Unoffiical Guide to Radiology

The Unofficial Guide to


Chief Editors: Mark Rodrigues & Zeshan QUreshi

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“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 labelling enabling one to be absolutely certain of which is the endotracheal tube, the nasogastric tube and the central line, for example.”

Bob Clarke photo

Bob Clarke
Associate Dean, Professional Development, London.
Director, Ask Doctor Clarke Ltd.

“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!”

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Simon Maxwell
Professor of Student Learning, University of Edinburgh

“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 ease of use, detailed pictures and emphasis on key points of this one should cement it as the number one undergraduate book for radiology.”

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James Brooks
Medical Student

“I find this book to be a superb resource in preparation for my upcoming OSCEs. The basic science behind the different imaging modalities is explained clearly and good examples and analogies make understanding and recall easier. The book goes through the main modalities you will need to be aware of as a medical student and a junior – X-rays, CTs, MRIs, USS, Nuclear medicine scans and fluoroscopy.

The high number of really useful images and the variety of MCQs are brilliant for checking understanding. The chapters are complete with ‘Key points’ boxes that are handy for subsequent reads. When you go through the images, you can use the checklist provided to get yourself into a routine.”

R. Kalenderov
Third year medical student

Radiology is an important part of clinical work for all doctors, whether it be understanding which type of imaging would be most useful, knowing how best to request the study or interpreting the images.

Unfortunately it is often an overlooked subject in the medical school curriculum, which many medical students and junior doctors find difficult and daunting.

The award winning The Unofficial Guide to Radiology aims to remedy this by providing a comprehensive overview of radiology relevant for medical students and clinical doctors. A large part of the book is devoted to X-ray interpretation, a key skill for students and doctors alike. A systematic approach to chest, abdominal and orthopaedic X-rays assessment is supplemented by over 100 cases to help hone your technique. The book also covers the basic science around X-ray production, relevant legislation and how to request radiological tests.

Since its release, The Unofficial Guide to Radiology has consistently been one of the best selling medical textbooks on Amazon, and is the winner of the British Institute of Radiology PHILIPS Trainee Prize for Excellence 2015. Its content is in line with the Royal College of Radiologists’ (UK) Undergraduate Radiology Curriculum 2012, written by both radiologists and clinicians, and reviewed by a panel of medical students to ensure it is relevant to today’s medical students and doctors.

Key Features

Written in line with the other books in the series, stations contain:

Over 200 large, high quality radiological images
On image annotations to highlight the key points and findings to the reader
Step-by-step approaches to interpreting chest, abdominal and orthopaedic X-rays

Chest, abdominal and orthopaedic X-ray chapters each has 20 cases covering common and important diagnoses.


  • X-rays are presented in the context of a clinical scenario – ‘Present your findings’ and come to your own conclusions before turning over the page to reveal a model X-ray report accompanied by a fully annotated version of the X-ray
  • Each case has 5 clinical and radiology-related radiology-related multiple choice questions with detailed answers. These are aimed to test core knowledge needed for exams and working life, and illustrate how the X-ray findings will influence patient management.
Bonus X-ray chapter provides over 50 further X-ray cases to help consolidate the reader’s knowledge and provide an opportunity to practice the skills they have learnt.
Introductory chapter covering the basic science of X-ray production, the X-ray legislation relevant to clinical doctors and how best to request imaging studies
Five chapters cover the indications and contraindication associated with computed tomography (CT), magnetic resonance imaging (MRI), ultrasound (US), nuclear medicine and fluoroscopy, as well as highlighting some important findings on these studies
Mark Rodrigues photo
Mark Rodrigues
Radiology Registrar,Royal Infirmary of Edinburgh;
Honorary Clinical Tutor, University of Edinburgh, UK

With this textbook, we hope you will become more confident and competent in these radiology competencies, both in exams and in clinical practice, and we also hope that this is just the beginning.We want you to get involved, this textbook has been a collaboration with junior doctors and students just like you. You have the power to contribute something valuable to medicine; we welcome your suggestions and would love for you to get in touch.

A good starting point is “The Unofficial Guide to Medicine” facebook page, an active forum for medical education. Please get in touch and be part of the medical education project.

The Unoffical Guide To Radiology - Annotated X- Ray

In Summary – This chest X-ray shows a largeright pneumothorax. There is no evidence of associated tension. There is no underlying cause discernible on this X-ray, suggesting that this is a primary spontaneous pneumothorax
The Unoffical Guide To Radiology - Mark Scheme Icon

Technical Aspects

Check patient details (name, date, birth, hospital number). N
Check the date of the X-ray N
Identify the projection of the X-ray N
Assess technical quality of X-ray (rotation, inspiration, penetration) N

Obvious Abnormalities

Describe any obvious abnormality N
Site (lung and zone/lobe) N
Size (if relevant) N
Shape (if relevant) N
Density N

Systematic Review of the X-ray

Position of trachea N
Assessment of lungs N
Size and appearance of hila N
Assess for cardiomegaly N
Assess cardiac and mediastinal borders and cardiophrenic angles N
Position and appearance of hemidiaphragms N
Evidence of pneumoperitoneum (free air under the diaphragm) N
Assess the imaged skeleton N
Assess the imaged soft tissues (e.g. surgical emphysema, mastectomy) N
Comment on iatrogenic abnormalities N
Look at review areas (apices, hila, behind the heart, costrophrenic angles, under the diaphragm) N


Present Findings N
Review relevant previous imaging if appropriate N
Provide a differential diagnosis where appropriate N
Suggest further appropriate imaging/investigations if relevant N


This is a PA chest X-ray of an adult.There are no identifying markings – I would like to ensure that this is the correct patient, and to check when the X-ray was taken.
The patient is slightly rotated; this is otherwise a technically adequate X-ray with adequate penetration and good inspiratory effort. No important areas are cut off at the edges of the film.
There is an obvious abnormality in the right hemithorax: a line can clearly be seen with absence of lung markings beyond it, in keeping with a lung edge.
The aerated right lung is otherwise normal in appearance.
The trachea and mediastinum are not deviated, and the right hemidiaphragm is not flattened.
Reviewing the rest of the film, the left lung is normal.
The heart is not enlarged, heartborders are clear, and there is no abnormality visible behind the heart.
There is minor blunting of the costophrenic angles which may represent small volumes of pleural effusion.
The hemidiaphragms are clear.
There is no free air under the diaphragm.
There are no soft tissue abnormalities or fractures; in particular, no rib fractures are visible.

  1. Which of the following are risk factors for a primary spontaneous pneumothorax?
    1. Male gender
    2. Smoking
    3. COPD
    4. Trauma
    5. Marfan’s syndrome
  2. Which of the following clinical findings would be supportive of a large simple right sided pneumothorax?
    1. Central trachea. Dull percussion and reduced air entry on the right side of the chest
    2. Central trachea. Dull percussion with bronchial breathing and crackles on the right side of the chest
    3. Central trachea. Hyperresonant percussion and reduced air entry on the right side of the chest
    4. Central trachea. Hyperresonant percussion and reduced air entry onthe left side of the chest
    5. Trachea deviated to the left. Hyperresonant percussion and reduced air entry on the right side of the chest. Hypotensive, tachycardic
  3. Which of the following are appropriate differential diagnoses for a patient who presents with sudden breathlessness?
    1. Pulmonary embolus
    2. Pneumothorax
    3. Pneumonia
    4. Heart failure
    5. Anaphylaxis
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