Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Head and Neck Imaging

Temporal Bone General The temporal bone is divided into five portions: Mastoid (posterolateral part that includes the mastoid process: attachment for sternocleidomastoid and other muscles) Petrous portion (pyramidal-shaped medial part; inner ear structures, internal auditory canal [IAC], petrous apex) Squamous portion (anterolateral part; forms lateral wall of middle cranial fossa) Tympanic portion (forms bulk of external auditory canal [EAC] and middle ear space) Styloid portion External…

Neurologic Imaging

Imaging Anatomy Parenchymal Anatomy Lobar Anatomy ( Fig. 6.1 ) Frontal lobe: anterior to central sulcus (CS) (Rolando) Parietal lobe: posterior to CS Temporal lobe: inferior to lateral sulcus (Sylvius) Occipital lobe: posterior Limbic lobe Central (insular lobe) Basal Ganglia ( Fig. 6.2 ) Lentiform nucleus: putamen + globus pallidus Striatum: putamen + caudate nucleus Claustrum Caudate nucleus consists of: Head (anterior) Body Tail (inferior) Subthalamic…

Musculoskeletal Imaging

Trauma General Fracture FRACTURE SYNOPSIS Fracture Finding Spine Jefferson Ring fracture of C1 Hangman's Bilateral pedicle or pars fractures of C2 Teardrop (flexion) Unstable flexion fracture Clay-shoveler's Avulsion fracture of spinous process lower cervical, high thoracic spine Chance Horizontal fracture through soft tissues and/or bone of thoracolumbar spine Burst Compression fracture with disruption of the posterior vertebral body with retropulsion into the spinal canal Face All…

Genitourinary Imaging

Kidneys General Anatomy The kidneys, renal pedicle, and adrenal glands are located in the perirenal space, which is bound by the anterior and posterior renal fascia (Gerota fascia; for anatomy, see the section Retroperitoneum ). Renal Pedicle ( Fig. 4.1 ) Renal artery Renal vein Collecting system and ureter Lymphatics Collecting System Minor calyces: most kidneys have 10–14 minor calyces. Major calyces Renal pelvis: may be…

Gastrointestinal Imaging

Esophagus General Anatomy Normal Esophageal Contour Deformities ( Fig. 3.1 ) Cricopharyngeus Postcricoid impressions (mucosal fold over vein) Aortic impression Left mainstem bronchus (LMB) Left atrium (LA) Diaphragm Peristaltic waves Mucosa: thin transient transverse folds: feline esophagus (vs. thick folds in chronic reflux esophagitis); tiny nodules in older adults: glycogenic acanthosis Gastroesophageal Junction (GEJ) Anatomy ( Fig. 3.2 ) Phrenic ampulla: normal expansion of the distal…

Cardiac Imaging

Cardiac Imaging Techniques Plain Radiograph Interpretation Normal Plain Radiograph Anatomy Posteroanterior View ( Fig. 2.1 ) Right cardiac margin has three segments: Superior vena cava (SVC) Right atrium (RA) Inferior vena cava (IVC) Left cardiac margin has four segments: Aortic arch (AA) (more prominent with age) Main pulmonary artery (PA) at level of left main stem bronchus Left atrial appendage (may not be visible in normal…

Quality Assurance and Commissioning of New Radiotherapy Technology

4.1 Introduction Comprehensive acceptance testing and commissioning of new equipment are the foundations for the safe implementation of new technology in a Radiation Oncology department. Once the unit is in clinical use, a routine quality assurance (QA) program must be followed to ensure that the unit continues to perform within acceptable limits. Many of the QA tests will rely on establishing baseline values at the time…

Chest Imaging

Imaging Anatomy Gross Lung Anatomy Segmental Anatomy ( Figs. 1.1 – 1.2 ) Right Lung Upper lobe Apical B1 Anterior B2 Posterior B3 Middle lobe Lateral B4 Medial B5 Lower lobe Superior B6 Medial basal B7 Anterior basal B8 Lateral basal B9 Posterior basal B10 Left Lung Upper lobe Upper Apicoposterior B1, B3 Anterior B2 Lingula Superior B4 Inferior B5 Lower lobe Superior B6 Medial basal…

In-Vivo Dosimetry

3.1 Introduction In-vivo dosimetry is used clinically to verify during treatment how accurately the planned dose is delivered to the patient. While American Association of Physicists in Medicine (AAPM) TG-62, Diode In-Vivo Dosimetry for Patients Receiving External Beam Radiation Therapy, sees in-vivo dosimetry as supplementary to a good clinical QA program, more recent developments in understanding failure modes in treatment delivery and adaptive radiotherapy have led…

Relative Dosimetry for MV Beams

2.1 Introduction Since the basic physics of dosimetry for radiation beams is extensively covered in textbooks on radiotherapy physics, this chapter will focus on the measurement of dosimetry data in clinical practice. There are two main goals in measuring relative dosimetry data: (1) confirming the accurate technical functionality of the accelerator to produce a symmetric beam of correct energy and known relative output as specified at…

Reference Dosimetry for Ionizing Radiation

1.1 Introduction The key to the accurate delivery of radiation is the ability to establish the absolute dose delivered. In radiation therapy clinical practice the primary tool used to measure absorbed dose is the ion chamber. The use of ion chambers has been well described by international codes of practice. While some of the details may differ slightly, the basic concepts of the various codes of…

Ultrasound of Muscle Injury

Introduction Muscle is probably one of the most difficult tissues in the musculoskeletal system to assess with ultrasound. There are a variety of reasons for this, including the complex anatomy of the structures involved, the isotopic nature of muscle, the different functional bundles present within muscles and compartments, and the varied site and appearance of muscle lesions. Once the examining sonographer appreciates the level of difficulty…

Ultrasound Imaging of Joint Disease

Introduction Ultrasound machines with high-resolution probes are readily available in most radiology departments and are routinely used to assess both articular and periarticular disorders. They are also becoming commonplace in rheumatology departments, reflecting the important role they now play in rheumatological disease. Ultrasound has many advantages over other imaging techniques with the ability to carry out rapid assessment of multiple joints at different locations, undertake dynamic…

Ultrasound of Soft Tissue Masses

Introduction Soft tissue masses of the musculoskeletal system are extremely common. The vast majority of lesions are benign and in many of these cases malignancy can be excluded from the history and examination without resort to imaging. Key Point Because of the overwhelmingly high ratio of benign to malignant lesions there is often a delay in diagnosing the latter and early imaging is therefore recommended when…

Specific Intervention Techniques

Shoulder Intervention Subacromial Subdeltoid Bursa Injection Patient and Probe Position Ultrasound-guided injections provide more reliable and accurate needle placement which is particularly useful to assess the diagnostic response to local anaesthethic in patients with a poor response to a previous blind injection. Guidance is also useful to ensure accurate medication placement and in difficult cases such as obese and postoperative patients. A quick wipe with a…

Musculoskeletal Intervention: General Principles

Introduction The superficial location of many musculoskeletal structures makes them readily amenable to injection therapy and many unguided injections are carried out in the office or ward setting. Large superficial structures are easily targeted, although success will vary with the practitioner's expertise. It is generally accepted that many of these unguided injections will miss their target, but, despite this, patients not infrequently report good responses. Good…

Disorders of the Ankle and Foot: Forefoot

Introduction The foot can be divided into three compartments according to the bony anatomy: the forefoot (comprising the metatarsals and phalanges, the midfoot (the cuneiforms, cuboid and navicular) and the hindfoot (calcaneus and talus). Midfoot pain and metatarsalgia are common clinical complaints. The aetiology of the symptoms is often difficult to establish clinically and imaging therefore plays an important role in the evaluation of patients. Although…

Disorders of the Ankle and Foot: Medial

Introduction Due to the superficial location of many of the structures that contribute to medial sided symptoms, ultrasound plays an important role in their assessment. Abnormalities of the medial tendons predominate, but disorders of the neurovascular structures, ligaments and even bones need to be considered. The technique for examining the medial ankle has already been discussed. Important points include the dominant role that axial images play…

Disorders of the Ankle and Foot: Lateral

Introduction The most common indications for an ultrasonographic examination of the lateral aspect of the ankle are suspicion of peroneal tendon pathology or lesions of the lateral ligament complex. Patients with ligament injuries are generally examined in a chronic phase to detect late complications of ligament tears or undiagnosed associated lesions. Ultrasonography, allowing a dynamic assessment of the structures, is the best imaging modality for examination…

Disorders of the Ankle and Foot: Anterior

Tendons Tibialis Anterior Anatomy The tibialis anterior tendon is the strongest of the anterior ankle tendons. Its parent muscle arises from the upper two-thirds of the lateral aspect of the tibia. It has a high musculotendinous junction and a strong distal tendon, which is constrained by a transverse superior and an oblique inferior retinacular band. The relationship of tibialis anterior to the retinacula is complex. The…