Tuesday, July 31, 2012

Follow up on Peroneal Split-MRI

Here is a  image of a full split, by Dr Brian Sabb, Here you can also see the convex fibular groove and the formation of a fibular spur.

Monday, July 30, 2012

Split Peroneus Brevis Tendon-MRI

Splitting of  of peroneus brevis tendon is more common than full thickness tear including that of  the tears of the long peronius tendon. Axial proton desity fat sat MRI shows splitting (has an inverted  'u' shape) in the peronius brevis and an intact peronial longus. There is fluid along the tendon sheath. The sagittal images are misleading.
Case submitted by : Dr. Vougiouklis Nikolaos

Tribute to Robert Ledley

Robert S. Ledley, 86 yr, biomedical researcher  who invented the first CT scanner capable of producing cross-sectional images of any part of the human body, died on Tuesday. Many of the CT scanners we see in hospitals are based on the Ledley design. Rest in Peace.

How old is practice of Teleradiology?

Teleradiology or the interpretation of facsimile roentgenograms obtained from distant sources by telephone or radio, has been used continuously since 1947. Following the initial trial of this system between Chester County Hospital, West Chester, Pa., and Philadelphia, a circuit was established over busy commercial telephone channels between the Ventnor Clinic in Atlantic City, N. J., and Philadelphia, a distance of 60 miles.

Reference : Gershon-Cohen, J., and Cooley, A. G.:  Roentgenographic Facsimile: A Rapid Accurate Method for Reproducing Roentgenograms at a Distance via Wire or Radio Transmission , Am. J. Roentgenol. 61:557-559 ( (April) ) 1949.

Sunday, July 29, 2012

Reduced CT Density Thyroid Gland

Thyroid gland appears bulky and shows reduced CT density. Normal thyroid gland is usually hyperdense because of iodine content. Hypodensity of thyroid on CT may indicate thyroid abnormality and requires further evaluation with thyroid function test. This may indicate decreased ability to concentrate iodine. This patient was clinically suspected as hypothyroidism and has midline swelling and hoarseness of voice.

Thursday, July 26, 2012

Non-traumatic Pneumopericardium-CXR

This is unusual CXR submitted by a medicine colleague Dr Achin Mehra, which shows pneumopericardium with no trauma and pericardial tap was suggestive of pyo-pneumopericardium due to gas forming organism. It is differentiated from pneumomediastinum as it does not extend beyond the aortic root.

Should Radiologists in India be allowed to compete for Clinical Superspecialization (DM)-Debate on social media

This is a thread from the facebook debate about Radiologist being allowed to compete for clinical DM as well. What do you say fellow Radiologists? This debate on our famous RRC (Radiology Resident Club) on facebook. A radiologist started this debate by this post and following this are the replies and comments::

Radiologist 1

Hello friends, colleagues and my seniors,,,,
Today we are standing at the cross-roads.. We entered the stream of radiology with hopes and aspirations considering it to be one of the most challenging branches in the fields of medicine... But for last few days, few questions are buzzing my head after I have encountered the real lyf experiences... I want to share them wid you...

- I strongly feel that we are treated as a "second class citizens" in the field of medicine.... Al of us would agree to the point that there is a vast difference between the current scenario in radiology compared to the yesteryears.. Now, radiology is studded with the most brilliant brains in the field of medicine. But somehow i feel all our brilliance comes to an end point due to incompleteness of the subject itself. 
- I feel that our potentials are never exploited to the fullest extent.. We deal with all the branches in the health sciences and we are better acquainted with pathological anatomy of the body then any one else... So I hv few questions to discuss wid u people where I also need ur valuable suggestions...
We should be allowed to do DM in the branch of Gastroenterology and Neurology to which we are intrinsically and indispensably related... Except for the part of endoscopic procedures, we almost do all the imaging as well as interventional procedures with in depth knowledge of all the diseases included in these branches,, My point is if a MD paediatrician is allowed to persue DM in these branches without getting exposed to some f the disease processes(E.g., Alcoholic liver diseases), then why should we be deprived from doing the same.. Another good example is that a biochemist is allowed to do DM in the branch of Endocrinology... We are quite capable of doing justice to the patient if we are allowed to pursue these courses,,,
So kindly think over it and put ur valuable suggestions..

Sumer Sethi i think u ve put across a valid question but need of the hour is not fighting for clinical DM but having our own subspecialities and practises... better would be to have DM Gastro-rad, DM Neuro-Rad, DM MSK, etc...time has come for people to realise that going for pay packages is not the only goal of life, idea is to be good at what u do.. and we need Sub-specialization in India Radiology soon...  if we have to treated with respect by super specialists we need to be good at what we do...

Radiologist 2 ....superspecialisation is only going to solve the problem partially. cases will still be sent by a so called clinician who will not give you any clinical information . entering into the clinical field as initial post has suggested is a much better option. be the king of yourself
Radiologist 3 agree wt you,  i specially feel so 4 neuro..
Radiologist 4 i completely agree with sumer..we ought to subspecialise..it will definitely be more involving and satisfying work - wise..
Radiologist 1 Thanx to all.. I have just shared my thoughts wid u.. My idea is not to earn money by becoming a clinician, but to work in a better enviroment.. I think all of us wil agree that we have to gv a gud amount of incentive to the clinicians for every cases .. Which reallly make me feel bad... N idea about doing DM is to open a new horizon for the radiologist.. Coz I think, there wil be a long list of radiologist who want to do sumthng more than wat they do rite now..
Sumer Sethi Radiollogy in essence is about diagnosing and we have to best in what we do, improved training and subspecialization is need of hour.. if u want to be a clinician-- interventional radiology is ur forte..
Radiologist 5 if any body thinks that we r not clinician it is wrong. my teacher scolded us so many times for not considering clinician. without clinical knowledge and training one ant come up to diagnosis and without diagnosis on cant intervene it ( so called clinicians/ interventional radiologist).
Radiologist 6  Also clinicians with no qualifications (radiological) whatsoever should not be allowed to practice radiological modalities and should be considered as malpractice....If they think they are better than us they should be made to give md exams just as we do after procuring pg seats like we do.....
Radiologist 7  I totally agree wid Dr, sumer, sub specialty is the order of the day. I have been following Dr sethi for quite some time, I also subscribe to his views on radiologists not accepting pay package handed out by the clinic/diagnostic centre owners. I understand kaushik and akshay's genuine concern as they prepare themselves to face the world as professionals.
Sumer Sethi yes problem is radiologists like any other professional is lured into working for other by pay package.. let it be profit sharing relantionship only..
Radiologist 8 i totally agree with intial post....md radiology should be considered eligible for dm in gastroenterology, neurology and pulmonary medicine.....if md pediatrics is allowed to do dm in gastro....why not us......n i think who else see the abdomen more than us.....the horizon of radiology should be enlarged.....odr than endoscopic procedures we are capable of doing all imaging and interventional procedures.....we do all d diagnosis n interpretation n clinicians take the appreciation from all.....lets change the system.....
Radiologist 2 why do you think we are not capable of endoscopy we actually are and can perform similar endoscopies or even better the same way as they think they are equal or better to us in radiology
Radiologist 3 ..ur teacher had to scold u for not considering urself clinician...it means before ur teachr scolded u, u dint consider urself as clinician....so dre must be some reason for considering urself as non clinician....u seem to contradict ur own opinion....n again in ur previous post u said....sabkuch hum karenge to CLINICIANS kya karenge.....here whom do u refer as clinicians....atleast u dint include urself by saying clinicians....dat means u r not a clinician.....newys....what Poster has suggested seems great....if we fight n get it .....we wl be d kings....

Radiologist 2  my view is very specific and very harsh too. So called clinicians think they know more radiology than us and try to humiliate us using their clinical knowledge which is wrong. It is their legal responsibility to provide us with specific clinical details and clinical differentials it is what they have been trained for, paid for and govt spends lakhs for which they are not doing. It is the responsibility of senior radiologists in institutes to stringently ask for clinical details corm the clinicians. These branches of medicine have been devised to work as a team and not to use as weapons against anyone. make a rule of providing clinical details in writing and legal implications of not doing so and you will see change in standard of radiologists also. d worst part is our knowledge and expertice is measured and examined by d so called clinicians , who (not all) has atleast less radiological knowledge than us.....if they say that reporting was correct....its gud....n if they disagree, even if they r wrong....radiologists have to be blamed.....

Radiologist 1 d career of a radiologist is very uncertain....our job is time bound....even though u r called a consultant radiologist u r alwys answerable to d owner/clinicians....u wl have to wait for patients or must be available according to patients convinience....no one is going to wait for u.....most importantly u wl have to work in a way so that it pleases the clinicians.....may it be time factor or reporting....we are so much dependent on odrs.....how long wl d radiologists keep doing such things....where is our self respect...where is our dignity.....frends dont u thnk we should do somethng to change this?????? someone said that clinicians so solely dependent on us....yes its true....but when they send a patient to u they think it d odr way....if a clinician sends a patient to a radiologist, he/she thinks that its d clinician who has helped us providing our roti....n on d odr hand we think we have helped them....ofcourse we help them but our help is never acknowledged....rather we have to thank them for sending d case...inspite of providing d illegal cuts...

Sumer Sethi lets discuss two things separately, academic side of it and business side of it... it is some of the radiologists who started the cut practise and we cannot blame the referring physicians fully for this, you cannot clap with one hand... however, academically speaking we need much more improvement in quality that we are seeing right now... and subspecialization will get our respect back if not business...
Radiologist 1  i have been a follower of u, sir, even before i entered radiology....we have lot of scopes for improvement academically....sir...need ur guidence alwys....bur a points feel that even the bestest of the radiologist is not properly recognised for his/her work.....d fight is for all radiologists...for our existance....

Radiologist 9  sir,if u r interested in clinical superspeciality u can do intervention radiology.., if u r so much intersted in doin gastro or some other DM den u should hav joined MD GEN MED OR MD PAED..,its u who choose MD RD..,so y now worry bout spilled milk..,lets put our creative energies on how to improve radiology - academically & economically.
Radiologist 10 todays scenario is clinicians refer patient for radiological investigations and think that they are providing roji roti and completely forgetting the fact that radiological opinion is atmost important for his stuck up management without diagnosis...this mind set will not change even after radiologist do sub speciality..academically it will satisfy radiologist and few of the genuine referring peoples also ( by the way do they really exist?) else nothing will change much..and after doing subspeciality radiologist will stuck up with that limited group of referring people...ortho people still will feel they know more MSK MRI than a radiologist who has done sub speciality in it and so will the neuro people.... 

Saturday, July 21, 2012


"Large herbivores like Diplodocus got through enormous amounts of plants, their exact eating habits have remained unknown. Researchers from the University of Bristol and the Natural History Museum created a 3D model of a complete Diplodocus skull using data from a CT scan. This model was then biomechanically analysed to test three feeding behaviours using finite element analysis (FEA). Diplodocus' skull, with its long snout and protruding peg-like teeth restricted to the very front of its mouth, was perfectly adapted to strip leaves from tree branches."

Wednesday, July 18, 2012

Sodium MR for MS-New Update

Latest online edition of Radiology has concluded total sodium concentration (TSC) accumulation dramatically increases in the advanced stage of RR MS, especially in the normal-appearing brain tissues, concomitant with disability. Brain sodium MR imaging may help monitor the occurrence of tissue injury and disability.  For this study, authors used Three-dimensional 23Na MR imaging data were obtained with a 3.0-T unit

Tuesday, July 17, 2012

Dorsal Epidural Lipoma-MRI

Evidence of long segmental lipomatous leison noted in posterior epidural space. It is hyperintense on both T1W and T2W sequences and extends from D4 to D9 level and indents posterior thecal sac. Spinal cord appears normal in signal intensity and caliber throughout its extent. Case by Dr Swati Shah, Dr Sumer Sethi

Monday, July 16, 2012

Benign post-traumatic intracranial hypertension

This patient has history of headache with minor head injury 20 days back. There is evidence of partially empty sella and distended optic nerve sheaths which may indicate benign intracranial hypertension.  Benign post-traumatic intracranial hypertension has been reported following minor head injuries and following is a good reference for this. Further Reading.

Wednesday, July 11, 2012

Possible Sacrococcygeal Chordoma-MRI

75 year old male. There is presence of an expansile 14 x 10 x 10 cm sized mass noted in sacrococcygeal region involving sacrum sparing S1 vertebra with associated soft tissue component.It involves sacral foramina and sacral spinal canal. It is hypointense on T1W , hyperintese on T2W with lobulated margins and internal sepatated appearance. Anteriorly, large presacral soft tissue component indents the posterior wall of rectum with preserved intervening fat plane. Laterally, the mass infiltrates paraspinous muscles and left gluteus medius muscle and appears to be infiltrating left sciatic fossa with involvement of left sciatic nerve in gluteal region.  Posteriorly it extends upto subcutaneous fat . On MRI, sacrococcygeal chordomas are lobulated tumors, typically with low to intermediate signal intensity on T1-weighted images and heterogeneous high signal intensity on T2-weighted images. Case by Dr Sumer Sethi, Dr Swati Shah, Dr Ajay Garg, Dr Harwinder Bakshi (Orthopedician)

Monday, July 09, 2012


Skull shape is abnormal, non-visualized parieto-occipital and coronal sutures.  Sagittal suture is partially seen. There is evidence of exopthalmos because of shallow orbits. Skull shows lacunar defects/ Lueckenschaedel -appearance. Middle cranial fossa is pushed downwaord and forward. Findings are consistent with craniosynostosis (oxycephaly possible) .

Lacunar skull appearance;  Also known as: craniolacunia, mesenchymal dysplasia, may appear normal after several yrs associated with: Chiari malformation (almost always !), In contrast, increased intracranial pressure has: beaten-silver appearance, closed sutures, with or without abnormal skull size (Lueckenschaedel) So lacunar skull is synonym to “ Lueckenschaedel "
By  Dr. A. M. Altamimi
Consultant Radiologist
Canadian Specialist Hospital
Dubai, United Arab Emirates

Antioxidants before getting an Xray Done?

In the latest issue of Radiology, James Brink and John D. Boice observe that the scientific evidence linking the use of a mixture of antioxidants and glutathione-elevating compounds with a reduction in the number of double-strand DNA breaks in peripheral blood lymphocytes is an exciting step toward a biologic protective agent against the potential damaging effects of ionizing radiation at low doses.

Reference : Radiology July 2012 264:1-2; doi:10.1148/radiol.12120712

Wednesday, July 04, 2012

Perianal Fistula-MRI

Grade IV trans-sphincteric , translevator perianal fistula with internal opening in rectum at 2'o clock position on left side with perianal abscess track extending into gluteal region and showing futher bifurcations and multiple cutaneous openings in left gluteal region as described above. Also horse shoe extension of left perianal abscess is seen with extension of lesion in right interspincteric region. Case submitted by Dr Swati Shah, Dr Ajay Garg, MD Hospital.

Tuesday, July 03, 2012

Epidural Arachnoid Cyst

Evidence of an oblong posterior epidural lesion posteriorly extending from D11-L2 levels appearing hypointense on T1 weighted images and hyperintense on T2 WI, with no significant enhancement & scalloping of the posterior elements at these levels. Possible posterior epidural arachnoid cyst. This is a  14 year old boy with back pain.

Learning Point: Epidural cysts are most commonly located posteriorly and displace the dura. Larger lesions may cause symptoms by compressing the spinal cord. Most occur in the thoracic spine posteriorly. There may be erosion of the adjacent bony elements of the spinal canal.

Monday, July 02, 2012

Mammogram-Possible Malignancy

There is presence of architectural distortion and asymmetrical density noted in retroareolar region. A spiculated lesion is noted at fatty and glandular parenchymal interface. Clusters of microcalcification is noted. Areolar skin thickening and nipple retraction are noted.  Possibility of malignant lesion in retroareolar region . BIRADS - IV C. Case Submitted by Dr Swati Shah, MD, FRCR.

Sunday, July 01, 2012

Social Media from the Radiology Perspective: Interview

Social Media from the Radiology Perspective: Interview with yours truly, Sumer Sethi, is now featured in webicina.com by Dr  Bertalan Meskó.
Here is the link to the complete interview, enjoy!

Blog Archive