# Diagnostic Radiology

Radiology is the branch of medical science dealing with medical imaging. It may use x-ray machines or other such radiation devices. It also uses techniques that do not involve radiation, such as MRI and ultrasound.

## General Types of Radiology

As a medical specialty, radiology can refer to two sub-fields, diagnostic radiology and therapeutic radiology.
Diagnostic radiology is concerned with the use of various imaging modalities to aid in the diagnosis of disease. Diagnostic radiology can be further divided into multiple sub-specialty areas. Interventional radiology, one of these sub-specialty areas, uses the imaging modalities of diagnostic radiology to guide minimally invasive surgical procedures.
Therapeutic radiology—or, as it is now called, radiation oncology uses radiation to treat diseases such as cancer using a form of treatment called radiation therapy.

## Imaging Modalities

Commonly used imaging modalities include plain radiography, computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, and nuclear imaging techniques. Each of these modalities has strengths and limitations which dictate its use in diagnosis.

### Radiography

Radiographs are images created with X-rays, and used for the evaluation of many bony and soft tissue structures. Fluoroscopy and angiography are special applications of X-ray imaging. Fluoroscopy is a technique where a fluorescent screen or image intensifying tube is connected to a closed-circuit television system to image internal structures of the body. Angiography uses methods to demonstrate the internal structure of blood vessels, highlighting the presence and extent of obstruction to the vessel, if any. In medical imaging, contrast media are substances that are administered into the body, usually injected or swallowed, to help delineate the anatomy of blood vessels, the genitourinary tract, the gastrointestinal tract, etc. Contrast media, which strongly absorb X-ray radiation, in conjunction with the real-time imaging ability of fluroscopy and angiography help to demonstrate dynamic processes, such as the peristalsis of the digestive tract or blood flow.

### CT scanning

CT imaging uses X-rays in conjunction with computing algorithms to image tissues in the body. Imaging is usually performed in the axial plane; however, computer reconstructions can be rendered in other planes or to produce 3D images. Contrast media is often used to delineate anatomy and allows 3D reconstructions of structures, such as arteries and veins. Although the resolution of radiographs is higher for imaging of the skeleton, CT can generate much more detailed images of soft tissues. CT exposes the patient to more ionizing radiation.

### Sonography

Medical ultrasonography uses ultrasound (high-frequency sound waves) to visualize soft tissue structures in the body in real time. No radiation is involved, but the quality of the images obtained using ultrasound is highly dependent on the skill of the person performing the exam. Ultrasound procedures are best used for ante natal checkups. It is not harmful to fetus nor to the mother.

### MRI Magnetic Resonance Imaging

MRI uses strong magnetic fields to align spinning atomic nuclei (usually hydrogen protons) within body tissues, then disturbs the axis of rotation of these nuclei and observes the radio frequency signal generated as the nuclei return to their baseline status. MRI scans give the best soft tissue contrast of all the imaging modalities. With advances in scanning speed and spatial resolution, and improvements in computer 3D algorithms and hardware, MRI has the potential for great development in the next few years. One disadvantage is that the patient has to hold still for long periods of time in a noisy, cramped space while the imaging is performed.

### Nuclear medicine

Nuclear medicine imaging involves the administration into the patient of substances labelled with radionuclides or radiopharmaceuticals which have affinity for particular tissues. Generally speaking, Technecium-99m (half-life 6.02 hours) is the radionuclide used. The heart, lungs, thyroid, liver, gallbladder, and bones are commonly evaluated for particular conditions using these techniques. While anatomical detail is limited in these studies, nuclear medicine is useful in displaying physiological function. Processes such as the growth of a tumor can be monitored this way, even when the tumor cannot be adequately visualized using any of the other imaging modalities. Nuclear medicine also involves the therapeutic administration of isotopes labeled to antibodies or other substances, therefore delivering a high dose of radiation to specific targets such as tumors or the thyroid gland.

## Normal Radiological Anatomy

* Musculoskeletal Anatomy
* Chest Anatomy
* Cardiovascular Anatomy
* Gastrointestinal Anatomy
* Vascular Anatomy
* Neuroradiological Anatomy

## Imaging of Specific Anatomic Regions

This section assumes that you already know what the diagnosis is, and just want to know more about that disorder.
* Musculoskeletal Imaging
* Chest Imaging
* Cardiovascular Imaging
* Gastrointestinal Imaging
* Vascular Imaging
* Neuroradiological Imaging

## Diagnosis of Specific Anatomic Regions

This section assumes that you don't yet know the diagnosis, and are trying to move from the findings to the diagnosis.
* Musculoskeletal Diagnosis
* Chest Diagnosis
* Cardiovascular Diagnosis
* Gastrointestinal Diagnosis
* Vascular Diagnosis
* Neuroradiological Diagnosis

## Imaging in Pediatric Radiology

This section covers Pediatric Radiology by regions and etiology.
* Pediatric Radiology by Region
* Pediatric Radiology by Etiology

## Cancer Screening
### Screening Mammography

* Stephen W Duffy et al. Mammography screening reduces rates of advanced and fatal breast cancers: Results in 549,091 women. Cancer. 2020 Jul 1;126(13):2971-2979. (PMID: 32390151)
* Sahand Hooshmand et al. A review of screening mammography: The benefits and radiation risks put into perspective. J Med Imaging Radiat Sci. 2022 Mar;53(1):147-158. (PMID: 34969620)

### Low-Dose Computed Tomography (LDCT) Screening

* Asha Bonney et al. Impact of low-dose computed tomography (LDCT) screening on lung cancer-related mortality. Cochrane Database Syst Rev. 2022 Aug 3;8(8):CD013829. (PMID: 35921047)
* Richard M Hoffman et al. Lung Cancer Screening with Low-Dose CT: a Meta-Analysis. J Gen Intern Med. 2020 Oct;35(10):3015-3025. (PMID: 32583338)
* Daniel E Jonas et al. Screening for Lung Cancer With Low-Dose Computed Tomography: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2021 Mar 9;325(10):971-987. (PMID: 33687468)

## Oncologic Imaging
### Breast Imaging Reporting and Data System (BI-RADS)

* D A Spak et al. BI-RADS® fifth edition: A summary of changes. Diagn Interv Imaging. 2017 Mar;98(3):179-190. (PMID: 28131457)
* Samuel J. Magny et al. Breast Imaging Reporting and Data System. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. 2022 Aug 29. (PMID: 29083600)

### Ovarian-Adnexal Report Data System (O-RADS)

* Rochelle F Andreotti et al. O-RADS US Risk Stratification and Management System: A Consensus Guideline from the ACR Ovarian-Adnexal Reporting and Data System Committee. Radiology. 2020 Jan;294(1):168-185. (PMID: 31687921)
* Elizabeth A Sadowski et al. O-RADS MRI Risk Stratification System: Guide for Assessing Adnexal Lesions from the ACR O-RADS Committee. Radiology. 2022 Apr;303(1):35-47. (PMID: 35040672)

## Interventional Radiology
### Radioembolization

* Hojjat Ahmadzadehfar et al. Radioembolization, Principles and indications. J Clin Med. 2019 Jan 7;8(1):55. (PMID: 35354218)
* Aman Saini et al. History and Evolution of Yttrium-90 Radioembolization for Hepatocellular Carcinoma. J Clin Med. 2019 Jan 7;8(1):55. (PMID: 30621040)

## External resources

* Radiology Search — Radiology search is a peer-reviewed Radiology search engine.
* SearchingRadiology.com — Searching radiology peer-reviewed information
* RadiologyEbooks.com — a digital library of free educational radiology Ebooks and radiology Apps.
* Indian Journal of Radiology — Radiology in India.
* American Roentgen Ray Society — much information on radiology, including online American Journal of Roentgenology
* Radiology Links — browse the categorized medical imaging links.
* British Institute of Radiology — an independent forum which aims to bring together all the professions in radiology and allied medical and scientific disciplines
* RadiologyEducation.com — a digital library of radiology education resources
* Radiological Society of North America — huge amount of information on radiology, including links to online journals Radiology and Radiographics
* Radiology Teaching Files,hvac training — Collection of cases including challenging case of the week. www.svhrad.com
* Royal College of Radiologists — information on radiology and the Royal College (UK)
* Society of Interventional Radiology
* University of Washington Online Musculoskeletal Classroom — This site is currently donating many of the articles and images from its Resident Projects section to this textbook (registration for a no-cost and spam-free account is required to view the contents).
* Radiology Internet Journal Club
* Loyola University — A good introduction to reading chest X-rays
* Radiopaedia.org — encyclopedic collaborative resource with many cases]
* American College of Radiology
* Ultrasound Technician News and Information
* Radiology information for patients
* "Raynux: OpenSource and Radiology"
* RadiologyEd - radiology resource library — An education focused resource list with many cases

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