Course Book

Radiology for 5th Year Students of College of Medicine/ University of Sulaimani: 45 Lectures

Course coordinator and list of teachers

of this course

1 -Name of the Course: Radiology .

2 -Lecturer\ tutor in charge: Dr. Ameer Ahmad

3 -Department\ Branch and the college: Dept. Surgery/ college of medicine/ University of Sulaimani

4 -Contacts:

-Address: University of Sulaimani/ College of medicine/ Dept.

of Surgery .

amirkurda@yahoo.com-E-Mail :

-Website Link:

-Other participant Lecturers:

1- Dr. Kawa Abdulla

2-Dr.Abeer Kadhum.

3-Dr.Salal Fatih Tel no. 07701473771 salahkalary@yahoo.com

4- Dr. Nasreen Atrooshi

Course Overview

The student will be taught how to use the different imaging modalities properly & which imaging modality fits particular situation.

The student should also learn how to read the radiographs of common clinical problems e.g. he or she should learn how to diagnose different fractures, pneumothorax, pneumonia, intestinal obstruction, pneumoperitoneum etc….. Not only that the graduated doctor should also learn how to read CT scan in patients with Stroke & head injury.

Lastly the student should be taught about the update of Radiology & that radiology is no more used for diagnosis only, it is taking part in the therapy as well i.e. Interventional Radiology.

Reading lists:

1-Diagnostic Imaging …Peter Armstrong & Martin Wastie…..

Sixth edition ……2009

2-Textbook of Radiology & Imaging …….David Sutton

Seventh Edition….2003

3- Bailey & Love's Short Practice of Surgery

24th Edition…2004 2nd Chapter

4- WWW.LearningRadiology

Syllabus

No. Title of the Subject Lecturer's/Tutor's Name

2 Introduction Dr.Ameer

7 Chest diseases Dr.Abeer

4 Cardio-vascular diseases Dr.Abeer

1 Plain abdomen Dr.Kawa

5 GIT Dr.Kawa

3 Hepato-biliary system

Pancreas & spleen

Dr.Kawa

2 Peritoneal cavity and

Retroperitoneum

Dr.Kawa

7 Urinary tract Dr.Nasreen

3 OBGYN Dr.Nasreen

4 Bone & joint diseases Dr.Salah

1 Bone Trauma Dr.Salah

2 Spine Dr.Ameer

2 Skull & Brain Dr.Ameer

1 Sinuses, orbits & Neck Dr.Ameer

1 Interventional Radiology Dr.Ameer

45 Total

Detail of Syllabus Two Lectures on Introduction & Technical Considerations: given by Dr. Ameer

Objectives:

-Proper use of imaging department.

-How X-rays are produced in Conventional Radiography.

Syllabus:

-The basic radiographic densities.

-Projections in conventional radiology:…PA. AP. Lateral, Horizontal X-ray

beam, Lateral decubitus

-CT Scan, Ultrasound, MRI, Radionuclide imaging & PET , Basic principles

-Contrast agents in Conventional Radiography & CT.. Definition & side effects

- PACS

-Radiation Hazards

Spine: Two Lectures given by Dr. Ameer

Objectives:

-Role of different imaging modalities in the diseases of the spine. (Plain

radiographs, MRI, CT, Myelography)

Syllabus:

-Signs of abnormality on plain films.

-How metastases/ myeloma/ lymphoma appear on different imaging modalities and which one is the best.

-Infection of spine; Pyogenic & TB spondylodiscitis.

-Spinal Trauma.

-Degenerative disc disease (DDD); plain film & MRI findings.

-Disc herniation.

-Failed back syndrome.

-Spinal canal stenosis.

-Ankylosing Spondylitis.

-Spinal dysraphism.

-Spondylolisthesis.

-Spinal cord compression.

-Intrinsic disorders of the spinal cord..

Skull & brain; 2 Lectures given by Dr. Ameer

Objectives:

-Role of different imaging modalities in head injury, Stroke, Brain tumors.

Syllabus:

-Plain film; normal & abnormal intra-cranial calcification.

-Signs of raised intra-cranial pressure on Plain films.

-Normal & abnormal Brain CT.

-Cardinal signs of abnormal CT brain.

-CT angiography.

-MRI of the brain.

-MRA.

-US of the Brain in neonates.

-Brain Tumors; How common brain tumors appear by CT & MRI ? e.g. glioma.

meningioma. acoustic neuroma, pituitary tumors & metastases.

-Stroke Role of CT to exclude hemorrhage initially.

-CT in subarachnoid hemorrhage..

-Role of CT in infarction.

-Role of MRI in infarction. DWI.

-AVM in MRI & MRA.

-Infection & brain abscesses.

-MS.

-Head injury; Role of CT to show epidural, subdural & parenchymal hemorrhage. Contusion & fractures.

Sinuses, Orbits & Neck one lecture by Dr. Ameer:

Objectives

-Role of Plain film & CT in sinusitis.

-Different causes of opaque sinuses.

-Role of CT in blow out fracture.

-Exophthalmus.

-Diseases of Salivary glands & Role of plain radiograph, Sialography, CT & MRI.

-Thyroid nodules; Role of US & radionuclide scan.

Interventional Radiology: one Lecture by Dr. Ameer.

Objectives

To let the student know that Imaging has not only the role in diagnosis of diseases, but it can be of great help in treatment & may replace surgical procedures.:

How can imaging guide biopsy? Draining abscesses? putting stents & e.g biliary drainage ? .

Different interventional procedures via angiography; e.g. embolisation, thrombolysis.

Plain abdominal radiographs: One lecture given by Dr. kawa Abdulla

Objectives:

Proper analysis of plain films

Illustration of causes of abnormal plain films

Syllabus:

-The basic plain abdominal radiographs.

-illustration of normal & abnormal plain films

-analysis of GIT dilatation

-analysis of extraluminal air.

-analysis of GIT opacities & calcification on plain films

-analysis of hepatic & splenic abnormalities on plain films

-analysis of ascites; abdomino-pelvic masses on plain films

GIT Contrast examination &other imaging modalities:

Five Lectures by Dr. kawa

Objectives:

Analysis of role & findings of contrast studies & different imaging modalities in the GIT including US; CT; MRI; isotope studies& angiography

Syllabus:

-proper technique; limitations & hazards of contrast examinations.

-proper technique; limitations & hazards of other imaging modalities.

-analysis of causes & findings of barium study abnormalities; including

strictures; filling defects & ulcerations.

-dedicated evaluation of major topics: GIT malignancies; peptic ulcer;

malabsorption syndrome; ulcerative colitis & Crohns disease with

diverticular disease.

-emphasis on the role & findings on US; CT; MRI

-emphasis on the role & findings of isotope studies& angiography especially

in GI bleeding

Hepato-biliary system; three Lectures given by Dr. kawa

Objectives:

-analysis of role & findings of US; CT; MRI; isotope studies & angiography

in Hepatic; biliary; splenic & pancreatic problems

-analysis of role; findings; limitation& hazards of biliary contrast

examinations & isotope studies.

Syllabus:

-normal imaging appearances of liver; spleen; pancreas & biliary system

with the gall bladder.

-analysis of causes & findings of liver masses; cysts & abscesses.

-analysis of findings in cirrhosis & portal hypertension and in liver trauma.

analysis of role; findings; limitation& hazards of ERCP; PTC –

-analysis of imaging findings & limitations in cholecystitis ; GB &bile duct

stones

-analysis of imaging evaluation of jaundice starting with non invasive

studies US, CT; MRI & MRCP with occasional isotope studies then to

diagnostic& therapeutic ERCP & PTC

-dedicated evaluation of causes & findings in splenomegaly

-emphasis on the imaging findings in splenic trauma

-analysis of imaging role & findings in pancreatic tumors and in acute &

chronic pancreatitis.

Peritoneal cavity & retroperitoneum; two Lectures given by Dr. kawa

Objectives:

-analysis of imaging role & findings in ascites; peritoneal tumors& intra-

peritoneal abscesses

-analysis of imaging role; findings & limitation in evaluation of the adrenal

glands; abdominal aorta; para-aortic lymphadenopathy& retroperitoneal

tumors and abscesses.

Syllabus:

-analysis of imaging role & findings in ascites.

-analysis of role & findings of US; CT& isotope studies in intra-peritoneal

abscesses.

-analysis of findings on US& CT in peritoneal tumors

-US; CT & MRI appearance of normal retroperitoneal structures

- US& CT evaluation of para-aortic lymphadenopathy.

-imaging evaluation of adrenal adenoma-functioning conns & Cushing's and

non functioning adenomas

- US; CT; MRI &isotope studies evaluation of pheochromocytoma & adrenal

metastases

- Aortic aneurysms US; CT; MRI &angiographic evaluation.

-imaging evaluation of retroperitoneal abscesses & tumors

Chest : Seven lectures given by Dr . Abeer Kadum Abass

Objectives :

1- Role of different imaging modalities in the evaluation of different chest diseases .

2- Proper reading of normal CXR . 3- Correlation between clinical & CXR findings for accurate way of

achieving diagnosis .

Syllabus :

- Normal CXR interpretation .- Abnormal chest radiograph ; Silhouette sign & radiological signs of

lung diseases : air space filling ( pul. Odema & pul . consolidation ) , pul . collapse , spherical pul. Shadows , band like pul. Shadow , wide spread small shadows .

- Pleura ; CXR findings , & causes in pleural effusion ( free & loculated ) .

- Pleural thickening .- Pleural tumors .- Pneumo thorax ( diagnosis , causes & types ) .- Mediastinum ; compartment , plain chest film findings in mediastinal

masses & complementary CT. Pneumo - mediastium ( causes & CXR findings ).

- Hilar enlargement ; unilateral & bilateral ; causes & CXR findings .- Diaphragm : Normal anatomy , variant & causes of marked unilateral

elevation of hemi diaphragm .- Specific diseases : Infection : Bacterial pneumonia , viral &

mycoplasma pneumonia , lung abscess , pulmonary TB ( Primary & post primary ) , fungal & parasitic disease, pneumonia in immunocompromised host .Sarcoidosis . diffuse pulmonary fibrosis ; CXR findings & try to determining the cause of the abnormal CXR findings .

- Diseases of air way passages ( Asthma , bronchiolitis , acute bronchitis , chronic obstructive air way diseases , cystic fibrosis ) ; definition , & CXR findings ) .

- Respiratory distress in the new born (Meconium aspiration & hyaline membranes disease) CXR findings & complications of therapy.

- ARDS; causes & CXR findings.- Pulmonary embolism & infarction (CXR diagnosis, role of CT

angiography & Radionuclide scanning) .- Trauma to the chest (CXR & CT ) findings .- CA Bronchus (CXR findings in peripheral & central) , spread .- Metastatic neoplasm to the chest (lung, chest wall, pleura, &

mediastium) .- Lymphoma in the chest.- Mammography; indications, plain radiograph & US findings in benign

& malignant focal lesions.

Cardiovascular system ( CVS ) :

Four lectures given by Dr . Abeer Kadum Abass .

Objectives:

1- Role of imaging techniques in evaluation of cardiovascular

disease.

2- Proper interpretation of the CXR; regarding normal & cardiac

diseases.

3- Emphasized that CXR is useful for looking at the effects of cardiac diseases on the lung & pleural cavity , but provide only limited

information about the heart itself .

Syllabus:

- Evaluation of the CVS , with CXR , Echo & Doppler , CT & CT angiography , MRI & MRA , Radionuclide techniques , cardiac catheterization & angiography .

- Cardiac disease; size (common causes of chamber enlargement), Chamber hypertrophy & dilatation.

- Valve movement deformity & calcification.- Ventricular contractility.- Pericardial diseases (effusion & calcification).- Pulmonary vessels: increased flow (CXR appearance & causes),

decreased flow (CXR appearance & causes).- Pulmonary arterial hypertension causes & CXR appearance.- Pulmonary venous hypertension causes & CXR appearance.- Pulmonary odema : Types , causes & CXR findings .- Specific cardiac disorders; Heart failure , valvular heart disease , LT –

atrial myxoma & other intracardiac tumors .- Common Congenital heart diseases; LT –RT shunt, coractation of

aorta , Tetrology of Fallot .

Bone & Joint diseases: Four Lectures by Dr. Salah Kalary- First: principal of reading of bone images in different modalities

specially plain X-ray- Second: how student can approach focal bone lesion & steps of

imaging consequences- Third: principal of differentiation between aggressive & benign bone

lesions- Fourth: principal of differentiation between joint degenerative

changes like OA & inflammatory joint diseases like RAFifth: information about criteria of differentiation between most common type of polyarticular joint diseases.

- Syllabus:- Imaging techniques used in Dx of bone disease( role of different

imaging modalities in approaching the bone disease- Signs of bone disease in plain X-ray - Types of bone diseases; focal , generalized & alteration in the

trabecular pattern or changes in the shape - Radiological approach for diagnosis of solitary bone lesions - Bone tumors, including primary (benign & malignant)& secondaries- Bone infection: Pyogenic (acute & chronic) & TB- Generalize decreased bone density (osteopenia)- Osteoporosis.- Rickets &Osteomalacia.- Hyperparathyroidism.- Multiple myeloma. - Generalized increase in bone density- 1-Paget’s disease- 2- Thalassemia - 3-Radiation induced bone diseases

- Changes in bone shapes- Diaphyseal aclasia- Joints diseases ( 2 lectures each of 1 hr)- Imaging technique (roles of each modalities in Dx of joint disease)- Approach in Dx of arthritis & radiological features of deferent type of

arthritis including OA, inflammatory & metabolic arthritis & principle differentiating radiological points between them

- Osteochondritis including Perthe’s , Kienbock’s disease - Freiberg’s disease Kohler’s disease- Slipped femoral epiphysis- Developmental dysplasia of the hips (DDH or CDH)- Internal derangement of the knee joint- Shoulder Rotator cuff tear

Bone Trauma: One Lecture by Dr.Salah Kalary.

Objectives:

- Role of plain radiograph in bone trauma.

- Signs of Fracture & dislocation.

- Role of nuclear medicine, CT & MRI in bone trauma,

- Stress fracture.

- Insufficiency fracture.

- Pathological fracture.

- Salter Harris classification.

- Non-accidental trauma.