Radiology Fundamentals Harjit Singh ● Janet A Neutze Editors Jonathan R Enterline ● Joseph S Fotos Associate Editors Jonathan J Douds ● Megan Jenkins Kalambo ● Marsha J Bluto Contributing Editors Radiology Fundamentals Introduction to Imaging & Technology Fourth Edition Editors Harjit Singh, MD, FSIR Janet A Neutze, MD Professor of Radiology, Surgery, Associate Professor of Radiology and Medicine Associate Division Chief, Ultrasound Director of Education, Penn State Heart Co-director, Radiology Medical Student and Vascular Institute Education Program Fellowship Director, Cardiovascular Pennsylvania State College of Medicine and Interventional Radiology Penn State Hershey Medical Center Pennsylvania State College of Medicine Hershey, PA, USA Penn State Hershey Medical Center [email protected] Hershey, PA, USA [email protected] Associate Editors Jonathan R Enterline, MD Joseph S Fotos, MD Resident, Department of Radiology Resident, Department of Radiology Pennsylvania State College of Medicine Pennsylvania State College of Medicine Penn State Hershey Medical Center Penn State Hershey Medical Center Hershey, PA, USA Hershey, PA, USA Contributing Editors Jonathan J Douds, BS Megan Jenkins Kalambo, MD Medical Student Resident, Department of Radiology Pennsylvania State College of Medicine University of Texas Health Science Center Penn State Hershey Medical Center at Houston, Houston, TX, USA Hershey, PA, USA Marsha J Bluto, MD Practicing Physician Physical Medicine and Rehabilitation Mill Valley, CA, USA ISBN 978-1-4614-0943-4 e-ISBN 978-1-4614-0944-1 DOI 10.1007/978-1-4614-0944-1 Springer New York Dordrecht Heidelberg London Library of Congress Control Number: 2011938463 © Springer Science+Business Media, LLC 2012 All rights reserved. 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The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) To everyone who worked so hard on this book over the years, thank you. I couldn’t have done it without you. To my wife, Bina and my children, thank you for the support and encouragement. To Dad, thanks for watching over me. HS For all of those who helped – thanks. For all of those who waited – thanks; I’m coming home now. JAN To all those that ever wrote a book, I can now empathize. To my family and wonderful wife, Lindsey, for their endless love, encouragement, and prayers. JE To my lovely wife, Melissa, thank you for your love, encouragement and boundless support. To all of those who have worked so hard on this project over the years, thank you. Your contributions will be appreciated for years to come. JF Preface to the Fourth Edition The fourth edition of the Radiology Syllabus is directed towards medical students, non-radiology housestaff, physician assistants, nurse practitioners, radiologist assis- tants and other allied health professionals as a curriculum guide to supplement their radiology education. This book serves only as an introduction to the dynamic fi eld of radiology. In fact, the most diffi cult decision in compiling this fourth edition did not involve what to include, but rather determining what to leave out. The goal of this text is to provide the reader with examples and brief discussions of basic radio- graphic principles that should serve as the foundation for further learning. We hope that it will foster and further stimulate the process at the heart of medical education: self-directed learning. Each edition continues to expand upon the fi rst edition of the photocopied pages and fi lms, written and organized by the original authors, Dr. William Hendrick and Dr. Carlton “Tad” Phelps. As mentors, Dr. Hendrick and Dr. Phelps of Albany Medical Center wanted a curriculum guide to reinforce the teaching concepts of their radiology elective. Dr. Harjit Singh, editor and author of much of the text of the fi rst print edition, formalized the material in 1988. Our third edition, updated by faculty and students at Penn State Hershey was a fi rst effort at organizing and digi- tizing the information for publication. Dr. Marsha Bluto led that conversion of both text and images. Drs. Megan Jenkins and Jonathan Enterline assisted in the multiple rewrites and desktop publishing. Our fourth edition is an effort to expand and reinforce the original authors’ work by 14 new contributors. Dr. Joseph Fotos and Jonathan Douds (MD 2012) are new additions to the writing, illustrating, and editing side. vii Radiology continues to explode in breath and depth. Health practitioners are using radiology studies not just to confi rm a clinical suspicion but to make a diagnosis. We are performing 20 times more CT scans than we did in 1980! From both cost and safety standpoints, clinicians and radiologist need to know what they are doing. We hope this book, used in conjunction with lectures, electives, and discussions, is a start. Hershey, PA, USA Harjit Singh Janet A Neutze viii Contents 1 Patient Radiation Safety and Risk ......................................................... 1 2 Introduction to Radiology Concepts ..................................................... 7 3 Conventional Radiology.......................................................................... 11 4 Ultrasound ............................................................................................... 17 5 Computed Tomography .......................................................................... 23 6 MRI .......................................................................................................... 29 7 Nuclear Medicine .................................................................................... 31 8 Cardiovascular and Interventional Radiology ...................................... 35 9 Heart and Mediastinum ......................................................................... 39 10 Lateral Chest ........................................................................................... 45 11 Pulmonary Mass Lesions ........................................................................ 51 12 Air Space Disease .................................................................................... 59 13 Interstitial Disease ................................................................................... 63 14 Atelectasis ................................................................................................ 69 15 Pulmonary Vasculature .......................................................................... 75 16 Pulmonary Edema .................................................................................. 83 17 Pneumothorax ......................................................................................... 89 18 Miscellaneous Chest Conditions ............................................................ 95 19 Tubes and Lines ....................................................................................... 105 20 Breast Imaging ........................................................................................ 111 ix 21 Women’s Ultrasound .............................................................................. 125 22 Women’s Health Interventions .............................................................. 131 23 Abdominal Calcifi cations ....................................................................... 137 24 Abnormal Air Collections in the Abdomen .......................................... 143 25 Barium Studies of the Upper GI Tract.................................................. 147 26 Barium Enema and CT Colonography ................................................. 157 27 Bowel Obstruction .................................................................................. 167 28 Infl ammatory Bowel Disease .................................................................. 175 29 Defecography ........................................................................................... 181 30 Intra-abdominal Lymphadenopathy ..................................................... 189 31 The Gallbladder ...................................................................................... 193 32 Abdominal and Pelvic Pain Evaluation ................................................ 201 33 Imaging the Trauma Patient .................................................................. 211 34 Concerning Lesions ................................................................................. 219 35 Incidental Lesions ................................................................................... 229 36 Radionucleotide Evaluation of