Rad

TOPIC 1: PHYSICS RADIOLOGY 1
TOPIC 1 : PHYSICS So,
1. ACS in medical imaging stands for : Water 0

A. Planned archiving common system
Air -1000
B. Planned archiving computerized system
C. Picture archiving and communication system Cortical Bone +1000
D. Picture archiving or computerized system Fat -50 (approx)
C
(CT)............(AIIMS PGMEE - MAY 2008) 3. At t=0 there are 6 radioactive atoms of a substance,
which decay with a disintegration constant (X) equal
• PACS or picture archiving and communication to 0.01/sec What would be the initial decay rate?
system are computerized network dedicated to the A. 6X10 23
image acquisition, storage, transportation and B. 6X1022
display. C. 6X10 21
D. 6X1020
C
(decay rate)............(AIPGMEE - 2005)
The radioactive decay law:

The rate at which a radioactive substance N decays is
given by:
Where:
• N is the number of radioactive atoms and
• l is called the decay constant, which represents the
PACS aims to replace conventional analogue films and paper
probability per unit time for one atom to decay.
forms & reports with a completely computerized electronic
• dN/dt is the rate of decay of N
network whereby digital images are viewed on monitors
in conjunction with the clinical details of the patient and
The fundamental assumption in the statistical law for
the associated radiological report displayed in electronic
radioactive decay is that this probability for decay is
format.
constant, that is, it does not depend on time or on the
• The most common format for image storage is DICOM
number of radioactive atoms present.
(Digital imaging and communications in medicine)
Substituting the date provided, into the radioactive decay
equation
2. In computed tomography (CT), the attenuation values
Number of radioactive atoms = 6 X 1023
are measure d in Hounsefield uni ts (HU). An
Decay constant (disintegration constant)
attenuation value of ‘0’ (zero) HU corresponds to:
l = 0.01/sec.
A. Water
B. Air
C. Very dense bone structure
D. Fat
A 4. In MRI the field used is:
(CT)............(AIIMS PGMEE - NOV 2004) A. .05 tesla
B. 1.1 tesla
• Computed tomography is a special type of X-ray procedure C. 5 tesla
that involves the measurement of the weakening, or D. 11 tesla
attenuation of X-ray beams by body structures at B
numerous positions located within the patient. (MRI)............(AIPGMEE - 1997)
• These attenuation values are named in honour of Godfrey
Hounsefield, the inventor of CT scanning. The fields used in clinical practice range from 0.15 to 1.5
The density of water was arbitrarily set at ‘0’ HU and that of Tesla (1,5000 to 15,000 Gauss) as compared with the
air at -1000 HU. Earth’s magnetic field of 0.5 Gauss
• Unenhanced computed tomography scan of adrenal
adenoma. Hounsfield units are 0-20, in contrast with
higher attenuation of fresh blood.
HELP LINE NO. 9391567707

5. The EEG cabins should be completely shielded by a Occurs when a low energy incident photon interacts with
continuous sheet of wire mesh of copper to avoid an atom’s inner shell electrons
the picking of noise from external electromagnetic It uses up all its energy to ionize the atom and eject an
distur bances. Such a shielding is called as: inner shell electron
A. Maxwell cage The ejected electron form the inner shell is called a
‘photoelectron’
B. Faraday cage The original energy is absorbed completely and there are
C. Edison’s cage no scattered x-rays.
D. Ohm’s cage
B
(MRI)............(AIIMS PGMEE - NOV 2004)
Compton effect
Occurs when a high energy incident photon interacts with
an atoms outer shell electron.
It uses up only part of its energy to ionize the atom and
eject an outer shell electron.
The ejected electron is called recoid electron or ‘compton
Faraday cage is an electrical apparatus designed to prevent electron’
the passage of electromagnetic waves, either containing It retains most of its original energy in the form of a scattered
them in or excluding them from its interior space. X-rays.
7. The gyrometric property of ———— is used for NMR

imaging technique :
A. Positron
B. Neutron
6. Photoelectric effect can be best described as an : C. Proton
A. Interaction between high energy incident photon and D. Electron
the inner shell electron C
B. Interaction between low energy incident photon and the (proton/electron/neutron)............(AIIMS PGMEE - SEP
outer shell electron
1996)
C. Interaction of the high energy incident photon and the
outer shell electron
D. Interaction between a low energy incident photon and
the inner shell electron
B
(photoelectric effect)............(AIPGMEE - 2008)
The photoelectric effect results from an interaction between

a low energy incident photon and the inner shell electron.
8. Functional basis of ionizing radiation is dependent on:

A. Removing orbital electrons
B. Pyrimidine base pairing
C. Adding orbital electrons
D. Linear energy transmission
A
There are two predominant interaction between photons (proton/electron/neutron)............(AIIMS PGMEE - SEP
and matter in diagnostic X-rays 1996)

• “Absorption of energy from radiation in tissue often leads 17. Gamma camera in Nuclear Medicine is used for:
to excitation or ionization. A. Organ imaging.
• Excitation involves elevation of an electron in an atom B. Measuring the radioactivity.
molecule to a higher energy state without actual C. Monitoring the surface contamination.
ejection of the electron. D. RIA.
• Ionization involves actual ejection of one or more B
electrons for from the atom” (radioactivity measure)............(AIPGMEE - 2005)
9. In MRI, images are produced due to

A. H+
B. CO2
C. N2O
D. K+
A
(proton/electron/neutron)............
(AIIMS PGMEE - NOV - 1993), AIIMS PGMEE - MAY - 1994)
(AIIMS PGMEE JUNE - 2000), AIPGMEE – 1999, AIIMS
PGMEE - DEC 1997 18. Curie is unit of:
A. Radiation exposure
• NMR or MRI is based on the basic properties of B. Radiation absorption
proton C. Radioactivity
Note that D. All of the above
- In MRI there is no radiation exposure C
- So no known hazard to patient (radioactivity measure)............(PGI - JUNE 1997)
- It is safe in pregnancy
MRI is contraindicated in The curie (symbol Ci) is a unit of radioactivity, defined as
- A cardiac pacemakers
- Cochlear implant 1 Ci = 3.7×1010 decays per second or becquerels.
- Ferrous intra ocular foreign body This is roughly the activity of 1 gram of the radium isotope
- Prosthetic heart valves 226Ra, a substance studied by the pioneers of radiology,
- Some aneurysmal clips Marie and Pierre Curie. The curie has since been replaced
by an SI derived unit, the becquerel (Bq), which
NMR or Nuclear Magnetic Resonance Imaging is synonymous equates to one decay per second.
with MRI.
The basic principles of MRI depend on the fact that nuclei Therefore:
of certain elements behave like small, spinning, bar
magnets, and align with the magnetic force when 1 Ci = 3.7×1010 Bq
placed in a strong magnetic field . and
Hydrogen nuclei (protons) in water molecules and lipids
are currently used. 1 Bq = 2.70×10"11 Ci
12. Maximum scattering in X Ray plate occurs in 19. Principle used in radiotherapy is
A. Carbon A. Infra red rays
B. Mercury B. Ionizing molecule
C. H+ C. Charring nucleoprotein
D. Ca++ D. Ultrasonic effect
C B
(proton/electron/neutron). (radiotherapy)............(AIIMS PGMEE - MAY - 1994)
(AIPGMEE - 1996), (AIPGMEE - 1997)
• Radiation therapy is the t/t of malignant tumour
with ionizing radiation.
• Ionizing radiation is defined as energy that cause
ejection of an atomic orbital electron when
absorbed.
There are two forms of ionizing radiation

a) Electromagnetic radiation - They do not possess any
finite mass, examples of electromagnetic radiation are
i) X-ray
ii) Gamma ray
14. What is atomic number:
• Particulate radiation - These refers to radiation that
A. Proton
posses finite mass.
B. Electrons + protons
C. Protons + neutrons
These include -
D. Protons + protons
i) Electrons ii) Protons iii) Neutrons iv) Atomic nuclei v)
A
Alpha & Beta particles
(proton/electron/neutron)............(PGI - June -2001)

Mechanism of injury of radiation in cells – sites that may not be appropriate for surgical
- Radiation usually damages DNA resection o r in patients who wo uld not be
- Generates free radicals from cell water. Free radicals in candidates for surgery. SBRT is associated with few
turn damage cell membrane proteins and organelles. side effects because the treatment field is generally very
- Radiation damage is dependent on 02 So Hypoxic cells are small and treatment is precisely delivered
resistant to radiotherapy
- Rapidly dividing cells are more radiosensitive
21. The tech nique employed in radi otherapy to

counteract the effect of tumour motion due to
breathing is known as:
A. Arc technique.
B. Modulation.
C. Gating.
D. Shunting.
20. Stereotactic Radio-surgery is a form of: C
A. Radiotherapy (radiotherapy)............(AIPGMEE - 2005)
B. Radioiodine therapy
C. Robotic surgery • In certain locations in the body, such as the lungs and
D. Cryo Surgery abdomen, tumors can move as the patient breathes. In
A the past, this movement has confounded doctors
(radiotherapy)............(AIIMS PGMEE MAY - 2003) ability to accurately deliver radiation therapy to
these tumors.
Stereotactic (or stereotaxic) surgery - When one breathes, the chest wall moves in and out, and
It is a type of brain surgery that use a system of 3 dimensional any structures inside the chest and upper abdomen also
co ordinates to locate the site to be operated upon. move Organ motion during the respiratory cycle is known
In it focussed high dose of radiation is administered to a to be a source of inaccuracy in treatment delivery because
precisely defined volume of tissue in a single treatment, it leads to tumor displacement and sub optimal dose
usually using the gamma knife. delivery. Respiratory gating is one of the latest
techniques in radiation therapy and involves
matching radiation treatment to a patient’s own
respiratory pattern.
With respiratory gating , radiation treatment is timed to
an individual’s breathing pa ttern, targeting the tumor
only when it is the best range. This approach decreases
possible complications and side effects, while using higher
doses and getting better outcomes.
It can potentially achieve tumour ablation without invasive
surgery.
How Respiratory Gating Works
Major limitation of stereotaxic surgery is that it can be used
Respiratory gating, involves tracking the patient’s natural
for only relatively small tumours.
breathing cycle via computer and determining an algorithm
to control radiation administration at the optimum
moments - the “gate” - to deliver dose. The computer
synchronizes the beam to switch on only when the
target area is within the calculated parameters. The
patient’s respiration is continuously monitored and the
beam switches off as the tumor moves out of the target
range.
Stereotactic Body Radiotherapy (SBRT)

• Stereotactic Body Radiotherapy (SBRT) is an emerging
image-guided radiation technique that is used to treat
small and well-defined targets within the body. SBRT
normally deliver very high doses of radiation precisely to
tumor sites within the body with the purpose of improving
local control and limiting side effects. SBRT may be used
for small lung cancers or metastasis, small isolated
liver tumors or bony tumors, and tumors in other

22. Principle used in radiotherapy is

A. Cytoplasmic coagulation
B. Ionization of molecules
C. DN A damage
D. Necrosis of tissue
B
(radiotherapy)............(AIPGMEE - 1997)
Ionizing radiation is the energy that during absorption causes

the ejection of an orbital electron. Ionization radiation
may be Electromagnetic or Particulate.
Examples of Particulate radiations are the subatomic particles • the electron of the atom is ejected d/t bombardment of
: electrons, protons, alpha particles, neutrons and atomic the high speed electron from the electron beam
nuclei. All of these have been experimentally considered • this creates a vacancy in the orbital shell
or are being used in Radiation Therapy. • this vacancy is filled by another electron which falls
in from an outer shell electron
23. Radioactive isotopes that are used in treatment of • this outer shell electron had more energy than the
cancer are : ejected electron.
A. Cesium. • this difference of energy is released as x-rays when the
B. Cobalt. outer shell electron falls into the vacant inner shell.
C. Carbon.
D. Technetium.
E. Nitrogen.
A and B
(radiotherapy)............(PGI - DEC 2003)
• Radio Isotopes used in treatment of Cancer :

- 137
cesium, 60 Cobalt, 226 Radium, P32, 131I, Au 48, Boron ,
10
yIttrium 90 etc.
• Carbon 14 is used for Carbon dating.
24. For the treatment of deep seated tumors, the

following rays are used.
A. X- rays and Gamma- rays
B. Alpha rays and Beta -rays 26. Which one of the following therapeutic mode is
C. Electrons and positrons commonly employed in intra-operative radiotherapy?
D. High power laser beams A. Electron
A B. Photon
(rays)............(AIIMS PGMEE MAY - 2003) C. X-ray
D. Gamma rays
X-rays and gamma rays are electromagnetic waves with A
highest penetrating power. (rays)............(AIIMS PGMEE NOV - 2003)
For deep seated tumours rays with maximum penetrating
power is required so x-rays and gamma rays are Intraoperative irradiation:
used. “Intraoperative electron beam used as a boost followed by
“ High energy penetrating beams deliver a less intense photon beam treatment is an innervative regimen for
superficial dose and spares the skin”. pancreatic, gastric, and rectal cancers; retroperitoneal
sarcomas; head and neck cancers; and genitourinary and
25. X-ray are produced when some gynaecological cancer”.
A. Electron beam strikes the nucleus of the atom
B. Electron beam strikes the anode 27. Which one of the following has the maximum
C. Electron beam reacts with the electromagnetic field ionization potential?
D. Electron beam strikes the cathode A. Electron
B B. Proton
(rays)............(AIIMS PGMEE NOV - 2002) C. Helium ion
D. Gamma (y) - Photon
• X-rays are produced by energy conversion when a fast C
moving stream of electrons produced by cathode (i.e. a (rays)............(AIPGMEE - 2006)
heated tungsten filament) strikes the anode
Penetration power:
The high energy electron beam when strikes the anode, Gamma ray > X ray . Beta-particle > alpha-particle
produces x-ray radiation by the following mechanisms (or helium ion) :
1) the electron strike the nucleus of the atom
in the process they loose all their energy in the form of x- Ionizing & Damaging power : is reserve
ray radiations alpha-particle (or helium ion) > Beta-particle> X ray >
2) the high speed electrons strike the electrons within gamma ray
the orbits around nucleus

28. Which of the following is the most penetration beam? * Linear accelerators are the commonest mega voltage units
A. Electron beam in use in the developed world. The main advantage is the
B. 8 MeV photons ability to produce X-ray & electrons of varying
C. 18 MeV photons energies within the same machine.
D. Proton beam * Two types are used in clinical practice:
C Low energy linear accelerator (LELA)
(rays)............(AIPGMEE - 2004), AIPGMEE - 2002 High energy linear accelerator (HELA)
HELA & LELA produces photon of varying intensity.
Proton beams : * The availability of accessories like multileaf collimators (MLC)
can be taken to represent alpha particles. & the micro-multileaf collimators have made it possible to
Electron beams : use accelerators for highly sophisticated treatments like
can be taken to represent beta particles. stereotactic radiosu rgery & radiot herapy,
Photon beams: conformational therapy & intensity modulated
can be taken to represent gamma particles. radiotherapy (IMRT).
On radioactive disintegration three types of particles are 38. Slice of tissue X-rays is :
emitted namely alpha, beta and gamma. A. Tomography
Penetrating Power of various particles in decreasing B. Mammography
order is as follows: C. Contrast studies
Gamma rays (high energy photons) > Beta-rays (high energy D. All of the above
electrons) > cc-particle (helium nuclei) A
Gamma particles (photons) have the highest penetrating (rays)............(PGI - June -1999)
power.
Also 18 MeV photons will have higher penetrating power • Tomography is a variation of simple x-ray film method
than 8 MeV photons and hence is the answer of choice. which permit tissue section radiograph to be
obtained.
30. In radiation therapy rays used are
A. α , β
B. α , χ
C. β , χ
D. γ , α , β
D
(rays)............(PGI - 1999 - Dec), (PGI - 2001 - Dec)
PGI - DEC 2003, PGI - DEC 2002, PGI - JUNE 2006
PGI - June -2001
• In radiation therapy rays used are alpha, Beta, (gamma)
Radio active emissions consists of alfa, beta and gamma rays. Radiation
IONIZING NON-IONIZING
Electromagneti Corpuscular
c During the x-ray exposure the x-ray tube and x-ray film
-X rays and • alpha particles • UV radiation are moved in opposite direction so as to produce the
- Gamma rays • Beta particles • Visible light equivalent of a body section x-ray.
• Proton • Infrared radiation
• Microwave radiation
• Radio frequency radiation
• alpha-radiation are not useful in clinical medicine, as they are most damaging to
tissues.
• Most damaging radiation to tissues : X-rays particles.
• Most penetrating radiation – gamma rays.
35. Principle of linear acclerator is used in:

A. X-rays
B. Gamma Rays
C. alpha Rays
A
(rays)............PGI - JUNE 2006, PGI - JUNE 2004
40. Acoustic shadow in USG is due to

A. Arte fact
B. Absorption
C. Reflection
D. Refraction
C
(ultrasound)............
(AIPGMEE - 1994)

• (ii) Pulse wave Doppler: Shows depth of information; it

extracts velocity data from the echoes used to form a
two-dimensional image and gives useful qualitative
information.
41. The intensity of color in Doppler is determined by:

A. Direction flow
B. Velocity of flow
42. Piezoelectric crystals are made use of In:
C. Strength of returning echo
A. MRI
D. None of the above
B. US
B
C. CT
(ultrasound)............(PGI - 1998 - Dec)
D. All
B
• The Colour Doppler visually demonstrates patterns and
direction of blood flow.
AIIMS PGMEE - NOV 2004
Various colours indicate change in direction and velocity
of flow.
Piezoelectric crystals are used in ultrasonography.
Piezoelectric effect: The ability of certain materials to change

their physical dimensions when an electric voltage is applied
In colour doppler system the pulses along each scan line to them (i.e. they are mechanically deformed). They are
are divided on return to transducer, sad some are thus able to convert electric voltage to sound energy
used to provide imaging” information and the rest are and vice-versa. These s ubstances are used in
used to calculate the mean doppler shift within small pixels ultrasonography to produce the ultrasound beam .
of image. The piecoelectric crystals used now a days in USG are made
This mean shift information is coded on a colour of lead zirconate titanate.
scale and, displayed as a colour map over the gray scale
image.
The Doppler shift frequency is directly proportional
to the blood velocity.
Choice of colour is an arbitrary; usually shades of blue and
red are used to represent flow towards and away from
transducer, with paler shades of colour representing
higher velocities.
43. Ultrasound frequency used for diagnostic purposes
Advantage of the technique in obstetrics :
— Areas of abnormal and normal flow identified and localized A. 1-20 MHz
rapidly. B. 20-40 MHz
• Velocity of flow can be acquired and displayed by : C. 40-60 MHz
(i) Continuous wave Doppler: Collects all the velocity data D. 60-80 MHz
from the path of beam and analysis it to generate a E. 80-100 MHz
spectral display. A

TOPIC 2: RADIONUCLIDE RADIOLOGY 8
TOPIC 2 : RADIONUCLIDE
45. Ion used both in brachy and tele therapy is:

A. Iridium
B. Chromium
C. Selenium
D. Cobalt
D
(brachy/teletherapy)............(PGI - 1997 - Dec)
AIIMS PGMEE - JUNE 1998
• Therapeutic radiation is given in three ways:

- teletherapy, with beams of radiation generated at a Cobalt 60 (Co-60) is the common teletherapy source for
distance of aimed at the tumors within the patient, external beam radiation therapy, the other one is caesium-
137 (C, - 137).
47. All may be used in interstitial brachytherapy except:

A. Co60
B. Ir192
C. Au195
D. Cs137
A
(brachy/teletherapy)............(AIPGMEE - 1999)
Isotopes used in Brachytherapy are

• Radium
• Caesium : e.g. for Ca cervix
- brachytherapy with encapsulated sources of radiation • Iridium : e.g. for Ca tongue and Ca breast
implanted directly into or adjacent to tumor tissues Gold 198, Iodine , and Radon seeds are also used for
- systemic therapy with radionuclides targeted in some permanent implants.
fashion to a site of tumor.
• X-rays & gamma rays are the forms of radiation most

commonly used to treat cancer. X-rays are generated by
48. Which of the following radioactive isotopes is not
linear accelerators; gamma rays are generated from decay
used for brachytherapy -
of atomic nuclei in radioisotopes such as cobalt & radium.
A. Iodine - 125
B. Iodine-131
• Cobalt is used in both tele-therapy & brachytherapy.
C. Cobalt - 60
D. Iridium-192
46. For tele therapy, isotopes commonly used are:
B
A. 1-123
(brachy/teletherapy)............(AIIMS PGMEE - NOV
B. Cs-137
2005)
C. Co-60
D. Tc-99
Radionuclides used for brachvtherapy
E. Ir-191
• Radium 226
B and C
• Caesium 137
(brachy/teletherapy)............(PGI - June -2002)
• Cobalt 60
• Iridium 192
• Radioisotopes which are commonly used for therapeutic
• Iodine 125
purposes are : Radium 226, Cs-137, gold-198, iodine-125,
Other radionuclides which can also be used are Radon 222,
Cobalt-60. indium-192.
Gold 198, Palladium 103, Americium 241, Samarium 145,
Ytterbium 169, Strontium 90.
• When a beam of electromagnetic wave or particulate
Brachvtherapy –
radiation is directed to the tumor site from a distance
• Radiation therapy with encapsulated sources of radiation
(100 Cm) it is called teletherapy or external beam-
implanted directly into or adjacent to tumour tissue.
radiotherapy.
Brachytherapy can be delivered in two ways,

(i) Intracavitary therapy B. Radium-226

(ii) Interstitial implantation C. Cobalt-59
Interstitial implantation can be of two types D. Cobalt-60
Interstitial implants
D
Permanent implant T emporary implant
(cobalt)............(AIPGMEE - 2003)
• A permanent implant stays in place • A temporary implant does not
• The implant emits a slow dose of stay in place forever Cobalt 60 is used as a radioactive material in Teletherapy
radiation slowly over a period of time • Special applicators are used machines.
• The radiation affects only a small for temporary implants. X-rays & Gamma rays are the forms of radiation most commonly
area around the implant and there is • They can be either low dose or used to treat cancer.
little risk of affecting other people high dose
Gamma rays are generated from decay of atomic nuclei in
Examples of radioisotopes in Au 198, I-125, Pd-103, Cs-131
radioisotopes such as cobalt & radium.
• Permanent implant Cs-137, Ir-192
Cobalt 60 is the most commonly used isotope, another
• T emporary implant
important isotope being cesium-137 (gamma rays)
• An intensity modulated whole pelvic radiation
therapy treatment plan in a patient with early-stage 53. Isotopes used for radiotherapy :
endometrial carcinoma. A. Radon
B. Cobalt-60
C. Indium
D. Cesium
B,C and D
(cobalt)............(PGI - 2000 - Dec)
Isotopes used for radiotherapy

• Cobalt 60 • Gold Radium-226
• Iridium • Phosphorus-32
• Cesium • Iodine-125
50. A/E - is used in teletherapy
A. Cobalt-60 54. True about Cobalt - 60 :
B. Computerized planning A. Natural radioactive agent.
C. Simulators B. Atomic weight 59.
D. Iridium C. Emits Beta & Gamma rays.
D D. Half-life is 53 years.
(brachy/teletherapy)............(AIIMS PGMEE - DEC 1998) E. Used in both brachy & teletherapy
All
• Iridium192 is used in brachytherapy. (cobalt)............(PGI - DEC 2004)
• Cobalt60, is the most preferred agent for teletherapy.
• Computer and simulators are used for planning the • Cobalt - 60 has the following features:
radiotherapy; the distance at which the radiation source - Naturally occurring radioisotope.
would be placed to maximize the therapeutic gains and - Atomic no- 27
minimize the radiation hazards. - Atomic weight 58.93
- Half-life 5.3 years (Radiation); 9.5 days (biologic)
51. Which one of the following radioisotope is not used - Emits Beta & Gamma rays
as permanent implant: - Used for both brachy & tele therapy.
A. Iodine-125.
B. Palladium-103. 55. Artificial radioisotopes :
C. Gold-198. A. Radium
D. Cesium-137. B. Uranium
D C. Plutonium
(cesium)............(AIPGMEE - 2005) D. Iridium
E. Cobalt
D and E
(cobalt)............(PGI - DEC 2002)
56. Which of the following agents is used to measure

Glomerular Filtration Rate (GFR):
A. Iodohippurate
B. Tc99m-DTPA
C. Tc99m-MAG3
D. Tc99m-DMSA
B
(DTPA\DMSA)............(AIPGMEE - 2008)
AIPGMEE – 1995, AIPGMEE - 1999
52. Which of the following radio-isotopes is commonly
used as a source for external beam radiotherapy in Tc-99 Diethylene-Triamine-Pentothenic-Acid (DTPA) is
the treatment of cancer patients: the agent of choice for assessment of Glomerular
A. Strontium-89

Filtration Rate (GFR)

Radionuclide that are excreted almost entirely by
glomerular filtration can be used to estimate GFR
Tc99m- labelled DTPA
Chromium 51- labelled EDTA
• An IVP is particularly useful to demonstrate tumors & calculi

within the urinary tract which are sometimes difficult to
see on USG.
It may also be useful to show details of abnormal anatomy
DTPA is freely filtered at the glomerulus with no tubular which are difficult to interpret on an USG.
reabsorption or excretion.
A DTPA Renogram is useful for each kidney.
Indication :
1. Measurement of Relative Renal function in each kidney.
2. Investigation of Urinary tract obstruction
3. Diagnosis of Reno Vascular cause for hypertension
4. Investigation of renal transplants
DMSA(ISOTOPE SCANNING) :
- Tc99 DMSA is widely used for Renal morphological imaging.Q
This compound is fixed in Renal tubules and good images
may be obtained 1-2 hrs affect injection.
Lesions such as tumors show a filling defect as do benign
lesions such as cysts
58. Functional analysis of kidney is best done by: 60. Half life of I131 is
A. Radionuclide scanning A. 4 hours
B. IVP B. 8 days
C. Ultrasound
C. 4 days
D. MRI D. 10 days
A B
(DTPA\DMSA)............(PGI - JUNE 1997) (half life)............(AIPGMEE - 1994)
• Radioisotope scanning is used to obtain information about
61. What is the t 1/2 of Cobalt-60 :
function in individual renal units using gamma camera, DTPA
A. 3.4 yrs.
labelled with technetium-99m can be followed during B. 1.2 yrs.
its transit through individual kidneys to give dynamic C. 2.3 yrs.
representation of renal function. D. 5.2 yrs.
A 99m TC-DTPA scan is particularly useful to prove that D
collecting system dilatation is due to obstruction.
(half life)............(AIIMS PGMEE - JUNE - 1997)
By USG, the size, thickness of the cortex, & the presence & Half life of some commonly used isotopes
degree of hydronephrosis, intra renal masses can be
• Cobalt 60 — 5.3 years
measured with great accuracy.
• Gold -198 — 2.7 days
• Phosphorus 32 — 14.3 days
• Iodine125 — 60 days
• Iridium192 — 74.4 days
• Cobalt 60 — 5.3 years
• Caesium137 — 30 years
• Radium226 — 1620 years
62. Which of the following isotopes is used for RAIU?

A. I123
B. I125
C. I131
• By MRI, the size, site of tumors, degree of invasion, D. I132
presence of enlarged lymph node & invasion of renal vein A
& vena cava can be detected. (iodine)............(AIPGMEE - 2007), AIPGMEE – 2003
But MRI is not clearly superior to CT scan. PGI - 2000 – Dec, PGI - June -2002,

I123 is used as an isotope for RAIU. • Radioactive iodine uptake scan showing hypothyroid
RAIU: Radio active iodine uptake/Thyroid count/capsule count (decreased uptake) condition, or thyroiditis, in a 42-year-
is a thyroid imaging method that measures the fraction of old woman with subacute granulomatous thyroiditis
orally administered iodine isotope taken up by the thyroid
it is measured at interv als of 4 & 24 hours after
administration of the isotope.
The various modalities of thyroid scintigraphy are :
Tc99 in pertechritate scan
I123 scan [Agent of choice]Q
I121
Interpretation of RAIU
Increased Normal Decreased

In Grave’s disease < 25% at 4hrs Insubacute
thyroiditis
However RAIU is not diagnostic of hyper thyroidism without
measurement of hormonal levels.
Clinical Manifestations of Thyroiditis Subtypes

Subtype Etiology Neck RAIU TSH T4 Thyroid
Pain autoantib
odies
Chronic Autoimm No Variable Variable Variable Present
lymphocytic une
(Hashimoto’s
disease)
Subacute Viral Y es ↓ ↓ ↑ Absent
granulomatous
Subacute Autoimm No ↓ ↓ ↑ Present
lymphocytic une
Microbial Bacterial Y es Variable Normal Normal Absent
inflammatory fungal,
parasitic
Hashitoxicosis Autoimm No ↓ ↓ ↑ Present
une
Invasive Unknown No Variable Normal Normal Variable
fibrous
• Isotopes for thyroid scaning are :

- I131, Technitium99, I123, I125
• Radioactive iodine uptake scan showing normal condition I131

in a 30-year-old woman with postpartum thyroiditis • Most commonly used in hyperthyroidism
(subacute lymphocytic thyroiditis • Half life-8days
• Also used in carcinoma thyroid
• Emits alpha and Beta rays
• used in form of sodium salt given orally
• Treatment of choice in hyperthyroidism after 35
years of age and when patient is not fit for surgery
due to medical problems
66. All of the following radioisotopes are used as

systemic radionuclide, except:
A. Phosphorus-32
B. Strontium-89
• Radioactive iodine uptake scan showing hyperthyroid C. Iridium-192
(increased uptake) condition in a 52-year-old woman with D. Samarium-153
Graves’ disease. C
(iridium)............(AIPGMEE - 2006)
67. Phosphorus32 emits:

A. Beta particles
B. Alfa Particles
C. Neutrons
D. X-rays
A
(phosphorus)............(AIPGMEE - 2006)
P-32,Sr-90 and Gamma 90 emits Beta particles

TOPIC 3: RADIOSENSITIVITY RADIOLOGY 12
C. Technetium-99m( Tc).
99m
Rays Radioactive elements 11/2
D. Technetium-99m linked to Methylene disphosphonate
β P-32 Phosphorous 14.3 days
Sr-90 Strontium 28 yeats
(99mTc-MDP).
Y-90 Yttrium 2.54 days D
β, γ Pa-226 Radium 1622 (TECHNETIUM)............(AIPGMEE - 2005)
Au-198 Gold years
I-131 Iodine (mainly 2.7 days
β) 8 days
γ Ir-192 Iridium 74.5 days
Co-60 Cobalt 5.2 years
Cs-137 Cesium 30 years
Xe-133 Xenon 5.2 days
I-123 Iodine 13 hours
I-132 Iodine 2.3 hours
Tc-99 Technirim 6 hours
Cu-70 Gallium citrate 3.2 days
Ti-201 Thallous 3.1 days
Rn-222 chloride 3-6 days
Cr-51 Radon
K-81 Chromium
Ce Krypton
Selenium
N, γ Cy-252 Californium 2.6 years 71. Tc labelled RBC’s are used for
Ta-182 Tantulum 4 months A. Biliary tree
B. Renal disease
68. Radium - 226 emits : C. Pulmonary embolism
A. Alpha rays D. Splenic disease
D
B. Beta rays
(TECHNETIUM)............(AIPGMEE - 1995)
C. Gamma rays
D. X-rays
(radium)............(PGI - June -2000)
• Radium is an alkaline earth metal that is found in trace

amounts in uranium ores. It is extremely radioactive. Its
most stable isotope, 226Ra, has a half-life of 1602 years
and decays into radon gas.
• Radium preparations are remarkable for maintaining
themselves a t a higher temper ature than their
surroundings, and for their radiations, which are of three
kinds: alpha particles, beta particles, and gamma rays.
Isotope Half-Life Natural Specific Decay Radiation Energy (MeV)
Abun- Activity Mode Alpha Beta Gamma TOPIC 3 : RADIOSENSITIVITY
dance (Ci/g)
(%)
72. Most Radio sensitive stage
Ra-226 1,600 yr >99 1.0 Alpha 4.8 0.0036 0.0067
A. S2 phase
69. Radio isotopes are used in the following techniques B. G2 phase
except C. G2 phase
A. Mass spectroscopy D. G2M phase
B. RIA D
C. ELISA ............(AIPGMEE - 1996), AIPGMEE – 1998
D. Sequencing of nucleic acid PGI - 1997 – Dec, PGI - JUNE 2005, AIIMS PGMEE NOV –
C 2002, AIPGMEE - 2008
(RIA)............(AIPGMEE - 2004)
Most sensitive to radiation is M Stage followed by G2M Stage
ELISA (Enzyme Linked Immunoabsorbent Assay) is an
enzyme based immunoassay and does not use radioactive
isotopes. A test similar to ELISA which uses radioactive
isotope in place of enzyme is known as
Radioimmunoassay (RIA)
Nucleic acid sequencing, mass spectroscopy & RIA are
tests using radioisotopes.
70. In Radionuclide imaging the most useful radio

pharamaceutical for skeletal imaging is:
A. Gallium 67 (67Ga).
B. Technetium-sulphur-colloid (99mTc-Sc).

For most cell lines, cells are most sensitive at the G/Mitosis 80. Most harmful to individual cell:
(G2 M) interface. A. X-rays
Less sensitive in G1, and most resistant towards the end of B. alpha Particles
synthesis ‘S’ phase. C. beta particles
Most sensitive phase is the junction of G2M phase D. X-rays ( gamma rays)
Susceptibility of various phases of cell cycle to radiation: B
G2M >G2>M>G1> Early S > Late S ............(PGI - June -1998)
• Dividing part of cells are most sensitive to RT
• Non dividing cells are relatively resistant Alpha particles are ten times as harmful as X- ray, beta particles
• Hypoxic cells are relatively resistant or gamma rays.
• Phase of cell cycle that is most sensitive® to radiation :
G2M > M 81. Most sensitive structure in cell for radiotherapy is :
• Phase of cell cycle that is most resistanfi to radiation : End A. Cell membrane
of S phase B. Mitochondrial membrane DNA
• Phase of cell cycle in which radiation exposure leads to C. Enzymes
chromosomal aberration : G1 D. ER
• Phase of cell cycle in which radiation exposure leads to C
chromatid aberration : G2 ............(PGI - June -2002)
75. Organs sensitive to radiation are : 83. Which of these tumors is least radiosensitive
A. Gonad. A. Ewing’s sarcoma
B. Bone marrow. B. Osteosarcoma
C. Liver C. Wilm’s tumor
D. Fat. D. Neuroblastoma
E. Nervous tissue B
A and B ............(AIIMS PGMEE - MAY 2007)
.............(#)
84. A/E_____ are Radiosensitizers:
76. Tumors that are sensitive to chemotherapy : A. BUDR
A. Lymphoma. B. 5-FU
B. Germ cell tumor. C. Cyclophosphamide
C. Leukaemia. D. Hydroxyurea
D. Choriocarcinoma C
A,B and C ............(AIIMS PGMEE - DEC 1997)
.............(PGI - DEC 2003)
• Radiosensitizers are compounds which increase the
• Tumours considered curable by conventionally available effects of radiation (i.e. increase the sensitivity of the
chemotherapeutic agents are : cells the radiation)
- ALL and AML (pediatric / adult) • These are -
- Hodgkin’s disease (pediatric / adult) • Cisplatin
- Lymphomas-certain types (pedjatric/adult) • Halogenated pyrimidines (5 FU,
- Gestational trophoblastic neoplasms Cytarabine)
• Hydroxyurea
- Germ cell neoplasms
• BUDR
- Ovarian Ca
• Buthione sulfoximine
- Small cells lung carcinoma
• Actinomycin D
- Paediatric neoplasms, Wilm’s tumour, Embryonal
rhabdomyosarcoma, Ewin g’ s Sarcoma, perpher al
85. Drug that is radioprotective:
neuroepithelioma, Neuroblastoma.
A. Paclitaxel
B. Vincristine
• Melanoma is poorly responsive to chemotherapy.
C. Amifostine
D. Etoposide
77. Radiosensitive tumours are:
C
A. Seminoma
............(AIPGMEE - 2001)
B. Lymphoma
C. Sarcoma
Amifostine also known as WR2721 is a well known radio
D. Ewing’s sarcoma
protective agent. It is believed to act by releasing free
E. Leukemia sulphide groups which scavenge the free radicals produced
A,B and D due to radiation. It has also been tried as an antiradiation
............(PGI - JUNE 2006), PGI - JUNE 2003 agent for astronauts.
AIIMS PGMEE - MAY 2005, AIIMS PGMEE - MAY – 1993
AIIMS PGMEE - MAY - 1994 86. Most radiosensitive tumour of the following is:
A. Ca kidney
* Radiotherapy has a dramatic effect in Ewing’s B. Ca colon
sarcoma, but overall survival is not much enhanced. C. Ca pancreas
* In acute leukemia & lung cancer, radiation therapy can D. Ca cervix
prevent the development of leptomeningeal disease & D
brain metastases. ............(AIPGMEE - 2001)

Treatment of choice for carcinoma cervix is Radiotherapy 88. Which of the following is most radiosensitive
for any stage beyond stage IIB. A. Mucinous cystadenoma
B. Brenner’s tumor
• To give you guys a briefing here is a comprehensive list C. Dysgerminoma
D. Teratoma
Highly sensitive : Moderately sensitive : C
-Lymphoma -Small cell lung CA ............(AIIMS PGMEE - MAY 1995), AIPGMEE - 2006
-Wilms -CA Breast
-Myeloma -Teratoma
-Ewing’s sarcoma -Ovarian CA
-Seminoma -Basal Cell CA
-Medulloblastoma
-Dysgerminoma
-Nasopharyngeal carncinoma
Relatively Resistant : Highly Resistant :
-Squammous cell CA lung -Melanoma
-Hypernephroma (Renal Cell CA) -Osteosorcoma
-Rectal CA/colon CA -Pancretic CA
-Bladder CA -Hepatoma 89. Which of the following in radioresistant
-Soft tissue CA (filosarcoma) A. Seminoma
-Carcinoma cervix B. Cartilage
C. Ewing’s Sarcoma
87. The most sensitive tissue to radiation - D. GI epithelium
A. Skin B
B. Liver ............(AIIMS PGMEE - JUNE - 1997)
C. Gonads
D. Spleen
C
............(AIIMS PGMEE - MAY 1995), PGI - DEC 2003
• Organs which have a high dividing rate are more sensitive

to radiation.
• Bone marrow > Gonads > mucosal lining of GIT are
most sensitive.
93. Radiation therapy to hypoxic tissues may be

potentiated by the treatment with:
A. Mycostatin
B. Metronidazole
C. Methotrexate
D. Melphalan
B
............(AIIMS PGMEE NOV - 2003)
First lets see the simple Principle of Radiotherapy-

Radiation therapy is a form of physical therapy that damages
any tissue in its path.
Organs in which cells are stable (not multiplying e.g. heart, Mechanism of injury of radiation in cells -
skeletal muscle, nerves, cartilage) are radioresistant. - Radiation usually damages DNA
- Generates free radicals from cell water. Free radicals in
turn damage cell membrane proteins & organdies.
- Radiation damage is dependent on oxygen. So Hypoxic

cells are resistant to radiotherapy. Augmentation of
oxygen is the basic of radiosensitization.
“Metronidazole and other nitroimidaoles can sensitive hypoxic
tumour cells to the effects ofionilation radiation”
Other nitroimidazoles
• Tinidazole
• Nidazole
• Ornidazole
• Benzinidazole

TOPIC 4: RADIATION EFFECT RADIOLOGY 15
TOPIC 4 : RADIATION EFFECT Whole liver radiation tolerance is ~30 Gy, which is not
sufficient for “cure” but is sufficient for palliation of painful
96. Ionisation radiation acts on tissues leading to: disease
A. Linear acceleration injury
B. Excitation of electron from orbit 100. Most common presentation of radiation carditis is
C. Formation at pyrimidinediamers A. Pericardial Effusion
D. Thermal injury B. Atheromatous plaques
B C. Myocardialfibrosis
............(AIPGMEE - 1998) D. Pyogenic pericarditis
A
Absorption of energy from radiation in tissue leads to ............(AIPGMEE - 1997)
ionization or excitation.
Excitation: involves elevation of an electron in an atom Asymptomatic Pericardial Effusion may be the most
or molecule to a higher energy state without actual common manifestation of radiation induced heart
ejection of the electron. Ionization: disease.
Involves actual ejection of one or more electrons from Radiation Carditis manifests itself as :
the atom. Asymptomatic pericardial effusion
- most common
97. Maximum permissible radiation dose in pregnancy is: - usually detected by chest X-ray and confirmed by an
echocardiogram.
A. 0.5 rad.
B. 1.0 rad.
C. 1.5 rad.
D. 3.0 rad
A
.............(AIIMS PGMEE NOV - 2003)
• Maximum permissible radiation dose

Is that dose which if received each year for a 50 year
working lifetime would not be expected to produce any
harmful effect.
• The maximum permissible dose for a pregnant Acute pericarditis
woman is 0.5 rads in gestation period - The symptoms may include chest pain and fever, with or
• The gestation period when the fetus is most sensitive to without pericardial effusion.
the effect of radiation —8-15 weeks of gestation - The syndrome is usually self- limited and typically manifests
itself a few months after treatment.
• The ’10 day rule’
This rule advices that any x-ray examination involving the 101. Most common skin manifestation seen after 2 days
abdomen of a women of child -bearing age should be of radiation therapy is:
carried out within 10 days of the onset of A. Erythema
mensturation. B. Atopsy
C. Hyperpigmentation
D. Dermatitis
98. Which one of the following imaging techniques gives
A
maximum radiation exposure to the patient?
............(AIPGMEE - 1998)
A. Chest X-ray
B. MRI Most common early (acute) local skin reactions to radiation
C. Ct scan therapy include, erythema and desquamation.
D. Bone-scan Desquammation follows Erythema.
D The earliest skin manifestation therefore is Erythema.
............(AIPGMEE - 2006)
• Maximum single time radiation exposure is given by bone

scan; because the radiation isotope remains in body for
hours (according to half life).
• Radiation exposure (in decreasing order)

- Bone scan > CT scan > X-ray
- MRI & USG has no radiation risk
99. The radiation tolerance of whole liver is : 102. Late effects of radiation therapy :
A. 15 Gy A. Mucositis
B. 30 Gy B. Enteritis
C. 40 Gy C. Nausea and vomiting
D. 45 Gy D. Pneumoina
b E. Somatic mutations
............(AIPGMEE - 2004) A,B,D and E
............(PGI - DEC 2002)

TOPIC 5: PREGNANCY IMAGING RADIOLOGY 16
TOPIC 5 : PREGNANCY IMAGING
105. Ultrasound can detect gestation sac earliest at

A. 5-6 weeks of gestation
B. 10 weeks of gestation
C. 12 weeks of gestation
D. 7-8 weeks of gestation
A
103. Features of interstitial therapy are all except: ............(AIIMS PGMEE - NOV - 1993)
A. Only used in head & neck
B. Damage to normal tissue Ultrasound assessment of fetal age
C. Temporary or permanent • Detection of fetal structures by both transvaginal (TVS)
D. Only iridium used and transabdominal ultrasound
E. Used for early accessible organ
A,D and E Sign or fetal Menstrual age (in weeks) when
............(PGI - JUNE 2006) structure defected
Transvaginal Transabdominal
• Interstitial radiotherapy is a form of brachytherapy.
Gestational sac 41/2 5
• Other types are:
Intracavitary
Transluminal Yolk sac 5 6-7
• Brachytherapy was used in the treatment of malignant Fetal heartbeat 51/2 61/2
tumors shortly after the discovery of Radium . Head 8 9
– Radioactive other sources that are used are: Radon,
Ventricles 81/2 11
Cesium, Iridium, Iodine, Palladium & Strontium.
Gestational sac ultrasound
Yolk sac ultrasound

The implants that is used in brachytherapy to deliver
radiation can be used for a well defined period & then
removed (temporary implant) or can be permanently
left behind in the tumor (permanent implant).
* Brachytherapy has clinically been used in almost all
malignancies where radiation therapy is a component of
treatment.
104. Cardiotoxicity ca used by radiotherapy &

chemotherapy is best detected by
A. ECHO
B. Endomyocardial biopsy Fetal head -ultrasound
C. ECG
D. Radionucleide scan
B
............(AIPGMEE - 1999)
Myocardial fibrosis, as caused by Radiotherapy, can not be

best diagnosed by anything less than a tissue or
endomyocardial biopsy.
106. Earliest sign of fetal life is best detected by

A. X-Ray
B. Fetoscopy
C. Real time USG
D. Doppler
D
............(AIPGMEE - 1994)

Doppler is an interpretation of audible signals of USG 108. USG done at 18-20 weeks mainly to:
By listening fetal heart sounds and seeing blood flow A. Detect fetal abnormality
we can detect fetal life at earliest. B. Determine sex
C. Estimate liquor
107. Parameters used to estimate gestational age in last D. Determine maturity
trimester: A
A. CR length ............(PGI - 1997 - Dec)
B. Abdominal circumference
C. BPD • Ultrasound scan at 18-20 wks has got advantages in
D. Femur length addition to 1st trimester scan:
B,C and D (i) detailed fetal anatomy, & to detect any structural
............(PGI - 1997 - Dec) abnormality including cardiac,
(ii) Placental localization.
• By sonography, the following parameters are used to • Ultrasound examination at 18-20 wks is performed as
estimate the gestational age: a routine at all the centres in the developed world,
- FIRST TRIMESTER : Estimation of gestational age by though doubt remains about its absolute benefit.
crown-rump-length (CRL) is most precise, variation = • Some workers therefore called this ultrasound scanning
±5 days. as anomaly scan.
109. Best for unruptured ectopic pregnancy is:

A. Per abdominal US
- SECOND TRIMESTER : Gestational age is determined by
B. HCG
BPD & FL (variation ±10days).
C. Transvaginal US
D. Amniocentesis
C
............(PGI - 1997 - Dec)
THIRD TRIMESTER : Gestational age estimated by BPD,

FL, AC & HC, variation ±3wks.
• Best test to detect unruptured ectopic pregnancy is

transvaginal USG (TVS)
• With the advent of TVS, more & more ectopics are now
being diagnosed In unruptured state.
A BPD greater than 9.2cm indicates fetal pulmonary • Transvaginal sonography (TVS) significantly eliminates the
maturity corroborated by L:S ratio diagnostic limitation of transabdominal sonography (TAS)
in very early ectopic pregnancy,

110. Ultrasonography of umbilical artery is done to know • Doppler spectral waveform of the ductus venosus shows
about not just absent diastolic flow, but actual flow reversal
A. Heart beat during diastole. This is an ominous sign and suggest severe
B. Gastational age fetal compromise (ie: hypoxia). It is associated with very
C. Fetal weight high fetal morbitidity and mortality. In this fetus, the
D. Fetal maturity Resistance Index for the vessels in this case are as follows:
A • Umb. Artery: 0.92 ; MCA: 0.75; DV: 0.99
............(PGI - JUNE 1997)
• Ultrasonography of umbilical artery helps in the detection
of heart beat of the fetus.
• Umbilical artery USG does not help in the determination
of gestational age, fetal weight, & fetal maturity.
• The cerebro-placental ratio = RI (mca)/ RI (umb.

a.) = 0.75/0.92 = 0.81.
• The normal ratio is > 1. This suggests severe fetal
growth retardation (IUGR) in this fetus possibly due to
severe placental insufficiency. Ultrasound imaging and
biometry also confirmed evidence of growth retardation
in this fetus (28 weeks by ultrasound versus 31 weeks by
Last Menstrual period). All these ultrasound and color
doppler images suggest fetal growth reardation with fetal
Doppler of umbilical artery compromise and anoxia- meaning we have a very sick fetus
that needs prompt delivery
• Color doppler and spectral waveform imaging of the
umbilical artery shows reversal of diastolic flow. This is an 111. Most sensitive sonological indicator for aneuploidy
ominous sign of fetal compromise/ hypoxia and is
requires us to evaluate the fetal middle cerebral A. Gestational sac volume
artery and ductus venosus . B. Crown-rump length
• The diastolic flow reversal in umbilical arteries signifies severe C. Nuchal transluscency
placental insufficiency and increased placental D. Serum P HCG level
vascular resistance, which is bad news for the fetus . C
............(AIIMS PGMEE - NOV 2006)
“The most effective sonographic marker of trisomy 21

and other chromosomal defects is increased nuchal
translucency (NT) thickness at 11 to 14 weeks
gestation.”
112. The characteristic finding in USG of Ectopic

pregnancy is-
A. Resistance in coloured doppler
Doppler of umbilical artery B. Absence of gestational Sac in uterus
C. Free fluid in peritoneal cavity
D. Complex adenexal mass
B
............(AIIMS PGMEE - DEC 1998)
• Color doppler and spectral waveform of the middle

cerebral artery shows increased diastolic flow in the
fetal brain suggesting a “fetal brain sparing” effect ,
whereby, the fetal cerebral vessels “open up”, • Diagnostic Undines ofEctopic pr egnancy on
lowering the cerebral vascular resistance to increase sonography.
flow to the brain thus diverting blood to the • Absence of gestational sac in the uterus with a positive
important organs in a state of overall fetal hypoxia. pregnancy test.
• Empty uterine cavity with B HCG value greater than 2000
W/L.
• Empty uterine cavity with failure to double the value of B
HCG by 48 hrs.
• Fluid in the pouch of Douglas
• Adnexal mass clearly separate from the ovary.

TOPIC 6: BONE TUMORS RADIOLOGY 19
TOPIC 6 : BONE TUMORS • MCpresentation is—gradually increasing swelling

113. A lady has a lytic lesion in X-ray of the upper end
of humerous. The diagnosis is :
A. Osteosarcoma
B. Unicameral bone cyst
C. Osteoclastoma
D. Osteochondroma
B
............(AIIMS PGMEE JUNE - 1999)
• Mortise and lateral views, distal leg and ankle. A large,
geographic lesion can be identified centrally within
the distal tibial metaphysis .
(Note that it has not crossed the physis nor invaded the
epiphysis.) It is expansile, but the cortex is not disrupted.
Some trabeculations can be seen within the lesion .
This lesion was histologically confirmed to be an
aneurysmal bone cyst.
• Unicameral bone cyst or simple bone cyst is the only true

cyst of the bone.
• Most common site is the upper end of the humerus.
• Most common presentation— Pathological fracture
• ABC (aneurysmal bone cyst) components in GCT are

not uncommon. We have even had patients with recurrent
lesions being sometimes a GCT and sometimes an ABC.
There is likely some sort of relationship between GCT and
ABC
• Unicameral bone cyst of young males , most common

in long bones such as humerus, femur and calcaneus,
usually complicated by fractures.
114. Dense calcification is characteristic of:

A. Fibrosarcoma
B. Osteosarcoma
C. Chondrosarcoma
D. Chondroblastoma
B
............(AIIMS PGMEE - SEP 1996)
• Calcaneal unicameral bone cyst
Mottled fluffy calcification were seen in both chondrosarcoma
and chondroblastoma.
• X-ray appearance of chondroblastoma
“Rounded well demarcated radiolucent area in the epiphyses.”
• Aneurysmal bone cyst — most common site is the

metaphyseal region of the knee.
• Aneurysmal bone cyst is most common in those
regions of the skeleton where there is both a
relatively high venous pressure and high marrow
content

TOPIC 6: BONE TUMORS RADIOLOGY 20
• X-ray appearance of chondrosarcoma. B. A metastatic tumour in the bone

“Radiolucent area with central flecks of calcification, or C. An Osteogenic sarcoma
fluffy calcifications.” D. An Ewing’s sarcoma
C
............(AIIMS PGMEE - MAY 2004)
Sunray appearance and Codman triangle are types of

periosteal reaction seen in osteosarcoma.
115. The Radiological hallmark of Osteogenic Sarcoma-

A. Soap bubble appearance
B. Sun ray appearance
C. Osteoid formation by neoplastic cells
D. Cotton wool appearance
Onion-peel type of periosteal reaction is seen in Ewing Sarcoma
B
............(AIIMS PGMEE JUNE - 1999)
X-ray features of Osteosarcoma.

• Area of irregular destruction of metaphyses
• Erosion of the overlying cortex.
• New bone formation in the matrix of the tumor
• Periosteal reaction (which is irregular; periosteal reaction
in osteomyelitis is smooth)
• Codman ‘s triangle
• Sun-ray appearance
• Although sunray appearance & Codman triangle are typical
of osteosarcoma, it can also be seen in fast growing tumors
eg: Ewings. Onion-peel appearance although typical
of Ewing can also be seen in osteosarcoma (rarely).
118. What dose of radiation therapy is recommended

for pain relief in bone metastases
A. 8 Gy in one fraction
B. 20 Gy in 5 fractions
C. 30 Gy in 10 fractions
Codman triangle.
D. Above 70 Gy
Diagram shows elevated periosteum (arrow) forming an
C
angle with the cortex
............(AIIMS PGMEE - MAY 2004)
Actually all the first three options are recommended for pain
relief in bony metastasis. Trials are being conducted to
find out the best.
It has been found that 8 Gy in one fraction or 30 Gy in 10
fractions have similar effect on pain relief but pain relief
lasts a longer duration in patients who receive longer
course of radiotherapy (i.e. 30 Gy in 10 fractions.)
119. Most chemoresistant tumors among the following

is
A. Synovial sarcoma
116. Most chemoresistant tumors among the following B. Osteosarcoma
is: C. Malignant fibrous histiocytoma
A. Synovial sarcoma D. Embryonal rhabdomyosarcoma
B. Osteosarcoma C
C. Malignant fibrous histiocytoma ............(AIIMS PGMEE - NOV 2006)
D. Embryonal rhabdomyosarcoma
C • Malignant fibrous histiocytoma appears to be most
............(AIIMS PGMEE - MAY 2008) chemoresistant.
• Chemotherapy forms a part of t/t of all the other three
117. “Sunray appearance” on X-rays is suggestive of options, whereas only surgery & radiotherapy are the t/t
A. A Chondrosarcoma options for malignant fibrous histiocytoma

TOPIC 7: CHEST X-RAY RADIOLOGY 21
Chemosensitivity of different tumors 121. Left Cardiac Border bulge can be seen in all, except:
1. Highly sen sitive (which may be used by A. Enlarged Azygous Vein
chemotherapy) B. Left Appendicular overgrowth
Teratoma of testes C. Coronary Artery Aneurysm
Hodgkin’s disease D. Pericardial defect
High grade non-Hodgkin lymphoma A
Wilm’s tumour ............(AIPGMEE - 2000)
Embryonal rhabdomyosarcoma
Chorio-carcinoma Azygous vein is present to the right and not the left side.
Acute lymphoblastic leukaemia in children All others may give rise to a bulge on the left cardiac
Ewing’s sarcoma border.
2. Moderately sensitive (in which chemother apy may

contribute to cure)
Small cell carcinoma
Breast carcinoma
Low grade non-Hodgkin lymphoma
Acute myeloid leukaemia
Ovarian cancer
Myeloma
3. Relatively insensitive (in which chemother apy may
sometimes produce palliation)
Gastric carcinoma
Bladder carcinoma
Squamous carcinoma of head and neck
Soft tissue sarcoma 122. True about chest X-ray is all except:
A. Left hilum is higher
TOPIC 7 : CHEST X-RAY B. Left dome is higher
C. All fissures are clearly seen on lateral film
120. A/E show a normal hilar shadow in a plain chest x- D. None
ray: B
A. Bronchus ............(PGI - 1997 - Dec)
B. Pulmonary Artery
C. Upper lobe veins • In most patients Rt. hemidiaphragm is higher than the
D. Lower lobe veins left. This is due to the heart depressing the left side
D & not to the liver pushing up the Rt. hemidiaphragm.
............(AIIMS PGMEE - FEB - 1997)
The hila are composed of

• Pulmonary arteries and their main branches
• The upper lobe pulmonary veins
• The major bronchi and
• The lymph glands.”
Normally Lt. hilum is 2.5 cm higher than Rt. Of all the structures
in the hilum, only pulmonary arteries & upper lobe
veins contribute significantly to the hilar shadows on
plain film.
• “The lobe pulmonary veins do not cross the hila in their

course to the left atrium and therefore do not
contribute to the hilar shadows.”
The main fissures separate the lobes of the lung but are
usually incomplete allowing collateral air drift to occur
between adjacent lobes.
They are visualized when X-ray beam is tangential.

TOPIC 7: CHEST X-RAY RADIOLOGY 22
The horizontal fissure is seen, often incompletely, on

the PA film, running from the hilum to the region
of the 6th rib in the axillary line, & may be straight or
have a slight downward curve. Occasionally it has double
appearance.
Right ventricle does not form the right border of the heart
or mediastinum. It forms the anterior border of heart visible
on lateral film
125. Lt border of the heart in C. X.R. is formed by

A. Pulmonary artery
B. Pulmonary Vein
C. Abdominal aorta
D. Arch of aorta
123. Base of heart formed by : E. Rt ventricles
A. Rt. Ventricle A and D
B. LV ............(PGI - JUNE 2003)
C. LV + RV
D. RA + RV 126. If the right cardiac silhouette is obliterated, it
E. RA + LA means the pathology involves:
E A. Right middle lobe
............(PGI - DEC 2006) B. Right lower lobe
C. Right atrium of heart
• Base of the heart is mainly formed by Left atrium and by D. Right ventricle of heart
a small part of Right atrium. A
............(AIIMS PGMEE - MAY 2008)
• An intra-thoracic radio-opacity, if in anatomic

contact with a border of heart, aorta or diaphragm,
will obscure that border. This is known as silhouette
sign.
An intra-thoracic lesion not anatomically contiguous with
a border or a normal structure will not obliterate that
border.
• When examining the lung fields of a normal CXR, the
124. Structure forming right border of heart silhouettes of the heart borders, the ascending and
A. SVC descending aorta, the aortic knob and the hemidiaphragms
B. IVC
should be clear.
C. Rt. Atrium
Obliteration of any of these silhouettes by a radio-opacity
D. Lt. Atrial appendage can be caused by infection in the lung, blood, pus, etc.
E. Pulmonary vessels
A,B and C
............(PGI - JUNE 2006)
• All of these silhouettes, or structures, are in contact

with a specific portion of the lung . Therefore, by
determining exactly which structure is obliterated,
you can determine where the lung pathology is
located.

TOPIC 8: CONTRAST AGENTS RADIOLOGY 23
• Iohexol is the non ionic contrast media which is used

for this purpose.
Advantages of Iohexol -
• Chest r adiog r aph shows silhouette sign, with — Non neurotoxic
obscuration of right border of heart (arrows) — Do not cause epileptic fits
— No arachnoid toxicity
128. Radiocontrast is contraindicated in all except:

A. Renal failure
B. Patient on metfonnin
C. Dehydration
D. Obesity
D
............(AIPGMEE - 2007)
Obesity itself has n ot been mentioned as

contraindication for the use of radiocontrast.
• Contrast nephropathy classically presents as rise in blood
Silhouette/Structure Contact with lung urea nitrogen and creatinine and is more common in
individuals with pre existing:
Upper right heart Anterior segment of RUL
- Chronic renal insufficiency
border/ascending aorta - Diabetes mellitus
Right heart border RML (medial) - CCF
Upper left heart border Anterior segment of LUL - Hypovolemia (dehydration)
- Multiple myeloma
Left heart border Lingula (anterior)
- Patient on metfomin
Aortic knob Apicoposterior segment of • Interaction between Metformin & contrast agent
LUL
Hemidiaphragms Basal segment.of lower Metformin is excreted by kidneys as an active compound-
lobes In case of renal insufficiency metfo rmin accumulate
and may increase the risk of lactic acidosis.
TOPIC 8 : CONTRAST AGENTS • Both metformin & radiocontrast causes renal
insufficiency and should not be used together
127. Contrast media of choice for Myelogram Is
A. Urograffin 75% 129. Allergic Reactions to Radiological Contrast Agents
B. Conray 470 are:
C. Iohexol A. Anaphylactic reactions
D. Biligraffin B. IgE mediated reactions
C C. Urticaria
............(AIIMS PGMEE - MAY - 1993) D. Edema
A
Mvelographv - ............(AIPGMEE - 2008)
• It is a radiographic study that outlines the spinal canal
and its contents. 130. What contrast is needed for proper radiographic
• Water soluble non ionic contrast material is injected image is a heavy bony built person?
into the subarachnoid space via a lumbar or cervical • ↑ ed ma
puncture. • ↑ed kvp
• ↑ed exposer time
• ↑ed developing time
A
............(AIPGMEE - 2002)
For proper Radiographic Imaging

↓ ↓
Contrast is increased by Penetration is increased by
↓ ↓
Increase in tube current (ma) Increase in KVp

TOPIC 9: INTRACRANIAL CALCIFICATION RADIOLOGY 24
• Contrast is increased by increasing intensity of X Ray

which depends on no. of electron striking the target i.e.
rate of emission of electrons.
It can be controlled by varying the filament current.
So increase in current leads to increase in contrast.
• Voltage : By enhancing voltage penetration of X-Ray is Myodil (pantopaque) is-a contrast medium used for
enhanced myelography.
High penetrating X-Ray are k/a hard X Rays.
Low penetrating X Rays are k/a Soft X Rays.
The higher the kVp or mA setting or the longer the
exposure time, the greater is the film density regardless
of the nature of the tissues within the body
LOW KVp gives high subject contrast while MA control

film blackening (density)
131. Contrast material used in the diagnosis of

esophageal atresia is
A. Gastrograffin
• In esophageal atresia, contrast agent used is Dianosil,
B. Conray 420
as in most of the cases, esophageal atresia is
C. Dianosil
frequently associated with a tracheo-esophageal
D. Myodil
fistula, So, on instillation of contrast media, there
C
is risk of flooding in the lungs .
............(PGI - 1997 - Dec)
• If instead of isotonic contrast agent, other agents are
used, there occurs many difficulties.
Dionosil. brand name of propyliodone, a water-insoluble
The newer isotonic contrast media do not suffer from the
X-ray contrast medium
disadvantages.
• Dianosil is the contrast media of choice for diagnosis of
For instance ,iopamidol 200 has osmolarity which is near
esophageal atresia.
enough to that of plasma, to make it a highly satisfactory
medium for many studies in the neonatal period.
132. Contrast used for MRI :

A. Iodine
B. Gadolinium
C. Metrazamide
D. omnipaque
B
............(PGI - 2000 - Dec), PGI - June -2000
• Contast for MRI is Gadolinium.

Field used in MRI for clinical practice range from 0.15 to
1.5 tesla
Conray 420 is an I.V contrast media & is not used in

esophageal atresia.
Gastrogfaffin enema (diluted l/3rd with water) is used to

check the Patency & integrity TOPIC 9 : INTRACRANIAL CALCIFICATION
of a recent surgical anastomoses. Gastrogaffin is also
recommended in the investigation 134. Plain x-ray skull showing intra-cranial calcification
of adult patient with idiopathic megacolon or possible with cystic lesion :
Hirschprung’s disease, since in these A. Craniopharyngioma
conditions there is likely to be difficulty in evacuating barium. B. Glioma

TOPIC 9: INTRACRANIAL CALCIFICATION RADIOLOGY 25
C. Meningioma 137. Basal ganglia calcification is seen in all except:

D. Medulloblastoma A. Hypoparathyroidism
A B. Wilson’s disease
............(AIIMS PGMEE - SEP 1996) C. Perinatal hypoxia
D. Fate’s syndrome
• Out of the 4 given options, all can give rise to intracranial B
clacifications except medulloblastoma. ............(AIPGMEE - 2007), PGI - JUNE 2003
• Craniopharyngioma shows calcification in over 75% of cases
whereas calc ification is seen in on ly 10-15% of Basal Ganglia CalcifIcation
meningiomas and 5 to 7% of gliomas. 1. Physiological with aging
• Craniopharyngiomas are often cystic whereas meningiomas 2. Endocrine
and gliomas are not cystic. - Hypopar athyr oidism, Pseudohypopar a thyroidism,
Hypothyroidism, Hyperparathyroidism
3. Metabolic
- Fahr’s disease. Mitochondria 1 defects, Cockayne’s
syndrome
4. Toxic
- Birth anoxia, CO poisoning, Lead poisoning
5. Infection
- Toxoplasmosis, congenital rubella, CMV, cysticercosis
6. Chemotherapy / Radiation
7. Vascular malformation
• Craniopharyngiomas are seen mainly in children
• The characteristic feature is the position of the calcification • Fahr disease is a rare neurologic condition, which is actually
- midline and just above the sella not a single entity, but represents a diverse group of
disorders. The condition is characterized by abnormal
135. Supra sellar classification along with growth calcification within certain regions of the brain, most
retardation is found in : predominantly within the basal ganglia .
A. Thalamic tumor • Symptoms develop when the deposits accumulate,
B. Pituitary tumour including progressive deterioration of mental
C. Craniopharygioma function, loss of previous motor development,
D. Pineal tumour spastic paralysis, and athetosis .
C • In addition, optic atrophy may occur. The condition is
............(AIIMS PGMEE - Dec - 1995) generally considered inherited, idiopathic cases have been
identified.
• “Presence of suprasellar midline calcification immediately
suggest the diagnosis of craniopharyngioma.”
• Craniopharyngioma is the most common cause of
suprasellar calcification
136. Calcification of basal ganglia is seen in A/E

A. Berry’s aneurysm
B. Cysticercosis
C. Idiopathic hyperparathroidism
D. Wilson’s disease
C
............(AIIMS PGMEE - FEB - 1997)
• Hypoparathyroidism or pseudohypoparathyroidism causes

basal ganglia calcification (not idiopathic
hyperparathyroidism)
• All the other given options can cause basal ganglia 138. Physiological calcification of Skull in X-ray Is seen
calcification. in :
A. Pineal gland
B. Choroid plexus
C. Red nucleus
D. Basal ganglion
A and B
............(PGI - 2001 - Dec)
• Physiological calcification in skull X-ray seen in

— Chloroid plexus
— Pineal Gland in old age
— Falx cerebri -
— Petroclinoid ligament
— Lateral edges of diaphragm sellae.

TOPIC 10: PANCREATITIS RADIOLOGY 26
• In congenital syphilis, the skull lesions may be purely

sclerotic or may present as a combination of sclerosis &
osteolysis. In purely sclerotic lesions, new bon e may be
laid down in the frontal & parietal region, so producing
the ‘hot Cross bun’ skull.
139. Calcification is best detected by :

A. X - ray
B. USG
C. CT Scan. TOPIC 10 : PANCREATITIS
D. MRI.
E. PET Scan 142. A person with C/o pain epigastrium, radiating to
C back off & on. The investigation of choice :
.............(PGI - DEC 2003) A. USG abdomen
B. Radio nuclide scan
141. Periventricular calcification is often due to: C. MRI
A. Toxoplasmosis D. CT abdomen
B. Cytomegalic infection D
C. Congenital syphilis ............(AIIMS PGMEE NOV - 1999)
D. All of the above
B • History of the patient is suggestive of acute pancreatitis
............(PGI - 1997 - Dec) and the investigation of choice in it is CT abdomen.
• Though the first investigation in this patient (or any patient
• In Cytomegaloviral infection (CMV), there may be severe with acute abdomen) would be USG.
intrauterine brain infection, often with microcephaly & a • First investigation in this patient — USG
characteristic widespread periventricular calcification may • Best investigation (Inv. of choice) — CT abdomen
outline the dilated ventricles. The calcification is
stippled, bilateral & symmetric & there is usually
microcephaly.
• Edema and swelling of the tail of the pancreas with loss

of sharp borders.
The Calcification in toxoplasmosis is characteristic, consisting

of multiple scattered flecks in the cortex & linear streaks
in the basal ganglia.
• Pseudocyst Development at the site of pancreatitis.
Persistent swelling of tail with some edema.

• Ultrasound of an obstructive stone in the distal common CT findings of acute pancreatiti s

duct indicated by lines and arrows. 1. Pancreatic edema & enlargement
2. Poor contrast enhancement d/t necrosis
3. /// defined pancreatic outline d/t blurring of fat planes
& fluid collection.
144. Chain of lakes appearance in ERCP is seen is

A. Acute Pancreatitis
B. Chronic Pancreatitis
C. Carcinoma Pancreas
D. Ductal Adenoma
• Chronic Pancreatitis, echogenic irregular appearance to B
the body of the pancreas. ............(AIPGMEE - 1996)
• Acute - Gasless abdomen in X Ray
Pancreatitis
• Chronic - Chain of lake appearance
Pancreatitis
Acute pancreatitis
Enlarged edematous pancreas “P” 4cm pseudocyst “C”
Carcinoma Pancreas
- Double duct sign
- Scrambled egg appearance
- Inverted 3 sign
- Rose thorning of medial wall of 2nd part duodenum
• MRI Pancreatography: Demonstration of Pancreas Divisum
with two pancreatic ducts being identified. Double duct sign in 47-year-old man with ampullary
• Second duct indicated by the arrowhead in image carcinoma. (a) Transverse CT scan without intravenous
B contrast material enhancement shows dilatation of
common bile duct (arrows) and main pancreatic duct
(arrowheads).
143. Which of the following is not a CT scan feature of Coronal T2- weighted single-shot Mrcholangiopancreatogram
acute pancreatitis ? shows dilatation of
A. Ill defined outline of the pancreas the common bile duct (white arrows) and main
B. Enlargement of the pancreas pancreatic duct (black arrows ).
C. Poor contrast enhancement The combined
D. Dilated main pancreatic duct dilatation of the common bile and pancreatic ducts
D create the double duct sign.
............(AIPGMEE - 2004)
Dilation & Beading of main pancreatic duct and its branches
and calculi (calcification) is pathognomic of chronic
pancreatitis. (Seen as Beaded/string of pearls/chain of
lakes & rat tail appearance in ERCP).

• The inverted-3 sign of Frostberg . There is a widened C. Inferior vena cava

duodenal sweep with fixation of the duodenal wall at the D. Duodenum
papilla (arrow), producing the inverted-3 sign. This patient E. Portal vein
had acute pancreatitis, so that the inverted-3 sign is not A,C and E
specific for pancreatic carcinoma ............(PGI - June -2002)
• The celiac trunk is a short, wide & midline vessel arising

from the anterior aspect of the abdominal aorta at the
level of the junction of T12 & L1 vertebra.
A horizontal section at this level i.e. T12-L 1 will show the
following structures :
- Liver
- Ligamentum teres
- Porta hepatis
- Inferior vena cava
- Aorta
145. ERCP in pancreatitis is done to know about: - Left kidney
A. Gall stones - Left suprarenal gland
B. Associated cholangitis - Spleen
C. Ascites - Body of stomach
D. Pancreatic divisum - Diaphragm
E. Annular pancreas - Body of pancreas
D - Lesser sac
............(PGI - June -2001)
147. USG is sensitive in
• Pancreas divisum literally means “divided pancreas”. In early A. Ureteric colic
life the pancreas consists of two small ‘buds’ arising from B. Gall stone
the primitive foregut. One is located in front (called C. Blunt abdominal trauma
ventral), the other one in the back (called dorsal). D. Appendicitis
At the end of the 6th week of pregnancy, however, these E. Pancreatic pathology
two buds have rotated in such a way that they are close B,C and D
together and can fuse ............(PGI - JUNE 2004)
• The dorsal bud and its ducts (drainage tubes) form the
body, tail and part of the head of the pancreas. The ventral • In ureteric calculi, it is rare to demonstrate within the
bud completes the head and a part of the pancreas known ureter, but may be seen at the vesicoureteric junction a/
as the uncinate process. The ducts fuse forming a main w some local ureteric distension
and an accessory pancreatic duct. • USG can’t diagnose early mucosal disease in
• If the fusion of the dorsal bud and ventral bud does ulcerative colitis, because its spatial resolution is inferior
not happen, the pancreas ducts are disconnected, to double contrast barium enema, however it can readily
a condition known as ‘pancreas divisum’ diagnose bowel wall thickening.
• In acute appendicitis, USG has a sensitivity of around
90%.
• Pancreatogram demonstrating pancreas divisum with

a tortuous, ectatic dorsal PD and extravasation of
contrast into the peritoneum (arrows) at the level USG is very sensitive in abdominal trauma in detecting
of the mid-body. hemoperitoneum, & other solid organ damage.
• Pancreatic calcifications are present. Cholangiogram is
normal
• The accuracy of USG in detecting gall stones is over

98%.
146. In a CT scan at the level of celiac trunk, following • USG is often the initial investigation for most patients with
structures will be seen : suspected pancreatic disease, however obesity, excess
A. Pancreas small & large bowel gases & recently performed barium
B. Gallbladder contrast examinations can interfere.

TOPIC 11: PULMONARY EMBOLISM RADIOLOGY 29
TOPIC 11 : PULMONARY EMBOLISM 151. Best method to diagnose pulmonary embolism:

A. Pulmonary angiography
148. Pulmonary embolism is best diagnosed by B. Scintillation perfusion scan
A. USG C. CT scan
B. X Ray Chest D. X-ray chest
C. Ventilation - Perfusion Scan A
D. CT Scan ............(AIPGMEE - 1998)
C PGI - 1997 – Dec
............(AIPGMEE - 1996) PGI - JUNE 1997
• Computed tomography angiogram in a 53-year-old man

with acute pulmonary embolism. This image shows an The most specific investigation available for establishing the
intraluminal filling defect that occludes the anterior diagnosis of Pulmonary thromboembolism is
basal segmental artery of the right lower lobe. Also - selective pulmonary angiography.
present is an infarction of the corresponding lung, Lung scan or perfusion ventilation scan.
which is indicated by a triangular, pleura-based - lung scanning is the principle imaging test for the diagnosis
consolidation (Hampton hump). of PTE
- lung scanning is particularly useful if results are normal or
near normal, or if there is high probability for PTE
- A high probability scan for PTE is defined as having two
or more segmental perfusion defects in the
presence of normal ventilation.
• Selective pulmonary angiography is the most specific

examination available for establishing the definitive diagnosis
of PTE & can detect emboli as small as 1-2 mm.
• Scintillation perfusion scan is the principal imaging test for
the diagnosis of PTE.
• CT Scan of chest with intravenous contrast effectively
diagnose large, central PTE but may fail to detect more
peripherally located thrombi that are clinically important.
• The pathophysiology of pulmonary embolism. Although • CXR—is normal or near normal in PTE.
pulmonary embolism can arise from anywhere in the body,
most commonly it arises from the calf veins . The • Pulmonary angiogram in a patient with PE. The clot
venous thrombi predominately originate in venous appears as a filling defect (arrow).
valve pockets (inset) and at other sites of presumed
venous stasis. To reach the lungs, thromboemboli travel
through the right side of the heart
Spiral CT in a patient with PE. The clot appears as a

filling defect (arrow).
• Ventilation-Perfusion (VQ) Scan. Clots appear as perfusion

defects, without corresponding defects on the
ventilation scan (‘mismatched defects’).

TOPIC 12: RICKETS RADIOLOGY 30
• Palla’s sign - enlarged right descending pulmonary artery.
Chest radiograph demonstrating focal oligemia in the right

lung (area between white arrowheads) and a prominent
right descending pulmonary artery (black arrow).
152. In Pulmonary. embolism, findings In perfusion scan

Is:
A. Perfusion segmental defect
B. perfusion defect with normal lung scan & radiography
C. Tenting of diaphragm • Perfusion lung scintigraphy demonstrating large bilateral
D. Normal chest scan perfusion defects, one of which corresponds to the
area of focal oligemia seen on the chest radiograph
............(PGI - June -2000) (white arrowhead).
Ventilation-perfusion scans showed mismatch in the right

upper lobe, right basilar segment, and left lingular segment
TOPIC 12 : RICKETS
153. Hampton’s hump is seen in chest X-ray in:
A. Bronchogenic Ca 154. Which of the following show the Looser’s Zone or
B. Aspergillosis Pseudo fracture :
C. Pulmonary TB A. Vitamin C deficiency
D. Pulmonary embolism B. Osteoporosis
D C. Thyroditis
............(AIIMS PGMEE - NOV 2007) D. Osteomalacia
D
Hamptons’ hump is one of the classic radiographic findings
of pulmonary embolism. ............(AIIMS PGMEE - JUNE - 1997)
It appears as a peripheral wedge shaped opacity on chest PGI - June -2002
x rays. It is d/t pulmonary infarct.
• Westermark’s sign - it’s a focal area of oligemia due to

venoconstriction distal to embolus. Osteomalacia (means softening of bones)
• Is the adult counterpart of rickets.
• X-ray feature
a) Decreased bone density
b) Looser’s zone (pseudo fractures) -
• Bilaterally symmetrical transverse lucent bands of uncalficied
osteoid
• Common sites are -
Scapulae
Femoral necks and shafts
Pubic rami and Ribs

TOPIC 12: RICKETS RADIOLOGY 31
c) Protrusio-acetabuli
d) Triradiate pelvis in females
e) Biconcave vertebral bodies
• Radiograph of the knees of an 11-year-old boy with

treated vit amin D–resistant ric kets. Image
demonstrates bilateral multiple growth arrest lines
and underdevelopment of the medial aspect of both
the tibial plateau and the femoral condyle.
155. Flaring of anteri or ends of the ribs is

characteristically seen in:
A. Neurofibromatosis
B. Scurvy
C. Rickets
D. Hypothyroidism
C
............(AIPGMEE - 2008)
Findings in patients with rickets
• Anteroposterior and lateral radiographs of the wrist of an
8-year-old boy with rickets demonstrates cupping and
fraying of the metaphyseal region.
• Radiographs of the knee of a 3.6-year-old girl with

hypophosphatemia depict severe fraying of the
metaphysis
• Radiograph in a 4-year-old girl with rickets depicts

bowing of the legs caused by loading.
156. Earliest evidence of healing in rickets is provided

by
A. S, Ca+T
B. S. PO43
C. Radiological examination of growing bone ends
D. S. Alkaline Phosphate level
C
............(AIPGMEE - 1995)
• Radiograph in a 4-year-old girl with rickets, focused Response to treatment in Rickets following administration of
on the knees. Image depicts the development of vitamin D3 orally or parentrally is monitored on repeated
knock-knees. X-ray plates of bones.

TOPIC 13: MILIARY SHADOWING TOPIC 14: RADIONUCLIDE HEART RADIOLOGY 32
PGI - DEC 2003

Important radiological features in Rickets and PGI - DEC 2006
osteomalacia includes:
PGI - JUNE 2006
Osteomalacia (Adult)
Rickets (children)
• Causes of Miliary Mottling are:
Looser’s zone Widening of epiphysis
A. Infection :
Cod fish vertebrae Cupping & splaying of
(1) Bacterial: Disseminated tuberculosis, bronchopneumonia,
Rugger jursy spine (in metaphysis
Brucellosis.
CRF) Ricketsry rosary
(2) Fungal: Histoplasmosis, Coccidiodomycosis Blastomycosis.
Genu valgum
etc.
Triradiate pelvis
Wind swept deformity
157. Fraying and cupping of metaphyses of long bones

in a child does not occur in:
A. Rickets
B. Lead poisoning
C. Metaphyseal dysplasia
D. Hypophosphatasia
B
............(AIPGMEE - 2003)
PGI - June -1999
B. Allerglic :
Differential diagnosis Tropical eosinophilia; Loeffler’s syndrome drug reaction.
of Fraying of C. Neoplastic:
Metaphysis Lymphangitis, carcinomatosis, alveolar cell carcinoma, leukemia,
• Rickets Lymphoma.
• Hypophosphatasia D. Pneumoconiasis
• Copper deficiency
E. Cardiac:
Multiple pulmonary infarction, pulmonary oedema.
F. Miscellaneous:
RA, Sarcoidosis, haemosiderosis; interstitial pulmonary
fibrosis, Hyaline membrane disease.
G. Artifacts :
Skin warts etc.
• Varicella Pneumonia radiographically shows nodular
infiltrate.
• Klebsiella Pneumonia : classic lobar infiltrate with bulging
fissure is seen. Disease may progress to
Pulmonary necrosis, pleura! effusion and empyema.
TOPIC 14 : RADIONUCLIDE HEART

Differential diagnosis of
cupping of metaphysis 165. Which isotope is used In ventriculography
A. Gallium
• Rickets B. Lipoidate
• Hypophosphatasia C. Technetium
D. Diatrizoate
• Bone dysplasia
C
- Achondroplasia ............(AIIMS PGMEE - MAY - 1994)
- Metaphysial chondrodysplasia
• Scurvy • Radionuclides used in cardiac imaging –
• Metatropic and diastropic 1) Radionuclide ventriculography - Technetium”
dwarfism
TOPIC 13 : MILIARY SHADOWING
160. Miliary shadow In chest X-ray Is seen In A/E:

A. TB
B. Loeffler’s pneumonia
C. Klebsiella
D. Varicella pneumonia
C
............(PGI - 1999 - Dec)
PGI - 2000 – Dec

TOPIC 15: RENAL TUBERCULOSIS RADIOLOGY 33
2) Radionuclide used to assess myocardial perfusion -

Thallium
166. Cold spot in MI is visualized by -

A. Albumin 168. The most accurate investigation for assessing
B. Gallium ventricular function is:
C. Th-201 A. Multislice CT
D. Pyrophosphate Tc99 B. Echocardiography
D C. Nuclear scan
............(AIIMS PGMEE - SEP 1996) D. MRI
AIPGMEE - 1998 B
............(AIPGMEE - 2006)
Cold spot that is visualized by using Technitium” scan.
• The radionucleotide scan is distributed in the myocardium
in proportion to the myocardial blood flow . It is Transthoracic eehocardiography is the most commonly used
concentrated by viable myocardium, cardiac imaging examination after the chest X-ray and
MI is seen as a cold defect. probably approaches the electrocardiogram in its clinical
utility. It is harmless and relatively comfortable for the
patient and is the first-line technique for evaluating most
abnormalities of the cardiac chambers, valves and great
vessels.
TOPIC 15 : RENAL TUBERCULOSIS
170. Which of the following imaging modality is most

sensitive to detect early renal tuberculosis.
A. Intravenous urography
B. Ultrasound
C. Computed tomography
D. Magnetic resonance imaging
• Although these scars are extremely sensitive, it cannot A
distinguish acute infarcts from chronic scars. ............(AIIMS PGMEE MAY - 2003)
AIIMS PGMEE NOV – 2002
167. The most recent advance in noninvasive cardiac AIPGMEE – 2006
output monitoring is use of. AIIMS PGMEE - MAY 2004
A. PA catheter AIIMS PGMEE - JUNE 1998)
B. Thermodilution technique
C. Echocardiography Intravenous urography or pyelography (IVU OR IVP) is the
D. Electrical impedance cardiograph technology most sensitive modality to detect early renal tuberculosis.
D In the early stages it shows irregularity or destruction of
............(AIIMS PGMEE NOV - 2002) one or more renal papillae.
Ultrasonography is of limited value in the initial

investigation of the genitourinary TB.”
CT is of limited value in the early investigation of
genitourinary TB because intravenous urography gives
such accurate pictures”.
MRI has very little application in the management of

genitourinary TB “
• “
On an IVP, in the very earliest stages of the disease the
normally clear cut outline of a renal papilla may be rendered
indistinct by the presence of ulceration.

TOPIC 16: SILICOSIS RADIOLOGY 34
• Excretory urography in a woman with a history of

tuberculosis of the breast. The film shows irregular
cavitation in the lower pole calyx of the left kidney
due to renal tuberculosis.
• Earliest symptom of renal tuberculosis —

Urinary frequency
• Earliest diagnosis can be made by — IVP.
Genitourinary tract tuberculosis. Plain radiograph of the Excretory urography in a patient with advanced renal
abdomen in a woman with renal tuberculosis shows tuberculosis shows lobar calcification with no excretion of
calcification of varying patterns (curvilinear, contrast on intravenous urogram.
amorphous, speckled).
• Lobar calcification in a large destroyed right kidney

in a patient with renal tuberculosis. Note the
involvement of the right ureter.
• Excretory urography in a patient with renal tuberculosis
shows an irregular cavity at the upper pole calyx of
the right kidney.
• Note the multiple tiny calcifications in the liver, spleen,
and right adrenal gland due to calcified tuberculous
granuloma
TOPIC 16 : SILICOSIS
175. Egg shell calcification is seen in:

A. Silicosis
B. Sarcoidosis
• Intravenous urography series in a man with renal C. Asbestosis
tuberculosis shows marked irregularity of the D. Berylosis
bladder lumen due to mucosal edema and ulceration A
............(AIIMS PGMEE MAY - 2002)
PGI - JUNE 2006
PGI - JUNE 2003
PGI - June –2001
AIIMS PGMEE - DEC 1998
• Egg shell calcification is seen in both Silicosis and Sarcoidosis.

TOPIC 17: SOL LUNG RADIOLOGY 35
• Causes of Egg shell Calcification

• Silicosis
• Sarcoidosis
• Scleroderma
• Histoplasmosis
• Amyloidosis
• Lymphoma following
radiotherapy.
182. A patient presents with a solitary pulmonary nodule

(SPN) on x-ray. The best investigation to come to a
diagnosis would be:
A. MRI
B. CT Scan
• ‘Eggshell’ calcification is seen in C. USG
• Silicosis D. Image guided biopsy
• Coal miner’s pneumoconiosis B
• Sarcoidosis ............(AIIMS PGMEE MAY - 2002)
• Lymphoma following radiothrapy
•“ In most situations when the plain chest radiograph

demonstrates a suspicious nodule and certainly when
TOPIC 17 : SOL lung these additional radiographic technique are inconclusive,
CT should be used because it is the most effective,
objective and widely available radiologic technique
180. X-ray showing soft tissue mass in chest with rib to further assess the nature of a presumed solitary
erosion is seen in all EXCEPT. pulmonary nodule.
A. Ewing’s SA
B. Osteo SA Computed tomography may provide conclusive evidence of
C. Leukemia calcification within the nodule and justify conservative
D. Multiple myeloma clinical management.”
C • CT is most useful as it can provide conclusive evidence of
............(AIIMS PGMEE - SEP 1996) calcification within the nodule. This helps in differentiating
• Multiple myeloma is cause of ‘Rib Lesion with Adjacent malignant lesions from benign ones and thus avoid
soft-tissue mass unnecessary invasive procedures for beningn conditions
and concomitantly identify low stage, potentially curable
malignant lesions.
• CT is far more superior then MRI is seeing calcifications.
183. High resolution CT of the lung is a specialized CT

technique for greater detail of lung parenchyma and
it utilizes
A. Special lung filters
B. Thick collimation
C. Bone algorithm for image reconstruction
181. The Popcorn calcification is pathgnomonic for : D. Large field of view
A. Lung hamartoma C
B. T.B. ............(AIIMS PGMEE NOV - 2002)
C. Metastasis
D. Craniopharyngioma HRCT gives detailed images of the lung parenchyma (which
A is comparable to gross tissue inspection) and thus allows
............(AIIMS PGMEE - Dec - 1995) detection of diseases at an earlier stage than conventional
AIPGMEE - 1997 CT scans.

TOPIC 18 : BREAST CARCINOMA RADIOLOGY 36
HRCT utilizes thin collimination (i.e., thin slices of 1 or 2

mm.) as compared to thick slices of conventional CT scan
(of 5 to 7 mm.)
The field of view is reduced to increase the resolution of • Normal mammograms in a 40-year-old woman show
the image. dense breast parenchyma.
HRCT utilizes High spatial frequency algorithms, such as bone • invasive ductal carcinoma. This stellate (spiculated)
algorithms, rather than traditional soft-tissue algorithms lesion has ductal-type microcalcifications
(as used in conventional CT scan) for image reconstruction.
It smoothens the image data and gives more sharp
images and finer lung details.
• a fibroadenoma with well-defined edges and a halo

sign.
TOPIC 18 : BREAST CARCINOMA
185. Investigation to diagnose stage-1 carcinoma breast:

A. B/L mammogram
B. X-ray chest
C. Bone scan
D. Liver scan
E. Liver scan
A
............(PGI - 2000 - Dec)
• Benign microcalcifications: cystic hyperplasia.
• Early stages of breast Ca can be d iagnosed by
mammography’:
• The mamographic changes of carcinoma are :
— Clustered micro-calcification or fine punctate
calcifications within the lesion.
— Overlying skin thickening or tethering, dimpling.
— Irregular margin with spiculations.
— High density lesion enlarging architectural distortion.
• 57-year-old woman with breast carcinoma. Mediolateral

oblique mammogram of left breast shows more than 50
tightly clustered pleomorphic microcalcifications with no
associated mass

TOPIC 19 : COARCTATION OF AORTA RADIOLOGY 37
• Bilateral mammogram shows diffuse inflammatory • Most common sites of primary for bone metastasis.
carcinoma of the left breast - In males————Prostate > Lung
- In Female———-Breast > Lung
- In Children———Neuroblastoma.
• Most common cause of osteolytic metastasis.
- In male—————Lung Cancer.
- In Females———Breast Cancer
• Most common cause of osteoblastic metastasis
- In males———Prostate Cancer
- In females———Breast Cancer
• Skeletal sites most frequently involved.

- Spine > proximal femur > pelvis > ribs > sternum > proximal
186. Mammogram abnormality in Ca-Breast is indicated humerus > skull
by : • Lytic expansile metastasis seen in
A. Change in density Renal Cancer
B. Micro calcification - Thyroid carcinoma.
C. Change in architecture • Bone metastasis with soft tissue mass.
A,B and C - Renal Cancer
............(PGI - JUNE 2005) - Thyroid carcinoma.
• Osteolytic lesions are associated with hypercalcemia and
Mammographic features of breast cancer are: excretion of hydroxyproline - containing peptides.
• Mass lesion :
• Density -more than rest of the breast; • Osteoblastic lesions are associated with increased levels
• Outline -mostly spiculated or irregular; of serum alkaline phosphatase.
• Size- mammographic size is less than the palpable mass. • Metastasis distal to knee and elbow is rare and usually
B. Microcalcification arises from a primary tumors of the
C. Asymmetric density. Bronchus
D. Architectural distortion Colon or
E. Segmental enlargement of duct - Bladder.
187. Which of the following is the most common cause 188. Which of the following features on mammogram
of sclerotic skeletal metastasis in a female patient? would suggest malignancy?
A. Carcinoma breast A. Well defined lesion
B. Carcinoma ovary B. A mass of decreased density
C. Endometrial carcinoma C. Areas of spiculated microcalcifications
D. Melanoma D. Smooth borders
A C
............(AIIMS PGMEE - MAY 2005) ............(AIIMS PGMEE - MAY 2006)
“Most lesions (of breast carcinoma) are osteolytic but breast TOPIC 19 : COARCTATION OF AORTA
carcinoma is also the commonest cause of an osteoblastic
metastasis in a woman “ 189. Young man with hypertension, giudiness, X-ray
• Skeletal metastasis may be osteolytic or osteoblastic. chest revealing anterior notching of rib. Diagnosis is
Although some tumors like renal cell carcinoma may produce A. Coarctation of aorta
purely osteolytic lesion majority of metastasis are mixed B. Raised intracranial tension
type - predominantly osteolytic. C. Ebstein anomaly of adult
D. Pulmonary emphysema
Predominantly osteoblastic lesions arise from None
- Prostate ............(AIIMS PGMEE - MAY - 1993)
- Stomach AIPGMEE – 2006
- Carcinoid. AIPGMEE - 2008
Rib signs in coarctation of Aorta

• Rib notching is typically present on inferior surface
(sometimes post).
• Rib involvement is unusual before 10 years of age.
• Upper 2 ribs are not involved.
• Usually affects 4-8th rib.
• Usually the ribs are affected bilaterally.
• Unilateral and right sided if the coarctation is proximal to

the left subclavian artery.
Other Radiological features of Coarctation of Aorta.
• Prominent Assending Aorta and small descending
Aorta with an intervening notch.

TOPIC 20 : INTERSTITIAL LUNG DISEASE RADIOLOGY 38
• Left ventricular enlargement and possibly sings of heart

failure.
• Aortic coarctation visualized by aortic angiography.
• High-resolution CT (HRCT) shows rapid changes

associated with the use of amiodarone over a 3-
month period
• Coarctation of the Aorta.

The red arrows point to rib notching caused by the
dilated intercostal arteries.
The yellow arrow points to the aortic knob, the blue
arrow to the actual coarctation
and the green arrow to the post-stenotic dilation of the
descending aorta
• Amiodarone lung. CT image shows nearly diffuse

ground-glass opaciti es and reticulation.
Subsegmental consolidation in the lower lobes is
also note
192. Rib notching is found In :

A. Ncurofibromatosis
B. Lymphangiomyomatosis
C. Aortic aneurysm
D. Taussig-Bing operation
E. Aortic obstruction
A,C,D and E
............(PGI - 2001 - Dec) • Differential diagnosis of drug-related lung disease.
High-resol ution CT (HRCT) sho ws changes
TOPIC 20 : INTERSTITIAL LUNG DISEASE associated with biopsy-proved alveolar proteinosis
193. 1invest igation of choice for d etection and

characterization of interstitial lung disease is:
A. MRI
B. Chest X-ray
C. High Resolution CT Scan (HRCT)
D. Ventilation Perfusin Scan (VP Scan)
C
............(AIPGMEE - 2008) • Differential diagnosis of drug-related lung disease.
AIPGMEE – 2003 High-resol ution CT (HRCT) sho ws changes
AIIMS PGMEE - MAY 2005 associated with hypersensitivity pneumonitis
High Resolution CT (HRCT) is investigation of choice for

interstitial lung disease and bronchiectasis as it can
delineate the lung parenchyma upto the level of secondary
pulmonary lobule.
• Nitrofurantoin lung. Scattered areas of reticular

opacities, consistent with fibrosis, are apparent

TOPIC 21 : MENINGIOMA RADIOLOGY 39
195. Honeycombimg of lung in C. X.R. is seen in: TOPIC 21 : MENINGIOMA

A. R.A.
B. T.B. 197. A 45 year old female complains of progressive
C. Scleroderma weakness and spasticity of the lower limb with
D. Carcinoma difficulty in micturition. CT scan shows an intradural
E. Interstitial lung disease mid dorsal midline enhancing lesion. The likely
A,C and E diagnosis is:
............(PGI - JUNE 2003) A. Meningioma
B. Intradermal Lipoma
• Causes of honeycomb lung : C. Neuroepithelial Cyst
- Collagen disorders : Rheumatoid lung; Scleroderma. D. DermoidCyst
A
- Extrinsic allergic alveolitis. ............(AIPGMEE - 2007)
- Sarcoidosis. • A typical calcified meningioma arising from falx cerebri.
- Pneumoconiosis.
- Cystic bronchiectasis.
- Cystic fibrosis.
- Drugs : nitrofurantoin, b usulphan, cyclo-
phosphamide, bleomycin, melphalan.
- Langerhan’s cell histiocytosis.

- Tuberous sclerosis.
- Idiopathic interstitial fibrosis (Cryptogenic fibrosing
198. Which one of the following tumors shows
alveolitis).
calcification on CT Scan:
A. Ependymoma
- Neurofibromatosis.
B. Meduloblastoma
- Interstitial Lung diseases.
C. Meningioma
D. CNS lymphoma
• Idiopathic pulmonary fibrosis:
C
.............(AIPGMEE - 2005)
– This HRCT image is from a patient with IPF and is typical
of the disease.
Neoplasms showing calcification
Carciopharyngioma – calcification in over 75% of cases
– Most significant is the presence of peripheral cystic
Glioma – oligodendroglioma shows calcification in 50% cases,
structures surrounded by thickened white lines , a
posterior fossa glioma in over 20%.
finding termed honeycombing
Meningioma – in 10%
Ependymoma – unusual but if seen dense
Papilloma of choroid plexus – around 25% calcify
Pinealoma
Chrodoma
Dermoid, epidermoid and teratoma
Harmortoma
Lipoma (bracket calcification in lipoma of corpus callosum)
• Hyperattenuated partially calcified extra-axial mass with

adjacent vasogenic edema.- Meningioma
• Hypersensitivity pneumonitis: This HRCT is from a
patient with hypersensitivity pneumonitis and is
also typical of the disease .
• Most significant are the scattered areas of grey lung (so
called ground glass) alternating with areas of darker
lung (so called mosaicism ) and the absence of
honeycombing.
199. Finding in meningioma are all except:

A. Vascular markings around falx cerebri
B. Calcification
C. Erosion
D. Osteosclerosis
C
............(PGI - 1997 - Dec)

TOPIC 22 : MRI RADIOLOGY 40
• Meningiomas are particularly gratifying to diagnose since TOPIC 22 : MRI

they are the commonest intracranial tumor.
The falx is a common site of its origin. 201. Pt. with a metallic foreign body in eye, which
• Calcifications in these tumor is sufficient to make them investigation is not done :
radiopaque in around 15% & is often specific. A. MRI
Thus homogenous ball like calcification at a typical site is B. USG
virtually diagnostic, as is less regular or dense C. X-ray
calcification adjacent to typical bony changes. D. CT
• No bony erosion seen. A
............(PGI - DEC 2006)
• Gadolinium-enhanced MRI of a meningioma invading
the overlying dura and bone. 202. Radiation hazard is absent in :
A. MRI
B. Doppler USG
C. Digital substraction Angiography
D. Tc 99 scan
A and B
............(PGI - JUNE 2006)
MRI is non ionizing & hence no risk of radiation.

Doppler USG is the audible signals of USG. In USG, high
frequency sounds are directed into the body from
• Tentorial meningioma. A, Contrast-enhanced CT scan
tranducer. It is not ionizing.
shows the enhancing meningioma. Transverse T1-
Angiography & radionuclide scaning has radiation hazards.
weighted MRIs shows isointensity of the tumor compared
with the surrounding brain (B) and its homogenous
203. Absolute contra-indications of MRI :
enhancement (C). Coronal (D), coronal enhanced (E),
A. Pace makers
and sagittal enhanced (F) T1-weighted MRIs. Posterior
B. Pregnancy at 1st trimester
circulation angiograms show tumoral blush (arrow
C. Aneurismal clip
in G) and the Bernasconi-Cassinari artery (arrow in H).
D. Phobia
A and C
• This is an extra-axial tumor. Glioblastoma multiforme (GBM) ............(PGI - JUNE 2005)
and astrocytoma are intraparenchymal tumors, and GBM AIIMS PGMEE - MAY 2008)
enhances in a variegated fashion .
• Acoustic schwannomas are seen in the posterior fossa • MR is considered among the safest imaging modalities for
but not in this location. patients, even at very high field strengths, more than 3-
• Fibrous dysplasia involves the skull but does not cause 4 tesla.
this amount of compression. • But Ferromagnetic objects under magnetic field can be
vulnerable to adverse effects:
• Movement (causing structural injury),
• Current conduction (potentially causing electrical shock),
• Heating (possibly causing burn injury), and
• Artifact generation
• Serious inju ries can be caused by a ttr action of
ferromagnetic objects into the magnet, which would act
as missiles if brought too close to the magnet.
• Ferromagnetic implants, such as aneurysm clips, may torque

(turn or twist) due to the magnetic field, causing damage
to vessels and even death.
• Metallic foreign bodies in the eye have moved and caused
200. A 40-years-old female patient presented with intraocular hemorrhage.
recurrent headaches. MRI shown an extra-axial, dural • Pacemakers and pacemaker leads are a contraindication,
based and enhancing lesion. The most likely diagnosis as the pacemaker can malfunction and cause arrhythmia
is: or even death.
A. Meningioma • However with growing expansion of MR, increasing number
B. Glioma of implant medical devices are being MR safe. So newer
C. Schwannoma pacemaker and aneurysm clips are being made which are
D. Pituitary adenoma MR safe.
A Absolute Contraindications for the MRI scan;
............(AIIMS PGMEE - MAY 2006) • Electronically, magnetically, and mechanically activated
implants
• Meningioma, Schwannoma and Pituitary adenoma’ are • Ferromagnetic or electronically operated active devices
extra-axial tumors. like automatic cardioverter defibrillators ,Cardiac
• Of these only meningioma is the ‘dural based lesion as it pacemakers ,Metallic splinters in the eye Ferromagnetic
arises from the meninges. haemostatic clips in the central nervous system (CNS)

TOPIC 23 : NEURAL TUBE DEFECTS RADIOLOGY 41
• Patients with an implanted cardiac pacemaker have been Anencephaly

scanned on rare occasions, but pacemakers are generally • “In the first half of pregnancy, the diagnosis is made by
considered an absolute contraindication. elevated alpha feto protein in amniotic fluid and confirmed
by sonography”
Relative Contraindications for the MRI scan: • Absence of cranial vault in diagnostic
• Cochlear implants
• Other pacemakers, e.g. for the carotid sinus
• Insulin pumps and nerve stimulators
• Lead wires or similar wires (MRI Safety risk)
• Prosthetic heart valves (in high fields, ifdehiscence is
suspected)
• Haemostatic clips (body)
• Non-ferromagnetic stapedial implants
• Women with a first-trimester pregnancy
• Tattoos (only a problem in higher-strength magnetic field
i.e. more than 3 tesla) Placenta previa
• “Sonography provides the simplest, most precise and
205. MRI rooms are shielded completely by a continuous safest method of placental localization. It can precisely
sheet or wire mesh of copper or aluminum to shield determine the extent of placental margin in relation
the imager from external electromagnetic radiations, to the internal OS.”
etc. It is called.
A. Maxwell cage
B. Faraday cage
C. Edison’s cage
D. Ohms cage
B
............(AIIMS PGMEE NOV - 2003)
206. A 40-year-old female patient on long term steroid

therapy presents with recent onset of severe pain in
the right hip. Imaging modality of choice for the
problem is:
A. CT scan • Placenta previa. The cervix is seen on the right side of
B. Bone scan the image and is covered by the edge of the placenta.
C. MRI The placenta is the homogeneous structure on the
D. Plain X-ray anterior wall of the uterus.
C
............(AIIMS PGMEE - MAY 2005)
• This patient is most probably having avascular necrosis of

hip, a common complication of long term steroid
uptake.
• MRI is the investigation of choice for avascular necrosis.
• MRI scanning is the most sensitive and accurate means of
detecting changes in avascular necrosis. Sensitivity and
specificity for avascular necrosis approach 100%.”
• Placental abruption. This retroplacental hemorrhage is
visualized in a patient during the third trimester of her
pregnancy. Retroplacental abruptions carry a poorer
prognosis than marginal abruptions.
TOPIC 23 : NEURAL TUBE DEFECTS
207. USG can be used to diagnose A/E -

A. Neural tube defect • Neural tube defect
B. Anencephaly • “Prenatal diagnosis of neural tube defect is possible by
C. Plancenta previa estimating AFP level in the maternal blood or in amniotic
D. Down’s syndrome fluid in early pregnancy. A rise in AFP in suggestive
D but diagnosis should be confirmed by ultrasound.”
............(AIIMS PGMEE NOV - 1999)

• A mid sagittal section of the fetal profile must be

obtained with the ultrasound transducer held parallel to
the direction of the nose. The ultrasound transducer
should be gently tilted from side to side to ensure that
the nasal bone is seen separate from the nasal skin.
• large open neural tube defect seen as diverging neural

arches in the lumbar region. This is well documented in
2D and 3D imaging.
• A third line, almost in continuity with the skin, but at a

higher level, represents the tip of the nose.
Absence of the bottom line of the equals sign represents
Down’s syndrome the absence of the fetal nasal bone seen in DOWN’S
• Although on prenatal U/S, a Down’s syndrome fetus may syndrome
reveal increased nuchal fold thickness and reduced length
femur and humerus, these findings are not diagnostic;
only, suggestive of Down’s syndrome.
• Diagnosis is made only on chromosomal study of
fetus either by chorionic villous sampling or amniocentesis.
208. Earliest congenital malformation that may be

detected on USG is
A. Down’s syndrome
B. Hydrocephalous
C. Anencephaly
D. Sacral Agenesis
C
............(AIPGMEE - 1994)
• The Nicolaides group, basing on their findings in 1015

fetuses at 10-13 weeks with nuchal fold greater than
3mm arrived at the following risks estimates:
• 3mm ——— 3 times
• 4mm ——— 18 times
• 5mm ——— 28 times

USG:
• Earliest detectable congenital anomaly is Anencephaly.
• 6mm ——— 36 times
• It can be diagnosed as early as at 10 weeks.
the incidence by maternal age.

• It is best diagnosed (100% accuracy) at 12 weeks.
209. Neural tube defect is best detected by

A. USO
• Transaxial ultrasou nd image shows the
B. Chromosomal analysis myelomeningocele sac (short arrow) and divergent
C. Amniocentesis posterior ossification centers (long arrows
D. Placentography
C
............(AIPGMEE - 1995)
210. Sonographic finding of Spinal bifida

A. Ventriculomegaly
B. Obliteration of cisterna magna
C. Small BPD
D. Abnormal curvature of cerebellum
E. Club foot
A,B and D
............(PGI - JUNE 2004) • Cranial ultrasound findings associated with “open”
spina bifida and the Chiari II malformation. (A)
• Spina bifida results from a failure of the neural tube to Inward scalloping of the frontal bones (arrows),
close at 3-4 wks. It may occur anywhere along the spine also known as the “lemon sign.”
but are commoner in lumbosacral (90%) region, than
in thoracic (6%) or cervical
(3%) spines.
• Sonographic findings may be difficult & the spine should

be imaged in all three planes (sagittal, coronal &
transverse).
• Small posterior fossa and banana-shaped cerebellum

(“banana sign”) (short arrow) and effaced cisterna
magna (long arrow).
Ultrasound findings of anencephaly. The cranial bones are

absent. Amniotic fluid is seen above the orbits (arrow).
The USG findings are :

• V shaped profile on transverse imaging, due to outward
flaring of the two posterior ossification centers.
• Bony defect of spine.
• Presence of an intact sac extending from the posterior
aspect of spine.
• Sac filled with fluid or solid tissue in meningocele or
myelomeningocele.
• Myelomeningocele. (A) Sagittal ultrasound image Lemon sign : Flattening of the frontal bones on transverse
demonstrates the break in the skin line (arrow). image through the head.

TOPIC 24 : PERICARDIAL EFFUSION RADIOLOGY 44
Banana sign : Cerebellum is stretched around the brainstem 215. Flask shaped heart is seen in following except:
with effacement of the cisterna magna. A. Ebstein anomaly
B. Pericardial effusion
Hydrocephalus with ventriculomegaly is a common feature C. TOF
in marked spina bifida. Foot deformities like pes cavus D. TAPVC
may be associated. D
............(PGI - 1997 - Dec)
211. USG diagnosis of Anencephaly can be done at:
A. 24-37 wk of gestation • In Ebsteins anomaly, the heart show massive globular
B. 10-12 wk of gestation cardiomegaly with pulmonary oligemia;
C. 20-24 wk of gestation
D. 14-18 wk of gestation
D
............(AIIMS PGMEE - SEP 1996)
TOPIC 24 : PERICARDIAL EFFUSION
212. Investigation of choice for pericardial effusion is

A. CT scan
B. MRI scan
C. Echocardiography
D. X-ray chest
C In Fallot’s tetralogy (TOF) in the classic, developed
............(AIIMS PGMEE - NOV - 1993) appearance, there will be concavity in
AIPGMEE - 1997 the left-borders in the region of the hypoplastic main
pulmonary artery, upward prominence
• Echocardiography is the investigation of choice for of the cardiac apex due to the distortion by the large
pericardial effusion. right ventricle, pulmonary ollgemia &
Advantage of echocardiography - in some cases a right sided aortic arch.
1) It is very specific and sensitive
2) Simple, may be performed at the bedside
3) Can identify accompanying cardiac tamponade
4) It also allows localization and confirmation of quantity of

pericardial fluid.
CT and MRl are superior to echocardiography in detecting
loculated pleural effusion and pericardial thickening.
213. Best investigation for cardiac temponade is In pericardial effusion, appearances depend on the amount
A. 2-D Echocardiography of fluid & its distribution; If
B. M-Mode Echocardiography there is sufficient fluid the heart shadow will be enlarged.
C. Real time echocardiography Although the heart shadow appears
D. USG enlarged, there are no features in the film to suggest
A selective chamber enlargement
............(AIPGMEE - 1994)
• 2-D- Echocardiography is IOC for

- Pericardial effusion
- Cardiac Temponade
• M-Mode ECHO is IOC for Cardiac Vulvular disease
Echocardiography is ideally suited to detect pericardial

effusion. Even quantities as small as 20-50 ml of
pericardial fluid c an be diagnosed by
Echocardiography.
Unless the amount of fluid exceeds 200 ml, Radiological In total anomalous pulmonary venous connection (TAPVC),-
diagnosis of pericaridal effusion may be difficult. the thoracic X-ray shows
Pericardial effusion can also be diagnosed at CT & MR1, plethoric lung fields in non-obstructive TAPVC.
although they are rarely performed primarily for this In the first two years of life, characteristic
purpose. pattern of the ‘SNOWMAN’ or ‘FIGURE OF 8’ configuration
in. the supra-cardiac TAPVC
draining to left innominate vein is not seen.

TOPIC 25 : PLEURAL EFFUSION RADIOLOGY 45
Right lateral decubitus chest X-ray

• Most dependent recess of the pleura is the posterior
costophrenic angle
The characteristic roengtenogram of the obstructive

TAPVC consists of a normal sized heart with severe pulmonary
venous hypertension resulting
in ‘ground glass’ appearance of the lungs.
• So in pleural effusion this recess would be filled earliest .
TOPIC 25 : PLEURAL EFFUSION But at least 100-200 ml of fluid would be required to this
recess before it can be detected on a PA view.
216. Interlobar pleural effusion can be detected best by
A. Lateral decubitus
B. Lateral oblique
C. Reverse lordotic
D. Posterior oblique
B
............(AIIMS PGMEE - NOV - 1993)
• Interlobar pleural effusion is best detected by lateral

view.
• B/W lateral oblique and lateral decubitus lateral oblique is
the better option
• Interlobar pleural effusion will not be visible in lateral
decubitus position. • In cases of minimal pleural effusion the best method to
detect it would be Decubitus view with a horizontal beam.
• Most common cause of interlobar pleural effusion heart

failure.
217. A boy presented in the OPD with minimal pleural

effusion on the right side. The best method to detect
this would be:
A. Left side chest X-ray 218. Which one of the following statement is false about
B. Right side chest X-ray loculated pleural effusion:
C. Right lateral decubitus chest X-ray A. They form obtuse angles against the mediastinum/chest
D. Left lateral decubitus chest X-ray wall when viewed in profile
C B. They have unsharp margins when viewed enface
C. They do not conform to segmental distribution.
............(AIIMS PGMEE MAY - 2001) D. The opacity may show air bronchogram
D
............(AIPGMEE - 2002)
The opacity may show air bronchogram

Presence of air bronchogram excludes any pleural or mediastinal
pathology.
Air Bronchogram is visibility of bronchi with in parenchmal

lesion, so it is found in alveolar

TOPIC 26 : TAPVC RADIOLOGY 46
• Total anomalous pulmonary venous connection (TAPVC)

consists of an abnormality of blood flow in which all 4
pulmonary veins drain into systemic veins or the right atrium
with or without pulmonary venous obstruction .
• Systemic and pulmonary venous blood mix in the right
atrium.
– An atrial defect or foramen ovale (part of the complex) is
important in left ventricular output both in fetal and
in newborn circulation.
• Total anomalous pulmonary venous connection

(showing pulmonary veins connected to the left
pathology as - Consolidation innominate vein)
- Infarction 1 - superior vena cava
- Contusion 2 - atrial septal defect
- Alveoloar Cell CA/ 3 - left innominate vein
- Lymphoma 4 - pulmonary veins
219. Decubitus view is useful in diagnoslsng :
A. Pleural effusion
B. Pleural effusion with dependent hemithorax
C. Pericardia! Effusion
D. Middle lobe consolidation
A and B
............(PGI - 2001 - Dec)
• Pleural effusion is best visualised by X-ray in decubitus

posture (on the same side of pleural
effusion).
• When the patient is supine a small or moderate effusion
gravitates posteriorly producing a generalised increased
density with an apical cap of fluid, erect or decubitus film • Oxygenated blood returning from the lungs is
confirms the diagnosis. routed back into the superior vena cava , rather than
In pericardial effusion-X-ray shows cardiomegaly and the left atrium. The presence of an atrial septal defect is
echo-cardiography helpful for diagnosis. necessary to allow partially oxygenated blood to reach
the left side of the heart.
• Minimum amount of pleural fluid required for detection by
conventional erect posture PA view chest is 170-200 ml, • As a result of the mixture of pulmonary and systemic
and that in lateral view is 75-100 ml. venous flow, right atrial and right ventricular volume loading
• The radiological diagnosis of pericardial effusion can be develops in all patients with TAPVC.
difficult unless the amount exceeds 200 ml. • Whether right heart pressure loading is also present
depends primarily on whether restriction to flow occurs
TOPIC 26 : TAPVC at the atrial septum or an obstruction to pulmonary venous
flow develops.
220. Figure of 8 in Chest X-ray is seen in • If the foramen ovale is restrictive, right atrial pressure
A. TAPVC elevates, and systemic and pulmonary venous congestion
B. Tetralogy of Fallot both occur.
C. Transposition of great vessels
D. Ebsteins’ anomaly • Pulmonary blood flow increases, and pulmonary artery
A hypertension may occur.
............(AIIMS PGMEE JUNE - 2000) – The left atrium and left ventricle receive less than the
normal flow and pump less than the normal volume, with
TAPVC some decrease in the cardiac index.
• TAPVC (Total anomalous pulmonary venous connection)
is of two types - Chest radiography
• Non-obstructive type and • In patients with total anomalous pulmonary venous
• Obstructive type connection (TAPVC) with pulmonary venous obstruction,
• X-ray features of chest radiographs reveal a normal heart size with a
• Non obstructive type TAPVC diffuse reticular pattern fanning out from the hilum.
• Cardiomegaly with plethoric lung fields
• Snowman or ‘figure of 8’ appearance • There is cardiomegaly with increased pulmonary
arterial markings .
• Obstructive type TAPVC
• Normal sized heart • There is dilation of both the left and right innominate
• Ground glass appearance of lung due to severe pulmonary veins and the right superior vena cava producing the
venous hypertension classical,

• Plethoric lung fields are seen in congenital heart diseases

which increase the pulmonary blood flow.
These conditions are
• Left to right shunt
like ASD, VSD, PDA, Aortopulmonary window, coronary
artery fistula into right heart
• Persistent truncus arteriosus
• Total anomalous pulmonary veins (the supra cardiac

& cardiac types)
• Transposition of great arteries with ASD or VSD.

“snowman” or “figure of 8” appearance. The superior
mediastinum is enlarged secondary to dilation of the right • Persistent truncus arteriosus
vena cava, innominate vein and ascending vertical vein. in this condition, a single arterial trunk (truncus arteriosus)
arises from the heart and supplies both the systemic &
• When the pulmonary veins are unobstructed , the pulmonary circulations.
heart is enlarged (right atrial and right ventricular • a VSD is always present.
enlargement), and pulmonary markings reveal active
increase in size of the pulmonary hilar and midzone vessels. • there is mixing of blood across the VSD
• Most patients with isolated TAPVC have a patent foramen • the flow in the pulmonary arteries is very large, because
ovale with some degree of restriction to transatrial flow. it originates from the common truncus which is at systemic
– If no pulmo nary venous obstruction is present, pressure, thus causing plethoric lungs.
pulmonary blood flow increases (eg, 3-5 times the
systemic volume) in early infancy, and arterial oxygen
saturation is maintained, usually at 90% or higher. Signs
of right heart volume load or right heart failure are evident.
• If obstruction of pulmonary venous flow is present, then

pulmonary venous congestion occurs with increased
pulmonary lymphatic flow and increased flow through
available alternate pulmonary venous pathways.
Reflex pulmonary arterial vasoconstriction may also occur.
Increase in pulmonary vascular resistance leads to decrease
in pulmonary blood flow and a lower volume of saturated
blood in the venous mixture. Decrease in systemic oxygen
saturation along with a decrease in the cardiac index may
lead to a severe decrease in oxygen delivery.
221. Figure of 8 in chest X-Ray is seen in:

A. Total anomalous pulmonary venous connections
B. Ebstein’s anomaly
• Total anomalous pulmonary veins
C. Tetralogy of Fallot
in TAPVC, all the pulmonary veins come to a confluence
D. Transposition of great vessels
behind the left atrium, but do not communicate with it.
A
Instead they drain into the right atrium directly or indirectly.
.............(AIPGMEE - 2000)
AIIMS PGMEE - MAY 2008
There are 4 types of TAPVC.
Characteristic chest x-rav in non-obstructive type (TAPVC1
a) Supracardiac type (most common type) - here the
shows:
right and left pulmonary veins meet behind the LA in a
1. Cardiomegaly with plethoric lung fluids.
venous confluence from which a large vein passes upwards
2. Snowman or figure of ‘8’ configuration in the supra-cardiac
to drain into the left brachiocephalic vein (which then
TAPVC draining to left innominate vein.
drains into the rt. atrium through SVC)
Characteristic in obstructive type:
1. Normal sized heart
b) cardiac type - here the pulmonary veins drain into the
2. Ground glass appearance of lung due to severe pulmonary
right atrium, either directly or via the coronary
venous hypertension
sinus.
222. Plethoric lung fields are seen in all of the following
• In supracardiac and cardiac types of TAPVC, the RA thus
conditions, except:
receives both the systemic and pulmonary venous
A. Atrial septal defect (ASD)
return, which then pass into the enlarged RV and then
B. TAPVC (Total Anomalous Pulmonary venous connection)
to lungs through pulmnary arteries, leading to plethoric
C. Ebsteins’ anomaly
lung fields. A small amount of blood passes through
D. Ventricular septal defect
patent foramen ovale or ASD into the left atrium.
C
............(AIIMS PGMEE - MAY 2006)

Drawing shows the pattern of blood flow (arrows) through

the heart with transposition of the great arteries.
The aorta (1) arises from the right ventricle (2), and
the pulmonary artery (3) arises from the left ventricle
(4).
Communication between the systemic and the pulmonary
circulation—an interatrial septal defect (5), an
interventricular septal defect (6), or both—sustains
life by allowing oxygenated blood from the left
atrium (7) to mix with deoxygenated blood from the
right atrium (8) before it flows via the right ventricle to
the aorta and via the left ventricle to the pulmonary artery.
c) infracardiac or infradiaphragmatic type
here the confluence of pulmonary veins, drain through a
descending vein into the portal vein or IVC.
This is a high resistance circuit because of the vascular
resistance of the liver together with compression of the
descending vein at the diaphragmatic hiatus.
because of the high resistance, there is always high pressure

in the pulmonary veins leading to interstial or pulmonary
edema. The lungs are therefore congested rather than
plethoric.
Classic imaeine siens of congenital cardio-vascular

abnormalities
• Boot shaped heart/coeur en sabot- Tetrology ofFallot
• Box shaped heart - Ebsteinis anomaly Type I TAPVR. (a, b) Chest radiograph obtained in a
• Snowman/Figure of 8 appearance - TAPVC (total neonate (b the same as a
anomolous pulmonary venous connection) with a superimposed drawing) reveals the classic snowman
• Figure of 3/ Reverse fig of 3 - Cocactation of aorta. sign, sometimes referred to as a figure-of-eight sign
• Gooseneck sign - Endocardial cushion defects
• Drawing (anteroposterior view) of an endocardial
cushion defect shows the concavity of the medial
margin of the left ventricle (1) below the mitral valve
and resultant narrowing of the left ventricular
outflow tract
Drawing shows the return flow of venous blood (arrows).

Instead of draining into the left atrium (1), the
pulmonary veins (2, 3) converge behind the heart
to form a common pulmonary vein (4) that connects
to the vertical vein (5), which joins the left
innominate vein (6).
The left innominate vein drains into the superior
Transposition of the great arteries compared with normal vena cava (7).
anatomy. (a) Chest radiograph obtained in a neonate shows Since all of the systemic and pulmonary venous blood
narrowing of the superior me diastinum, enters the right heart, survival is maintained by a right-to-
enlargement of the cardiac silh ouette with left shunt through a communication at the level of the
abnormal convexity of the right atrial border, and atrial septum (8). 9 _ right atrium, 10 _ right ventricle, 11
increased vascular flow —typical features of transposition _ left ventricle.
of the great arteries. (b) Same image as a with a
superimposed dr awing shows the cha r acteristic
cardiomediastinal silhouette: the egg-on-a-string sign.

(d) Frontal view obtained with angiocardiography in a neonate • Tetralogy of Fallot. (a, b) Chest radiograph obtained in an
shows the aberrant cardiovascular anatomy: The upper infant with a right-sided aortic arch (b the same as a with
left heart is bordered by the vertical vein; the superior a superimposed drawing) shows the characteristic boot-
part of the heart, by the left innominate vein; and the shaped sign produced by upturning of the cardiac
upper part of the right heart, by the dilated superior vena apex because of right ventricular hypertrophy and
cava. by the concavity of the main pulmonary artery
Partial anomalous pulmonary venous return.

(a, b)
Chest radiograph obtained in a patient with a heart murmur
(b the same as a with a superimposed dr awing)
demonstrates a prominent curvilinear opacity that
extends downward from the right hilum: the
scimitar sign.
• Drawing depicts the pattern of blood flow (arrows) with

the characteristic ventricular septal defect (1),
infundibular pulmonary stenosis (2), overriding
aorta (3), and right ventricular hypertrophy (4). The
oxygen-rich blood in the left side of the heart (5) mixes
with oxygen-poor blood in the right side of the heart (6)
before it proceeds to the aorta (7).
(c) Drawing shows the pattern of blood flow (arrows).
The luminal diameter of the scimitar vein (1), which may
drain all or part of the right lung (2), enlarges as
the vein descends below the diaphragm (3) to
empty into the inferior vena cava (4).
Occasionally,
the vein may empty directly into the right atrium (5).
• Aortic coarctation with associated rib notching. (a, b)

Frontal view (a) and close-up frontal view (b)
obtained with chest radiography in a young man with
hypertension
• Endocardial cushion defect. (a, b) Lateral view obtained

with angiocardiogr aphy (b the same as a with a
superimposed drawing) shows shortening of the left
ventricular inflow tract and elongation and show the figure-of-three sign formed by prestenotic and
narrowing of the left ventricular outflow poststenotic dilatation of the aorta, with an intervening
tr act, which together produce the ch ar acteristic indentation at the site of coarctation and with bilateral
gooseneck sign rib notching caused by pressure from intercostal blood
vessels. (c, d)
• Left anterior oblique view of the chest, obtained with

barium esophagography (b the same as a with a

MINOR TOPICS RADIOLOGY 50
superimposed reversed 3), shows an indentation in the tricuspid valve (1), with resultant formation of a common
esophageal contour because of pressure from the chamber (3) consisting of the right ventricle (2) and the
coarctated aorta. dilated right atrium (4), and by the right to- left shunt
of blood through a defect at the atrial level (5). 6 _
left atrium, 7 _ left ventricle, 8 _ aorta, 9 _
pulmonary artery.
Localized (postductal or adulttype)

aortic coarctation. Drawing shows a focal constriction of
the aorta (1) just beyond the origin of the left
subclavian artery (2 ) and the ligamentum
arteriosum (3). The contour of the aorta is deformed
by both pre- and poststenotic dilatation, and the left
subclavian artery is dilated. 4 _ left common carotid artery,
• Scimitar sign- Partial anomalous pulmonary venous return
5 _ innominate artery, 6 _ right hear structures, 7 _ left
• Egg on side appearance - Uncorrected TGA
heart structures, 8 _ pulmonary
artery
TOPIC 27 : CHF
224. All are seen in Congestive Cardiac Failure, except:
A. Kerry B lines
B. Prominent lower lobe vessels
C. Pleural Effusion
D. Cardiomegaly
B
............(AIPGMEE - 2000)
225. Chest X-ray picture in CCF :

A. Cardiomegaly
B. Thick interlobar septum
C. Superior mediastinal widening
D. Multinodular parenchymal lesion
• Ebstein anomaly. (a, b) Frontal (a) and lateral (b) views A and B
obtained with chest radiography in an infant show massive ............(PGI - DEC 2004)
cardiomegaly with decreased pulmonary flow. (c) Frontal • The chest X-ray findings in CCF are :
view (same as a with a superimposed drawing) best - Cardiomegaly
depicts the box-shaped heart, an appearance - Pulmonary venous hypertension
caused by enlargement of the right atrium and - Relative dilatation of upper lobe veins,
hypoplasia of the pulmonary trunk . perivascular edema (haziness of vessel
outlines), interstitial oedema & alveolar
fluid.
- Pleural effusion may be B/L or Rt. sided.
226. In rt. sided hemithorax on chest X-ray PA view what

can be excluded:
A. CCF
B. TB
C. Pulmonary infarct
D. None of the above
Ebstein anomaly -lateral (b) views obtained with chest A
............(PGI - JUNE 1997)
radiography in an infant show massive cardiomegaly with
Causes of Rt. sided unilateral hemithorax on CXR PA view are
decreased pulmonary flow.
as follows:
• Pleural effusion
• Pleural thickening
• Consolidation
• Lobar Collapse
• Lobectomy
• Obstructive causes like foreign body, tumor, Macleod’s
syndrome.
• Vascular causes like absent or hypoplastic pulmonary artery,
obstructive pulmonary artery
• (d) Drawing shows the pattern of blood flow eg by tumors or embolus.
(arrows) caused by downward displacement of the • In C.C.F unilateral hemithorax is not found.

TOPIC 28 : CHOLECYSTITIS • There is an impacted obstructing stone in the neck

of the gallbladder (arrow)
227. Thickened gall bladder wall in USG seen in:
A. Acute cholecystitis.
B. Mucosal thickening
C. Cholesterosis
D. Ascites
E. AIDS cholangitis
A,B,C and D
............(PGI - DEC 2004)
• Transverse ultrasound image of the gallbladder in a 79-
• US in a 59-year-old woman with acute cholecystitis shows year-old afebrile woman with RUQ pain. There is diffuse
the layered appearance of a thickened gallbladder gallbladder wall thi ckening (6 mm) and a
wall, with a hypoechoic region between echogenic hyperechoic material (arrow) in the gallbladder
lines lumen. The gallbladder is distended
RIGHT: At contrast-enhanced CT the thick-walled
gallbladder contains a hypodense outer layer
(arrow) due to subserosal oedema
• Chronic cholecystitis. Longitudinal sonogram of the • Longitudinal US image shows acoustic shadowing
gallbladder shows slight wall thickening (arrow) and casted from hyperechoic material, representing a
an intraluminal non-obstructing stone gallstone
• Gallbladder wall thickening on USG seen in :

i) Billiary • Ultrasound): Grossly thickened gallbladder wall
Cholecystitis (Acute & Chronic) (12.8mm measured between callipers, normally up to
Cholesterosis 2-3mm) with calculi (arrow) within the gallbladder and
ii) Non-billiary pericholecystic fluid.
- Hepatic cirrhosis
- Viral hepatitis
- Chronic congestive heart failure
- Chronic renal failure
- Hypoalbuminemia
- Ascites of any cause
- Portal hypertension with or without cirrhosis.
• Cholangiopathies on USG demonstrates areas of segmental
duct dilatation with or without increased periductal
echogenicity.
229. The investigation of choice for acute cholecystitis
228. True about features of cholecystitis on USG: is :
A. Thick fibrosed gallbladder wall A. USG
B. Stone impacted at neck of gall bladder B. HIDA-scan
C. Perigallbladder halo C. CT-scan
D. Increased vascularity D. OCG
A E. X-ray
............(PGI - June -2001) A
............(PGI - June -2002)
• 43-year-old woman with acute calculous cholecystitis.
Contrast-enhanced CT shows a distended gallbladder • In acute cholecystitis, an ultrasonogram may demonstrate
(arrowheads) with a slightly thickened wall and calculi & or a thickned wall of the gallbladder & is the
subtle regional fat-stranding (asterix). diagnostic procedure of Choice (DOC).

Radionuclide scanning with DISIDA or HIDA or PIPIDA is • Filling of the gallbladder indicates a patent cystic duct
the most effective diagnostic study in this situation. and normal hepatic billirubin uptake. Most of the
• Oral cholecystograpy is of limited value beause of impaired radiocontrast is concentrated in the gallbladder since the
absorption of dye. patient is fasting and hepatic uptake and secretion is nearly
completed.
• In hepatobiliary scintigraphy , typically 5 millicuries of
Technetium-99-m is labeled to a hepatobiliary
iminodiacetic acid analog (HIDA) and is administered
intravenously to the patient.
• The patient should be NPO for at least for hours prior to
the exam to ensure the gallbladder is not physiologically
contracted. If the last meal has been over 20-24 hours
• Normal HIDA Scan : Normal scan with visualisation of
prior, synthetic CCK administration is helpful to empty the
the gallbladder (GB) indicative of a patent cystic
gallbladder of non-radiolabelled bile prior to the start of
duct.
the exam.
• The common bile duct (CBD) is also clearly identified.
• In a patient with a healthy liver, gallbladder, and
non-obstructed biliary tree, Tc-99m HIDA is quickly
taken up by the liver and transits promptly into
the biliary tree, the gallbladder and into the small
intestine, typically within an hour.
• In the setting of cystic duct obstruction due to
acute cholecystitis, the gallbladder is not visualized.
If the gallbladder is not visualized initially, the exam may
be continued out to four hours.
• In biliary tract diseases, CT scan is of value in patients
who may have a cancer of the gall bladder or bile ducts &
• Nonvisualization of the gallbladder at four hours is diagnostic
in these patients will define its extent, the presence of
of acute cholecystitis. Low dose morphine, which causes
lymphadenopathy & the presence of metastasis.
contraction of the sphincter of Oddi and increases pressure
within the common bile duct may be given after an hour
TOPIC 29 : CRANIAL IRRADIATION
of nonvisualization of the gallbladder to speed the exam
process. Nonvisualization of the gallbladder within 30
230. Craniospinal irradiation is employed in the
minutes of the adminstration of morphine is also diagnostic
treatmentof:
of acute cholecystitis. Morphine may be administered if
A. Oligodendroglioma
there is no evidence of common bile duct obstruction
B. Pilocytic astrocytoma
(i.e., positive bowel activity), and if there is sufficient
C. Mixed oligoastrocytoma
activity remaining within the liver to allow subsequent
D. Medulloblastoma
imaging (otherwise reinjection may be necessary). A
D
related finding that may suggest gangrenous cholecystitis
............(AIPGMEE - 2002)
is the presence of the “rim sign,” which is a region of
increased radiotracer uptake in the liver parenchyma
Prophylactic Craniospinal irradiation is useful in CNS malignancy
surrounding the gallbladder fossa, which appears as a
which show dessemination via C.S.F. or any malignancy
curvilinear stripe of increased activity. Theories as to the
with high risk of CNS spread.
cause of the rim sign include reactive hyperemia of the
- Medulloblastoma
surrounding liver parenchyma, cholestasis within the
- Glioblastoma
surrounding liver parenchyma, or actual leakage of bile
- Germinoma
from the gallbladder due to microperforations
- Small Cell Ca of lung
- ALL
• These two images from the IDA scan demonstrate
- Non hodgkin’s lymphoma
hepatic uptake of the radiopharmaceutical agent .
• The image is shown as a negative (left) and as a positive
(right) just for comparative viewing. Hepatic extraction
of IDA r adiopharmaceut ical from the blood is
demonstrated. In order to evaluate the gallbladder and
biliary bile flow there must be uptake of the
radiopharmaceutical by the liver and excretion of it
into the biliary ducts
232. Prophylactic intra cranial irradiations are given in:

A. Small cell Ca of lung
B. Testicular Ca
C. Ca breast
• These two IDA nuclear scan images (left) negative, D. Ca stomach
(right) positive show a filled gallbladder following A
uptake of radioisotope IDA. ............(PGI - June -1998)

• Prophylactic intracranial irradiation is given in small cell

carcinoma of lung.
TOPIC 30 : HISTIOCYTOSIS
233. An eight year old boy presents with back pain and
mild fever. His plain X-ray of the dorsolumbar spine
reveals a solitary collapsed dorsal vertebra with
preserved disc spaces. There was no associated soft
tissue shadow. The most likely diagnosis is :
A. Ewing’s sarcoma
B. Tuberculosis
235. Causes of non-visualization of kidney in excretory
C. Histiocytosis
urogram :
D. Metastasis
A. Renal duplication
C
B. RVT
............(AIPGMEE - 2003)
C. Hydronephrosis
D. Amyloidosis
Letterer-Siwe Disease
E. Hypoplasia
Permeative with periosteal reaction (lamellated)
B and C
Geographic
............(PGI - JUNE 2005)
Rind of sclerosis
Soft tissue mass (5-10%)
TOPIC 31 : KERLEY LINES
Sequestrum (button-like); Hole in a Hole
236. A/E are true about Kerley B lines :
A. Run from hilar area to periphery
B. Due to pulmonary venous hypertension
C. Horizontal
D. Due to thickening of Septa
A
............(AIIMS PGMEE - FEB - 1997)
234. VERTEBRA PLANA SEEN IN :

A. Eosinophilic granuloma
B. Trauma
C. Paget’s disease
D. Malignancy
A and D • It is not Kerly B-lines, but Kerly A lines that run from the
............(PGI - JUNE 2005) hilar area to the periphery.
• Three types of Kerly lines have been described.
Vertebra plana is a condition manifested by collapse & • Kerlv A lines
increased density of a vertebral body , with normal Thin nonbranching lines, several inches in length, radiating
adjacent disc spaces or increased in width. from the hila.
• Kerley A lines (yellow arrows) are longer lines coursing
diagonally toward the hila in the inner half of the
lungs. These are caused by distension of anastomotic
channels between peripheral and central lymphatics
of the lungs.
The causes of Vertebra plana are:

a. Osteochondritis of the vertebral body (Calve’s disease)
b. Histiocytosis; Eosinophilic granuloma
c. Leukemia
d. Ewing’s sarcoma
e. Metastasis
f. TB

• Kerly B lines Causes :

Are short (1-3 cm long), thin, lines extending from the Pulmonary edema
pleural surface. Mitral valve disease
They lie always perpendicular. to the pleural surface. Pneumoconiosis
Best seen in the costophrenic angles. Lymphangitis carcinomatosa
Sarcoidosis
• Kerley B lines (red arrows) are thickened interlobular Idiopathic (in the elderly)
septa visible as 1-2 cm long horizontal linear opacities Infections ( viral, Mycoplasma)
in the subpleural region, which meet the pleura at Interstitial pulmonary fibrosis
right angles. They are typically seen as a ladder up the Alveolar cell Ca
side of the lungs beginning at the costophrenic angle. Lymphoma
These are most readily identified at the costophrenic angles Lymphangiectasia
on the PA radiograph and substernal region on lateral Lymphatic obstruction
radiographs. They represent interlobular lymphatics which Lymphangiomyomatosis
have been distended by fluid. They are usually an indication
of raised pulmonary venous pressure and interstitial
pulmonary oedema (e.g. Left ventricular failure or Mitral
stenosis). Other causes include pulmonary fibrosis and
lymphangitis carcinomatosa.
TOPIC 32 : LUNG SOL
239. In lung X-ray, heterogenous shadow is due to:

A. Haemangioma
B. Pulmonary infarction
C. Metastatic lesion
D. TB
• Kerly “C” lines C
• Fine interlacing lines throughout the lung producing a ............(PGI - JUNE 1997)
spiderweb appearance.
• All the three types are produced by the same pathological • Pulmonary metastatic lesion vary in size from a few mm in
process. They are seen due to. diameter to several centimeters. They tend to be spherical
• Thickening or widening of the interlobular septa with a well defined margin.
• Distention of interlobular lymphatics
• Causes of Kerly lines

• Pulmonary venous hypertension
• Left ventricular failure
• Mitral stenosis
• Lymphatic obstruction.
• Pneumoconioses
• Lymphangitis carcinomatosa
• Sarcoidosis
• Interstitial pneumonitis
238. Kereley’s ‘B’ lines are found In :

A. Interstitial edema. An ill defined margin may signify haemorrhage.
B. Pulmonary venous congestion
C. Pericardial effusion.
D. Mitral stenosis
A,B and D
.............(PGI - DEC 2003), AIIMS PGMEE JUNE - 2000
• Kerley lines are thickened interlobular septa due to visible

thickened lymphatics and surrounding connective tissues.
A - lines : Thin non-branching lines radiation from the hilum,
2-6cm long
B - lines : Transverse non-branching thin lines at the lung
base, perpendicular to pleura, l-3cm long

Cavitation may occur in metastasis from any primary site, 241. Cavitating lung lesion is seen in all except:
but is more common in sq. carcinoma & sarcomas. A. Malignant melanoma
B. Renal cell carcinoma
C. Carcinoma cervix
D. Osteosarcoma
D
............(AIIMS PGMEE - DEC 1997)
TOPIC 33 : MEDIASTINAL MASS
242. The following is not in the differential diagnosis of

an anterior mediastinal mass.
A. Teratoma
Calcification is unusual in pulmonary metastasis, being seen B. Neurogenic tumor
most often in osteogenic sarcoma & rarely in C. Thymoma
chondrosarcoma & mucinous adenoma. So, on x-ray we D. Lymphoma
get a heterogenous shadow. B
............(AIIMS PGMEE NOV - 2002)
243. Right side of mediastinum shadow is not formed

by
A. Superior venacava
B. Right innominates
C. Right atrium
D. Right ventricle
D
............(AIPGMEE - 1995), AIPGMEE - 1998
• In haemangioma, pulmonary infarction, TB, we get a
homogenous shadow.
pulmonary infarction - homogenous shadow
240. Which of the following organs should always be

imaged in a suspected case of bronchogenic
carcinoma.
A. Adrenals
B. Kidney
C. Spleen
D. Pancreas
A
............(AIIMS PGMEE - NOV 2004)
Because adrenal metastases are so common in lung cancer,

and became the adrenals may be the only site of
metastasis, the adrenal glands should be included in the Right ventricle does not form the right border of the heart
CT examination of all pts. presenting with a lung or mediastinum. It forms the anterior border of heart visible
cancer.” on lateral film
Right border of heart Left border of heart

(mediatinum) (mediatinum)
• Superior vena cava (Right • Aortic knuckle
innonimate vessels constitute • Pulmonary trunk of left
the right border further pulmonary artery
superiorly) • Left atrial appendage
• Outer border of right • Outer border of left
atrium
ventricle

TOPIC 34 : MITRAL STENOSIS • Prominence of the main pulmonary arteries

• Dilatation of the upper lobe pulmonary veins (Inverted
245. A patient is having Mitral stenosis. His x-ray will Moustache Signs)
show all of the following finding EXCEPT- • Backward displacement of the esophagus by an enlarged
A. Lifting up of left bronchus left atria
B. Double atrial shadow • KerlyB lines
C. Obliteration of retrosternal shadow on lateral x-rays • Lifting of left bronchus
D. Posterior displacement of esophagus on barium swallow • Double atrial shadows
C • Haemosiderosis
.............(AIIMS PGMEE MAY - 2002) • Horizontal short line shadows, septal (Kerley “B”)
lines above the costo-phrenic recesses, indicating
Frontal chest x-ray shows normal-sized heart interstitial oedema of the septa, often with haemosiderin
with enlarged left atrium IN Mitral stenosis in the adjacent alveoli. Female aged 49. Severe dyspnoea
Assessment of pulmonary venous pressure.

• (A) Venous grade 0; (B) Venous grade 1;
246. A/E - are Radiological features of Mitral Stenosis: • c) Venous grade 2; (D) Venous grade 3.
A. Pulmonary hemosiderosis
B. Lifting of the left bronchus
C. Straight left heart border
D. Oligemia of upper lung field
D
............(AIIMS PGMEE NOV - 2000)
In mitral stenosis upper lobe veins are congested and

prominent leading to antler’s sign or the inverted
moustache sign (No oligemia).
247. Earliest sign of Left Atrial enlargement is:
A. Posterior displacement of esophagus
B. Widening of carinal angle
C. Elevation of left bronchus
D. Double shadow of right border
A
............(AIPGMEE - 2008)
TOPIC 35 : MULTIPLE MYELOMA
248. Multiple punched out lesions in X-ray skull are seen

in
A. Down syndrome
B. Multiple myeloma
C. Hyperparathyroidism
Other X-ray features of MS D. All of the above
• Straightening of the left border of the cardiac B
silhoutte (Earliest change) ............(AIIMS PGMEE - DEC 1994)

Multiple punched out lesions in the skull is a classical - There are several possible reasons for bone activity - cancer
characteristic of multiple myeloma is one of them, but other reasons include arthritis,
Eosinophillic granuloma can also cause lytic lesion in skull, fractures and bone infections and nothing in the bone
but in 75% of cases the lesion scan itself can distinguish between them.
d) Diminished activity in the bone phase
- This is due to absent blood supply eg. in the femoral
head after a fracture of the femoral neck or to a
replacement of bone by pathological tissue.
Increased uptake on bone scans

l. Metastatic disease - multiple, randomly scattered lesions
especially in the axial skeleton.
2. Joint disease - commonly degenerative in the cervical
249. An old man had lytic lesions in the vertebra. The X- spine, hips, hands and knees. Also inflammatory joint
ray skull showed multiple punched out lesions. The disease
most probable diagnosis is: 3. Fractures - stress fractures or other undisplaced fractures
A. Multiple myeloma undetected on plain x-ray.
B. Osteomalacia 4. Paget’s disease - diffuse involvement with much
C. Hyperparathyroidism increased uptake.
D. Metastasis 5. Superscan - high uptake throughout the skeleton often
A due to disseminated secondary disease with poor or
............(AIIMS PGMEE NOV - 2000) absent renal images but often with bladder activity.
6. Metabolic bone disease - high uptake in the axial
‘ Multiple ‘punched out’ lesions are characteristic of skeleton, proximal long bones, with prominent calvarium
and mandible.
multiple myeloma. The lesions are purely osteolytic
7. Dental disease - inflammation, recent extraction.
with little or no osteoblastic activity.’
8. Infection - increased uptake in vascular and blood pool
phase also.
There are two cardinal features of multiple myeloma
on X-ray - Photopenic areas (defects) on bone scans
• Generalized reduction in bone density (Osteopenia) 1. Artefacts - the commonest cause.
• Multiple punched out lytic lesions especially involving the a) External - metal objects such as coins, belts, lockets,
axial skeleton (Lesions are also K/a raindrop lesions) buckles.
b) Internal - joint prosthesis, pacemakers.
250. Bone scan of a patient with Multiple Myeloma 2. Avascular lesions - for example cysts.
shows - 3. Multiple myeloma - may show increased uptake.
A. Diffusely increased uptake 4. Leukaemia - may show increased uptake.
B. Diffusely decreased uptake 5. Haemangiomas of the spine - occasionally slightly
C. Hot spots increased uptake.
D. Cold spots 6. Radiotherapy fields - usually oblong in shape.
D 7. Advanced cancer - especially breast. Possibly related to
............(AIIMS PGMEE - NOV 2006) chemotherapy.
8. Spinabifida.
• A bone scan is a nuclear scanning test that detects areas
of increased or decreased bone metabolism. TOPIC 36 : OSTEOMYELITIS
• Radionuclide isotope used is technetium-99. It is linked to
a bone-seeking phosphate compound. 251. X-ray finding of ostemyelltis within 8 day tat
• Thus Technetiu m-labelled hydroxy methylene A. Cystic swelling
diphosphonate (Tc-HDP) is injected intravenously and its B. Soft tissue swelling
activity recorded by a gamma camera at two stages - C. New bone formation
D. Sequestrum formation
l) shortly after injection, while it is still in the blood stream
B
or the perivascular space (the perfusion or blood pool
............(PGI - 1999 - Dec)
phase
2 -3 hours later when the isotope has been taken up in
• X-ray finding of osteomyelitis within 8 days will be “Soft
bone (the bone phase) tissue swelling’ & is the initial X-Ray finding.
• Periosteal reaction is seen after 10 days of infection
• 4 types of abnormality are seen • Lytic changes can be detected after 2 to 6 weeks when
a) Increased activity in the perfusion phase. 50% - 70% loss of bone density occurs.
- this is due to increased soft tissue blood flow - one of
the cardinal features of inflammation (eg. acute or chronic
synovitis)
b) Decreased activity in the perfusion phase
- This is much less common and signifies local vascular
insufficiency
c) Increased activity in the bone phase
- This is due to either excessive isotope uptake in the
osseous extra cellular fluid or to more avid incorporation Roentgenogram of left hand. The proximal phalanx of the
into newly forming bone tissue. fourth digit shows well-organized, periosteal thickening.

252. A 2 yr old boy suffering from leukemia; following B. Carcinoma head of pancreas
are the x-ray finding : C. Duodenal ulcer
A. Osteolyiic lesion in flat bones D. Duodenal ileus
B. Metaphysial osteoporosis B
C. Periosteal new bone formation ............(AIPGMEE - 2004)
D. Osteosclerosis of long bone
E. Transverse line of dark bands below the growth plate
B,C and E
.............(PGI - JUNE 2003)
• Important features of leukaemia in X-ray :

- Metaphyseal Lucencies :
- affects maximum growth-distal femur, proximal tibia and
distal radius.
255. “Spongy appearance” with central sunburst

calcification is seen in
A. Pancreatic adenocarcinoma
B. Mucinous cyst adenocarcinoma
C. Somato statinoma
- Diffuse destruction of bones. D. Serous cystadenoma
- Osteolytic lesions of diaphysis of long bones. D
- Osteoblastic lesions : rare, occur in metaphysis. ............(AIIMS PGMEE - MAY 2007)
- Mixed lesions.
- Periosteal reactions. What is a serous cystadenoma?
A serous cystadenoma (SCA) is an uncommon pancreatic
CHLOROMA is seen in myeloid leukaemia where skull, spine, neoplasm characterized by nemerous cysts filled with a
ribs, sternum of child is affected by geographic tumour glycogen-rich, low-viscosity serous fluid and lined by flat
caused by collection of leukaemic cells. or cuboidal epithelium. Imaging by CT, EUS, or magnetic
resonance imaging (MRI) classically shows a honey-comb
253. The gold standard for the diagnosis of Osteoporosis of small cysts with a sunburst calcification in a central scar.
is SCAs grow slowly, and more than 99% of reported cases
A. Dual energy X-ray absorptiometry are benign. Conservative observation may be appropriate
B. Single energy X-ray absorptiometry for an elderly or high-surgical risk patient. Complete surgical
C. Ultrasonography resection is indicated if the patient is symptomatic or if
D. Quantitative computed tomography the diagnosis is uncertain.
A
............(AIIMS PGMEE - MAY 2004)
Dual energy X-ray absorptionmetry (DXA) is the ‘gold

standard’ for the diagnosis of osteoporosis.
Microcystic serous cystadenoma with central calcification often

described as “sunburst” appearance (arrow), shown on
CT.
TOPIC 37 : PANCREAS CARCINOMA
254. On radiography widened duodenal ‘C loop with

irregular mucosal pattern on upper gastrointestinal Macrocystic serous cystadenoma in a patient with von Hippel-
barium series is most likely due to : Lindau disease. Note the large cystic locules in this tupe
A. Chronic pancreatitis of serous cystadenoma.

Describe the clinical characteristics of a serous • Pheochromocytoma: An Imaging Chameleon

cytadenoma.
The usual presenting symptoms of SCAs are nonspecific

gastrointestinal complaints, such as nausea, vomiting,
abdominal pain, weight loss, or an abdominal mass. Up to
one third may be discovered incidentally during autopsy
or abdominal imaging. SCAs have been described in adults
only.
What disease commonly manifests by retinal angiomatosis,

central nervous system (CNS) hemangioblastomas, and
pancreatic serous cystadenomal? Retinal angiomatosis and Pheochromocytoma in a 50-year-old man. Coronal (a) and
CNS hemangioblastomas in association with multiple axial (b) FDG PET scans show increased uptake (arrow)
pancreatic serous cystadenomas are the common due to a right adrenal pheochromocytoma
manifestations of von Hippel-Lindau disease (VHL). VHL is
also associated with renal cell carcinoma, islet cell tumors, MRI or PET scanning with 18F dopa is useful in identifying
pheochromocytomas, and benign cysts of the liver, lung, extradrenal tumors.
spleen, adrenal gland, and kideny. VHL is caused by a Abdominal aortography or venous sampling at different
mutation of a tumor suppressor gene on chromosome levels of the inferior and superior venacavain search of
3p25. The mode of inheritance is autosomal dominant catecholamine gradient has been useful in the past but
with variable penetrance. The pancreatic cysts may are rarely necessary now.
precede other manifestations of the disease by several
years and may be the only abdominal manifestation. An An additional localizatin technique involves radionuclide
evaluation for VHL is recommended for patients who have scintiscan after administration of MIBG. This type of
both pancreatic cysts and cysts in other organ systems. scanning may be useful in characterizing lesions discovered
by CT when biochemical confinnation is indeterminate but
256. Intraoperative radiotherapy given in case of- is less useful at loca lizing extradrenal
A. CA thyroid pheochromocytomas than MRI or PET
B. CA cervix
C. CA breast Percutaneous fine needle aspiration is contraindicated; indeed,
D. CA pancreas pheochromocytoma should be considered before adrenal
D lesions are aspirated”.
............(AIIMS PGMEE - DEC 1998)
259. The diagnostic procedure not done in case of
TOPIC 38 : PHEOCHROMOCYTOMA pheochromocytoma.
A. CT scan
257. Which one of the following imaging modalities is B. MRI
most sensitive for evaluation of extra- adrenal C. FNAC
phaeochromocytoma. D. MIBG scan
A. Ultrasound C
B. CT ............(AIIMS PGMEE - MAY 2007)
C. MRI
D. MIBG scan TOPIC 39 : PROSTATE CARCINOMA
C
............(AIIMS PGMEE MAY - 2003), AIIMS PGMEE NOV 260. Hypoechoic lesion within prostate in USG seen in:
- 2002 A. Adenocarcinoma
B. Normal Prostate tissue
• Once pheochromocytoma is diagnosed, localization should C. Infertility
be undertaken while the patient is being prepared for D. Urethral obstruction
E. BPH
surgery. CTorMRl of the adrenals is usually successful
A and E
in identifying intradrenal lesions.
............(PGI - DEC 2004)
• In normal USG of prostate, the central zone looks

hypoechoic & the peripheral zone hyperechoic.
• In BPH, adenomat ous nodules are seen as
predominantly well-defined echo-poor nodules
although they are sometimes hyperechoic.
• Urethral obstruction commonly caused by calculi appears
as bright echogenic foci with or without acoustic
shadowing.

Intensity modulated radiation therapy (IMRT) is an

advanced mode of high precision radiotherapy that utilizes
computer controlled X-ray accelerators to deliver precise
radiation doses to a malignant tumour or specific areas
within the tumour.
The radiation dose is designed to conform to the three
dimensional (3-D) shape of the tumour by modulating
or controlling the intensity of the radiation beam to focus
a higher radiation dose to the tumour while minimizing
exposure to surrounding tissues.
Prostatic carcinoma most often demonstrates a hypoechoic
echo texture. – IMRT can also be used to treat lung cancers, but
• The normal seminal vesicles appears as paired lobulated there are several technical reasons to delay the widespread
echo-poor structures which often contains multiple small use of IMRT for lung Ca at this time.
echo-free areas
TOPIC 40 : PYLORIC STENOSIS
263. Pyloric stenosis is featured by a - X-ray

A. Multiple air fluid level
B. Double bubble appearance
C. Single bubble appearance
D. Gas under diaphragm
C
............(AIIMS PGMEE - JUNE - 1997)
• Single bubble appearance is seen in — Pyloric stenosis

261. Lytic lesion in skull are seen in following except: • Double bubble appearance — Duodenal atresia
A. Multiple myeloma • Mutiple air fluid levels — Intestinal obstruction
B. Metastasis ca bronchus • Gas under diaphragm — Pneumoperitoneum
C. Thalassemia
D. Ca prostate • Radiograph of a 36-week gestational-age, one-day-old
D neonate with EB-PA. Note the single gastric bubble
............(PGI - JUNE 1997) (white arrow).
• Cancers in the bone may produce osteolysis, osteogenesis

or both.
• Osteoblastic lesions result when the tumor produces
cytokines that activate osteoblasts.
• Although some tumors may produce mainly osteolytic
lesions (e.g. k idney cancer) & others mainly
osteoblastic lesions (e.g. prostate Cancer). Most
metastatic lesions produce both types of lesions & may
go through stages where one or the other predominates.
• Abdominal radiographs may show a fluid-filled or
• Multiple nyeloma, metastatic Ca of bronchus & thalassemia
air-distended stomach, suggesting the presence of
produces osteolytic bony lesion.
gastric outlet obstruction. A markedly dilated
stomach with exaggerated incisura (caterpillar sign)
262. For which malignancy, intensity Modulated
may be seen, which represents increased gastric
Radiotherapy (IMRT) is the most suitable -
A. Lung peristalsis in these patients
B. Prostate
C. Leukemia • Supine radiograph in an infant with vomiting
D. Stomach demonstrates the caterpillar sign.
B
............(AIIMS PGMEE - NOV 2005)
Currently Intensity modulated radiotherapy is being used

to treat cancers of:
• Prostate
• Head & Neck
• Breast
• Thyroid
• Lung
• Gynaecologic cancers
• Liver
• Brain
• Lymphomas A UGI study was once considered the test of choice
• Sarcomas for hypertrophic pyloric stenosis (HPS ).

Findings on UGI studies include the following: In Pyloric obstruction there will be only single air fluid
• Delayed gastric emptying (if severe, this may prevent level.
barium from passing into the pylorus and severely limit For multiple air fluid levels on X Ray obstruction should be
the study) distal to duodenal bulb.
• Cephalic orientation of the pylorus Pyloric stenosis - single bubble appearance
• Shouldering (ie, filling defect at the antrum created by Duodenal atresia - double bubble apperance
prolapse of the hypertrophic muscle) Ileal atresia - multiple air fluid levels
• Mushroom or umbrella sign (ie, thickened muscle that
indents the duodenal bulb; the name refers to the TOPIC 41 : RENAL MASS
impression made by the hypertrophic pylorus on the
duodenum) 266. The investigation of choice to evaluate IVC & Renal
• Double-track sign (ie, redundant mucosa in the Vein thrombosis in Renal Cell Ca is :
narrowed pyloric lumen, which results in separation A. IVP
of the barium column into 2 channels) B. Colour doppler
C. CT Scan
• Lateral view from an upper gastrointestinal study D. Ultra sound
demonstrates the double-track sign. C
............(AIIMS PGMEE NOV - 1999)
• Diagnostic investigation in Renal cell Ca-

• CT Scan is the most valuable imaging test for renal cell
carcinoma.
264. String sign is suggestive of

A. Toxic megacolon
B. Hypertrophic pyloric stenosis
C. Ulcerative colitis
D. Irritable bowel syndrome
B
............(AIIMS PGMEE - NOV - 1993) • But the best investigation for evaluating renal vein and
with thrombosis is – MRI > Doppler
• String sign is seen in hypertrophic pyloric stenosis
• String sign of Kantor is seen in Crohns disease • Doppler - is able to detect the venous thrombosis as
• String sign (ie, barium passing through the echogenic material in the venous lumen and absence of
narrowed channel, creating a single, markedly flow. But it has got its limitations and is thus inferior to CT
attenuated, and elongated track) & MR.
• CT is the imaging modality of choice for diagnosing and

staging renal cells ca.
267. Technique of choice for studying Renal Cortical Mass

A. 53Cr study
B. 99Tc Pyrophosphate
C. 99Tc DMSA
D. none of the above
D
............(AIIMS PGMEE - MAY - 1993)
• Transverse sonographic image in a patient with
Tc DMSA is a radionuclide imaging procedure
proven hypertrophic pyloric stenosis demonstrates
• In this procedure dimercapto Succinic acid (DMSA) is
the target sign and heterogeneous echo texture
labelled with radioactive technetium.
of the muscular layer (pylorus is deep to the
anechoic gallbladder).
• DMSA attains a very high concentration in renal
cortex and provides very high quality images of renal
265. A newborn presenting with intestinal obstruction
morphology.
& constipation showed, on abdominal X-ray, multiple
air fluid levels. The diagnosis is not likely to be:
• So DMSA is very useful in detection and follow up of
A. Pyloric obstruction
renal parenchymal defects.
B. Duodenal atresia
C. Heal atresia
• DMSA scan showing major defects in uptake in the upper
D. Ladd’s bands
and lower poles of the left kidney and slight reduction
A
in uptake in the lower pole of the right kidney.
............(AIPGMEE - 2002)

270. The most sensitive imaging modality for diagnosis

Ureteric stones in a patient with acute colic is:
A. X-ray KUB region.
B. Ultrasonogram.
C. Non contrast CT scan of the abdomen.
D. Contrast enhanced CT scan of the abdomen
C
.............(AIPGMEE - 2005)
The test of choice at most centres for diagnosing an acute

stone is a non contrast helical CT scan .
Spiral CT (non contrast) has become the study of choice
in emergent situation as the entire urinary tract can be
scanned rapidly and without contrast injection.’
271. DD for Rt. Upper quadrant calcification :

A. Gallstone
About 99Tc DTPA -
B. Renal stone
• In this procedure diethylenetriamine pentacetic acid
C. Calcification in vessels
(DTPA) is Labelled with radioactive technetium. D. Hepatic hemangioma
• (DTPA) is freely filtered at the glomerulus with no All
tubular reabsorption or excretion. ............(PGI - JUNE 2006)
• A DTPA renogram is useful for evaluating perfusion and
function of each kidney. D/D of calcification in Rt. hypochondrium are:
• Gall stone
• DTP A scan showing Left PUJO , there is significant • Calcified lymph node
retention of tracer even at 2 hours. Curve is non-draining • Calcified costal cartilage
type • Phlebolith
Small calcific bodies in the substance of a kidney
• Hepatic adenoma
• metastasis
• hemangioma
• Calcified (Porcelain) gallbladder.
TOPIC 43 : SCURVY
272. A/E are radiological signs of Vit. C deficiency:

A. Widening of epiphysis
B. Osteoporosis of bones
C. Weinberger line
D. White line of Frenkel
A
............(AIIMS PGMEE - Dec - 1995), AIPGMEE - 2004
268. Abdominal Ultra-sonography in a 3 year old boy
shows a solid well circumscribed hypo-echnoic renal Key imaging features of scurvv or Vit. “C’Def.
mass. Most likely diagnosis is: • Osteoporosis
A. Wilm’s tumor • White line of Frankl
B. Renal cell carcinoma (at the growth plate, although cartilage proliferation is
decreased, mineralization is unimpaired and as a result,
C. Mesoblastic nephroma
the zone of provisional calcification becomes wide
D. Oncocytoma
and dense)
A
• Trummerfield zone or scurvy line
............(AIPGMEE - 2002)
• Wrist showing dense metaphyseal line, corner sign
and, to a slight extent, scurvy line and spur
Wilm’s tumor is described as Clean lesions
formation.
- usually confined by renal capsule & presents as well defined
echogenic Space occupying Lesion.
- Mean age — 3 years (< 5 years)
TOPIC 42 : RENAL STONES
269. All of the following form radiolucent stones except:

A. Xanthine.
B. Cysteine.
C. Allopurinol.
D. Orotic acid
B
.............(AIIMS PGMEE MAY - 2003)

Pelkan’s sign (the zone of provisional calcification extends TOPIC 44 : SUBARACHNOID HEMORRHAGE
beyond the margins of the metaphyses, resulting in
periosteal elevation and metaphyseal spurs) 275. Best test to determine the etiology of SAH:
A. MRI
• Wimberger’s sign (Ring of increased density surrounding B. Intra arterial digital subtraction angiography
epiphyses C. Enhanced CT
• Moderate case showing ground-glass osteoporosis, dense D. Unenhanced CT
metaphyseal line and “halo” epiphysis (Wimburger’s B
sign). ............(AIIMS PGMEE - MAY 1995)
• The various etiologies of subarachnoid harmorrhage are -

a) Ruptured arterial aneurysm
b) A-V malformations
c) Pitutary adenomas (rare)
• Moderate case showing dense metaphyseal line, “scurvy

line”, and lateral spur.
• Once SAH has been diagnosed by CT (Without contrast)

or lumbar puncture, digital substraction angiography
(DSA) is done to determine the etiology.
• Now DSA is being replaced by noninvasive vascular imaging
methods such as MRA (MR Angiography and CTA. (CT
Angiography).
• Investigation of choice for diagnosing SAH—Unenhanced

CT (i. e. without contrast)
• Periosteal elevation • Inv. for determining etiology of SAH
• Widening of the epiphysis is seen in Rickets (Vit. D. Def.) MRA > CTA> DSA
• Epiphyseal widening — Rickets 276. The first investigation of choice in a patient with
• Epiphyseal dysgenesis — Hypothyroidism suspected subarachnoid haemorrhage should be :
• Epiphyseal enlargement — Juvenile Rheumatoid A. Non-contrast computed tomography
arthritis B. CSF examination
C. Magnetic resonance imaging (MRI)
274. Radiological findings of scurvy are A/E: D. Contrast - enhanced computed tomography
A. Epiphyseal widening A
B. Metaphyseal porosis ............(AIPGMEE - 2004), AIPGMEE - 1998)
C. Metapyseal infarction
D. Pelkan spur TOPIC 45 : AORTIC DISSECTION
A
............(PGI - 1999 - Dec) 278. Investigation of choice in aortic dissection is
A. USG
In SCURVY Radiological features are : B. CT Scan
• There is loss of epiphyseal density with a pencil thin cortex C. MRI
(wimberger’s sign) D. Digital substraction Angiography
• Bone is poorly mineralised and cortex is thin so that there C
is ‘Ground Glass1 appearance and a fine ‘pencilled’ cortex. ............(AIPGMEE - 1996), AIIMS PGMEE - DEC 1997
• Subperiosteal haemorhage particularly in the region of
metaphysis; metaphyseal lucency (TRUMMERFELD ZONE) MRI followed by CT Scan is investigation of choice for
• Metaphyseal corner fractures through the weakened Aortic dissection.
lucent metaphysis (PELKAN SPURS) resulting in CUPPING Non invasive procedures like CT and MRI are the diagnostic
of metaphysis. procedures of choice.
• WHITE LINE FRENKEL CT and MRI are both highly accurate in identifying the
• Epiphyseal widening is seen in Rickets. intimal flap and the extent of dissection. Each has a
sensitivity and specificity exceeding 90%.
Earliest sign of scurvy occur at KNEES. MRI is preferred because it can detect blood flow and
distinguish antegrade versus retrograde dissection.

C. Axillary artery
D. Radial artery
A
............(AIPGMEE - 1999)
Route is the most commonly used route”.
Remember :
• Most common route for cerebral angiography is : Femoral
artery,Q
• Most common route for fluorscein angiography is : Cubital
vein
TOPIC 46 : BRAIN TUMOR TOPIC 48 : DIAPHRAGMATIC HERNIA
280. Which investigation should not be done in a patient 284. The most likely diagnosis in a new born who had a
suspected of brain tumor: radiopaque shadow with an air fluid level in the chest
A. Ct scan along with hemivertebrae of the 6th thoracic
B. Lumbar puncture vertebra on plain X-ray is
C. MRI A. Congenital diaphragmatic hernia
D. X-ray-skull B. Oesophageal duplication cyst
B C. Bronchogenic cyst
............(AIPGMEE - 1997) D. Staphylococcal pneumonia
A
Lumbar Puncture may precipitate brain herniation in patients ............(AIIMS PGMEE NOV - 2002)
with Brain Tumor.
Lumbar puncture carries a risk if the CSF pressure is high 285. In X-ray, loops of bowel on left side of hemithorax
(evidenced by headache & papilledema), for it incorporates and shift of heart shadow:
the possibility of fatal cerebellar or tentorial herniation. A. Eventration of diaphragm
If this possibility exists & if CSF examination is required, it B. Foramen of bochdalek hernia
is wise first to obtain a computed tomography (CT) or C. Morganian hernia
magnetic resonance imaging (MRI) scan to exclude a mass D. Any of above
lesion / mid-line shift before proceeding to lumbar B
puncture. ............(PGI - 1998 - Dec)
281. Which of the following techniques in the best for • Hernia through the foramen of bochdalek is really the
differentiating recurrence of brain tumour from persistence of pleuroperitoneal canal and the opening
radiation therapy induced necrosis? is in the dome of diaphragm posteriorly.
A. MRI It is the most common diaphragmatic hernia in
B. Contrast enhanced MRI children.
C. PET scan There is classic triad of :
D. CT scan — Respiratory distress
C — Apparent dextrocardia
............(AIIMS PGMEE - MAY 2005) — Scaphoid abdomen
• This type of hernia is apparent shortly after birth with
• “MRI or CT scans are often unable to distinguish radiation over 80% presenting on Left side.
necrosis from recurrent tumor, but PET or SPECT scans There is radiological appearances of bowel in hemithorax
may demonstrate that glucose metabolism is increased and mediastinal shifting.
in tumor tissue but decreased in radiation necrosis.” • Whereas eventration of diaphragm is an abnormally
elevated position of one or both hemidiaphragms
TOPIC 47 : CEREBRAL ANGIOGRAPHY from paralysis or atrophy of muscle fibres.
282. Which one of the following is the most preferred Hernia through foramen of Morgagni is an anteriorly
route to perform cerebral angiography? placed hernia with the defect in sternal and coastal
A. Transfemoral route. attachments of diaphragm .
B. Transaxillary route. The most commonlv involved viscus is transverse colon.
C. Direct carotid puncture. • Paradoxical restoration occurs in bochdalek hernia.
D. Transbrachial route
A TOPIC 49 : DIFFUSE AXONAL INJURIES
.............(AIPGMEE - 2005)
286. A young male is brought unconscious to the
The most preferred rou te to perform cerebral hospital with external injuries. CT brain showed No
angiography is the Transfemoral route. midline shift. Basal cistern were compressed with
multiple small Haemorrhages.
283. In cerebral angiography the dye is injected through: What is the likely diagnosis:
A. Femoral-artery A. Cerebral contusion
B. Brachial artery B. Cerebral laceration

C. Multiple infarcts • Dysgerminoma corresponds to seminoma of the

D. Diffuse Axonal injuries tests and one is very well aware that seminomas are
D highly radiosenstive tumors.
............(AIPGMEE - 2007), AIIMS PGMEE - NOV 2006 • List of highly radiosensitive tumors
• Lymphoma
• Diffuse axonal injury (DAI) and Cerebral contusions • Seminoma
are the most common primary brain injuries in non- • Myeloma
penetrating trauma to head, comprising almost 95% • Ewings Sarcoma
primary injuries. • Wilm’s Tumor
• Diffuse axonal injury
- {the most common primary brain injury), there is shearing TOPIC 52 : FOREIGN BODY ASPIRATION
injury of axons most commonly at the cortico-medullary
junction, due to sudden acceleration/deacceleration or 292. Pappu, a 2 yrs old boy, is brought with sudden
rotational forces on the brain. onset of stridor and respiratory difficulty. The chest
- These shearing injuries tend to be diffuse & bilateral. examination reveals decreased breath sounds &
- DAI is seen in cases of severe head injury and patient wheeze in the right side.
loses consciousness at the moment of impact. The chest X-Ray showed an opaque right hemithorax.
• Cortical Contusions Which of the following is the most likely diagnosis:
- are foci of hemorrhages, that occur because of brain hitting A. Pneumothorax
against the bony ridges of the skull and less often the B. Acute epiglottitis
dural fold. C. Massive pleural effusion
- compared to DAI, cortical contusion are less frequently D. Foreign body aspiration
associated with initial loss of consciousness unless D
they are extensive. ............(AIPGMEE - 2002)
TOPIC 50 : DUODENAL ATRESIA
• Foreign body inhalation is most common cause of acute
of acute collapse with peak age incedence in 1-2 years
288. X-ray showing double-bubble sign in -
Symptoms are -
A. Osophageal atresia
sudden onset choking, cough & wheeze with respiratory
B. Pyloric stenosis
distress, stridor and − ↓ed breath sounds on affected side.
C. Duodenal atresia
• Pneumothorax
D. Colonic atresia
- may have similar symptoms with radiolucent hemithorax,
C
............(AIIMS PGMEE NOV - 1999), PGI - DEC 2004 - stridor and wheeze are also not present.
Condition in which double bubble appearance in seen Causes of U/L radio paque Hemithorax
• Duodenal atresia 1. Pleural effusion
• Duodenal stenosis 2. Collapse
• Annular pancreas 3. Consolidation
Double bubble appearance or double stomach appearance is
seen because of gross dilatation of the stomach and upper 293. A child with acute respiratory distress shows
part of the duodenum with two-air fluid levels. hyperinflation of unilateral lung in chest X-ray. Most
likely cause for above presentation is:
TOPIC 51 : DYSGERMINOMA A. Staphylococcal bronchopneumonia
B. Aspiration pneumonia
290. Tumor responding best to radiation Include C. Congenital lobar emphysema
following: D. Foreign body aspiration
A. Melanoma D
B. Dysgerminoma ............(AIPGMEE - 2002)
C. Teratoma
D. Choriocarcinoma Radiological findings of F.B. inhalation
B Hyperinflation of Atelectasis Pneumonia
............(PGI - JUNE 1997)
affected lobe (50%) (collapse) I.e. (5%)
• Melanoma do not respond to radiotherapy. The main mode Radiopaque (45%)
of treatment of Melanoma is Surgery & Local regional TOPIC 53 : HEMOPTYSIS
isolation & perfusion with high dose cytotoxic agents.
• Dysgerminoma (Seminoma in male counter part), 294. A 40 years old man presents with a recurrent
Best responds to radiation. hemoptysis and purulent cough. X-ray was found to
be normal. To next investigation done to aid in
291. Which of the following is the most Radiosensitive diagnosis is :
ovarian tumours : A. MRI
A. Dysgerminoma B. Bronchoscopy
B. Dermoid cyst C. HRCT
C. Serous cyst adenoma D. CT guided biopsy
D. Endodermal sinus tumour
B
A ............(AIIMS PGMEE MAY - 2002)
............(AIIMS PGMEE - DEC 1997)

295. A young man with tuberculosis presents with TOPIC 55 : HYPERPARATHYROIDISM

massive recurrent hemoptysis. For angiographic
treatment which vascular structure should be 298. X-ray of which bone (s) would be diagnostic
evaluated first hyperparathyroldism:
A. Pulmonary artery A. Skull
B. Bronchial artery B. Phalanges
C. Pulmonary vein C. Long bones
D. Superior vena cava D. Scapula
B E. Spine
............(AIIMS PGMEE NOV - 2002) A and B
............(PGI - 2000 - Dec)
• Most common vessel responsible for the hemoptysis in TB
(or even in Bronchitis, Bronchieactasis, or Bronchogenic • Radiological changes in hyperparathyroidism can be severe
carcinoma) are the bronchial arteries but occuring in less than 30% of the patients.
As with lung abscess and bronchiectasis, the intense The changes include :
inflammatory process in the periphery of a tuberculous
- Characteristic change is true osteoporosis.
cavity tends to promote hypertrophy of bronchial arterial
- Subperiosteal bone resorption of phalanges (best
and pulmonary arterial branches. These may be eroded
seen on r adia l side) are very char ac teristic of
by the necrotizing process in the centre of the cavity to
produce hemoptysis. The vessel responsible is most hyperparathyroidism.
frequently a dilated bronchial arterial branch, referred
to as a Rasmussen aneurysm
TOPIC 54 : HYDATID CYST
296. Spring water cyst is another name for:

A. Hydatid cyst of lung
B. Lung amoebic cyst Fine granular skull “pepper-pot skull”.
C. Pleuro pericardial cyst
D. Enterogenous cyst
C
............(PGI - 1997 - Dec)
• Tumors of pericardium are rare, the only common tumor

encountered is the benign Sprin g Water Cyst
(synonym Pleuro pericardial Cyst, Pericardial - Loss of definition between inner and inter tables and the
coelomic Cyst). These Cysts are unilocular thin walled
diploe.
attached to the pericardium. They are most commonly
- Loss of Lamina dura of teeth, dense cortical line of their
found in the pericardiophrenic angle, more often on Rt.
surrounding bone.
than Lt..
- Bone cysts.
299. The Pathognomon ic lesion of primary

hyperparathyroidism is -
A. Diffuse osteopenia
B. Loss of lamina dura
C. Subperiostial resorption of phalanges
D. Salt and pepper skull
C
Though they can occur in any part of the lower half of the ............(AIIMS PGMEE - DEC 1998)
mediastinum on fluoroscopy, they may be seen to change
shape with respiration. • Though all the given options are seen in hyperpara
• In the majority of cases, the diagnosis is usually obvious thyroidism, subperiosteal resorption of phalanges is
on plain X-ray, when they appear as rounded, sharply
pathognomic.
defined cystic shadows anteriorly in the pericardiophrenic
• “Subperiosteal erosion of bone, particularly along the, radial
angle. Rarely a morgagni hernia which may be filled
aspect of the middle, phalanx of the middle and vndexjingtr
only with omentum in the elderly, may cause
is virtually pathognomic.”
confusion. Barium study will distinguish the two.
• Radiological features ofhyperparathyroidism
• Diffuse osteopenia
297. Floating water lily sign is seen in
• Loss of lamina dura
A. Aspergillosis
B. Hamartoma • Salt and pepper appearance of skull
C. Hydatid cyst • Brown’s tumor - Expansite lytic lesion generally affecting
D. Cavitating metastasis maxilla /mandible.
C • Subperiosteal resorption of bone; common sites are -
............(AIIMS PGMEE - NOV 2007) Phalanges
• Separated membranes floating with the cyst give the Lateral end of clavicle
appearance of water lily. Proximal tibia
• It is pathognomonic of hydatid cyst. Femur

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TOPIC 1: PHYSICS RADIOLOGY 1

TOPIC 1 : PHYSICS So,

1. ACS in medical imaging stands for : Water 0

The radioactive decay law:

HELP LINE NO. 9391567707

7. The gyrometric property of ———— is used for NMR

The photoelectric effect results from an interaction between

8. Functional basis of ionizing radiation is dependent on:

HELP LINE NO. 9391567707

9. In MRI, images are produced due to

There are two forms of ionizing radiation

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21. The tech nique employed in radi otherapy to

Stereotactic Body Radiotherapy (SBRT)

HELP LINE NO. 9391567707

22. Principle used in radiotherapy is

Ionizing radiation is the energy that during absorption causes

• Radio Isotopes used in treatment of Cancer :

24. For the treatment of deep seated tumors, the

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• In radiation therapy rays used are alpha, Beta, (gamma)

35. Principle of linear acclerator is used in:

40. Acoustic shadow in USG is due to

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• (ii) Pulse wave Doppler: Shows depth of information; it

41. The intensity of color in Doppler is determined by:

Piezoelectric effect: The ability of certain materials to change

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45. Ion used both in brachy and tele therapy is:

• Therapeutic radiation is given in three ways:

47. All may be used in interstitial brachytherapy except:

Isotopes used in Brachytherapy are

• X-rays & gamma rays are the forms of radiation most

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(i) Intracavitary therapy B. Radium-226

Isotopes used for radiotherapy

56. Which of the following agents is used to measure

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Filtration Rate (GFR)

• An IVP is particularly useful to demonstrate tumors & calculi

62. Which of the following isotopes is used for RAIU?

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Increased Normal Decreased

Clinical Manifestations of Thyroiditis Subtypes

• Isotopes for thyroid scaning are :

• Radioactive iodine uptake scan showing normal condition I131

66. All of the following radioisotopes are used as

67. Phosphorus32 emits:

P-32,Sr-90 and Gamma 90 emits Beta particles

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(radium)............(PGI - June -2000)

• Radium is an alkaline earth metal that is found in trace

70. In Radionuclide imaging the most useful radio

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• Organs which have a high dividing rate are more sensitive

93. Radiation therapy to hypoxic tissues may be

First lets see the simple Principle of Radiotherapy-

- Radiation damage is dependent on oxygen. So Hypoxic

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• Maximum permissible radiation dose

• Maximum single time radiation exposure is given by bone

• Radiation exposure (in decreasing order)

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