H

LA
SA
C
R

By Dr Salah
M
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Imaging for GIT

-0
Xray - Erect Chest Xray - If asking for initial management
For perforated viscus /duodenal ulcer (initial management)
Intestinal Obstruction - Dilated loop/Air fluid level

O
Ultrasound For any collection like abscess
Gall Bladder - Thickening of wall
Pericystic fluid collection- inflammation
Intra/extrahepatic biliary dialation
CBD Stone - MRCP/ERCP (Diagnostic and Therapeutic)
If ERCP fails then PTC

H
O
CT scan Pancreatic Necrosis
Hepatic Hydatid Cyst
Colonic Abscess

LA
Staging and Grading

o
CT with Contrast If asking for best investigation
Any suspected perforation - Colonic Perforation /
Complicated diverticular disease
Traumatic Perforation
SA
O
MRI For pts with Liver lesion - like metastasis

O
Enema Gastrograffin- Any perforation / leakage
C

water soluble - Acute obstruction

Acute Diverticulitis
R

Barium Enema - Fistula Uncomplicated diverticular disease

Follow Through contrast - Bowel - Ileum / jejunum pathology

M

-
Upper GI Endoscopy Massive fresh bleeding / haematemesis
Malena- first Upper GI endoscopy -then angiography

O
Colonoscopy Rectal bleeding - in clinic - 1. Sigmoidoscopy
2. Colonoscopy If normal then
3. Upper GI endoscopy if normal then
4. Angiography to diagnose angiodysplasia

o
Angiography 1) Rectal bleeding When colonoscopy and sigmoidoscopy and upper GI
endoscopy all negative
2) Vascular cause like mesenteric ischaemia
 o
Orthopaedic Imaging

Th
X - ray Initial investigation for trauma
Fracture, Dislocation

O
CT Scan Best investigation for fractures
Missed or unclear fracture

H
Intraarticular fracture
Complex Supracondylar fracture
Calcaneal fracture for more details
Scaphoid fracture not clear in X-ray

O
MRI

LA
Soft tissue oedema
Knee ligaments
Back/ Spine - Disc prolapse with neurological manifestations
SA
Joints - Ligaments, Capsule involvement
Scaphoid fracture- Early (first 24 hours) for soft tissue oedema

O
Bone Scan Metastasis
Perthes disease
C

O
Back Pain 1. Initially - Xray
R

2. Traumatic - CT Scan
3. Cauda equina syndrome/ Neurological manifestation - MRI
4. Signs of Metastasis- Bone Scan
M

o
Scaphoid Fracture 1.Scaphoid fracture with soft tissue oedema - MRI
(Usually initial 24 hours)
2. Missed fracture - CT Scan
(After soft tissue oedema is subsided)

o
Facial Fracture 1. Initial - X ray
2. Best - 3D CT Scan
3. Diplopia/ Extraocular muscle involvement - MRI
TEO
Vascular Imaging

Arterial Venous
Claudication/ Ischaemia

1. Hand Doppler 1. Hand Doppler

Pulse
ABPI

H
2. Arterial Duplex 2. Venous Duplex

3. If planned for Surgery

CT Angio
MRI Angio - If renal imp
LA 3. Venography
Golden Standard
SA
4. Arteriography - Invasive precedure
Diagnostic and Therapeutic
C

Arterial Disease in Bowel

R

(Mesenteric Ischaemia Embolic / Thrombotic Event) - CT Angio

M
 t
Breast Imaging

O
Ultrasound Women - < 40 years

O
Mammography Male Breast
Women - > 40 years

O
MRI 1. Lesion not confirmed by US / Mammography
2. Lump over scar of mastectomy
3. Ruptured Implant
4. Lump over Implant in High Risk patient

H
Follow Up Ultrasound

0€Implant

.
Rupture

Lump
LA
MRI

Normal
=
Ultrasound

High Risk MRI

SA
O
Breast Biopsy

Pus - Culture

T Negative - Discharge
C

o
FNAC Cystic Lesion
Fluid - Cytology
Positive - Arrange Biopsy
R

o
Excisional Biopsy Fibroadenoma
M

-Core/ True cut Biopsy Any Lump except cystic

Suspected Malignancy

s
Sterotype Cone Biopsy Microcalcification
Unclear Mammography
If Stereotype cone Bx not in option - Go for MRI
 -0
Thyroid Imaging

o
1. Ultrasound

O
2. FNAC If inconclusive - Go for Hemithyroidectomy

H
O
Cancer Imaging

O 1. CT and
MRI
LA
For Neck tumours including
SA
o
2. PET Scan
CT Chest, Abdomen, Pelvis For staging and Grading
C
R
M
 O Renal Imaging

t
Ultrasound Stone, Mass, Pelvic examination
Young chilren, Young girls, Pregnant woman

O
CT Scan Golden Standard for renal mass or stone
(Trauma/ Tumour/ Stone)

H
O
DMSA Secreted by kidney

LA
1. PUJ Obstruction
2. Ectopic kidney
3. Cortical defect
SA
O
DTPA Assess GFR

o
MAG3 Renogram Failing transplanted kidney
C

If PUJ obstruction is diagnosed by CT Scan - Next investigation

is MAG3 Renogram
R

-
Cystourethrogram Urethral stricture
Vesicouereteric reflux (Pain on Voiding)
M

Bladder and Urethral injuries

Fi
Cystourethrogram

.
Antegrade Retrograde
From Bladder down From down to up

To check Bladder pathology To check for urethral injury

Or Stricture