Contents Cover 1 Front Matter 3 Chapter 1 - Basic atomic structure, radioactive decay 12 Chapter 2 - Production of X-rays 32 Chapter 3 - X-ray interactions 58 Chapter 4 - Film-screen radiography 73 Chapter 5 - Factors affecting the radiological image 88 Chapter 6 - Image intensifiers and fluoroscopy 103 Chapter 7 - Mammography 113 Chapter 8 - Special radiographic techniques 124 Chapter 9 - Gamma imaging 127 Chapter 10 - Digital radiology 146 Chapter 11 - Computed tomography 155 Chapter 12 - Radiation detectors 162 Chapter 13 - Radiation hazards and protection 173 Chapter 14 - MRI 199 Chapter 15 - Ultrasound physics 232 References 254 Also Available 255 Published by Developmedica 2009 Castle Court Duke Street New Basford, Nottingham, NG7 7JN 0845 838 0571 www.developmedica.com © 2009 Developmedica Digital Edition converted and published by Andrews UK Limited 2010 www.andrewsuk.com All rights reserved. Purchasers of this book are instructed that they can only use this guide for the purpose of improving their knowledge and revising for the FRCR Part 1 Exam and are prohibited from redistributing this book or any part thereof. This book cannot be reproduced in full or in part without the express written permission of Developmedica. Developmedica recommends that you consult the Royal College of Radiologists website for information and guidance on how to sit your FRCR Part 1 Examination. The views expressed in this book are those of Developmedica and not those of the Royal College of Radiologists. Developmedica is in no way associated with the Royal College of Radiologists. The contents of this book are intended as a guide only and although every effort has been made to ensure that the contents of this book are correct, Developmedica cannot be held responsible for the outcome of any loss or damage that results from the use of this guide. Readers are advised to seek independent advice regarding completing the FRCR Part 1 Examination. Every effort has been made to contact the copyright holders of any material reproduced within this publication. If any have been inadvertently overlooked, the publishers will be pleased to make restitution at the earliest opportunity. Succeeding in the FRCR Part 1 Exam: Essential revision notes and over 1000 practice MCQs Pervinder Bhogal, Thomas Conner, Guarrang Bhatnagar & Habir Sidhu Edited by Anmol Malhotra FFRRCCRR--pprree..iinndddd 11 1111//1144//0099 99::5599::3311 AAMM Dedication To our friends and families for all their love and support FFRRCCRR--pprree..iinndddd 33 1111//1144//0099 99::5599::3322 AAMM About the editor Anmol Malhotra Anmol completed his radiology training at Barts and the London NHS Trust in February 2005 and spent time as an observer in MRI imaging at Memorial Sloan-Kettering, New York. Anmol now works as a consultant at the Royal Free Hospital in London. About the authors Dr Pervinder Bhogal Pervinder trained at Royal Free and University College London Medical School and graduated in 2004. After university he passed his MRCS Exam and is currently studying for a Masters Degree in Medical Education. He entered Radiology training in 2007 and passed his FRCR Part 1 on the fi rst attempt. Thomas Conner Thomas gained a 1st Class Honours degree in Anatomy and Developmental Biology and graduated in Medicine from University College London in 2004. He is currently a Radiology Registrar on the Royal Free Hospital radiology rotation. He is interested in academic radiology. Gaurrang Bhatnagar Gaurrang is a Radiology Registrar on the Peninsula training scheme. He moved to the South West in 2008 after completing basic surgical training FFRRCCRR--pprree..iinndddd SSeecc11::77 1111//1144//0099 99::5599::3322 AAMM viii About the Editor in London. A fi rm believer in the statement “he’s a doctor not a physicist” (Dr Leonard ‘Bones’ McCoy, Star Trek) he found question books such as this one the ideal way to revise for the FRCR Part I. Harbir Sidhu Habir graduated from University College London Medical School in 2004. After undertaking basic surgical training in the Yorkshire deanery, he moved to the Southwest. He is currently working in the Peninsula training scheme as a Radiology Registrar. FFRRCCRR--pprree..iinndddd SSeecc22::88 1111//1144//0099 99::5599::3322 AAMM List of contributors Yen Zhi Tang Radiology Registrar Royal Free Radiology Rotation Ynyr Hughes-Roberts Radiology Registrar Cambridge University Hospital Radiology Rotation About the publisher Developmedica is a specialist provider of books, courses and eLearning solutions tailored to meet your career development needs. Visit our web site at www.developmedica.com and fi nd out more. Our approach is friendly and we have time for individuals. Phone or email and let us know your requirements. FFRRCCRR--pprree..iinndddd SSeecc22::99 1111//1144//0099 99::5599::3322 AAMM Abbreviations ARSAC Administration of Radioactive Substances Advisory Committee Bq Becquerel (disintegrations/second) c Speed of light ( 3 ¥ 108m/s) C Coulomb CTDI Computed Tomography Dose Index DAP Dose Area Product (Gy cm2) DRL Diagnostic Reference Level eV Electron volt (1 eV = 1.6 ¥ 10–19 joules) f Frequency FFD Focus Film Distance Gy Gray H Planck’s constant (6.626 ¥ 10–34 Js) HVL Half Value Layer HSE Health and Safety Executive IRR 1999 Ionising Radiations Regulations 1999 IRMER Ionising Radiation (Medical Exposure) Regulations 2000 kVp Peak electrical potential across an X-ray tube LAC Linear Attenuation Co-effi cient lp/mm Line pairs per millimeter mA Milliamperes mAs Milliampere – seconds MTF Modulation Transfer Function SI Systeme Internationale Sv Sievert – the unit of effective dose and equivalent dose Z Atomic Number FFRRCCRR--pprree..iinndddd SSeecc22::1111 1111//1144//0099 99::5599::3322 AAMM Preface The FRCR Part 1 Examination for the Fellowship of the Royal College of Radiologists is the fi rst in a series of examinations that radiology registrars must undertake in order to gain membership to the College. This book is a comprehensive, all-in-one revision guide for candidates. Comprising over a thousand Multiple Choice Questions (MCQs) which test the exact topics on which candidates are examined, the authors also explain the answers to each question in depth, introducing additional detail so as to cover every subject fully and ensure your success. We therefore offer you the opportunity to test yourself using questions structured to refl ect those in the real examination, and at the same time bring your knowledge up to the required level. Our intention is that by careful revision using this book alone, you will be equipped to pass what is for many a daunting examination. We offer up-to-date questions to keep abreast of developments in CT, MRI and Nuclear Medicine, and with sections on MRI and Ultrasound physics we address challenging new topics recently introduced into the examination. As well as FRCR Part 1 candidates, we believe that this book will be extremely useful for the following readership: ∑ Radiologists sitting FRCR Part 2b, for which physics knowledge is again required ∑ Foundation Year doctors interested in applying for radiology ∑ Radiographers undertaking training. ∑ Outside of the UK, graduates undergoing radiology training We hope you will fi nd this book easy to use and essential to your preparation. Good luck in your studies! Dr Anmol Malhotra Consultant Radiologist Royal Free Hampstead NHS Trust FFRRCCRR--pprree..iinndddd SSeecc22::1133 1111//1144//0099 99::5599::3322 AAMM