and the gbtulator
internus muscle above.
The fossae communicate with each other grrguglt

loose rl=-sue behind the fl.!.E'?_E!_BE9Yld9 H

True

True

horseshoe-shaped path for the spread of infection.

The at-gal canal and levator aqj,mt'Isclas form the medial wall of each lossa.
The ischiorectal lat pad allows for dilatation of the
anal canal during dfacation and of the vagina
during parturition.
-

False

B
C

True
False

The non-pregnant uterus normally measures

approximately B_crn5<_ cm.

False

True

l
HI
:

3'

' _ '
l

65 The right lschiorectal fossa;

" " A
A has part of its lateral wall formed by the obturator externus

MUOID

True
True
True

A
B
C

QI

bowel meseotery. The left ureter lies posterior to the

left colic-vessels and the sigmoid mestery.

the subpubic angle in the adult female is greater than that in

C
D

_/I

..</

l
W \: or.t\:_d-y

anterior to t'l"t iliac vessels.

posterior to the gonadal vessels.
posterior to the ileocolic artery.
'
inferior to the vas deferens in the male pelvis. ,
inferior to the broad ligament in the female pelvis.

v_

"J"~J"J7J"-aV\I-"\I'\I"1l'

The prostate is approximately 3 cm long and icm

wide.
T"""'
W W
The normal dimensions of the adult ovary are
2cm><3cm><~lcm.

l'

II

CV

Q7

HI

-ii

lvluu tutul in nautulugy

"61

Regarding the uterus:

the pouch of Douglas is an anterior relation.

r
-

mUQWl>

'3:-.*-'3L'_}<

57

False
False

the paired round ligaments are folds of peritoneum.

the arterial supply is from the lntelliac artery.
it is covered by peritoneumori all but ihE'ir'1lerior surface.
the isthmus is in continuity with the cervix.

True
True

True

The pouch of Douglas lrectoutgrineipouchl lies

posterior to the uterus.
-The round ligaments support the uterus and

comprise li_t_grgmu_cul_r bends extending from the

labium maiorum, tlirough the deep inguinal ring to

attach to the uterus. The broad ligaments are folds of
peritoneum.
"' K ' ' I H V

K
.;

The isthmus is the lowest halfcentimetre_gQ1_i1ody

of the-uterus and this is 'oo'rTtiiiuous with the cervix.
"~

%/ -mm:m|mm
\'.

WUOID

Q
1

ITIUOGI

True

the folds of mucous membrane are arranged in the most

complex manner in the region oi the ampulla.

True

69

True
False

they he anterior to the ureters.

The uterine tubes lie in the superior border of the

broad ligament.
The other segments of the uterine tube are: the
uterige, arnpulla and iniungigglum. '
The uterine tubes are lined with mucous membrane
which is arranged in folds which are sparse in the
isthmus and become increasingly complicated
_ towards the ampulla.

"
Venous drainage of the right ovary is to the_iQfg[i_q_r
vena cava. Venous drainage of the left ovary is to the
left renal vein.

False
False

They lie t3_9l.E_!'Qi.&leral to the uterus.

Physiological calcification is rarely visible in the

corpus albicans.

True

-'1

I
P.;. _-4 __-|

l
t

the isthmus is the narrowest segment.

False

they communicate with the peritoneal cavity.

they lie in the lnlerior border ol the broad ligament,

they lie enterolateral to the uterus.

they commonly calclfy in normal individuals.

\
\

True
True

Regarding the ovaries:

A prior to ovulation follicles measure approximately 13-24 mm
venous drainage of the right ovary is to the rloht renal vein.

.{l

,.
\I

68A

each tube is approximately ll) grn long.

'4

\?;

"-JP *J"~J' J"J' J J J

/\_

J J J J

Tie

co) In

antenatal ultrasound 1
-t
the fetal heart is rst detectable
at 4 weeks gestation
B the cr_o\1v_p_:rurnp length is the l:--_"-st measurenient for assessing

L/\

"

C
t

D
E

maturity at 642 weeks gestation.

False
True

70A
B

"'

d J J 6 47 W W GI W W rmunv 3 C 7 w it

True
True

C
D

l
.I

\"'
J"

C/Tll

. 'r.'\._

ll

False

-':

the distance from the midline to the lateral wall of

the lateral ventricle by the distance from the mitlline
to the inner table of the skull, in the coronal plane.
A loop of gut extrudas into the umbilical cord as the

A.
FIDO

rm
it
-..

3;!

I 71 '.Tha.testis':,
B

"physiological hernia" at about the and of the sixth

week oi gestation, and returns to the abdominal

I,
.r,t

\'._

gr?

cavity towards the end of the tenth week.

fl -'

The lateral veiiricular ratio is calculated by dividing

the gut is normally extra-abdominal at it-3 weeks. gestation.

Biparietal diameter may be used to assess maturity

at 1g3O v_veeks_ femur length at llZ2 weeks and

fetal abdominal
weeks.
____, circumference at 30-40
_._%

the normal biparietal diameter 2'. :t_weel:s is approximately

1\
"
40 mm.
the lateral ventricular ratio should not exceed 35%.

It is iirst detectable attgygggs gestation.

-A

has the epididymis as an imrnetliate posterglateral relation.

:5 surrounded by a fibrous capsule called the tunica vaglttal':;i_
has its venous drainage to the internal iliac vein.
contains the rggtg testis near its posterior border.

usually lies within the scrotum by the seventh fetal month.

_ ._ ._ i.d4_i.~L_

A
B

True

False

True

False

False

|:-

The tunica vaginalis is a sergusgac covering the

anterior and lateral surfaces of the testis. The tunica
albuginea is a librouscapsule.
l
Vttouswdrainage of the testes is via the _Qg!t.

veins; The right testicular vein drains to the in_g[i9__r

vena gave and the lgit__ to the left__r_e_n_l,vein.
Semen drains via seminiferous tubules into the rate
testisrlrom where the vasa erlerentia pass towards
thagpidldymis.
Y
By the seventh fatal month the testis lies at the deep
inguinal ring. It should be in the scrotum hy birth.

,__

\)

*i.&r.TItl?&.'i..l!9'.=cet1==
A
'
B
-{C

"TOO

is arnbryologically derived from the W9_1_iiia_n duct,

commences at the head of the epiclidymis. '
is t=.p_qr_a_p_e_ritoneal within the pelvis.
at the ampulla, lies medial to the seminal vesicles
loops over the ureter as the ureter enters theblad-tier.

72A
B

True

C
D
E

True
True

'

False

A.

Each vas deierens commences at the tail of the

epttlidyntis in the scrotum.
"

True
.

\.-._z
.t
\

l-I}-ii

_..

-.

- 1

r._,.

I!

./.

'.

'
,

2,,

._'7

"'1

_-

tl

J
T

;,.=__|.=

.l

|-

J-/..'

.
1

'

|'

'\l'

-*1 Tl

1--

t
i

'

~
I

Fer

lIl:l'
lrl

x.

ti

J
-1
T!

MCU Tutor in Radiology

-lb

Regarding the male urethra:

Anatomy
-/E

73A _Fa|se

A the membranous urethra is the widest part.

B the verumontanum is on the anterior wall oi the prostatic

False

penis.
74

lt
i

C
t

'

True
False

True

V,

M The prostatic urethra is the wiilft part.

The veriumontanum is on the postQ'i,cy'_yval| Of the

prostatic urethra and has the utricle and__e_jac_ulatory

duct orifices on its ventral wall. _h

urethra.

C the prostatic duct openings lie |a_te_ra_l to the veruntontanum

D the navicular lossa lies within the bulb of the urethra.
E the penile urethra lies within the corpus spongiostrm of the

The navigular lossa is a short dilated region just

proximal to the external urethral meatus.
5

1-'__

Regarding the bladder:

A it has a capacity of approxirnately 1.5 lg
the trlgone lies between the ureteric orifices and the urethra.
the seminal vesicles are posterigr__rgla_tions in the male.
the obturator internus rnuscle_is an inferolateral relation.
YTIUQCU
the pubovasical ligaments support the bladder superiorly.

'

74

77'

Capacity is about 500 ml.

False

True
True

'47

True
I
I

FHUOWP

False

The pubovesical ligaments are condensations of

pelvic fascia that support the bladder tnferrorly, along

with puboprostatic ligaments in the male.

75

.<r/

..rL;-f)/\3

Q'.

\/

The following hive their lymphatic drainage predontintmtly to

the external iliac lyrnph nodes:

A
B

testes.
bladder.

prostate.
UiBl'U5.
WOO

rectum.

75A

False

B
C

True
False

D
E

True

The testes have their lymphatic drainage to the

para-aortic lymph nodes.
i
D

The prostatehas its lymphatic drainage to the

internal iliac nodes and sacral nodes. A

False

The rectum has its lymphatic drainage to the

pararectal, preaortic and internal |i|ac nodes.

False

The loramen rotttngtrm transmits the maxillary

nerve. The-superior orbital fissure transmits the QM
___;P. {Dun}, and 5i_x__h_rtnial nerves, and the first branfh
ohe fifth cranial nerve, along with the SUpErl_Ol'
ophthalrnicyein.
l

1
I

Concerning the cranial loremlna and canals:

A the superior orbital fissure transmits the maxillary division of
the fth cranial nerve.
B the foramen eye]; transmits the mandibular qiyision of the
filth cranial nerve.

"" '
C the loramen spirtgsgnt transmits the ntic1rll_e _trtn_irtgea_l artery.

the superior orbital ssure lies between the greater and lesser

the leh jugular foramen is usually larger than the right.

76A

l
True
True

wings of the sphenoid.

ITIUOW

True
False

Tlae right jugular forarnen is often larger than the left.

..____

4.

__
t

'4

*I$*~0"~llI'\llI"Ql'\IYIV@\$WI\U'
. .._'
.\
'
l\rlt,_Lt lutur in hauitllogy

W T? =9"-"aw U W w\w w w

"@t"@
Ti?

body oi the splienoid bone.

'
B the occipital bone forms the posterior hall of the cliviis.
C the occipital condyles are situated at the posterior half at tha
forarnen magnum.
D the jugular foramen lies lateral to the hy;-cglossai i;_an;i:_
E the internal jugular vein is transmitted thrcuglt the medial
portion of the jugular foramen.

77

A
B
C

True

D
E

True
False

True
False

Regarding grooves and sutures of the calvorium:

A the .. parietal star II is caused by venous sinuses impressing on
the inner table of the skull.
B parietal foramina are usually situated close to the sagittal

78

the bregma is the point where the sagirtal suture meets the
lambdoid suture.
the asterion is the point where the lamb-doitl suture meets the
squamosal suture.
sutural sclerosis becomes incite apparent with increasing age.

it

' qy1Vj'l1qg__5rt1lng~thefskull'inlfinfancy.
' -~-t u'sn4tIv'*$t'i"~'=!
tart;.,g,_..=tw,..'
.~.-;.~t-_
andchTidhood'

H the metopic suture passes obliquely through the occipital bone.

UJ)> themetopic
suture
usually fuses within the first 6 mo ntlts of
.
_
extrauterine life.
C closure of the posterior fontanelle occurs at '18 mnntlts of age.
D at birth there are no vascular markings and no tzur-.~.-ulutiottal
impressions.
E

??TY

the spheno-occipital synchondrusis begins to close by the ago

of 5 years.

1;
,

The occipital condyles lie at the antg_ri9_r_h_al oi the

loramen magnum, their posterior poles separated by
the width of theaoramen and their anterior poles
lying closer together.
The internal jugular vein is transmitted lhrOugh the
lateral portion of the jugular foramen. The n_ip_tlt.
t_h1'lT'ahTl"elevi3itth cranial nerves pass through the
1
I

False

The "parietal star" is caused by veno_g_pl_gxuses

B
C

True
False

The lambda marks the junction of the sagittal and

True

the sagittal and coronal'st'tTl'fr's.

The pt@rt'6;t matks'the point where the coronal suture

True

False

False

SUN-ll'E.

49

nlggjgj portion of the jugular foraman.

Anatomy

Fl egarding the bones of the sl\u|:

A the pterygoid proc_s_ses arise lroiri the inferior surface of the

TYTYIQI
_

lying between theinner and outer tables of the skull.

lambdoid sutures. The bregma marks the junction of
meets the sphenoid bone latera||y..

Sutural sclerosis is a physiological bony bridging

process across the suture.

The mepdosal sutures pass obliquely upwards and

inwards from the lower part of the occipital bone
bilaterally.
"
The metopic suture of the frontal bone is present at

birth, disappggrs from the ninth __l9_nth onwards and

is usually fused by the end of the second year.

Occasi0nally_it persists into adult life. '
Closure of the posterior fqrttanelle usually occurs at
' months. Closure of the anterior lgntanelle usually

False

True

The vascular markings and convolutional impressions

False

The spheno-occipital synchondrosis begins to close

during puberty.
' '

occurs at t5_;l months.

E.

"

appear bervv@==9__5l1s second anti thirst Years-

lift
it

E?
1.:

.r

50

MCO Tutor ln Radiology

K/r B '1-' 1r.it:-I.-Tilt.-.tw;r*ti

'

I?

..*"?i

.t,- rs: *r_s_t;;_tg;ttlt5t;";'&ttIa\lRlEl{l5t'i''tT

F &Wce.

A True
B True

A the loramen spinosum.

the lateral wall of the maxillarysantrum.
the odontoid process ol the axis._
the carotid canal. QM J

/..\

.._

ol the skull:
'\"
A the loramen ovale.\'l\/fly
.
B the loramen rotundurn\.-Z)/C\y
the internal auditory meatiz
"TOG

True

False

The foramen _ol/aha is best seen on the

False

the pineal gland in approximately 5% of adults.

83

lIlUE'J(I7]>

B
C
,

habenular commissure.
petroclinoid ligaments.
lalx cerebri.
dlaphragma sellae.

Regarding the branches of the aortic arch:

A

D
E

the common carotid artery bifurcatas at about the level ot H18

second cervical vertebra.
in the neck, the internal carotid artery lies medial to the
external carotid artery throughout its length.
the left common carotid artery arises from the innominate
artery in about 27% ol cases.

an aberrant right subclavian artery occttrs in uhmjt 1% gl l'te

populallon.

51
,_

C. Tru e
o False

the superior orbital fissure. ts F

the condyle of the rn_andible.}_

the
the
the
the

__

True
False

/nfZ<i.7l3'.1iii3;*2'F;ll?i*!.ntt!l3tltsa'.Pi."sat?anOccur?-ii-tt=.'
/

C
D

\_

Anatomy

_._ .

i St \ The following may be seen on a hall-axial (Townes) projection

.5 -r
Q7

'
The lateral wall of the maxillary antrum has an
_Sv-shaped configuration which is superimposed on
the lateral wall of the orbit; the latter appearing as a
straight line.
"l
The dorsurn sellae is seen on lateral and half-axial
(Towne'sl projections.
"F.-I '

ihe dorsum sellae. it 00 -1

MUOCU

the left common carotid and left sulmlaviart arteries have

common origin in about l% of cases.

Fl

83

subntentovettical projection.
The foramen ro_tur1_clum is best seen on the
occipitolrgrttal projection.

The superior grlgjtal fissure is best seen on the

True

occipitofrohtal projection.
,

False
True
True
True

lt occurs in__about_'/lQ3)>_f_ adults.

ln about 5019 of adults.
ln about '%'ol adults.
in aboutt7/:10! adults.

ITIUDWD

True

False

False

LPM
C

True

D
E

True

The common carotid artery divides into the external

and internal carotid arteries at about the level of the
fourth gervical vertebra. 4/ '
The internal carotid artery lies p9_t_rior to the
external carotid artery; initially lateral t0. and then
medial to it.

'

Thlsis the most common normal variant affecting

the arteries arising from the aortic arch.

True

rt

ltw

52

r W10-9'9-U 9-W W -U
|

MCC1Tutor in Radiology

U-'UO~CCUUU~lU-'.C
Anatomy

w
53

84A

)> 84 The following arteries arise directly tron. the internal carotid
artery:

False

the mertingohypopltyseal artery.

the anterior communicating artery.

the callosomarginal artery.
the posterior cornmunicattng artery.
the ophthalmic artery.

WIUOW

True

H
.,

False

The nieningohypophyseal artery arises posgriorly

within the cavernous sinus.

The anteriorcornrnunicating artery acts as an arterial
bridge between the anterior cerebral arteries. The

i
i:

laner are dirgct branches of the internal carotid

arteries...
The CQllQ__Qfll_Q[Qllldl artery is one of the three inain
branches of the anterior cerebral artery, distal to the
anterior communicating artery. The other distal

branches of the anterior cerebral artery are the

-Q-II--1.-i".- -._

True

True

DJ)?

85

85

Regarding the internal carotid artery:

A it usually has no main branches in the neck.
B on entering the cranial cavity, it becnrnes subaracltnoiil in
position.

False

thecarotid siphon is formed by the cavernous segment only.

it gives rise to the anterior choroitlal anery.
ll anastomoses with both the external carotid and

C
D
E

vertabrobasilar arterial systems.

True

I
i

False

t
i

True

ll9!Ei:Bla and P3ll.!l.l._il!.lel'ia5-

The posterior comrnunicating artery arises posteriorly

from the distal loop of the i:ar0_tiQ_siphon__to link the
internal carotid artery with the posterior cerebral
artery.
M .
The ophthalmic artery is usually given off just after
the carotid artery leaves the cavernous sinus; but its
origin is variable.
W
'

it lies external to the dura mater within the cranial

cavity and cavernous sinus, and enters the
sub-arachnoid space at the level of the anterior clinoid

process.
"
The carotitig siphon is formed by the cayernggs and

stipraclirtoid segments of the internal carotid artery.

The anterior choroidal artery arises posteriorly lrorn

the carotid siphon just distal to the posterior
communicating artery.
'

True

. _ V

__n_ ____,; _

-_-._:--.- ;-_:;_-. B41;

as

/(i tiwilig,h$a>rtenacaot1artgrQt\it;'s.riseito:~
3> the ascen tng pharyngeal artery,

True
False

the inferior thyroid artery.

the internal maxillary artery.

the occipital artery.

MUOW

the posterior auricular artery.

thyrogeryicgl trunk which arises from the subclavian

arfry. The superior thyroid artery is usually the first

_

True
vi

True
Tru e

t
i
r

The inferior thyroid artery arises iromftha

branch of the external carotid artery, but may arise

from the terminal part of the common carotid artery.
The internal maxillary artery is one of the terminal
branches of the external carotid artery; as is the

Sllpsiel Pampers! answ-

The external carotid artery also gives rise to the

lingual and facial arteries.

_,

__..-.- .

_r

-- 4

5-l

_
_ _
~="" v

87

J.-'<

$1

. l7

_,

>__~.__

.._

,.---.~.-1

_..0=-a-.~:

<._

<

*_"

' '

'

Q ,._

Anatomy

5-mt

The vertebral artery:

A usually has a wider calibre on the left titan the right.
B usually enters the loramen transversarium of the seventh
cervical vertebra.
C

if

"

MCQ Tutor in Radiology

.

-;-,t.~1.
~-.r.-'.

87

4{,1Ql-I

A True

'

arises from the thyrocervical trunk in some individuals.

is usually the rst branch of the subclavian artery.

usually gives off the posterior inleii_cerebellar artery iust
before entering the loramen magnum.

The left vertebral artery 1s_usually the larger, but the

right is larger in about(g)_j4Jof cases.
The vertebral artery usually passes through the
foramina transversaria of the upper six cervical
vertebrae. it enters the fora en of the seventh
cervical vertebra in aboutilgsof cases.

...

False

C 1 True

._ "-

.,.D ..True
E False .

>1?

The vepebral artery gives off the posterior inferior

cerebellar artery after entering the cranial cavity.

.,_.. J"
r .,-r

55

_____________..._.__-

88

The cavernous sinus:

33

A drains the ophthalmic veins.

l

drains into the superior and iulerior petrosal sinuses.

1/

"_'/(!)/
"I t -/1
1
.

89
=

____

/L

B
C
D

I.

IT:

-"
.| if

D
E

Regarding the cerebral veins:

A

_i'r

' 1
___..

"

F5

-,

-vi

False

v
'

lies in the subarachnoid space.

_
tr

A
C

lies lateral to the sphenold sinus and pituitary lossa.

munm

"

the septal vein and the thaiarnostriate vein join to fours the
great cerebralvem ol Galen.
the great cerebral vein oi Galen joins the interior sagiua! sinus
to lorm the slgrnold sinus.
the superior saglttal sinus usually drains to the right
transverse sinus.
the great cerebral vein oi Galen lies in the quadrigenrinal
cistern.
H
.

the v infrritemporal
iossa.
.

True

True

True

the cavernous sinus cornmunicares with the veins of the face.

rs

,, __~

__ |_.wr*;a-M?-i' "
.(..n

4.

IE...-.
_*1ff-_--e:

Gib

M ,

-'
gm.-:
s,;i.1'*3
4 it:l

rt

i '"

Q.

,_.

"

Via the ophthalmic veins anti pterygoid

plexus.
_____...i--__

1'

kl,

'

..
(J ":9, r '

.\rr;1\O.."*

-'

r .. l-'-

f'.'r::.,-[

\
,5

1/ .

I
:
""

".1,

r.-,.c-"~~

it

,r-q -._ J -t

Ji

dura
mater.
_
.. ..4...

The great cerebral vein joins the inferior sagittal

sinus to form the straightsinus.
The superior sagihal sinus usually becomes the right
transverggnus, the right sig_r11_gi5l sinus, then the
right'intg_r_r]al jugular vein. The straight sinus drains in
a sirhilar sequence on the left side.

r-~

The internal ggrelaral veins and basal veins of

Ro%nthl'ioin to lorm the great cetiibral vein of
Galen: '
M"

'

The septal veiifahcl the thala_rn_ostriate vein join at

the-veno-uslahgle to forrn the int_F._:_F_r1:l cerebral vein.

- .- ._

False

ti

The cavernous 'sinus lies between the layers oi the

U

1 '1

The third, fourth and opl1_t|1lQ;)jg__ar|d gigrillary

dlvlsliiie of the liith cranial nerves lle in tiisleteral
wall of the cavernous sinus. The sixth cranial Herve
r'u?{s through the cavernous sinusTiiTo__r_an_gl_ateral
to the internal carotid artery. The maFi_G_ib_uiar nerve
passes downwards through the fo|"arner'i__gyale into

True
False

39 A False

Iv

3:

B _ True

'

contains the mandibular division oi the trigaminal nerve.

'

Y-'\V'&I"nr

?Y'f'7

MCt.1]Tutor in Radiology

'

'

lateral ventricle

"

Vv

False

The interventrfzular iorarnina of Munro connect egg} _

'

'

'.\ttuv_n|t 1'

'

.-

'.

lalill Yetttttgle to the th_irrl_ ye_ntricTe:'A mitlline

the interventricular forarnen connects the third ventricle with

the fourth ventricle.
'
L

channel, the cerebral aqueduct of Sylvius connects

they communicate with the central canal of the spinal cortl

the roof of the anterior horn of the laterat ventricle is formetl
by the corpus callosum.
the pineal body lies in the posterior wall of the third ventricle

True
True

the media" _aPerture ll0ran][l_gj Mggeridiel connects the

fourth ventricle with the cerebellomedullary cistern.

True

True

the thjrd_ anq fourth_v'tTiEl.'" _ '

Below the fourth ventricle the central canal extends
through the spinal cord into the upper and of the
lum terminate.
The oor of the anterior horn oi the lateral ventricle
is formed by the caudate nucleus grtgthalamus.

The hagggular corrtmTs'sTt?e, pineal body and

posterior cgrgrrtissure form the posterior wall of the
third\}eFitricle. The lamina tgrminalis forms the
anterior wall and the tl_'t'a_lamt4s forms most of the
lateral yyalls. The hypothalamus forms the l9_w_gr
lateral yvall and most of the lloor.
Whereas the Qajred lateral apertures lloramina ol

Luschlgal open into the pontine cistern. Through

these three apertures. one median and two lateral,

the cerebrospinel uid escapes from the ygntrrcular

systerrt into the suharaghgd space for absorption
by the \arachnoid
villi:
'
_-.

-r- - ._

3;.-.

:;.-,-" --

~~

ta,

l e spurt ' formed by the junction of the external auditory

canal and the lateral wall of the attic.

the promontory forms the roof_

the handle pl the malleus is attechetl to thu tyntpanic

membrane.

True
False
True
True

the tncudornallear and incutlostapediel joints are synovial.

the osstcles have the appearance of a molar tooth on a
lateral tomogram.

True

This is also referred to as the sgy_m. lt forms the

superior attachment oi the tympanic membrane.

The tegrnen ryrnpani forms the roof. The pony
capsule of rhg basal turn of the _cg__hlea is called the
prornoT'itory.

The incudontellear joint lies between the head of the

rnalleus and the body of the incus. The
incuclostapedlal ioint lies between the long @ess

. ,.~

of ghe -incus and the hea_Q gfthg srapes. W

The crown of the tooth is made up of the head oi

the matleus and the body of the incus. The "roots" of

the tooth are the handle of the malleus and the tong
process of the incus. The malleus is anterior to the
incus.

. rr
n

E-

,..\

iv.

Q.

54
rm

M50 Tutor in Haulcilonv

Mutt luioi ill iiauiology

/
.

-.

the carotid canal lies in the anterior wall of the middle 9

the oval window lies superior to the round window

the mastoid antrum lies posterior to the middle ear.

the pyramid lies superior to the aditus to the antrum.

an

oval is

True
True
True
False

"nth

Q _ I. 9 -;

B
C
D
E

sea

iey are rudimentary in the neonatal skull

the!
'
'
- _
cavgomal 9'"5 P9"9 ""0 ll"! SUPEFIOF mcatus oi tlie nasal
the ma ill

cavitv X ary,s'n"'9 Opens into the middle rrieatus of the nasal

lh

'

__

59

True

ggfrlrigcgsgrpgglgi the facial canal lies inferior to the latemi

munw
pi.

Anatomy

41

'

93

True
False
True

are |m.ed sinus

by clllaleg
lT!!!?"5
ll'!'lI'ril'
8 ilhelitim.i h ey
e spheno-id
I5
usually
divided
'
' '
'imo
I : twop by a ihm
septum, .

The facial canal is divided into three pans. The rst

part, or genu, curves anteriorly adjacent to the
cochlea and contains the geniculate ganglion. The
second part doubles back posteriorly to lie beneath
the lateral semicircular canal. The third part descends

vertically posterior to the external auditory canal to

emerge at"the stylomastoid foramen.
-t

Thmopening into the antrum, a__clitus tothefantrum,

lies in the superomedial part of the posterior wall of

the middle ear.
The pyramid is a bony projection from the posterior
wall of the middle ear, lying below the aditus, and
giving rise to the stapedius muscle.

The sinuses develop during childhood; the m__a_>_illary

and ethmoid developing earlier than the frontal d
sphenlolldnslhusee.
" M '
The frontal sinus opens into the middle meatus by
the frontonasal duct.
'

In addition, the sphenoid _i_nus opens into the

spheno-ethmoidal recessIThe anterior and middle

ethmoidai air cells open into the middle _i-neatus and

the posterior ethmoidal air cells into the superior

meatus._ '
"
."
True
True

in the temporomandlbular joint;

an articular disc divides the joint cavity inn; gnjeriq, aaj

False

B
C
g

Posterior compartments.
'
~ "'
the lateral pe"Y9'd
' YT"-'$l6 I5
- Inserted
_
.
' _
partly into the articular

True

disc

th fnagrisiglgs
l ' attached ~inferiorly
. to the coronoid
. yirocess- of
H:
ll"! Sphenmndlbular ligament lies "l9lll3|l\ ' '
Siabllliv is maximised by occlusion
/' .
.

flu!

\.

'35;
:3.-

I ggi

TI n

..

":2f-

False
ll

True
True

The fibrocartilaginous articular disc divides the ioint

cavity into sugergr and in_fi_qr compartments which
allow sliding and rotational movements respectively.
The lateral ptarygoid muscle passes through the
capsule of the joint to be inserted into the disc. T
The capsule is attached inleriorly to the neglt _o__f the
condylar process of the mandible.
The splienomandibular ligament passes from the
spine of the sphenoid to the lingula gf the mandible.

The joint is less stable in the open position.

'

. _._".,

.i/
e

<57

\lL"\IL,

4! _~,;-,_::4;._.-.(=r"" "4y%w}.;V-_,k_ 1.,

> U ..h;_v

\""*-W

as I
'~;,

-st

-I

r -

\I'~

._ .3,

'_Il'

._I

' T"'"""

\__y

"""-

J;

J,

\_v

Jky

~-_.

T?

U1

--

$!I'CC@"C*""@vvivir%

True

_._._E

, the normal adult has 32 teeth.

there are normally 20 decrgtrlous teem
O
U1>1. me _P*?"d"lal membrane IS seen as a raclictiett-as line
outlining the root of a tooth on a ra:lio_qr-ash.
D enamel ts the most radiopaque tissue in rho llC|!'\,-
m
_
I 7
_. . .
E
8 permanent teeth start to erupt at about b years or agr-t_

B True

C False

Regarding the paroticl gland;

A the retromandibular vein passes through it.
B the parottd duct opens onto the cheek opposite the seconrl
C

*9lats=

D
E

the mastoid process is a posterior relation.

an accessory parottd gland usually lies superficially rm the
rnasseter muscle.

'

't
1..

_'

The periodontal membrane is seen as a ratliolucent

line Outlining the root. The lamjlta gura lies outside
this, and__a'p'pears as a radio Taque line around the
root continuous with that ofefhe adiacent teeth.

True

lt has a calcied inorggfjg content of 97%. Mgtaic

True

The permanent teeth in each quadranv erupt from

medial tg lateral. The lower teeth erupt -lg months
earlier than the upper. Eruption is complete by about
20 years of age. "
_

True

SSA

upper premolar tooth.

the parotld duct pierces the masseter rntrscir-1,

"

Each quadrant has two incisors, one canine and two

llings _g_e;_more radiopaque than enamel.

__ _.._-._..

96

2123

Each ttuatlrant has two incisors, one canine, two

premolars and "tree rt1.eLar$-

False

False

True

Yiiilj

_._.....

..

':~-

The retrorntLihulat.yeln. the racial nerve and the

extejl-i$l'Olid artery all pass through the parotitl
gland.

lt opens onto the cheek opposite the s_e@nd_upper

molar tooth.
The parotid duct passes forwards over the tttasseter

muscle, turns medially at its anterior border and

fJl8l'C the htttrinator.
The paroticl gland is related anteriorly to the angle of
the mandible and the muscles attached to it. The
external auditory meatus and temporomandibular
ioint lie superiorly. The styloid process lies medially,

True

E
...._... _.__.,..-_-.._._

1: 8
._,

D
E

J7

he ama_"" maQlI\5 Qf"the thoracic Vertebral bodies may

appear irregular.
-sf.
.
. . _
.Rh

,3,

-L

t_

'

it

L-

ts

),,,;r_

_i:-H
rt: '

J).

.25-".1

-I

.~.-,; t

-all.-,

'

'.*2i'
t.-c".
t..,-.-

.. Al
wt.

'-

_-

f,-.r

"-

_.

False

Fusion ol tho neural arches posteriorly starts in the

llllllll-ll l\l\|ll)ll ttt T lg '5 yggtrtt utttl prttuuutla cupltttlrttl
the sacral region occurs last.

the dens may have more than one ossiticattrm Cent;

-, .
.t . -,\ 5 \.- >_,,

'

to the cervical region up t_o_]_ygr of age. Fusiott in

earliest in the lumbar regior*if*'.-5"

ve secondary os_st_f|_gat|on cetttrg_;ai"e prutient in catch
vertebra at puberty?
y
-;;_I
..z
_ __

r
lttsion of thu posterior clpuuls
ul lltu lluttrttl ,,,-r-mu
commen:es"earllost in the cervical region.
f uslon of the neural arches. with
- the cenrrum commences

'. -, '

tnt1tt'lpttrulttl tlttr;t.

__

Rega'dinQ noun?" d3VB|0pm6nt Of the vertebral coluntn;

A

superficial to the carotid sheath.

Several clucts open from an accessory gland into the

I
'

True
True

True

posterior margins of the thoracic vertebral bodies.

representing vascular remnants and the basivertebral
~___.

._...--I.-.-...

.._.

veins. The term Hahrts fissure relates to the anterior

,:_;_'-is

,.

C
D

'l_

Fusion oi the neural arches with the cep_t_rum starts in

the cervical regigrtgg Qyears and proceeds cautlad to
the lu'rn:ba'r' region, which ossifies at 5 years of age.
Fusion in the sacral region occurs last.
These centres fuse at about 25 years.
Thu dens may have tvyo )[1|'][Q>Q$5lflCZ1llOl\ centres;
lractures may be simulated.
There may be irregularity at the anterior and
_

. ., V
'

False

irrgularitll.

T J '
\

.
_

62

lt

k\ kl
ll-\r I

\,

_
'

.-' _

MCU lutot in lladtology

f
- 9 B
I \_..\

/O

__ I

\_' r

$1
7

_,

~ " 1'

the sagittal diameter of the cervical spinal canal at the level

_-'~

-,

True

False

of C4 should not be less than t6 mm.

'

*'
7 ._ .1 .._ h. -

...

.,,,h;;'

'

'

"-1 B8 i l't_ ~ T or a -l 'amen{sin!tl't'ervti:'ia"l Splir

~1-r Armih-tr-nmd4:-5 H alerts -use Mn" -it" '
E gem ma lavgaere enached to the intetvenebral discs
and vertebral bodies anteriorly.
B the membrane tectoria is a continuation oi the posterior
longitudinal ligament.
,
l.
C
D

99

False

the ligamentum nuchae may crtlcity. ('1

.. "
the cruciform ligament lies immediately behind the (lens ol i

True

anterior edge ol the loramen magnum.

_True

True

True

9@
'
T
A , the spinal
cord usually ends at the level of the Ll/2 disc

\/

mtvram

I00

space in adults.
the spinal cord has its maximum diameter at th= level of C7
the caude equine is situated within the subarachrtoid space
th e spinal
'
' supported by the denticuiate
'
'
cord is
ligaments.
the artery of Adltmltlawlcrls the major arterial supply to the
dortroluntber spinal cord.

I?

True

children. It should measure no more than 3 mm in

__

The ligamenta flava extend between adjacent

laminae. The anterior longitudinal ligamentis

False
True

True

The transverse part of the cruciform ligament passes

between the lateral masses of the atlas and behind

the dens to form the posterior part of the median
atlanto-axial joint.

t's'giQt cords end within the limits of the vertebral

level. ' '
The spioalcord has its maximum diameter at the

level 0flC5_)

The cauda equina consists of lumbar and sacral nerve

roots and the iilgrn terminate. As the segmental
nerves leave the v'bral canal, they are invested in
the meningeal covering of the cord.

The denticulate ligaments, layers of pia mater. lie

laterally and are attached to the arachnoid and dura

down to the level of the twelfth thoracic nerve.

It is an enlarged anterior radicular branch of a
seginerital artery in the T8-L4 region. It is left sided

in about 60%\al cases.

_

attached to thelntg_F\r_ei1elgLal discs and vertebral

bodies enteriorly.
i
The posterior longitudinal ligament extends posterior
to the vertebral bodies from the occipital bone to the
sacrum. The membrane tgfoiia refers to that part
vvhich extends from thifoccipital bone to C2.
The IigamentuLn__[lllgltae is'p'a'rt of the supraspinous
ligament, which joins the tips of the spinous
processes and extends from the external occipital
protuberance to the sacrum: ' "

bodies of Li and L2,{Ij99_lat the level ofllz andgfa at

True

_.

<i@At lglrth, the spinal cord usually ends at_th___QJ

I
l

This physiological subluxation is caused by

-ligementous laxity in children.
_
The atlanto~axial distance is less than Ii-imm l

F"

the axis.
E the apical ligament passes from the apex of the dens to the

L-Ta];

63

adults.
False The sagittal diameter of the cervical spinal canal at
the level of C4 may range from approximately
- 12-22 mm, 1
True
True

t_4 rn__m}in width at the level of the nasopharynx

the interpedlcular distance should increase from l.t to L5.

__. . _ ,|.l .1,

'

1 mm behind the posterior spinal line.

i
in children the atlanto-axial distance may be up to 8 mm.

D ig_p\revertebral soft tissues in the adult should be less than

'

Anatomy

Regarding normal measurements in and around the spine:

A in children thaboslerior laminar line of C2 may be up to

ts/\ t ** E

_.fI

"r-.l-'~r -

i "T

?'ik.\>'~Jl<I<(.D

@9"3'iF0*'@I@r0@'@-33
*

74%

it G

"U656

at
6 a a Ten it."

Techniques

\F_Z;Lr)7_(
1

-H

{n Lt

RBQaFdi"Qr@nventional high-osrnolzir contrast titedfazi

A Ihif vlssiry at 20C is approxiniatelv half that at 3'I?f
M?
'
/ B the use of meglumine salts. as against
sodisirn salts, is

..<*
ZN,Iif 4/M}!/C

D their osrnolality is five to eight times the )|iy:5l0l'_,'~qic3i 5 _-Q

E

'38PhYiaFil4i reactions are usually CiOSGlidp'lti.ElTi.

ttt
;

"M

\..I T ..

_.

-.

_
~r- 1_\v:_.,
- .. _-'.-I-W yaw

.,//"WDOCUIP

Tr e

C
D

The osmolality oj '|o_g;9__,q1Qlar contrast media is _

about o_rt5t_riirg_the osmolality oi conventional ionic

contrast media, but still twice the physiological

osmolality of plasma.

if

lotrolan.

re

False

Anaptxylatoid reactions are ra@lvg__qg-_QgQi1g&__I\lHyperosnwolar adverse reactions are dosetlepentlent.

False

False

True

This is a iOW'Ot?|TlOiBf _lgi;egiqic_dim_er with an

iodinezparticle ratio of 6:3. it may be used for
intravenous cholangiography.
. u.
_
This is a conventional h_igi1_-vgmolar'rionic rnonomer
with an iodinetparticle ratio of 3:2. \"""""'T"
A nongic monomer has an iodinezpariicle ratio of
3:1.

False

\J
-M

False

1 a;ir?5;iv|d ' 1,F''t,di:"tecetve. low-osmo lari "contrast"

\T_}' _
(3__(i\%Frath3'ii%ha?\ codtientionoliliiQl15_ot1iQlt1;t;orttra$:$

{me'3i.5;'iHOCMl?

WUDUJP

infants and the elderly.

poorly hydrated patients. .
patients with myelomatosis.

This is a low-osmolar non-ion_ic dimer with an

lOaiEZP&|'TlC|B ratio oi 6:1.
'
'\6- we mo L,-_t,~,

These groups are at increased rislt oi the zitlversc

hyperosmolar affects oi contrast media.

And also those with a history of severe contrast

medium reaction. Both groups are at increased risk

L~i>-~ i}-JJF5-13

_ ,
,
ry r}[r." /J:iF.f75'(/)'Zy:.~'/'1';-I//, ' I

band rneir/oer/1

True
True

This is a low-osmolar rnorgg-acid dimer with an

ioclinezparticie ratio oi 6:2.

of the anaphylactoid effect of contrast media.

patients with a strong history of allergy?

51, ,v1a-LL;/*riein,'f <2(,ro' -5=*--.51 wk] IMF

True
True
True

A patients with renal failure.

ITIUDW

therefore reduces the urinary iodine__0j9lt8li0 in

intravenous urography. The use ofsoditim salts is
pyelograms.
preferred. Sodium
> salts produce denser
'

rneglumine ioglycarnate liligraml.

iothalamata lConray),
iopamidgl (NioQat)_

meglumine and sodium ioxaglate ll-lexabrixl. Q

-WJ

Viscositfat 20C is about twice that at 37C.

Meglurnine salts have a strong diuretic effect which

(_

T ____"~'"P.""
,*sessm4teee2een.tsereiqwrosmoiai
H0014?
onomerv
"'=="""*=.
'

False
False

preferred for intravenous urography.

.
the
~ T ~ to 'il|(|'a-'E||'[ef|g]]
"
/2
v-3
_ _ incident:
_
_ e 0 f severe a d verse reactions
intecttons is about one third oi those ioilov.-irit_,; iniraveriotis _>;
ff
in|ections.

'" '"
. _
osmolality of P lasrria
" -

A
B

Dr. Zajn H_ AL H
1
"3

'

"Q. it-v

...._~. -.-...i Il| IILIUIUIUHY

__

*-

Regarding contrast media;

Techniques

False

C
D

True
False

False

Gastrografin is contraindicated because it is

hyperosmolar and may cause pneumonitis and/or
acute pulmgijag oedema it aspirated. lt may also
cause dehydration by its hyperosmolar effect in the
small intestine. Dilute barium or a lowosmo!ar
non-ionic contrast medium should be used.
Low-viscosity high-density barium should be used.

False

Condent reassurance alone is usually adequate.

True

This is an antihistamine. Intravenous corticosteroids

True

False

False

True

B
C

True
True

True

True

V a

- \<=1l
D
E

-I-/>

l.'riy,.')'_

UOUJ

physical or emotional stress increases a patient's susceptibility

E: an adverse reaction (following intravenous lnj5c[iQn'|_

-\\
r

' l
intravenous metoclopramide shotild le given for nau5ga_
intravenous chlorpheniramine maleatl lPtritonl is indicated in
severe generalised urticaria.

intramuscular adrenaline 0.5-1 mg is a lirst-line drug to be

used in the treatment of anaphylactoid shock.
corticosteroid prophylaxis is mandatory in astlmiatic atierits.
.
,
_
P
ralsmg lh_B Dallels f_ELl.1as no value in contrast-iridticed
hypoiension.

ianeesth atic: I
n solution is the maximum sale dost: in adults.
?Q_rnl of e 1/B
it is ellectively absorbed from mucous riierribranes.
(2'0VU'lSlO are a recognised complication of toxicity.
t_iere_is_an increased risk of lignocaine toxicity in patients Q
cimetidine.
it is contraindicated lor use in actite porphyria.

7 /1Mj7_',n ' v L_A/15.? m,}9,t,1 ; er! _;-Lu ,_,,L.,/if/l-,.L..(

,.
. ,
.

+//
U 1 I lu
'

Ll

The quoted adverse reaction rate of conventional '

high;-ssmolar contrast media is about 5.8%.
The urographic nephrogram is produced by ltered
contrast medium in the lumen ofthetibules, mainly

the
proximal convoluted tubules.
,_.-

astrogran is indicated when attempting to demonstrate a

67

5\R9aYdi"9 "19 mrligrnentpi possible adverse reactions to

Intravenous contrast media. -

_
I

/5

"8l180-oasophageal stula in an infant.

E lll9h*Vl5O$lY low-density barium should be used in doublecontrast barium meal examinations.

.<4.
-~

True

__

A the adverse reaction rate of ilfavengug lowesmoiar Comma

media is about one fth that of intravenous conventional
high-osmolar cdntrast media.
B he 'Q9'3Phlf "ephoiam 15 Produced by contrast medium in
the renal arterioles.

intravenous aniiemetics are rarely necessary.

should also be given.

Intravenous llgjgs, antihgtqmlnas, corticosteroids and

nebtilggbeta-2-agonists may also be necessary.
EClonitoring, oxiletw and blood pressure
monitoring should also be carried out.
The value of corticosteroid prophylaxis remains
unproven and co_r@@rsia|.
' $imple manoeuvres alone may be effective in
vasovagal syncope.
The maximum safe dose of lignocaine for local
anaesthesia is 200 mg.
. t='tl

Other side effects include agitation, euphoria, nausea,

pallor, sweating and respiratory depression.
'
Lignocaine toxicity can also cause hypotension,
bradycardia and cardiac arrest.
Cimetidine in_h_iQit_ the metabolism ofjiocaine,

thus increases il\.erii2!.miitv.

Lignocaine may induce actite porphyrlc crises. lt is

also contraindicated in hypovolaemia and compgte
heart Ulock.
-""'_"'
_"

;,,,(;( /J>[4u,/7 /r1t:'.:.r.4& 1;(r:.=//213'!/'lJ;I/3%) .1.-.-/'

.
r I.

"_KJn1ll.'l(),{),tC(k'_fJ1t{.,l"i)l(v'1:"

*1?

ii

r
/'

. .

-~a4>eun':nniH$

at

g g 5? 1'.E-f 2.gt

' 'f<?.<.=' "4

bd

Regarding local anaesthesia in radiology:

A paraesthesiae and sweating are eariy signs oi lignotzaine
'

"Ti.
-,1- n

1'3!-/\?('1jb

/ D

adrenaline should always be added to lignotzaine to prolong

its local anaesthetic eifect.
ct
lignocaine is a consti tt.l__ent ofEg1la urgent.
procaine is recomme ndcd In Order to anaesthetist: the
pharynx prior to passage of tiE i3 entaroclysis. _

B jal_se

C True

FBSPWBIOW depression as a result of lignocaine overdose may

be reversed by naloxone.

False

False

_ \_x

\
Q
\

i "Tti1m<.1'ue*9'tto"'w'aar

in addi/tioo pallgr, speech disturbance, tremor and

auditory hallucinations. These may progress to

A True

overdose.

"

\t;\
J

\J

central nervous system and cardiovascular

depression.
Adrenaline, ayasoconstrictor, should not be added to
lignoca_itre*wl\er\ used as a_local anaesthetic in
appendages or digits as it may produce ischaamic
necrosis.
'
'=':~;H-<"'
Emla cream consists of a combination of lignocaine

and another locat anaesthetic agent. lt is often used

topically in children when it should be applied to the

skin untletian occlusive dressing 1-5 hours before
any procedure. "
Procaine, a local anaesthetic, is poorly ggsorbed lrom
muggy; g_1_eg1;,ranes. it is of no value as a surface
anaesthetim Ligno_t;_'m__,pray. which is _v_y_ii_gp__rirbed
from mucous mernbranes. is used instead.
QQQEQTEGVBISBS respiratory depression caused by

opioid aQa_lg_escs. Respiratory depression caused oy

ttgnocaine overdose must be managed by spppomve
measures as there is no specific antagonist available.

A True
B True
C False

8 Regarding pharmacologi cal agents used in gastrointestinal

radiology:

"

A g_lu_c;t_gon is a more p otent smooth muscle |'L1ii.1K&il'ii than

It

8
C
g

hyoscine butylbrornide iBuscopanl.

hyoscine butylbrornide l8uscopan) may cause at.-ute gnstrit;

. dilatation-

'

/i

-llt/ .|*/'_<': ~

-rvc_},),_('('}'.;g}'

'7)

a;=. I//is ff,"

'
.
I

- ..
-- _--'_J/g"
)){,5(f 7(g;rJ,,/ti?/7/l-1/1
rj I
1

Fa!/)(1(\l0/l-;'t:r./' '_-'1'
J
1
.

- [TU Z5'4./.-.-./-7/ '

'.\'/l
/

.1.

p.

,;,i
_

.)i;t

H11. r52ltl?t hr t'i-;/ $1 it"

all
'

1, '

\-,- 'i\._.-1.,

"

_t

'

I/A/I

'

'1

..

'

"

\*\/\9

/*

,/

" /-1"

_\\'/Q./~(
-'
(
1

L7\D

/1.'.*_t'.'.("i'

--'

+ F t"""---< -1',
I )\ "f(|" I

1"'

la

oi! -.-_,-'.-'.-'(

/Ir?/.-J/I #11-it ;Vt1 -lzudf-5

, ( .=~.-

_)_..

_J-1'5;

/>/r///-' ///'
__r

"1 i

/1' J

_|__-

./it

ti

'7'

I l

lH_

'

"

'

r|'r,t"

-. -.

ii] r

'

ill!!! "1

-.

.t'=

I
.

/'.~'
h

,,.'~,-'1./'

if /H6

'1I(
%
\

'

'

.\

{nu-f;/'\J"i("I

b(.fr-,

ii

__/_. _-,4] i"

Plrf

,-.|_,rtl'i.H-

it,-'vii"i 'I""

, 1}! 1,-~~rf'<
' I

' ' f- r / ~

|P("",

l;

f-r-t

/7'15/K/)(_,( t-"l-'1 I I
'

-vi;

-'

"'

,9

'

LI

*'\{\_i

r"

(F

"

(U

ll

',I_.rf r'( |J('(/tiftf -\- t1:.'t;-//)Ii't'!) il.~IF

MP Ir

,1

\-*

l'

"Ii
t:

\\'.'.\'V

(k;\U_.___X

';|
. I ._-.--,,.trr[l-'
III
,
."

'.

r---i
i

,.. 1-
"1'=/1.7

,.
.
._.fI-/_.

I I

__._

, ..

Metoclopramidt: increaseigastrig peristalsis thus

reducing small bowel transit time.
Extrapyrannidal side eifetzts may occur if the dose
uxcuurls 0.5 tntilkg.

False

E True

glucagon is contraindicated in tliohetic patients.

metoclopramtrlo increases small howol trtttmit limit.
with mulocloprttmitlu . u><tr:t|1yr.tmitl.\l :;itlo ullt':t:t:; tut; mum
likely to occur in chilt lion than in ntlttllzl.

* .(".),;.!,.;/1-1-11:1/,"t@r[ -iygfi

A rare complication due to its attticltgligrgig action.

Glucagon is contrainrlicated in patients with either a
pnaegghrornocvtoma or an irguliponia.

1'
/H

r\

/'

iiift.

./

'

l'>!_}.

.-I

i(

"1,-1,!//rt
'

/)

[t1il\l

t... .; .

70

MCU Tutor in Radiology

. H.\ ~i-"!IQ!?5l91l
-~

. .."\

A
' '
B intravenous 9 luc ago n . scontrain d lceted in glaucoma. ta hi
intravenous glucagon I5 contraindicated in patients wit
phaeochromocytoma.
C tachycardia is a recognised side effect of intravenous ii oscine
~___
Y
butylbroride lBusoopanl.

>1 E

mg

Techniques
False

True

(Maxolonl decreases gastric emptying time.

-_-L,

meloclopramide lMaxolonl is contraindicated in atients with

_,,____ . .
P
pltaaocitromocytoma.

True

True
-\

10

True

gastrointestinal tract:
barium with a density of 250% w/v is ideal for a barium

False

A.

B
C
D

lollow-through. _
Gastrografin may be used in the treatment oi meconiurn ileus.
barium may be used if aspiration is a possibility.

True

intraperitoneal barium has a mortality rate ol approximately

a solution oi ].Q _r1'J of Gastrogralin in one litre oi n flavoured \

1
drink is recommended to opacity the bowel prior to a CT jww ',2t~\P A \d1-.O
EXBYTTIFTBUOH.

7/~,,..>

1
I-\

.-

./
I:
/.r

. ) /

-,

,. .-_

,__

_.

__

.-\ *\ _,K -

,,

__

.~ t._ -

,t.- _..

._
\

_ _. -\

The hypertonic Gastrografinpclrawswater into the

4?
l

P
/-

Vi

Wt

diagnostic barium enema must be performed first.

When contrast media is likely to enter the lungs.

either barium or a low-osmolar contrast medium
should be used. Aspiration of Gastrografin causes

True

Even with treatment, there is still a 50% mortality

rate il barium leaks into the peritoneal cavity. ll
perforation is suspected, watensoluble contrast
should be used.
A solution of 1_j5__giof Gastrografin in one litre is
recommended. This dilution minimises a_rt_fa_gt_
arising from the contrast medium." "T '

False

onL

t12_(:1~/v is suitable lor a barium enema.

True

//

Barium with a density of_ ;2$Qf/q__\)/y is suitable for a

dt;L1blt2_-tzgttrast barium meal, 190% w/y;barium is
reco mended lor a barium follo\iv~t_hrough, and

bW@' h@'F?lf*9 E9 dislodge the mB<>nium- A

50%.

/'

il"\lFq\8I'lOL|8 Btigggpan is contraindicated in

closgi-5glg_glat_ig_oma due to its mydriatic action.
intravenous giucagon can be safely used as an
alternative smooth muscle relaxant in this situation.
Glucagon administration in phaeochromocytoma
may cawigmggrrelease of catechglgmipes,
resulting in sudden ricl'FaTRd_hTpertension. Other
contraindications to glucagon are previous
hypersensitivity reactions and known or suspected
insuli_F'ii'a.T
Other anticholinergic side_ehects include blurring of
\_/igignlrylnouth and uri_ngry retention.
This effect eFiha_nces the transit of barium during a
lollow-through examination.
Maxoion adminstration in phaeochromocytoma may
induce an 8C_LyQ___Qii/Q_LBSDOl'\S8.

Regarding contrast media in the examination of the

\/

~,

71

PU|fttQ_rtglyvgg_der'na.

"

\%

Ti

ti

I
_t>

4'?\I

~i

G
. -. G

i 9' \.v J J \,v J qr J J -J

t , ,

. l1

A barium swallow:
A

'

11

provides better mucosai cletai' than does a Gastro:-ratizt

swallow.
"
A

should be performed with the patient prone when ass-essirtli

oesophageal motility.
'
C is preferred to a Gastrograiin swallow in suspected aspiration.

12

d~daI4iIww'I'I<wwwwq'

requires high-density (250% w/vl barium when a single~

contrast examination is carried out.

should preferably be performed using a double-contrast
Echnique when studying motility?"

''"':"M"

.
= (Q
L\

i\

True

~- "-i

therefore cogtraindicated in's_us'pcted'aspiration.

Aspirated Barium is usually coughed up without any
sequelae. Smaller volumes can be expactorated by

physiotherapy, but larger volumes can give rise to

severe respiratory embarrassment. Non-ionic contrast

media can be used safely in any situation where
there ts likely to be aspiration or extravasation.

False

-Fur a single-contrast study, a mediurQ;_tl_e_rlsity

False

A's'i_ngle-contrast study is used when looking ior

oesophgggal dysnjtotility. compression or
djsplacetnet.
~

5;,

the prgrtg position should be atloproti when otttzttlptittg in

False
False

200~t(ml IS an adequate volume of gas.

The RAO ltlm demonstrates the antrum and greater

curve. The LAO lilm demonstrates the lesser curve

.

Tlue
It

demonstrate the anterior wall ol this tlttudetsuln.

""\\\]|

metsarattrariw

significantly affects the incidence of demon"st rabi e 1._;astro

P
CO
U0

EH |'8C6.

the HAO film demonstrates the lesser t2\li."3 en .:.t;e.

a supine patient position is optimal lor tletttorlstratittq the

fundus of the stomach.

'
B effeg/ascent granules with good bubble |Ortttt:itirm 5hQr;l(l he
use .
.
. C the administration of hyoscine btrlylhrorrlitle luscopanl

? D

-_:__
_ _. _

approximately 1000 ml of gas should be procltice-;l in the

stomach for a satisfactory double contrast stutiy.

1-

T"l

examination.

complete large bowel obstruction is a cnrttrainditzation.

llO0% wlyl, low-viscosity bariumiandicated.

Smoking causes increased gastric motility.

True

A the patient should be advised not to smoke on the day of the

C

Aspiration of Gastrogran causes a ch_e_n_'t_igal

pneugnonitis and acute pulmonary oedema; it is

' C True

When performing a barium meal:

B

Water-soluble contrast media. such as Gagtrggraiilt,

give relatively poor tttttggsal detail.

A True

oesophageal reflux.
lling
of the duodenal bulb_ with barium occurs mnr
.
. e rel'lably

with glucagon than hyosctne butylbrolnide luscoparli.

the areas gastrlcae are usually best seen on an age; lm_

T3 A Fttlsa
B
"

Fill"

be cheap and easy to swallow.

False
D Fair
d
E

False
/_.

o
L/

\.\
>

>

' "

l20_0~400 mil, ltqn-igttetierenpe with barium coating

and rapid dissolution with no residue. it should also

7/

it tlulttu_n=stt:ttus thu antrum ltntl hotly oi lhu stomach.

The ideal gasptoducittg agent should have gg
bubglg production, adequate gas production

Filling of the duodenal bulb with barium occurs more

tallest!
with Eiuseeeen eeseese it rBla><.ss!L==..exl%u$~
They are best seen on the supine iilms. /"
_ j__,___.-...

'

_ I

7n

urn 1

-~ :_ '1--=!~

ii

"

l4

J!
_

.1

For a small bowel barium follow-through examination;

A the
l
patient should be advised to empty their bladder
piior to
B

Techniques
14

the examination.

Gastrogralin added to the barium is recognised as a means of

betas!
uensit toii~-ea'@d"i"e.resl!
suitab e volume
of barium
give a child is

True

"

l5 ml/kg body

False

False

weight.

D serial supine abdominal radiographs should be taken after the

barium has been ingested.

False

E a pneumocolon technique is a recognised method of

producing improved visualisation of the i_ern_1_i_ria_l igum.

;.

V.
IF-3
._-t

t J

RI). \<\ t\t\ 'K'(blQin\

.'~.

True

to advance the catheter through the pylorus. it may be helpful

to turn the patient onto their left side.

C the catheter tip should ideally be positioned 5-10 cm beyond

the ligarnent of Treltz.

_A'?iill bladder helps to raise the loops of small bowel

out of the pelvis.

Approximately lQ_nll _C_Lrp_grafln should be added

to the barium in order to achieve this effect.

in children, 3-4 ml_/Kg body weight is a suitable
volume of barium.
Prone films should be taken because the
_.Fompression of the abdomen helps to separate the

loops ol small bowel.

_
n@im5r air from the colon into the terminal ileum

will are visualisation in many patients.

it is contraindicated in suspected small bowel obstruction.

I

75

D barium should be infused at a rate of appr0xlmately_Z_n1l/min

I E t'he procedure may be complicated by inducing a paralytic
i
I eus.

15

False
True

True
True
True

Enteroclysi_s_is not contraindicated in suspected smali

bowel obstruction. Barium will be diluted by the

srnell intestinal fluid thus avoiding impaction.

v--/9/uwr

When on the left side, air collects in the antrum and

duodenal bulb, and may encourage the tube to move
towards the duodenum.
If the tip of the tube is in the jejunum then the risk of
reflux of barium into the stomach is minimised.

Q
c_'

Too fast an infusion of barium may distend and

paralyse the iejunurn, resulting in delayed lling of

ileal loops.
16

if/f y.

Z;

Regarding a barium enema examination:

A the procedure should not be performed within 4 weeks of a

16

lull thickness rectal biopsy.

(E; toxic megecolon is an absolute COntrair1dic' i
at on. for a slngle- F
B _1% iv/v_ barium suspension is recommended

False
True

contrast barium enema.

'
" "
D a Ha_mpto_ns view (prone angled view of the sigmoid) is taken
with the tube angled 30 cephalad,
E perforation as a complication occurs in one in 1000
examinations.
'

True
False
4

are/tacit-$5 EA/lg D9

False

in general a 7 day interval after a rectal biopsy allows

the mucosa to grow over the biopsy site and thus
minimises the risk of perforation.
i
The friability of the colon in toxic megacolon renders
it very susceptible to perforation.
On the other hand a 12531; vy/v barium suspension is
recommended for a double~contrast enema.
The tube should be angled_IQf_gaudally with the
patient prone. This view helps to visualise the
rectosigrnoid.

Perforation is the commonest serious complication of

the barium enema. Its incidence is quoted at one in
12000.

"

'

>

,.,J1

"'1

auuwwww-ww"wo=aauae!av""'
f
'5'-"4%\1J"<V~'\"J-aV~J"J-\'-ll_VJJ'~..V"..V~J-JJ"J~iUal7<FJiJ/
; \\

17

With respect to a double-contrast barium enema examination:

A if to be performed within 3 days oi a small bowel barium

J
\
examination, the bariumenema should be pEl'fQfl'9(i First.
/in B a pattlertt with a prosthetic heart valve should he given
a
.
Z K.
nti long MQl1i1y|axis.
//l C the transverse colon is usually barium-filled in the supine
position.
V
y,
r,- D tleal reflux of_ banurn lsminimised if air insuillation is
performed with the patient supine.
E ileal reflux_is increased when intravenous hyoscine
butylbromide lBusc0panl is used.

l7

'
I

D
_

J9
V

False

Transient bacteraemia may occur during a barium

enema. ,,.,.,
On a supine film the transverse colon is usually seen
in good double-contrast. On a prone lilm the
transverse colon is seen lled with barium as it is

False

False

False

under l year of age.

True

for barium reduction of an intussusception the barium should

be raised _ 100 cm
'
_ _ above the table for 5 minutes.
at maximum
of three times.

D
E

True

A.

False

B
C

True

18

radiologically if the symptoms have been present for over

24 hours.
the explorator grid should be removed when screening infants

when examining for gastro-oesophagealbreflux the baby

shouldbe placed in the prone oblique pQ5irjQn_
.

True

'

False

the sinus.

extensive track system than is visible on conventional i

fluoroscopy.

3.*i

i
.

'3_7l0jg_r_';\~

intravenous smooth muscle relaxants increase the

likelihood oiileal reflux.

The baby should be positioned pron_e to visualise

contrast passing from the oesophagus into the
trachea.
_
The contraindications to radiological reduction are
the presence of peritonitis, perforation or advanced
intestinal obstruction. Duration of the symptoms per

seis not a contraindication.

By removing the grid. the ra_g_igti9_[t dose can be

reduced by as much as 511"/Q. Acceptable images will
be obtained as there is little scatter.
Reflux is also best sought during episodes oi crying.

If ait_er this the intussusception has not reduced, .ll is

considered radiologically irreducible.
i

'7

The catheter should be inserted as far aigossible

into the sinus track until resistance is felt. This should
ensure optimum lling during il'i|8CIiOtl.
The amount ol contrast medium depends on the

track system. if there is clinical evidence of a fistula,

True

False

or the stula is shown.

This allows the orifice to be identified easily on all

lms, irrespective of the angle at which the tilm is
taken.

'

- 3 sh
yr

dependent in the supine position, making rellux of

barium into the ileum likely.

contrast should be injected until either ijellggg occurs

Sinography performed during CT rareTy demonstrates a mqrg

.. S

then dependent.

The ileocaecal valve is most commonly on the

posteromedial wall of the caacum, and is therefore

19

."\

z)

True

True

With respect to sirtogahy:

A the catheter should be inserted to a maximum disiame of
3 cm into the sinus track.
B water-soluble contrast medium should be used.
C A maximum of 20 ml of contrast medium should be injected.
D A radiopaque marker should be placed next to the opening of
E

B reduction of an intussusception should not he attempted

t k

The small bowel and stomach should be examined "

rst as they will be clear of'barium after a iew hours,
and the preparation for the enema will then remove

Regarding examination of the gastrointestinal tract in Citilrlfen;

A barium investigation or a tracheo-oesoptiageal fistula should
be performed with the patient supine.

who

False

the residual barium from the colon.

IR

18

'.".1'.7v

it

'Ii'i

kAffi 1'-Ion-1- D....4:_.1.

...-

VI tiuoliulwu)

Techniques

79

\\

'20

20A True

Regarding biliary contrast media;

A

intravenous agents are actively excreted into the bile by

hepatocytes.

they are concentrated in the normal gall bladder.

True
True
True

they bind to serum albumin.

an infusi9_n_1technique for intravenous agents is preferable to

boiu_s intention.
" '
they are contraindicated in pregnancy.

fl

Oral agents are conjugated with glucuronic acid by

hepatocytes to forth conjugates which are more

water-soluble.

'

i
=
infusion of intravenous agents, rather thanje bolus
injection, results iman optiijrtggt plggna ._

concentration vxgith maximum biliary excretion and

Trtie

produces fewer side effects.

_
They are alspcontraindicated in combined hepatic
and_rgl__l'ailure, and when there is a history 0
iodine
hypersensitivity.
.

_____,.__.-i

21A

_8/ 2i\ Regarding orel cholecystographyz

A
./___ii,.C
)

it may be useful in the diagnosis of acute cholecystitis.

the cystic duct and common bile duct are rarely visualised.
a lat-containing meal should be taken on the evening prior to

the examination.

False
True

o when e single dose technique is utilised, the

Acute choiecystitis is a contraindication to oral

cholecystography es the gall bladder will not Qpacify.
Other contraindications include hepatore__n_al failure.
dehydration. an lV cholangiogram within the
previous week and previous cholecystectomy.

This empties the gall bladder and allows better

subsequent filling.
False
.T-he chole\cystographic agent\s\hould be taken
'\ 14 hours prior to the appoiritme__r1.tlirB- The Colml
fil?i;i:Fn_u't therefore be taken when the patient makes
hisher appointment. as the gall bladder will already
be opaciiied when the patient arrives for the
investigation.
False
Tomography is often utilised in intravenous
cholangiography.

cholecystographic agent should be taken approximately one

/_,iE

False

hour belore attempts are made to visualise the gall bladder.

tomography to show the gall bladder is usually necessary.

\\
\

22A

M l22l Regarding intravenous cholangiography:_

;'

visualisation oithe biliary tree may be3inadequate in up to

approximately examinations in patients with normal
hepatic function.
it is contraindicated in patients who have had a pruvious
cholacystactomy.
ifltlta contrast medium ls infused i oo quickly. renal rather than

True
False
Trtie

biliary excretion may occur.

intravenous cholangiography may provide__u_ggl

information in post-cholecystectomy patients with
recurrent symptoms of biliary tract disease.
An infusion of Biligram 9_\f|t_e_[_)___t"_i_'t_l_r%
(3-4 rttlgu/kg/rrtinl gives optimum plasma
_ _
concentration with maximum biliary excretion. ll it is
infused too quickly, there is insufficient time for
albumin binding. so renal excretion may occur.

intravenous glucagon may improve visualisation of the

common bile duct.

the mortality rate is approximately 1 in 5000 examinations.

True

it achieves this by three mechanisms: (ii contraction

-"'."i
"_

(2) increased qhglgrgsis and (3) increased hepatic

blood flow. M l
Other complications include impairment of liver and
renal function and the precipitation of abnormal
paraproieins in patients with Waldenstrom's

I _

i
.

True
O

I)

of the sphincter oi Oddi, followed by relaxation;

I"<Ir<II*I
\/

&/

i23

"

Regarding post-operative(T-tube)cholangiography;

the examination should be performed at ehuut

the tenth t'la Y

23

post-operatlvely.
e
"" "
a control lm or the gall bladder area is rer uired
.
l
cholangtovenous reflux of contrast medium can occur.

retained calculi can be removed via the T~tube within a few

days of post-operative cholangiograplly.
percutaneous
extraction ,of_ retained biliarv- calculi ina Y be
.
complicated by pancreatltls.

A True
a True
True
False

The biliary ducts absorb contrast medium and

cholangiovenous reux can occur with high injection
pressures.

When a calculus has been identied on the T-tube

cholangiogt=am, the patient should be dischargetl
with the T-tube clamped for atEt__gv_gel< to allow

the formation of a fistulous tract. The T-tube can then

be removed, and the stone extracted through the

True

$tt"Ou$ tract with a basket.

Other complications of this technique include the

creation of false sinus passages, SBpliC3_E_lTli_d and
vagal stimulationiwlth shock.
*
._P.l--

2.4

e re

in endoscopic retrograde cholangiopancreatography lERCP);

A the presence of a pancreatic pseutlocyst
K
_ .
is. a, t.otltraintlicauon
to the procedure.
B

low-osmolar contrast medium with an iodine content of

24

True

False

150 mg/ml should be used to exarnine the pancreatic duct.

C
D
E

intravenous buscopan may allow easier identification of the

am pulla of Vater.
if both the biliary tree and the pancreatic duct are to be
opacied, the bile duct should be ctirinulatad first.
hyperamylasaemia may occur in up to 70% of patients.

True

False

True

__l..

Other c,ont?aindications include acute pancreatitis,

severe cardiorespiratgry disease, and any other

contraindication to endoscopy.

Dilute contrast medium USE) mggm should be used

to examine the bile ducts to ensure calculi are not
obscured. A more concentrated contrast medium
n>_i_"n_g_r_w_)
(240
/ l s h ou l d b a used f or pancreatic duct
T minatio fl.
Due to its choloretic action.
The pancr'gtig_duct should be cannulated first, and

the iniection of contrast should be stopped as soon

as the lateral branches of the pancreatic duct are
seen.
Asymptomatic elevation of the serum amylase is
common and usually related to over-filling of the "
pancreatic duct.
'-

82

Ml.'Lt lutol in haululugy

_

luulttriquua

__

5) Regarding percutaneotrs transhepatic cholanglograplw.lPTCl5-f.

,
A a platelet count of less than 100 $5.103 l" is a contraindication

to the procedure.
T
a Chiba needle should be inserted through the liver via an
anterior approach.
Cg the incidence of complications is primarily related to the
B

True

False

Other contraindications include an e@_td

pr9_}_h_ro_mbin time, hydatid disease and 5E\/fe
caitftgptllfgnary disease.
-\% \.l.-.-\lt'ur

if contrast medium is seen in the intrahepatic lymphatics, the

procedure should be terminated.

is therefore inserted parallel tg the pla'r'le.Q_htj_b|c

and advanced during su7sp'ei1'cled respiration through
the right lobe of the liver.
M
The incidence of complications is not related to the

False

internal biliary drainage is indicated if ductal calculi are

demonstrated.
ii

False

False

number of passes. A maximum of l020 passes may .

be performed. The likelihood of success is directly

related to the degree of duct dilatation and the
purber of passes made.
Excessive parenchymal injection may result in
lymphatic opaciiication. This usually clears
_
spontaneously and the procedure can be continued
with the needle in a different position.
The presence of ductel calculi is a contraindication to
endo rosthesis insertion.

26
M V"
\/

The following situations will increase the risk ol taacteraemia

during percutaneous transhepatic cholangiography lPTCl:
A puncture of the portal venous ra_dic_les.

THUG

27

multiple percutaneous punctures.

presence of cholangitis.

Regarding the use of contrast media in intravenous urography:

A the recommended dose in adults is 300 mg oi iodine per kg oi

B

-v

the recommended dose in children is approximately l ml of

370 contrast medium per kg of body weight.

patients with renal failure require hall the standaid amount ol
iodine.
I
the density of the nephrogram is determiner! by the degree ol

the density of the pyelogram is greater with sodium salts than

body weight.

True
True
True

overdistension of intrahepatic ducts."

complete obstruction oi the common bile duct.

hydration oi the patient.

with the equivalent meglumine salts for the same amount of

injected iodine.

The Chiba needle (22Gl is inserted in the mid-alrlllary

tige in the right seventhgr eighth intercos_ta_l3p_ace. It

number of passes prior to entering e duct.

aw

.1?

FTC should therefore be covered with prophylactic

antibiotics.

"

mUOUJ>

True
True

True

B
C

True

False

Patients with renal failure require at least twice the

False

True

Nephrogram density is determined by the contrast

med_iu_g1_dge, the peal_plasma contrast
concentration and the glomeruler filtration rate. it is
in-dependent oi the degree ofT15ti?iThydration.
Sodium salts produce less of an osmotic diuresis

standard amount oi iodine li.e. 600 -mg iodine/kg).

than meglumine salts because sodium iTabsorbed.

Sodium salts therefore produce denser pyelograms.

gm

my

..

47

~a'd"9-3Q\.l@it.J(I'wgu.$.;g.@

<5

_ @@"U'Ui'd'@"J'~8'J'J'@-iQ'@Q7'dslWJld'wl? it
True
False
True
True
mUDw)> False

FOF in"-QVEHQUS uwgraphy, low-osrnolar contrast media are i

recommended in preference to high-osrnoiar media in patients
with:
A diabetes mellitus.

TNDOID

systerrijg lupus erythernatosus

sickle cell dlS8_8.h_
cardiac failure.
pulmonary
emphysema.
______,,,__

__- _,c_-(~
A

True

A is a recognised cause of vasovagal symptoms.

B should be applied 15 minutes after the contrast medium has
been injected.

False

C
D

False
False

True

False

True

True

False

False

is essential in neonates.
is acceptable even when there is an abdominal mass,
provided that the mass is not tender.

is contraindicated if there has been recent dD(iQtTtil'li'Ji surgery.

The following techniques are recognised as assisting

radiographic visualisation on an IVU:

A the tube should be angled 15 ceigliaiag to obtain ti coiled

\)

gm

Ureteric compression in intravenous urography:

C
D

post~micturition bladder view.

the ingestion of a zg d_ii_'il_<__to aid visualisation of the kidneys.

35__1ntei:iot Oblique renal views to improve delineation of the

C it prone lilm to aid ureteric visualisation.

E

renal outline.
tomography centred Onva point halfway betweenthe table top
and the anterior abdominal wall Wlii aid visualisation of the
renal outlines.

L-J Q

When this occurs the compression should be

.
released. and the patient placed in the head down
position.
4
_

ll compression indicated it should be applied 5minutes pOSi-li]8CiiO|1.

Compressio_p_is,riot used in young infants.
The presence oi an abdominal mass is an absolute
contraindication to compression.
Other contraindications include renal trauma and
renal obstruction.
For a coned view of the bladder the tube is angled
15 caugad. It is centred 5 cmab_o\_1e_ the pubic

symphysis.
W '
In children a fizzy drink will produce a gas-filled

stomach which acts as a window through which the

kidneys can be seen.

When the patient is prone the ureters are more

dependent aiding visualisation. .,.

Obligue views of the kidney should be taken as 35

PQElQ(.QD_Q\_4a$-

In general, the tomographic mid-point of the kidneys

lies at one third the distance from the table top to the
anterior abdo'rn'ih'al wall at the inferior costal margin.

86
31

Techniques

MCQ Tutor in Radiology

True

Regarding retrograde pyelography:

A it is recognised as being useful in delineating a lesion
inadequately shown on intravenous urography.
B contrast medium with an iodine concentration of 340 mg/ml '
should be used.

False

b0 ml of contrast medium is required to delineate the

False

pelvicalyceal system.

D in the presence of ureteric obstruction, contrast rriecliurn

should be aspirated prior to withdrawal of the catheter.
E pyelosinus bacldlow is usually asymptomatic.

True
True

32

Percutaneous renal puncture:

True

32

is recognised as being a useful technique in the evaluation of

A retrograde examination is a useful adiunct to an

ipeionclusive lVU to help demonstrate the site, length

~~and lower limit of a lesion.

Dilute contrast medium (l50200 mg iodine/ml)
should be used to ensure'hTiTFn_a'll_l'E_i3ns are not
obscured.
Usuallyv5-10 ml of contrast is needed to delineate the
pelvjcalyceaifsfem. The injection should be
terminated if the patient complains of loin pain.
This minimises the risk of development oi a chemical
pyelitis or a pyoneplirosis.
Occasionally
it may result --~in pain, fever
and rigors.
-s~
.
ll an apparently simple cyst is present together with
unexplained fever, haematuria or pain, it may be

helpful to drain the cyst via percutaneous renal

puncture. Double contrast images of the cavity

renal cysts.
8 is e luridamentiil pan oi the Whitaker Test.
C should be directed towards the upper pole calyces for
nephrostomy tube insenion.
D may be complicated by an arteriovenous fistula in
approximately 0.5% of cases.

True

is contraindicated in the presence ol urinary tract infection.

i

.
False

True
False

l
l
I

8/

should then be obtained.

'

The Whitaker Test is used to distinguish between an

obstructed and dilated system. A catheter is ' 'introduced percutaneously into the renal collecting
system, and saline infused at a rate of 10 ml/min. A
relative renal pelvis pressure (i.e. bladder pressure,subtracted from renal pressure] less than 13 cm H20
is normal.
u
"""-'""' TI"
The aim is to puncture a lower Q9l3|Y><' Pa55l"9

through the least depth. oi paienchyma to reach the

collecting system. This reduces the chance of
vascular damage.

Percutaneous renal puncture and drainage via

nephrostorny is not contraindicated in the presence
of obstruction and inlected urine; but prophylactic
antibiotics should be given.
" '

33

,%

Reqrdig mlcturating cystourethrography:

satiation should not bu given.

Wdler-soluble contrast medium with an iodine ,;onCEm,m;Dn or

100-150 mg/nil is recommentlecl.

1
\

False
True

oblique position.
'
lateral views should be taken when attemptinii to denmnsrraie

True

Young infants may need to be sedated particularly

prior to ctitheterisaiion.

These lateral views should include the sacrum and

the symphysis pubis. These bony landmarks are used

to assess bladder neck descent.

fhisyensures visualisation oi the long axis of the
itretlira.
T "*."'_

'
(4

False
True

C to Semkngtrate stress incontinence erect lateral views ggnggl

o _ie a_ der only should be taken at rest, straining, and
during micturition.
.
D in male irifants, the urethra should be imaged in the anterior

"""Q.lt.! 9...!9\;sis.l it_stiile==.I

33

t.

r"

-1.0.,
88
34
i

MCQ Tutor in Radiology

" V V I?

t
_!

C_wC'iU'rQntgt"._,,-

Posterior urethral valves may not be demonstrated

on this examination, as they only ll out and obstruct
d uring
' mic
' t urition.
'
Micturaiing
' c stouret h rograp i iy 'lS
therefore the investi 9 ation of choice for suspected
posterior urethral valves. The main indications for
asceritiingiurethrography at suspected tirethrgl
\. tratima and the assessment gig urethral stricture:

A False

34

Ascending urethrograiphy;
A is the examination of choice to tiemonstrate posterior urethral

valves

B should not be performed within 2 weeks of urethrai

instrumentation.
C requires about g&jjQv[[\_|_in/Eiitii-SOilli.)lt3 contrast medium.
D is the radiographic
examination of choice for dernonstratinH
.
the prostaiig urethra.
a
i: is complicated by intravasation of contrast medium in
approximately 5% of cases.

i.
8

Thisisdue to the risk oi intravas on of contrast

True

medium from the mucosal damage that may have

been caused by recent instrumentation.

C True
D False

_..__.---

4
T" CL-T
The urethra IS well seen as far as if
ll
portion on ascending urethrography. To demons rate
the proximal. rostatic urethra, a radiograph should

be taken during micturition.

as

35

Regarding hysterosalpingography (H56);

it is contraindicated if there is a history of untreated salpingitis

it should be performed in the week preceding the menstrual

period.

during the preceding 6 months.

C pethidine can be helpful if given as an analgesic before the

procedure.
D the procedure should be terminated if venous intravauation
OCCUFS.

pain may persist for up to i-2 weeks after the procetltire.

.5 ._.\ .3

35
J

.-

', J.

Regarding G3V8|'l'i0$0gr'aphyA

it is a recognised procedure for investigating male erectile

5

di:ife112iiPn~
~;"~--
a needle is positioned in each corpus cavernosum to ensure

bilateral opacication.
C approximately/_ 20 ml of contrast medium is required to opacify
the corpora ca\TFn35.
_7
D venous thrombosis lS a recognised complication.
E it is contraindicated in the presence t>'r'aia?5~;5ii uriiiery tract
infection.

I
i

ah .

True

HSG is contraindicated until a course of antibiotics

has been given and there is clinical evidence of
successful treatment.

A True
B

False

False

False

Trua

HSG should be performed in the first week after the

menstrual period.
Pethidine stimulates smooth muscle coriirggtign,

which impedes the filling of the fallopian tubes with

contrast medium.
r.
Venous intravasation may occur in 8ppl'0XiiT\i:llt3iy6%9
of cases. but it is of little significance when
i.vater~soluble contrast media are used.

i
.

36

A True

B False
C True
D True
E

llui postulated that this is due to pelvic irritation.

Other indications are the demonstration of the extent
of P_eyroniesisease and the investigation of
priapismand penile trauma_;_
The corpora gaygrnosa on both sides are opacified
from a unilateral contrast injection.
2_0 Q1! 9f Q |Qw;Qm_olar contrast medium is
recommended.
Venous thrombosis can lead to priapism with /i

imi>_<1.tsnes==-

'

4,. \_G.3i;,;,y\,."_

'

-|

Yf:.l\
I-1;
, 'tii\'
In rd

,.,iii-is

_ I

'l,f_r-,. -l-_

it

."/."1/ft

The only contraindication is a history of

typrsensiiivity to_contrast media.

False

'}lC|:

Jiiqvoitfi

(IN

"

'-+l~t- e,-'rI'/Ic Hiiwi ctr(/mi

ft)

I
V J ..iLr""f~=
\_Uty~,{- .-4
TY," \>ey\lr
Cf/""5f C:.-/ {Mr

1'

_,;Zrf,
_
-.
,
. ~;- ("T3
-"
.~,, r,-rr-r/on QHK/,P,,41! f/fv /

MLJU ltiior lll neurology

90

i 37
tr

ln arthrographyzjf

37A

A control lms are not usually recommended prior to the

procedure.
B

joint effusion is a contraindication becauso of the risk of

negative contrast medium is absorbed from tire joint within a

few hours.
delayed lms may be useful in the investigation of a

Conlrelilms should elicayees tezimee EH2 *0 "'

False

injeetion of contrast medium.

Joint effusion is not a contraindication to

False

arthrography. The effusion should be aspirated prior

to contrast injection in order to avoid dilution of
contrast medium and bubble formation.
Negative contrast medium_j_qj;]_may take up to_{A_
days to be completely absorbed from the joint space.
Positive corgitrast medium is absorbed within a few_

introducing sepsis.

False

suspegtgdloose body.
adrenaline shoujd not be added to the contrast "|ediU[T|_

@9915 T

True
False

X
38

38

False

B 5"j9_|8-c_oiitrasi technique is usually recommended.

the injection site lies at the same horizontal level as the

False

C "18 Patient lies supine with.the forearm pronated to allow

False

A
I

'1
j

Regarding shoulder anhrogrdphyz

coracoid process.

EBSY needle entry into the joint space.

T examination requires a smaller volume of positive contrast
medium.

an axial radiograph is routinely performed following contrast

lf'l|8ClfOl'l.

True

True

39

,/

in double-contrast knee arthrography:

A the needle is introduced at a point 1 cm posroriqr [Q the
B
C

':r'\g:[\5if_1\i
1Ei'E9lF!! at OiflJO9lliV9
the Rill-_contrast--~-~
medium ls r'at:ornme|1d9(j_
j

_5 ""9 0 lite, needle tip should be confirmed by

39

True
False
False

D aspiration of synovial fluid. ,.

E

2:? kg;-eo5i?U|d b ilptilated following contrast injection.

c m on occuring in tho joint at iz hours I5 abnormal.

r'\

True

False

Adrenaline (0.1 ml of a 111000 solution) may be

added to the contrast medium in order to delay its
absorption from the joint space. "" "
H ' ""
A double contrast study is usually performed using
about 1t_)_ r1_w_l_gf__pgitive contrast medium and lqwmj
of air.

The injection site lies abo_ut,A<,:,m infer.i9.[.inFi 1255.8

to the tip of the coracQid'process.

The patient lies supine yyith the forear_m__upinated - ,_-'_
and close to th'body. This allows the long_head of /
biceps to rotate away from the vertical path__of the
<_needle. In addition, the articuiar surface of the
glenoid will face anteriorly avoiding damage to its
labrum.
Up to 3 ml.
'
___,,-...--.... < I

Either via a medial or lateral approach into the patellaiemoraljgirit space.

-- .

About-Q _rr'i_l\of positive contrast medium and 50 mlmof "t

air are injected.
Tu
Correct siting of the needle tip within the joint space

is confirmed by a test injection qlf a srrtaiivglume of

contrast mei:iium't]iw't'ir~r_iitioroscopic control. Contrast

mtadium should flow rapidly around the joint.
This ensures even distribution of contrast medium
within the joint.
Some discomfort may occur in the joint for up to
about 2 days. The patient should be warned about
this.

W.
~'
'
_- nwwytw
-_g y to tetra W \W<d<dUld@lE@llUl@4U@*iU'W~"U@ri
0 to 0 0 I tI_-with U 1' '0 I U
40 When performing myelograplty of the lumbar region;
A e lumbar
'
. puncture within the preceding week is a contrai ndication
B approximately ]Qn1_l'9fwater-soluble contrast medium with an
- iodine strength of 2\40 mg/ml should be used.
C contrast should be iiFt'dwith the X- rayr table tilted
'
l5i~> head

J/

/
u \l

40

week of the rst, the pool of leaked cerebrospinal fluid

D_ routine frontal and lateral views of the lower thoracic cord are
mandatory.
,
E

A small amount of cerebrospinal fluid often leaks into the

subdural or extradural space after a lumbar puncture.
and if a second lumbar puncture is performed within a

down.

VJ

True

the patient should lie flat for 6 hours following the procedure

B
C

True
False

True

False

may be tapped instead of the subarachnoid space.

__.=a-z

The table~should be tilted 15 l9_9t_g_qv_1n during the

iniection to ensure poolingf contrast in the lumbar

subarachnoid space.
.
ln order to excluclgunsuspected intraspinal tumours
which can mimic a disc prolapse. H ' '

Following the procedure the patient should sit up so as to

pool the contrast metliurn in the lumbosacral region.
The patient is then allowed to remain ambul_ant ii he/she
wishes.
l._;lJ/-"\
H

.,_

.-.- ._, .

41
5}

41

ln myelographyz
A lateral cervical puncture should be performed when there i5 a
5
n in the upper cervical damil,
B less dilution of contrast medium occurs if the contrast flows E

cep h a I a dl the spinal canal via a lumbar puncture than it um

C
D
E

\4

"ID

True
True
D False

This is a contraindication to direct cervical puncture.

Other contraindications include cerebgllartgitsillar

herniation, suspected lumbar spinal dysraphism and
certain spinal deformities leadingto loss of the Cl/2
interspace.

contrast flows caudad via a cervical puncture.

lateral cervical puncture is a recognised method of demonstrating

prolonged headache is a more frequent complication in females

then in males.
-

True

Post-myelographic headache occurs in 20-30% of

patients, and about 10% will have more severe
prolortged headaches. particularhgfemales.

True

a macroradiography technique is recornmenrted,

an occipitofrontal 20 control film is taken.

A
B
C

Q;52.0 ml of ljpiodol ultrafluicl is recommended.

btl'ztEFal_raiher than unilateral examination is common practice

D
E

True
True

Thus magnifying the i__m_gg Qgtained.

The control film"is'"an_occipitomegtgl int.
The lower canaliculus is usually cannulated preferentially
as it is more convenient and functionally more important.

the upper level of a spinal block.

a postmyelogram CT should be delayed for 24 hours after the
myelogram in order to reduce the contrast density by dilution.

%
-> a
In dacrocystugraphyz

amt
42

False

'

LC L'- 1 i:|,J_(i

A delay is not needed between the myelogram and CT,

unless the investigation is lor__yring_q__n1yglia, in which
case a 24 hour delay is ideal to show the syrinx.
J5;_.- _

s '
-I-. .

T"
-

I ,

42

cannulation of the superior canaliculus is recornmendecl.

False
False

This enables comparison with the normal side, or, if

abnormalities are bilateral la common finding) the

simultaneous demonstration of the two sides.

is
.

_ ._

.l'.

pk ,

(L) ~ mi ' cg)? J

Ft'

).

l
l

Techniques

MCQ Tutor in Radiology

94

95

A?!

In sialograpny:
A Lipiodol ultrauid can be used as a contrast medium. 1
5 Pain ggyufvs _rnore readily with a water-soluble contrast

43

ll

t.

"

contrast medium should be injected into the parotid duct at 3

an oc_cluE_\l fgdlggfaph is useful in the evaluation of the

parottd duct.

.8

\5

D
E

the anth_rQl29lQQlEEl_Egselinepasses from the otrt__er_a'nlttt! 91

45
O

a;9lm9@'Phv maY be U59l""V mPlOyed in the lateral

0 lque VIBW of the lemporomandrbular joint,
the cororwlcl process of the mandible is well shown on 5
"'_"""""_
.
T
>
standard occipttomental
pro|ectton.
'-'

I9

=31

=;
ill
-r

a lateral view of the C8l'VlCB| spine is 2.5 cm posterior to the

angle of the mandible.

---'"

B AP view of the shoulder is the acromion.

a lrog lateral o_l the hips IS the lemcral heat],

"TOOK?

a PA chest radiograph is T4.

a PA view of the hand ls the capitate. '

noebe advanced any further.

Contrast medium should be iniected very slowly at a

False

False

rate of approximately 0.2 mllgjip.

This view is useful in evaluatiT3 the submandibular
duct;
"~""' i

44A

False

This is a description of the Qllilllmeatal lor

radiographicl baseline. The anthropological baseline

passes from the infragrhital point to the upper Qgrger

'" 3 5l5"a3"'rlPll0lrOntal projectiontliie'beai'i's angled

cephalad.
in a submentovertical proiection the radiograpltic baseline
should be parallel to the |m_

An appropriate radiographlc centring point tor;

A

After passing the probe about 1 cm into the parotid

duct. resistance will be met where the duct
perletrates the buccinator muscle. The probe should

. .5Y?_E Ll? EEBEEE Ql lli Qlilellll tIl_I10-">1 meatus.

t
l

True
False .

B
C

rate of approximately 2 ml/min.

'~___...'-

oil-bas'e"d.m'edium, Lipiodol, can be used in

accidentally iniected into the soft tissues, may remain

in sltu lor many years.

44 The following statements are true:

A

Either a wateesoluble gontrasl medium or the

sialography.Oi|-based media are more viscous and, if

medium"than with an oil-based .-.i'geat."''*'

C aliens probe should be passed at least 2 cm into the parotld
D

True

43A

False

u
True

False

True

ASA
B

True
False

False

True

False

of the external auditory meatus. These two lines are

at .=m"a'h'g|e oi about 10 to each other.
The beam is anQl_e_l___cu_g|ly and centred in the

mine E1l>@v@>tl1=B,_r:>,1<1yiit%-.11 occipital erqtruberance to

emerge from thefnasion._

The beam is directedat right angles to the
Qrbitomeatal plane and centred midway betwellle
external auditory rneati.
T''
Open and closed mouth views of the
teirttupoionwanvdibular joint do not employ patient
movement.
a

This is approximately the lev_el3[__Q._l

For an AP view of the shoulder, the beam should be
centred on the coracoid process. For an axial view,
the centring point is the acromion.
A lrog lateral view is taken of both hips
simultaneously. The hips are llexdfatiducted and
laterally rotated, and the centring point is in the
njtidline, at the level Ql_the ferggral pulse.
For an AP chest radiograph the appropriate centring
point is the sternal notch.
For a PA view ol the hand, the beam should be
centred on the head of the third metacarpal.

av

\7~~@

~.v\t

46

war-~wIuI'tIIIr-u\_Ilw

WI

Z-srl

elf

egarding skull radiography:

A the eye dose is up to 200 times greater with an AP projetrtir-.--t

W :
Q\

than with a PA projection.

a horizontal beam lateral lm is essential in the case of head
tnlury.

46

True

True

False

False

True

\j

,9._.- 4;.-qMpqt_4

in 3 _CiPli0"ff0I8l iQF) 20 film. the rierrotts flCiQt:5 should

be pro|ected at or near the superior orbital margins.

laaljowne s view requires 30 cranial angulation of the central
for a submentovertical view, the radiographic baseline should

be parallel with the film.

if

'
to "'0 "0 0
0 Q O
wecntiqwswtt/wt wt U = Q

Tneretore it is desirable to choose a PA proiection

ll

whenever possible.

To exclude iirfllttigileyels in the cranial cavity, the

ventricles or the sguses.

On an OF 20 radiograph, the petrous ridges should

be proiectedsonto the inietl9.!.2[P_l1! .?.9l"5- le*'=W"\9

an unobstructed view of the bony orbits.
A Towne's view is taken with the patient supine, the
tube angled Q caudally and the beam centred on
the forarnen magnum.
With the patient supine, the neck is fully

hyper-extended until the baseline is parallel to the

lm. The beam should be centred midway between
the angles of the mandible.

l
Q-t

\5 %7' HBQal'<"9 Fadl9l'BPl\y of the facial bones and teeth:

33
A the zygomatic arches are best demonstrated on the lateral

5/ Z
D

t'..'/'{

47

False

view.

the central ray is angled 30 caudally for the standard

occipitomental (OM) view.

whe Perform?-l9 l'1h.l3.?!{E9Fl"9aPhy the patient should

gently open and close their mouth during the exposure,
t/hswmaxtllary antra are best shown on the occipitomental (OM)
me 0=l\1.5a.l,__Ql_ane is a horizontal plane passing through the
opposing biting surfaces of the teeth.

False

False

True

True

The zygomistic arches are visualised on

occipitomental projections, but an underpenetrated

SMV view gives the Clearestdemqnstration. They

may also be seen on a Townes view collimated to
include the zygomatic arches.
For a basic OM view the central ray is not angled.
For an OM 30 it is angled 30 caudally.
p
The patient should remain stationary. To prevent any
movement, most units utilise head clamps, a chin
rest and a bite rod.
*
Together with the frontal sinuses and anterior

ethrnoids.

er

/in

48

The following statements are true:

48

Oblique views of the cervical spine are usually performed wirh

the patient supine.

when taking an erect right anterior oblique view of the Cervical

spine the median sagittal plane of the head is parallel to the
l m.

"1 he AP.bq P"lll9". lhe cervical intervertehral l

foraminae demonstrated are those on the side nearer the
X-ray tube.
_
\ >3? D a right posterior oblique lRPOl view of the lumbar spine will
demonstrate the left pars interarlgl|laris_
E

for an oblique view ofiheiuhalqosacral junction, the patient is

rotated approximately 45.

'

False

B . True
C

True

False

True

These views are most commonly performed with the

patient erect.
_
The median sagittal plane of the trunk is about 45 to
the film.

ln a PA oblique prolection oi the cervical spine, the

iritervertebral foraminae that are seen are those
nearer the lm.
Oblique views of the lumbar spine show the pars

interarticularis on the side to which the gallant IS

turnerTleTg. RPO shows the right pars).
_._-'

V/B8

MCO Tutor in Radiology

Techniques
,4;

Regarding imaging of the breeztt:

compression should nor be used during mammography when

cysts are suspected. A

49A

ultrasound should be performed with a low frequency l3.5

MHz) transducer.
the standard mammography lm series comprises a craniacaudal view and a stralghtlateral view of each breast.
the nipple shotrlcl_be seen tn prole in the standard
mammographic views of the breast.
ductography involves theinjection of 5 ml of a water-5gl\_|b|g
contrast medium into a dilated duct.
50

99

False

False

False

D
E

True
False

Ultrasound should be perlormed with a high

frequency, high resolution transducer_j5_:]Q_MliZl.
_.
The standard series comprises a cranio-caudal and '
oblique lateral view of each breast.
1:-'v_-:..i~'."~-'-

0.5-1 ml of aiwater-soluble contrast medium should

bet'rij'Etet:l into a duct slowly and the injection

terminated when the patient experiences pain.

"T-t

Regarding lower limb -lymphography:

"
the internal iliac lymph nodes are usually well demonstrated.
it should not be performed within 6 months of radiotherapy.

_
4.

right-to-left crossover ol lymphatics is more common than

vice versa.
.
7 ml l_|pi_odol ultratluid should be used lor each lower limb at
an l|8CllOl1 rate of 1 mi/mm.

50

-_
I
l

False

False

yvel<_s of radiotherapy as disruption of mWr?BiT

C True

Hepatic Oli embolism is a recognised complicatiorl.

The internal iliac, mesenteric, retrocrural, splenic and

renal hilar nodes are not seen in this investigation.
Lymphography should not be performed_within 3

False

True

node architecture may allow oily contrast medium to

pass into the systemic circulatioi-ll
Therefore visualisation of both sides is possible if
only the right side is injected.
7 ml Lipiodol ultrafluid per lower limb should be
injected o\_/r_g3_ minutes by a pump injector

tapproximately 0.2 ml/min). "

I

This occurs?/TIhe'Ft"th'ere is lymphatic obstruction and

lymphaticoportal venous communication.
'

ascending venography of the lower limb:

a tourniquet applied above the ankle may occlude the nmmal

51

anterior tibial vein.

the study ts complete when the deep lemoral vein has been

demonstrated.

~"""""

e single projection radiograph oi the deep call veins is

adequate.

OP

6Q _t1_tl iolteggol 2-1Q would be o suitable contrast metlittm.

at the end ol the procedure the needle should always be
flushed Wllil normal saline.

True

False

False

True

True

The absence of anterior tibial vein filling by contrast

is not therefore always indicative of venous
thrombosis.
'
The deep femoral vein is only opacified in about_Q%

of cases when there is gloog connggion wit_he_

superficial fe[n_c_>_ra_l_Qin, or when retrograde filling
o'ee'5;?d6'ra'ng the Valsalva manoeuvre.
Harliographs of the deep calf veins should be

obtained with the leg in internal and_et_erp_gl_rgttion

to avoid superirnpositi5TT5i' Bones and veins.

To avoid stasis of contrast medium in the leg leading

to phlebitis.

1,./-'~;,.___,,--~
4

wt

v-

1Jir&iZiZf

too

//

Mcotutariiirtsuinio V V V "' w V T " ' '.~.~i ._ ' ' ' ' ' ' ' "" " ' ' "

in superior vena cavography:

A contrast medium injection into asirrgligledian antecubital
vein is usually adequate.
B the total volume of contrast medium injected should not
exceed 30 ml.
C a Valsalva manoeuvre facilitates opacificaticn.
D catheterisation of both subclavian veins is rarely necessary to
obtain good opacification.
;
E

52.

-l

False

Contrast medium should be iniected into a_y@n_1r1_

False

superior vena cava.

3i)TniTEbT\Tr'at_meditim should be injected into each

C
D
E

True
True

False

indirect purtography results from iniecting contrast

False

Ponal venography is indicated to demonstrate the

C
D

True
False

- -wag

i
1

1 gt atit at 1

both ar__r'Qs simultaneously in o_rder to opectly the

?'.'fJ-

__4-

True

the normal azygos vein is often opacified.

Regarding portal venography:

A indirect portal venography is performed via a transplenic
approach.
8 portal hypertension is a contraindication to the procedure.
C for the transplenic approach. 506O nil of a low-osmolar

53

contrast medium (370 mg iodine/ml) should be inected at

8-10 ml/sec.

D whenusing the transplenic approach, a larger volume of

contrast"medium is required in patients with splenomegaly.
E after transhepatic portal venography, a plug ofgel-fuarn
should be placed in the catheter track.

True

into the cqeliac or superi_gL_rr_1a_rit_eri arteries and

obtaining diayed lms of the portal vain.
anatomy:d'f the portal system in patients with portal
hypertension. Direct percutaneous splenoportography

can be used to measure portal venouipressure.

For transplenic portal venography, there is no need

to increase the volume oi contrast medium |n_
splenomegaly. However. when performing indirect
portography li.e. late phase coeliac or superior
rnesenteric angiographyi an increased volume of '
contrast is required in splenomegaly labout_]0 ml

low-osmolar contrast medium 370 tng_it3tl|neE1i at

8 ml/sec).
<
4
Tl'ii_s-T'd~uces the chance oi blood or bile leakage into
the peritoneum.
1" .
I

54

Regarding intravenous digital subtraction angiograpliy llVDSAl:

54

A the basilic vein is preferred to the cephalic vein as a site of

access.
B the right atrium is preferred to the superior vena cava as a
central site for the catheter tip.
C

abdominal compression may be useiul when imaging

abdominal vessels.

D contrast medium with a lower concentration oi iodine per ml

than that used in intre-arterial USA GADSA) is recommencled,
E

A 15 ml volume delivered centrally at a rate oi 10 ml/sec is

suitable for each injection of contrast medium.

True

True

True

lt is more difficult to negotiate a catheter through the

cephalic vein in the region of the c_lavipe_t_:to_ral_ fasciaThe right atrium is the optimal site for contrast
injection as it produces good mixing oi blood lrom
the superior and inferior vena cavae.
Subtraction errors due to bowel gas movement may

be reduced by abdominal compression and

intravenous Buscopan.

False

'

l\1p_/_\_ uses f_ull;strength contrast medium labour

Q50 rng'ip"cline/mll. l,f\D_A gees contrast medium

diluted to about one-third to one-h_al[ gf the normal

False

concentration. '
'
I
5 I_1n1l_vglyme delivered at a rate oi 20 ml/second is
suitable.
_"_"""'_

102

MCQ Tutor in Radiology

Techniques

103

/55 i Regarding angiographlc equipment:

l

\..

C
D

/rt
ax

A the French size of e catheter is a measure of the circumference

oi the catheter tip.
B polyethylene catheters are stiar than polyuretha e catheters

S7

and this provides better torque control. TTD

guide wires consist of two inner straight wires with an outer

wire coiled around them.

a typical guide wire measures 0.QI_iE_hes (0.89 mml or

55

_>ri

True
False

Polyurethane catheters are stiffer than polyethylene

cathetuefsii
One inner straight wire runs the whole length of the
guide wire to reduce the risk of fracturing. The other
inner wire terminates near the end of the guide wire
to produce a soft flexible tip; it may be movable for
variabje stiffness of the tip.

True

0.038 inches (0.97 mmj in diameter.

' '
a typical catheter measures 60-100 cm in length.

True

Typical length of a guide wire is ]_Q_Q_]Q cm.

Mqgiiliagnostic angiography is performetimtivith

True
<-

Regarding anglography:
A the hole in the vessel wall produced by u 6 French catheter
has an area four times larger than that of a 3 French catheter.
B sheaths are sized according to the largest size catheter that

they will accommodate.

C single-wall arterial puncture requires a two-pun needle.
D

56

'

True

False

pulsation.

True
True _

aortic bifurcation in lumbar aonography. """""'

the most reliable guide to the position oi the common lemnral
anery lor percutaneous puncture is the site of maximal

A low-osmoiar contrast medium with an iodine concentration ol

350 mg/ml delivered at these injection volumes and rates would
be appropriate lor use in the following conventional
arteriographlc examinations:

A 3 French catheter produces a hole 1 mm in

d' lameter. A Gfrench catheter prodfides a hole 2 m_rn
in diamete'F.'This represents a four fold increase in '
area (rt x radiuszi.
_

True

the catheter tip should be positioned about 5-10 cm above the

57

Double-wall arterial puncture requires a two-part

needle, which consists oi a bevelled central stilette
and an outer blunt cannula. Single~wall arterial
puncture uses a one-part needle with a central bore.
This site lies at the level of L3/4.

True
True

Approximately the same volume and rate of contrast

medium injection for coeliac arteriography. inferior

mesentg_rE .."!!l9graphy requires about 15 m__i_

voluFrT at rate -n_1_l/_s_ec.
""''_'

A lumbar aortography: approximatejy 5Q rnl yoiumra; rate

1;

'2

D
E

T 8:12 mllseu

superior mesenteric arteriography: approximately 59 rnl

volume; rate _6_-__1Q mijgec.
pulmonary arterlography: 6pplO>:in'|'lluly 20 ml volume; rate
8-10 ml/sec.
right coronary arteriograplty: 3D|JlOXilY\8l8iy 15 ml volume;
rate 10 ml/sec.
common carotid arteriography: approximately 12 ml volume;
hand injection.

-l French or 5 French catheters.

False

Pulmonar\'/"Z-irteriography requires 40-50 ml volume

at rate 20-25 ml/sec.
"T-"""_

Flight coFcTrT;r7'aHeriograpl1y requires Q78 ml volume

False

by hand injection. Left coronary arteriogr_aph'y

requires ~_1Q__rnl volume QLlt_a_n_ injection.

False

A contrast medium iodine concentration oi 3Q_[11g/ml

is too high for common carotid arteriograp'h-y. About
\..

i2T'i".!":">F!19!F29513525 J9iE!' Wit" 3" dine

6E'>Fc"iitration oi not more"ih_qQp_ mg/ml is suitable.

This should be given by hand injection.

 " '1vi'5t lCffTuigrii?Ha$o|t5y'w W "' W 4 "" W W -0

'"

<5 "CC
l

5&1, in pulmonary angiography: '

A the catheter tip should be sited at the blfttrtjarign Dr me

258

(L I!)

False

The catheter tip should be sited ]-Q ant above the

pul_rp_orLary_yaive, i.e. below the bilurcation'o'f the

False

False

The anteroposterior projection is adequate. Obli ue

vifyvg 519* a_l_t_>_p_e useful. A lateral projection IS of no
value life main-stem pulmonary artery inietztton due
to superimposition.
-
Pigtail catheters are mostyggmrnonly used. insertion
of the guidewire to straighten out the end of the
catheter, prior to withdrawal, avoids this
complication.

D
E

True
False

False

pulmonary artery.

B ame}'P0sterior and lateral projections should be obtained

routinely.
C ptgtatl catheters are not suitable clue to risk of rupture of the
right ventricular chordae tendinae on withdrawal.
D lms WhlCh record the arterial, capillary and venous phases
should be obtained.
E pulmonary hypertension is a contraindication.

En 2. at C]'fUUUU'

-vaawavwwr l

pulmonary artery.

._- .t->

Pulmonary hypeitension is an indication lor

pulmonary arteriography.'Ho\X/everjnthete is increased
risk that the procedure may be complicated by
cardiorespitatory failure in these circumstances.

vi

58

,-_

in angiocardiography:
A the right side of the heart is studied via a catheter passed
retrogradely from the femoral artery.
B a cine-lm frequency of 15 frames per second is usually

l_

59

from the femoral artery. in children, it is ttstrslry

possible to manipulate a_vt_:__t1gus catheter through a

adequate.
i
a pigtail catheter is suitable for left ventricttlar injection-s.

patent foramen ovate to examine the left heart.

D ihe "Qhl Bl8rl0r Oblique pl'D]8C[lD will tlernonstrate the

B H58 in the incidence of ectopic heats otmttrs with increasing

COHUESI ll'\|8CllO FBIES.

FDUOW

60

in coronary arteriography:
A

51

8
C
D

the tip of the left J_udl<ins' co l'O3('y

curved than that of the right.

True
True
._

~-~s-

the Sones
techni ue requires right and left co on"
________________9
rt
catheters.
r My a aw

60

False

True

HYKBFY catheter l$ fTlOl'l:

8_jQ:'_9udl;cranial view is ideal for visualisation of the left

'"e!a~sm sotsaw artery.

- -- -

"_'"a"V aFi9T3l3/ is U5aY Preceded by left ventricular

angtography.

E coronary artery dissection is not usually clinically 5ignir;an[_

About 25-80
. . frames
___- per second are required.

False
True

mitral valve satisfactorily.

The rtght heart is studied via a catheter passed

anterogradely into a peripheral vein. In adults, the lei
heart is studied via a catheter passed retrogradely

___

__

_.._

q-_

The Sqnes technique uses a single catheter via a

btachial Brlfiliqtomy.
To aid engagement of the coronary ostia by the
catheters.

True
D True

Left ventricular angiography is carriec_l_ out using a

Coronary artery dissection is usually followed by

cardiac arrest.

False

right anterior oblique projection.

,,\/-\/X./'\-

__

it

M/" 1

Techniques

NICO Tutor in Radiology

106

107

get

ecognised complications of diagnostic artgiography include:_

TWUOIIJ

True

retroperitoneal haumorrhage following transfemcral

' P tincture.

brachial plexus iniury.

anerlovenous stule formation.

cholesterol embolisatioh.

True

bacterial endocardttis

fl
True

Transfemoral puncture may also be complicated by

haematgma formation in the femoral sheath,
su:ritgneal and intraperitoneal spaces, scrotum
and fasciai planes of the thigl"i._w '
This may complicate axillary artery puncture. It
occurs either due to primary nerve injury or
secondary to extrinsiciiompression of the brachial
plexus by,haematoma. '

Other complications local to the puncture site include

anerialthrombus and spasm, subintimal dissection,

sepsis, false aneurysm and perivascular dxtravasation
of contrast medium.
True

62
\/

The following statements are true of vascular interventional

techniques:
a

A prior to balloon dilatation of a leg vessel, the guitletvire must

be removed.

B
C
D

63

iliac arteries are preferably dilated antegradc-ly from a femoral

puncture on the side opposite the lesion.

heparin should not be given during angioplasty due to the
increased risk of haematoma formation.

following an embolisation procedure, the patient may have a

fever for up to 10 days.
.
embollc material should always be radiopaque.

The ideal radlopharmeceutlcnl shuttltlz

A
B
C
D
E

have a hall-life that is approximately four times the length 0|

the scintigraphic examination.

emit mainly charged particle ernissionsf

produce emissions with an energy between at) key and

300 kt-:-V.
localise only in the area or interest.
be mono-energetic.

True

Other complications remote from the puncture site

False

Dilatation should be performed with the guidewire

include subintimal dissection, arterial thrombosis and

spasm, embolisation, catheter knotting, guide wire
fracture and septicaemia.

remaining across the stenosis/occlusion until the

procedure is completed.
lliac arteries are preferably dilated retrogradely via an
False
.1-V. cl? ip_ila_teral puncture.
'The patient should be anticoagulated during an
False
angioplasty procedure using 3000-5000 units of
heparin.
""""_"_ "
Post-embolisation syndr0me- comprises fe\_/er, pain,
True
leucocytosis and a general feeling of bein_g unwell. it
sh_oul_d' only be diagnosed when other treatable
causes of the patient's condition le.g. infection) have
been excluded.
Non-opaque emboli should always be iniected as a
False
suspension in contrast medium so that they are
visible as filling defects during the injection sequence.

False

The hall-life should be of a similar length to the

False

The radionuclide should emit gamma rays and there

True
True
True

duration of the examination.

Ti

should be no charged particle emissions li.e. aip_l1a

and beta emissions} as these increase radiation dose

witlt0 uting to image quality.
This ensures that the emissions penetrate tissue, but
will be stopped by the detector.

ma

MCQTUIOHHRHGIOIOQY

6-I

wvwwvwwcwwcwwcwv

'

Regarding isotope brain scanning: r-r_:/.;.t,,.;,-it-.~l [-~.-apt! (_2:Ilj.T.-H/1' A :"Tc H_MPAO does not cross the blood-brain barrier.
B
_"T d*e5nz!2___._=
"""'"B eectaaeelsesld QTEAJ is useful in

i .,

FY

and
":t.seaepmsi;. -r - ~- s
Perteclineiate is the cheapest of the three

True

tadiophatmaceuticals, but has the disadvantage that

it is the only one to accu__rfrt_tilate inthe choroid

mandatory when 99Tr: HMPAO is used.

plexus, thyroid and salivary gTa_nds. Thisis prevented

by the administration of perchlorltt-_;_Q_45 minutes
before the investigation.
The dyngpjigpltase is imaged im_t_t\_q_t_ia_t_e_ly following
the iniection 0fl$0lOp6. and theaigimages are

False

Regarding isotope bone scanning:

A ist is a highly specihc investigation.

True

take 1-.2 hearts nest lt~is'=tl<>t\Anato'mical_letail is getter displayed using SPECT at

False

The bone scan ls highly sen_i_tiyg_ butppn-specific as

any lesion in bone ie.g. fracture, infection, tumour or

healing bone) will show as'an area of increased

48 hours.

\\\ -

A * Q WK./u~ot.Q
\'\/\ Q

<i&.<\-Q7

activity.
Preparation involves reduction of the pertechnetate
ion. After 5 hours this may reoxldise back to free
pertechnetatewhitih would locallse in the thyroid and
the stomach and thus degrade the scan.

False

The remain;g.iar is excreted by the kidneys.

The patienfshould be encouraged to drink plenty oi
uidand to empty the bladder regularly so as io__
reduce the radiation dose to-thti blQQdB'-

True

False

.\\cv<,\ i.t.\

The blopd pool phase should be imaged l_t__

l'l'\ilii__Q_Qvi[\jBC_liD. The bl_gg;1_Iigyy phase and the
_5ic_phase shoiild be imaged in the ii_rt__1J_ secottds
and at
3l4__._.-_
hours
respectively.
.
. _
.. -

False

Qyko w\ Q_.y-Uu \\_,\'

'-T<"\'\ W\ - H Pi A - W\0.<._ Jo L-\%3f"C

az,4/-' L-//11'/"/J

.:\.lJ-\ Q-~" o~131'*"

@8645 -/) d'.1Ft.r$tan pay}/.4/1 41/ /L65 (1-l~'~j '5("""i

TC. ..0\<1\ w\ - PK D PC "W H'l:.)(-1,-<.z r;'/7'}/~'JJ-/7/})c*'7Kf' )
L.< 'i'.>c/I/K1

E; C4-M.

==<,]'r-94!-7/'

DI.

I
_
If
__ _f
.1
1/;--Z"
i<_oq(],(,//;cgi4,w<d,,42,_f,/ea
'vfrLL7t~/
,_,nL

1/

(Lo-K

ct/Y _).l'-"gt-1 fi

If/qC{}/Y,iesfa-xi,/b?L/I-)&[

[Of

l7/
{C

Y.
/

Faun
l

i/4-'-?f/'"'\lf.
I

Zaiu

'\.5\ K~t'uJ\)~r;ioc)~/:~/\9rjV

__\_,l

\1'~S___U\$ecj
V

K-at
i
-"

2/0 yllut u,7,,)_

I-Y\'\'\\

H.

\"|

'

\~\r'\e_(c\

v\%-Ye) \_u

\-\/\-'~j1';\(i\\.l\\f\ \'-*~vl$

'

., ._F.t_ _ _,

any time from 2 minutes to B hours after iniection.

"T methvlene dinhvsnhonate lNiDFl remains stable for

C 20% of the injected 59"Tc MDP localises in bone.

D to ensure adequate counts the patient shoulrl not pass urine
between the isotope injection and imaging the static phase.
E the blood pool phase should be imaged approximately
15 minutes after injection.
'-\__

brain imaging are 99Tc DTEA, 99Tc pertechnetate

D imaging should be commenced 1-2 hours following injection.

E single photon emission computed tomography lSPECT) is
P

\.5/ 65

l09

The three principal radiopharrnaceuticals used for

True

beforehand.

Techniques

99'"Tc HMPAO is a lipophilic radiopharmaceutical

which does cross the blood-brain barrier.

False

clinical practice.
"""
C when using 99Tc pertechnetate, perchlorate must be given

t?ii'i'iiT

\-"J\">d

\\~\\u\
r~. Q9

Lang"/)

H
J
J
I vx 't
"
ILL I

f/}r.y0rIr'1c3lrZ4i[)6'J/"/)1
|||,|.u all It/Tr

iv'\<i/tru\VV'l>"?. Vl'<' T*cS

1)"""+'

l - \ \.--....~i cr rt-1-> ,

56

ieuiiiirques

MCO Tutor In Radiology

110

66

Regarding isotope examinations of the thyroid and parathyroid

glands:
A sgglrgkghe most frequently used agent lor examination of the

B! is used mainly in the study of metastatic thyroid

cagcer. lt is not used for routine thyroid imaging due

to the high radiation dose from beta-emission. The

/(Ll

' _l has a hall-life of 13 hours.

prior use of an intravenous non~ionii: contrast medium will
rfsult in poor uptake of the isotope within the thyroid gland,
D i iethyrorrl lmsges should be obtained with a Converging
collimator.
E the parathyroids are imaged via a subtraction technique,
subtracting the 2Tl image from the 99'"Tc image.
B
C

at

False

B
C

most frequently used agents are(23l and 99'_Tc

pertechnetate.
ml has a half-life of __days.

True
True

67

L-l\\'i"\ ',
' i-*

Vi

.\:k'k1t-<'ri"&

Qwr.r-in

\\,I

7&1 ...
\\

\\/\J.

("0' "

if.

iv... 0 i(t

False

2'Tl is taken up by the thyroid and parathyroid

_9la7i'ds1fl1Ts is taken PP lit the thvrviq Qld vulv-

\.,-r-Ct
t.

Parathyroidiimages are therefore obtained by

subtracting the 99""Tc image frorri the 2Tl image.

67

Fle garding the iadlnpharmaceuticals used lor lung ventilation

studies:
-_-___-.__._.-.
A
B

'3
D

E
l

i 1' -

r'-

<

B _krypton ventilation study can be performed simultaneously

with the perfusion study.
lggealb Uslfl EFT/Pivrg. lateral oblique views should be avoided

I
I

|"~ll_

/ Win
In

'

washout phases.

'

...

J! I J
, . .

energy 99fTg gamma rays used for the perfusion

scan. 27X'emits gamma raysiwith higherenergy
than 33Xe and 99'"Tt: and so can be used to gerform

I,/K77-7 I//1.",/' '

I.

N1 5,,

MK)
.

l/;(>

rlluk/C

.-

1/

,
/j//{i~

4
'?
-'
,
r(__'j(/lififil/

_,(/i_/

/K"

False

True

a ventilation stud after a perfusion scar].

lf duel energy data acquisition is performed; as

krypton emits gamma rays with an energy of 180 keV

and 99'Tc emits gamma rays with an energy of

i,w

ln a krypton ventilation study, six views of the lungs

should be obtained: anterior; poster_ior; RPO; LPO;
right lateral; and lelt lateral.

Aerosols clump and therefore cause focal areas of

increased uptake in patients with chronic airways
disease

\ \.

Ii

,/ '_',l'-/I __'l

____\

\\| 6.

,
,1
p

True

X'-' (wiiaii) '2/i"> , ii/M1, i/rm /(/3"]-' A

,7/.1

140 keV.

").").?,

compromised by scattered radiation from the higher

When using 33Xe, the ventilation study must be

performed first otherwise image quality would be_

a/4-~.~'~("/-'1'-*l

_' .'{|'Hi\/1'

-1I_'Ill|7g>J-..:-fr,/F
.

f)'i(!"

1. inn rft.-,4 -I

4/
!

5 '

\/6.! /((.tl"I'If

'2";

False

_
.
_ I
aerosols should not be used in patients
with chronic airways disease.

~-

I53

ideaHyS69s%\1ic8D%(;2USlO caused by overlap oi the two lungs.

._,

True

Xe,_the ventilation study must be performed

prior to the perfusion study.

Because of the high radiation dose, a single breath

technique is employed. images are taken in one
position only (usually posterior). The images
obtained are in inspiration, equilibritlh and in two

WEB" 5l"9 13>! B Single breath technique is e!Tlpl0yed_

W?" Using

""_"

Thi gives high resolution images. Ndt that this is at

the expense of increased imaging time and some
degree of image distortion.

,_.Qzt.

"""

Uptake of either 99""Tc pertechnetata or iodine is

inhibited by recent high ingestion of iodine.

ID True
E

Ill

I
J

\
I

_\"\,-/
l

r ./34.;
u

In

is

kit

1'

~qp-- ~w"'~qr'~ "\w'"\Ir- -tcw-~w::a~t

.._.._,

~11

-7=$'#T$-T'$\$\$TCCTTT"CTIITT$$iY"'T1"Z'TTTT

__,__,

23$ Regarding perfusion isotope lung imaging:

in Ul'CluT
A it should be performed after a ventilation scan
*
" to
diagnose pulmonary embolism.
B

. 68 A False

the patient should be imaged in the supine position to

maximise visualisation of the lung apices.

the 99'Tc-macroaggregated albumin particles occlude less

False

D the syringe should not be shaken before the injection as this

True

False

than 0.5% of the total capillary bed of the lung. '

may damage the albumin macroaggregates.

'1
respiratory failure may be induced in patients with pulmonary

hypertension.

True

A normal p_erf_gsion scan will exclude ad_igpgt oi

pulmona_ry embolism. A perfusion seas should
therefore be;,pei'formed rst. and the ventilation scan
only needs to be done if the perfusion scan is
abnormal.

Imaging shqpld be performed in the sitting position.

The iniectionihould be given with the pati_rit_upine.

The bronchial circulation maintains pulmonary '
nutrition so there is no irreversible tissue damage.

The syringe should be shaken so asto prevent i

particles settling, as this would cause clumping on
the image.

A slow iniection srtlould be given in patients with

pulrr'i6'naFy]1ypenension, and microspheres should

be used wheneder possible. Perfusion scanning is

t:ontraindicated_i_n patients with tiqt m.leit.catt1Lig
he possibility of systemic microernboli.

\/\/59

T ll-tile

f(t>-rr(

f-tl"{'1"/1,f_/-"-

'

.|_1' Gr

|\i-art,

(mu iC- -

__

'

- l4 ?

lf

.<

_____

"3
-('/YOIK

_____

r\<\\\\

,z,_c, r

_L.
\-.-

v\,\ c.\ "1

qU" \<. _ *"*A(UC<:=l-"-<--.p*i\'\"'-h r 300 If/5% /-1<'cwt'

;{< \.>~_$~\et-.t'
,-

True

"

'4 lg, ;- ..(-'..,,r. , Cr-/1/'4' inc-'--'~ir'<: tzrrl-1( L)/,-/..

llui -r M

99"Tt: DMSA is bound to plasma proteins and is

cleared from the blood by renal tybular absorption.

When injected intravenously, 99'Tc DTPA IS
distributed throughout the extracelluar space. lt is
excreted rapidly from the body by glomerular
filtration.

True

r r

True

99"Tc DTPA is excreted by glomerular liltration.

99"Tc DMSA is never used to obtain a renogram curve.
the peak of the renogram should occur alike minutes.
99Tc MAG-3 is excreted by glomerular filtration.

TTIUOCD

True

Regarding isotope examinations oi the urinary tract:

_59"Tc__QlylA has specific affinity ior the proximal convoiuted
tubular tissue.

' A

False

99Tt: DMSA is used only for s;ati__@nal imaQi"Q-

99Tc. MAG-3 and 59"Tc _DTPA_ara thecominonest

radiopharmaceuticals used to o'bt'ain' a renogram.

The normal renogram comprises three phases; the

vasgglar phase, th? secretgry phase _r1_cltl1%gretOt_'y

phase. The peak o the renogram occurs at minutes

post iniection, and it takes 10-15 minutes for the
activity to drop to lialf its peak value (the clearance
halt-time).
99Tc MAG-3 is excreted by tubular secretion and

has an extraction efficiency tree ll_"tBS greater than

59Tc DTPA.

(nit)-(rt I/F6./(K T7 (7l Ilcili/in "I'M, )

\()(;

fltrjfv

l (j

- -;- ill-I:' t ti-do irL.\1).9'1

)4.-' lilfjell

...

[J

(lab

.1: w__-, .

ii 3*
-

.\

a_'L~r_-

.-

inlftllt-1~"1l_>

yl"
C53

ll-1

Techniques

MUU lutor t Radiology

115

- as

t/\

70

Regarding radionuclide investigation oi the gastrointestinal tract:

70

A patient preparation is not required lor a radionuclide Meckels

diverticulum scan.
.
B gastrointestinal bleeding will only be detected if the rate of
blood loss is greelcf than approximately g__m_l[min.

$u_lel1u.2!I9ida lull bladder ls encouraged in a Meckel's scan in order

elevate and separate small bowel loops.

True
True

"

to

True
False

//

'1 _;_;_,'- \/71

,.

~ _

71

False

multiple gated acquisition (MUGAl may not be possible it the

C
D

patient is in atrial librillation.

Tl is taken up by skeletal muscle.
rnethoxy isobutyl isonitrile lMlBl) is excreted via the
hepatobiliary route.

in myocardial irtfBfCl imaging with 5g'Tc py|'QphQ5ph3te_

True
True

infarcts show tracer uptake from 24 hours and'clo so for up to

10 days.

Prior administratiorfof an H2 blocker or pentagastrin

Barium causes signicant attenuation of gamma

photons and may mask a bleeding site.
ln adults; orange luice labelled with 99"Tc colloid
niay be used to demonstrate reilux, and in young
children a normal milk feed may be similarly labelled.
The bladder should be empty. A full bladder may
obscure the Meckel's diverticulum.

"tT r

Regarding cardiovascular radionuclide imaging investigations:

A red cells are labelled with chromium ions.

Nil by rnouthigr 6 hours unless it is an emergency. '

is also advised so as to enhance detection by
increasing the uptake of 99:1T_pertechnetate into
gastric mucosa and inhibiting its release into the
lumen of the stomach or bowel.

"

C a recent barium study may mask a bleeding site.

D gastro-oesophageal reflux may be demonstrated with 99"Tc
E

False

True

Red cells are labelled with 99_fTc ertechnetete. but

be ore this they are primed with an \n|actron of
stannous ions. The stannous ions reduce the
pertechnetate and allow it to bind to the red blood
cells.
ll the patient has an arthythmia, the computer cannot
identify an acquisition cycle.
1
Distribution of thallium is related to blood flow and
metabolism. lt is mainly taken up by muscle and
thyroid, but some uptake occurs in the liver, spleen
and kidney. it is used lor myocardial pegfgion
imaging.
'
V
The gall bladder may therefore appear as an area of
increased tracer uptake on a 99'Tc MlBl scan. A drink

of milk or a fatty meal3060 minutes alter injection

"/if
'

/11

_:- _"(

'

I-.:,,',

'

H \,-_/ff/(
_

l n .-

A 4.

'

lug-,r rt .l_| in gt?/i\:\:\lh\OVl

4
,. .
"H

li' (l

H T

kn

nil!--1-,,/.'ri1n|t.1rl.=-'rw

ll

(5-T"./If (1

/V
-*

-~

I'!~:!r"/R."
..
,. '

""
f

'-

I\;f

y/,_;__!_
-

'/2

_ 2!/I7! _ Hia/_-i:',l' l'I-'~"'- I '54"!

15--0

H('}'-;,;,b_,___;

2
\

. Wu/"
C

'

-:l[ll)"

l-
ll
\t(!l~n_\jt,L~,J|l./
,/_"'

__

72- - /5 I26/(4%/1' fl".

.1"

True

\-z-\-",\r.|\1Sat"(\$ (I
.
v

"

cl
l~.- ' Lzl,
\\=(.(ll._,'
fl]

helps to clear the radiopharmaceutical from the liver

and gall bladder so that myocardial perfusion can be
imaged.
'
The size and intensity of myocardial uptake is related
to infarct size.

\/ 72 -The following statements are correct:

A in Ga scintigrsphy uptake within the bowei is often a no

esmTc tin colloid is taken up in the liver by the hepatocytes. I

lit colloid scintlgraphy, focal liver disease may be mimicked b

overlying breast tissue.

in normal cholescintigraphy, the gall bladder should be

l
False
True

True

73

Tricyclic antidepressants block MlBG uptake, as does

reserpine, labetalol and cocaine. The thyroid should
be blocked before MIBG scanning with potassium
perchlorate or Lugol's iodine,

True

This should not be mistaken for a stone in the cystic

False

assessment of gall bladder wall thickness is preferably carried

out after a tarry meal,

reflectivity of the normal liver parench ma i 'l' h l h

than that of the normal renal cortex. Y
S S lg W lgher
D ;:\a:f::fCOSt_l_pp__r'oach ls optimal lor examining the adrenal
E

99"'{Tc N-substituted iminodiacetic acid iHlDA) is taken

up by hepatpcytes and secreted intoihe bile in the

True
if

In ultrasound of the upper abdomen:

A the spiral valve of the cystic duct will frequently produce an
acoustic shadow.
..
u

same way asislbilirubln. By one hour the gall

bladder is normally visualised.

hm/--'~-I rt-' f'

f"'

DOWBI ouuvtty ta Ptuutllluru -r .-. ._

.of the main drawbacks oi 5-[Ga imaging lor

abdominal infection. Delayed imaging is essential.
Radiolaiielled colloids are taken up by the l<uger_
cells in the liver.
___.-a-L
lhere I5 considerable variation in normal liver
appearances. For example, focal abnormalities can
also be mimicked by rib impressions, hepatic veins,
and the impression of the right kidney.

Trlcycllc_antlde_pressants should be stopped prior to a

radlolodlne M-lodobenzylguanidlne ilvllBG] scan for
phaeochromocytoma.
y

a[Z/<,uH.(.<>J'-rcf() viral /5--I

lrue

visualised by 1 hour.

[Ill]!/('11,-//I

73

rma

t.

/\

G-0

feature.

\l N

True

True

hepatic veins have highly reflective walls.

False

duct. The normal gall bladder is contracted and

thick-walled alter a fatty meal. These appearances

cannot be distinguished from pathological
contraction. Therefore, gallbladder wall
measurements should only be carried out in the

lasting state, when wall thickness is normally less

than 3 mrrjl.
Reil_cTi'vity of the normal liver parenchyma is also
slightly higher than that of the spleen.
'

Hepatic veins have poorly reflective walls. Portal

veins have highly reflective walls.

~z
S

I
I
.1

3!

_. . .._ 7

_._.

___.

=|: .:7__ _. _.

._.. _.. r-....

. 1'

_;'____; __;__ __.____.e _-.__A _

1-7

.~u\_.

.2 '

.(

MCO Tutor in Radiology

I18
74

l
i

;
.
In ultrasound of the a
the pancreac dug 2:122: normany be visualised

/E

,
_
:3'r;l?i|'::1?r? :f:1g$el2'e)g)t;?tri1;ly visualised with the patient
the normal pancreas is homngneous with
_. .
meme, than or equal to may h?\/er
3 '9 le""VllY
the maximum ameroposte0rTi_dT . 1
I
pancreatic head is 15 mm
arne er o the normal

False

7
The pancrleatic duct can normally be visualised in

True

This produces an acoustic window through the

>

~i a .

a an oral uid mad may be he|puL

)-.,.

.. I

almost 30 / of patients. its maximum diameter, in the

region of thepancreatic body, is up to 2 rnm in
patients under $0 veers of age. The calibre oi thepancreatic duct increases with age.
stomach. This helps to visualise the Pancreati_bBE'V
andtail vi/hen the patient IS turned onto ll18__l_l'__1fI_

'

vvhhand
the the
patient
is turned
onto
Light sfle.
gldei
Pancreatis
h.?.d
andtheir
ucil
l.l9.'=e5

T C True
D True

Variations in the level of reflectivity of the pancreas

probably relate to the degree of fat content; this
commonly increases alter 60 years of age.
The maximum AP diameter of the pancreatic head is
25 mm. The pancreaiicjligy _has e maximum AP
diameter .of i5 mm.

r
l

False

75' Rgmding Url&i'y tract ultrasound

A

/'i

B
C
D
E

True

75

the r|enal sinus is normally ecliogenic.

ren
.
I 3 "9lh5 le preferably measured -in the Bteroptjstgrigr
D ane lor standardisation.

Due to tat sujryguggjgg the renal collecting system

and blood vessels. This reflectivity is reduced_ii'i_

mat Ema I "_ell"_Q

.--iY$tem dilatation
does_ not normally 0(:(:i_ir
belore the third trimester of praggaiiqy

Qemleies.

parse

False

True

True

Due to the ellect of normal ufEll_'~E BeFl5la|9l5-

False

False

A high resolution transducer in the lrequencY range

1.5-l0 Ml-iz ls desirable.
_
_
A water bath clears the organ being examined from
near field interference and ensures that the organ lies
within the focal _zorie of the transducer.
_

Mild collecting system dilatation occurs as early as

Slag: bladder appears '9!l1t3Li|a.lZl@i?_8d in transverse

V12 weeks gestation. This increases throughout

{egnancy until term, when dilatation is usually more
marked on the right side. Following delivery, the
dilatation decreases but may persist lor at least

a ier of urine entering the bladder is commonly observed

"'-"'

Flenal lengths are measured by rotating the probe

around the long axis of the kidney and recording its
longest lenglh.'_'

l
I

_3 months.
.

76

' I

'

In
USZEO:/1:: ;ar:'s':1"::3e:fr.""f?~
A 8 water bath is not usefeciuency is recommeiided.
B
CO

76

he normal ems Is hem" I

me mediasunum testis k:Q9"E0\_J5 I'_l8Xlure. I
_
Iongiwdinany
seen as a thin reflective bani! lying

the head of me H did m_s I

esliB..r i_sT____y

f _ _

I I

s o siiiiilar rellectiviiy to the

C False

W.

The normal testis is acoustically homogeneous. it IS

of medium reflectivity.
_
_
itconnective
is a normal
structure
of
tissue
withinrepresenting
the testicularcondensations
stroma.

D True
E

Bur the rests? the Bilididvmis is_l.e.s_ll1i\_'@ than

True

testicular tissue.

"i\

~
I
t

<.

t
r

,- -

,.- .~

'

'

'*
,.
.,_~w .

.. t.--.
.-Ne-Ly.
.. 4.3..-,
.
>

i \

..

. - 1,
,,.,~ i_..|,.
.'

1
_"- ..
.1-__-.1,
.. ....
I __

'
-E
..

.",_..i _, \_

. .._,-.,
-_.._.._
1
...
11

'

--

, _
4'

i"

g,

_i

'

A -,
.,,__>_M
;_' _ _
.

. H

is

---rs..-. ;

_ _

N;

~<

__

.4

115%,

3
-L:i.
.>-CI
r-so, '_viP.,;7

':f.r_-

wtJ'w"ey"w"e.v'w~wswww\wweavea\@w<eI~@\rawaJ0uwr~I~I0ua'I
_ w 5 MHZ fre q uen W transducer -.
1.. suitable for scanning the;

\J

orbit.
thyroid.
salivary glands,
breast.

mUOCU>J>

78
.

ln ";"'"| neonatal ultrasound:

A

the pancreas is markedly echogenic.

ad
.\
.
'e"a| Qllld ls rngwre easily visualised than that

the renal pyramids appear profininent

a 3.5 MHz linear arra tran d
'
'
_~
the brain
Y
s ucer IS preferred when bt.8f'llI1Q

t e neonatal
e of
the adum

/I

U1

True
True
True
-.~

neonatal hip,

5! .0Eel wnpcwwus
EC

I'TlUOID>

True
True

A
B

False
True

I "4

I .'__\ :.
I

mi

The pancreas is, et:hopoor_1g_neonates.

For several reas'oris:' th''T1e0nata| adrenal gland is
proportionally larger; there is less neonatal perirenal
fat; and higher frequency transducers are used,
improving resolution. The normal adrenal cortex

~ 4

.,t.*~

aplilggrs eghopogr and the medulla B.<2l10.Q.Bnic.

the tri- radme

.
t .
a"|a9e cannot be idenufled.

True.

D
E

False
False

The renal pyramids are large and echopoor

compared with ie thin echogenic'co'rtit'. These

neonatal appearances alter between 2 and 6 months
of age when the adult pattern emerges.

Ag;Z.5 MHZ sector transducer should be used.

The tri-radiate cartilage is seen as an echopdgg area

between the bony iliurn and ischium. Ultrasound of

the neonatal hip is successfully carried out using the

cartilaginous femoral head as an acoustic window

into the acetabulurn.

79

J
/
(' ;

In

uma5ud f me eatal brain

A scanning
the anterior funtiinelle lS
' preferentially
'
.
used as at Wmquw
for
e ma choroid plexus is llltlhly echogonic.
c the corpu_g||95um is eghiopoor.

{ha CHVUITI Sepfufn

I _ ~

of fulmerm infamip lucldum can be visualised Ill Z1l)Q1|[ 95%

a 7.5 M

True

True

C
D

True

Fulsu

' "

The posarior fontanelle and temporofparietal bone

can also be used.
'

The cavum septum pellucidum can be visualised in

about 50% of all full-term infants. By 6 r_no_n_tl3 of

age, its incidence is similar to that reported in adults

.
Hz "a' Nev transducer ls ideai
E

False

(15-20/til.
This letzhniquu requires a sector transducer. A linear
array transducer has a long rectangular scan head

and a field of view which is unsuitable for

visualisation of the whole brain through a small

acoustic window.

it
'

"

I
.

I.
I

MCO Tutor in Radiology

l22
80

Techniques

In endoscopic ultrasound examination of the oesophagus:

A patient preparation should include drinking at least 1 l of fluid.
B the heartvelves can be identied.
5
rnanorneiry is carried out as part of the procedure.
"IUD

pH monitoring is part of the procedure.

all the layers of the oesophageal wall can be identied.

False

True

False

False

True

123

The ultrasound probe is attached to a rubber bag

containing water so that acoustic contact can be
maintained between the oesophageal wall and probe.
identication of the heart valves helps to define local
anatomy.
Endoscopic ultrasound defines anatomy rather than
function. Manometry require'T5'pi*fGs'drnultilurnen

tG5ET

pH monitoring requires a pH probe to be positioned

in the lower oesophagus for 24-hour monitoring.
t

transrectal pro static ultrasound:

81

0
A the reflective
peripheral zone constitutes the major part of the

True

MUOCU

False
True
True
False

False

False

normal gland.

patients are examined prone.

an anal stricture is a contraindication.

MUOUJ

B2

no bowel preparation is required.

the seminal vesicles era highly echogenic.

Regtdiiig lnterventlonal techniques in ultrasound:

A the transducer should be sterilised by eutoclaving following
8 ultraaoundpuided puncture and biopsy.

needle positionwlthin the tissues I5 demonstrated by the

C highly echogenic needle shaft.
_
D fine-needle biopsy is safely performed on an outpatient basis.
ocal anaesthesia is necessary prior to transrectel guided
t

l>i0i>5v vi the prostate gland.

C
D
E

prophylactic intravenous antibiotics are recommended prior to

lransrectal guided biopsy of the prostate gland.

True
False
True

The peripheral zone constitutes 70% of the normal

gland. lt is more reflective 'th'arTt'li''remaining
transitional and central zones of the gland.
Patients are examined in the left lateral position.
The seminal vesicles are echopoor with fine internal
echoes.
Ultraso_und transducers do not tolerate autoclaving.
Sterility is achieved by the u$_p of sterile rubber
coverings for the transducer or by immersion of the-

equipment in cleaning fluids.

A needle shalt within tissues is poorly visualised

under ultrasound guidance. However, the needle tip

is usually well visualised as a strong echo.

No local anaesthesia is required.

Prophylactic intravenous antibiotics should be given
immediately belore. and subsequently orally for 3
days post-biopsy.
"

1/
1

7*

ai iiilCff'Tuiciriit'Ha3Toloy' W W V -V
B3

A True
B True

ln Doppler ultrasound:

QQ
O

0
F
",_')
._

Xv
\\V

wt-w~U~siIsI\pw

W -W W tr tw

g<|)gFglg1L?1l%L|$ Wage Doppler may be used in fetal heart detection.

w wit in the popliteal vein can be augmented by
manual calf compression.
'
the portal vein isbest assessed via an anterior apprciat;h_
the normal velocity waveform of the common carotid artery

.- _ ._._ .i,

This manoeuvre l5 useful in examination of the deep

veins of the leg where normal low velocity blood
flow may not otherwise be detected. The Valsalva

.~:~

17;

manoeuvre is also followed by a compensatory

transient irttttiease in blood flow in the deep veins of

the leg.

shows continuous forward flow in diastole.

the normal velocity waveform of the external carotid artery - -

may show reversal in diastole.

-""""~|lw'{uw

False

'

An anterior approach to the portal vein is optimal for

imaging but provides a poor beam/vessel angle for
Doppler studies. ln Doppler ultrasound the

beam/vessel angle should be no greater than 60.

Therefore, the right lateral i_n_ti_ggg__tal approach
optimises the eat-rat/vessel angle.

True

True

This is characteristic of a low resistance arterial llow

pattern.
This is characteristic of a high resistance arterial flow
pattern.

. 5,
iv.
l

r.-.

ll
l

A True

-// H34

Z:/ith T5599 I0 Doppler imaging of the leg veins;

the normal venous flow signal in the legs varies with
respiration.
B compressibility of veins is one of the rnost reliable signs of
,\
patency.

\ C

an established collateral venous system may Simulate now in

y
a patent ma|or vein.
,,; D Poppler flow studies are more reliable in detecting thrombus

\/

' \\)
//
\Y/

A
8

85

the vague nerves are commonly visualised.

the mediastinal structures are best derrionstrared with a

narrow window width.
the normal pericardium is not visible.

True

C
D

True
Falst-tx

True

Thus compression studies are important.

A
B

Fa1se
True

A narrow window width le.g. 300 Hounslield units)

False

False

False

normaimediastinal lymph nodes are not visualiged

the . maior
fissures are demonstrated as
" l|'tl
' white
' lines
I
.
i
majority of cases.
H the
t

.4
l

I t

vein will cause the normal vein to collapse. lf

thrombus is present. this will not occur.

Thus causing confusion and inaccuracy.

Duplex Doppler studies have a high degree of
accuracy in detecting occlusions in the femoral.
popliteal or iliac veins. Below the knee the study is

t
l

i
l

difficult, time consuming and less reliable.

~35 1 ln' chst computed tomography {CT};

\.

(0)

in the veins below the knee than in those above the knee
thrombus may be anechoic.
'

When the patient lies supine, the venous flow signal

decreases on inspiration and increases on expiration.
Direct pressure with the ultrasound probe over the

and a soft-tissue level le.g. l_J__5U'tiit_siield unitsl

are optimal.
"""_'~
The normal pericardium is visible as a thig stripe of
soft tissue density around the heart outlined by
mediastinal and epi_C_a__rgi_al fat.

""-

Normal mediastinal lymph nodes may be visualised.

A diameter of 1 cm is considered as the ugpe_r limit
of a normal noi;l'inmost parts of the mediastinum.

I1I

The major fissures are demonstrated as thin white

lines in only ]QZQ% of CT scans. However their

position can be interred from the relatively avascular

plane of lung lying either side of each fissure.
l

A.

i;

l2Z

it/l Trim in i::-.r:..r-_.

Techniques
126

MCQ Tutor in Radiology

A

False

True

normal interlobular septa may be visible.

True

motion artefact adiacent to the heart is eliminated.

D
E

False
False

86
85

127

When the thorax is examined by high-resolution CT:

A contiguous 1 mm thick sections'are usually obtained.
the mA is usually increased compared with conventional chest CT.

-r

a soft tissue algorithm is used.

MDUW

1 mm thick sections are usually obtained at intervals

fro_n'iTiie lung apices to bases.
increasing mA reduces the visible image noise and
improves scan quality.
Normal centrilobular arteries may also be visible. The
centrilobular bronchiole is not normally seen.
A bony algorithm is used in high-resolution CT.
4-

is

87

37

egarding percutaneous lung biopsy:

A a previous contralateral pneumonectomy is a contraindication.
Q D
B a prieumothorax will be detectable on a chest rarlio ra h in
approximately 60% of cases.
C the risk oi pneumothorax is increased if the biopsy needle

A
B

True

C
D

True

False

A
B

True
True

False

l)
E

Frllsu

traverses a fissure.

$_

in the case of a large or cavitating lesion it is importairt to obtain

material from its margins.
a CT scan is required in all cases to accurately locate the lesion.

D
E

i/A

88

ii?

B8

Iii CT scanning ol the upper abdomen:

A the normal spleen enhances irregularly lollowing bolus intravenous
B
C
D

contrast agents.
the normal gastric wall can be 10 mm thick.
pancreatic examination may require a left lateral decuhitus position.

True

B8C8l.l_B a pneumothorax would be poorly tolerated.

Achest radiograph demonstrates a pneumothorax in
15-25% of cases. CT shows a much higher percentage
labour 60%).
Thelbiopsy needle will be traversing four layers of pleura.
The cells in the centre of the lesion may be necrotic and
unrepresentative of its true cytological nature.
A.
The lesion can often be adequately detected using'
biplane iluoroscopy or a C-arm.
Due to variable rates oi blood flow through its pulp.
The normal small bowel wall is up to 3 mm thick. The
normal colonic wall is up to 5 mm thick.
in pancreatic CT examination a right lateral decubitus
position immediately alter oial contrast medium may be
hulpltrl in rmzlcilying the tltrtitlontrrn.

zitltorlrll glands ore vistlalisctl in rl|li)lt)Xll'l1iI1UlY 10'3"}. nl rinriirril

iiritrtililzr

False

Atllt:l\llt_]ltlllll1-Iilll:Vltilltllltiutllllillllltltilillllit)Illll\lil(lllll5.

Trtru

llltl gull lrlritlrler wull l)l\l\LllltZt!$ rrrrirlttitily ltrllnwirig rrrtrrrvnirrrirzz

t.urrtru:.t ulrlruncuriierlt.

89

n CT oi the abdomen:
A dilute barium can be used to opaciiy the bowel.
normal intrahepatic bile ducts are usually visible.
oral contrast medium should be given 1 hour prior to the
Om
examination to produce large bowel opacification.
D the diapliragrnatic crura can be rnrstrrkcri ior erilargecl lyiirph nrrtles
E rmtlge interpretation is easier in thin rather than tlllctsu pant.-rils.

A
B

True

False

False

Barium concentrations between 1-3/tr w/v are optimal

Normal intrahepatic bile ducts are not usually visible on
CT.
Oral contrast medium should be given at least 4 hours
prior to the examination to produce large bowel
opaciliczition. Oral contrast medirrrn should be given
gradually over rt pnriotl ol 1 hour liolbie scanrrirrg itu
protlrrco small lmwul opacilicatiun.

D Titre
E 'False

Much ol the natural contrast in CT is provided by fat,

thus making image interpretation easier in obese patients.

l
t

'

.___,_,\

128

ta J "I ~I /I~-I~II">IUU'UiIUUC.Q
Techniques

MCQ Tutor in Radiology

ln CT of the normal pelvis:
vaginal tampons should always be tcriiovetl prior to scaiir-ting

%
D

W91

the prostate is separated from the bladder by a fat plane.

False

True

the spermatic cord is visualised in the inguinal canal.

l
i

A vaginal tampon is indicated in pelvic scanning. Air

trapped by the tampon produces negative contrast.
They are difficult to identify on CT.

ti

lt is seen as arthin-walled oval structure of lat density

containingsmall dots representing the vas delereri
and spermatic vessels.

.
91

False
True

patients on chest CT.

True

filling defects may be seen in the normal superior vena cttva

during contrast enhancement.
CT pelvimetry has a much lower radiation dose than
conventional pelvimetry.
patients undergoing a pelvic examination should have tt lull
bladder.

in CT examination oi the brain:

A most adults heads are adequately examined in apiiroximately
15 contiguous 10 mm thick axial sections.
)8 when SC3l'llI'lQIT18 posterior cranial iossa liony nttefact is
reduced by increasing slice thickness.
intravenous contrast enhancement should precede pituitary
lossa examination.

/-E

False

to avoid confusing artefacts.

the ovaries are readily identified.
the paired seminal vesicles have a characteristic bowtie~
shaped appearance.

92
- .

rt?/;

9O

False
True

Regarding computed tomography:

A suspended respiration is required for examination of the neck
B air is seen within the oesophagus in approximately 80% oi
C

'

_en

True

Suspended res_piration is not required. However, the

patient should be asked not to swallow during the
exposure.
r

".7
" _ 'T";"'"'"

Filling (,i8i&Cl5'zit| the superior vena cava result from

incomplete mixing of opacilied and unopaciiied

blood.

CT pelvimetry measurements are also accurate and

reproducible.

True

DZ

True

Ftilse

TYUE

False

white matter is more dense than grey matter.

the internal capsule is oi a ltlglior ttttanuation vt-iltiti than the

False

catidate nuclei.

i0 mm tltitzk coiitiguotts sections from the posterior

arch of the atlas to the vertex.

When scanning the posterior cranial lossa. thinner

and more frequent sections will reduce bone
artclacts and improve scan quality. Alteration iii
gantry angultttion may also reduce artelztct.

White mutter is less dense li.e. has a lower

llntinslieltl nuiuheri than grey matter.

_
The iuternul capsule is of at lower Zll\GllUtlllOl\ vtilue
than the isaudate nuclei.

1;
t~

vi

l
i_-_--.e__-. ~.
-q4_

Am-\

..._._._

lvlL.U lulor l Radiology

IJU

Techniques

s3

131

In CT scanning of the orbits:

93

A the superior ophthalmic vein cannot he distinguished separately

from the superior rectus muscle.
direct coronal sections are often necessary.
intravenous contrast enhancementris mandatory.

//4

WUOID

False .- 4%
True
In addition to axial sections. Coronal reformats should
be reserved for those patients whose dental fillings

False

D
E

True
False

axial sections are acquired parallel to the neuro-ocular plane.

the prone patient position is essential when obtaining direct
coronal sections.

E_:'J
)-7!

make direct coronal sections difficult.

intravenous contrast enhancement is generally given

to show up space-occupying lesions in better detail or
when there is suspicion of intracranial involvement by
a lesion. it is not necessary in thyroid eye disease nor
followinq_t[a_tu;n,a,
Te-obtain direct coronal sections the patient usually lies
prone with the chin elevated. However, if this is not

possible, then direct coronal sections may be obtained

by placing the patient supine with the neck

hyperextencied.
"
When imaging the larynx:

94

A lateral tomograms give a better demonstration of the vocal cords

B
C
D
E

False

True

titan anteroposterlor tAPl tomograms.

phonating "ee" approximates the vocal cords.
axial CT sections of 5 mm thickness are tecltnically appropriate _
ossication of the laryngeal carttlages is more easily seen on the?
frontal radiograph than the lateral radlograplt.
' '
soit tissue discrimination is better on it/ll than FT.

DOW}

True
False

Tru e
a

95
\

.It
at

Dimeglumine gadopentate [Gadolinium]:

A is superparamagnetic.

CO

'

.y_-__-

95

shortens the Tl-relaxation time.

is excreted by the kidneys.

A
B

False

True

ptotltrtzes tl ttttttstent tntzretttatt in :.t.-rttttt trttn |t:vt:|s lt1ilttwt|tt_|

intravenous tttjuctiun. '

The vocal cords are best seen on AP tomograms.

Laryngeal cartilage ossification is best seen on the
lateral radiograph which avoids superimposition of
cartilage over spine.
in addition, the use of coronal and sagittal sections in
MRI allows visualisation"bf the intrinsic laryngeal
muscles.

Gadolinium is a paramagnetic contrast agent.

Gadolinium leads to an increased signal on
T1-weighted MR images and is therefore known as a
positive contrast agent. Superparamagnetic contrast
ttgtmtz; ||:(it|t;t: llm T2 ttzlttxitlttnt tttnu. luntling] to u

has, no severe adverse effects

C
O

True

False

True

tillt.2lUtI:$t.ti slgnztl on T2 tvuigltlutl intugus. Tlttty um

known as negative contrast agents.
it has a plasma half-life of about 90 minutes.

Therefore serum iron estimations may be inaccurate in

the 24 hours following intravenous injection.

Gadolinium may result in art anaphyloctoid reaction.

Minor reactions are seen in El-mUTT1

following injection; these include nausea, local burning

sensation, urticaria and headache.

ll
fr

.. .,_ 5

t t

..,_.

~11

at "MearsQ.~.te.t..Qmrl
Ix)

36

"' l" " ~" " ~' W ~' W he W - ~ - iv - w w ~ - ~ -

Regarding spin echo imaging:

A structures with a short Tl produce nigh signal intensity l
Tl-weighted images.

96

True
False

structures with a short T2 produce high signal intensity in

T2-weighted images.

fat produces a higher signal intensity than muscle on a

Ti-weighted image.
D cerebrospinal fluid usually produces a lower signal intensity ,;
than grey matte-r on a T2-weighted image.
E conical bone has a high signal intensity on Tl- and

True
False

False

T2<weighted images.

W " %Cil.ql-ES Q33. . _ -

Structures with a long T1 prgdug lqw signal

intensity on Tl-weighted images.

Structures with a long T2 produce high signal

intensity on T2-weighted images, Structures with

short T2 produce low signal intensity on T2~weignted

images. ~**=
Fat has a shorter Tl than muscle.
Cerebrospinal fluid usually has a longer T2 than grey
matter.
Cortical bone has a low signal intensity on Tl- and

F
i.

I.~ 1

i
l

T2-weighted images.

l
1.

%*/

Regarding MRI of the brain:

A the pituitary gland enhances poorly with intravenous
B
C
D
E

W.
/

98

(D \-l

Gadolinium.

True

mascara should be removed prior to the examination.

the parainasal sinus mucosa enhances t-vitlt intravenous
Gadolinium.
on T1-weighted images grey matter has a higher signal
intensity than white matter.
on T2-weighted images white matter has a higher signal than
grey matter.

A significant deflection (rotational movement as a result of the

primary field) of the following implants/devices will occur during
MRI:

False
True

98

False
False

The reverse is true.

The reverse is true.

False

Most orthopaedic implants do not undergo

False

A Charnley total hip replacement prosthesis.

B Bjork-Shiley heart valve replacement.

significant deflection and are therefore safe.

Many modem prosthetic heart valves are submitted

to a deection force which is notglinically significant

However, some prosthetic valves, including the

Starr-Edwards valve, may undergo significant

copper intra~uterine contraceptive device.

ITIDO

lt enhances strcngly.
.
- Mascara may contain ferromagnetic material and
thus cause s'ignal lossi9 eometric
distortion.
.

deflection.

dental amalgam.
all surgical clips.

False
False

False

>.

Whether a surgical clip undergoes significant

deflection or not depends on the individual type of

clip.

-u-.A._-_.-

|..>U

134

iVlL.L) llllr In D.-..4:_.r_

MCQ Tutor irt Radiology

Techniques
T

99

The following statements regarding MRI are true:

A the entire scanning suite is designated a controlled area.

/ B

'

l
5t

C
D

the noise heard during scanning arises from the transmitted

radiofrequency pulses.
_
60% w/v barium is used as a positive bowel contrast agcnt.~
Gadolinium enhancement helps to disr.-riminate between

brosis.
cardiac gating improves image quality in examination of the

99

recurrent intervertebral disc prolapse and postoperative

N1

False -' The area inside the 10 Gauss line is designated as

controlled. Any person entering the controlled area
should remove all loose ferromagnetic objects
susceptible to the missile effect, and any magnetic
cards. Persons with pacemakers must not enter.
False The noise which is heard during scanning arises

from vibration in the gradient coils due to the varying

False

cervical spine.

True
_ ._ . _ . t - r

True
t

100

gt, .2

_|"i.~/
I1

~./T : ;

~-1'

- '

'

gl

In magnetic resonance imaging:

A Ti-weighted spin echo (SE) images usually visualise
anatomical structures better than TI-.'-weighted SF. irnztges.
the signal from fat is suppressed by short T1_~lg)yc-rsion

C
D

Recovery tSTlRl sequences.

135

100

True
True,

'

healthy tendons can acquire abnormally high signal on short

TE sequences if orientated at 55 to the static magnetic field.
rapidly flowing blood or cerebrospinal fluid usually has high

True

signal on spin echo sequences.

regarding magnetic resonance arrgtography lit/IRA}, the time
oi flight technique is more sensitive to slow iluw than the
phase contrast technique

False

magnetic elds.

Barium is used as a negative bowel contrast agent,

by shortening T2 and therefore appearing gk on
"T2-weighted spin echo images. Gadolinium and fatty
oils are used as positive bowel contrast agents.
Imaging must be performed shortly after intravenous
Gadolinium as fibrous tissue enhances immediately
but disc material does not enhance within 10 minutes
of injection.
Artefact produced by cerebrospinal fluid pulsation in
the cervical spine can be reduced by synchronising
data acquisition to the cardiac cycle.
'
_T2_-weighted spin echo images usually demonstrate
pathology better than T1-weighted SE images.
it is particularly useful in ihe examination of tissues
with a high lat content leg. orbit, parotid gland, bone
marrowlf
This is referred to as the magic angle phenomenon
and may mimic pathological tendinous change. The
effect is most likely to be seen in curved tendons
leg. supraspinatus tendon).
in spin echo sequences, rapidly following blood or
cerebrospinal fluid usually has low signal. Slow
flowing blood usually has high signal. However in
gradient echo techniques, virtually all vessels are

False

hyperintense.
The opposite is true. Time of flight tTOF) MRA uses a
gradient echo sequence with a flip angle of 30-60 to
maximise flow-related enhancement of vessels that
occurs due to the entry phenomenon. Thus in-plane
flow will produce less signal so that TOF techniques
are less sensitive to slow flow within the imaging
plalle.

1
l

K|

I
.

..

K 1

'v-W

O
D

-I

ur

or

\w

var

-up

~q'

(4

S/C

s
W?

ti?

vi

3',

L-.-.'_'_._. .

an electron in the K shell has a higher binding energy than an

electron in the M shell.
the nuclear forces that are called exchange forces are effective
only at very short distances.

A
B

False
False

An electrffnllias a mass of 9_.l09 x 10' kg.

in an electrically neutral atonifthe number of protons

True

The atoritigtgass of an element is comprised of the

number of protns and the number OLQQQEFDHS
present in thenucleus. The atomic mass will therefore
always be equal to or greater than the atomic number.

True

True

False

an isobar is any nucleus which contains the same numba rof

protons as another given nucleus.
C all isotopes achieve stability by the process of radioactive

an alpha particle is four times heavier than an. electron,

.-,.~

-it

shag rar\g'lorceS and are effective at distances oi

m.

Use the 2n2 law to calculate the number of electrons

allowed in any orbit. Here n is the shell number. The

K shell, n = l, number of electrons = 2
L shell. n = 2. number of electrons = 8
M shell, n = 3. number of electrons = 18

decay.

The binding energy is greater lor those shells which

are closer to the nucleus.
The exchange forces in the nucleus are also called

shell number n starts from n = 1 for the K shell.

the maximum number of electrons in the M shell is 64,

D the binding energy of an electron in a particular shell

increases with an increase in-the atomic number.

is equal to the number of orbital electrons. ' ' '

10'

Q_2_'mHe'gaidTng':_radloaqtivit_,r
B

l37_

'

A an electron has a unit negative charge and no mass.

B the number of neutrons is the same as the number of orbital
electrons in an electrically neutral atorn.
- C the atomic mass (Al of an element is always equal to or
greater than its atomic number (Z).

Physics

Regarding the structure of the atom:

3 Physics

"'7

False

False

True

False

The number oi electrons in the M shell will be l8 and

not 64.
An isobar is any nucleus which has the same atomic
i Ti ass un ti yer as another nucleug.
N_oF___a!l_isotopes are radioactive, e.g. ZC and C are

isotopes olf carbon but neither is radioactive.

The shell radii are smaller with increasing atomic
number and the binding energy is greater for those
shells clos_er to the nucleus.
An alpha particle is 7280 times heavier than an
electron.
~""'_"

"

"

an:

\Af\r\-v.__l

r\.n_|

B
138
3

MCO Tutor in Radiology

Regarding radioactivity:
A the unit of radioactivity is the Becquerel (Bql where 1 Bq is 1
disintegration per minute.

False
False

False

the unit of specic activity is Betzquerels per millililre (Bq/ml).

it is possible to slow the radioactive decay process by

lowering the temperature of the radioactive sample to -4C.

D stable heavy nuclei contain an increased number of neutrons
relative to the number of protons.
E gamma rays exceed X-rays in their maximum possible energy.

Uy 4

temperatgire of the sample.

An increased number of neutrons reduces the extent

of repulsive columbic forces between the positively
charged protons.

True

Gamma rays originate from unstable nuclei and

True

X-rays originate from changes in the electron shells.

The maximum amount of energy available during
nuclear transformation is much higher than that

involved in the electron transfers lBremsstrahlung).

Regarding radioactivity:

A
B

C
D

Fnlae

C decays to N by the pr0CeS5 of isgipgrig: transition.

during positron and electron annihilation twogamma plintons

of 150 keV energy are emitted.

False

during a beta decay the total energy carried by the beta

particle and the associated neutrino is constant.
lor ionizing radiations, frequency lvl multiplied by its

wavelength ti.) is always constant.

the quantum energy (E) associated with the iniiiviiiliml X-ray
and gamma photons can be calculated by dividing l"lartt.:k'.s
constant (hi by the frequency of the radiation.

True

True

False

I39

1 Bq is equal to 1 disintegration per second.

Bgjgwl is a concentration of radioactivity and not
specic activity; the letter is expressed as Bq/kg, i.e.
activity per unit mass.
_"_
The radioactive decay process is not affected by the

l
t

Physics

g.-=11

_l\'.'~\

isomeric transitions occur between metastable and

stable states, e.g. 99'Tc decays to 59Tc. Note that the
metastable state is denoted by the letter m.
An annihilation process involving a positron and an
electron produces two gamma photons of 0.511 MeV
energy. This follows the principle of mass and 'ner'g'y
equivalence.
"
During beta decay the kinetic energy is shared
between the beta particle and the neutrino. Therefore
the total energy carried by a beta particle and a
neutrino for a specific beta transformation is always
constant.
The product of frequency iv) and wavelength (it) is
constant and is equal to the velocity of light

c i3 x108 m).

The electromagnetic radiations can be considered as

energy quanta or photons. The energy associated
with the photons is given by the following
relationship: E = h\~. The energy is a product of the
frequency (vl and Planck's constant (h) 6.63 x 1O3 Js.

'

..=l-T

I 1

H w

""J" J \J'14-{' mcffugrfiqaffodgf at av J aw -ta 1 -.41 -w J to re two ta ea tr u e -u :9 tw -9 I rl .-I w ghggcsts 1% 9 w Q Q

or

Regarding the interaction of electrons with matter:

electrons travel ohiy a short distance in tissue ranging frurn e

few mic rons to a fa w millimetres

_ ' .
8 ' Bremsstrahlung radiation occurs
when .i low eneriJV electron
interacts with matter.

C
D
E

the average energy required to form an ion pair is

approximately 10 O00 eV.
units of linear energy transfer are expressed as kezl urn.
a low atomic number material, such as perspex, is more

A
B

True
False

False

D
E

True
True

suitable than a high atomic niirnlier material, such as lead, for

Regarding the attenuation of X- and galntna radiation by mutter:

A the linear attenuation coefficient (til is the fractional reduction
in the monoenergetic photon beam per unit mass. i
B the half value thickness (HVT) is the thickness of material

which will reduce the intensity of the photon beam to 70% of

its original value.

under narrow beam conditions. for H30 i<e\/ pliotrins, the hail

False

False

False

value thickness lHVTl for \Ni.ll8i is less than the half value

the mass attenuation coefficient is given by the linear

attenuation coefficient divided by the d_eri_s_ity.

six half value layers reduce the photonbeam intensity to 1.56%
of its original intensity.

D
E

- ,

o)

during elastic scattering the photon is deflected from its path

and suffers no loss of energy.
.
the energy _of _the Compton scattered P hoton is the same as

that of the incident photon.

decreases with iricraasintJ enor El ~/C the _ attenuation
_ coefcient
,
D during elastic scattering no ionization occurs.

E
Galahad

F6-afr'>a:i=y
8

.@&

..

..

_____

Regarding the photoelectric effect:

A an interacting photon disappears coriipleiely.

W44.

no further ionizations or excitations occur in the matter as the

photoelectron slows down

.
/4':-Zigc

_.

4-ac
,.w<,-Z1?/i
~99 - /-0%

'

ca />:r71
W i Cw 5.1 i
/
,

._

This is the definition of mass attenuation coefficient.

True

False

C
D
E

True
True

A
B

True
False

False

D
E

True

_'

_'(d E Ffaiv

* 7X"( 1/ -.adi:<:-/.
.__I./ r/iaiti
_, .,___-- P7

it iu
i

\
- \:/J \-/'

'

The energy of the Compton scattered photon is less

than that of the incident photon.

True

Very low energy photons are scattered almost

.
equally in all directions but as the energy increases a
greater percentage is scattered in a forward direction.
< 1

I
1I

It produces characteristic X-radiations.

ITIUDII

The H\fT will reduce the intensity oi the photon beam

to 50% of its original value.
For a given photon energy the value of the HVT is
invergglyprgponignal to the atomic number of the

it is an interaction between a photon and a free electron.

it does not produce an ionised atom.

<

True
True

during Compton scatter the direction of the scattered photon

depends on the energy of the incident photon.

The lineartattenuation coefficient is the fractional

reduction in the monoenergetic photon beam per
unit length.

ii

'\/435g'gsjrgri'g_ipe _imraiia'ii"Mxrryanaga"mi*m1iiays'with mat;

Qalwrwj

Bremsstrahltirig radiation is dependent on the atomic

number of the interacting matter. Therefore a low

material. Water is a low atomic number material and

therefore will have a higher value of HVT than lead
which is a high atomic number material.

thickness of lead.
D

electron is de-accelerated by interacting with the

electric eld of the nucleus.
The average energy required to form an ion pair is
34 eV. "'

atomic number material such as perspex should be

used as a shielding material for pure high energy
beta ernirters. I.

protection against pure beta emitters.

t/3

Brernssiralilung radiation occurs when a hiqh energy

"ii

Ft.

37??\,

__._

False

The interaction is between a photon and a bound

electron.
_
A bound electron is ejected during the photoelectric

effect resulting in an ionized atom.

The photoelectron loses its energy by causing further

ionisatioiis and excitations in the matter.

.\\ __0,.'.s, '75 KJV

we l \"<>=\r'?'

'l~l Kw

D
rt

iii:

:3;

.-is
.-

1 _
it-t
..-5*
tr
4%

142

MCO Tutor in Fiadiolo gy

Regarding pair produm-On;

Physics
9

False"

it is the predominant process of interaction for photons._ with

energies less than 1.02 Me\/.
.

False

an electron-positron pair.

C
D

True
False

Trtte

the incoming photon interacts with zt free electron to produce

.'.\'_i
.-'~-;_ :
_,_.4..

it is an example of creation oi mass from energy.

.p-

,..

during an annihilation process a positron interacts with an

electron to create_[g_u_r 0.51 Me! photons.
the annihilation process is an uxatnple ul Ct)V(:tSlUlr of trr-ass
into equivalent energy.

143

nit

Pair production requires the energy of the interacting

photon to be more than 1.02 Mev.

Pair production octztirsi/vhen the photon passes close

to a nucleus.
During an annihilation process two 0.5] MeV

photons are formed.

'

-1-

15.-3

10

-;.i

Regarding photon Interactions in the patient during diagnostic

X-ray imaging:
.
A they are independent oi the kv used.
'
B photon interactions in the suit tissue are Ittaittly scattering
events.
"
C the average atomic number of soit tissue is higher than that of
bone.
fr D photoelectric absorption is the main BTIC-3I'ttti|lllJ process
occuring in bone.

ll

'

-< - t@9n.5$.t1'5.
B

"

all the energy oi the incident photon is trarrslc-ire.-d to the

orbital electron.
the ejected electron is usually trapped within tltt: electron

traps in the soft tissues.

- following the eiection oi the talentron the vacancv Created i

u.

filled by an outer shell tor valency bond) electron.

it is the means by which alumrniurn [ilters rerrttr-.-t; lQ,\/v on ,-9:I

'1.
.-15*.

photons.

Iiii

it is the predomirlgtnt mechanism ot X-ray interatrtmrr with

iotlinated contrast agents.
?._ .___.--___<-

._:_h
4-

.,

ft
-,.

.--"1.

B
C

True
False

True

True

True

D
E

True
True

True

The nature of the interaction depends on the photon

energy and therefore on the kV used.
Compton scatter is the predominant interaction.
The average atomic number of soft tissue is 7.4 and
that of bone is 14.0.
Pair production does not take place below 1.02 MeV

False

\/61%'5i1e' ollowin state ants.a_rt:;Attjttt*rol_,tlte,p_hotuele-ctrit: etlect_._in mtg

A

the pair production interaction does not take place.

10

,.

11

False

The eiecteti electron loses rts kinetic energy as tt

passes through matter as a result of further
interactions with atoms and molecules. After losing
all its kinetic energy the electron populates the
conduction bantl.

-"i-.1)"-J'~uJ"=..Jt7biL1I"W7V"'@'\F awww-0 iwtvww fa

t,f<iI*iI"-7sU~U\I$PI&,4U';'~.,@\y55E5'45'

T'i!bThe:fHolfi3ihi{fhg $fEiTmEDt5iT__t_C_|3$
A

\". .\~ B

reduction in the intensity per unit length.

the mass attenuation coefficient depends on the density of the

interacting medium.

C the mass attenuation coefficients of l g of ice antl 1. g of water

are the same.
D the higher attenuation coefficient oi muscle compared tr. that
of fat produces enhanced radiographit: contrast at low photon
energies.
8

'l2A

the linear attenuation tzoefiicient is tleiinetl as the ft-notional

True
True

.-/

The mass attenuation coefficient is a ratio of the

???

linear atteniiation coefficient and the density of the

True

The linear attenuation coefficients for water and ice are

._- . -it;v-

interacting medium.

different L92) 4 cm" and 0.196 cm respectively). The

densities of water and ice are different ll g/cm3 and
0.917 g/cm3 respectively). Therefore the mass

attenuation coefficient for water is

0.214/1 = 0.21-l cmz/g and that for ice is

minimum X-ray absorption is achiei.-eti when the K edge of an

absorber is equal to the energy of the X-my l:ieui"i'i.

D
E

True
False

0.196/0.917 = 0.214 cm7'g.

This will result in-Fmaximum X-ray absorption, since

photoelectric absorption is maximal when the _X-ray

beam energy equals the binding energy of an inner

shell electron of the absorber.

t,

13

T4

Regarding the interaction of X-rays with matter:

A attenuation in fat is predominantly clue to Compton
interactions at 60 keV.
B attenuation in bone is preclomiiiaritly tlue to the pliotoelectiit:
affect at 60 keV.
C the majority of electrons in the soft tissues may be consitleretl
to be free electrons.
D bone gives rise to more scattered radiation than muscle per
unit mass.
E virtually all of the photon energy is trtinsfarretl to tht-.- oietitetl
electron in a Compton interaction.

13A

The linear attenuation coefficient of an X-ray beam:

A is defined as the reduction in intensity per unit length.

is higher for bone than for fat at 30 ltell.

is higher for fat than for bone when Compton interaction
predominates.
.
D can be used to calculate the half value thickness (H\fl') of a
material for a given monoenergetic photon beam.
B
C

is constant for a monoenergetic beam.

_'_a_*_.__

True

False

C
D

True
False

False

14A

False

B
C

True
False

True

True

ln soft tissues Compton interaction is pr_etloi_ninant.

The photoelectric interaction becomes signiiicant
only at very low energies.

The attenuation in bone is predominantlv title 1

Compton scattering at 60 lteV. Photoelectric

absorption predominates at about 30 ltev anti below.

Almost all the scattered radiation at diagnostic

energies comes from Compton scatter. Muscles

proclutza more Compton scatter per unit mass than
lioiiu ll) tlio liil(_]|ll)t3UU uiit.-rgy range. _
> I
Ti18J'lllt-:l'aCling photon retains most of its original energy.
The linear attenuation coefficient is the fractional

redtiction in intensity per unit length (for an

innitesimally small length).

it is higher for bone than for fat because of the

density effect even when Compton interaction

predominates.

The HVT = 0.693/linear attenuation Coefficient for a

given material and monoenergatic beam
combination.

5!?

i-\u

--iL,\.t

ii.|\u|

J
Iii |'\t.lU|Lll\)By

[/ 15

Physics

Regarding X-ray production in diagnostic imaging:

A the lament is raised to incandescence by it high filament

current which produces-a space charge of ;>_gtut_t>i1_s around the
lament by thermionic emission.
B the filament ls made out of tungsten because it is lf'lX|')8l'lSl'v'l!
.
and easy to replace.
C the focusing cup of a cathode is made of a relatively poor

l
I

False

False

True
D True
E False
C

thermionic emitter material that has a high melting point.

D the tube current is measured in milliamperes.

over 99% of the energy carried bymelectroiis is converted

into X~rays and less than 1% of the energy is lost as heat.

ta

147

Q1

Th'e process will produce a space charge of electroris__

around the filament.
"' l l
The filamentiis made of tungsten because it is a
good thermionic emitter. does not vaporise easily,

and can be readily drawn into a thin coiled wire.

For example nickel.

V

Less than 1% of the energy carried by the electrons

is converted into X-rays and over 99% of the energy
is los;_as heat.
y

J
T

15

R993"-'1l"QIlle Xvray lube used in diagnostic radiography:

A
B
C
-

17

the focusing cup oi the cathottci is designed so as to spread

the electrons over the entire stiiiace of the anode.
the addition of rhenium in a tt_t_gten target rnakes the target
l0\'9_l1Er and less likely to crack tintler the stresses caused hy

heating.

,,'

'

a dtial locus tube has two lilriments ol (littering size, which

enables the production of two different sizes of election loci
on the anode.
the glass envelope is filled with an inert gas stich as neon in

the glass envelope is metle of liorosilicme.

order to increase heat dissipation during X~ray protluiztion.

'

False

B
C
D

True

True

True
False

The small filament is used for line locus radiography.

The glass envelope of the X-ray tube is evacuated so
as to allow the free movement of electrons from the
filament to the anode.

in

.-----.-.-v--<.~

Hegarrling X-ray production:

the filament current is the srinie as the X-my tube ctiriorit.
B the mA is related to the filament current.
a compound anode is usually ntatie of co;i|inr ciiitl zinc.
DO the electrons from the hlziment aim it.)t'.ll:}f1(lOlli1 tiiii,-tit
material sticli as ltingg-;tQ|1_
E the niioilu tingle is~tllt.: tingle l)l;lfvL'L.'|l the plant: nl the t_'-lllllltlit
filament and the plane of the miotte,

The focusing cup is designed so that the electrons

are concentrated on a smell pert of the anode called
the focal spot.

_
|
I

False

I3

True

C
D
E

False
True
True

The filament tztirrent and the Xray tube current are

not the same. The filament current is typically of the

order of 5 A while a typical X-ray lube current is

about 200 rnA.

An inizrtzaise iii filament current will result in an

lll(IlCl$t3tl tlittiiiiiriitic eniissinn of electrons and this
rcsttlls in tin 'iiicicase in lllu liilit: current.
The ziiiotle is ustizilly matte of copper and tungsten.
The anode angle varies between 6" and 20". The

smaller thu anode angle, the smaller the apparent lor

effective) local spot.

uliplliln:

_@_.~~ 1 7-

V~.I.~<J"uVv.r_@J

@_i,.@@w
in E1 l0 ugy

l48MCO.l'tltOr

new

""""i*"*"~"*"*" P

@'~$~J'

$5

/'\

""'*''i'~""""'Pir$i-"ieaiv*='">\vv

'

the deceleration of electrons in tlte target produces X-rays,

B _ theiprocessesv of Bremsstrahlung radiation and characteristic

radiation are involved.
'
C the anode heel effect produces a rccliiciioit in the K-ray

True
True '
True
False

E5

lii.

..
UOCUP

Intensity for those X-rays which are emitted from the anode at

near-grazing angles to tlte face of the target.

D a tube Wliita fixed anode has better cooling cliaracteristitzst
than one with a rotating anode because more heat is

te

True

The rotating anode tube has better cooling

characteristics as the heat generated on the anode is
spreadrf/er a much larger area. Therefore there is a
greater area available to lose heat.
High atomic number elements such as tungsten
(Z = 74) are ideal as target materials.

produced during anode rotation.

the intensity of an X-ray heath tup to l'DU kevl is proporiiiyiiat

to the atomic-number lZl of a thin target.

-\

i'_/ii

Regarding the rating and operation of the X-ray tube:

A any two X_-ray tubes used lor similar diagnostic pl'OtJl:Lii.ll'tiS
will_have identical rating charts.
B Fellalivn. thermal capacity of the t(iOLlt:, and the anode

False
False

Each tube has its own rating chart.

Trtie

The rating oi the X-ray tube using the line focus is

True

True

TBA
B
_ . .,_.-,._.

angle are selectable during the operation oi an X-ray tithe,

C
D

me F3"".l of an X-ray tube for fine focus tlzit: is |0wt:r lhuii that
for broad tocus use.
the rating chart depends on several factors inizlutluig the ltvp
used.

a rotating anode tuha has =1 signilicantly liitilier iatiiig than it

lube which uses a stationary unode.

These factors are not selectable hut are

precletermiiied.
'

lower titan that when using the broad locus as the

electron beam is focused onto a smaller area and
this catises a higher temparaltiru for the some ntA.
The rating ol tin X~ray tuhu tlopentls on the log-31
spot site, tho _k\/p, the cxpustiro tiiitu tintl lhu
rectification K-

A rottitiiig uiiotlu has ittoro oflitziuiit htitit loss;

because of the moving track the-energy is deposited

over a larger area on the anode resulting in a higher

rating.

ti

re

__

><2o

Regarding X-ray timers:

A the timer switch controls the X-ray exposure by controlling tho

filament current.
B a thyratron is a gas-lled tube that functions as an electronic
switch.
C mechanical timers are accurate to 0.01 seconds.
D in electronic timers a resistancecapacitor circuit is used to
dotormina the length of the X-ray exposure,
E ionisation chambers are not in-iltrihln lor iiuo tin X-my tirrtcru'

20A

False

True

The timer switch controls the X-ray exposure by

controlling the high voltage supplied to the X-ray
tube. The lilanient heats and cools relatively slowly
and therefore cannot be used to regulate the
exposure times.
A thytatron is a gas-filled le.g. low pressure argon)

C
D

False

place.
Mechanical timers are accurate to only 0.25 seconds.

x
u

True

False

triode valve. The potential on the grid is used to

switch the thyratron on. The thyratron is switched off
by reducing the anode potential to nourly cathode
potential so that gas multiplication no longer takes

ionisation chambers can be used as phototimers.

They are designed to be as radiolucent as possible

so that they can be placed in front of the X-ray film.

.
ruu

rtrcu rutut til naururugy

Physics

paIaBr'*=\i5lmti8!l3$$f$
focal spot
A

21

a centrally peeked radiation intensity distribution gives a focal

spot with improved resolving power.

B size increases with an increase in the tube current.

size increases with increasing kVp.

"""

A True

gieometric unsharpness due to asymmetrical

True

False

True

This effect is called blooming and is more marked at

low kVp and high mAs.
The focal spot size decreases slightly with increasing
k\/p.
The apparent size of the focal spot changes away
from the.;central ray. The focal spot length is shorter
when_rneasured at the anode _end than at the

True

D size measurement mtrst be ntarfe in the central part of the

X-ray beam.

the modulation transfer function lMTFl deteriorattrs with an

increase in the focal spot size.

radiation distribution is thus minimised.

151

cathode end of the X-ray beitfa)

Ag increase in the focal spot size increases the

magnification factor which causes deterioration in the
MTF.

B
1

- U 2 M areLee}:-RsQ=.'si1tsat'zer1_s1'swntr*
A true magnification is always smaller titan geometric
\\v\\'\=-1\L --t>

:-cc1"r,z.4:J *nt"O.
ii :4-tr -7' (Uz'4h.v

iybuw $412

_-

\/

O7

yy
/
i)

..1/ ///
.

/ 23

MP0,

star test pattern imaging is gerteruily rnr:ornmt_-ntletl lor

assessing locul spot sizes lrrrqcr than 0.3 nmt.

the actual physical size of ct loctrl spot can he directly

measured in a star pattern imaging test.

Magnification depends on the focal spot size.

Geometric magnification is calculated assuming that

A__ False

-Yr!

'

\F
s

.\_

-.5

'

QM
2

False

12

False

J
.

**.------

Regarding X-ray film:

A the silver halides are sensitive in the blue part ul the vtsihie
spectrum at approximately 480 nm.

the addition of a small amount of Sllvif iodide to sliver

the cut-off sensitivity of an ettrtrlsion is the wot.-elengtlt

distribution of radiation goaltg local spot,

Z2

False

J!

magnification.
.
star test pattern irnaging demonstrates the itttgnsity P-I-b=\"Q,%

C a pinhole Elrameter of 0. nt is recommended for

measurement of a lO l less than 1 mm.
D

bromide reduces the sensitivity of the film.

beyond which the int is no longer sensitive.

the spectral sensitivity of silver halide is altered by adding
cenain dyes to the emulsions

23

False

A
B

True
False

lT1OC7

True
True
False

all X-rays riginate from e point source. in reality, the

local epotilitas finite dimensions and therefore the
true magnification is always greater than the
geometric magnification.
Star test pattern imaging measures the resolving
capacity of the focal spot. The intensity distribution of
rzttlintiort is tlernortstrzuerl hy pinhole imaging.
The recommended diameter is 0.003 rnnt.
S_ta_r__pat_tern imaging is recommended for focal spot
sizes smaller than Q3 mm as the piole image of a

0.3 '11rn1_fQgal_pot is difficult to assess withotrt

'_t;rer:_iaiised equipment.

The local spot size can be derived from the star

pattern imaging test using a formula.

,The addition of silver iodide increases the film

sensitivity.
Such a film is sensitive to a wide range of exposures.
it therefore has a high exposure latitude and a lows

film contrast.

an emulsion with a wide range of grain sizes pr0ti'.1t:e:s e iilm

that has a high lm contrast.

_.- J\._t-muuti

-1

'

"tn

$3

w-~r~qrvw'$'I$T*T'GI'~WW$
iii rtduluiuyy
fl it./i

Regarding X-ray film:

A the latent image is produced on the film alter exposure and

\/i'Z4

development.

J24

\-

False

24A
'\
ll

True

B
C

lh latent image IS rormed by partial reduction of the silver

True

lm emulsion.
.
- .->'
'"-~--
_
thespeed of an emulsion is largely tiepentlerit on the range of

grain sizes (grain size distribution).

_________,___.___

True

False

/ii
\.7\.

1/ 25

ix H/xx J

Regarding sensitometryz
A the transmission ratio is the ratio of tr;-znsmittetl to incirlertt
light (i.e. ll/lo).
"
the opacity is the rec_ip_rot:al of the transmission ratio ti.e l,,_~'l,j_
the optical density is an antilog value of the opacity.
i
the density is linearly related to the weigltt oi the iil m si"l vet.
"TDD!! the characteristic curve oi a tilm is a plot of optical density lDl

The latent image is formed after exposure anti heiore

development.

These are some of thejeasons why gelatin is used:

when tit; silver halide +5 formed the gelatin keeps the
layer; gelatin protects the latent image.
Film emulsion contains grains of silver halide -

approximately 90% silver bromide and 10% silver

iodide.

The speetl of an emulsion is largely tlepettdertt on

the average_siz;a of tltggrgigts. Tlte_largoi"ilte_?@-tygfggiu
grain size, The greater the speed or the.emuTsion.
1-

25A

True

True

A perfectly transparent area of an image has an

opacity of one. A perfectly opaque area has an >
infinite opacity. The blackest part oi a racliographic

False

The optical density is a log value of the 0l1allY-

A pel'it3Clly opaque area has a zero transmission

ratio. A perfectly transparent area has a transmission
ratio of one.

image has an opacity approaching 10 O00.

-1'"

r/'

"ICC

True
False

Regarding X-ray film:

A the normal density due to the base plus log of a correctly
stored unexposed film is approximately l.

linear part of the characteristic curve oi the film.

the greater the exposure range over which the density lDl
versus relative log exposure (log El is linear. than the greater

is the latitude of the film.

The characteristic curve is a plot of optical density lDl

against the log of the relative exposure llog El.

False

The density due to base plus tog for these con_ditions

False
False

The level of base plus log increases with ageing.

'0

True

The average slope of the linear pan of the

characteristic CUN8 gives the gamma of the lm-

True

is approximately QL

The greater the film latitude, the lower the lilrrt

gamma and vice versa.

t-

The level of base plus log increases with art increase

in the processor temperature.

1
1

._
.2s,A
.)
__-e

B ageing oi the film decreases the overall level oi base plus log.
C the base plus fog level is independent of the processor
temperature.
D density
is proportional to the logarithm of film exposure irl the
_

U U "U I

U1 L-1

against relative exposure (E).

J2.

graittsilispersed; gelat n forms a flexible transparent

fit.

\'\pIt
WU,
5
l/
Q 'Jt_)' Q

yix

wvwwrtwwb-Ii1I'IDID~iI
Physics

ab 9

gu

i it

bromide crystals during the exposure.

C gelatin is used as the basis of the emulsion.
D there is an excess of silver bromide -aver silver iodide in the

ti

._

>

l54

M661 Tutor in Radiology

Physics

contrast
ezssgtrqisseeizmmamraatmeaeiteg

inherent contrast of the lm.

B development conditions of the lilin.

MUO

contrast of the subject.

viewing conditions of the film.
basic l09-

2, A

True

The inherent contrast of the film is determined

B
C

True
True

Subject contrast can be influenced by several factors

oi which kV, scattered radiation and intensifying
screens are the most important.
.
The overall effect of a high basic fog (base plus fog)
on a normally exposed radiograph is to reduce the

B True
E ~True
'

,_ A

.3.-i-~"*v"":;=--it
Regarding processing of X-FRY mills:
A the developer has a pH range between 11 and 13
)

ii"

t?

155

the fixer has a pH of 7.

True

E\\ C the developer precipitates the metallic; silver from the

bromide, chloride and iodide salts.

D the numerical value of the arnplilication gain achieved by the
process of developing is 102.
E the fixer contains ammonium ll1lOSlll[JllEllE.

41
'

ratliographic contrast.

False
False

B3 x
~.

'7"

during the manufacture of the emulsion by the size

and size distribution of the grains of silver halide.

UQWP

False

T"-'9

False

False

True

True

Developers have a pH range between _.6 and 10.6.

The lixer has a pH range between 4.2 and 4.9.
The a""P|l3ll 985" ailhieved is much hlghe Le109.
ii,
\"' "

29
Eb

R993-"9 mm P'955T m"i1Fl"!J1

A ll"? 5959 Plus fog level is estiinatetl h\,- measuring the tlensity
ol the most exposed pan nl the lilm.
B 1?
l f""1 l1f0E$$' Per'icrmarit.;e should be ctihtll
- __
tmct: a
C
D

29
.

'\33|~'-

the iilm speed and the film tzuntrnst zzhuultl he Illt-Lill-iillutl llilllyi
the lilrn pmcussur should ln: lIlC1llllOl't.'tl ul .i llJUtll(|r nine
during the clay.

the films which are use-ti for t1'tUtlitt)titlq iilni |;rucessn:~;

should be taken from a specially reserved lilrn box.

.- '

lulu

The measurement is rnade"on an unexposed part of

The lmThe film processor performance should be checked
dai|v'"
"__'_

lltili i=l uritflllt-ll ill "Hit-'1 1" i\tl\lt>\'" '0l"Q'~l\|llibilllY vi

"W tE'5"l\1F-

'l>

I9 awe? a at Pf - - 13%;:/_a6-/"' -1 '--=-:4-~ "2! *1 J

E - rue.-.-~; _
a

'ili+=-1%**~"
a

)' h""j

I LN, 214') )' | -Ll)

,4

I F
._

=*QLi *4'rvlL.i.iL'-MOfi'Pit\i.'!.'tiulQQy"I

30

"P

iv

tar

any

tr

MI

-tr

~17

"~w<w~v~r=t4rU~iII'IiIiUUI'g\Y5!_i5q5,www"*q
.

Regarding silver conservation:

30

Q the electrolytic method produces 50--70% pure 51h/gr_

in high current densih/electrolytic units the fixer solution is

kept under constant agitation.

the silver content of a xer solution can be estimated by a
simple test paper.
_ around 10-20% of the available silver is recoverable by using
a metal exchange method.
E tting metal exchange units in tantlern improves the overall l
silver recovery efficiency.
C

A
B

False
True

.- _ ,_. -._- i

The electrolytic method produces 95-98% pure silver.

The agitation oi the solution brings fresh Silver ions
close to the surface of the cathodeand speeds up the
rate of deposition of ineiallic silver. This allows the
use of a higher current and a smaller surface area
cathode wititiinut the danger of sulphiding, which can

eventually stop the plating process altogether.

Sulphiding describes the decomposition of the fixer

by unused current in the cathode. The products of

this decomposition react with any silver ions present
in the fixer to form a silver sulphide precipitate,

which turns the cathode deposit black.

True

False

True

"
The metal exchange method is 70% efficient in

[Jl'3CUCt3.
1

' it

313$?-The followipg statements are true regarding film/screen

combinations?
"
' ' " '""
A after X-ray exposure, the film produces an image which
\ I B
results from light and direct X-rays in equal p|'O[)L)l[iQn5_
Sb/rot ihe'X-ray beam IS absorbed by the plioioelectrit; gffgrjr
within the intensifying screen.
'
during the process of fluorescence the phosphor absorbs long

K. //-c

D
E

32

wavelength radiations and emits short wavelength radiations

modern film-screen combinations have a resolution range
between 200 and 300 line pairs mm.
the speed of rare earth phosphors is inclepcrtderit of the kvp

Regarding intensifying screens:

A in
' t eitstfying
~' ' screens redtici.
-1 the il|I\Ul|[][
T
- gf _ct__1rm,-ed rmi|;mLm_
B czilcium iungstaite protlucus liiiht wiili .ii prizilt w=ivvlcnr;ih of
C tillntit 700 ntinnrnutrmi iliitiiiti llrrrirrr;;r;t_,rrr;_

tlioiiitiiiisic uilirziriiiizy ut lllu phniiiiliiii it. llillililltl nu ii; |'t||,||i,.,,

D

31

False

True

False

D
E

False
False

32A

False

the inierisification factor of tho 5(Jfl!Utl is ihu rilllu of ihi- X~ ru

.
- ' v
exposures needed to produce the same density on a film with

The rest of the image is formed by the direct action

of the X-rays on the film.
During the process of fluorescence the phosphor
abs0rtgs_sl]ortyavelength radiations tkisl and

emits long wavelength radiations ilighil.

The resolution range is 2-18 line pE?iitiii".

The speed of rare earth phosphors depends on the
kvp. The rare earth screens show maximum speed at
80 kvp. Lower speeds occur at both low and high
kilovgltages.
a
-

intensifying screens are used to convert relatively

low tlhstilliittl X-my photons into iiiatiiy light photons.
Thus iliu X i-iy ilniiu in the pzitiutit is riultitzuil whilr:

if

Ftiiriu

zalill :illuwiiii_i .i |llll|)\l||\/ iniiiiizauil X i.iy liliii.

Hill punt; vvrivuluiittili nl lliii litiltt tiiniluiauil lb uliniit
-tjittriiii iiiitl hue iii tliu hliiu int|iuii Ul lliu Vltillllil

Falsu

tTiit:triiiii lwtivnluiriiili i;iiii_|ti 350-5M0 iiinl.

Thu iniriiitsic ullitziuitcy its tluliiind us tliu ratio oi thu
light uiii;_rgy_[ili_urtituil liy ihu crystal to tho X-rtiy

0| fltllil tiliuiuiizi priii.liii;uil tiur iiiiii ;iiu;i ltrlrrritrmt hm -)

dpproxtiiiiiluly hull lliu tiuiiuitituil lflll it'irii:_liii:s lliii lilin iilill

thu rust is absornotl in ihu si:ri.-un.

The majority l95%l of the image is produced by light.

energy absorbedf The intrinsic efficiency of calcium

and without the screen.

._ . -_. a_ ._ -

iiingstniu is ntiprnximaiely 5%.

Triiu

Truu

158

MCQ Tutor in- Radiology

Physics

J3

159

Regarding intensifying screens:

the rare earth phosphors fluoresce maximally in the pure state

the X-ray to light conversion efficiency of rare earth

33A

phosphors is the same as that of calcium tungstatc (Ct-rW0,,l.

the K edges of barluf_n, lGfll_l_]_a_fl2Tll and gadolinium correspond

False

closely to the mi3<'iTnum intensity of diagFi5'tlE'$<'-rays in the

primary beam.
as a result of fluorescence the terbiurtr-activated gadolinium
oxysulphide phosphor [Jt0t.lUCt25 a continuous sprzrtrrum of
light with a maximum peak at 430 iiitT'"'_'

True
False

the rare earth screens show maximum speed at about 80 kvp.

_.

erasesasrarrtaaratarazihta<srseaas=w-

J A

True

.-

the speed of the calcium tungstate screen and its ability to

record detail have a reciprocal relationship.
the ability of phosphors to fluoresce is independent of the
ambient tgmprature.

False

34

True

False

they s ould be cleaned at regular intervals with an antistatic ;

True

compound and a detergent applied gently with a lint-tree cloth.

the film cassette should be i:heckr:tl lor goorl scrrrran-iilm
corttrtct ill regular iritcrvnls.
ll1t:lltltttllllfiillltill l.ir:tui rrl i:trlr:ttrrir trrrtgsirrtrr llltiruilsili; wtllr
an increase in the kVp of the X-ray beam.

True

True

Regarding grids used in diagnostic radiography:

l
A they are used to improve contrast.
.
they consist of lead loil strips separated by calcium tungstate
spacers.

the grid ratio is dened as the ratio between the total area
covered by the lead foil strips and the total area covered by

the interspacing material.

the grid ratio of a crossed grid is equal to the average of the
ratios of the two superimposed linear grids.
a linear grid allows the operator to angle the X-ray tube along
the length of the grid without loss of primary ratliation.
~

35

True
False
False
False
True

The rare earth phosphors, such as gadolinium

oxysulphide, fluoresce maximally when atoms of
terbium (0.3%) are incorporated to activate the
gadolinitiw oxysulphide.
The X-ray to light conversion efficiency of _CMa_\_/YO is
approximatelyiyg while that of the rare earth
phosphors is approximately
'_'_
Baritlm K edge 37.4 keV; lanthanum K edge 38.9 keV;
gadolinium K edge 50.2 keV.
The spectral emission of this phosphor is due to the
terbium ion. Therefore it is not a gg_Qt_inuous
spectrum but is concentrated in narrow lines with a
strong peak at 544 nm.
__.__-

_ eftt;-,

intensifying screens fluoresce more brilliantly at

lower temperatures. A higher ambient temperature
would require an increase in the exposure factors in
order to.produce a film with the same optical density.
It is important ito keep the intensifying screens clean.
Any foreign material org. the screen will block light
photons and produce an arerr of underexposure on
tltt: lilrn. Rngirlttr t:lt;.'inirti_; with llll nrrtistulic and
tlrilrtrgtint rzurtiimiriitl sltnrrlrl t!llllllll;llt2 this |irul>lr:in.
The cassette in which the intensifying screen is
mounted holds the film in tight contact with the
screen over its entire surface. With a poor screen~iilm
contact the light produced in the intensifying screen
will diffuse before it reaches the film and result in
itrtiligrgss of the rtrtliograpltic image.
High kVp X-rays are more abundantly absorbed by
the photoelectric process in calcium tungstate
screens. This results in a high intensification factor.
Gritls improve contrast by absorbing scattered
radiation before it reaches the film.
A grid consists of a series of lead foil strips separated
by X~rr.|y transparent spacers. The interspaces are
filled with aluminium or an organic compound.
The grid ratio is defined as the ratio between the
height of the lead strips and the distance between
them.The grid ratio of a crossed grid is equal to the sum of
the ratios of the two linear grids.
1

war

V]5trM'LW|l'5"n"*3mbl0''"WW-Wwtiivtriwitirsy.

\'|,l-D,'l\'{,
~iy=.w~lr.r~-vi.rsIurraJIiI.7VIi

Regarding a grid;

False

A he
dened as a ratio of th e l ieignt
T ' or' the
smps
. Qfld
to ratio
their iswidth.
~ > lead

False
True
True

ghiengeaasd srripfs are approximately 1 mm mik_

fire 0 primary beam traiisiiiissiori l$ user] in the
D gvaitiatfion of grid perf0rmanr;e_
uc y actor
is used as a measure of the ehil'try or' the grid
' to
femove
scatter.

False

us; of a grid is the most important method of improving

ra lographic contrast.

Grid ratio is defined as the ratio between the height

of the strips and the distance between them.
The lead strips are approximately _,____..
0.05 mm thick.
The Bucky factor is the ratio of the incideiit___r_agiation
falling onrihe grid to the trai_1_smitted radiation
passing through the grid. lt is a measure ol the
ability of the grid to remove scatter.

Contrast improvement depends on various factors

such as kVp. field size and patier_it_tl\_icl<ness. The use of

a grid is?Te of theimeans of improving radiographic

contrast by reducing the scattered radiation.

37

False

Regarding grids used in diagnostic radiography;

A thosewith a low grid ratio are more efficient in removing

8

C
D

Sottered radiation than those with a high grid (amt

primary transmission tTp) of a grid is inversely
proportional to its grid ratio.

the measured primary transmission is always I555 than ma

calculated primary transmission.

the primary transmission lTpl is the s"m " ti
of the grid.
G e as e Bucky factor

True
True

Grids with a higher grid ratio have relatively teller

lead strips and shorter distances between the lead
strips making them more efficient in removing

scattered radiation.

The difference is mainly duo to some absorption of

the primary radiation by the interspace material.

False

The primary transmission lTpl indicates the amount

True

High-ratio grids absorb more scattered radiation and

have larger Bucky factors than low-ratio grids.

the Bucky factor increases with an increase in the grid ratio

of primary radiation absorbed by the grid while the

Bucky factor indicates the amount of absorption of
both primary and secondary radiation.

or
f

I:

162

MCO Tutor in Radiology

'

\/

38

sag

Regarding gridsi

38

A the contrast improvement factor lKl is usually detei"mined at

70 l<Vp by utilising e small field and scatter free conditions.
B the higher the Bucky factor, the greater the exposure factors
and radiation dose to the patient.
y'
C the contrast improvement factor (Kl remains constant for all

A False

The contrast improvement factor is dependent on

kVpI field size and patient or phantom thickness

usually determined at i_QQ_l_\ip with a large field and

grids.

True

be with ordinary magnification.

grid cutoff caused by lateral decentring of the grid is best

identified by close inspection of the film under a bright light.

False

D
E

True
False

A
.-i-

a 20 cm ttifglg phantom:

'
ll the Bucky factor fora particular grid-energy

combination is 3, then exposure factors and patient

exposure both increase by a factor of 3 above that
which would be necessary for the sameexamination
without that grid.
The contrast improvement factor increases with an
increase in the lead content of the grid.
During grid cutoff caused by lateral decentring all the
lead strips cut off the same amount of primary
radiation. This results in a uniform loss of
transmitted radiation over the entire surface of the
grid and thus produces a uniformly underexposed
radiograph.

Regarding filtration in diagnostic radiography:

A it is the process of increasing the mean energy of
8
C
D
E

39

polychromatic radiation by passing it tliio-igh an alasorlirrr.

the process of beam filtration does not rctluce the patient
dose
the inherent filtration of a typical diagnostic tube varies
between 0._fi and 1.0 mm of leads;
the beryllium window X-raytube designed for stilt tissue
radiography has a minimum inherent filtration.
the glass envelope alone is responsible for the ini
tereiit
filtration of a typical diagnostic X-ray tube.

163

these three factors determine the amount of

scattered radiation. To permit comparison between
different grids, the contrast improvement factor is

D grid cutoff is the loss of primary radiation that occurs when

the images of lead strips are proiecteci wider than they would
E

Physics

True

False

The process of beam filtration removes the low

False

energy photons from the X-ray beam. The low

energy photons do not contribute to the radiographic
image and their removal by the process of filtration
therefore reduces the total patient radiation dose.
The inherent filtration of a diagnostic X-ray tube is
measured in aluminitim equivalent, which is the
thickness of aluminium that would produce the same
degree of attenuation as the thickness of the
material. It usually varies between 0.5 and 1.0 mm of

True

False

aluminium.

'

'

The insula_tin_g_9_i_l surrounding the X~ray tube and the

window in the tube housing, as well as the glass

itrtvplpiie, ririi responsible for the inherent filtration of

a typical iliagiiostic X-ray tithe.

_ _

.__ _._a

MP

uuV

/0

sat/"-<0

MCQ Tutor in Radiology

I64
/'

<hlW'HlV

3iU'ulV

\l,u'

.1,"-tr

4'

kilI_i'

ti

Regarding lters used in diagnostic radiography:

A copper and aluminium are the materials or choice lor added

filtration of the X-ray beam.
B copper is always used in combination with aluminium as a
filter material.
C in a compound lter the higher atoniic riiimher niatarial filter

40

-----ii

._ __-.-__.j

1'

True
True
False

See answer (Cl.

See answer (Cl.

Most filtration occurs in the higher atomic number

material lcopperi and the purpose of the lower

atomic nu_i_xi,oer material (aluminium) is to absorb the

characteristic ragiatign from the former. Therafor_ein
a compound filter copper (atomic number 29) always

faces the patient and the lower atomic number material tiller

-.1tI!!:Iyws's..I~;<J
Physics l65

faces the X-ray tube.

i
the characteristic radiation produced by an ulurnitiiurn lter
can give a significant radiation dose to the skin.

faces the X-ray tube and aluminium (atomic number

an added lter of aluminium 3 mm thick is advantageous over

an aluminium tilter 2 mm thick.

l3l faces the patient.

False

The characteristic radiation produced by aluminium

has a very low energy (1.5 itgy/_l which is absorbed in

False

An aluminium filter gfnrn thick absorbs most of the

photons with eiiergies less than 20 lteV. Increasing
the filter thickness to 3 mm of aluminium does not
oer any luither advantage. The excess filtration will

the air gap lHeri"th"patient and the filter.

cause overall attenuation of the beam without

significantly altering the quality of the beam.

41

Regarding the air gap technique used in diagnostic radiography:

41

A scattered radiation is decreased mainly as a result of filtration

caused by the air gap.
B

C
D
E

False

more scattered radiation reaches the film from the scattering

events which occur near the entry surface rather than the exit
surface of the patient.
a larger air gap is desirable when imaging a tliicker part of the
body.
image sharpness deteriorates with an increase in the air gap
unless the focal-film distance is also increased.

False

appreciable beam hardening.

No fonivard scattering bias exists. At the energies

involved. a photon is likely to scatter in almost any

direction equally.

Most of the scattered photons reaching the film arise

nearthe exit surface of the patient due to a greater
anglegf capture and less tissue attenuation. '

True

The ratio of scattered to primary radiation tor a given

thickness or an absorber depends on the size oi the
air g a p pr e sen.
t A l ar a air
' a wi"ll re d rice th__e;_r_a_tio
K

-'2

Scattered radiation is reduced because scattered

photons miss the film. Very small quantities of
radiation are absorbed in the air gap without

there is a strong bias for forward scattering in the diagnostic

energy range.

False

True

l 5a!@'Ee.L9_2tim;Tr%.l1gtl@An iiTc'rse in the focal-lm distance compensates

for the greater magnification produced by an
increase in the air gap.

H?

5'

42

MCO Tutor in Radiology

166

The following statements are true regarding noise in images

produced by a film-screen combination:

Physics
42

the image quality of low contrast images is st;-riotisly alfected

by noise.

images of comparable optical density contain less noise if rtp_

earth screens BIB US8d rather thijln Calciirn t_tri1gst,3te stgreens

the noise decreases as the mean number of X<ra\,' photons

that are utilised in the formation of the image iaiagea.

an increase in the phosphor thickness will increase the rioise

43

to produce a given optical density.

the main factor determining the noise is the number of >1-ray
photons utilised by the screen.

Regarding radiographic mottle:

~
structure
mottle is caused by defects iii the iritensilyirig
screens.

43

True

in ldyv contrast images the density difference

False

C
D

True
False

thus reduce image quality.

Lower ex osures are use d wit' h rare earth screens
and thus noise is increased.

True

A
B

True
False

C
D

True
False

lilm graininess makes a significant contribution to the

radiographic mottle observed in clinical radiology.

quantum mottle is caused by statistical iluctuatioris iri the

number of X-ray quanta absorbed per unit area of the

intensifying screen.

quantum mottle increases with an increase in the number oi

X-ray quanta used.
quantum mottle will be greater with at high ltvp.

True

between adjacent structures is less. An increase in

the noise can mask the difference in contrast and

With an inrease in the phosphor thickness the noise

will be cinchanged as the number of photons used by

the screen remain the same due to the reduced
egtposure.

Film graininess is visible only when radiographic film

is examined with a lens to produce a magnification
of >< 5 to >: 10. Under normal viewing conditions film
graininess does not make a significant contribution to
the mottle.

Quantum mottle increases with a reduction in the

number of Xeray quanta used. Quantum mottle

decreases with an increase_in the number of X-ray
quanta used.
A high kvp will produce a higher intensification
factor and therefore quantum mottle will be greater.
r.

4-1

Fiegarditig the radiographic image:

parallax utisharpness IS seen with the use ot singlr. omtit~_iit_iii

film.
the edge gradient is the rctiiiin oi partial illtiniinzitttin that
su_tr_otg1ti_s the complete sliatlow.
\"-""*' "-"*

the width ol the pU['lUlT\l)l'i'il5iU5ti0llliiHl1(l(it) tiiilu lli.-iii tin

44

False

B
C

True
True

l)

l'-.il:iu

False

litil tltlllitllld Stti.

iiliziitiiatinit \l|\iilitIl||l'lt::i.i i:: t|it:.iii:;.l iii trli|i;t.i:i Wllll :;li.n|i

utliiiis.

motion utislizitpnoss is iiicrutisetl with sltuttut cxiitistxre tiiiitis

167

Parallax tinslizirpiioss l5 protliicctl by the formation oi

two images on a tluublg emulsion film where the
einiulsions are separated by the width of the film
base.
The oriizntation of the anotlc angle prntiutzes loss

lmiiiiiitliiii till tliti iiiitiilu :;itltt.

i
'lIii: illI!ilH|llltlll ti|i:'.li.ii|ititi:;:; lli Hllltlllltil ltn tttitiiil ui
iiv.il iil>|t:t:|;: l|ii:i iy|iii til tinsltnipiititts JHIHUS lrutn
tlii: grzitttitil ulttiitgt: iii lliu X-ray i1l)St)l|lllt)lt ticruss
the hotrtitlary.

Motion unsharpness is minimised by reducing

exposure tithes. Patient immobilisation and organ

compression devices also help to reduce motion

ttnshzirpness.

w.

~_

--

--

/'45

-1

<-

-..-

uw

ww

ur

<07

sir

'47

~17

47

~$

~17

~17

~47

Regarding resolution:
A the resolution olf a l'ilm-screen 4C(_]l11UilTa[lI.]r\ is exp,-8555-U by
the number of line pairs per millimetre.

it

8
'

/Li

D
E

in a 4 li_ne_pair per mm test object the width of an lCliVl(Iil|ill

lead strip is 0.2; mrn.

the information available.

is normally greater than 1.

can be calculated from the corresponding line spread fiiiiction

B
C
D
E

True
False

C
D

True
False

False

45A

False

"g\(\i.is xx) \.b ,;$

MTF curves can be used to compare image qualities of

competing systems.
resolving power can be considered to be a single specified
pointon the MTF curve for use in the comparison oi different "
imaging systems.
.
a 30% response on the MTF curve corresponds approximately
to the resolving power of an imaging system.
thetotal MTF of a cascaded system is obtained liy adding the

individual MTF components.

. 1'C4-4-"1:(J'df

..-L [zz//)("'

iv -

-:

-IS

.7

.7

S'Il|.UUb$H.>-Y

The LSF is the prole of the intensity curve obtained

by collinjatittg the X-ray beam through a very narrow

ilit. The LSF of ari-ray lm exposedrwitout a

screen is very narrow as there is no diffusion oi
X-rays iti,;,he lilni.

A line pair refers to a single lead strip and a space oi

nonabsorbing material.
The width of the lead strip will be 0.125 mni.

ii

MTF is a function expressing the ratiogjjriiiiiitiirles

oi
atial fre uency under___,_.
different COLdlll0S. lt has
_ s Q_}
no units. v
\-

B
C
D

True

True

47A

True

B
C
D

True
True

False

The resolifing power of a system corresponds

False

The total MTF is a productof the individual MTF

components.

True

False

The recorded iniorniation is normally never greater

than the available information and therefore MTF is
normally less than l.
The mathematical operation known as Fourier
transformation is used to derive the MTF from the
corresponding LSF data.

(A ;\\_v" '/7\L4.;"\'7;-:3)

the MTF of a film-screen combination may he assessed hy

imaging a grating.

.7

lt_:Fl data.

Regarding modulation transfer function (MTF): ""5'~L"_"""," "-. J

45

Q7

provides an obiective measurement of resolution.

can be understood as a ratio of the infcirrnation recorded and

47

_.._. . i

-I

without a screen is very wide.

The modulation transfer function (MTF):

A is expressed as the number of line pairs per rnin.

\/6

~27

the line spread function (LSF) of an X-ray film exposed

C i 5/Slem _WiIl1 hlghresolving power is able to record separate

images or small obiects placed very close together.
D in a resolution test object a line pair refers to a pair of
adiacent lead strips.
J

'17

ll

Different inethotls Oi evaluating the MTF exist. These

are based on exposures of slits or gratings tollowett

by analysis using a itiicrocleiisitottietet.

U
l

approximately to the 10% response on the MTF Curve

1-?

J7

170

MCQ Tutor in Radiology

3;

-'

J 4_8- ln an image ir_1_tansier:Qg

48

A the fluoroscopic X ray tube is operated at zi rr.i.ic.li lower tube

B
C

current compared with that used in conventional radiography.

the input fluorescent phosphor is made of calciumtgrigstzite.
the distance between the liiput screen and the photocatliocle

the anode has a positive potential of ai:-proximately l-S00 l<V.

is about 1 cm.
D the photocatitode absorbs electrons anti emits visible light.

True
False

False

. D False
E

False

Physics

171

The input screen phosphor is made of caesium

l9..lide-

" ' "

The distance between the input screen and the

photocathode is only a fraction of a millimetre. This
proximity _is essential to minimise loss of resolution.
The pltotocathode absorbs light photons and emits
plTOIO6l8CllJ_;tS.

The anode has a positive potential of approximately

25 kV. V

~___4

t\%s Regrdlg
image lntensillersi _
A the Output
.
fluorescent phosphor is
B

50

D
E

"

rri:-ride of caesium iodide

a layer ol aluminium is coated on the iiinci surface of the
output phosphor to increase its mechariicul strength.
the aluminium layer removes spent rilcctrons from the output
phosphor screen.
the conversion factor is the ratio ol the luminescence oi the

False

C
9

True

False

in general the overall brightness gain oi rnodern image

intensiliers is between 50 and 100.
50

tlir: sup-:rior image qtinlil:/W r:.1r:sium irirliclii pliri:;pliiir:: is l.il!(:

nurnbr.

tleitsit and liii liur UllLl__'[i'JI,' utu-iiii;

J"P__""2"

J ' ~444444444

using an aluminium disc.

the image distortion of an image interisilier is assessed iisini.1

Tr u I:

lt is the ratio til luminescence ol the output phosphor

to the input exposure rate.
"
The overall brightness gairi is more than 1000.
.

A television viewing system has several advantages

which include prorliiction ol zitieuiiate light output

front the television monitor tn rillciw cone vision oi

illl tltl\|)llllUl.l llll;l\_]U. It tz; iilsu .i vuiy iilliiziuitt SYZHUIH

because it results iii minimal loss ol information, and

the video signal can be recorded giving a permanent

unequal magnication across the OUll')lll.llUO!E3St1l.-Bill screen

causes an increase in brightness at the peripliery.
the contrast ratio of an image intensifier is typically measured
a rectangular grid.

Thus avoitlitig a build up ol negative charge.

to its t ll_:itl.t.:I uckin

False

The output fluorescent screen phosphor is made of

ilygr_ activated zinc cadmium sulphide.
The thin aluminium layer prevents light from
travelling back through the tube and reactivating the
photocathode.

output is usually viewed tliietttly by ti ielovisinii izzinit.-iti.

l3

lllQl.t[_QhOS[,)hDf' to the input exposure rate.

False

'

Regarding image lntnrisillercz

\// 49 A

record ol the investigation.

;
i-

True
False

False

'

The brightness at the periphery is reduced and so

causes vigriettirig.
\
.
The coi'itra'st ratio oi an image intensifier is typically
iiieusuiiiti iiiiirig .i luiiil ilisc whicli has ti ili;u'nr:ter

10% llli'll ul the iinzt-t_)'tTintensilit:r. Thu contrast fl.lllO is

l'lUlUlll|llll:ll liy iiii.-asiiiing the light output oi tlic
iiiii|iiiI pliiiaipliiii witlt iiiirl witliniit tlii: lixtitl (lint:

|i|tii:i=il :i| tliii i:r:iitii: Hl tliii irii:ii|ii iiituitiiiliiir.

[rue

5..-7-4__;:_,,./I
._'--3-'-""_"___

..

44 ~_*_

Ir:
51

MCQ Tutor in Radiology

Physics

"nu.-

ln a TV camera:
A the fluoroscopic image from the intensifier is focused on to
the Vidicon target using an electronic focusing system.

False
True
False

focusing and deflecting coils control the electron beam of the

Vidicon tube.

.-__ . -

the antimony trisulpliide globules are in tlireci contact with the

signal plate.
D the end plate of the anode is a wire mesh which allows the

The fluoroscopic image is focused on to the Vidicon

target using an optical system.

The antimony trisulpliide globules are insulated from

the signal platttl-1 by a mica matrix.

True
True
\

electron beam to reach the target.

the antimony trisulphide tnatrix converts the tltioroscopic
optical image into an electrostatic iiitage.

173

I
1

52

Regarding digital subtraction angiograpliy lDSA):

A
B

'

C
D
E

False

the analoguedigltal converter (ADC) converts the digital

voltage output of the video camera into a range oi analogue
signals.
the ana|oguedigita| conversion for the entire video image is

True

False

carried out in real time.

the subtraction process improves anatomical detail.

the video cameras which are usetl characteristically exhibit a
significant amount of lag.
Plumbicon cameras utilise lead oxide lPhO) as the target

False

material.

FL

Regarding subtraction techniques used in diagnostic

radiography:
-

False

A an image without contrast medium is electronically adcled to

False

C
D

an image with contrast medium.

an image with contrast medium is known us the stihtractien

mask.
"'_""'
there must be almost perfect registratiori in order to obtain

good subtraction.
pixel shifting is a form of post~processin-3 that can be used to

eliminate motion artefact.

when used in angiography the vessels filled with contrast
medium appear black on the subtracted image.

DSA improves vascular detail by employing the

process of digital subtraction of other anatomical
details.

Lag is not desirable in video cameras used in DSA. lt

is important to reduce the lag so as to reduce the

motion artefacts which are caused by the rapidly

changing image as the contrast bolus passes throiign

True
53

The ADC converts analogue signals. from the video

. camera into acrangts oi digital numbers.
T

True

'
True

the vessels.
PbO exhibits low lag properties.

An image without contrast mediunl is electronically

subtracted from a subsequent post-contrast image.

A'tTbtraction mask is a pre-contrast image.

There should be perfect superimposition of structures

- between the pre- and post-contrast images. Any

movement between the two images produces

registration artefacts and degrades the resultant
image.
.
This involves moving one image either horizontally
or vertically in order to improve the alignment of two
images prior to digital subtraction.

True

l74

NICO Tutor in Radiology

, 7

iii

54

Regarding dental radiography:

,
A
_
.
it is a high frequency and high dose techniqttee.

C
D

j-fl

54
~

the voltage across the X-ray tube should be less than 50 kv.

False

a typical dose from a single pamornographic exposure is

approximately 1 mSv.
equipment used lor intra-oral films must be fitted with at lit.-Id
defining spacer cone.

False
False

True
FUUOU1

True

Physics
. ..

_..

175

Dental radiography is a high frequency but low dose

technique.

--*~

The voltage across the X-ray tube is typically 70 kV.

The dose is approximately 0.08 mSv.
"""""
In order to reduce radiation*cl5.
ln order to reducE"iFte skin dose.
I

.-

'-' __'_<'

for equipment working up to 60 i;\./ the cone mttsl ensure at

minimum focus to skin distance oi 10 cm.

mammography
I_saittrtaa"rttti
t1=ri=i i=

U! U\

a high energy X-ray spectrum is employetl in urclor to

8
C
D

the mammography unit is usually operated at 80 l<'\/p vo-ltac_te.

the X-ray beam used in mammography usirtg molybdenum as
a target consists almost entirely of Brenisstraltlttng radia ion.
the K-characteristic radiatirtrt ol a ntolylztdenum target lor tts

a double-sided emulsion film~st.-reen combination is ttsec to

visualise structures of low contrast.

False

False

False

an intense band between 17.9 Lev and 19.5 kev.

The connective tissue, glandular tissue. skin and tat

have very similar attenuation coefficients and thus
produce little subject contrast. To visualise structures
of low contrast a low energy spectrum is used.
The maximum tub'T:tfa'gE'f5r~m?mmograplty is
about 30 kVp.
'

With loT~7'romic number target materials the

Bremsstrahlung production is less efficient The

mammography X-ray tubes are operated at low

voltages. The combination of low atomic number

reduce radiation dose to the breast.

True

False

anode and low tube voltage reduces the efficiency of

Bremssttahlung production and characteristic
radiation becomes doittinant.
'._""'_'
A sin le-sided emulsion film and single screen
combaination is used to maximise resolution. A

single-siclett emulsion film eliminates parallax: and

the single screen is positioned behind the film as this

causes slightly less loss in resolution than il placed in
front ot the ltlm.

lt
t

56

True

False

the window of the X-ray tube is made oi thin borosilicale

False

D the X-ray tube voltage should be accurate to :10 it-V.

E the mean glandular dose increases with the use ol a scatter
grid.

False

True

M A

.7
l
' t
- v

(2

. i;

Regarding mammography:
ior magntlication ntutttrttugraphy a local spot size of i-ass than
0.2 mm diameter is required
B the total permanent filtration ol the X~tay tube should not he
.lass than 2.5 mm ol ulutninittnt.

55

lor standard mammography. 'The total liltration of a mammography X-ray tube

should not be less than 0.5 mm of aluminium or
O O3 mm of molybdenum.

glass.

The window of the X-ray tube should be made ol

beryllium with a maximum thickness oil ntnt.
Beryllium is the material ol choice due-to its low
atomic number.
The tube voltage lor mammograplty should be
accur-ate to 11 kV.
Higher exposures will be needed with the use of a
scatter grid.

-I
l

,5;

"i_ L

A focal spot size in the range of 0.2-0.5 mm is used

1*
t

or

47

tutu _t.rivitiIu t~iILu..Jr|i-UtJiuU-y?

57

'1-P

tr

tI

cw

t?-T

~
-t
~.
F
c
"Q" *1
7$~I~PII"D.!I!'YwPasm?7

Regarding linear tomography:

A the X-ray tube and lm are cglnectetl lay a rigid rod which

57

rotates about a fulcrum.

1/U/,1
B the amplitude of tube travel is measured in centimetres.
C the plane of interest is positioned approximately 10 cm below
the fulcrum.
D the extent of blurring of_ an image point is proportional to the
distance between that point and the fulcrum plane.
_
'
E the X-ray tube and film move in the same direction.
58

A
B

True
False

False

D True E False

Regarding linear tomography:

:~. the exposure angle and the tomographic angles are always

~c

tube travel.
the orientation of the obiect does not affect the extent of
blurring.

o the blur margin produced by a linear motion tomogram is less

E

D
./
ill

lower than that of the incident beam.

gas detectors are lled with an inert gas such as xenon at atm9Dheric pressure..

the detectors are mass-produced in order to ensure identit.-g_l

sensitivities.
i
P

S9

"

" "W

When the X-ray tube moves in one direction the lilm

moves in the opposite direction.
Occasionally X-rays are not emitted during part of
the tube travel. inwhich case the tomographic a_ngle

True

The blur width refers to the distance over which the

False

True

1'lQ..-,l'n, comptiiAid*tEli*i1'o'gFaiiihythe following statements are true;

A
.

.
the X ray tube is rypically operated at about 70 kvp. V D "
8 filtered baclt projection is the most common image
reconstruction technique utilised in the most modern scanners.
C the average energy of the emerging beam is significantly

and is called the tomographic arc.

The plane of interet'Tp_diiioned at the same level

as the fulcrum, The plane of interest remains in locus
while planesibove and below are blurred.

False

_ _ -i_ _ o1._u

sharp than the one produced by a circular motion tomogram.

section thickness is directly proportional to the amplitude of
X-ray tube travel.

The amplitude of tube travel is measured in degrees

equal. '

a theblurlwidth is directly proportional to the amplitude of the

False

A. False
B False
C False

D False
E

False

3'5 ".9

is 9iea_E[.ll_}.ll_.F2.Q_HliD9|9-

"T

.
~.'
r.
l
l

image of an object is spread out on the film,

When the longitudinal axis of a long and narrow

organ is orientated in the same direction as the X-ray

tube travel, the image is not blurred even if it is lying
outside the focal plane. '
With linear motion tomography the entire image is
uniformly blurred and fades off gradually at its edge.

With circtilar motion tomography the blurred image

is not uniform and the margin appears sharper.
An inverse relationship exists ibetween the section

thickness and the amplitude of tube travel. i.e. the

larger the tomographic angle the thinner the section.
qt

The X-Pay tube is typically operated at about l2O kvp.

Analytical methods have superseded iterative or back

proiection methods of image reconstruction.

A photon loses only a small amount of its energy
during Compton interagtigg which is predominant in
the CT energy range.
The gas detectors are lled with an inert gas at a

high pressure of about gbatrriospheres to increase

the detector efficiency:
The detectors do not need to be perfectly matched a S

the sensitivities are calibrated during imaging.

i
I
|

'l

E1

ii

it

l.

no

|||\4vJ lull-oi HI rmdtuit.-gy

un-

60

\2

Regarding detectors used'iri'5cohiif5iited trirnograt;

A sodium iodide detectors are 60% efficient in ll1E_t2lit-Jgnostir;
B
C

O! O

X-ray range.

bismuth germinate detectors are used in prefetence ti; 5Q('|iu|~n

iodide detectors because they are cheaper.
5

the voltage between the electrodes is set high enough to

'

D
E

gas-filled detectors are more efficient than sodium iodide

False
False

C False

--. - -Q

produce an avalanche effect iii gas detectors during radiation 3

detection. "
"

@
_/,

'

detectors.
gas . detectors
, have a linear response which is not affecter1 t
the intensities used.
W

False

True

Physics

179

_Sodium iodide detectors are almost 1_QQf4= efficient in

the diagnostic X-ray range.

Bismuth germinate detectors are superior to sodium
iodide detectors as they have higher efciency and
no afterglow.
<
' " '
Tl:ie_\/oltag in ionisation chambers is adjusted such
that it does not cause an avalanche but is such that
the resultant current is proportional to the energy of
absorbed X-rays.

Gas-filled detectors are less efficient due to their low

density compared with that of sodium iodide detectors.

\/\/\.1

61

Regarding computed tomography:

,
A a first generation CT scanner is less efficient in eliminating
scartered__radiation than a third getmranon QT 5-,_;im,,e,_
B 9"el9Y dlscmtnators are used to eliminate scattered iadiiitioii
C detector collimation is the only method ol controlling
i
scattered radiation.
- D detector collimators reoulate
the thick ness~ o l t t re torziograpliic
-_,

STA

False

eliminating scatter than is the fan beam geometry

False

SECUOH.

the long axis (cathodeanodel of the X-ray tithe is

Defuendicuiar to the fan beani. ll

In computed tomography:
A each square element in the image inatrix is called El pi:-zel.
H a vowel represents a group of tour zictiaccni pixel;-:_
U0

mu 5' i 3 ll"' is ""lll llv llirlerlor wlliiiicitttn

the size of a voxel is detizrrnined by the width of the X-ray

62

True

True

True

This arrangement eliminates the asymmetry in the

True

A typical image matrix is made tip of 256 >< 256 pixels

False

(3 False
D True

beam.
a weighting lacigr is apniied during image recoitsiriiction so

which is employed in third generation scanners.

The CT X-ray beam is polychromatic and the photons
lose a very small amount of energy due to Compton
scatter; therefore, a discriminating window would not
be useful in eliminating scattered radiation.

62

A first generation scanner uses a pencil beam

source-detector geometry which is more efficient in

X-ray output caused by the heel effect.

A voxel represents a unit volume of tissue sampled.

The size of an image pixel is determined by the
cuntptitci progrtiinine.

True

85 O cmP9"53!E lor the difference between the size and

shape of the scanning beam and the pi';ttire matrix

.
\..
=t_;ii..

E7

r'.-Q -My

"~l~ ~.&Vi-Is iu-.4i4,Iiiq,l_..L,iJw

,5,

4'

Regardingthe CT number:

ifszisfgsbthe linear attenu_ation coefficierrt in each pixel.

to image
rciictgi
(K) of
moo qr more
_ _ matignlgisjgviiiIi:nhaigiie:EaUh)'n
_
igher
linear
atteniiuiinn

335,55?"WViUPl"UiiEsTIie!S$'
53

False

B
C

True

True

The linear attenuation C08ffiCiBlS of adiacent pixels

are independent oi each other.
The linear attenuation coefficient of a pixel is multiplied
by a magnifying constant to give the CT number.

Typical Cl"numbers with a magnification factor of T000

are: bone ldensel=_;_1QQ9, intracranial soft tissue = rlt)
to +50, water = 0, fat = 400, air = -1000.
"T"

coefficient than bone it is necessary to utilise a higher CT

number.

it can represent variations of linear attenuation coefficient to 5

the fourth decimal place in a pixel.
J Q,-5* fj

Regarding computed tomography: r

A the cupping effect seen at the centre of a iiiiiform density
phantom is caused by hardening nf the K-my beam,
B quantum mottle is more apparent on n CT image when a with-3
window wiclth is used.
C a variation of :5 Hounseld units in the water CT ntirii'ner
obtained during routine quality control checks is acceptable
D a 10% deviation from the expected slice thickness is
acceptable during routine quality control r;m;;;i<$_

ya

'

A it represents a relationship between the linear attenuation

coefficient in a pixel and that of its immediate flEigi'"li)OUfS.=.

i/

64

the standard deviation of the CT numbers of the pixels in rim

same region of interest used for water level calibration

represents the noise in the image.
-'*

D
E

True

True

'_"T

"'-"'

True

False

True

As the polyenergetic X-ray beam passes through the

uniform density phantom, the lower energy photons
are removed and the beam becomes harder with
increasingfdepth. As a result, the pixels near the

centre of the image will be assigned smaller values

of linear attenuation coefficient than pixels near the
periphery. This effect is referred to as cupping.

Quantum mottle becomes less apparent when a wide

window width is used.
This is the maximum limit acceptable. The water CT
number calibration is tested by scanning a region of

interest of at least several hundred pixels oi a circular

in cc mputod to mo grap|\y;""
slaitisticul
HUi$iJ
riztliices
iliu ctiiiirtlst
l'l30|tlllt)|\
til iliii iiii l lqt:
.
.
.
,
_
"
_
_
_
B statistical noisn is rt.-ducutl by an iiicreusu iii pixel ;;|u_
increasing scanning time reduces statistical noise
reducing slice thickness increases spatial resolution.
mDO reducing slice thickness increases contrast resolution
A

lili

plastic phantom filled with water.

True

This is the maximum limit acceptable. The slice

Truu

iilitiiitiiiii.
u

A
B

Truu

Si:ili:;tit:.il iiinzin is also iiiiliiizutl by illi illLllLItl5U in tliu

True

thickness.
increasing the mAs increases the number of photons

Ttiin

thickness is assessed by measuring the length of the

image of an angiilateo plate within zt special
"

rluu

slice ihicknt.-ss. Noise is inversely proportional to slice

reaching the detectors and therefore increases the
-ziiinnl in nniiin itiiin.

liiilsu

Uy iurlticiiig slicu tliicluiuss, luus uniittutl nurintu uiu

ilntc-t;it=rl tintl tliii signal to nnisu ratio is tlutzruaisutl. This
decreases contrast resolution. in addition, reducing
slice thickness decreases partial volume effects.

is

-'\ _.

.-,4

III ltdututuyy

Regarding helical C1?

A it is analogous to spiral CT.

True

Falsa

True

66

B _P?"e$ Bl 3 Slglllflnlly highell l<Vp than conventional CT.

C 5l'P'""Q lBl1Ol0gy is employed in a helical CT scanner to

allow the gantry to be rotatetl conitntially in a given direuiion

D a lull data set of 360 protections is acquired throu h the

59""? planar section as the reconstructed slice
Q
E the pitch of a helical scan is given b tr
bl y

D False

tissue-water interface.

67

_____ __

>

RE9a"ll"9 diagnostic ultrasound:

A B pulsed wave transducer cannot be used to detem mo
Doppler shift,
"
B mini
in 1 con l in tiotis~ wave tr,instltit.ur
~ luvt) |)l(?/t}t;||}(;[r|4L,\,,;,_,;5; W:
C

lll
Ill,

""9ll$IlY tlticnys smootlily with (fl$lt|lltIU \Vlllllli lllt: I-it,-;;,|l;i

58

False

.
False

~ .
.
.
. iii.tili: til tl
iiti l:l titl vvttvti tittit_.tltit.ui
lint,
ti li.it;l<iiit_; wlitcli 1:;

TH"!

the Doppler shift.

l")iii: t:ty:;t.-tl is: ii::i:t| tn lrrinsrnit tho tiltrristiiinil liiizim

Faise

.uitl tlti: tillttii is. ii:-titl Iii iiit.tiivti llll) itittiittiitgi Ullllllllii.

litiensity decays smoothly with distance in the

Ftiitiiinlitilltir l_Ul|l: lliir lit.-ltll (Jl l|lL' tiltitisoiiic beam,

wltit:lt hm; litiytintl int: finsntil mitt) (tit:-'ii' liultll. Thu

A\

<

A continuous wave or puled wave ultrasound

transducer may be used in modern studies to detect

Tum

approxtittately half the spatial iitilsi: Itiiititli

The disturbance is in the same direction as that of

the propagation of the wave.
ll-l_g is 1;cycle per second.
Less than 1% ofthe ultrasound beam is reflected at a
soft tissue-water interface, dyer 99% of the ultrasound
I
beam is reflected at a soft tissue~ai'r interface.
ln the majority of soh tissues the speed of
transmission is jtist over 1500 metres per second.
The speed of ultrasound in soft tissue is essentially
constant and is independent of the frequency used.

ho limit of axitil ltluiith) iesoltitioii for il stznnnm gs

_-!\
t

circular contact with sliding brushes. Due to this

arrangemht the gantry can be rotated continually in
a given direction.
During helical scanning the patient table is advanced
while the gantry is rotated, thus continually acquiring
the data in a helical fashion around the patient. To
reconstruct planar sections the raw helical data is
inte[goh2i_tgd so as to approximate the acquisition of a
full data set of 360 projections.
For example. a pitch of 1 means the table increment
per 360 rotation of the X-ray tube (measured in mml
is equal to the slice thickness (measured in mm).

'"" l'"JlIl llultll of tho tiltitisoiiic litiiini

t-

Helical CT operates at a similar kVp to that used in

conventional CT.
In a slip-ring gantry the electrical connections to the

False

tt.ii:.i.- tlttttiping nmlertal.

E

True

A Tme
3 Faise
C Fal e
t
S

ll so f t_ t'issues the speed ol ll'6l1slIllbSl0fi

r.
bl
of the ultrasound
ream '5 3" 15 009 "'"=ll'95 Der second.
.
" *
. ,
_
. soft
_ i e spee
of transmission
of the, tlllfi3..rO'.lll(l
beam
lll
issues will increase /Vlllt increesiiig liecitiei-icy of the
transducer.
___-__....._..__.___

68

The following statements are]

l-.lltrasound:*-- ---we regarding diagnostic
A ultrasound vvaves are longitudinal waves.
B me Wm Of l'eQ"9nY H9"? lH1l l5 "73 lIYFl@$ Der second
C Over 99% of the ultrasound beam is reflected at a soft A
D

183

X-ray tube and detector array are achieved using a

_
_ y ie ta e increment per
360 ''a"" f he XfaY lube divicletl by the collimation.

67

Physics
xiii

E
'

"

True

Fititiuiiltolltii mite consists of rt divergent main lobe

.iiiil :i ittiiitlrtti tif iul;ttivt:ly wutik sitlo Iolms. Ctllllllluk
intensity varialiorts result from interference effects in
the Fresnel zone immediately in front of the
lli]flSdllt.Zl;l.

1irv...,~v

~ir.._wn'-

184

vriur

tr

'-er

~17

~-t

vi

'3 my

,|y.

aw

yr.w..y

v.7

$7

MCQ Tutor in Radiology

Physics

$553? R8981diglhe ultrasound__t_rensdueer?-1

i

A the majority of diagnostic ultrasound machines operate at

185

True

True
False

frequencies between 1-10 MHz.

the bandwidth refers to the complete range of frequencies
generated by the transducer.
the lateral resolution is independent of the beam width.
the side lobes of the ultrasound beam are occasionally
.
responsible for image artefacts. '
1
mU
Q
HI . the ultrasound pulse length is kept to -"i minimum to optimise

True

the axial resolution of the transducer.

True

The lateral resolution is the resolution across the

beam. This resolution depends on the effective beam
width at-fe depth of the target. _
Image artefacts occur when highly reflective
structures fall within the side lobes and return high
amplitude echoes to the transducer. These are then
registered on the screen and create artefacls.
If the pulses are unduly long ll.e. of the order of

hundreds of rnicrosecondsl the ultrasound

equipment will He less able to determine the position
of an interface with a high degree of accuracy and

thus the i3I'.l8l resolution will be reduced.

t.

70
1

The following statements are true regarding diagnostic

ultrasound:

OJ\7

7/

B
C

D
E

for a 2 MHz transducer a 2 cycle pulse lasts for 1 x. 10'

seconds.
the frequency of the transducer is also known as the pulse
repetition frequency (PFtFl. .,
.
by increasing the PHF from I0 000 to 100 O00 pulses poi
second a significant improvement in the image resolution can
be achieved.
y

the intensity (or powerl of e continuous ultrasound beam is

measured in number of pulses per square centimetre.
for a continuous wave transducer the intensity or power is

usually measured close to the transducer surface.

7O

True
False
False

The frequency with which the pulses are transmitted

is termed (the pulse repetition frequev (PRFl._
No significant improvement of the image quality can

be achieved beyond a certain PRF value. The general

range of PRF is from 50_0 to l5QQ I1d8i_'S8C_C:lt1d. as

False

True

The intensity or power is measure

lmWl per square centimetre.

in rni iwa
'""_'-Q

-v

\
v

i
r

2.
.
1

.1,

...-4;.-~i*r'~~~
-'1.

\_,

. V. _4": r-'

..'

,=...i .

;_

._

wt

'

**

" T

t.

--

"

;' .
'-2-sf

-"n-,'~"|;\,i

'

'

,
.

--

.
-'
1

.
,
-

'

1 :.-'.. 2-: -'1

.=..<;;':i. --.
-='\Li|l.-'~1,:,'.\.
._ ';r.'__'

.'.~'=,i.t;. it

ll

"
. .-_-... -- |<
r

,,|r

lt-

. ('t,"'l

-'1 51-"'

.
{'1-;g_l-c":J.~$J~;:=' '
4 _.
_

_l

_.

186

MCO Tutor in Radiology

Physics

187

'7

/1

Regarding the Doppler effect: i

gist

P ihapgrent frequency ol a signal is altered if the Sourcg of

--=--il 1" iiivvirig with respect to the Observer

'\\e.{{("1\Ll?HCYDfihB_ reected tillrasound waves decreases ii

- --. ilnca I5 movinq towards the ll-ansducer
C-iiil-ht?tqi1ifUd_e of the increase in the frequengy is (ii,-ect|._,
..lt1(.rufllUllBi to the velocity of the moving object.
l
mg LFITqU8CYd3[f)1lfT depends ori_the_sine of tiie angle between

rasoun eam and the direction of movement of the

blood when used to measure blood flow
a_li1_i1g arises when the Doppler shift frequency Exceedg hair

..

' ,il:n:l

True

False

The reflected frequency iqgrgases if the iiiteitace is

moving towards the transducer and vice versa.
The shift frequency is also diregtlyprgpgrtional to the
original ultrasound frequency used.
It depends onrthe cosine of the angle between the
_
ultrasound beam and tlieidirection of movement of the
blood,lbeam/vessel angle, B). Therefore, the l1_l)il_;l_lg_f\l
Doppler frequency shift is obtained when 6_i_O_" and so

cosine 6 is _l. Conversely, when 8 is 90, then cosine 9 is

the pulse repetition frequency (PRF) Q! me [men-Ogalin

ultrasound beam.
9'

True

0 and no Doppler signal is obtained. in clinical Doppler

examinations, it is important to lteep 8 as low as
possible so as to ma5rimise the Doppler sigi"ial.' "
There are several approaches to overcome aliasing in

clinical practice. The PRF may be increased if the

ultrasound equipmenF pplar shift

frequency may be reduced. The shift frequency may
be reduced by using a lower ultrasound transmission
frequency or by increasing the beam/vessel angle (8).

72

The following statements are triie:

A he angular il'9"l'-19"!-V Oi Drecession of a nucleus is
deiermined by he p""' " "9 9V'0IQa0[1et_ig ratio of the

72

ucieai BPBCFBS and the E:.\lfBfftdi field strength T

for the aid 5"9"lS"'Y9 Wliilllly used in it/ii? imaging

applications, the proton Larmor fieqiienuy lies in the range

II

u ti : "tlltt
'
- iimniuiitum oi gm ,,,,L|m,:,_.
llm -ii\giil.\i
it l"l"""|J
I
-. "ll lllli .r.i|mi iil iiiip.iiii.il
. _ llllillllili mitt ||.;t;||.,
|l'i

it L|\)1lullti5 on tliii oihiiiil llltiilult Hi Hlti- ,,.,\|,,,,,.

.
.
|||lUif|H\||,,

llm iiiiuliiiti :i|llH viiltm ll ir,

Illrt-1;--|
.. . ...iii l |u_if ur'

a magnetic field.

f ii I
=.;
' U mi
iii

True

B
C

True
True

2-80. MHz:
thietgyrorragnetic ratio ol hydrogen UH) is gag MHZ,-|-_
MP 5 5 /9' Qvrtagnetic ratio than those mi 13c_ 15N_ or
tliia
' ' _; l:::;
Hm irilativit
"H. M ritoriiir
H
- oltiinilriiim-r i-.l l"('
. -'"ll liviiii
i ill 1 i- :i li|g|h.i
'

False

False

nucl 8' " 5 "weal Spin villu ll) ol zero are Sltiihig rm Mitt

The gyromagnetic ratio of 3Q_iss_1_Q_;Z MHz/T. The

gyromagnetic ratio of SN is Ali]

The
gyromagnetic ratio of P is 17.21 MHZ/T.
The relative atomic abundaTi'r':e'olT~l is 1.0 whilst the
relative tttoiiiic ubiirirlaiicr: of ZC is 0.19. Of all the
iitiirrt nliiiriilziiii l)itllI\l.lH5 iii iiitiii, ll liiis tho most
tiruiiiisiiiti iiiiultizii |)ll||)\!lUU5 liir Mill.

/ll

/\
ll

lruii
l'mu,

iillfi i:. iiiliiiiiiil Iii .i:. fill] hlllll iiiigiilsii _i_i_i_i_i_iiiuiiiiiiii.

||\l:Z Iii iiilirtiutl ill .i:. llm uihiliil llllullfill iiiuinuiitiiiti.
It 3:: :ii:tii:tl|y tzriiiststl liy this spiniiiiig| iittiltuii (if tho

\Il\lllll iiiii;luii:. iiitluii tli-iii liy llllr uiiliiiiiiiiil_iiiil iiiiilinii

iii this iiiiliviiliml iiiii:liiiiii:i.

" WHY"
Hill!lillfiltjllb
Hi II w|:n|ii
lliu piuciissiuii
til lllU
wlim,iitiiiiliiii.
:;|;,(;mi 5,,

This is the Larmor equation. Therefore the

precessional frequency of a nucleus increases linearly
with increasing externakmagnetic field strength.

Fulsu

D
E

True
False

The iiuclutii spin Vililll! ll) isytilwiiys zero, a multiple

of l/2 Ul a wliole niimher.
Nuclei with a nuclear spin value of zero do not

precess in a magnetic lielcl. Nuclei with spin values

ol other than zero are suitable lor Ml.

__v._-.\_-sq--3-.wwvs-r.__vrvr<w\>r\iw.awr'7i%'I'UIWW'

'i\-1't.t4'iutor in Ha .iioiog--,

I00

i i

When a t3Lllt)frEqt.l-.itCy pulse is applied to a tissue slice wi

thin
an MR magnet:

74

74

resonance does not occur it the energy is delivered at a

different frequency to that of the Larmor frequency of the

True
False

nucleus.

D
E

False
True

As a result of resonance the NMV moves out or

alignment away from the direction of the external
ntagiieti field.

This only occurs when the flip anglais 90.

at a flip angle of 45 the longitudinal NMV is cornplett;-ly

transformed into a transverse l\lM\/.

as a result of resonance the rnagnetit; moments of the i'|tit:lGi

4|

within the transverse NMV move into pliZS& with :8tIll other.
75

'

Regarding spin echo pulse sequences:

A
.
_ .
the recovery time constant ii is the Kim: ii takes lor 50% of
the longitudinal magnetisation to recover in the tissue.
8 the Tl recovery is also termed the spin-lattice relaxation.
C during free induction decay (FIG) tne magnitude ol (lit: voltage
in the receiver coil is reduced as the ntagnittide oi trrinsverse

75

the echo time (TE) is the time from opplicati-.:-ti of the Ft? pulse-.
to the peak of the signal intiuced in the receiver coil.

_
I
-he; ,.
V . ._
_
A spin
' 0- spin
relaxation describes thu decay or trrinsverse
magnetisation.

C
D

False

lt IS The time needed for '3_% of the longtttidtiiil

True

The recovery oi the longitudinal magnetisation is

magnetisatiori to recover.

>

termed T1 recovery. Ti recovery is caused by "YB

stirrounding en_v_iro__nQ"iertt or lattice and IS trml

\\//7%i*?i%1tiiiii=?ft=$@ne'is.tmssitw~l!\g1!3!l= tit
8

resonant nuclei sharing their ext;ess_enert__|y_vvtllithe

rnagnetisatton decreases.
D the repetition time (TR) of the ratlioireqtieiicy (RF) pulse has ti
valueof more than S sacoritis.
.

189

True
Om}

resonance does not occur ii the energy is delivered at an

angle other than 90 to the net magnetisation vector ifNl\'lV).
C during the process of resonance the aligrinient oi the Tll'\/lv of
protons and the external magnetic field is unchaiiged.
8

Physics

76

the relaxation time constant T2 is the time it takes for 63% in

spin~ia'ttice_rr|axation.

True

False

True

True

A 5'i'E|_B~r"\E'lTz.tge is only indticett IN the receiver

coil it the magnctisation in the transverse r>l.tne is in

phase.

The TR is measured in [[Til|_l_Q_D_d_- Tvwwl /alum

long Tl"-_i_ QQQQ ins, short TR 250__7Q{J_ miTypical values: long TE 8'0 ms; short TE to-25 rns._
.

.
Spl-':i[ll\ relaxation is also termed T2 decoy. Thu
decay of transverse htagnetisatioti is catisetl lay the

redistrihution oi excess eiiorgy among tilliut iesonatit

nuclei which are rolatively less excited.

the transverse magrietisation to bu lost.

T1, T2 and 12 rate constants descrihe exptlmential rlt1r;5-'15,

Tl Lia

True

the time constant T2 is always shorter than the time coilstaiit

T1 in biological materials.
y
the time constant T2 is always longer than the time iii,-i5t;,m
T2 in practice.
_
_.

|'l" OD'-3-'1

True
False

in practice. the time constant T2 is shortertliari the

time constant T2. This is because loss oi split

coherence is iiiiluenced by other factors, such as

locztl inagnetit: field inhomogeneities. in dtl(lll|O to

spin-spin inter.-"ictions. The time constant T2 denotes

the obscweti decoy constant.

_._

t
E

ta.-; i

77

r\'"~/

>

viii
L?
,_ll..
uq

in a spinecho puise sequence:

_
A hydrogen ih water loses trarisverse magnetisation faster than

the hydrogen in fat.

L,'~

Physics

.-.... --.~\vt ur ttdululugy

_.r

'

False

the Tl recovery of fat is shorter than the T1 tecove of wla

_
_
_
FY
ter.

True

me T2 decay time of lat is approxirnately 80 ms. I

E
9 5"-*_"9\ 07 5'9"?" Pfdtlced in a T1-weighted imagei

False
True
True

the T2 decay time of water IS approxiniately 5 ms

THUOCIJ

77A

proportional to the amount of transverse rnagnetisatign

produced after application of the RF pulse.

_\11-

~;'
-Ty

!L'I,/2;
1

!U~i

"""
r. .;-

91

t
'1

'.."

11;,,

73

lgegerding parameters affecting the MR image:

('3

/ti

t./'

_/t r/'

nu

l;f

rt

/5./r_'e

oi excitations.

1.

bandwidth decreases.

True
True

m____._

an increase in the field of view can be useci to overcome an

aliasing artefact.
r

U8

-.1,-:'lr.'t."'
.:r-(1/ti

_h,_}

Ti

(ill 75

False
False

the signal to noise ratio increases as the square of the t'tttrl'il)er

the signal to noise ratio is reduced in rlirect t)r0[)0r'tiQn to

decrease in slice thickness.
D the sigrtal to noise ratio increases as the clata acquisition

/.t

,...

.,_;-

78A

antncrea_se in the eld of view (FOV) decreases the signal ,to

noise ratio.
,

Z1

.tr

An increase in the FOV increases the voxel volume.

Large voxels contain more spins than small voxels
and therefore have a higher signal to noise ratio.
The signal to noise ratio increases as the squareledczt
of the number of excitations. The number of
excitations refers to the number of times each value
of phase encode is repeated.
Le. thin slice images are noisy.
Reducing the data acquisition bandwidth results in
iess noise being sampled relative to signal. However,
chemical shift artefagt increases as a consequence.
An aliasing artefact occurs because the imaged
abject is larger than the chosen field of view.

..
False

A superconducting electromagnet has the best

with other types of magnet.

False

A resistive magnet is water cooled while a

superconducting 8l8Cll0fT\t':lQf'l8l is cooled using

tron-cored resistive magnets can o t)Gl1i0 at fieltl

'
st rengths= upto 0'5 Tesial
*

True
False

\[]79.t':B95i'dih9. magnetic resonance lntaging (Matt;

79

a perntanent magnet has the best t etnporal stability compa;-ett

B
C
ta:
It

For example, there is more transverse magnetisation

in fat than in water after the RF pulse. Fat therefore

la

.l._,t_..( _,..':

magnetisation faster than water.

_
Therefore lat has higher signal on T1-weighted SE
sequences than water.
r
The T2 decay time of water is approximately 200 ms.

_ _.?_ _ __

r~:-i_,- r~.-1'_, ,.-,- .-

longitudinal axis titan water and loses transverse

:__~ __ I: 55

, ...

Hydrogen in fat recovers more rapidly along the

has a higher signal and appears brighter than water

in a T1-weighted image.

r.

2%?
,A_-.
(

191

al_ '9_5,'5l
'
' cooled using
- lluitls
. such as
magnel _lS
cryogenic
iqutdiheltum and liquid nitrogen,

glpmrgagttettc field requires rt homogeneity Qt 0_1 pa,-ts De,-

in vivo spectrometry tequitcs '1 titzignct with ti Pi =|| between 0.1 and 0.2 Tesla. Q l
L Sucnwh

temporal stability.
ctvogetttc lluitis.

False

The field liomogcneity needed is 10 parts per million.

The field strength required is in the region of 1-2 Tesla.

.- r-. l

. Jr;-.-..

131-"{yi

~ r

we./_._.

"1

wv

wr' I

w-

w-

. \-

. qr

\u>

\-

up

-1

H7

>|'

Ir:-_w'_v\.w_<_ysy,'

192 ~ MCQ Tutor in Radiology

\J

00 S

outside the magnet.

there are three sets of gradient coils.
a gradient field is used to perform slice selection.
slice thickness can be altered by changing the bandwidth of
the applied radiofrequency pulse.
2
shim coils are used to perform frequency encoding and phase
encoding.
T

B
C
D

\Iv t av

. up

False
True

True

Q7

1'

|_I

Physics

y,

~
/-friffr;
-i</
1'.

True

The gradient coils, shim coils and radiofrequency coils

must all lie within the inside diameter of the magnet.
A gradient coil generates Q transient change in the
magnetic field which varies lapproximatelyl linearly
with position along the axis of the magnet bore. lt
i

A gradient field is superimposed on the external

magnetic field. Protons along this gradient iietd are

sensitivity and spatial resoltitiori aie iiitleperitlerit of ez.it:li otliet.

its resolution is equal to the square root oi the stint oi the
st]ti.ittt:t til tliu tttlrtitstt: t_|.'tiititt;t tzriiiitliit ;liiil t:ulliitt;ilt.ii'
|tlUU|tlllt)l\5.

to the precqssional frequencies of the protons in that

particular slice.

Slice thickness can also be altered by modifying the

steepness oi the gradient field.

Gradlentcoils are used to perform frequency
encoding and phase encoding. Shim coils are used to
achieve better magnetic elcl i\9lnQQ|1tilY. This
process is called shinii"r'\it"i'tj'."-T

'81ti-Trtititsllrisr-qtaartlmeii=2gt$gt;gs;5~9:.~gii=;q;.g
B

raise
True
False

-"-'-

High sensitivity is associated with poor spriiial

resolution anti vice versa.
its spatial resolution decreases with E.llllt'1Ct_21St3 in

tltt.-;iilliiii:itiii tii iili|i:t:t ili:;li'iiii:n.,Tlti:i is triiii for iitl

l"/|it::; til i:tilliiii.i\tii

its siizilial resolution increases with on l(lCfl:il5U iii the

it produces approximately 40 visihle light photons for each

pulse height analysis is tisetl to select those pliotniiiiiliipliiii

colliniator-to-object distance.

incident M0 kev gamma photon that it detects.

tubes tPMTsl in the detector heail which have dettictitil Ll

scinullatioii.

Fulse
Ftilse

The tleti:i;toi systeni tiiutltictis .i|iiiio.\.iiii.iti:ly -ltltlt)

visible light photons for each incident gamma photon
that it detects.
Pulse lieiglit ;lthl|YSl$ is tisetl to select those pulses
geiiurtttiztl liy the PMTS wliit;h_cut"rt:sponil ttl_t_hu

gaiiiinri ray eiiert til the ratlioiiuizlitle being eiiiiitcil.

in principle, plli$3iGlQ|1l analysis allows tscriiination
between scattered and unscattered monoenergettc

ganiiiiai rays.

~\\
\.

~\\_

\.~

'*~\

=1. i Hf

ix

.;=~- .

5F:-'3t-1~5"i1?'~'7-. _
-l4/I

it

~~<-

193

exposed to tlilferent magnetic field strengths and

therefore have different precession frequeiicies. A

II}

slice _can be selectively excited by transmitting a

radiofrequ.=.iicy pulse with frequencies corresponding

.;-

II- .!I

each other.

_i
-._v

False

r_.

.37

generate field gradients in directions perpendicular to

1I

3'

thus produces a field gradient. The three sets of coils-

tqyv, Q

ln a MRI scanner:
A the gradient coils, shim Coils and radiofrequency coils lie

80

.&Iv.

... .

.-':'r. =.;'Za

_""i""

4-'1"

- wt

.?'//5'"-y.

_i.;:!_;t--J_

\__

~- _

\\

\_

'~--<.'=tlt<-:e~.-:>:~r1i*1--- '-*4-.

.21Li_Mg

'

'09 X -\

-_q

~<

1.

!'

g.

.-_

vi

-,
..
. . ..
. , ,-- . ._-'i~-i'Li".i'.
_ ..
. .3
- , i . _
D
___,>._-_
,_
q _"V
31;:
.1;;;-.,-r;
_ -, - -t. .r--'.'-' ~ f s _~-'1"-ti.-'__;.;
1-J.$JZJ*
____
.
,.,
y ._~- -,..,
'
-1; jy-_"_.
:'-_
..,._..':L_l--'~"--.1" ' - .
.
..
71' !~-=l'5'{;i.1.- 5*? $133-=:_'5'_._':3
ii.'

.r'

Yr

_f..'.=_.r,tf':<-.
.<>

.-_.

T)

'

--/:3,/"

Qw

'

..

"
'. g
a '
,_,5*_:_.;_,_, ___. i ..,,_..erivstaiitresgm~"es'ii@1
.

Physics___195
_=i'

True

Ttp_ high dBSllY and B Tllql Ell".-ritir; numi;-_-1'

Th'"lTigll_t_o__itiic number favours a plioio_el_ectric

is a pure sodium iodide (Nail crystat. ,

is typically 9-12 mm thick.

,,must be placed in a liermeticalli/' s}aieri container.
0mct
mi. has an improved sensitivity when it is thick rather than tltin.

False

____@-

_c

True

tr:

True

'

B3

>>/

0 //

Regarding a gamma camera collimator:

"
A
\
a parallel hole collimator fc-rrnjs
an image by relraciirig gainiiia
rays and bringing them into focus at the sodium iodide

detector surface.
a high resolution collimator has a low sen-siti-.~ity.
a_slant_hole collimator should be used lor gated cardiac

B
C

L0 =

I
. '
-.
. . :
agar ing-iSingie~Photon
Emission
Computed
Tomography-i,
_

J Z
I

r>%

.~.y

E
\-

False
True

False
.
False

False

"

B single headed gamma camera must always rotate a full 360

around the patient to register e SPECT acquisition.
the most widespread mode oi toiiiograpliic acquisition is the

True

time as compared _with a single headed gamma Camera

False

step-and-shoot method.
a multiple headed gamma camera increases the acquisition
because comparatively more gamma rays will need (Q be
detected.
'

"

True

True

R5"' d-

isPEcTiii.
A

Z\

acquisitions.
a lan beam collimator helps to keep the teniperature of the
gamma camera electronics low.
by increasing the length and number oi the collirnr-itur liules
the intrinsic resolution ol the gamma carriers criri be iitipru-.-etl.

a single headed SPECT camera cati only follow a circular or

elliptical orbit around the patient.
'
the centregol rotation (CORJ correction is stored in the computer
memory at the time of installation and is applied to all

subsequent SPECT studies.

This ensures that the crystal has a high stopping

efficiertcy for gamma rays for a given crystal thickness.

False

False

interaction which results in a light pulse that is

prop'c'>'?ii'oTiEil to the gamma ray energy.
The scintillation crystal is a sodium iodide (Nail crystal
doped with approximately 0.1% thallium (Tll. The
thalliurn increases the light output irom the crystal.

The Nal(Tll crystal is hygroscopic.

"However, a thicker scintillation -rysta| degrades

iritrirti_ic_;g_c_ilution and therefore the crystal thickness
that is chosen represents a compromise.
A parallel hoie collimator works on the principle of
an absorptive collimation. Unlike visible light, gamma
rays cannot be refracted.
increased resolution can only be achieved by
reducing the overall sensitivity.
A 15 slant hole collimator is best suited for
separating the left atrium from the left ventricle.
A fan beam collimator refers to the arrangement oi
individual collimator septa and is used for cardiac
and cerebral SPECT imaging. Collimators do not
control the temperature oi the electronics.
The intrinsic resolution of the gamma camera is a
function of the sodium iodide crystal thickness.
number and shape of the photomultiplier tubes and
associated electronics. The collimator characteristics
do not affect intrinsic resolution.

A SPECT acquisition can be performed by a gamma

camera rotating 180 around the patient (e.g.
myocardial perfusion study: 180" rotation).
A multiple headed gamma camera is much faster
i\B a single headed camera because multiple
projections can be acquired simultaneously.
Modern SPECT camera heads can follow an operator
defined contour around the patient. This reduces the
distance between the detector and (he gamma camera
thus preventing loss of resolution.
The extent of COR correction can change with time.
Therefore the COR correction is assessed on a regular
basis (e g at least once a week) and then stored on the
(_QFnpUIQf_ his a plied to

e.SP CTm a e

rl

WP

196

xi

X7

J7

4?

~47

-Y

*1

II

-W '

BA

c
o

T \ T

Physics

Regarding positron ernistilon toitiotirapliv lPETl:

"

MCO Tutor in Radiology

35 A False

a positron . has a unit positive charge and no mass.

a neutron is convened into a positron and a proton during

raise

positron emission.

the scintillation detector is usually made of bisrntith german:-ite.

the positron decay is detected by a coincident detection method
the positron emitters that are used in PET imaging have
,
longer half-lives than that of 99Tc.
'

True

A positron has a unit positive charge and the same

mass as that of an electron.

During positron emission a proton is convened into a

negn and a positron. A positron and a neutrino are

e|ected fr00Wth'rT_ticleus.

The high atomic number of bismuth (Z = 83) and the

high density of the crystal give a high intrinsic detection
efciency for 5ll kev photons. These phototTsFe_
produced by the positron annihilation process.

True

False

197

The tatlionticlides used in PET imaging have very

short half-lives, e.g.'C l20.5 mini. "N no mini. so

(2 min), '8F {H0 min). The half-life of 95"Tc is E hours.

t
a
rt
U.
.
ti
t,
= eg'ardin'g;tha-handling
of:unsealediradionurzlidasztt
tIl"ia"adri'tinisiered activity
is measured using a scintillation

False

detector.

False

False

lead syringe shields are used during the dispensing of

radiopharmaceuticals.

True

performed using a calibrated dose rate meter.

False

routine contamination monitoring of controlled areas is

Caiil[Q_lOf.
t
'
lsotopetzalibrator performance depends on the source
geometry. Different calibration factors are used lor the

the performance of an isotope calibrator is independent of the

source geometry.
mouth pipetting of radioactive liquids with low specific
activities is permissible provided that it is performed in a well
ventilated fume cupboard.

Activity is measured using a calibrated isotope

same radionuclide presented in different geometries,

i.e. 99'Tc activities measured in a syringe and in a vial
require the use oi different calibration factors.
Mouth pipetting of radioactive liquids is not permitted
under any circumstances.
The use of lead or tungsten syringe shields reduces
nger dose.
A calibrated contamination monitor tnot a dose rate
meter for appropriate radionticlides is used.
.,

87

Regarding patient dose resulting from the atlministration of a

radiopharmaceutical:
the dose received depends on the decay scheme of the
radionuclide.
the absorbed dose is directly proportional to the arneunt oi

radioactivity administered.

True
True
False

the biological hall-lile does nut aileci the ahsorbutl dose.

Patient dose is independent of the image acquisition

times using a gamma camera. lt depends primarily
and other measures taken to reduce patient dose
iii.t|. lltyttiij liititikinqj tiititlrtl.

int Aliti/\C iiitzuitiiittmtltitl t|n:iu:t lliti nil<tt.l:vu llkliiit t;\|\|lV.|ilI|ll

absorbed radiation dose.

on the amount of radiopharmaceutical administered

the patient dose can be decreased by retlticing the ticquisiiiori

times using El gamma camera.
lEUl) ti; tilwiiyzi lusts lhiiii S tiiSv.

the type of radiation emitted and the presence oi

radioactive daughter products will influence the

|3itl:tu

litir tixiiitiiilir, tliu tltmti tliiti iii *'' ll itziutl lll

False

A shorter biological hall-life reduces the absorbed dose

lliYUL2Llli.llil| iititigttig is lttt_)liut', Lu. Blliiitiv.

'7

ct

.,e
"T-4]

Physics
88

A the average total annual radiation dose to a m8rt"|bet of the

UK population is 2,5 mSv.

made contribution to the radiation burden ol the population

living in developed countries.
_
_ _

the average effective dose from a skull radtograpu is

the average effective dose from an l\/U exarntnatirm is

approximately 0.15 mSv.

_ er
A True
B False
True

nuclear fall out and discharges account for the largest inan-

True
False

approximately 3.5 mSv.

99
_
the average effective dose from a '"Tc MD. bone scan is

_
Regarding radiation doses'
B

.-- at
""r.1

l. ..

MCO Tutor in Radiology

I98

'1-~

.__

The effective dose:

'

89

A is the same as the effective dose equivalent.

8

True

of an abdominal radiograph is approximately i.-5 rnSv.

of a barium enema is equivalent to approximately 4.5 years

natural background radiation.

of a chest CT scan is equivalent to approximately 40 PA chest
films.
of a 2lTl myocardial perfusion scan is less titan that of a
99"Tc methoxy isobutyl isonitrile tMlBll myocardial perfusion
scan.

D
E

True

True
False

Regarding the radiation monitoring film badge:

y
A the X-ray lilm used inside the badge has a fast il'\Ul$ltZ2-I! on
one side and a slow emulsion on the other side.
B the cadmium-lead filter is used to estimate the e.~.tmsi'irr: to
thermal neutrons.
C the photographic lilm becomes progressively less optically
dense as a result ol exposure to t'.',-nising radiations.
D the use of plastic, tin anti aluminium litters tn a ltlrn laatlge
enables the _:distinction to be made between X-ray and

ultraviolet exposures.

E
.$.!'_it
r ' '/

effect on the whole body of the radiation doses to

several different organs or tissues in the body.

The effective dose from a 99'Tc MDP bone scan is

approximately 5 mSv.

so

False

False

the lilm badges are calibrated by exposing sonic badges lrotn

the batch to e known amount of radiation.

True

True

-'

The 1990 Recommendations of the international

Commission on Radiological Protection llCRP
Publication 60l now use the term effective dose,
which is analogous to the term effective dose
equivalent used in previous ICRP publications.
The effective dose of a barium enema is
approximately 9 mSv.
The effective doses of a chest CT and a PA chest film
are approximately"8 mSv and 0.02 mSv respectively.

Therefore the dose of one chest CT is equivalent to

False

-v t

Medical irradiation contributes up to 90% of the total

man-made radiation dose.
The effective dose is a measure of the combined

approximately 15 mSv.

199

Tru e

that of 400 chest films.

The effective dose ol a 2'Tl myocardial perfusion ,t
scan is approximately 20 mSv. The effective dose of
a 5'9""Tc MIBI myocardial perfusion scan is
approximately 4 mSv.

ll a high exposure of radiation has occurred. the fast

emulsion can be removed and an estimate of the
dose can then be made from the measurements on
the slow emulsion.
The neutron capture by cadmium nuclei results in
gantttta emission which exposes the lilm.
The photographic lilm becomes progressively more
dense as a result of exposure to ionising radiations.
The different filters allow the distinction to be made
as to whether the dose was the result of beta particle
emission, high or low energy X-rays, or gamma rays.

~-

-1

200

tw

wy

sw

<7

wt

\t

~17

"JP

-W

$ '

\7

\7

tt

3'

,7

Physics

MCQ Tutor in Radiology

201

/_

An air equivalent wall ionisation chamber:

A is unsuitable for measurement of radiation at the higher

91

False

An ionisation chamber is suitable lor measurement

of radiation at all kilovoltages used in diagnostic

False

The amount oi an electrical charge or current

released inati ionisation chamber is very small.
Unlike the Geiger counter, the ionisation chamber
cannot be used to count individual radiation events.
Instead the total amount of current passing through

radiology.

kilovoltages used in diagnostic radiology.

B is more sensitive than a Geiger counter.

C can be used to measure cxpsut talesD may be convened into a chamber whose response varies with

photon energy in the same way as the standard air chamber.

requireshigh gas pressure inside the chamber.

True
True

the chamber can he measured using an elecirometer.

By adjusting the size of the aluminium electrode and

the amount of carbon.

False

The gas used is air at atmospheric pressure.

True

The RBE oflthe radiation is a ratio of the dose from

standard raliiation (usually 200 kvp X-raysi to
produce a given biological effect to the dose from the

Regarding radiation protection:

\)
\7
V

A the radiation weighting factors (quality factors) depend on the

relative biological effectiveness (RB_El Of the r8dili0- I
B the radiation weighting factor [quality factor) for X-rays i_Q__5__
C the annual whole body dose limit for a member of the public
D
E

False

is ten times less than that for a radiation worker.

the average annual whole body dose per person in the UK
due to natural background radiation is 10 mSv.

True

exposure to natural background radiation mainly arises from

men. "K and "c.

False

test radiation to produce thesame biological effect.

The radiation weighting factor for x_ffa\/5 (and

gamma rays and beta particles) is l.
The annual whole body dose limit for a radiation
worker is_9 mSv. The annual whole body dose limit
for a member of the public isj mSv llonising
Radiations Regulations 1985).
The UK population average annual whole body dose
due to thenatural background radiation is

approximately 2.175 mSv.

True

J The radiation weighting factor lqtitililv lvlllrl is:

A
.
.
.
.

.9

8
DO

dependent on the relative biological effectiveness.

greater for radiations with a low linear energy transfer.
. .
.
a factor determining equivalent dose.
higher for all particulate radiations than it is for Co gzininizi

emission.

True
I

"5'

False

lt is greater lor radiations with higher linear energy

True
False

The quality factor for electrons (except Auger

--

transfer.

elociroiis utiiiiteil from iiiiclei huiintl to ON/Xi is tho

snniu as llliil lnr Cu gainniii niiiissintis.

ctiitsitlnrtitl in hit izunstiiiit for lliii iliziiiiiiizitii: itintiu iii X rtiys.

lrttu

t
.

Physics

2o2 MCQ Tutor in Radiology

9 A False

94 6Rii=$!*!iiI!,2.i!119.l.P"$!5?i'iiiiiiiiti'55ii'=iBdi5'9PW3""?.5@
7educed byzqj

reducing scatter with a grid.

decreasing the object to fllm distance.

compressing the abdomen during an lVU examination.
using rare-earth phosphors in the screen.

B
C
D

selecting the highest tube voitage consistent with acceptable

image quality.

95 Regarding diagnostic imaging:

\/ B

gamma emissions from 99"Tc have a higher linear energy

transler iLETl than 100 kVp X-rays.
small temperature changes in irradiated gonads are thought to
be responsible lor the consequent genetic effects.

converted to heat energy in the tissues.

dehydrated patients are at a higher risk of t8di6tiOr\<inLitit;E\d

k/ Qe

U0

'

True

False

The LET is the number of keV lost per micron of track

of ionising radiation. lt is similar for X-rays and gamma
rays.
Temperature changes are insignificant. Genetic
damage is caused by the interactions betweert ionising
radiation and the genetic material of the germ cells.
The state oi hydration is not relevant.

False

False

USA

False

False

Fiilsti

I)

Fiilsu

False

Tliii lllvtltiill i:; tiini

'
'
Gamma emissions and X-rays are both equeliy likely
to produce itori-stochastic eilects.
'

97A

True

Above the threshold dose, non-stochastic eflects

True

When the tliresltuld dose level is exceeded, the

severity ol the non-stochastic effects is proportional
to the radiation dose.

C
D
E

True

the severity of stochastic eflects is dose depeiitlent.

Cancer induction is an example of a non-stochastic effect.

y
All the somatic effects oi radiation are SiOCilc!S[iC.
radiation dose levels in tliagntistic rtiiiiiilugy ant more liitely in
|JlLItillLll: nun ::tticli.islit: etiutzts iiill LiiOt2ihi:5!I\1 t.-lltrctzz.
gaiiiinu 0ll\iSSlOI\$tilOl1i ratliortticlitle iitiiigiiiiii tilt} iiiriiu lilutly

lu iiititlucu llU|l'LiiUb|ir'.l!.l|iC ullucte ihiin utu X~l|lYll-

of the non~stochastictefft'si:'is ,;
0 . tollowing,;tatatjn_artts.arevtrue
.
.
4
ii Z_g;,_Ilte
tndintlo_rtL_*_
C

l/ A
B
C

D
E

.:_~

True

95A
B
C

Agfid always absorbs some primary radiation in

addition to scattered radiation and therefore exposure
factors need to be increased when a grid is used. This
increases the radiation dose to the patient.

damage.

Smegarding 'the?biological~.al'fects-of radiation:

i
I
r_...\

"TUBE

thermionic emission ls preceded by electronic excitation.

'
a large proponion of the energy in the incident Xiray beam is

True
True
True
True

203

lliuie is it threshold dose below which rioii-stocliastic eilects

do not occur.
the severity of the effects is at least in part dose deperiiilent.

the effects are assumed to be rton-atldilive if the lime interval

between tliti exposures is strllitzitrriily loiig lu iiimiiit crrrriiiletii
recovery.

a pleural allusion lollowing ratlioiliciepy is an \;K3l11t)|U oi a

non~stocliastic effect.
skirt erytliema is an example oi a non-stochastic effect.

The strut-.iity ol stochastic effects is not dose

dependent. The Qrobability of the effect occurring is
dose dependent without a threshold.
Cancer induction in somatic tissue is a stochastic
eilect oi itttiizilion. Genetic effects are also stochastic.
Tlin :it)H\iliit nfititzts til mtiirititiii iirti hoth sioclinstic
Jltli HUH-5lULIi\ilSllC.

_ g __ ___

urztztii with rt high tiegrct: (Ii predictability.

True

Trim

Czitarzicl (urination is unotlier exziinple of a nonstocliastic ullctzt ul iatliatioit.

""

I'~II\Wi~Yv'

ww10IW\I'IFW-"I-IIl'i'Q TTTT
Physics 205

MCQ Tutor in Radiology

Regarding radiation protection lgislalinr

33

the POPUMET regulations (1988) are concerned with the

radiation protection of radiation workers.
the Radioactive Substances Act H993) does not apply to
hospitals.
the ARSAC issues licences to administer radioactive
substances under the Medicines Act (1978).
the Radioactive Material load Tf8SpOil) Act (1991) only
applies to the nuclear power industry.
_

False

False

C
D

True
False

True

A
B

False
False

The limit iStS8l at 150 mSv per year.

True

False

Note also that the dose limit to the abdomen of

_
women of reproductive capacity is set at 13 mSv in
any three consecutive months.
The whole body dose limit for a classified worker is

False

No level of radiation dose is considered to be safe for

False

the ionising Fladiations Regulations H985) are designed to

protect the public as well as staff.

K;/tt. Aagardingith ,_ atutgg!raai;;i9ihg9se|i_mr_i lien ._1se,.

99

for radiation workers"ti1ei:lo"eliri"1i{tFior the lens oivthe eye is

15 mSv per year.

"

the whole body annual dose limit for a trainee radiation

worker aged under 18 years is the same as that for a
radiation worker aged 30 years.
the dose limit for the abdomen of a pregnant woman is 10
mSv during the declared term of pregnancy.
the whole body dose limit for a classified worker is 5 mSv
per year.

a radiation dose below these statutory lirnits is considered to

be free of any harm.

100

Regarding the ionising Radiation (POPUMET) Regulations 1988:

medically qualified persons can direct medical exposure for

a diagnostic purpose without any additional training.
they do not apply to the in vitro use of ionising radiation in
scientific research.
FHUOW

the core of knowledge training records of all staff who are

involved in clinically or physically directing radiation dose

are maintained by the employer.

responsibility for medical exposure lies solely with the

person physically directing it.

the protection of persons undergoing medical

examination or treatment.

The Radioactive Substances Act (1993) applies to all

work plac_e,s involved in the use of radioactive

substances.
V

The act equally applies to hospitals which transport

radioactive materials. Note that the Radioactive

Material (Road Transportlifireat Britain) Regulations
became law in 1985.

The whole body dose limit for a trainee radiation

worker aged under 18 years is 15 mSv per year; this
is less than the limit for a radiation worker aged over
18 years (50 mSv per year).

50 mSv per year.

stochastic effects.

According to the POPUMET Fleglations 1988 all '

persons directing clinical or physical exposure need

to be adequately trained to acquire a core oi
knowledge in radiation protection matters.

True

it ls the duty of the employer to maintain an up to date

inventory of the X~ray equipment.

The POPUMET regulations H988) are concerned with

True
True
False

The responsibility lies with the person clinically

directing it. The person physically directing it is required

to keep the dose as low as reasonably practicable.

uruuugiupiiy

LIJI

Maisey M, Britton K"Gilady D. Clinical Nuclear Medicine. 2nd edn.

London! Chapman and Hall, 1991.
Martin A, Harbison S. An introduction to Radiation Protection. 3rd edn.

Bibliography

London: Chapman and Hall, 1986.

McMinn RMH. Lasts Anatomy. 8th edn. Edinburgh: Churchill

Livingstone, 1990.
Nleschan l. An Atlas of Normal Radiographic Anatomy_.__2_g_d edn-

Administration oi Radioactive Substances Advisory Committee

(ARSAC). Notes for Guidance on the Administration oi Radioactive
Substances to Persons lor Purposes of Diagnosis, Treatment or
Research. London: Department of Health, 1993.
Agur AMR. Grant's Atlas of Anatomy. 9th edn. Baltimore: Williams and

Wilkins, 1991.

London: B Saunders, 1959.

.
N
Moores B, Henshaw E, Watkinson S, Pearcy B. Practical Guide to
Quality Assurance in Medical imaging. Chichester: John Wiley and
Sons, 1987.
9
Moores B, Stieve F, Eriskat H, Schibiila H. The BIR Report 18. Technical
and Physical Parameters in Medical Diagnostic Radiology. London:

'

Ansell G, Wilkins RA. Complications in Diagnostic imaging. 2nd edn.

Oxford: Blackwell Scientic Publications. 1987.

BlR, 1989.

British institute oi Radiology. Assurance of Cluaiiry in the Diagnostic

X-ray Department. London: BIR, 1988.

British National Formulary Number 27 lMarch 1994i. i_Ot1tlon: British
Medical Association and the Royal Pharmaceutical Society of Great

_.A__

Radiologists, 1995.

'

Sander RC. Clinical Sonography: A Practical Guide. 2nd edn. Boston:

Little, Brown and Company, 1991.
Sharp PF, Gemmell HG, Smith FW. Practical Nuclear Medicine. Oxford:
lRL Press, 1989.
Sorenson J, Phelps M. Physics in Nuclear Medicine. New York: Grune
and Stratton, 1980.
The ionising Radiation (Protection of Persons Undergoing Medical
Examinatiog or Treatment) Reguiations..,,Statutory instrument No.
778. London: HMSO, 1988.
The ionising Radiations Regulations. Statutory instrument No. 1333.
London: HMSO, 1985.
Welsh S. The Physics oi Motiicul imaging. Bristol: Atitim Hilgor, 1988.
Weir J, Abrahams PH. An imaging Atlas of Human Anatomy. London:
Wolfe, 1992.
Westacott S, Hall JRW. Key Anatomy for Radiology. Oxford:
Heinemann Medical Books, 1988.
Westbrook C, Kaut C. MR1 in Practice. Oxford: Blackwell Scientific
Publications. 1993.
Whitehouse GH, Worthington BS. Techniques in Diagnostic imaging.
2nd edn. Oxford: Blackwell Scientific Publications, 1990.
Wiilts R. Principles of Radiological Physics. 2nd edn. Edinburgh:
Churchill Livingstone, 1987.
Wotton R. Radiation Protection oi Patients. Cambridge: Cambridge

Britain, 1994.

Bushberg J, Seiben J, Leidhoidt E, Boone J. The Essential Physics oi

Medical imaging. Baltimore: Williams and Wilkins, 1994.
Cafiey J. Paediatric X-ray Diagnosis. 8th edn. Chicago: Year Book
Medical Publishers, 1985.
Chapman S, Nakielny R. A Guide to Radiological Procedures. 3rd edn.
London: Baiilire Tlndaii, 1993.

Chesney D, Chesney M. Fiadiographic imaging. -ttli edn. Oxford:

Blackwell Scientic Publications, 1981.
Clark KC. Positioning in Radiography. 9th atln. London: William
Heinemann Medical Books, 1974.
Cosgrove D, Meiru H, Dewbury K. Clinical Ultrasound: Abdoinirial anti
General Ultrasound. Edinburgh: Churchill Livingstone, 1992.
Curry TS, Dowdey JE, Murry RC. Christensens introduction to the

Physics oi Diagnostic Radiology. 3rd edn. Philadelphia: Lea and

Febiger, 1984.
-

Dendy PP, Heaton B. Physics for Radiologists. Oxford: Blackwell

Scientic Publications, 1987.

'

RCR Working Party. Making the Best Use of a Department of Clinical

Radiology: Guidelines lor Doctors. 3rd edn. London: Royal College of

Grainger RG, Allison DJ. Diagnostic Radiology. 2nd edn. Edinburgh:

Churchill Livingstone, 1992.
Hornsby VPL, Winter RK. Aids to Part l FRCR. Edinburgh: Churchill
Livingstone, 1988.
Hospital Physicist's Association. The Physics oi P-adiotiiagnosis. 2nd
edn. London: HPA, 1977.
institute oi Physical Sciences in Medicine. Report No. 59. The
Commissioning and Routine Testing of Mammographic X-ray
Systems. 2nd edn. York: lPSM, 1994.
_

University Press, 1993.

institute oi Physical Sciences in Medicine. Report No. 87 Quality

Assurance in Dental Radiology. York: IPSM, 1994.

Johns H. Cunningham J. The Physics oi Radiology. 4th edn.

Springfield, lllinois: Charles C. Thomas, 1983.

Keats TE. Atlas of Normal Roentgen Variants That May Simulate

"
:' " '"'
"
"1 -' ~- 9*"---~-=~~~--=----=-~--~ wee

'.

'

**IV

\$\$

I7-I

\$

\.i

silt

UI

ow

-g

The FRCR part i syllabus

The Royal College of Radiologists has kindly given permission to the
authors to include the present FRCR part l syllabus in this book. it
should be noted that this book is not an official publication of the
Royal College of Radiologists, and detailed information on any aspect
of the fellowship examination and the syllabus should be obtained
from:
The Examinations Secretary,
The Royal College of Radiologists.
38,'Portland Place.
London W1N 4-JO.

gl

1.0 RADIOLOGICAL ANATOMY AND TECHNIQUES

1.1 Radiological anatomy

General comments

The candidate should be familiar not only with the basic anatomy
relevant to all the common radiological examinations but should also

be familiar with cross-sectional anatomy In the axial. coronal, sagittal

and. where appropriate, oblique planes. A knowledge or normal
anatomical variations will be expected. it is expected that the formal
teaching course will build on the anatomical knowledge already

expected of a radiological trainee, in much the same way as the

interpretation of radiological abnormalities is built obn a sound

knowledge of basic pathology.

Candidates should know the normal appearances in the growing

child including apiphyseal ossification, but need not memorise the

dates of appearance of the ossification centres.

1.1.1 The syllabus for anatomy as shown by imaging examinations

includes the following systems:
The skull including the facial bones, mandible, teeth, lacrirnai
apparatus
The remainder of the skeletal system
'
The respiratory system
The abdomen

The
The
The
The

gastro-intestinal tract and biliary system

urinary tract
cardiovascular system
lymphatic system

$3

$\Y;$$$-i-\Y'TTT7

5=1Egi_.. B! IIs gti

Ffii

- The male genital tract

The brain, spinal cord and meninges

The endocrine system.

1.2 Radiological techniqupr

'

1.2.1 The candidate will be expected to show familiarity with, and

experience of, everyday investigations. A detailed knowledge is only

required for those techniques which a candidate is expected to have
carried out personally and on his/her own during the first 9 months of
training in radiology. These examinations are standard contrast
examinations of the gastro-intestinal tract, intravenous urograplty.
urethrography, cystography, leg vanography, sialography.
dacrocystography, hysterosalpingography, T-tube cholangiograptty.
sinography and a nephrostqgram.

1.2.2 A knowledge oi the basic principles underlying the techniques

used in arteriography, interventional radiology, biliary tract imaging,_
nuclear medicine, ultrasound, CT and MR1 will also be expected but in
less detail. For these investigations. the candidate should know. in
outline only, the following:

- The principal indications and contra-indications

-

Patient preparation

Radiographic apparatus-used
Contrast media (see 1.3 belowl

- Outline of technique with main variations

- Principal complications and their treatment.

_

1.3 Contrast ntediafradiopharmaceuticals and drugs

1.3.1 Contrast media: The contrast media _to be studied are those
which relate to the practical procedures mentioned in 1.2 above. They
include the contrast media in current clinical use for radiography.

computed tomography and magnetic resonance imaging. For each

contrast agent the following are expected:

Ofcial name
'
Doses, including doses for children
Constitution (not the detailed formula)
Modes of administration and the clinical uses
Routes of elimination

~ Relative advantages of the different types of media

- Side effects and treatment of reactions
- Contra-indications to use.

The female pelvic organs, including the pregnant uterus

The anatomy and ultrasound dating of the normal foetus

The female breast

>

210

MCQ lutor Ill ltadiology

_-at

1.3.2 Fladiopharmaceuticals: The choice of iadiophzirriiaceuticals.

Preparation oi the gastroilntestinal tract. including drugs

The changes in content and recommended time contained in this

revision of the syllabus,,are designed to reflect the introduction of
the newer imaging modalities.

- Prophylaxis and treatment of reactions to contrast media

Equipment design and construction details will not be examined,

but an understanding oi the function of equipment components

modifying bowel behaviour

Sedation before radiological procedures

Prophylaxis and treatment of reactions to radiological procedures

other than to contrast, e.g. in phaeocliroihocytoma.

relevant to image formation may be tested.

A mathematical approach to the physics Syllabus is lnapfoflaiei

the emphasis should be placed on a clear understanding of the
physical basis of radiological practice in 6 qualitative SenseHowever, the knowledge of the approximate magnitude of
quantities encountered in daily practice will be expected, e.g.
percentage transmission of X-radiation through a patient; the
activity of a radionuclide used for bone scanning.

1.4 Radiography

General comments

Candidates will be expected to demonstrate a knowledge of the

standard radiographic projections relating to the regions outlined in

the radiological anatomy syllabus lsection 1.1 above). Candidates

should, therefore. be able to comment on the positioning and tithe

Basic electricity, magnetism and mathematics are not included in

the syllabus and questions on these subjects will not be included in
the examination.

angulation used to obtain the image and should be able to give

practical advice on improving the quality of the film. A knowledge of

infrequently used projections will not be expected.

During formal teaching, all physics demonstrations/practicals

should have a direct relevance to everyday rBCll0l09Y-

1.4.1 Knowledge of. and practical familiarity with, the following will be
expected:
Positioning oi patients. The use oi ll'l'll'tlOlJlllSll1g devices and
protective devices
Standard radiographic projections and angles. Correction of
errors in centering an exposure
The specic problems of mobile radiographic techniques
The following standard radiograpliic projections:
Basic skull views including the facial bones
AP and lateral projections of the spliie

Knowledge of the principles of quality assurance, contrast

resolution. spatial resolution and noise is expected for all the
sections listed below.
2.1 ionising radiation (5 hours)

Structure of the atom.

Radioactivity and raclioniiclides: basic definition of alpha. beta and
gamma radiation; principles of exponential decay, half-life, specific
activity and units of activity.

PA and lateral chest radiograph

Erect and supine abdomen

Electromagnetic spectrum.

AP pelvis
Standard views of the shoulder girdle, pelvic girdle and
extremities.

,.
.1

Ii

General properties of X- and gamma rays: wavelength, energy,

inverse square law.
Interaction of X- and gamma rays with matter: coherent, Compton
and photoelectric interactions; concepts of attenuation. absorption

2.0 PHYSICS

and scatter - and their practical consequences.

General comments-

A basic knowledge oi physics is assumed.

"Tl,.,i

T'l

On the assumption that the whole of the physics syllabus can be

covered in approximately 40 hours of formal teaching, the hours
.

211

the approximate proportion of questions devoted to each topic in

the MCQ part of the examination and the depth of knowledge
expected in the topic.

1.3.3 Drugs: Some knowledge is expected of those drugs commonly

used in radiological practice, including their dosage. These can be
considered under the following headings:
.
i

The FRCR part I syllabus

indicated in hrackets are a ouide as to how these 40 hours might

2.2 Radiation protection (7 hours]

Statutory responsibilities: an appreciation of relevant legislation

and Codes of Practice.
.

i.

.._

|__ ___..

i|7.ii_i7i73371-ii7(ii
'7
.
,>

_
.
Tttw-ttyttw

212 MCQ Tutor in Radiology

Genetic and somatic effects of ionising radiations.
Relative risks of ionising radiations.

The FRCR part i syllabus 213

2.6 Magnetic resonance imaging (5 hours)
Basic principles and origin of the signal.

The principles of dose limitation. iBlL1diQ fl"-L various practical

means of dose reduction to staff and patient with special
T
considemuon of females and chdm

Principles of basic sequences in clinical use.

__ Staff and patient doses; magmmde and measuremem

2'3 Pmdumion of X_rays [3 hours,

2.7 Radionuclide imaging (5 hours)

The basic principles of a rotating anode X-ray tube.

Basic factors which influence X-ray output from differing types of

X-ray machinery; anode material. l<\/, rnA, focal spot size, tube rating,
filtration. lDesign and construction details will not be examined.)

2.4 The X-ray image (10 hours)

=2-L

Magnetic eld hazards to patients, staff and passers by.

The function of a gamma camera.

Properties of radiopharmacgeuticals.
Static and dynaniii: imai_ing.

Handling of radionuoiides.
Introduction to single photon emission computed tomography

lSPECT) and positron emission tomography lPET).

Geometricxfactors and magnication, effect of focal spot size,

geometric movement and unsharpness.

Conventional film/screen systems: basic structure; characteristic

curve; latitude; density; speed; contrast anti how to inlliicnrzc or
manipulate it.
Basic principles and effects of film processing.
Basic principles of image intensification. Optzratorcontrolletl
variables.
-

ii

Principles of tomography, particularly CT, with emphasis on

operator-controlled variables, e.g. slice thickness, partial volume

effect, field size and effect on resolution, data storage and display,
pixelfvoxol, window width and level, and grey scale.

Basic principles of digital imaging and picture archiving and

communications systems (PACE).
~
2.5 Principles of diagnostic ultrasound l5 hours)

_The basic components of an ultrasound system.

Types of transducer and the production of ultrasound with
emphasis on operator-controlled variables.
*
The frequencies of medical ultrasound.

The interaction of ultrasound with tissue, including biological effects.

The basic principles of A,_B, M, real-time and duplex scanning.

The basic principles of pulsed, continuous wave and colour
Doppler ultrasound.
"
Recognition and explanation of common artefacts.
l

Concept of T1, T2, proton density and effect of motion on signal

II

#1

_ 4:

index
-

:-

Abdomen, CT scanning, 126-7

Abdominal compression
IVDSA. 100-1

radiation dose. 202-3

Acinus, 14-15
Acromiohumeral distance. 4-5
Acromion, 94-5
Adductor magnus muscle. 40
Adrenal glands. 35-7
CT scanning, 126-7
neonatal ultrasound. 120-1
right, 38-9
ultrasound examination. 116-17
Adrenal veins. 35-1
Adrenaline, 66-7, 68-9
arthrography. 90-1
Air gap technique, 164-5
Airways, 10-11
Aliasirtg, 186-7. 190-1

Alpha particle. 135-7

Aluminium filter. 164-5

Ammonium thiosulphat. 154-5

Ampulla of Vater, 80-1

Amylase level, ERCP. 80-1
Anaesthesia, local. 6&7, 68-9
Anal stricture, 122-3

Anapliylactoid reactions. 64-5

Angiocardiography, 10-1-5

Angiography, 102-3
complications. 106-7
diagnostic, 106-7
digital subtraction, 172-3
equipment, 102-3
pulmonary, 104-5
vessel appearance. 172-3
Angular momentum, 186-7
Annihilation process, 139, 142-3
Annual whole body dose. 200-1,
204-5
Antenatal ultrasound, 44-5
Anthropological baseline 94-5

Antibiotic prophylaxis. 76-7. 82-3.

86-7. 122-3
Antimony trisulphide globules,
172-3
Aorta, 24-5
abdominal, 30-1
branches to kidneys. 38-9
descending, 16-17
Aortic arch, 14-15
branches, 50-1
Aortic knuckle, 18-19
Aortic nipple, 14-15

Aortic valve, 22-3

Aortogra-play, lumbar. 102-3
Aortopulrnonary window, 1B-19

Apical ligament. 62-3

Appendix, 28-9
Areae gastricae, 72-3
Arrhythrnia, 114-15

Arteriography
arterial puncture. 102-3
contrast medium, 102-3
Arteriovenous fistula, 106-7
Artery of Aclamkiewicz, 62-3
Arthrography, 90-1

Articular disc, 58-9

Atlanto-axial distance. 62-3
Atom
ionized, 140-1
structure, 136-7
Atomic abundances. relative. 155-7
Atrial fibrillation, 114-15
Atrioventricular groove, 24-5
Atrium

left, 22-3

right. 22-3. 100-1

Auditory meatus, external, 94-5

Auricular artery, posterior, 52-3
Axillary artery, 4-5

Azygos vein, 14-15,~16-17,-1'30-1

Azygos venous system,. 16-17

.
.

.
_.z..-_.__m...-a,1hi

vrwwrwww-art
iNDEX
219

Q">$'F&"3*$'$\\YVNYW"\!i"W?'YT

A15

|NlJt:)\

ultrasound rellectivity. 118-19

Costoclavicular ligament, 10-11

Cranial foramina. 46-7

ERCP see Cltolangiopancreatograpliy,

endoscopic retrograde
.
Erectile dysiuntion, 88-9
'
Exchange forces. 136-7
Eye. radiation dose, 96-7

Cranial fossa, posterior, 126-9

Cranial nenres. 46-7. 54-5
Crista terminalis. 22-3
Crown-rump length, 44-5
Cruciate (cruciform)
ligament, 62-3
posterior, 6-7
Cystic artery, 36
Cystic duct, 36-7
spiral valve, 116-17

Cystourethogrephy. micturatlng, 86-7

Dacrocystography, 92-3
Dental amalgam. 132-3
Dentition, 60-1

Devices, deflection during MR1, 132-3

Diabetes mellitus, intravenous
urography. 84-5
Digital subtraction arlgiography,
172-3
Dlrrieglumina gadopentata see
GBdO|1l\.ll'1'1
Doppler effect. 186-7
Doppler ultrasound, 124-5
Double-contrast study, 72-3
Ductography, 98-9

Ductus arteriosus, 15
Ductus nooe,"1B-'-19 'Duodenum, 26-7. 38-9

barium meal. 72-3

kidney relationship, 38-9

Fabella, 6-7
Facial bones, radiography. 96-7
Facial canal, '18--9
Fallopian tubes, ~12--3

Fat
attenuation coefficient, 1411-5
MRI signal. 132-3. 134-5, 190-1

Dental radiography, 174-5

Denticulate ligaments. 62-3

Diaphragm, 16-17,18-19,24-5

Gas detectors, computed

tomography, 176-7. $18-9
Gastro-oesopltageal reux, 6-7,
114-15
Gastrografin, 66, 70-1, 72-3, 74-5
Gastrointestinal radiology -7"
pharmacological agents. 68-9
radionuclide investigation, 114-15
Gastrointestinal tract. see also Bowel;
Gut; Oesophagus; Stomach
Geiger counter, 200-1
Gel-loam, 100-1
Gelatin. 152-3
V

Epiploic lorarnen. 38-9

'

Femoral artery, 8-5Femoral epipl1ysis,'2-3

Femoral head, 8-9
Femoral neck, 8-Q
Femoral vein, deep, 98-9
Fetal hean, 44-5, 124-5
Film viewing session, xi
Fine-needle biopsy, 122-3
Focal spot, 150-1

Glenohumeral joint. -1-5

Glucagon, 68-9. 78-9
barium meal. 72-3
Gonadal arteries, 36-9
Gonadal veins, 30-1
Grey matter. 128-9. 132-3

-|52_3
cutoff, 162-3
diagnostic radiography, 160-1
linear, 158-9
primary transmission, 158-9. 160-1
ratio. 158-'3. 160-1

posterior, 48-El
Foramen trattsvrarszirinm. 54--5
FRCR pert l
examination, xi-xiii
syllabus, 208-13
Free induction decay, 186-9
Frontal sinus, 56 -9

Guide wire. 102-3

Gut

Ga scintigraplty, 116-17

'1-i telattve atomic abundance, 185-7

Hall value thickness. 140-1
Hand, radiograpnic centring point.
94-5

divarticutum, 32-3
fatal, 44-5
see also Gastrointestinal

radiology
0
Gyromagnenc ratio. 186-7

uqtnvtlluttl. 1116-7. 1'.ltl-9

Elucllontt. 136-7
ejected, 142-3
interaction

with matter, 140-1

with photons, 140-1. 142-3

Ernlmlic rnaturial. 106-7
Embolisatron. 105-7

adverse efincts, 130-1

ntagneltc rertonance imaging,
1
132-3, 13-1-5

lluuzztru. 28 -9
lli:.ul injury. 96-7
|1t:tlk1tlChU, post-rttyologrzlpltrc. 12-ll
lli:;1r|_ 21! -Ti
nritpin:zttll1u5|r.tplty. H14 .1
Mum; ML H4,

Gilll liidtltiut, .3-1-5

Clllilrttail inertia, 711-9

C1 -scrinning. 126-7
__ w.1li lhttsittnztia. 116 ~17
lmittrrti; 11.1111-nu llu1tn.'lut :-ytitutti

. 192-3

l\t: l. -14-5

tlulllmtitor, 194-b

1 snmtnl rESOl1lllC1ll, 192--3

Epididymta, 4-1-5

G.\l'l1t11&l rays. 138-:1

Vmvu E224 w.4__5

'
' J
i:||lt>:scopr<: ultrnsnunrl nl
,,Um,U|,_,,,5 122 .3

~ 1

SPECTimaging,19~1-5

'

b Do
I 1 Jlur Uilfdtatliili 121-

Ir.:s0lt|li0l"l, 182-3
"'?u s|l'* ]9j'5
rlurlnplu ltuntlutl. 1214-b
scintillation crystal,
194-5
_

Energy disr.-rirninators. 178-9

Enteroclyais, 74-5

Hepatic veins, 35
ultrasound examination. 116-17
1-lepatobiliary system. 36-7
Hilar angle, 12-13

'

Hip, 8-9

joint capsule. 8-9

neonatal, ultrasound scanning.
120-1
prosthesis. 132-,3
radiograpttic centring point, 84-5
Humarus, 4-5
Hyoid bone, 20-1
barium meal. 72-3
Hyperosmolar adverse eects ol
contrast media, 64-5
Hysterosalpirtgography. 68-B

f1. 110-11
-"1. no-tt

lleal rellux. 76-7

lliac artery
dilatation. 106-7
internal, 42-3
lliat: lymph nodes
external, 46-7

internal, 98-9
lliolernoral ligament. 9
Image inteffsifier, 170-1
contrast ratio. 170-1
TV camera viewing system, 170-1.
172-3

Ga<l(rl1t\1t|tt1, 13i)1

Ear. 58-9
see also Middle ear
Echo time. 188-9
Ectopic heart neat. 104-5
Effective dose. 198-9

Hepatic oil embolism, 98-9

Hyoscine butylbromide. 68-9, 70-1

Grid
contrast improvement factor.

Fontanelle
anterior, 120-1

Heparin. 106-7
Hepatic aneries. 36-7

- , 132-'3

y vu::Jpu:c,f,r|TS G 2_,_5
1. . vein.9 16-17
'
llerniazygos
1lrmlrillittllttrlgut. ' 24-1

Implants. dellection during MR1. _

132-3
lncudomaliear ioints, 56-7
lncurlostapediat joint. 56
. lttctts. 56-7

lnlurinr vunn cava. 25. 30-1. 35

llttorvortlrrctrlat i-rtury. 2+
l|\|()|Vu(lQl)|'i1I inrnrtunzm, curvrrzal.

U6-7

'

|llH'-J \ll\JIlllU l.'Ullililtltl|l1lV\$ 111-JVICU.

,; copper, 132--3
lrttlttvunotts digit-ll sullllnctmn
angiography tlVDSAl. 100-1

lntussuscuption, I6-7
lutlntu. 1.12-3.1113 l
concentration tor artenograplty.
102-3
lohexol. 98-9
Inn tnnr. 141.1-1

~'

I
216

-1

INDEX

'

>

' t~oE><"'" 2'11 l._I-'_?.

._'~I

WI

radiography technique, 174-5

ultrasound scanning, 120-1
Bregma, -18-9

Bacteraemia

barium enema. 76-7

percuraneous transhepatlc

Bremsstrahlung radiation, 1-10-1,

cholangiography, 82-3

Bacterial endocarditis, 106-7

148-9. 174-5
Bronchial artery, 14-15
left. 18-19

Barium
bowel

enema, 74-5
double-contrast, 76-7

'

effective dose. 198-9

antaroclylla, 74-5
follow-througn, 70-1

gastrointestinal tract radionuclide

investigation. 114-15
investigation in children, 76-7
meal, 72-3

double contrast. 66-7, 72-3

gas production. 72-3

swallow. 72-3
Basilic'vein. 100-1

Beam filtration, 162-3

MR1. 134-5

visualisation, 78-9, 126-7

Biparietal diameter. letal, 4-1-5

Bismuth germinate detectors, 178-9

Blood. MR1. 134-5
Blooming, 151
Bone

isotope scanning, 108-9

occipital. -18-9

spin echo imaging of conical,

132-3

X-ray attenuation, 144-5

Bowel

"Ga scintigraphy, 116-17

MR1 contrast agent, 134-5

Brachial plexus injury, 106-7
Brachiocephalic vein, right, 16-17
Brain
CT examination. 128-9
internal capsule. 128-9
isotope lctlnrting, 108-9
tnugllultc rusnnoncu imaging,

132-3

neonatal ultrasound, 120-1

ventricles, 56-7
.

helical, 182-3
pitch. 182

slip-ring technology, 182-3

larynx, 130-1
_
noise. 180-1
number, 180-1
orbit, 130-1
pelvis. 128-9
quantum mottle, 180-1
slice thickness. 180-1
third generation scanners, 178-9
upper abdomen, 126-7
water calibration number, 180-1

normal ligaments. 62-3

oblique view. 96-7

"C relative atomicabundattce, 186-7

Cadmium-lead filter, 198-9

radiographic cenrring point, 94-5

Chest CT scan, 124-5. 126-7
effective dose. 198-9

Caosium iodide, 170-1

Calcillcatlon, intracranlal, S0-1
Calcium tungstate, 156-7, 158-9

Chest radiograph centring point. 94-5

Chiba needle, 82-3
Ciilorpheiramine maleate. 66-7

intensification factor, 158-9

Cali.-uli, biliary, 80-1, 82-3

Call veins. deep, 98-9

Cholangiography

postoperative (T-luD1. 80-1

endoscopic retrograde, 80-1

Choroid plexus. neonatal ultrasound,

.

common. 50-1
artarlography, 102-3

normal velocity waveform,

1
1

124-5
external. 52-3

normal velocity waveform,

124-5
internal, 50-1, 52-3
Carotid canal, 58-9

Carotid sheath. 20-1

Carotid siphon, 52-3

Lartilaginous joints, 10-11

Catheter
~
French size, 102-3
guitle wire, 102-3. 106-7
Jt|clkin's coronary artery, 104-5

120-1

Choroidal artery, anterior. 52-3

Cimetidine. 66-7
.
Circumflex artery, 2-1-5
Cisterna chyli, 16-17
Clavicle, 10-11
rhomboid fossa, 10-11
60
_ Co gamma emission, 200-1
Colic vein, right. 36-7
Collateral ligaments of knee. 6-7
Collitnator, 194-5
converging, 110-11
high resolution. 194-5
Communicating arteries. 52-3
Compton interaction, 144-5
Compton scattered photon, 140-1

Computed tomography, 178-9

abdomen, 126-7

'

cupping effects 180-1

- . _. .. . . II

_ .

adverse reactions, 66-7

urography, 82-3. 84-5

low-osmolar. 64-5, 66-7
adverse reactions, 66-7
myelography, 92-3

paramagnetic, 130-1
retrograde pyelography, 86-7

superior vena cavography, 100-1

C opper filter, 164-5

Coronary arteriography, 104-15
right, 102-3

Coronary artery, 24-5 _

Cutonrny sinus, 24-5

cltusl, 124-5
contrast resolution. 180-1

Calida equina. 62-3

70-1

nigh-osmolar, 64-5. 66-7

intravenous

dissection, 104-5
,
vintiaiisntion. 104-5

humn t:nur(|y, 176--7

11111111. 1211-9

C.tvmt\t1\\:A r.n\u~t 54-'5

Contrast improvement factor. 162-3,

Contras"i medium, 66-7
aneriography. 102-3
arthrography.'90-1
cholangiopancreatography, 80-1
cholangiovenous reflux, B0-1
CT scanning, 126-7
gastrointestinal tract examination,

Chordae tendinae. 22-3

Caroti_d artery

ca"~~"\5"11"\0h\i, 33-9

196-7

Cholecystitis. acute. 78-9

Cholecystographts oral. 78-9
Cholescintigraphy, 116-17
Cholesterol embolisation. 106-7

investigations, 114-15

sltcutli, 102--3

X-ray tube, 176-7

alignment, 178-9
see also Single photon emission
computed tomography
lSPECTl
_
Contamination monitor, calibrated,

Cholangiopancreatography,

Cardiac gating in MR1, 134-5

Cardiac veins, 2-1-5
Cardiovascular radionuclide

tttritnriztl. I02-3
rlitytnil, 104-5

weighting factor, 178-9

intravenous. 78-9
percutaneous transnepatic, 82-3

urography, 84-5

Biliary tree, 80-1

Cervical spine

Capitulum. 2-3
Cardiac failure, intravenous

Biliary contrast media, 78-9

B19351 11-3

Cervical os, internal. 40-1

Capitate, 2-3

Biliary calculi, 80-1. 82-3

_, _ -3 1,-_._,,,,,,,-\3\;pl\3\\3\].s\\B,.>3 A...-,2. ..

left main, 18-19

Bucky factor, 160-1, 162-3
Buscopan. B0-1

gas detectors, 176-7, 178-9

Cerebrospinal fluid, MR1, 132-3,,

134-5

Cailosomarginal artery, 52-3

Calvarium, 48-9
Carinaliculus, 92-3

Beta decay, 138-9

Beta emitters, 1-10-1
Bile duct, intrahepatic, 126-7

energy discriminators, 178-9

ltered back proiection, 176-7
first generation scanners, 178-9

Cerebral veins. 54-5

Bronchus. 10-11

contrast agent, 134-5

.CT scanning. 126-7

Th ,

Cavum septum peliucidurn, 120-1

Centre of rotation correction, 194-5
Cerebellar artery, posterior inferior,
54-5
Cerebral vein of Galen. great. 54-5

Corpus cullosuttt. 120-l

Corpus cavernosum, 88-9

..

Corticosteroids, 65-7

.-

-_

- -

'

220

INDEX

INDEX

lonisarion chamber, 148-9

air equivalent wall, 200-1

gas pressure, 200-1
ionising Radiation (POPUMET)
Regulations 119881. 204-5
ionising Radiations Fiegulzit|on5
(19851. 204-5
loparriidol, 64-5 i
loihalamatg,>-gm
lotrolari, 64-5
lrradiation, medical, 198-9
lscniolemoral ligament, 8-9
lschiorectal fat pad, 40-1
lschiorectal fossa. right, 40-1
isomeric transition, 138-9

av?

i ii

isotope scanning

-- i

Levator arii muscles, -10-1

Ligaments of Cooper, 22-3

Ligarnentum aneriosum, 14-15,

18-19

gradient coil, 192-3

gradient field. 192-3

Ligamentum ilavum, 62-3

Ligamentum nuchae, 62-3

Ligamenturn teres, 35

Lignocaine. 66-7

larynx, 130-1

overdose, 68-9 J
'
Linear attenuation coefficient, 140-1,
1-14-5
Linear energy iransler. 202-3
Linear toinograpliy, 175-7
Lingula, 14-15
Lipiodol
artrzrocyslography, 92-3
Liver, 34-5

caudate lobe, 35

colloid sciritigraphy. 116-17

duclal calculi, 82-3
quatlraie lobe, 35, 38

lsotopelsl. 135-7
calibrator, 196-7

rarliolaliclltztl tzolloitl upitiltu.

118-17

Jeiunum, ZB-9
Joint effusion, 90-1
Jugtilar loramen. 46-7, -18-9
Jugular vein, internal, 48-9

ulirasoilntl rellutllvliy. 116--ll

Lower limb
asctmiling vuiiogrcipliy, 98-9
Doppler imaging of veins, 1'2-1 5
lyriipliograpliy, 98-9
veins, 8-9

Kidney, 38-9
left. 32-3

'

radiographir: visualisation on 1\/U

84-5

'

see also Nephrogram; Fienogram

Knee, 6-7
L)

arthrography, 90-1

collateral ligaments, 6-7

manipulation lollowing contrast
iniecilon. 90-1
Krypton ventilation siirtly, 110-11

Lumbar aortograpliy, 102-3

Lirmhar puncture, 92-3
Lumbosacral joint, obliqtro view. 95-7
Lung, 14 -15
fissures, 12-13, 124-5, 126-7

high r8501\.l110l'1 CT, 126-7

pertzutaneouis biopsy, 125-7

periusion isotope imaging, 112-13
vonlilntion studies, 110-11

Lymphatic drainage, 16, 17

Lyriiplinrrrtiplty, lowur liitilr, 989

resistive magnet, 190-1

11821111101, 192-3
shim coils, 192-3

signal to noise ratio. 190-1

1I

paper, xi
.
practice, xiii
syntax, xi
Multiple gated acquisition, 114-15
Muscle attenuation coelficterit.
144-5

slice thickness. 19?.-3

'
spin echo images. 132-3, 13-1-5
split-spiii relaxation. 1118-9
T1 weigtiteu. 130-1. 132-I1. 13-1-5,
188-9. 190-1

T2 weighted. 131. 132-3. 134-5.

188-9. 190-1
time constant. 188-9
Magnetic resonance magnet. 188-9.
<
190-1
Mrillutis, 56
lv1u|niiiograp1\y.9B-9. 174-5
scatter grid. 174-5 _
Niill1lliJllUSl1:l|1i1l101111, 11, 14-15
Mtiaitziiin. 132 -3

Muss iI.lllOl1UJllL)l\LZU\3iiiClU|11. 1-10-1,

144-5

Mastoid antrum. 58-9

Mlistoitl prouuss. 50:1

lvlnxillary tintra. 58-9. 915-7

Maxillary artery, internal, 52-3
Maxillary sinus, 58-9, 95-7

Mecltels tliverticulum. 213-9

rutlioiincliuo scan. 11-1-15

Motliastinum, posterior, 16-17

Larmor equation. 186-7

Larmor frequency, 196-7, 188-9

Laryngeal cartilage. ossication.

130-1

Larynx, 20-1

CT scanning, 130-1 '

Lateral ventricular ratio. letal. 44-5

Lead oxide. 172-3

Manic tingle plicnornunon, J34

Miignetic resonance Bliigfilplly,
13-1-5
Magnetic resonance imaging, 198-_9.
213
'
aliasing, 190-1

brain, 132-3

cnntrolltl area, 134-5

V
' dellection of irnplanislduvices, '
I32-3'
<
iieltl ol view, 190-1 '

Myelography

cervical puncture. 92-3

lumbar, 92-3

Myelomatosis, 6-1-5
Myocardial infarct imaging, 11-1-15
Naloxone, 68-9
Navicular. 2-3

Navicular lossa, -16-7

Neclt-, CT scanning. 128-9
Needle. twp-part. 102-3

Needle shaft. irltrasound, 122

Neonates. tilirasounu scaiiiiiiig,

120-1
Nopnrogrom. 66-7. B2-3
Nuplirustoiny tuuu llltrufllklll. 116-7
Nut inugiiutrstitioii vector lN1\r1V1,
1138-9

Neural arches. 60-1

N(.tui!1D, T39, 196-7
Neutrons, 136-7. 138-9. 1156-7. 196-7

capture. 198-9
Nipple, 98-9
Nuclear spin value. 186-7
Nucleus. angular rnomenitirn.
186-7

Mutliiziiius Act 119781, 20-1-5

Mtrglirminu srilis, 6-1-5

Mirriilirirria luclurlu. 152-3

Mirritlns-'11 izirtirru, -19

Lambtloitl iitrture, 48-9

Llmlnnr llne. posterior. 62-3
Large bowel. 28-9

Molybdenum target. 17 4-5

Multiple choice question
answering, xii-xiii
error rate. xiixiii
guesses, xii

number answered. X11-X111

magnet temporal stabilitf 190-1

magnetic eld, 190-1
noise. 134-5
radioliequency coils. 192-3
relaxation time, 188-9

sialography, 92-3

' lung perfusion. 112-13

parathyroid, 110-11
thyroid. 110-11

Magnetic resonance imaging lcontdl

Gidlilum, 130-1. 132-3

lower limb lympnography, 913--9

bone. 108-9
brain. 108-9

1
l

Moiiiiiguliypopliysuul urluiy, 52--3

Muiiisuutl. riiutliul, G-7

Mi:-rseiiteric artery, inlerior. 30-1, :12- 3

Musoiitorir: vus-sols. superior. 25-7,
. ' 34-5

Mctocloprziinitlo. 68-9. 70-1

Motoplc suture, 48-9
MIBG scan. 116-17
Mitltllu uzir, 56-7

Mitral valve. 22-_3. 104-5

221

Modulation transfer lunction, 150-1,

168-9
7

Oliosity, 126-7
Oizcipiial rirtury, 52-3
Otztzipitul hone, 111-11
Occipiiul condylus, 411-9
Oosophageal hiatus. 2-1-5
Ousoplinguel rnotiliiy, 72-3
Oesopliagus, 12-13, 18-19, 22-3
CT scanning, 128-9
endoscopic ultrasound, 122-3

pH monitoring, 122-3

Opliihalrnii; artery, 52-3

Ophthalmic vein. 5-1-5

Optical density, 152-3
Oral examinations. xii

221

INDEX

[.14

Orbit
l
CT scanning, 130-1
'
intravenous contrast enhancement I
130-1

ultrasound scanning, 120-1

Orbital angular momentum, 186-7
Orbital ssure, superior, 46-7
Orthopantomography, 96-7

clavicle, 10-11
costal cartilage, 10-11
hyoid bone, 20-1
laryngeal cartilage. 20-1, 130-1

_._a_. ~_

Ovary, 40-1, 42-3

calcification, 42-3
CT scanning, 128-9
venous drainage, 42-3

Pain, hysterosalpingography, 88-9

Pair production. 142-3
Palmer arch, deep, 4-5 '
Pancreas, 32-3, 38-9
CT scanning, 126-7

-<

head. 34-S

neonatal ultrasound, 120-1

reflectivity, 111!-19

ttltrnsutttttf, 113-19

Partcrcuttc unct. 32-3, B0-1

ucccssory,26-7
ultrasound examination, 118-19

ulWirsut1g. 34-5

Pancreatic pseudncyst. 80-1

Partcreaticorlnutlenul urturtes, 31-1.
34-5
Patucolic gutter, 26-7

Paratfuotlonal lossa, 26-7

Paralytic ileus, 74-5

Paranasal sinus, 58-9

mucosa, 132-3

A_..-._-. _

Paraspinttl line, 14-15

Parathyroid glands, 20-1
isotope exantinatton, 110-11
P3f31IC|1BB| line, 14-15_
Parietal loramina, 48-9
Parietal star, 48-9
'
Parotid duct, 60-1
sialography, 92-3

Parotid gland. 60-1

Pate11a,2-3. 6-7
t

bipartite, 6-7
facets, 6-7
knee anhrograplty. 90-1

11~rtnt*r-itwnvywr

Pelvicalyceal system, 86-7

lytnphatit: drainage, 48-7

transrectal ultrasound, 122-3

Prostatic duct, 46-7

Protons, 186-7

Petrous ridges, 96-7

monitoring lm badge, 198-9

Prostate, 40-1
CT scanning, 128-9

PTC see Cholangiography,

tpercutaneous transhepatic

Phaeochromocytoma scan, 116-17

, mot-sx 223

-a

Procaine, 68-9
ha
Profitnda femoris artery, 8-9

Pelvis
"
bony, 40-1
-'
computed tomography, 128-9
Perchlorate, 108-9
Perlcardiurn, 22-3. 124-5
Peritoneal spaces, 26-7
lesser sac, 26-7
Pethidine, B8-9

Ossification

at birth, 2-3
centres of vertebral column, 60-1

-.-4

non-stochastic effects, 202-3

protection, 200-1. 211-12
legislation, 204-5
scattered, 164-5
somatic effects, 203
statutory close limits, 204-5
stochastic effects, 202-3
weighting factor, 200-1
Radioactive decay, 136-7, 138-9

Pharyngeal artery. ascending, 52-3

Phosphor, 156-7, 158-9. 170-1

Pterygoid muscle, lateral, 58-9

Pterygoid processes. 48-9

Radioactive liquids, mouth pipetting,

Photoelectric effects. 1411-1, 142-3

Photoelectron, 1/10-1
Photomultiplier tubes. 192-3

Pulmonary arteries, 12-13, 14-15

Radioactivity, 136-7, 138-9

Pubovesical ligaments. 46-7

Pulmonary angiography. 104-5
Pulmonary arterial/venous pressure,
14-15

fluorescence ability, 158-9

output fluorescent, 170-1
thickness and noise, 166-7

Pulmonary arteriography, 102-3

Pulmonary embolism, 112-13
Pulmonary emphysema, intravenous
urography, 84-5
Pulmonary hllum. 12-13
Pulmonary hypertension, 104-5
perfusion isotope lung imaging,

Photons, 138-9, 140-1, 142-3

energy, 144-5, 200-1
interaction with electrons. 140-1
142-3
' in screen and noise, 166-7

Phrenic artery, inferior. 36-7

Pnrenic nerve

112-13

Pulmonary trunk, 1-8-15

le. 14
right, 16-17

Pulrttonnry valve, 22-3

Pttlttttattatty vrtsttltttuiu, 14- I5
Pttltttnttttry veins, 1.1-15. 22-3
iul:.utt:t1rtlt|it1ttftt:t|tu:||t:y,
ttlttztsntttttl, llrl-1-5
lyt.-lt1t_)rntn tit.-rttttly, 5'2--3

Pttrotticocolit; ltg<1tt1L't'11. 32 -3
Pinttrtl lmrly, 56-7

P1511\'Jfll\13H)Ilf!, 2Piltttlttty 10551:. . . r.-_,;t.. ca

Pixel, 178-9
linmjr ultutttttttitzn coullioiurtt,
1110-1
'
5ltillirttJ_ 172-3

Pvttlugrnplty, retrograde. 85-6

|yulm;t|1us' llaultllow. 86-7

lyt.ttttrrlft:ttt1,58 1]

lytilottttlt1sso.20-l

Plrttttzids constant, 130-9

l-lurnhirzon ctrmura, 172-3
f"rtt:un-tucnlnu tecltnittuta, 74-5
itteutttotltnr:tx, 126-7
Punlitttttl artery, 8-9
Popliteal vein, 0-9. 124-5

L)u;||\lUtt'tt:l1t.'tt_)y, 138-9
Ouztnttutt mottle, 166-7, 180-1

ltatliztl artery, 4--5

Pupliletts torttfon, 6-7

Hnrfintion

POPIJMET regulations, 204-5.

Portal ltypurtentttou,
100-1
_

backgrourtd, 200-1
biological ulfeots. 202-3

P' "elm 36,

= clinical direction of exposure,

0097" u"'asu"d' 12475

Pn,a| Venograph/' 100-1 P5{""' 19_7_
Positron emission tomography lFETl,

204-5
dose, 198-9, 202-3
abdominal compression, 202-3
grid 202_3

Post-cmboltsatton syndrome, 106-7

Pouch of Douglas. 42-3

'"="- 88'

204-5 '

Radiofrequency pulse, 188-9

transverse 'n-tagnetisation, 190-1
Fiadiographic baseline. 94-5
Fladiographic centring point, 94-5
Radiographic image, 166-7
Radiographic mottle, 166-7
Radiography, 209
dental. 174-5
diagnostic
an gap technique, 164-5
filturs, 16-l 5_

fillrattott, 162-3

gunutu: rltttttttgtu, 202 -3

ttrttis, 1511-0, 160-1

ltyntauun state of notiuttt, 202-3

rnamrttography, 174-5

radiation dose. 202-3

~:tti)trut:1int1tucltttittttus, 172-3

visualisation of low cotttrast

sttucltnus, 17-I-5

Plutttnl ufltrsiurt, 202- 3

195? ,

196-7
Radioactive Material lRoad Transport)
Act (19911, 204-5
Radioactive Substances Act 11993).

limits, 204-5

_..,.,_,.-,_.2

equivayem dose 2004

mnisin q' 211

Rat1iomrt:litlel:;)
ltantlling unsealed. 196-7
imaging. 213
Rautopharntaceuticals, 106-7, 210
absorbed dose. 196-7
biological half-life, 196-7
effective dose equivalent, 196-7
emissions, 106-7
lung ventilation studies, 110-11
patient dose, 196-7
Flare earth screens, 158-9, 202-3
Rectovesical fistula, 86-7
Rectum, 30-1
wmphatic drainage 45_7

Recurrent
laryngeal nerve. 20-1
eh. 1849

99'" Tc penechnate Jab Ilin

Red cells. ,

I7

IT/uw\wvrI1"v0rwvwv

%Va7WIW\$%%
y

5TV@iY

224 i INDEX

Relative biological effectiveness,

200-1
Henal aneries, 38-9
Renal cysts, 86-7

Flenal failure, 64-5

intravenous urography, 82-3

Renal length. 118-19

Renal
Renal
_
Renal

puncture. percutaneous, 85-7

pyramid, neonatal ultrasound.
120-1
sinus, 118-19

Renal vein, 38-9

leh. 30-1.. 32-3

L1

Flenogram, radiopharrnaceuticals,
112-13
Repetition time. 188-9
Resonance, 188-9
Rate tntla, 44-5
Retromandibular vein, 60-1
Rhenium. 1-16-7
Ribs, 10-11

Fliedels lobe lliverl. 34-5

Rotator cuff. 4-5

Rutherford Morison's pouch, 26-7

Single photon emission computed

tomography lSPECT). 108-9,
194-5
_
centre of rotation correction, 194-S
Sirioatrial node, 24-5
Sinography, 76-7
Skull
bones, 518-9
half-axial proiection, 50-1
racliographic baseline, 95-7
submentovertical projection, 50-1
sutures, -18-9
Skull radiography, 95-7
Small bowel obstruction, 74-5

Smoking, 72-3

Sodium iodide, 194-5

detectors, 178-9
Sodium ioxaglate, 64
Sones technique, 104-5

Spe 'matic cord, 128-9

Spheno-occipital synchondrosis, =18-9

Sphenoid sinus. 58-9

Sphenomandihular ligament, 58-9

Spin angular momentum, 186-7
Spin echo images, 132-3, 134-5

Spin echo pulse sequences, 188-9.

Sacroiliac joint. -10-1
Sacrum, 40-1
Sagittril sinus, 54-5
i
Salivary glands. ultrasound scanning,
120-1

Salpingitis, 88-9
Sapnenous vein, 8-9
Scaphoid bone, 2-3

Scintillation crystal, 194-5

Scintillation detector, 196-7

Scrotum, 44-5

Seminal vesicles
CT scanning, 128-9
echogenicity. 122-3
Sesamoid. 6-7
Shimming. 192-3
Shoulder, 4-5
arthrography, 90-1

axial radiograph, 90-1

CT examination, 90-1

joint capsule, it-5

Sialography, 94-5

Sickle cell disease, intravenous

urography, 84-5
Signal

Doppler irequency. 186-7

intensity of fat. 132-3
to noise ratio, 190-1

190-1 .
free inductlgn decay, 188-9

Spinal canal. cervical sagiiial

diameter, 62-3

Spli-ll cord, 56-7, 62-3

Spine measurements, 62-3

32-3

=
=

Superior mesenteric vein. 37

Superior vena cava. 16-17, 22-3
lling detects. 128-9 i
Superior vena cavography:'1i'J0-1
Surgical clips, 132-3
Sutural sclerosis, 48-9
Symphysis pubis, -10-1

Syringe shields, lead.1ungsten, 196-7

5/$180119 lupus EFYlil8mi1l0$uS.
intravenous urograpliy, 84-5

112-13
DTPA, 108-9
aerosol, 110-11

urinary tract examination, 112-13

gamma emissions. 202-3

HMPAO. 108-9

MAG-3 urinary tract examination,

112-13

metlioxy isobutyl isonitrile scan,

114-15

methylene diphospnonate. 108-9

M181 myocardial perfusion scan,
198-9

pertecltiietaie. 108-9, 110-11, 115

red cell labelling, 115

Sternoclavicular ioinr, 10-11

Temporomaridibular joint, 58-9

blood supply, 28-9

double-contrast barium meal, 72-3
greater ctirve. 32-3

' wall thickness, 126-7

Stress incontinence, 86-7

Subacromial bursa, 4-5
Subcarinal angle, 10-11
Suoclavian artery

anorrant right, 18-19, 50-1

lelt, 50-1
Subclavian vein, 18-17, 100-1
Subtraction mask. 172-3

Superior mesenteric aneriograpriy,

102-3

Silver halides, 150-1, 152-3

isthmus, 12-13

ultrasound scanning, 120-1

veins, 20-1

Thyroidea ima eneiy. 20-1

Tibial vein, anterior. 95-9
Time of llight magnetic resonance
mm angtogrephy,134 5
image. 110-11
myocardial perfusion scan. 198-9
uptake. 114-15

examination,

pyrophosphate. 134-15
sulphur colloid. 114-15
tin colloid, 116-17
9""'Tc~macroaggregated albumin
panicles, 112-13

Stomach

isotope examination, 110-11

Taeniae coll, 28-9

Spiral valve of Heister, 34-5

Spleen, 32-3
CT scanning, 126-7
Splenic anery, 32-3
Spleriic vein, 36-7
Stapes. 55-7

Star test partern imaging. 150-1

cartilage, 20-1
interior artery, 52-3

'T
OMSA urinary tract

iiiff

Thyroid, 20-1
angle of laminae. 20-1

Superior rnesenterii: artery, 28-9,

81 Qt i

Tomography, 78-9
Toxic mega-colon, 74-5
Trechea, 10-11, 12-13

Tracheo-oesophagual lisiuia, 66-7,

78-7
Transfemoral puncture, 106-7
Transmission ratio, 152-3
Transrectal guided biopsy, 122-3
Transverse sinus, 22-3

Tri-radiate cartilage. 120-1

Tricuspid valve, 23
Tricyclic antidepressants, 116-17
Triquetrum, 2-3
Triticeel canilage, 20
Tunica vagiitalis, -t-l-5
13

Ultrasound

7.5 MHZ frequency transducer,

120-1
antenatal, 44-5
axial resolution limit. 182-3
beam
Frauenhoer tone. 182

teem, 60-1

occlusal plane. 96-7

Fresnel zone. 182

articular disc. 58-9

1 intensity, 184-5
reection, 182-3

Tendon MRI, 134-<3

Teroium ion, 158-9
Testes. 40-1. 44-5
lymphatic drainage, 45-7
ultrasound scanning, 118-19

side lobes, 184-5

transmission speed, 182-3

diagnostic, 182-3, 184-5. 212

Doppler eflect, 188-7

Thoracic artery. lateral, 22-3

Thoracic duct. 12-13, 14-15, 15-17

Thorax, computed tomography, "
124-5. 126-7. 198-9
Tliromliiis, Doppler imaging of veins,
124-5
Thymus, 1B-19

Thyratron, 148-9
(1
Thyrocervical trunit. 18-19

\--_\~.-4|

endoscopic cl oesophagus, 122-3

interventional techniques. 122-3

neonates. 120-1
pancreas. 118-19
pulse

duration, 184-5
length. 184-5
repetition lrequency, 184-5

/.4.

i i

226 lNUE><_.

|*.

Ultrasound lr:cnra1

Vesicovaginal fistula. 86-7

Vidicon tube, 172-3
Vocal cords. 20-1, 130-1

Voxel. 178-9

Upper aodornen
CT scanning, 126-7

Upper limb arterial supply, 4-5 _

Ureieric obstruction, B6-7

Ureteric peristalsis. 118-19

Ureteis. 38-9, -10-1

Urethography, ascending, 88-9

'

diagnostic radiography, 16011

quanta used, 166-7

radiographic contrast, 154-5, 160-1
rare earth screens, 158-9, 202-3
resolution, 168-9

latent. 152-3

silver conservation, 156-7

spacer cone, 174-5
.
timers, 148-9

motion unsharpness. 166-7

penumbra, 166-7

anode, 146-7, 148-9

\
diagnostic imaging. 146-7
electron deceleration. 148-9
energy loss, 145-7
filament, 146-7

Cllagnostit: lfl1(lQll1Q, 1-12-'3, 146 _.;_

160-1. Z02-3
emulsion, 150--1, 152-3
equipineiit inventory, 20-1-5
film, 150-1, 15?. 3

ultrasound, 118-19
Urination, isotope bone scaniiiiig,
108-9

sensitcimetry, 152-3

tube, 146-7

beryllium window, 162-3

computed tomography, 176-7

glass envelope. 146-7, 162-3

inherent filtration. 162-3

linear tomography, 176-7 _

mammography, 174-5

rating, 148-9

'

travel, 176-7
voltage, 174-5, 202-3

nXe vtirltilatiutt study, 110-11.

"xi-;- ventilation study, 110-11
Zinc cadmium sulphide, silver
activated, 170-1

Zygomatir: arch, 96-7

0

lit--5

isctope examinations. 112-13

'

parallax unsltarpness, 166-7

production. Z12

linear attenuation coefficient

Urinary tract
infection, 86-7, 88-9

...

intensifying screen, 156-7, 158-9

interaction with i0dinatedc0ntrast
agents, 142-3
intarnigtion with matter, 144-5
intrinsic efficiency of phosphor, "
156-7
line pair. 168-9
optical tlensity of image. 166-7

X-ray, 138-T9"
absorption, 144-5
base plus fog, 152-3. 154-5
beam
filtration. 162-3

Urethral valves. posterior, 88-9

Urinary bladder. J6-7

rt

cassette. 158-9

Urine, collecting system dilatation.

118-19

characteristic curve, 152-3

density, 152-3

Urography
intravenous, 62-3. 84-5
radiographit: visualisation. 84-5
Urticaria, 66-7

developer. 154-5
fixer, 1541-5
graininess, 166-7

inherent Contrast. 15-1-5

Uterus. 40-1, 42-3

inii-;i-oral, 174-5
line spread function, 168-9
processing, 154-5
processor monitoring, 154-6
spend, 154-5
'"
fllm-screen comhliiatioii, 156;}

lymphatic drainage. 46-7

Vaginal tampon. 128-9

Vague nerve, 12-13

computed tomography. 124-6

'

Y,iti~t\/(@137
,_-

r-\

r'l

double-sided, 174-5

Valleculae. 20-l
Valsalva manoeuvre, 100-1, 124-5

Valvulae conniventes, 25-7, 28-9

Vas deferens, 45
Vascular iriiervetttional techniques.

White matter, 121!-9. 132-3

Whole hody annual tlose limit, 20 O-1,
204-5
Wrist bones, 2-3

urography, 84-5

227

target, 148-9

_.-er

focal spot, 150-1

glass envelope, 145-7, 162-3
image, 212
absorption unsharpness, 166-7
intensifier, 170-1

Whitaker test, 86-7

Uroteric compression, intravenous

X -ray lcoiirdl

grids, 158-9, 160-1, 162-3

Water, spin echo pulse sequence.

190-1

ultrasound. 116-17

105-7
Vasovnoal svitttnue. E5-7

_ l

volume. 191

see also Doppler ultrasound

left. 18-19

'H
\

Veruii"-oniifnuili. 46-7

waves, 182-3

imaging, 86-7
male. 46-7
penile, 46-7
prostatic. 88-9

"T

Vertebral column, 60--1

transducer, 184-5
,
cleaning, 122-3
transrectal prostatic, 122-3
upper abdomen, 116-17
urinary tract. 118-19

Urethra

...

ventricle. rightllelt. 22-3

Vertebral artery, 54-5
Vertebral canal, 62-3

testes. 118-19

lNDEX

Venous ll\|'Ol1\bO5l$. 88-9

pulsed wave transducer, 182-Ll

reflected wave frequericy,.l86-7

>'
-r

4i.l.
l

~--i

M-mm"whip

modulation transfer function

168-9
noise in images, 166-7
resolution, 168-9

"

single-sided, 175
filter material, 164-5
local lilm distance, 164-5