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Hello. Hello, Blue. Exactly. I can see that I can join the stages. Is he with your hospital? Seem to be, uh, does it sound OK like, is it too quiet to loud? Yeah. Just when you the person who gets different there. But you're just beautiful. You really want to be that simple question? Uh, I get where we're coming from, but I also they have not had to do with the address. I think that's you're still in love. It so cruise. It's a lot of companies. It's a different system, but that she presented shit. Wait a minute. Mhm. Sorry. Uh, yeah. And I wonder what the fact that join weight. I'm going to sleep and be like, we're like, we're all, uh so I think I was like, All right. Okay. Is it like in the in terms of Australian? What does that mean? You want to read the There's people need china. African. Yeah, it's just to make sure that we can get uh Oh, yeah, yeah. Uh huh. I was stupid, but like I feel like and I experienced spirits, that person, how it's going to Woodward. Anything. This is what mhm. Uh, yeah, uh, beautiful exist speakers to just, like, just spray things. Everything will help. This is just a very normal, you know. It's funny. Yeah. Be a bit like also the first use have, like, no idea. What can I really just trust me? This is this, like, a green ball. But you were ahead corner source discussed me. Yeah. I mean, look at schools, okay? Integration, the answers and the issue is that, like, like all my answers and this is what people going out. So I was like, I'm going to tell you that this is obviously wrong. It has a here who died from it. Seems like happening with you. No, you go. Uh, like, the first year is what? I'm taking it on fresh. It's like, Can you explain? This is No, uh, no, that's funny. Yeah. I don't know how I gave you. See that? Yeah. No, no, I think that's I think now I think that was, uh it was, uh, but your spirit, your stuff in the question that is not, uh I mean, I'm glad. Uh, because I think I think it's fair. Mhm. I have a question this year, Uh, and also that's come back from here. This is a a special notice introducing, um, officially. Yeah. You better. Yeah. And everything is We're happy. Yeah, we speak. It starts to you through, I mean, Well, can you order to give yourself like this? Uh, well, like like it's not a good time. Hi. Can you guys hear this? We're, like, trying out different speakers. Oh, Grand. Okay. Um, all right, we'll just make a start. This is a lot clearer. Okay, Good. This is just I'm, like, on my phone, and then we've got it set up on our and we're like, a lecture theater right now, So I'm glad this is clear for you, because the mic wasn't really doing it for me. And can everyone see the slides grands? Okay, um, we'll just make a start then because that's just after five past, um, so welcome to our event. And this is radio radiological and ask me for second years. And it's mostly by the University of Glasgow Radiology Society. And these are are learning outcomes for this evening, which they're extensive, But don't be too worried. I'll send out the slides afterwards. You can always go back and take a look at things, and there should be recording of this event and so you can go back and look at parts that you didn't quite understand. Your list. Um, so in general, we base these are those off of the University of Glasgow room, second year and first semester. I alone. So the upcoming exam. But if you're not from the university glass where you're not second year, don't worry. Um, how kind of your system. So I was just missing my laptop. I could hear myself speak. And if you're not from the University of Glasgow, don't worry. Um, what was I saying? Yeah, Anatomy's and ask me Radiology's radiology. It will cover any sort of medical degree, and it will do you well in future years. So a brief run through will be going through lots of different imaging techniques, including a lot of special specialist imaging techniques, because often they're not mentioning medical school that you should know about them. And then we've got a bunch of anatomy that will run through, um just we disclaimer. We've included lots of cases to illustrate the and asked me. Some of these cases are quite tricky. We wouldn't expect you to be able to know them or to be able to recall them. And although we'll be very impressed if you know what we're showing you, but it just helps to make them asked me a bit more memorable, a bit more clinically relevant. Um, so don't be too worried if you're like, I don't know what's going on it And so we'll just start the basics. And so you guys are emotionally second year, so you should do a lot of stuff and I'll run through it. And it's the first off. Very, very basic. The answering. So this is actually radiation and man in the bottom of the image, getting an X ray taken and so you can see there's a source and the X rays passing source through the body and on to receive er plate. And so, in the bad old days, um, it didn't used to be like a computerized receive er play. It was a white sheet of film and and this film turns black when x rays touch it, and so you can see the X rays are blocked by dense objects, so metal bone things that contain calcium and and if the X rays are blocked. But they do not reach this in film, and the film remains white. And that's why all your bones look white. And on the contrary, X rays pass really well through air, so lungs or bowel gas and and they managed to touch this film and turn it black. And that's where your lungs look. Black and in between, you've got soft tissue, which blocks some of the X rays that lets some of them pass through. And that looks somewhere between. That's great, and you can kind of see in the hand X ray the bomb and sort of in between the bones. There's like gray, and that's just them. Soft tissue and indications for X rays are really good at looking at bones, fractures, dislocations. Uh, they're really easy. They're really cheap there really quick, and so they're often used as first line investigations and negatives wherever they do. Use some ionizing radiation. How much ionizing radiation used pens on what your imaging? And so something like a hand doesn't use that much radiation and but abdominal actuaries to use a lot of radiation, and therefore you should use them pregnancy and you should reconsider them in, uh, consider if you need to do it in sort of a young person, because there is a cancer risk associated. And so it's a two D image and of a three D structure, so lots of instructions overlap, and you can see the chest sex where you've got spine and heart breast tissue. And so it can be really difficult to make things out. Here we go, Um, which is why they invented MCT, which is basically a fancy X ray. And you can see the patient going through its rotating X ray source of the detector, and it creates 360 degree views of body structures, and it's using everything now, Uh, uh, process Mary mountains seem. Actually, you see some camera some more often, or even cover city to the coronary planet. And then this past stations opening scan of 20 minutes and constructions can give you some different things. We'll talk about things and couple slaves and overall constructors from the religion and and sometimes the technology actually reconstruct any body instructions. The three D and we've got examples that it's wrong and you can view things like vessels or even a full on and and three D has attitudes or funny back mountains. Next is to use a lot of my mental radiation. So then don't use some credits and reconsider it. And other people don't grow CTS having everyone and all the time and Moradi. So this is a bit more difficult to explain, and but you may just continue that utilizes and protons so hydrogen aisles and what you're finding Walter. And so it's basically a big dragnet. And in your natural state, hydrogen eyes inequality are spending on the face is way. So in case that more insert press anywhere when it comes to prospect, it's not that they all start facing some ways, so they will start spacing them and the machine and sense of courses of rigidity, energy, and that goes to the palms together. When folks in Northeast Machine and the news was participate and that causes the control is that we got from the east of YouTube, and when you do that, we'll give up a little popular energy, just takes about your shoot up, and you're living to understand how advantage is the terrorism. Um, but yours is normal possibilities of it and the machine from the entry you really fix infections can see that's already. That's, uh, bring. And so education is really good and it's it's just using. Investors or small questions are great in Nelson's latex and and it Doesn't Hit. You can analyze innovations safe in pregnancy natives. It's quite slow, which is so often it's gonna for any any five minutes. And, uh, just, uh, and I'm holding my phone is out there. Uh huh. Patient has to mean most humans and so hopefully asked to hold better, uh, breath, especially with emergency chest can purify close acrylic. And it's not just good for everyone. And starting with the metallic Egypt's have off the new scatter and sorry, just probably, you know, people get so excited. So I'm going to call this with them and okay, and certain things out of objects can use governor associative or migrants. You need to check any parts of Mexico in the body and, like it's safe to Scallon. It's also not be a little smaller offices really west of that. I was anything however I am, so make it easy. And so finally, finally, your medical school I'm not really sex. It's weak, too. And the rice when you think you should, you know, uh, right at 71 there are definitely other types of sequences for anyone to Tijuana to do. Uh, it's just the way that for me and computers or interprets and the energy that's given off and by the skin tones and it's the way that I'm back to it and it's and we'll make the main flows, it's just color. So you just colors and petitions different. And so we did, I remember, is turning into one party is that with the water star and the alternative to his kids here, Walters legs, uh, that will work for everyone. Find a way to remember it. You can see the t one weighted image, and that's is bright and and each other water the news of the snakes It you can see that that C s events going forward and t two e c CSF uh, this is very right. Great. And you're also seeing to like the brain from the season and the brains, uh, distrusting pizza and the other one they should build is and whether CT or MRI and the schools are super absolute. And so I'm starting to. So I called in the street is proven It's kranish. And so cruel image in the slices that often quite Spanish. And the way that I remember is if you're putting a crowd and on your neck. But anyone else here isn't just beaten. That's having difficulties or other people more busy. Ever do that related. Right. But the festival I'm sorry. Did you, uh mhm. What about now? If I hold my phone away from me, does that help? Much better. Okay, let me know. And I can always, like, move it around if it doesn't work. Okay, because that's so good. That's way better. Okay, just let just let me know. Just let me know we're doing it like technology is not my strong suit. Um, so just let me know if it cuts out again. Um, okay, So Crohn all is the upper right image. I imagine it as if you're putting a crown on your head. And that's kind of where your hands cut down If you were to take a criminal slice, um, sagittal means arrow. So if you imagine someone that's been pierced by an arrow. If you were to cut them so you could see the arrow going through their body, that would be a savage. Those lives and that's the one on the top left actually comes from Axel. That's the one on the bottom. And that's kind of like cutting someone like breads like a loaf of bread. Um, they're holding weights and the axles, the bar that runs through the middle, and that's kind of where they're being cut. Um, again, you don't really need to be able to interpret ultrasounds, Um, but you should know it exists and kind of how it works. Um, so it uses in sound waves, and they travel inside the patient and they bounce back to the probe and depending on how fast they return and how much is reflected back and the computer can create an image. And it can also use Doppler to show direction and velocity of bloods and indications. So it's good at differentiating between cysts, which are fluid filled or solid legion. So someone comes in with a lump on their neck. You might send ultrasound to see if it was a cyst or if it's solid, and it's good at kidneys. We'll talk about that, and we bit obviously use a lot of pregnancy. Good for Kanye replacements. Who can use the probe on someone's arm and find their veins and guide a cannula into their veins? Benefits again? No ionizing radiation. It's obviously use in pregnancy. It's safe. Negatives is quite technically difficult, Um, so there can be operator error. The sand ways also can't see past Erin Bone, so you often see reports say, you know the pancreas heads and cannot be visualized because of bowel gas. Um, so things can be missed. And just because the sun we can't see past it nuclear medicine again. This is not one that you really need to interpret, but you should know what exists and what it's used for. And so the basics and patient's ingest or injected with a radioactive substance. And so often it's radioactive, and it's like a radioactive form of glucose that they use. And so glucose is taken up by tissues and tissues that are metabolically active. Take up more of this radioactive glucose, Um, a scan er can then detect where that radioactive Google's is, and it creates a picture. Um, so see the three images at the top, the three in the road, the one on the left that is a pet scan. And so the bright white things. That's where the glucose is, so you can see the brain is very metabolically active. It appears quite white, because it takes up a lot of this radioactive glucose. You can also see a little bit at the kidneys and the bladder. And that's just cause this person is peeing out what they've been given, um, the one in the middle. That's just a normal CT scan, and then the one on the right is what's called a pet ct. Uh, the computer merges the two images together, and it means that you can demonstrate anatomy and see where these week call them. Hotspots are so these bright spots, these are hot spots, and it's really good for evaluation masses that you think might be cancerous because there's usually highly my spots active. They'll probably take up a lot of this glucose, and then we'll pure bright on pet ct. Um, so evaluation for metastatic disease who just have someone who has cancer, you can scan them. I can see if they have any bright spots and where you didn't expect to find those bright spots. Um, and so she used just one other example of your medicines using lung disease. Um, so that's the bottom image. And those are someone's lungs. So they've breathed in a radioactive substance that's then detected in by a camera. And it creates this pretty picture, and you can see there's any spots for the gas isn't going, and that could indicate dead space in the lungs. Um, so now we go onto basic T I anatomy. Um, so abdominal lecturers, um so indications and so mainly used an emergency presentations. And so toxic medical on that is the image on the left. I'm sorry. I thought too much. We don't have a pointer, so I'll try and and see what everything is. Um, and so top left image. That's toxic megacolon. And we can use some bowel obstruction ingestion, foreign bodies, um, monitoring of radiopaque renal calculi. So you can see if someone's got a stone that you can see on X ray. You can take Abdelmalek trees, um, and see where the stone is and see if it's moving along. Also using colonic transit studies So if you think someone's got quite sluggish bowel and you can give them these markers, this is the top right image, and you can see these little white dots so someone swallowed them. And then a couple of days later, they'll come back and get an abdominal X ray, and you can see whether these white dots have passed or not. And if they take a long time to pass, then you might think that there's something wrong. Negatives uses a lot of ionizing radiation, and this is one of the reasons abdominal X rays aren't used as much anymore. And people will tend just to go for an abdominal CT because in terms of ionizing radiation is actually quite similar, and most people have an abnormal abdominal. X ray will go on to have an abdominal CT anyway, and they have limited use, so they're less sense of and less specific than O'Donnell, ct and again, a huge radio radiation dose. So it's up to 35 times that of a chest X ray. And even though it seems like a similar longer space, and just to make sure the X rays penetrate everything, you have to give people a huge dose of radiation. In terms of positives, though, it is rapid and it is accessible. So these are abdominal X rays, and I will talk you through the adv. Ask me that you can see on these so there isn't actually much anatomy you can see in a dom luxury and when it's normal and so you can only see large bow. I took this from the Internet. It's highlighted and reds, so you can see. Um, it's on the pictures left hand side, but it's the patient's in, right. You can see the ascending colon that's the pink arrow and then goes to a hepatic flexure through the transfers, um, splenic flexure down, descending and then sigmoid colon. The small bell isn't annotated because you can't see it that well, but it's usually more sensual, and it's of a smaller diameter abdominal CT. So again, using trauma, cancer, abdominal aortic aneurysms, infection and information, and also to guide biopsy so someone can be in the scan. Er, um, images can be taken, and a radiologist can guide a needle in to see an abscess and take a sample out of it. Negatives. Obviously ionizing radiation positives is relatively quick and accessible, and it can be taken with oral and or IV contrast, so you can see things better. Um, you will get the slides. I I think it will be recorded. Um, I changed the setting, so it should record automatically. But if it's not recorded, I'll do a re recording. I did this for the first year. One. I'll do re recording, and I'll upload that instead. Um, and I'll send it out to you. And this is an actual CT abdomen. I'll run through it. Sorry, we're still going through and asked me. We get to the fun person. Um, so obviously there's a lot going on here, and if you're not used to CTS, then it can look a bit crowd ID. Um, but think of your basic and asked me. So Number eight is your liver. Your liver is very big, is in your right upper quadrant, so that's that huge organ there. The gallbladder is number one, and it's just nestled into the liver and kidneys either side. And that's number seven and highlighted in blue. Um, pancreas is well, I think it looks like a sausage. It kinda crosses the midline. Um, and then bowel is everything that, well, basically everything else bowel. You can kind of tell by the fact that it contains a lot of gas often and different, and it contains fecal matter, So it doesn't look the same color all the way through. This is the Corona CT. Um, again, you can see the liver upper right hand corner. It's quite big. And then gallbladder nestled underneath it. And and then on the other image, you can see, um, kidneys and then soaz muscles just below the kidneys. They're that sort of great triangular things. And then I just took this picture online because I thought it demonstrated the medicine tree quite well and attached to a small bell. And you can kind of see all the vessels fanning out, and I thought it looked quite nice. So now we enter our cases, which is the more fun part. Um, so this is a 12 year old boy who has a four hour history of right iliac fossa pain. He's got fever and he's got anorexia. He's very tender in his right, elect fossa and Robson sign is positive. And Rosenstein is that picture at the bottom. So if you palpate the left lower quadrant and the patient feels pain in the right lower quadrant and so look at the picture. Think of the history and what is the diagnosis. And yeah, we can again Don't be worried if you're not really sure what you're looking at. That's why we're here to talk you through it. And and I feel like anatomy is more fun to learn when you're looking at cool cases, so I can see a lot of you bring for appendicitis, which is the correct answer. Um, so appendicitis often presents with essential Donald Pain that migrates the right iliac fossa and the associated symptoms fever and anorexia, um, and Robson signs of positives. That's when you palpate the left side and you feel pain in the right. So on this imaging, I put in a like I've zoomed it on the image and and it just looks like great blurs, probably to you, but I'll talk you through it So there's a fecal if which you can often find an appendicitis, and that's that bright white dot sort of in the middle. And there's fat stranding, Um, which is a sign of information that you can sometimes see on CT, and you can see how the cecum in the top of the image you can see the border is very nice and clearly. And it's just black and outside of seeking. Yeah, when you come down to the appendix, which is that great triangle, you can't really see the borders that well. It looks kind of blurry. It's kind of hazy, and that's what we call fat stranding. And and it's just the reaction of fat information, and it is a sign of information just to appreciate it. Look on the Corona all image and the big one, and so you can see a lot of bowel. They're both large and small, and you can see the liver and you can see all the edges are very nice and clear. And outside of the organs it's just black. Whereas you get to the appendix, it's just this, like gray hazy mess. So now we move on to Upper GI and asked me Cool. Hi. So, um, we'll start off by talking about the celiac trunk. So that's, um, see that Trump would see, like our air rises from the aorta in the abdomen or the abdominal aorta that just branches to supply the liver, the stomach and the abdominal, part of the esophagus, spleen and the superior half of the, uh, duodenum and the pancreas. And you can see in the diagram on the bomb left that there's three main branches of the celiac trunk. So that's the left gastric artery, the splenic artery and the common hepatic artery. And, um um, you can see here that this, um so the But here it's just been annotated. And you can see that the number one you've got this long this big? Um, quite large, um, branch coming off to see that Trump, that's a splenic artery. Um, and you can kind of make out the borders of the spleen. Possibly, um, just as the splenic artery kind of branches to supply the various parts of the spleen. Um, and then on top of that, you've got the left gastric artery. Um, and then you've also got the hepatic artery which branches off to Syria trunk. Um, and then that splits off to form the gas. Or do do you know, um and you've also got the right hepatic and the hepatic arteries um, so this is, um so this kind of distribution of arteries and the Upton is you know, what we know is the standard distribution, but, um, in various patient's that you might see later on emplacements, um, they might have different kind of, um, distributions with the artery. But this is what we know as the standard kind of variants of like abdominal material distribution. Moving on, we'll talk about first about the, um, the barium swallows. And it's kind of, uh, I would say, not imaging technique that's not so used nowadays, but essentially what it is. It's, um you get the patient to swallow some barium contrast, and then you take a series of X ray images. Um, that contrast will show up as bright whites as you can see on the images here, um, these various images taken to assess the movement of the barium contrast, um, down the upper GI tract almost like a stop motion animation, and and what you can use it for is to evaluate the pharynx, the esophagus, uh, approximate part of the stomach. If patients have to Spadea, which is sort of painful swallowing, you can use that to evaluate what's happening there. If they've got high to Tonia, they've got persistent vomiting and you can use as well. But, um, an issue with using barium contrast is that if patient's have suspected preparation, um, or if they've got, uh, if they're being evaluated post operative post operatively for a week, you wouldn't use barium and instead use water soluble contrast. Um, but again, yeah, this is quite an outdated sort of imaging technique, and it's not really used so much nowadays. Um, we'll touch a little bit later on what sort of conditions that you would still use it on. But this has mostly been replaced by an upper GI endoscopy, which you can see things a lot better. And yeah, so this, um, you can see on the right. That's a barium contrast image. Um, so this is a case of a 70 year old female with three month history of dysphagia and regurgitation of food. Um, And what radiological sign do you guys think is seen on this image? Um, let me just start to pull. Cool. So, um yeah, Most of you have put birds beach sign, which is right, but don't worry, you got wrong. Um, um Yeah. So, essentially, that's just kind of it Looks like a It looks almost like a bird's beak. If you flip it onto, it's, uh, if you, you know, you flip it 90 degrees. Um, yeah. Um, I can see why it's where you went for the sale sign. Um, and essentially, this is a classic kind of, um, an imaging. This is a classic presentation of Ankle Asia. Um, and ankle Asia is just a failure of the smooth muscle to relax, um, at the bottom of the esophagus. And that causes the, uh, esophagus to remain constricted. And we've got this sort of tapering, uh, phenomenon and the lower esophageal sphincter narrowing of the gastroesophageal junction. So that causes sort of food to build up, um, unable to get the stomach. Um, so the veil sign? Um, that's not that's not seen in a barium contrast that's more seen in the chest X ray. And you can see that for a left upper lobe lung collapse. Uh, steeple sign. You would see it for croup. Um, sale sign again. Uh, lung collapsed, but it's a left lower lobe. I've got another case for you. So, uh, 60 year old male with a four month history of burning pain in the throat. Um, what do you guys think is a diagnosis? Yeah. So this is a sign of a hiatus. Hernia? Um, yeah, I can see it was a 50 50 split between the esophageal stricture and the heights hernia. And I can definitely see why some of you have picked the software structure. And and some of you may know from I believe they teach this in second year. Not so sure they still do, but yeah, So Hiatal hernia is a protrusion of the part of the stomach through the diaphragm, just into the chest or the thorax. Um, you can see in the red circle where the stomach is kind of pass it through the diaphragm. Um, and this, like, in this image, you really can't sort of because the stomach just kind of compressed. There's not much sort of contrast that stays in that area. Um, and that's why you get this kind of imaging, uh, within esophageal stricture. You probably would see something like this, but instead, um, just, you know, within the red circle, there would it would just be like a sort of, uh, like a concave shape in the middle rather than, like, nearly no contrast being seen within that red circle area. Um, with the height attorney, you can be a symptomatic in a lot of patient's, Um, but some present with heartburn, dysphasia or hoarseness. Um, and that's because when they're when the stomach acid kind of because the stomach half of it already, um, some of the stomach is in the thorax is very easy for it to kind of get the stomach acid can reflux into the esophagus that way, uh, and that can irritate the just the, uh, more upper structures need to like horse voice, um, obesity and increased age or risk factors. Obesity. Because there's more kind of pressure in the abdomen that can easily make it more easy to push your stomach through the diaphragm and into the thorax and increased age just because all the kind of muscles and all the structures that hold everything together just become weaker over time. And here with another case. So, uh, 30 year old female presents with chronic abdominal epigastric abdominal pain. Um, where do you think is the abnormality? So this was this has got a hard one. Um, this is a chronic pancreatitis. And, um, if you look at the read, uh, oval here, um, it was a very subtle sign on the the abdominal X rays. So you can kind of see, like, various dots and various, Um, yeah, just various kind of, uh, bright dots. Kind of in the pancreatic area. Um, And if we go back to what Laura said about how calcium kind of shows up as white on X rays, Is this essentially calcification You can see in the pancreas. Um, and yeah. Don't worry. You've got this wrong, because it would it have been quite hard to just spot it. Um, yeah. And, um yeah, so on the CT, uh, pancreas can look a bit like a sausage and kind of see how the it's all like a curved, like an s shape. Almost as well on the Yeah, on the CT. So, uh, you can see the pancreatic body and the pancreatic tail, um, and and often occurs chronic pancreatitis often occurs due to chronic alcohol. Uh, usage. Yeah. So moving on to lower GI anatomy. Okay. And so ct colonoscopy. Uh, colonography. Um essentially a virtual colonoscopy, and there's an imaging technique. So basically, you've got for patient's that can't tolerate, um, that can't tolerate a lower like a lower GI endoscopy than you would use a colonoscopy instead. For example, you want evaluate, um, whether there's any like suspected masses in the lower GI tract. You would use this if you can't tolerate a colonoscopy, and it's a minimally invasive technique used to screen for colon. Uh, colorectal cancer. Um, essentially just manipulates the image you account CT to create a three D image. Um, it's It's better than in a colonoscopy, in a sense, because it can also detect extra colonic extra colonic pathologies so you can see outside of just the outside of just alumin of the lower GI tract. It's less invasive. There's your complications, Um, but a huge downside is the fact that you can't biopsy at the time of the procedure, which is quite important when you see if patient were to go in for a colonoscopy. Um, there's a suspected mass. Then, um, you'd want to sample that just to rule out any sort of sinister pathologies like colorectal cancer, um, is ionizing radiation as well and fecal matter in the colon can also mimic masses. So, um, very important to just kind of get the bowel prep done well and for colonography. And we have that here we have another case. So 70 year old female with three month history of abdominal pain and constipation and and they've they're not tolerating colonoscopy. So ct colon was performed. And, uh, what do you think of the diagnosis? So this is an example of that particular disease, and you'll probably hear more of it when you start doing your surgical blocks in 3rd and 4th year. Um, essentially, um, these are various, like multiple out pouches that kind of, um, developed over time in some patient's, um and it's almost like a spectrum disease. So what happens initially is you've got these non inflamed out pouchings of the, uh, lower GI tract, most commonly in the sigmoid colon, and they're often a symptomatic. That's diverticula OSIs just the presence of these outpouchings. Um, but over time, these out pouching because they're just abnormal there, a bit kind of fragile, and they can become irritated and inflamed. Um, 4% of those with diverticula OSIs also knows diverticular disease can develop diverticulitis. Um, that's just when it starts to become symptomatic and these kind of outpouching start to become angry and start causing problems in the patient. Um, and instead of a CT colon, you can also use a barium enema, which can It's a similar to barium swallow just through the back passage instead. And and that can show up diverticular disease. But it's largely been replaced by CT nowadays. You really wouldn't do like, uh, CT is just kind of like a gold standard, um, investigation for these kinds of us, like lower gi um, conditions. Hi, everyone. It's me again. We're not going to go through Billary and asked me, um, great. I just wanted to say about the other cases. I know they're quite difficult. Um, but they're more to demonstrate the anatomy rather than testing that you guys know you know what chronic pancreatitis is? Looks like, um, it's just though, obviously it's very hard. I said an abdominal X rays to see normal anatomy. Um, but it's a lot easier to see abnormal anatomy, especially if it's calcified. Um, so it means that you now know where to look on. See an abdominal X ray and for the pancreas. And if you see an abnormality in that area, then you might be able to take a guess that the pancreas is affected. And so don't be worried of you if you didn't get it Anyway, we're going to bill you and ask me Now, um, so another radiological technique. So this is M R c p. So this is a fancy form of MRI. Um, so it's a magnetic resonance cholangiopancreatography pancreatitis graffiti, Which is a mouthful, um, so indications. And so it allows you to look at the biliary system. So the intra and extrahepatic biliary tree and and the pancreatic ductal system. And it's used to assess if there's gallstones in the common bile ducts. And I have an example of that later on, um, also to assess and sort of what the packages looks like. Um, so thanks a note so you can see on the image there's these, um, the ducks are appearing bright white and and that's not contrast. That's just like the magic of MRI is using the fluids in the Billary and pancreatic ducts as an intrinsic contrast medium. And this is a fun fact how That's quite cool. Um, and this is often used instead of e ercp, which is an endoscopic procedure. And I talk about that in a bit. Um, but this is rather than putting a patient through endoscopy, they just go for an MRI, and you can assess the anatomy quite well. Um, I've tried to label this diagram. I've gotten even better diagram the next slide, but you can see the big white blob on the left hand side. That's the gallbladder, and you can see the gallbladder is joined this duct. So if you follow the duct up to the top, you can see it's branches off into your left and right. Hepatic ducks, um, the branches enjoying to form the common hepatic duct. And then, after MBA cystic duct of the gallbladder joins, it becomes the common bile duct and and it's quite hard to see on my screen. But you might be able to see it better than yours, and you can see the pancreatic duct coming down and so see the other blob in the top right hand corner. And if you kind of fall along from that, you can see a very faint line and coming down in a diagonal, and it comes down and joins the common bile duct, and they both enter into the duodenum and at the sphincter body. It might be difficult to appreciate on, like a phone. Um, but I've got a better picture. Q. So this one's a lot nicer. You can see things a lot better. And so again, big and white blob, that's your gallbladder. And you see it's joined to the big, chunky bile ducts and with the cystic duct, and then you follow up, you can see it splits into your right and left hepatic ducks. And again, if you look at, um, letter E, that's your pancreatic duct, and at the bottom, I've kind of drawn around where the organs would be. Um, so yellow is roughly where your liver is. You can see in the bile ducts within the liver and blues. Roughly where your PAN cases you can see the pancreatic duct kind of runs right through the middle, head to tail. Um, and I've outlined in the duodenum in red, so you can see where the bile ducts come in, Um, and empty into the duodenum. Um and then I was wondering this. So see the really white stripe in the midline at the bottom of the picture. I think that's your CSF. I think that's your spinal cord, and you can see, um, sort of the nerves coming off and just looking an upside down V shape. And that's just a fun fact in case you're wondering what that bright stripe was. Um, so I've got another case for you guys. Um, this is very similar to the chronic chronic pancreatitis case. Um, so that's why we can't, um, is this a fortune old female? She's got three month history of right upper quadrant pain after eating. So again, Where's the abnormality? Is it in the gallbladder? Deliver the small belt for the stomach and you can see it on both the abdominal X ray and ct. Remember what I said? It's very hard to show normal and ask Be an abdominal X ray unless it's abnormal, especially if it's calcified. It's a lot easier to see, so I see everyone's going for the gallbladder, which is the correct answer. These are gallstones. Um, so now you've seen gallstones and that don't lecture, you'll know to look in that position in the future. Um, and hopefully it will help you remember where the gallbladder is on CT. Um, so call you with the isis. That's just gallstones in the gallbladder. And it could be multiple, like in the abdomen, luxury, or they can be single and large. And that's like the CT that I put in here. Um, so called a cold with the isis I said was gallstones within the common bile duct. And you can see in the bottom left that is M R C P. And you can see the bile duct. Um, at the top, you've got left and right and hepatic duct and you can see it comes down. And it's a nice white line until suddenly have this black dot and that is a gallstone within your common bile duct. And I mentioned ercp. Um, so this is a endoscopic procedure. Um, this isn't really done by radiologist. This would be more gastroenterologist, but it's good to be aware of it because it does produce, uh, radiological images. Um, so it stands for endoscopic retrograde cholangiopancreatography, which again is a mouthful. Um, so you get this end of scope is passed to the patient's mouth. You can see in the bottom image, and it's just kind of like your standard endoscopy, except instead of the camera being at the end of the scope. It's kind of at the side. You can see that middle image there. The camera's pointed, um, to the side, and that allows it to see and go into the Jodi numb and see the specter of body. And they can go through this victor and inject contrast and then take an X ray, which is that image at the top, and that lets them assess the anatomy of the bile ducks. Um, so it can also be a therapeutic intervention so you can do a sphincterotomy where you cut the sphincter of oddi and that can let gall stones pass easier. Um, biliary stenting. So someone comes in jaundice because they have a pancreatic cancer that's compressing their bile duct, and you can stent it and let bile drain. And that can help a person's symptoms. And it can also be used for bile. Duct stones removal, um, contraindications so it can't be used in a patient's unstable or they're high bleeding risk, and it's got many complications, so pancreatitis is the main one that you should remember, but also things like infection and perforation. So when you look at the radiological image, you can see the endoscope coming down. And then when it curves into that like a C shape, that's the duodenum. And you can see this thin white line coming out with the endoscope, and that's going through your sphincter body into your bile ducts. And then you can see contrast has been injected. And there's these black dots within the bile duct, and those are gallstones. And you should also know that this bile ducts quite dilated. Um, and that's a sign that it's been blocked by gallstones. So moving on to renal anatomy, Um, so CT key and PB sounds continue your chosen bladder. Uh, this is just another part craft CT that's used to look at the galaxy. Um, we tend not to use, uh, X rays as kind of a first line investigation. Um, for real pathologies. Marino symptoms. Uh, just because it sounds maybe like that. Yeah, no. All right. Okay. Mhm. Hello? Can you hear me? Okay. Okay. And then you could just do a little something. Okay. Hello? Uh, we'll get Switch back to the other, Mike. Just give us a few minutes. Sorry. Is that a bit better? Mhm. Okay, sorry. I just like my phone is connected to, um edgy. Roman, it wasn't working. Um, so that should be better now, but let us know if it cuts out again. Cool. Yeah. So, um, back to what I was saying about a double X rays just because a lot of your, uh, like, kidney anatomy is mostly soft tissue. It's quite hard to differentiate what's going on in an X ray. Um, as opposed to, uh, like the chest X ray or other parts of the GI tract. Um, so CTK be, um you use it for your with isis. So, like stones, Um, and it's the initial sort of imaging you would use in an emergency setting like the any, um, you can use it for hematuria, which was blood in the urine. And you can use it for flat plane as well. Um, you can use it to so findings you might find in a C T. K B would be like radiopaque zones and looking at the size that can help to guide what the management option is it can also see the second day of, like, sones obstructing the urinary tract so you can get hydronephrosis, which is, like, um, build up of, um, urine in the kidneys, dilation the ureters and also can help to identify infection such as Piland arthritis, which is like an infection of the upper urinary tracts. So here we have a 30 year old male with left sided back pain and intermittent hematuria. Um, what is the diagnosis? So, yeah, um, this is a staghorn, uh, calculus. So, um, it's, uh, back to what I said about how X rays aren't generally used for, um, abdominal, uh, for renal pathologies. And this is one of the rare kind of indicate, um, things that you do show up on an x ray. Um, because this is a, uh, like a stone that can show up on on X ray because it's calcified. Um, it has a very distinctive period. So it looks like, you know, like it's a branching kidney stone. Um, it's staghorn shape. So and once you see it, you'll you'll know what it is. And you know, you see it once. You'll next time you see it. You'll definitely know what it is. Um, and another imaging technique that can be used for the urinary tract is ultrasound. Uh, so you can use it for, um, assessment of hydronephrosis iss? Uh, maybe if you suspect that it's happening, you can confirm it. If you suspect in the obstruction downstream of the kidneys, you can use it to check that as well. You can use it to find, um, polycystic kidneys, and it can also be used to monitor the progression of chronic kidney disease. And just like any other sort of imaging using ultrasound, uh, it's very user dependent. Um, and it's good because it doesn't use ionizing radiation, but it's quite user dependent. And for those for like a larger patient's, it might be hard to visualize the, um, you know, deeper structures as well with ultrasound. Um, just because there's more soft tissue to kind of get through. Um, but the ultrasound is used for the urinary tract. So here, um, we have a 70 year old female with unknown bladder tumor that's obstructing her ureter physical junction. Um, an ultrasound of your kidney. Um, what does that show? Let me just pull pull. So this is, um, Hydronephrosis. And you can see how the collecting system of the kidney is quite dilated. Very dilated. Um, yeah. It's built up of what, uh, like urinary, uh, build up of urine in the in the kidneys. Um, often it's due to obstruction. So not just tumorous but evil. Scott Stone and mails. You can get enlarged prostate, which can cause this. Um, yeah. Um, here we have another case, so this is quite tricky. So don't worry if you don't get this. This is a six year old male, represents a frank hematuria. And, um, he's diagnosed with Nutcracker syndrome. Um, key vessel circles red. That's being squished. Uh, what is the name of this vessel? And I'll just jump in and say that I put this one in because I saw this on placement, and and it's very jerky. We don't expect you to be able to remember it or recognize it. Um, but on the next side slide, you'll see it highlights the anatomy. Really? Well, in my opinion, um, and and hopefully will help you remember this specific type of anatomy that we're about to discuss. Yeah. Um, yeah. So this it was the left renal vein that was being squished. And and it's quite a complicated case. But again, you can see the knot Me quite well, just from, um uh, the imaging. So just just to go back? Yeah. So, um, you can kind of see that on the image on the left and kind of see that on the left side. So radiological left the patient, so, um, it wouldn't be the right renal rain and the rent renal artery. And, um, that just leaves options so it could be the left renal artery left renal vein. Those two options left, and you can kind of see the aorta on. So on the outside of the so on the left image, you can kind of see the just on the border of the red circle. You can see like a circular structure. So that's the aorta that's not being circled. And it's not really being compressed. Um, and you kind of follow it onto the right image there. Um, you can kind of you can see the aorta, but it's not a circular, but it's not really being involved. And it's not really being like it's changed shape but you can. It's not really being compressed in the picture. So, um, you can see how, uh, and the the structure that's being squished isn't connected to the aorta. So that's going to be the, uh, real being then, um, and that correct er syndrome. And that's when the left renal vein is being squished between the S m A and the aorta. Uh, as S M. A branch is also the S M A is the small, superior superior mesenteric artery. And and, um, yeah, I'll jump in because I put this one in. Um, So, as I said, I saw this in placement, and I think it highlights. I've bolded it, um, So you can see I always used to forget what venal vein crossed the aorta. Um, until I saw this. And then I can think back on it, and I can kind of helps me remember. And I think it's a cool case, and you can see in the CT I put here and you can look at. So it's the kidney that's on the right of the image. But it's the patient's left kidney. You can see this really twisty vessel coming down. Um and that is the left gonadal vein. And it drains directly into the left renal vein, which is different to the right gonadal vein, which can see on diagram goes straight into in vena cava. And but the left gonadal vein drains since left renal vein and in Nutcracker syndrome and the left renal vein is getting squished. So everything's backing up, and everything backs up into the left gonadal vein and that causes it to become really twisty. And you can see that on the image you can see almost like, twist around on itself. Um, yeah, and that's just how like I kind of think about it and remember it. And yeah, you don't need to be able to recognize this case. I think it demonstrates and asked me in physiology quite well. And what happens And when things get blocked, Um, yeah, this is the last section. This is gentle, your anatomy. Um, so we've only got a couple of cases left, and this is a central male, and he presents with a three month history of hematuria and weight loss. Um, so look at the imaging and and think about what the diagnosis could be, is a stone bladder tumor. Is it prostate disease, or could it be a UTI? Um, yeah, I've put this one in because I don't know how else to, like, demonstrate in the so urinary anatomy. And I didn't want to just put in diagrams. So I've put in a couple of cases to show you where the main organs are, so I can see most people went for bladder tumor, which is the correct answer. Um, I don't have much to say about this other than this is where the bladder is. This is what the bladder looks like. It's filled with urine, and there's this gray fuzzy thing coming off the wall, and that shouldn't be shouldn't be there. Um, so this is a bladder tumor. Um, in terms of the prostate, usually MRI is used in for the prostate. Um, you can't see the prostate on this image. Um, but usually MRI is used, and yeah, this is just what the bladder looks like. And hopefully in the future, you'll remember where to look for the bladder, if that makes sense. Um, and then I think this might be your final radiological technique. And this is cystography and which is quite niche. But again, you should just be aware of it and where that exists. So this is another fluoroscopic study that images the bladder. Um, so you insert a catheter into the patient and you inject contrast, sort to fill their bladder and then take um, X ray and what you can see here. So you look at the top of the slides. There's three images, so the left image is before you've done anything to the bladder. That's just a normal entry. And in the middle you can see that the bladder appears as this white approval. And that's because it's filled with contrast. Um, and you can also see, um, a line coming off of the bladder filled with contrast. And that's the urethra. And this is because this image has been taken while the patient is passing urine and so passing the contrast. And that's why you can see the urethra and then on the right. You can see that's after they finished and urinating. And most of the contrast is gone. Um, so indications. So it's kind of used to assess both an ask me and physiology, and so you think someone might have a bladder leak, falling trauma you can inject. You know this contrast and see if it escapes the bladder. And if they've got dysfunctional voiding. And if you think that they might have a bladder outlet obstruction or something, stopping urine from passing and through the urethra. And sometimes it's used for hematuria. Um, and then congenital abnormalities of the general urinary track. So to assess anatomy. Um, so this is an example. This is, um, Cystography. And this is a 30 year old female chronic kidney disease. And remember what I said. You put in a cath after you fill the bladder up within this contrast solution, and just to give you a hint, if you look at the normal bladder's here, um, there's something in this image that is missing from this image. This one's an abnormal. So my question is, I've just given you that this one is Is it abnormal? No. And the answer is yes. This one is abnormal. Um, and and it's abnormal because you should not have urine coming from your bladder and then going up your ureters into your kidneys. So this is an example of physical your reflux. Um, so when you get the contrast and someone's bladder, it should not enter the ureters. And that indicates that this person person normally has urine going up the wrong way up a one way streets. That's your ureters. It usually occurs in Children, and then they can grow out of it. And but if they don't grow out of it and you get this constant refluxing of urine and up into your kidneys, that damages them, that scars them and you can end up with chronic keeping disease. Um, other sort of incidental findings in this image is that patient's bladder is really small. Um, if you look at the bladder and sort of on the right images, you can see that's a normal size and then on the left image and the abnormal. And that bladder is just really small, and you can see in that trio of images on the right hand side, that middle image. You can see that you can see the bladder. You can see the urethra. You cannot see the ureters, because contrast should not be going up that way. Um, this is just another, um, type of scan that you might see brought up in your lectures. And so this is a type of nuclear medicine scan. Um, so G. M S. A. It's a radioactive substance, and it's taken up by the kidneys taken up by nephrons and the kidneys, and it can assess how well your kidneys are working and and you can see on the top image. There's mild moderate, it's of you, and so you can see. So you see in the mild image you can see both kidneys. And that's because both kidneys are full of functioning nephrons that are taking up DMSA, and therefore, when you take a photograph, you can see both kidneys been severe, and you can see that one of the kidneys is almost missing. Um, and the kidney is actually there. It's just not working properly, so it's not taking up the DMSA, so it doesn't appear in the image, and you can also be used to check in kidney position, size and duplex kidney. So duplex kidneys kind of the horseshoe kidney. So that's the bottom image, and you can see it looks like a horseshoe, and sometimes someone will have two kidneys that are joined by fibers tissue, and but sometimes it'll be functioning. Um, so you can see in this patient? Um, there's a horseshoes shape which suggests that the whole of their horseshoe kidney can be is filled with in functioning nephrons. Because it's all taking up this radioactive substance. Great, that's us. We've gone through a lot in this evening. Um, so in conclusion, lots of imaging techniques exist. So at your stage, know the basics of chest X ray ct, MRI ultrasounds. And when thinking about what you think about, you know, are they good for bones and, like X ray and CT are are they good for soft tissue like MRI and ultrasound? Are do they contain ionizing radiations? That's your X ray and ct. Think about whether they might be first line. So I think you know X ray ct or maybe more. Second line that could be an MRI. And an ultrasound is increasingly being used as like a bedside test. And so be aware that she used a lot more and and then know some of the special tests. And so that's your like barium swallows and enemas. Nuclear medicine scans M R C p E R C P M, and then consider they're good tests were announced. More physiology. So, um, you're voiding cystourethrogram. That's quite good for physiology because it's taking more. The patient is urinating. Um, same with your barium swallows, um, that are taking while the patient swallowing, Um yeah, and just kind of know the basics of them. You don't really need to be able to interpret them, but you should know what they are and what they're used for and be able to recognize them and when you see them in your exams. And so one of the best ways, in our opinion, and to learn and after me is by comparing normal with the abnormal and so clinicals now is help to put in asking to context and make it more memorable and fun. And you can see, hopefully I've got the point across with the abdominal X rays, and they're quite a card to tell what's what until you're presented with an abnormal one. And suddenly it's quite easy to point out different parts the anatomy. So, you know, calcified pancreas or calcified. Give me and the key to imaging is exposure. It is really tricky. I've listed some sources here that you can use and When you get on placement, use Paps. It's the system that you can look at imaging on and read the radiology for. Ask doctors to show you the scans, and hopefully it will become a little bit more familiar with it. Thanks for coming. And this is our feedback form. I will send it to the chat. Um, it really helps us if you fill that out. I'm sorry about our sound. Issues were using a new room, and I should. I'll upload the slides and I'll upload the recording. It takes a couple of hours, sometimes to process, but I will upload it and I'll try and email you all and let you know when it's out. Does anyone have any questions? Um, if not, thanks for coming and And have a good evening. Uh