2024

Radiology
ANATOMY
Radiographs

• Branch of science that deals with radiant energy to treat and diagnoses
diseases
• X-ray is the radiant energy discovered by W. C. Roentgen in 1895/
• The x ray is produced by a wire that is connected btw a filament and a
tungsten filament and enclosed in a vaccum tube. When heated the tube
glows and emits electrons and on applying high voltage ejects the
electron out which on striking the target (patient) emits x-ray and the ray
are collected by the film
• Field with maximum absorption of x-ray is radiopaque. When passed
through organs and air sac form shadow and thus they are called as
radio translucent.
• The properties of x-ray are: -
o Penetration
o Photographic property: - the x-ray react with the bromium salt
on the film and forms a dark spot on the film while those that
don’t react form a white spot which is line of the structure of the
body
o Fluorescent property
o Biological property
• The film obtain is called as skiagram or radiogram and procedure is
called as radiography
• Views of the radiograph are
o Anteroposterior view: - x-ray in front and film on the back. Rays
pass anteroposteriorly. Organs in the back of the body are seen
in this view

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 o Posteroanterior view: - x-ray in back and film on the back. Rays
pass posteroanteriorly. Patient is made to stand for it. Organs to
the front of the body are seen by this view
o Lateral view: - x-ray and films are kept lateral to the patient
o Oblique view: - used to see back of ribs, lesion, oesophagus,
fractures and dislocation
• X ray that are taken without use of any dye is called a plain x-ray. These
x-rays are used in: -
o Bone fracture
o Heart
o Skull
o Dislocation
• X ray that uses radioactive dye such as barium sulphate, Sodium iodide is
used to check hollow viscera, vessel and organs. The different types are:
o Angiogram: - used to check leaks, aneurysm, block in arteries
and vein
o Barium swallow: - use of barium ice cream to check oesophagus
o Barium meal: - use of barium water and to see stomach,
duodenum, intestine
o Barium enema: - use of barium dye to see large intestine for
obstruction
o Hysterosalpingography: - use of the dye to check the uterus,
fallopian tube to check for obstruction, leakage, blocks etc.
o Sialography: - used to check the salivary parotid duct for any
stone that would have obstructed the path
o Pyelography: - two types are ascending and descending to check
the ureter continuation and urinary bladder condition
o Ventriculography to check for the ventricular structure, aortic
regurgitation, hypertrophy etc.

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• Requirements for contrast dye are: -
o Non toxic
o Sufficiently radiopaque
o Easily excreted
o Non absorbed by the tissue
• Way to read a radiograph: -
o Type of radiograph: - plain or contrast
o View of the radiograph: - AP view or PA view, lateral view
o Direction of the radiograph: - right or left
o Comment on region: - thoracic, hypochondriac, lumbar etc
o Identifying the structures present and associated anomaly

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• Radiograph of upper limb: -

o
▪ This is a plain x-ray of forearm and hand.
▪ It is of anteroposterior view of the left hand
▪ The bones that can be seen are: -
• Radius
• Ulna
• Metacarpals
• Phalanges
• The carpels present are: -
o Capitate
o Hamate
▪ Thus, the age of the person whose x-ray this is, is of 1 yr
old

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• Note: - the age of the x-ray of the person can be determined by the
following: -
o Presence of epiphyseal line of fusion. Line fuses by age 21
o Number of carpel bones present or formed

o Index finger fusion after 16yr

• This is a plain radiograph of anteroposterior view of wrist, forearm and
hand of the left upper limb
• The forearm is pronated and thus the radius is
crossed over ulna
• The bones observed are
o Radius
o Ulna
o Carpel bone
o Metacarpals
o Phalanges
• The patient is less than 16 yrs as the radial fusion cap
is formed, pisiform is absent, head of 1st metacarpal is
not fused yet

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• This is a plain radiograph of elbow joint
• It is posteroanterior view of the right elbow joint
• The bones present are: -
o Humerus lower end
o Ulna
o Radius
• This radiograph may be taken to check for dislocation of the ulna from
the olecranon fossa, dislocation of radial head from annular ligament
called as nurse’s elbow

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• This is a plain radiograph of chest
• It is posteroanterior view to see the heart
• Structure observable: -
o Clavicle
o Humerus head
o Scapula
o Sternum
o Ribs
o Heart and pericardial sac
o Diaphragm
o Liver
• No ventricular hypertrophy, pericarditis, pericardial effusion, lung defect
like bronchitis, pneumonia, tumour etc
• The secondary ossification centers of all bones fuse but only in humerus
the medial epicondyle center appears in 5th-6th year and fuses with shaft
later

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 • This is the plain radiograph of chest in posteroanterior view
• The heart shows a dextrocardiac condition as the apex is located on
the right 5th intercostal space
• The entire heart is inverted and the right atrium is present on the left
side along with right ventricle

• This is plain radiograph of chest in posteroanterior view

• The right lung has pleural effusion which is indicated by the white
translucent opacity in the chest

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• this is a plain radiograph of the chest in posteroanterior view
• Structures observable is: -
o Clavicle
o Sternum
o Ribs
o Heart shadow
o Diaphragm
o Air filled in the fundic region of stomach
• Boundaries of the heart: -

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 • this is a plain radiograph of
anteroposterior view of the shoulder
joint
• The humerus is fractured at surgical and anatomical neck

• This is an anteroposterior view radiograph of the left humerus

• There is a mid-shaft fracture
• It can cause: -
o Tear in deltoid and coracobrachialis muscle
o Compression on radial nerve and profunda brachi
o Chances of the transection of musculocutaneous nerve
o Fracture could be caused due to impact from fall from a bike

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 • this is a plain anteroposterior
view radiograph of right shoulder joint indicating dislocation of the
humerus
• It is the anterior and inferior dislocation of the humerus
• Commonly occurs in abducted and externally rotated position of
shoulder joint

• This is a plain radiograph in anteroposterior view of the left clavicle

• It shows a medial 1/3rd and lateral 2/3rd fracture of clavicle which is
the most common fracture
• Causes: -

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 1.

2
.

• Both are plain radiograph of the left hand

• The first radiograph is of lateral view showing distal radial shaft
fracture and downward displacement of radius
• The second radiograph is of anteroposterior view showing the radial
fracture btw the shaft and lower end of the radius
• Occurs when fallen on extended wrist
• This fracture is called colles fracture of dinner fork deformity

• This is a plain radiograph is a smiths fracture of left radius

• There is upward displacement of the radius bone
• Happen when fallen on flexed wrist

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 Lower limb radiographs

• This is a plain radiograph of the left hip joint

• It is in the anteroposterior view
• The parts to be identified are: -
1. Acetabulum
2. Head of femur
3. Greater trochanter
4. Neck of femur
5. Intertrochanteric line
6. Shaft of femur
7. Obturator foramen
8. Pubic symphysis
9. Ischial tuberosity
10. True pelvic cavity
11. Sacrum
12. Ischiopubic ramus
13. Shenton’s line
• Shenton’s line is the line formed by
an arch btw the lesser trochanter and extending till obturator
foramen. Any shift in the line indicates dislocation
• Nelton’s line is the line extending btw ischial tuberosity to anterior
superior iliac spine. The line is in close proximity with the greater
trochanter and if it is shifter it is due to: -
o Hip dislocation
o Coxa Vara: - angle of femur neck <120

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 • This is a plain radiograph of the knee joint of both the lower limbs in
the anteroposterior view
• The labelled structure here are: -
1. Lower end of femur
2. Upper end of tibia: - metaphysis
3. Fibula
4. Intercondylar ridge on the epiphysis of tibia
5. Growth plate of femur
6. Growth plate of tibia
• Differentiating btw epiphyseal line and a fracture is that an epiphyseal
line is continuous and in same plane while a fractured line is irregular
due to vascular supply and can be straight or oblique. In the report a
fracture is indicated by #.
• Lower end of femur fuses by 20th yr of life and upper ends of tibia
fuses by 20yrs and of fibula by 25yrs.
• In all these three structure the secondary ossification centers appear
just before birth. This helps to know viability of foetus and in
medicolegal cases.
• The lower end of fibula is an exclusion to the ossification principle in
which the secondary centre forms first and fuses first
• At junction btw epiphysis and diaphysis, a metaphysis is present
containing a growth plate

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 • This is a plain radiograph of the left ankle joint and left foot
• The one on the left is of lateral view and one on the right is of
anteroposterior view. And that of the foot is dorsoplantar view
• Labelled parts are: -
1. Talus
2. Lower end of tibia
3. Medial malleolus
4. Lower end of fibula
5. Lateral malleolus
6. Ankle joint space
7. Metatarsal
8. Sesamoid bone near the head of 1st metatarsal formed by the
tendons of flexor hallucis bravis
9. Styloid process of 5th metatarsal
10. Calcaneus
• Clinical significance of ankle radiograph is to help diagnosis of pain,
swelling, tenderness and deformity in ankle
• Calcaneal spur is a deposition of calcium on bottom of foot due to
constant stress and it forms an extra growth near the calcaneal
tuberosity. They can cause pain when the nerves and vessels are
compressed

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 • This a plain radiograph of the right ankle joint and foot
• The foot radiograph is dorsoplantar and that of ankle joint is lateral
view
• The labelled parts are: -
1. Tibia lower end
2. Fibula lower end
3. Growth plate at lower end of tibia
4. Talus
5. Calcaneum
6. Cuboid
7. Metatarsal
8. Proximal Phalanges
9th, 10th and 11th are cuneiform bones
• Age of the individual is about less than 15yrs as tibia is not yet fused

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 • This is a plain radiograph of the left knee joint
• The one on the left is an anteroposterior view and the one on the right
is the lateral view
• The labelled areas: -
1. Lower end of femur
2. Lateral condyle of tibia
3. Medial condyle of tibia
4. Neck of fibula and is related to anterior tibial artery and
deep peroneal nerve
5. Upper end of the fibula
6. Medial condyle of the femur
7. Lateral condyle of the femur
8. Knee joint space
9. Patella
10. Tibia shaft
11. Tibial tuberosity related to ligamentum patella
• Normal knee joint space dimension is an indirect way to measure the
distance btw distal femur and proximal tibia giving a measurement of
the thickness of tibiofemoral cartilage and it is 4.74 ± 0.75 mm
• Condition in which the space is reduced is osteoarthritis, age, overuse.

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 • This is a plain radiograph of the right foot taken in dorsoplantar view
• The labelled parts are: -
o 1st and 2nd are sesamoid
bones in the head of 1st
metatarsal formed by
the tendon of Flexor
hallucis bravis
o 3rd to 6th are metatarsals
o 7th is the 5th metatarsal
that is fractured
obliquely along the shaft
o 8th is calcaneum
o 9th is navicular
o 10th is talus
o 11th and 12th are cuneiform
o 13th is cuboid
o 14th to 17th are phalanges
• Clinical importance of foot radiographs is to asses fracture in the bones,
calcaneal spur, foot deformities, dislocation of tarsal bone, formation
of bunion, arthritis, cysts etc
• The ossification centre of all tarsal bone appears but only for calcaneum
a secondary center is formed. Os trigonum is non fusion of the
secondary centre of the calcaneum bone

• The secondary centre for base of the 1st metatarsal appears in the 3rd yr
and unite with the shaft at 17-18yr while for other metatarsal the centre
appears in 5th-9th yr and unite in 17-20yrs and for the base they appear
in 4th-10th yr and then unite at 15-18yr.

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 • This is a contrast radiograph of the femoral
artery of the left lower limb
• This is anteroposterior view
• The labelled parts are: -
1. Femoral artery
2. Popliteal artery
3. Hip bone
4. Shaft of femur
5. Tibia
• Arteriography is procedure done where a
contrast dye is injected into the artery to
increase its opacity and make is observable
on a radiograph. The film obtained is called
as an arteriogram or arteriograph.
• Branches of femoral artery are: -
o Profunda femoris
o Superficial epigastric branch
o Superficial external pudendal branch
o Superficial circumflex iliac branch
o Muscular branches
o Saphenous branch
o Cutaneous branch
o Terminates or continues as popliteal artery
• The femoral artery is the continuation of the external iliac artery from
the inguinal ligament and terminates at level of adductor hiatus and
continues as popliteal artery after piercing adductor magnus
• Adductor hiatus is the space in the adductor magnus that allows the
femoral artery to enter the posterior compartment of the thigh and
continue as popliteal artery

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 • Instruction to perform a contrast radiograph: -
o Patient is explained about the procedure
o Written consent taken
o Medication taken by the patient is recorded
o Allergic reaction to the dye if any are to be noted
o For women if the procedure is during fertility period then the
menstrual history has to be taken into consideration to ensure
the female is not pregnant
o The patient is kept orally nil for 8-10hr prior to the procedure
o The patient sensitivity to local anesthesia is taken into
consideration
o The wrist or the thigh is anesthetized and the radial or femoral
artery respectively is taken for the procedure
o The dye catheter is passed through the vessel in guidance of a
fluoroscope and then once dye is injected the radiograph is
taken
• This procedure is done for: -
o Coronary arteries
o Aorta
o Femoral artery
o Brachial artery
o Carotid arteries
• Indication: -
o Narrowing of lumen
o Hemorrhage
o Aneurysm
o Inflammatory condition
o Thrombosis
o Tumor

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 • This is a plain radiograph of abdomen and pelvis and is of
anteroposterior view
• The labelling are: -
o The 1st and 2nd labelling is the 11th and 12th rib
o 3rd is air shadow of the large intestine
o 4th is spinous process of lumbar vertebra
o 5th is transverse process of 5th lumbar vertebra
o 6th and 7th are the hip bone
o 8th is the sacroiliac joint
o 9th is the air fluid level
• Erect posture of abdomen is advised for the plain radiograph of
abdomen to observe air fluid level to check for obstruction of intestine
• Normal air fluid levels in abdomen are the air escaping the fluid and
creating an interface btw. If the number of air fluid is >3 then indicates
intestinal obstruction as on obstruction the fluid and gas accumulate
creating a characteristic air fluid pattern
• The air fluids are present in the stomach near fundic region, in small
intestine, in right subphrenic space

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 • This is a contrast radiograph of the gall
bladder called as cholecystogram. It is in
anteroposterior view and on the right side
• The structure observable here are: -
o Fundus of gall bladder
o Body of gall bladder
o 9th rib
o Artefacts
• The dye is given by an oral tablet called as
iopanic acid
• Instruction for cholecystography is: -
o Two days prior to procedure the patient is asked to consume a
normal dinner preferred with fat rich diet
o A day prior to the procedure the patient is given a low fat diet
and then on the day of the procedure the patient is given the
tablets 6 in number one every hour with water
o Nothing is to be eaten once tablet is given
o On morning of procedure nothing is given to patient and then
the procedure is performed where the dye outlines the gall
bladder and an enema may be performed to prevent air fluid
space from overlapping the intestine.
o The patient is then given fat rich drink to stimulate gall bladder
to release the bile.
• Patients allergic to the dye show signs of nausea, redness, itching and
difficulty to breath.
• Indication: -
o Gall stone of which 90% are radio translucent and 10% are radio
opaque that may be misled in diagnosis
o Polyps, obstruction, absence of gall bladder can be observed
o Modern day it has been replaced by ultrasound scan
o Cholangiogram is done to check the blood vessel of the gall
bladder

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 • This is a contrast radiograph of thorax.
This is of barium swallow to check the
oesophagus
• It is oblique view
• Barium swallow is a procedure done to
make pharynx and oesophagus
observable on the radiograph.
• Palatable barium sulfate suspension is
given to patient and asked to swallow.
The patient must continuous be given
the suspension and asked to swallow as
the procedure is being performed and
after procedure must be advised to eat
lots of vegetable and drink lots of water
to ensure complete excretion of the
barium else it will cause constipation
• In the radiograph the pharynx can be
seen above and oesophagus on
continuation
• This is performed to check hiatal
herniation, achalasia cardia, ulcers and
oesophageal cancers
• Constriction of oesophagus are at: -
o Pharynx and oesophageal junction
o Aorta crossing over oesophagus
o Passing of oesophagus into diaphragm

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 • This is a contrast radiograph obtained by a barium meal. It is in
anteroposterior view
• The parts that can be seen here are: -
o 1st is fundic region filled with air fluid
o 2nd and 3rd are cardiac end of stomach and cardiac sphincter
o 4th is greater curvature of the stomach
o 5th is insula angularis at the junction of body and pylorus along
lesser curvature
o 6th is pylorus and pyloric antrum
o 7th is duodenum cap
o 8th is continuation of duodenum
• Barium meal is a procedure done to study the stomach and
duodenum.
• Indication of ulcers, cancer, muscle tone, shape of stomach can be
identified with this

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 • Procedure of barium meal is: -
o 250-300ml of the barium sulfate is given to the patient 6-8hrs
after fasting
o As the emulsion comes in contact with the stomach mucosal
lining it lines the boundary of the stomach and makes it radio
opaque
o Any ulcers will be seen as crates and shapes of stomach is
classified as J or steer horn shape
o Once the patient is given the meal, they are given a normal meal
to ensure the gastric emptying occurs else it will delay up to 6hrs
o The barium follows into duodenum and forms a triangular
structure called as duodenal cap which is a radiological
derivative and then continues into the duodenum
o The barium meal lines the walls of the stomach and if muscle
tone is well then the greater and lesser curvature are parallel
else the greater curvature may sag
o The shadows of mucosal folds can be appreciated as the gastric
and duodenal emptying occurs.

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 • This is a contrast radiograph obtain by a barium meal follow through
procedure
• After the barium meal passes through duodenum, the dye enters the
jejunum and ileum where the and the radiographs are taken every
1.5-2hrs interval
• In this jejunum and ileum appear with feathery and superimposed
appearance due to peristaltic contraction of the intestine and due to
presence of villi and circular folds.
• The emulsion reaches the ileocecal junction 3hrs after ingestion and
emptying takes 12-14hrs
• The emulsion once enters the large intestine fills up the lumen and the
haustration can be appreciated
• Complete removal of the barium meal takes 48-72hrs
• In a barium meal follow through the small intestine is seen as a
feathery appearance with narrow lumen while in a barium enema the
large intestine has wider lumen and haustration are more pronounced

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 • This is a contrast radiograph obtained on barium enema procedure
• The barium sulphate emulsion is injected into the colon via the anal
opening using an endoscope
• The haustration produces a wider shadow with constriction at
intervals
• The sigmoid colon overlaps the rectum and thus appears brighter
• It is done to identify diverticulosis, carcinoma and colonic cancer
which gives an apple core appearance
• Labelled parts are: -
1. Haustration
2. Ascending colon
3. Hepatic flexure
4. Transverse colon
5. Splenic flexure suspended by ligament sustentaculum leinus
6. Descending colon
7. Sigmoid colon

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 • This is a plain radiograph of a female pregnant patient
• It is anteroposterior view and of the pelvic region
• The labelled parts are: -
1. Pubic symphysis
2. Obturator foramen
3. Head of femur
4. Fovea capitis
5. Hip joint space
6. Neck of femur
7. Lesser trochanter
8. Right hip bone
9. Ischial spine
10. Head of foetus
11. Rib cage of foetus
12. Right humerus of foetus
13. Lower limbs of foetus
• Radiography during pregnancy is restricted as the embryo is assumed
to be at same risk for potential carcinogenic effect of radiation as are
children

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 • This is a contrast radiograph obtained by the procedure of
pyelography.
• It is done to see the kidney canaliculi, ureter and urinary bladder
• The labelled parts are: -
1. Major calyces
Seen as cup shape
2. Minor calyces
3. Renal pelvis
4. Ureteric constriction at renal pelvis
5. Ureteric constriction at uterine artery
6. Urinary bladder
• The procedure is of two methods: -
o Intravenous descending pyelography: - dye is injected into the
veins and it reaches kidney via vein → heart → artery → kidney
o Ascending or retrograde pyelography
• The radiogram is taken 3 min, 5-6 min, 9 min, 15 min after dye is
introduced
• At
o At 3-5 min the dye enters kidney calyces
o 9-14 min the dye enters the ureter and bladder

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 • This is a contrast radiograph obtained by a procedure called
hysterosalpingography
• The procedure is done by injecting radio opaque dye via the vaginal
canal and to see the uterus and fallopian tube
• It is done to study the uterus for polyps, growths, adhesion, foreign
bodies, sterility of uterine tube
• Dye spill indicates if fallopian tube is patent as the peritoneum of
female are open
• Labelled parts: -
1. Canula in vagina
2. Cervical: - external os
3. Body of uterus
4. Fallopian tube
5. Internal os at intramural part of fallopian tube
6. Isthmus of fallopian tube
7. Ampulla of fallopian tube
8. Fimbriae of fallopian tube
9. Dye spill
• Indication: -
o Fallopian tube block in ectopic pregnancy
o Bicornuate uterus, septate, arcuate uterus
o The spillage indicates the patency of the tube and uterine cavity

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 • It is a contrast radiograph of abdomen of the abdominal aorta.
• The film is called an aortogram
• The labelled parts: -
1. Trunk of aorta
2. Common iliac arteries
3. Renal arteries
4. Superior mesenteric artery
5. Inferior mesenteric artery
6. Splenic artery
• Procedure: -
o A catheter is introduced into the right femoral artery of the
patient
o The reason for right femoral artery is to prevent spread of aortic
dissection into left common iliac artery as it is a common site for
aortic dissection
• Indication: -
o Aneurysm
o Coarctation of aorta
• Aneurysm of aorta is the dilation of the aortic wall and all three layers
of the wall is affected in aneurysm and is called true aneurysm.
• In pseudoaneurysm the outer wall is affected and is called fusiform
aneurysm

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 RADIOLOGY OF HEAD AND NECK: -

• This is a lateral view plain radiograph of head and neck

• The labelled parts are: -
1. Vertex of the skull
2nd, 3rd and 4th together form the diploe bone
5. Frontal sinus
6. Ethmoidal sinus
7. Pituitary fossa
8. External acoustic meatus near to petrous part of temporal
bone
9. Mastoid antrum
10. external occipital protuberance
11. maxillary sinus
12. C7 vertebrae
13. Angle of mandible
14. Ramus of mandible
15. C2 vertebra

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 • this is a plain radiograph of the skull
• it is taken in waters view which is also called occipitomental view
where x ray beam is at an angle of 45o
• this view is necessary to check the paranasal air sinus
• the labelled parts are: -
1. orbit
2. nasal bridge
3. bony nasal septum
4. maxillary air sinus open in semilunaris hiatus
5. zygomatic arch
6. symphysis menti
7. body of mandible
8. mandibular angle
9. foramen magnum
• opening of sinus: -
o frontal sinus into superior meatus
o anterior, middle and posterior ethmoidal sinus into middle
meatus at ethmoidal bulla
o maxillary sinus opens in to hiatus semilunaris

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 • this is plain radiograph of lateral view of the neck
• the labelled part: -
1. external occipital protuberance
2. mastoid antrum
3. external acoustic meatus
4. angle of mandible
5. ramus of mandible
6. maxillary air sinus
7. Atlantic vertebra
8. C3 vertebra
9. C3 vertebra spinous process
10. Intervertebral disc
11. C7 vertebra
12. Hyoid bone
13. Pharynx

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