European Diploma in Radiology (EDiR): Free Preparation Guide Study Guide

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A screening mammogram shows an asymmetry without available comparisons. Request prior studies and diagnostic assessment appropriate to the finding. Explain that the recall completes interpretation; the screening appearance alone does not establish malignancy.

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Diagnostic ultrasound shows a simple cyst exactly corresponding to a mammographic mass. Assign a benign assessment for that concordant finding. If a separate hard palpable area remains unexplained, address that clinical-imaging discrepancy independently.

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An irregular breast mass receives a suspicious assessment. Recommend image-guided tissue sampling using the modality that reliably demonstrates the target. After biopsy, compare the pathology with the original imaging concern before concluding evaluation.

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Cardiac MRI shows inferior subendocardial enhancement extending toward the epicardium in a coronary territory. Describe an ischaemic scar pattern and its transmural extent, then assess regional motion and global ventricular function for associated impairment.

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A stress study shows a reversible anterior perfusion defect without anterior late enhancement. Report inducible ischaemia in the affected distribution, while separately documenting a small inferior scar that does not explain the anterior perfusion abnormality.

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A ventricle has an end-diastolic volume of 160 mL and end-systolic volume of 64 mL. Calculate an ejection fraction of 60%, then still inspect each segment because focal motion abnormalities can coexist with preserved global emptying.

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An older adult's CT shows peripheral basal reticulation, stacked subpleural cystic spaces and traction bronchiectasis, without a dominant alternative pattern. Describe a UIP pattern and integrate exposure, connective-tissue disease and other clinical information before assigning an aetiology.

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Several peripheral round lucencies appear on one CT slice. Scroll through adjacent sections and multiplanar views: branching continuity supports traction bronchiolectasis, whereas clustered layered cystic spaces support honeycombing in the appropriate fibrotic setting on CT.

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A fibrotic CT shows substantial upper-lung involvement and extensive lobular air trapping on expiration. Highlight these alternative-pattern clues and seek relevant exposure history instead of assigning UIP solely because some peripheral reticulation is present.

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CTA shows an entry tear distal to the left subclavian artery but retrograde extension into the ascending aorta. Classify the dissection as Stanford type A and communicate the ascending involvement promptly to the treating team.

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A patient with abrupt chest pain has hyperattenuating crescentic ascending aortic wall thickening on unenhanced CT. Contrast images show no classic dissection flap. Recognise possible ascending intramural haematoma and escalate the acute aortic finding.

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CTA shows a descending dissection with poor enhancement of one kidney and compromised renal arterial inflow. Report the perfusion abnormality and implicated branch anatomy explicitly rather than ending the report with the Stanford category alone.

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A liver lesion has peripheral nodular enhancement matching vessels in the arterial phase and progressive inward fill-in later. In an appropriate clinical setting, recognise the typical haemangioma pattern rather than labelling arterial enhancement alone as malignant.

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A 2-cm lesion in a healthy liver is homogeneously hyperechoic, sharply marginated, shows posterior enhancement and has no halo. It meets the typical ultrasound criteria. The same finding in a patient undergoing cancer follow-up requires contrast-enhanced characterisation.

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A single-phase CT shows an indeterminate enhancing liver lesion that lacks enough information for haemangioma characterisation. Recommend a suitable dedicated contrast examination, comparing prior studies and clinical risk before considering whether tissue sampling is necessary.

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When a sac contains a yolk sac, confirm its relationship to the endometrium and implantation site before calling it a normally implanted pregnancy. A sac implanted in a caesarean scar or the cervix requires classification as ectopic rather than reassurance based on its uterine position.

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Transvaginal ultrasound demonstrates an extraovarian adnexal gestational sac containing a yolk sac, with no intrauterine gestation. Report a definite ectopic pregnancy and communicate promptly, including the location and any associated free fluid that is present.

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A clinically stable patient has a positive pregnancy test and no identified pregnancy on transvaginal ultrasound. Use pregnancy-of-unknown-location terminology and organise follow-up; new severe pain, collapse or other concerning symptoms require urgent reassessment rather than routine waiting.

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A solid hypoechoic thyroid nodule is wider than tall, smoothly marginated and contains punctate echogenic foci. Add 2 + 2 + 0 + 0 + 3 = 7 points, placing it in TR5 before applying size thresholds.

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A 1.2-cm TR4 nodule has no separate clinical feature requiring a different pathway. It meets the chart's follow-up threshold but remains below its FNA threshold. A 1.2-cm TR5 nodule would meet FNA criteria.

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Two otherwise similar thyroid nodules contain different echogenic foci: one has large comet-tail artefacts and the other punctate foci. Assign the appropriate different points rather than giving both an identical generic calcification score.

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The consent describes left renal biopsy, but the scheduling list says right renal biopsy. Review the referral and imaging with the responsible team and resolve the intended target before preparing or puncturing either side.

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Before angiography, review current creatinine, its trend, eGFR, urine output and the planned injection site. A suprarenal aortic injection produces first-pass exposure, while an infrarenal arterial injection produces second-pass exposure. Suspected AKI requires reassessment regardless of a previous normal result. Begin appropriate preventive measures as circumstances permit without delaying necessary emergency care to obtain laboratory results.

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A planned diagnostic angiogram has changed to a possible therapeutic embolisation. Confirm that the patient understands the expanded purpose, relevant additional risks and alternatives before proceeding, and document the updated discussion and agreed procedural scope.

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A patient presents with a small superficial lump that is readily accessible to ultrasound. Use ultrasound to characterise it initially. If the appearance is indeterminate or suspicious, advance to appropriate MRI and referral instead of assuming superficial means benign.

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A deep thigh mass is suspicious for sarcoma and has not been biopsied. Obtain appropriate MRI local staging and specialist input first, allowing the biopsy target and tract to be planned with the eventual treatment approach.

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A painless deep mass has enlarged over several months and measures 8 cm on imaging. Arrange specialist tumour-centre assessment before attempted excision, even if the lesion appears well defined and the patient reports little functional limitation.

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A patient develops sudden focal weakness, and MRI shows a vascular-territory lesion bright on diffusion-weighted imaging and dark on ADC. Recognise true restricted diffusion supporting acute infarction in the matching clinical and anatomical context.

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A T2-bright brain lesion is also bright on diffusion-weighted imaging, but its ADC is elevated. Explain that the diffusion appearance reflects shine-through rather than using brightness alone to label the lesion as acutely restricted tissue.

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A patient presents after several days of neurological symptoms. A vascular-territory lesion remains diffusion-bright but has near-normal ADC. Consider evolving infarction with ADC pseudonormalisation and integrate the other sequences rather than declaring the study inconsistent with infarction.

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Baseline CT shows several liver lesions and enlarged nodes. Select representative measurable targets within the overall and per-organ limits. Record liver longest diameters and nodal short axes so later sums compare the same lesions using the same conventions.

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The baseline target sum is 100 mm and the current sum is 68 mm, a 32% reduction. With no new lesions or disqualifying non-target progression, the target-lesion change supports partial response rather than stable disease.

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A target sum falls to a nadir of 40 mm and later rises to 48 mm. The 20% increase also adds 8 mm, satisfying both target-progression thresholds even though the sum may remain below its original baseline.

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A five-week-old infant has progressive projectile nonbilious vomiting and remains hungry after feeds. Request pyloric ultrasound to assess muscular thickening, canal morphology and passage, rather than beginning with a radiation-based examination intended for another obstructive question.

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A young infant has green vomiting and a nonclassic abdominal gas pattern, with malrotation suspected. Arrange urgent assessment and an appropriate upper gastrointestinal contrast examination rather than limiting the work-up to an ultrasound of the pylorus.

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During ultrasound for nonbilious vomiting, an initially narrowed pylorus subsequently opens with passage of gastric contents. Reassess the complete morphology and dynamic sequence before diagnosing fixed pyloric obstruction from the first captured image alone.

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A renal lesion has central fluid but a large enhancing solid component comprising most of its volume. Assess it as a predominantly solid mass with necrosis rather than assigning a Bosniak category simply because fluid is present.

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Contrast MRI demonstrates a smooth enhancing wall measuring 3 mm without a nodule. That feature supports IIF. If the enhancing wall instead measures 4 mm, the thickness criterion supports III, assuming the remaining assessment is compatible.

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A cystic renal mass contains a 3-mm enhancing convex protrusion with acute margins where it meets the wall. Recognise a nodule supporting Bosniak IV despite its size, because the acute-margin criterion has no minimum size.

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FDG PET shows avid tissue around a clinically infected prosthesis. Interpret the uptake within the infection-focused indication and anatomical findings rather than relabelling it as malignant solely because the activity is visually intense on PET.

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A patient has new left axillary uptake shortly after vaccination in the left arm. Review the injection history and CT morphology, and describe the plausible reactive explanation while considering whether the distribution matches the patient's known disease.

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A focal pelvic PET hotspot lies along the expected ureteric course without a corresponding mass on CT. Consider urinary tracer activity and review adjacent images before classifying it as a metastatic node or inflammatory lesion.

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A repeat CT is requested although a recent adequate examination already answers the unchanged clinical question. Review the prior study and indication before exposing the patient again; reducing the repeat scan's dose would not resolve its lack of benefit.

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A protocol reduction makes images too noisy to assess the small structure central to the referral. Reconsider the settings against the diagnostic task rather than accepting the lowest dose value as evidence that the examination is optimised.

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An audit finds the typical dose for a standard adult CT task consistently above the relevant DRL. Review protocol design, patient matching and image adequacy, rather than cancelling an individual clinically justified examination solely because its dose exceeds that benchmark.

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A protocol uses 100 mAs and has a measured noise level of 20 units. Increasing to 400 mAs would predict roughly 10 units under comparable conditions, but approximately four times the exposure rather than twice.

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A homogeneous region measures approximately 0 HU on an appropriate unenhanced image. Recognise water-like attenuation, then inspect morphology and partial-volume effects before deciding whether the region represents a simple fluid structure or another low-attenuation process.

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Two CT series use different mAs, slice thicknesses and reconstruction kernels. Avoid attributing their noise difference solely to exposure. Compare matched reconstructions or account for the other changes before recommending a protocol adjustment for the diagnostic task.

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A technologist finds two patients with similar names on the worklist. Match additional identifiers and the requested procedure before selecting the item, rather than assuming that an electronically populated demographic record must belong to the patient present.

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A scanner can send completed images to the archive but cannot retrieve scheduled appointments. Investigate the modality worklist C-FIND configuration and matching criteria rather than assuming that successful image storage proves the worklist service is functioning.

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A scheduled CT remains visible on the worklist after the patient leaves before scanning. Confirm the actual acquisition and workflow status rather than telling the clinician that imaging is complete merely because a worklist item exists.

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An outpatient CT reveals an immediately consequential acute aortic abnormality. Contact an appropriate responsible clinician directly and confirm receipt, escalating through the service's urgent pathway if necessary rather than relying on eventual routine report review.

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A scan excludes the suspected obstruction but reveals an alternative explanation for symptoms. State both conclusions clearly, identify any material technical limitation and recommend additional assessment only when it addresses a specific unresolved clinical question.

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A final review identifies a consequential finding missed in the preliminary report. Contact the responsible clinician, explain the changed interpretation and document whom you reached and when. Add the formal correction so the report and communication record agree.

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Among 100 people with disease, a test identifies 90; among 200 without disease, it correctly excludes 180. Sensitivity is 90/100 and specificity is 180/200, both 90%, despite the groups having different sizes in this study.

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The same test is used in an asymptomatic low-risk group and a clinically selected high-risk group. Expect a greater proportion of false positives among positive results in the low-risk group, assuming comparable sensitivity and specificity.

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In 1,000 people with 10% disease prevalence, a 90%-sensitive and 90%-specific test yields 90 true positives and 90 false positives. Half of positive results are therefore false, despite apparently favourable sensitivity and specificity values.

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A repeat examination is requested even though a recent accessible study answers the unchanged question. Resolve whether new imaging would alter care before scheduling it, combining appropriate clinical use with avoidance of unnecessary environmental and operational costs.

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A department introduces a shorter protocol. Compare environmental measures before and after implementation using consistent boundaries, and check whether repeat examinations increase. A lower energy figure per acquisition may not represent a net improvement if additional imaging is required.

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A service compares maintaining a functioning scanner with purchasing a replacement. Evaluate manufacturing and disposal impacts alongside expected operational savings, reliability and clinical capability over a common time horizon before concluding which option has the lower environmental burden.