Unofficial Guide to Radiology: Chest, Abdominal and Orthopaedic X Rays, Plus CTs, MRIs and Other Important Modalities: Core Radiology Curriculum

by Mark A Rodrigues, Zeshan Qureshi BM, BSc (Hons), MSc, MRCPCH, FAcadMEd, MRCPS(Glasg)

Overview

The Unofficial Guide to Radiology' has been endorsed by the Royal College of Radiologists, The British Institute of Radiology and the British Medical Association. It teaches systematic analysis of the three main types of X-rays: chest, abdominal and orthopedic, with additional chapters looking at all the other main radiology tests such as CT and MRI. The layout is designed to make the book as relevant to clinical practice as possible; the X-rays are presented in the context of a real life scenario. The reader is asked to interpret the X-ray before turning over the page to reveal a model report accompanied by a fully annotated version of the X-ray. To further enhance the clinical relevance, each case has 5 clinical and radiology-related multiple-choice questions with detailed answers. These test core knowledge for exams and working life, and illustrate how the X-ray findings will influence patient management. This book has relevance beyond examinations, for post graduate further education and as a day-to-day reference for professionals.

Product Details

ISBN-13:	9780957149946
Publisher:	Elsevier Health Sciences
Publication date:	03/21/2014
Series:	Unofficial Guides Series
Pages:	850
Product dimensions:	8.30(w) x 11.70(h) x 1.50(d)

About the Author

Zeshan Qureshi, BM, BSc (Hons), MSc, MRCPCH, FAcadMEd, MRCPS(Glasg)
Paediatric Registrar
London Deanery
United Kingdom

Read an Excerpt

CHAPTER 1

CHEST X-RAYS

This introduction to the chapter is aimed at providing a systematic framework for approaching chest X-rays. Further details and examples of the specific X-ray findings discussed below are covered more extensively in the example cases later in the chapter and in the bonus X-ray chapter.

In this book we look only at frontal chest X-rays (PA and AP X-rays), as these account for almost all chest X-rays performed. The lateral chest X-ray is not commonly performed and has been largely replaced by CT.

1. Projection (AP/ PA)

The projection of a chest X-ray can affect its appearance and interpretation. Therefore it is important to determine which projection has been used.

• The two possible projections for a frontal chest X-ray are the anteroposterior (AP) and the posteroanterior (PA). Somewhere on the X-ray you should see something that indicates whether it is AP or PA.

• The PA X-ray provides the best assessment of the thorax but requires the patient to be able to stand (or sit on a stool). This is the standard projection, so if there is no annotation stating otherwise, you can assume the X-ray is PA.

• AP X-rays provide a less comprehensive assessment than PA X-rays due to the effects of magnification and the position of the scapulae (figure 1). They are usually only performed for haemodynamically compromised patients.

• If you cannot remember which one is the standard view, remember, "AP is 'crAP', so PA is standard".

• If you are asked to justify why an X-ray is PA, remember that in PA X-rays, the patient's arms are positioned in such a way that the scapulae are pulled almost fully out of the lung fields. In AP X-rays, this positioning is not possible, and the scapulae are projected further over the lungs.

2. Patient Details

• It is important to ensure you are looking at the correct X-ray from the correct patient.

• The patient's details will be on the X-ray (unless anonymised for the exam).

• Say the name, age/date of birth, and when the X-ray was taken.

• The age and gender of the patient are useful for helping to formulate your differential diagnosis.

3. Technical Quality

• Check that the X-ray includes all of the thorax (both lung apices, the lateral sides of the ribcage, and both costophrenic angles). Important pathology can be missed if the entire thorax is not imaged.

• It is unlikely that you will be given an X-ray in the exam that does not show the entire lungs, but some parts are occasionally missed in practice.

• It is important to assess RIP – Rotation, Inspiration, Penetration.

Rotation

• The heads of the clavicles (medial ends) should be equidistant from the spinous processes of the vertebral bodies. If they are not, the patient is rotated.

• Patient rotation can erroneously give the impression of mediastinal shift or lung pathology (figure 2).

Inspiration

• PA and AP X-rays are taken in held deep inspiration. Count the ribs to assess inspiratory effort.

• You should count down to the lowest rib crossing through the diaphragm. Six anterior ribs or 10 posterior ribs indicate adequate inspiratory effort.

• Fewer ribs indicate an underinspired X-ray. This may be due to the timing of the X-ray, or, more frequently, because the patient is unable to take and hold a deep breath (due to pain, breathing problems, or confusion). Underinspired X-rays can cause crowding of the lung markings at the bases, incorrectly giving the impression of consolidation or other pathology. Additionally, the heart may appear falsely enlarged (figure 1).

• More ribs, particularly with flattened diaphragms, indicate hyperinflation due to airway obstruction, such as chronic obstructive airway disease (COPD).

Penetration

• The X-ray is adequately penetrated if you can just see the vertebral bodies behind the heart.

• "Underpenetrated" means that you cannot see behind the heart and "overpenetrated" means that you will be able to see the vertebral bodies very clearly.

• Over and under penetration can obscure or obliterate significant findings, particularly in the lungs.

• This is less of a problem with the advent of digital viewers which allow the X-ray "windows" to be manipulated. However, this function can only manipulate the image so far, so adequate penetration is still important.

4. Obvious Abnormalities

If you can see obvious abnormalities, say so and describe them:

Which lung is involved?

Which part of the lung?

• If possible, say which lobe is/lobes are involved. Remember it is not always possible to determine this on an X-ray – in which case use upper, middle, or lower zone to describe the abnormality's location. CT can locate abnormalities more accurately.

Size

Shape

• Is it focal or diffuse, rounded or spiculated, well or poorly demarcated?

Density

Describe the density of an abnormality in relation to the normal surrounding tissue, e.g. if the abnormality is in the lung, compare it to the normal lung; if in the bone, compare it with the other bones.

If the abnormality is denser (i.e. whiter) than the normal tissue, you can say that there is increased opacification or density; if less-dense (i.e. blacker), say there is increased lucency or reduced density.

Texture

You should assess whether the abnormality has a uniform or heterogenous appearance.

Other features

• If there is anything else in the abnormality, such as air bronchograms or fluid levels, then mention these as well.

• Are there other abnormalities, such as volume change, bony abnormalities, or surgical clips?

5. Systematic Review of the X-ray (Figure 3)

• Initially assess from a distance to see differences in lung shadowing/obvious masses. Previously, when using hard-copy X-rays, you would be taught to look at the X-ray initially from four feet; however, now most X-rays are viewed on computer so make sure you zoom out as much as possible for your initial inspection.

• After that, reassess from close-up to look for subtle abnormalities.

• It does not matter what system you use for assessing the X-ray, as long as you do not miss any areas.

• A useful system is ABCDD (Airway, Breathing, Circulation, Diaphragm/ Delicates).

• Also comment on manmade abnormalities, e.g. lines, pacemakers, a nasogastric (NG) tube.

A – Airway

• Is the trachea central?

• If not, is it deviated due to patient rotation or pathology?

• If the cause is pathological, is the trachea being pulled to one side (volume loss, such as lobar or lung collapse) or pushed away (increased volume such as a large pleural effusion or mediastinal mass)?

B – Breathing

• Start in the apices and work down to the costophrenic angles, comparing both lungs to look for differences.

• Ensure that you inspect the entire lung, including the apices, hila, and costophrenic angles.

• The left hilum should never be lower than the right. If this is the case, you must look for volume loss either pulling the right hilum up or pulling the left hilum down.

• Both hila should be the same density and have no lumps or convex margins.

• Look around the edge of the lungs, assessing for pneumothoraces. These can be particularly subtle at the lung apex.

C – Cardiac and mediastinum

• Assess the heart size. Cardiomegaly is defined by the maximal transverse cardiac diameter being greater than 50% of the maximal transverse internal thoracic diameter (cardiothoracic ratio). This can only be accurately assessed on a well-inspired PA X-ray due the effects of magnification on AP and underinspired X-rays (see figure 1). However, it is still important to assess cardiac size on an AP X-ray – if it's normal on the AP, then it will be normal on the PA; conversely, if it is grossly enlarged on the AP, it is likely to be enlarged on the PA X-ray.

• The cardiac and mediastinal borders should be clearly visible. If this is not the case, you must consider whether there is pathology in the adjacent lung.

• The mediastinum and heart should be positioned over the thoracic vertebra. If this is not the case, you must first check that the patient is not rotated. Then you must assess for volume change in the lungs (either volume loss pulling structures towards the abnormal side or increased volume pushing them away), accounting for the position of the mediastinum and heart. Marginal mediastinal shift can be observed if the margins of the thoracic vertebral bodies can be clearly seen beyond the cardiac and mediastinal contours on a well-centred X-ray.

• Widening of the mediastinum may be due to technical factors (e.g. AP projection), vascular structures (e.g. unfolding of the thoracic aorta or aortic dissection), masses (mediastinal tumours or lymph node enlargement) or haemorrhage (e.g. ruptured aorta). The clinical findings in such cases are important, as the cause can be difficult to determine on X-ray. CT can be used if required for further assessment.

• The right paratracheal stripe can be useful to assess, if visible. It is composed of the soft tissue between the medial wall of the right lung and the right wall of the trachea. It is visible in 50-60% of X-rays and should measure <5mm in diameter. If it is thickened, it is commonly due to lymph node enlargement.

• The aortopulmonary window is another area to assess for lymph node enlargement. The aortopulmonary window is located between the aortic arch and the left pulmonary artery. Normally there should be no soft tissue visible in this region, thus giving the impression of a window. If this is not the case, you must consider lymph node enlargement.

• You should assess the mediastinum for the presence of gas within it (pneumomediastinum). This appears as linear lucencies projected over the mediastinum. These often extend into the neck and may be associated with surgical emphysema (figure 4).

• It is important to remember that the lung continues behind the heart (a large portion of the left lower lobe is behind the heart). The cardiac shadow should be of uniform density. If this is not the case, you must consider whether retrocardiac pathology, such as consolidation, lobar collapse, or a mass, is present. This can be difficult to assess due to the overlying cardiac shadow. Inverting the image often makes any abnormality more obvious (figure 5).

D – Diaphragm

• Both hemidiaphragms should be visible and upwardly convex. Flattening of a hemidiaphragm suggests raised intrathoracic pressure either from lung hyperexpansion, as seen in air trapping with COPD, or tension pneumothoraces.

• The right hemidiaphragm is normally slightly higher than the left due to the mass effect of the adjacent liver. If this is not the case, you must consider whether one of the hemidiaphragms is is being abnormally pulled up or pushed down.

• Remember that the lungs extend behind the diaphragms, so you need to look for lung pathology through the hemidiaphragms. Again, inverting the image can make such pathology more obvious.

• Look for free air under the diaphragm. This can be difficult, as the gastric bubble and bowel loops can have a similar appearance (figure 6).

• The costophrenic angles should be sharp. If not, there is likely to be pleural fluid present.

D – Delicates

• Assess the bones. Look at the ribs for fractures or bone destruction. Assess the rib spaces, which should be roughly equal. Narrowing can be seen with volume loss in the underlying lung. Review the rest of the imaged skeleton for fractures or destructive bone lesions.

• Look at the soft tissues for evidence of surgical emphysema (gas [black areas] in the soft tissues) and previous surgery (surgical clips, mastectomy).

Lines(see Figure 7)

• An endotracheal (ET) tube should have its tip proximal to the carina. Problems can arise if it is inserted too far and the tip enters one of the bronchi. This will result in collapse of the non-ventilated lobes.

• The tip of a nasogastric (NG) tube should lie well below the left hemidiaphragm in the stomach. Problems to look out for include misplacement into the lungs, and the tip being within the distal oesophagus.

• Central lines are most commonly inserted into the internal jugular veins. Their tips should be in mid or lower superior vena cava. Complications include misplacement and a pneumothorax.

6. Review Areas

Double-check the following areas, since pathology is easily overlooked at these sites on initial viewing (see figure 8):

• Apices

• Hila

• Behind the heart

• Costophrenic angles

• Under the diaphragm

7. Summary

• Summarise your findings and give a differential list. Think about the history and clinical examination as well as the X-ray findings when making your differential diagnosis.

• Say whether you would like to review previous imaging if you think this would help.

• Suggest further investigations, including imaging, which may be useful.

• Suggest a management plan for the patient.

SPECIFIC FINDINGS ON CHEST X-RAY

Pneumonia

• Dense or patchy consolidation, usually unilateral.

• May contain air bronchograms (air containing bronchioles running through consolidated lung).

• In the lower zones, pneumonia may be difficult to distinguish from effusions, so both should be on your differential list (remember there is often a parapneumonic effusion).

• The silhouette sign is useful for locating in which lobe of the lung the pathology is located (figure 9). Normally, there is a sharp border between the aerated lung and the soft tissues of the heart and diaphragm. This is due to the large differences in the number of X-rays attenuated by the soft tissues (a relatively high proportion of X-rays) and the lung (relatively few X-rays).

• If there is consolidation, the normally aerated lung is replaced by fluid or pus. This attenuates X-rays to a similar extent to the heart and diaphragms. The usually sharp border between the lung and these structures is thus lost if there is consolidation in the lobe abutting these soft tissues.

• It is necessary to know which lobes contact the heart and diaphragmatic borders in order to be able to use the silhouette sign:

* Diaphragms: left and right lower lobes

* Right heart border: right middle lobe

* Left heart border: lingula (part of the left upper lobe)

• Remember that pathology can affect more than one lobe.

• It is not always possible to identify in which lobe pathology is located. In these cases, describe it as affecting the 'upper, middle, or lower zone'.

Pleural Effusions

• Look for blunting of the costophrenic angles, a homogenous opacification, and a fluid level manifesting as a meniscus (figure 10).

Pulmonary Oedema

ABCDEF can be used as an aide-mémoir for the features of pulmonary oedema (figure 11). Usually only some of these X-ray signs are present, and the diagnosis is made in conjunction with the clinical picture:

• A: Alveolar and interstitial shadowing

• B: Kerley Blines (little white horizontal lines usually in the lateral lower edges)

• C: Cardiomegaly (Cardiothoracic ratio of greater than 50% on a PA X-ray)

• D: Upper lobe venous blood Diversion (prominent upper lobe vasculature relative to the lower zones)

• E: Effusions

• F: Fluid in the horizontal fissure

Pneumothorax

• Air within the pleural space (figure 12).

• Loss of lung markings in the peripheral lung field. You may also identify a discrete lung edge.

• With a simple pneumothorax, there is no mediastinal shift. In contrast, if there is a tension pneumothorax, there may be tracheal/mediastinal deviation away from the pneumothorax, and flattening of the ipsilateral dome of the diaphragm. A tension pneumothorax should never be diagnosed by a chest X-ray! It is a medical emergency, and is diagnosed clinically and treated immediately with needle thoracocentesis.

Lobar Collapse(Figure 13)

• Look for loss of volume

* A raised hemidiaphragm ipsilaterally

* Tracheal and mediastinal shift towards the collapsed side

* Displacement of the hila

* Narrowing of the space between the ribs compared to the opposite side

Left Upper Lobe (LUL): Veil sign – the whole lung field looks like it's covered by a veil. This can be difficult to appreciate. Luftsichel sign is sometimes seen – radiolucency in the left upper zone, around the aortic arch, due to compensatory hyperinflation of the left lower lobe.

Left Lower Lobe (LLL): Sail sign – sharp line like the edge of a sail at the same angle as the left heart border – giving the impression of a double left heart border. The medial part of the left hemidiaphragm will be indistinct, but the left heart border clear.

(Continues…)

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Excerpted from "The Unofficial Guide to Radiology"
by .
Copyright © 2014 Zeshan Oureshi.
Excerpted by permission of Zeshan Qureshi.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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Table of Contents

Introduction, 11,
Chest X-Rays, 17,
Abdominal X-Rays, 181,
Orthopaedic X-Rays, 335,
CT Scans, 521,
MRI Scans, 543,
Ultrasound Scan, 557,
Nuclear Medicine Scans, 565,
Fluoroscopy, 571,
Bonus Cases, 579,
Bonus Chest X-Rays, 579,
Advanced Chest X-Rays, 603,
Bonus Abdominal X-Rays, 613,
Advanced Abdominal X-Rays, 625,
Bonus Orthopaedic X-Rays, 637,
Advanced Orthopaedic X-Rays, 671,
Index, 695,

Editorial Reviews

When a Medical Student or Junior Doctor asks me ‘how can I learn radiology from 1 book’ I now have the answer. The Unofficial Guide to Radiology contains 100 annotated radiographs displaying a very comprehensive range of diseases. The presentation starts with an unknown case, which you are invited to review. You then turn over the page and line diagrams are used to demonstrate what you should have seen. The perfect report is displayed, followed by a series of questions which examine your knowledge of the background medicine or surgery. This is a great way to get a feel for radiology as a whole and will deal with a lot of the problems that Medical Students and Junior Doctors face every day. I can also see its value for those much further on in their career who have specialised in one area and would like to revise radiology as a whole and reassure themselves that they can still remember what they learnt years before. The team producing the book have worked very hard to find good quality images with excellent examples of a wide range of disorders. It also reemphasises the importance of conventional radiographs, which we tend to forget now we concentrate heavily on cross-sectional imaging. I am very pleased to recommend this inexpensive book to a wide range of medical and paramedical professionals”. David Wilson Consultant Musculoskeletal Radiologist President of the British Institute of Radiology

David Wilson

Which radiographs from each system are most likely to be presented in exams? This excellent book presents the classics, and at one level this makes it a high-yield textbook that will be extremely valuable to medical students and junior doctors. What is especially striking is the definition and clarity of the illustrations, with on-image labeling enabling one to be absolutely certain of which is the endotracheal tube, the nasogastric tube and the central line, for example.

Bob Clarke

Radiology is a discipline encountered everyday as a medical student. From the wards to OSCEs, from theatre to outpatient clinics, radiology is everywhere at undergraduate level and beyond. The importance of understanding the principles of imaging, radiation doses and the clinical interpretation of results is paramount. With radiology being a key diagnostic and monitoring tool in modern medicine, the ability to assess an X-ray in a systematic order is a vital skill. The vast range of techniques, and the complexity of the human body means this is not a subject that can be learnt overnight, and this book aims to provide you with a grounding in this mammoth specialty. The author’s have ensured they have included the basic scientific principles underlying radiology. It covers many imaging modalities and presents them in a systematic order to give you a clear approach to interpreting what you see. Detailed pictures along the way point out normal anatomical features as well as deformities and anomalies. Perhaps one of the biggest strengths of this book is the cases section, allowing you to practice not only interpreting high quality images but also to link them to a case history. The questions that follow not only test your radiology, but also your ​understanding of signs, symptoms, underlying pathophysiology and management of the condition. As well as detailed answers in each section, the book also shows you the best way to present each case, whether in an OSCE situation or on a ward round. The Unofficial Guide to Radiology has quickly become established as one of the most useful undergraduate books. The easy of use, detailed pictures and emphasis on key points of this one should cement it as the number one undergraduate book for radiology. I hope you find it invaluable throughout your studies and it brings you success in all of your exams!

James Brookes

Another in the 'Unofficial Guide to' series, this book is primarily aimed at medical students and junior doctors. Edited by a radiology registrar and an academic clinical fellow, written by a team of radiologists and an orthopedic surgeon, and critiqued by a panel of student reviewers, it promises a wealth of knowledge presented in a relevant way. The book does not disappoint. It strives to cover what is often found to be, in the authors' own words, a 'difficult and daunting' subject matter. It does so by successfully demystifying the topic of radiology through teaching the reader how to systematically interpret and present imaging within a clinical context. The introduction gives a few very useful tips, including how to request imaging and how to actually talk to radiologists - a task that many newly qualified and inexperienced new doctors dread. Thereafter, the primary focus is on X-Rays, this being the most commonly requested form of imaging. The book does, however, also touch on all the other types of imaging a junior doctor is likely to come across, including ultrasound, CT and MRI scans. Each imaging modality is introduced by a few pages devoted to the science behind the scanning, as well as indications and contraindications, followed by annotated images to learn from. Explanations are concise and readable. The X-Ray part of the book is the largest and conveniently divided into three sections, covering chest, abdominal and orthopedic X-Rays. Systematic approaches are provided for interpretation. The editors recognize the importance of learning by looking at multiple X-Rays, and therefore plenty of case studies are provided. These are laid out in a very useful way. A clinical case comprising of a few lines of history and a large, clear image are given, without labeling, to encourage the reader to form his or her own conclusions and practice presenting. Turning the page reveals the same image, this time beautifully annotated, the correct verbal presentation, plus a management plan. Clinical multiple choice questions relevant to the case at hand follow, providing a useful revision tool. There is also a ‘bonus’ section at the end, to provide even more practice at actually looking at X-Rays. This textbook is quite a bulky one, and would likely be relegated to home study rather than to quick fire reference on the ward. Indeed at first glance it seems quite ‘heavy duty’, but it soon becomes apparent that the reason for this is due to a bold, spacious layout, which makes for a comfortable reading experience. It is also divided into sections by colour coding, and as such is easy to dip in and out of. One minor point noted is that there are not as many images in the modalities other than X-Rays, and these are not presented in the case-by-case basis described above. Nor are these sections as in depth. This is understandable, given that other modalities are less commonly requested and less likely to need interpretation by juniors. It is worth noting this however, as those wishing to practice interpreting other imaging modalities in greater depth might do well to look at additional resources. Overall, this book is slick, straightforward and highly relevant to its target audience. It can be used both for revision and for reference. This book would no doubt be a useful resource for any healthcare professional interested in learning some radiology, but may specifically be recommended as a staple for both the senior medical student and the junior doctor's bookshelf.

International Journal of Clinical Skills - Aarohi Sharma

This comprehensive textbook covered everything you could possibly need to know about radiology from a junior doctor's standpoint. It built upon what I learnt at medical school and filled in so many gaps to make day to day life on the wards a whole lot easier as I am now much more confident at interpreting images. I used to shy away from opening up orthopedic X-rays/CT images and just looking at the radiologist report. After reading through this colourful, very user-friendly guide I now have the confidence to make sensible interpretations of the images and have found I am finally getting things right! I can honestly say this is the first every textbook that was actually enjoyable to read through too, visually stimulating with lots of pictures, I will be recommending to all my colleagues.

Sharleen Hill

I wish I had this book just prior and during my first year of radiology training! It is exactly the right level of knowledge one needs to be able to accurately interpret and understand the myriad of radiological investigations we put our patients through. The best thing I liked about this book is that it's comprehensive. I don't need to go anywhere else to establish the core fundamentals or as a refresher. For the price, it's probably bargain of the century too. Chest xrays, bariums, even the basic MR! It's rare to find a book that can be appropriate for so many people at so many different levels: final year med students, junior doctors and junior radiology trainees - and all in an easy to read and understand colourful format/layout which is refreshing when you live the monochrome existence of a radiologist. Will definitely recommend to others.

Rashid Akhtar

This book is a comprehensive learning tool for medical students and junior doctors. As a trainee radiologist I appreciate the quality of the images and the explanatory text. The book has an 'easy to read' layout and colourful graphics. Chapters contain common clinical presentations and are followed by a quiz to test knowledge and consolidate knowledge, which is particularly useful when revising for exams.

Na'eem Ahmed

Expanding on the radiology chapter of The Unofficial Guide to Passing OSCEs, this book takes the same approach to providing students with a structured and logical way of interpreting a wide range of radiological imaging. With chapters on chest, abdominal and orthopedic x-rays as well as CT, MRI, ultrasound and nuclear medicine scans, the approaches provided for the interpretation of each imaging modality serve as a foundation upon which further knowledge can be built and are of value both in examinations and clinical practice alike - they will both score points in OSCEs as well as ensure a thorough and reliable interpretation of the most common images used in practice. Presented in a way that is easy to read and retain, a wide variety of high quality images are used to teach and revise the basic principles with further information provided in additional text boxes as in other books in the series. Each image has accurate and clear labeling so that both normal structures and pathologies are easily visible and tips are given for distinguishing between similar pathologies. Unlabeled images with separate printed answers are provided so the reader can test their knowledge. Overall I found this book to be of value both in preparation for finals as well as in practicing as a foundation doctor.

Ryan Breslin

Radiology is a constant challenge for students and doctors in busy clinical units: having a good command of the essentials is a real advantage. This book is well-presented and very accessible. The annotated examples provide realistic challenges with immediate feedback. It didn’t take long before I felt better prepared for my next ward round!

Simon Maxwell

I have not come across a text that is as comprehensive a guide to radiology and radiology services for medical students and junior doctors as this... Other books such as the Lecture Notes of Radiology and Crash course: imaging that are also aimed at providing medical students with an overview of various imaging modalities and how to assess for common pathology do not have the same breadth or readability as this text. Working through this book a student would undoubtedly feel more confident and prepared in presenting imaging findings on a ward round and the authors are to be congratulated on their efforts.

BMA Medical Book Awards 2015

This book is a must have for all medical students (and other healthcare professionals) struggling to get to grips with radiology! The book includes clear and easy to follow explanations on how to interpret and present x rays, CTs,MRIs and more with lots of detailed examples and cases to help aid your learning. Really helpful to have such clear guidance all in one place. Love this book - another fab "unofficial guide."

Fiona Richardson

Which radiographs from each system are most likely to be presented in exams?
This excellent book presents the classics, and at one level this makes it a high-yield textbook that will be extremely valuable to medical students and junior doctors. What is especially striking is the definition and clarity of the illustrations, with on-image labeling enabling one to be absolutely certain of which is the endotracheal tube, the nasogastric tube and the central line, for example. Clarke, Bob

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