CXR: 1) Devices / Lines 2) Vasculature a. Heart size, contour, valves, calcifications (valvular or arterial) b.

Look behind heart for retrocardiac opacit / hiatal hernia c. !ortic knob, calcifications, tortuosit , "idth of #ediastinu# d. $ul#onar arter trunk #o%ul and rt/lt #ain pul#onar arteries e. Left $ul#onar atriu# #o%ul f. $ul#onar Vasculature & ede#a, pruned ') (ediastinu# a. Hilar, subcarinal and paratracheal #ass/l #phadenopath b. )rachea #idline, superior #ediastinu# "idened c. pneu#o#ediastinu# *) !ir"a a. )racheal stenosis b. +ranchin% pattern of trachea, endolu#inal #asses / cutoff ,) $leural -pace a. $neu#othora. b. $lural #ass c. $lural fat / thickenin% d. $la/ues / calcifications 0) Lun%s a. 1onsolidations b. 2odules (side to side co#parison) c. 3ffusions d. !ir broncho%ra#s e. +ronchiectasis, peribronchial cuffin% or thickenin% f. 4etrocardiac area 5) 4ibs, clavicles, shoulders, spine, 6) !bdo#en (free air, %astric air bubble, bo"el %as pattern, calcifications)

KUB: 1) 7as $attern a. 2or#al b. -+8 Lo" %rade v. 9leus (s#all bo"el or colonic) c. -+8 Hi%h %rade (%asless or lar%e distention) d. :ree !ir 2) -olid 8r%ans a. 9dentif Liver ed%e, spleen, kidne s, psoas, bladder ') +ones *) !ppliances / -ur%ical 1han%es ,) $eripher of :il# a. $roperitoneal fat stripes b. Hernia c. :ree !ir Abdomen CT: 1) -cout 9#a%e revie"

2) 1ontrast bolus phase, li#itations, artifacts ') Heart base a. size b. ane#ia on non;contrast *) Lun% bases a. nodules b. airspace disease ,) -olid or%ans< Liver, 7allbladder, -pleen, =idne s, !drenals, $ancreas a. fatt liver, liver #asses, includes liver "indo" b. adrenal nodules 0) (esentar 5) 3sopha%us, sto#ach, duodenu#, s#all bo"el, a. special focus on ter#inal ileu# b. appendi. 6) 1ecu#, colon, rectu# >) 1oronal for ,;6 1?) Vessels a. include sa%ital 11) +ones a. include sa%ital 12) +od superficial soft tissue and #uscles

Hounsfield Units: ?;1? @ "ater 1?;'? @ #i.ed '?;*? @ blood un;clotted *?;0? @ blood clotted (sentinel clot) 6?;1'? @ blood and contrast (active e.travasation) 3nhance#ent is a A1, HB chan%e

)he 1ouinaud classification of liver anato# divides the liver into ei%ht functionall indepedent se%#ents. 3ach se%#ent has its o"n vascular inflo", outflo" and biliar draina%e. 9n the centre of each se%#ent there is a branch of the portal vein, hepatic arter and bile duct. 9n the peripher of each se%#ent there is vascular outflo" throu%h the hepatic veins.

Right hepatic vein divides the ri%ht lobe into anterior and posterior se%#ents. Middle hepatic vein divides the liver into ri%ht and left lobes (or ri%ht and left he#iliver). )his plane runs fro# the inferior vena cava to the %allbladder fossa. Left hepatic vein divides the left lobe into a #edial and lateral part. o!tal vein divides the liver into upper and lo"er se%#ents. )he left and ri%ht portal veins branch superiorl and inferiorl to proCect into the center of each se%#ent.

Chest CT: 1) 2) ') *) ,) -cout 9#a%e revie" 1ontrast bolus phase, li#itations, artifacts Lines and tube positionin% )h roid 1ardiovascular a. !rter < !orta, bracheocephalics, subclavian, carotids, vertebrals, coronaries, abdo#inal b. Vein< 9V1, -V1, bracheocepalics, internal Cu%ulars c. Heart< LV, 4V, L!, 4!, $ul#onar arter trunk dia#eter, calcifications, aortic and #itral valves d. 3picardiu# e. $ul#onar !rter (#a.. dia#eter D'?##) & fillin% defects f. !ne#ia (blood attenuates less than interventricular septu# attenuates in noncontrast & Hb% D 1?) 0) L #ph nodesE a.illar (D1.,c#) , paratracheal, hilar (D1c#), subcarinal, !$ "indo", esopha%eal 5) )rachea/bronchi, debrisF 6) Lun%< airspace disease, nodules >) -oft )issues a. +reast (asses, fibro%landular tissue b. (uscles and - ##etr 1?) +ones a. 4ibs, vertebral bodies, transverse process, clavicle, scapula b. ($4 for vertebral bodies 11) 3sopha%us 12) Bpper !bdo#en

"up!aclavicula! nodes #$ Low cervical, supraclavicular and sternal notch nodes :ro# the lo"er #ar%in of the cricoid to the clavicles and the upper border of the #anubriu#. )he #idline of the trachea serves as border bet"een 14 and 1L. "upe!io! Mediastinal %odes &'( &R$ Upper Paratracheal 24 nodes e.tend to the left lateral border of the trachea. :ro# upper border of #anubriu# to the intersection of caudal #ar%in of inno#inate (left brachiocephalic) vein "ith the trachea. &L$ Upper Paratracheal :ro# the upper border of #anubriu# to the superior border of aortic arch. 2L nodes are located to the left of the left lateral border of the trachea. )A$ Pre-vascular )hese nodes are not adCacent to the trachea like the nodes in station 2, but the are anterior to the vessels. ) $ Pre-vertebral 2odes not adCacent to the trachea like the nodes in station 2, but behind the esopha%us, "hich is prevertebral. (R$ Lower Paratracheal :ro# the intersection of the caudal #ar%in of inno#inate (left brachiocephalic) vein "ith the trachea to the lo"er border of the az %os vein. *4 nodes e.tend fro# the ri%ht to the left lateral border of the trachea. (L$ Lower Paratracheal :ro# the upper #ar%in of the aortic arch to the upper ri# of the left #ain pul#onar arter . Ao!tic %odes *'+ *$ Subaortic )hese nodes are located in the !$ "indo" lateral to the li%a#entu# arteriosu#. )hese nodes are not located bet"een the aorta and the pul#onar trunk but lateral to these vessels. +$ Para-aortic )hese are ascendin% aorta or phrenic nodes l in% anterior and lateral to the ascendin% aorta and the aortic arch. ,nfe!io! Mediastinal %odes -'. -$ Subcarinal /$ Paraesophageal 2odes belo" carina. .$ Pulmonary Ligament 2odes l in% "ithin the pul#onar li%a#ents. Hila!0 Loba! and 1sub2segmental %odes #3'#( )hese are all 21;nodes. #3$ Hilar nodes )hese include nodes adCacent to the #ain ste# bronchus and hilar vessels. 8n the ri%ht the e.tend fro# the lo"er ri# of the az %os vein to the interlobar re%ion. 8n the left fro# the upper ri# of the pul#onar arter to the interlobar re%ion.

M"K: :racture Description (7eneral) 1) Location a. 3ither in pro., #id, distal thirds or specific anato#ic location. 2) ) pe a. 9nco#plete i. +o"in% ii. )orus (buckled corte.) iii. 7reenstick b. 1o#plete i. -i#ple ii. 1o##inuted ') Direction a. )ransverse, obli/ue, spiral, lon%itudinal, se%#ental *) !li%n#ent a. !n%ulation i. Gape. #edial/lateral an%ulationH b. Displace#ent i. Distal fra%#ent relative to pro.i#al fra%#ent !nkle (ap, lateral, #ortise) -houlder (ap, a.illar , scapular ) =nee (ap, lateral, obli/ue) 3lbo" 1) anterior / posterior fat pad si%n 2) hu#eral capiteller line :oot (ap, obli/ue, lateral ) F linin% up of 2nd #etacarpal and cuneifor#s $elvis 1) 2) ') *) ,) 0) 5) 9liopubic line (anterior colu#n) 9lioischial line (posterior colu#n) -acral !rcuate lines -9 Coints $ubic s #ph sis !nterior acetabular ri# $osterior acetabular ri#

,4 ("orthless stud that #isses 1/' of renal #asses & still perfor#ed at the V!), replaced b 1) 9V$ at #ost institutions at this point. 1) $reli#inar scout radio%raph to detect calcifications 2) )hree to#o%ra#s follo"in% I1??#l (children 1cc/lb) of 9V contrast. )he #ost posterior cut (e% > of >, 1?, 11) should have L2 pedicles in focus. ') 2ephro%ra# should appear s ##etric *) 3d%e around kidne should be co#plete ,) !.is of kidne (lon% a.is of kidne should parrellel the psoas) 0) 1ollectin% s ste# a.is (should be relativel in line "ith the lon%itudinal renal a.is o/" a #ass is posible 5) !ll the calces should displa contrast si#ultaneousl . !n a#puted infundibulu# #a be )11 or )+ 6) , #in radio%raph. 1heck for sharp forni., pappillar necrosis (ball on tee, lobster cla", #edullar spoun%e, cal . tic Dover the forni. tip as opposed to over the #id papilla as in necrosis) >) 12 #inute bilateral obli/ues. (a also %et prone or upri%ht vie"s at this ti#e to see "hole ureter 1?) 1olli#ated bladder pre and post void

%eu!o -pine (49< $rotocol< 7eneral 2ote< )1 se/uences are an%led "ith the disc so ou %et entire disc en face. )2 are in a fi.ed a.ial or se#i;a.ial plane to allo" deter#ination of pars defect 5isc disease 6ithout h7 of ope!ation< -a% )1, )2E !.ial )1, )2 5isc disease 6ith h7 of ope!ation< -a% )1, )2, postcontrast fat sat )1E !.ial )1, )2, postcontrast fat sat )1. $ost contrast se/uences are re/uired to differentiate scar fro# disc #aterial. Disc does not enhance before 1? #inutes or onl ri# enhances fro# ri# %ranulation tissue. -cars enhance diffusel and i##ediatel . Ce!vical "pine< -a% )1, )2E !.ial %radient. 9f there is h. sur%er , %et )2 a.ial for hard"are (less artifact). -car is less of a concern in c;spine so contrast is not needed. T!auma< -a% -tir, %radient echo, )1, )2E !.ial )1 and )2 Metastasis 8 ,nfection< -a% -tir, )1, )2, postcontrast fat sat )1E !.ial )1, )2, postcontrast fat sat )1 1) -a%itals )1< 1ord Disk si%nal/hei%ht Disk contour Vertebral bodies/#arro" si%nal -pinous processes 2erve roots 2eural fora#ina 1entral canal Li%a#ents (!LL/$LL, interspinous, supraspinous 3pidural -pace 9n 1;spine 11;12 interval, atlanto;occipital Cunctions, clivus 9n lu#bar look for conus ter#ination. (uscles 2) -a%ital )2< 1ord Li%a#ents (all, pll Dattached fir#l onl at vertebral corners, interspinous, li%a#entu# flavu#). !nnular tear check J disc h dration 9n c;spine check basilar void and chiari, brain ste# and sphenoid sinus. ') -a%ital -)94< (arro" si%nal (should be isointense to #uscle). Li%a#ents for hi%h si%nal *) -a%ital 7radient< 3pidural he#ato#a (usuall bri%ht on )1 as linear structures) ,) !.ial )1/ )2< 2erve roots (clu#pin%) 1ord Disk contour Vertebral bodies 2eural fora#ina

 1entral canal Lateral recesses Li%a#ents (li%a#entu# flavu#) 3pidural space :acets $araspinal #uscles !orta 4etroperitoneu# or prevertebral soft tissues / or%ans 4oots for clu#pin% !.ial and -a%ital )1 post;contrast -oft tissue, cord, roots or for scar enhanc#ent. 0) (-ee separate docu#ent for no#enclature).

Head MR, 1) !.ial )2 a. (uscles of #astication i. Tongue, (asseter, (edial J Lateral pter %oids, )e#poralis, lon%us coli b. $arotids c. 8rbits i. 8ptic 2erve, 3.traocular #uscles, 9ntraconal and e.traconal post septal fat, 8pthal#ic vein, Lense, Vitreous d. 2asophar n. J $aranasal sinuses i. 2asal 1avit ii. :ossa of 4osen#ueller, )orus tuberious, eustachion ostiu# iii. $aranasal sinuses and #astoid air cells iv. (iddle ear ; black v. 9nner ear ; "hite e. +lood Vessel voids i. 2 Verts to basilar ii. 1arotid (cervical, petrous, laceru#, cavernous, supraclinoid) iii. (1!, !1!, !18(, $18( f. +rain ste# %. +asal 7an%lia h. )hala#i i. 1orpus 1allosu# C. 1erebral he#ispheres k. -ulci l. - lvian :issure #. Ventricles i. Lateral, :ora#en of #onroe, !/ueduct of - lvius (check of flo" void artifact), :ourth ventricle, :ora#en of Luschka and (a%endie. n. -upraseller cistern and associated structures. o. 9!1Ks 2) :L!94 a. +ri%ht thin%s ') -a%ital )1 a$ Tongue b. 1alvariu# c. -kull base, clivus d. !tlanto;occipital Coint e. Vertebrae f. -pinal cord %. 1erebellar tonsil position h. 1erebellar ver#is i. (edulla, $ons, (idbrain, )ectu#, $ineal %land, (a#illar bodies, )uber cinereu#, $ituitar stalk, 8ptic chias# C. 1orpus 1allosu# k. -a%ital -inus flo", -trai%ht sinus l. )entoriu# *) 7radient a. +lood products ,) )1 !.ial a. 4evie" osseous structures

0) Diffusion a. Diffusion restriction 5) $ost 1ontrast )1 a. (enin%es, ventricles, cisterns, nasal cavit , facial nerve, choroid, orbits, infundibulu#, pineal

Head CT: 1) -cout 2) +rain Lindo" a. 2 Vertebral to basilar, carotid arter b. +rain ste# c. 1erebellu# d. +asal %an%lia e. )hala#i f. 1orpus 1allosu# %. 1erebral he#ispheres h. -ulci i. - lvian :issure C. Lateral and 'rd ventricles k. $ituitar stalk / optic chias# l. -uprasellar cistern #. Muadra%e#inal plate cistern n. 9nterpeduncular cistern o. *th ventricle and fora#en of Luschka and (a%endie p. $ineal %land re%ion /. $ituitar re%ion r. -a%ital and transverse sinus s. Ndensit of vessels & basilar, bilateral (1! ') -oft )issue Lindo" a. $eripheral soft tissues b. (uscles of #astication c. $har n., d. 4etro#a.illar fat, paraphar n%eal fat e. 8rbits *) +one Lindo" a. -inuses b. (astoids c. -kull base and fora#ina d. -utures

Ce!vical "pine CT: 1) -a%ittal 4econs a. -kull base b. !tlantooccipital Coint c. $redental space d. 1livus dens relationship e. !li%n#ent (ant/post spinal, spinola#inar, posterior spinous) f. :acets %. -pinous processes h. $revertebral soft tissue "idth 2) !.ial -oft )issue a. Lun% "indo" i. Lar%e air"a s, Lun% apices b. -oft tissue i. $eripheral soft tissues ii. !erodi%estive )ract 1. 8ropha rn. 2. 3pi%lottis, vellecula '. !r epi%lottic folds, pirifor# sinus *. Vocal cords ,. 3sopha%us iii. )h roid iv. L #ph nodes v. -ub#andibular and $arotid %lands. vi. Vessels 1. bl 1arotids, bl Vertebrals, bl int Ou%ular ') !.ial +one a. Vertebral bod , posterior ele#ents b. -pinal canal J 2eural fora#en c. H oid d. )h roid cartila%e

%ec9 "oft Tissue: 1) 2) ') *) ,) 0) -pinal 1anal +rain al%orith# 8rbits 2asophar n. -oft palate/uvula ()ensor Veli $alatini 12 P, Levator Veli $alatini 12 999) )on%ue (7enio%lossus, %enioh oid, # loh oid, h o%lossus, di%astric, fat filled sublin%ual space "ith h po%lossal neurovascular bundle) 5) -trap #uscles (o#oh oid, sternoth roid, th roh oid) 6) (uscles of #astication >) $arotids (-tensons duct posterior to facial vein, facial #uscle is anterior) 1?) $araphar n%eal fat 11) 4etro#a.illar fat 12) -ub#andibular %lands 1') $har n. 1*) 3pi%lottis / Vellecula / $irifor# -inus / !r epi%lottic folds / $re;epi%lottic fat 1,) :alse 1ord, ventricle, true cords 10) -ub%lottic lar n. and trachea 15) H oid 16) !r tenoid cartila%e 1>) )h roid cartila%e 2?) 1ricoid cartila%e 21) )h roid %land 22) 3sopha%us 2') 2odes< ri%ht, left, #ediastinal, supraclavicular (an "here ou can see clavicles is supraclavicular level), posterior trian%le 2*) Vessels / carotid sheath 2,) $osterior neck tissues 20) Lun%s 25) +ones 26) -inuses 2>) -a%ittal bones

Level 1< -ub#ental Level 2< 9nternal Cu%ular fro# skull base to carotid bifurcation. (or h oid bone) Level '< 9nternal Cu%ular belo" carotid bifurcation to o#oh oid. (or h oid bone to cricoid cartila%e) Level *< 9nternal Cu%ular belo" o#oh oid. (fro# cricoid to supraclavicular re%ion) Level ,< $osterior trian%le. Level 0< !dCacent to th roid. ()his level can spread all the "a to #ediastinu#, the 2,',* stations are like train station and #ust spread to each one before hittin% #ediastinu#.) Level 5< )racheal esopha%eal %roove and superior #ediastinu#. ()racheoesopha%eal %roove is "here recurrent lar n%eal nerve lies)

Level , < belo" # oh oid to h oid bone anteriorl , Level ,a < sub#ental, Level ,b < sub#andibular Level ,, < Cu%ulodi%astric (base of skull to h oid) Level ,,, < deep cervical (h oid to cricoid) Level ,4 < Vircho" (cricoid to clavicle) Level 4a < accessor spinal (posterior trian%le) < superior half Level 4b < accessor spinal (posterior trian%le) < inferior half Level 4, < prelar n%eal / pretracheal / Delphian node Level 4,, < superior #ediastinal (bet"een 11!s, belo" top of #anubriu#)

+rain Bltrasound<
1) Ho" to !/uire i#a%es< Bse F,/6(hz curved s#all transducer. Li%ht points to patient ri%ht on transverse and for"ard on sa%itals. 1apture serial cronoal i#a%es anterior to posterior. !/uire sa%itals startin% on ri%ht then to left. 2) Ventricles a) 1hroid ple.us usuall in bod , tri%one, e.tendin% into 'rd ventricle. -hould not be in frontal or occipital horns b) 3cho%enicit . +lood A choroid ple.us A periventricular blush. c) Differential for echo%enic si%nal is blood, acute stroke or periventricular leuko#alacia, periventricular blush d) 'rd ventricle t picall not visible unless enlar%ed. ') $eriventricular paranch #a for $VL (c stic lesions chronicall or echo%enic acutel ). *) 7 ration & pre#ature brain has less % ri. ,) 1alcifications & look periventricularl & indicitive of )841H infection 0) 1audate 2ucleus & on sa%itals a h poechoic band adCacent to lateral ventricles. 5) 1orpus callosu# 6) 1audo;thala#ic %roove for he#orrha%e. >) Vein of %allen (posterior to 'rd ventricle)

L'spine: Lateral 1) 2u#ber of rib bearin% vertebrae 2) !li%n#ent ') -pinous processes *) :acets ,) +od shape 0) Disc hei%ht !$ 1) )ransverse processes 2) !li%n#ent ') $edicles ("idened in dural ectasia and spinal tu#ors, %one in #ets or sur%er ) *) Brolithiasis C'"pine: Vie"s< 8pen;#outh odontoid, !$, Lateral, 8bli/ues ("hen patient looks to the ri%ht, ou see the left neural fora#en) 1) Look for 1;collar 2) 1ount vertebral bodies visible on lateral vie" ') !nterior vertebral line *) $osterior vertebral line ,) -pinola#enar line 0) $osterior spinous line 5) Bncal;vertebral Coints should shin%le 6) $redental space D '## adults, D ,## children >) 3.a#ine skull / #andible / occiput for fractures 1?) -pace bet"een atlanto;a.ial space (base, dens and lateral #ass of c1 J c2 should line up) 11; 12 distance should be D '## in adults 11) -cottie do%, check neural fora#en 12) $osterior soft tissues< H oid J st loh oid li%a#ent, epi%lotis and are epi%lotic folds, vallecula, lar n., sub%lottic trachea 1') $revertebral soft tissue 1*;1, can be "idth of vertebral bod , above this, D@5## or 1/' vertebral bod "idth oka ) 1*) Lun% apices

"inus

lain :ilms: -inus Develop#ent< +irth< rudi#entar eth#oid and #a.illar ';, rs< Develop#ent of sphenoid and then frontal "ith enlar%e#ent of ethoids and #a.illar 4isuali;ation of the a!anasal "inuses< (a.illar 2 ; ' #o 3th#oidal ' ; 0 #o -phenoidal 1;2 :rontal 6 ;1? !ll Vie"s< 3valuate thin cortical ri# of sinuses and adCacent densit (#ucosal thickenin%) and look for strai%ht lines (air fluid levels). A : evaluate eth#oids, frontal Late!al: evaluate sphenoid, frontal, eth#oids) =ate!s: lookin% up to #ove petrous te#poral (#astoid) out of "a of #a.illar sinus

1ardiac (49 1) Left Ventricle cha#ber size 2) Left Ventricle "all thickness ') Left Ventricle contractilit *) 4i%ht Ventricle cha#ber size ,) 4i%ht Ventricle "all thickness 0) 4i%ht Ventricle contractilit 5) 4i%ht !trial size 6) Left !trial size >) 9nteratrial septu# 1?) 9nterventricular septu# 11) !ortic valve 12) $ul#onic valve 1') )ricuspid valve 1*) (itral valve 1,) (velocit encoded se/uences)

+reast 1alcifications< 1) Densit a. Hi%h b. Lo" 2) 1alcification a. 4ound or linear b. 1ourse or fine c. (ono or pleo#orphic ') Distribution a. Bni or bilateral b. :ocal or #ultifocal c. Diffuse or se%#ental.