2. In December 1895, German
physicist Wilhelm Roentgen
discovered these mysterious
rays: X-rays, with X standing
for unknown. In recognition of
his discovery, Roentgen in
1901 became the first Nobel
laureate in physics.

3.  They are an electromagnetic radiation
emitted by charged particles interactions
 Photons which can penetrate through matter
 They have no mass or charge
 They travel at the speed of light

6. Enables radiologists to
visualize X-ray images
in real time on a
television monitor. In
most instances the
procedure would
involve the
administration of some
form of 'contrast' agent
to outline the region of
interest

7. Barium Used to Visualize Intestines

8. A mammography
machine is an X-ray
machine dedicated to
breast images.
Compared with
conventional X-ray
techniques,
mammograms are
obtained with much
lower energy X-rays of
around 20,000 volts.

9. It is a diagnostic procedure
that produces X-ray pictures
of blood vessels. A catheter is
inserted in the vessel to inject
contrast fluid into the lumen
of the blood vessel, which
then becomes visible on X-
ray images.

10. First Angiogram(1896, Hankel):
Mercury was injected in a post Digital Subtraction Angiography
mortem hand (Mistretta, 1980s)

11. Angiogram of The 3-D Angiogram of
Coronary Arteries The Brain Arteries

12. The technique of CT
scanning was developed
in 1973 by Hounsfield. A
thin fan beam of X-rays
generated by a
conventional X-ray tube
passes through a single
'slice' of a patient
through to a bank of X-
ray detectors.

13. The number of slices (images) a CT scanner can
acquire per revolution of the x-ray tube depends
on the number of rows of detectors. Spiral CT units
today may be referred to as multislice or
multidetector CT scanners.
The current number of slices acquired per revolution
in most scanners is 32-64 slices.
These multislice scanners can produce slices that are
submillimeter in thickness and can acquire these
images in less than a second. Decreasing the slice
thickness produces an increase
in the spatial resolution and the ability to visualize
smaller structures accurately.

14.  Multiple plane visualization
 Minute details, within slices
 3d reconstruction

15. More apt in soft tissue pathology diagnosis.
 images that provide information that is either
T1-weighted, proton densityweighted, T2-
weighted, T2∗-weighted, or IR:inversion
recovery.

16. joint effusion (arrow). osteomyelitis of the
middle phalanx (low
signal).

17. T2-weighted image of
same knee with
increased signal
characteristic of a
tear.

18. Proton density–
weighted sagittal
image of the knee
demonstrating an
anterior cruciate
ligament tear.
 Small joint effusion
and small popliteal
cyst.

19. T2∗-weighted coronal
image of the knee:
Small joint effusion
and
small popliteal cyst.

20. short-tau IR (STIR) and fluid attenuated IR (FLAIR) are used to
null the signal coming from a specific tissue such as fat or
cerebrospinal fluid (CSF), respectively.
Nulling the signal from a specific tissue allows the surrounding
tissue with similar signal characteristics to be visible.
A STIR pulse sequence, commonly used in musculoskeletal
imaging, is used to null the signal from fat. This allows
better visibility of free fluid and partial or complete tears.
This may be used in combination with a T2-weighted sequence
(Figure 1–14) to better visualize pathology that may be
difficult to see because of similar high (bright) signals.
 When imaging the brain or spinal cord, FLAIR images may
be used to null the signal from the CSF, allowing improved
visibility of the surrounding periventriclar area of the brain.

21.  STIR pulse sequence demonstrating osteomyelitis
(high signal) of the middle phalanx of The same
index finger.

22. T2∗-weighted
sagittal image of
the same knee
with fat
suppression.
Small joint
effusion and
small popliteal
cyst.

23.  Different tissues in our body absorb X-rays at different
extents:
 Bone- high absorption (white)
 Tissue- somewhere in the middle absorption (grey)
 Air- low absorption (black)

24. The initial assessment of any xray is the same:
Film Specifics:
Name of Patient
Age & Date of Birth
Location of Patient
Date Taken
Film Number (if applicable)
Film Technical factors:
Type of projection (Supine is standard)
Markings of any special techniques used

27.  A = Anatomic appearance, Alignment,
Asymmetry
 B = Bone Density
 C = Cartilage (joint, disk spaces), Contours
 D = Distribution, Density, Deformity
 E = Erosions
 S = Soft tissues

37. Trace the unbroken outline of each
vertebrae (including Odontoid on
C2). The vertebral bodies should
line up with a gentle arch (normal
cervical lordosis) using the anterior
and posterior marginal lines on the
lateral view. Each body should be
rectangular in shape and roughly
equal in size although some
variability is allowed (overall height
of C4 and C5 may be slightly less
than C3 and C6) . The anterior
height should roughly equal
posterior height (posterior may
normally be slightly greater, up to
3mm).

39. Trace the unbroken outline
of each vertebrae
(including Odontoid on
C2). The vertebral bodies
should line up with a
gentle arch (normal
cervical lordosis) using
the anterior and posterior
marginal lines on the
lateral view. Each body
should be rectangular in
shape and roughly equal
in size although some
variability is allowed
(overall height of C4 and
C5 may be slightly less
than C3 and C6) . The
anterior height should
roughly equal posterior
height (posterior may
normally be slightly
greater, up to 3mm)

40. Disc spaces should be roughly
equal in height at anterior
and posterior margins.
Disc spaces should be
symmetric.
Disc space height should
also be approximately
equal at all levels. In older
patients, degenative
diseases may lead to
spurring and loss of disc
height.

41.  Preverteral soft tissue swelling is
important in trauma because it is usually
due to hematoma formation secondary
to occult fractures. Unfortunately, it is
extremely variable and nonspecific.
Maximum allowable thickness of
preverteral spaces is as follows:

Nasopharyngeal space (C1) - 10 mm
(adult)
Retropharyngeal space (C2-C4) - 5-7 mm
Retrotracheal space (C5-C7) - 14 mm
(children), 22 mm (adults).Soft tissue
swelling in symptomatic patients should
be considered an indication for further
radiographic evaluation. If the space
between the lower anterior border of C3
and the pharyngeal air shadow is > 7
mm, one should suspect retropharyngeal
swelling (e.g. hemorrhage). This is often
a useful indirect sign of a C2 fracture.
Space between lower cervical vertebrae
and trachea should be < 1 vertebral body.

42.  Some fractures can be very
subtle, and soft tissue
swelling may be the only
sign of fracture. In this
case, the lateral view
shows only slight soft
tissue swelling anterior to
C2, and no obvious
fracture is seen. On the
subsequent CT, a type III
dens fracture (fracture of
the dens and extends into
the body of C2) is
demostracted.

44.  Alignment on the A-P view
should be evaluated using the
edges of the vertebral bodies and
articular pillars.
The height of the cervical
vertebral bodies should be
approximately equal on the AP
view.
The height of each joint space
should be roughly equal at all
levels.
Spinous process should be in
midline and in good alignment. If
one of the spinous process is
displaced to one side, a facet
dislocation should be suspected.

56.  Osteophytes
 Disc space narrowing
 Loss of cervical
lordosis
 Uncovertebral joint
hypertrophy
 Apophyseal joint
osteoarthritis
 Decreased vertebral
canal diameter

74.  Preferred imaging modality to address
suspicion of associated ligamentous injury and
the assessment of the status of nearby neural
tissues

75. 1. Vertebral body.
2. Intervertebral disc.
3. Posterior body edge adjacent to disc
space (site of potential osteophyte
formation).
4. Posterior disc margin (site of potential
disc prolapse).
5. Posterior longitudinal ligament (site of
potential ossification and cord
compression).
(6) Cerebrospinal fluid in front of cord.
(7) Spinal cord.
(8) Ligamentum flavum (site of potential
hypertrophy and cord compression)

77. Axial cervical spine anatomy.
(1) Anterior vertebral body endplate. (2) Uncus (constituting one side of
uncovertebral joint). (3) Vertebral artery within foramen transversarium. (4) Lower
facet. (5) Medial aspect of facet joint. (6) Lamina. (7) Site of attachment
ligamentum flavum. (8) Spinous process.

78.  major disruption of
the C4–5 segment in
 this 23-year-old man.
Increased signal
intensity is evident in
the intradiskal space
along with injury to
 the posterior
longitudinal ligament.
Edema within the
spinal cord is evident
spanning multiple
levels
 around the injury.

79.  A sagittal section T2-
weighted MRI of the
cervical spine in a 21-year-
old man. Note the
 signal change present
within the spinal cord
approximating the C3–4
levels, which is consistent
with
 edema and a spinal cord
contusion. This individual
was particularly
susceptible to injury
because of congenital
 stenosis.

80.  The outstanding feature
of this sagittal section
T2-weighted MR image
is the increased
 signal intensity
consistent with edema
from soft tissue injury.
The presence of such
findings warrants
 particular caution to
examine scrupulously
for the presence of
fractures.

81.  T1-weighted MRI
revealing basilar
invagination. Observe
the protrusion of the
odontoid
 process into the
foramen magnum and
the resulting
displacement of the
brainstem.

82.  In this sagittal slice of a
T2-weighted MRI of the
cervical spine in a 44-year-
old man,
 changes typical of the age
are evident including the
decreased signal intensity
of the cervical
intervertebral
 disks, bulging disks
(without herniation), and
osteophytic lipping at the
disk and vertebral body
 margins.

83.  In this sagittal section
T2-weighted MRI,
herniation of the C5–6
disk is evident.

84.  In this axial T2-
weighted MR image,
the effect of displacing
the spinal cord and
cervical
 nerve root is visible.

85.  A sagittal view T2-
weighted MRI revealing
advanced degenerative
change resulting in
 central spinal canal
stenosis. Note the
absence of signal from
the cerebrospinal fluid
in the areas of
 osteophytic growth and
disk bulging.

86.  Although this image is
somewhat degraded by
motion artifact,
involvement of the
vertebral
 body of C4 with findings
consistent with
osteomyelitis is readily
apparent. Images
degraded
 from patient motion are
frequently a challenge for
the physician undertaking
interpretation.

87.  In this sagittal section
T2-weighted MRI,
diffuse metastatic
disease is seen in
multiple cervical
 vertebrae as
highlighted by the
increased signal
intensity.

88.  This T2-weighted MRI
with contrast shows
areas of altered signal
within the spinal cord
 consistent with plaque
lesions typical of
multiple sclerosis. The
plaques are not contrast
enhanced,
 suggesting the image
was not captured
during a flare of the
disease.

89.  Same 4 lines are
present in normal
alignment
 Rectangular bodies
 Gradual increase in
disc height
 With caudal
progression in the
lumbar spine, the
interpedicular
distance increases

90.  Triangular canal

92.  Normal AP view

94.  Lateral view
radiograph
demonstrating wedge
compression
deformity of the T12
vertebral
 body.