This page intentionally left blank Applied Radiological Anatomy for Medical Students Applied Radiological Anatomy for Medical Students is the definitive atlas of human anatomy, utilizing the complete range of imaging modalities to describe normal anatomy and radiological findings. Initial chapters describe all imaging techniques and introduce the principles of image interpretation. These are followed by comprehensive sections on each antomical region. Hundreds of high-quality radiographs, MRI, CT and ultrasound images are included, complemented by concise, focused text. Many images are accompanied by detailed, fully labeled, line illustrations to aid interpretation. Written by leading experts and experienced teachers in imaging and anatomy, Applied Radiological Anatomy for Medical Students is an invaluable resource for all students of anatomy and radiology. paul butler is a Consultant Neuroradiologist at The Royal London Hospital, London. adam w. m. mitchell is a Consultant Radiologist at Charing Cross Hospital, London. harold ellis is a Clinical Anatomist at the University of London. Applied Radiological Anatomy for Medical Students PAUL BUTLER The Royal London Hospital Edited by ADAM W. M. MITCHELL Charing Cross Hospital HAROLD ELLIS University of London CAMBRIDGE UNIVERSITY PRESS Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo Cambridge University Press The Edinburgh Building, Cambridge CB2 8RU, UK First published in print format ISBN-13 978-0-521-81939-8 ISBN-13 978-0-511-36614-7 © Paul Butler, Adam W. M. Mitchell and Harold Ellis 2007 2007 Information on this title: www.cambridge.org/9780521819398 This publication is in copyright. Subject to statutory exception and to the provision of relevant collective licensing agreements, no reproduction of any part may take place without the written p ermission of Cambrid g e University Press. ISBN-10 0-511-36614-0 ISBN-10 0-521-81939-3 Cambridge University Press has no responsibility for the persistence or accuracy of urls for external or third-party internet websites referred to in this publication, and does not g uarantee that any content on such websites is, or will remain, accurate or a pp ro p riate. Published in the United States of America by Cambridge University Press, New York www.cambridge.org paperback eBook (EBL) eBook (EBL) paperback Contents List of contributors vii Acknowledgments ix Section 1 The basics 1 An introduction to the technology of imaging 1 thomas h. bryant and adam d. waldman 2 How to interpret an image 17 adam w. m. mitchell Section 2 The thorax 3 The chest wall and ribs 23 jonathan d. berry and sujal r. desai 4 The breast 31 stella comitis Section 3 The abdomen and pelvis 5 The abdomen 36 dominic blunt 6 The renal tract, retroperitoneum and pelvis 47 andrea g. rockall and sarah j. vinnicombe Section 4 The head, neck, and vertebral column 7 The skull and brain 64 paul butler 8 The eye 81 claudia kirsch 9 The ear 86 claudia kirsch 10 The extracranial head and neck 91 jureerat thammaroj and joti bhattacharya 11 The vertebral column and spinal cord 105 claudia kirsch Section 5 The limbs 12 The upper limb 113 alex m. barnacle and adam w. m. mitchell 13 The lower limb 129 a. newman sanders Section 6 Developmental anatomy 14 Obstetric imaging 146 ian suchet and ruth williamson 15 Pediatric imaging 153 ruth williamson Index 159 v [...]... used, 10 0 10 00 times higher than audible sound 5 thomas h bryant and adam d waldman An introduction to the technology of imaging Procedure Limbs and joints Chest Lumbar spine Pelvis Abdomen IVU Barium enema CT head CT chest CT abdomen or pelvis Bone scan PET head (FDG) Typical effective dose (mSv) Equivalent number of chest X-rays Ͻ0. 01 0.02 1. 3 0.7 1. 0 2.5 7 2.3 8 10 Ͻ0.5 1 65 35 50 12 5 350 11 5 400... increasing the contrast Image display Gray-scale or B-Mode (B for brightness) is a two-dimensional real time image formed by sweeping the beam through the tissue The echogenicity of the reflectors is displayed as shades of gray and is the main mode used for ultrasound imaging (Fig 1. 12) Modern ultrasound machines operate at a sufficient speed to produce real-time images of moving patient tissue such... mechanisms to detect X-ray photons and convert them to a visible image (Fig 1. 5) How X-rays produce an image Film Production of a radiograph, an X-ray image, is the result of the interaction of X-ray photons with the patient and detection of the remaining photons Although photographic film is sensitive to X-rays by itself, fluorescent screens are used inside X-ray cassettes that convert X-ray photons to visible... great osmotic load The normal physiological turnover of iodine in the body is 0.00 01 g per day, while for typical imaging applications 15 g to 15 0 g or 15 0 000 1 500 000 times as much may be required Barium sulphate (atomic weight 13 7), and iodinated compounds are the only agents in regular use as extravascular agents Fig 1. 7 Barium enema Barium sulphate has been introduced into the large bowel by a tube... X-ray range (Fig 1. 4) Photoelectric absorption is more important at low energy (low kV) X-ray photon energies and is seen more with elements with high atomic numbers – such as calcium in bones Compton (incoherent) scattering becomes more important for biological tissues as X-ray photon energies increase (high kV) and is proportional to tissue density (b) X-ray (a) X-ray e– Carbon atom Fig 1. 4 A representation... must be evaluated with particular care before undertaking the procedure (Fig 1. 9) X-ray tube Focal plane X-ray table Film Radiation dose All ionizing radiation exposure is associated with a small risk A small proportion of the genetic mutations and cancers occurring in the population can be attributed to natural background radiation Diagnostic Fig 1. 6 Conventional tomography The X-ray tube and film move... closed so that only the part of the patient to be imaged is exposed to the X-ray beam e– X-ray e– Fig 1. 3 (b) Characteristic radiation When a free electron knocks one of the “cloud” of orbital shell electrons out of an atoms, an electron from a higher energy (outer) shell moves to fill the gap, shedding the excess energy in the form of an electromagnetic photon which will be an X-ray photon if the energies... imaging Fig 1. 3 Diagrams of the (b) production of X-rays (a) Bremsstrahlung or Braking radiation occurs when the free electron is deflected by the electric field around the nucleus of a target atom, shedding energy in the form of a photon as the free electron is slowed (a) X-ray e– Nucleus is made of the correct material and the electrons are accelerated enough (by at least 10 00 volts), X-rays will be... reflected or refracted away Fig 1. 10 Typical effective doses for some of the commonly performed Imaging investigations The typical United Kingdom background radiation dose is 2.2 mSv/year (ranges from 1. 5 to 7.5 mSv/year depending on geographical location) It has been estimated that the additional lifetime risk of a fatal cancer from an abdominal CT scan could be as much as 1 in 2000 (although the overall... coating of barium on its inside surface X-ray images are used to examine the lining of the bowel for abnormal growths and other abnormalities Barium studies Barium is only used in a modern X-ray department for studies of the gastrointestinal tract These are usually based on a fluoroscopic image intensifier on which a moving image can be seen Studies can be performed of the swallowing mechanism and esophagus . in print format ISBN -1 3 97 8-0 -5 2 1- 8 19 3 9-8 ISBN -1 3 97 8-0 - 51 1-3 6 61 4-7 © Paul Butler, Adam W. M. Mitchell and Harold Ellis 2007 2007 Information on this title: www.cambridge.org/97805 218 19398 This. of any part may take place without the written p ermission of Cambrid g e University Press. ISBN -1 0 0-5 1 1-3 6 61 4-0 ISBN -1 0 0-5 2 1- 8 19 3 9-3 Cambridge University Press has no responsibility for the. page intentionally left blank Applied Radiological Anatomy for Medical Students Applied Radiological Anatomy for Medical Students is the definitive atlas of human anatomy, utilizing the complete