NR Medical Academy

NR Medical Academy Coming soon Radiation Protection Officer (RPO) course.

Academic activities Medical: CME for x-ray license renewal (4 CPD points), 40 hour course for new license holders (20 CPD points), PoCUS Ultrasound Workshops & Radiographic Technique Workshop.

BREAST CYST42F, initially presented in 2022 with a left breast lump. Ultrasound showed an 8mm well-defined simple cyst w...
21/02/2026

BREAST CYST
42F, initially presented in 2022 with a left breast lump. Ultrasound showed an 8mm well-defined simple cyst with benign sonographic features. No suspicious solid component or vascularity. Features are consistent with a benign simple breast cyst (BI-RADS 2). No surgery was done. She came again in 2026 and a similar cyst is seen at the same region. The size and shape are about the same.

What is simple breast cyst?
Simple cyst = anechoic, thin wall, posterior enhancement, no solid component, no vascularity.

What To Do for a simple breast cyst
👉 No treatment is required
👉 No aspiration is needed
👉 Routine screening follow-up only

What is the natural history of simple breast ccyst?
Can fluctuate with hormones
Can spontaneously disappear
Can remain the same
Are not premalignant

When Further Work-Up Is Needed
Solid component inside cyst
Thick septations
Internal vascularity
Rapid enlargement
Bloody aspirate
Associated suspicious mammographic finding
KLINIK PAKAR X-RAY NR, SHAH ALAM, SELANGOR, MALAYSIA

POSTERIOR CRUCIATE LIGAMENT AVULSION INJURY 56M, alleged stepped into hollow container, tender right popliteal fossa.X-r...
20/02/2026

POSTERIOR CRUCIATE LIGAMENT AVULSION INJURY
56M, alleged stepped into hollow container, tender right popliteal fossa.
X-ray knee showing minimally displaced intra-articular fracture of posterior tibia (yellow arrows). Suprapatellar bursa is obliterated (red arrows) indicating a large hemarthrosis. Fracture is at the expected site of the tibial insertion of the posterior cruciate ligament. This is posterior cruciate ligament (PCL) avulsion injury.
PCL runs from posterior tibia → medial femoral condyle. It prevents posterior displacement of tibia.
Classic mechanism is dashboard injury when tibia pushed backward while knee is flexed. It can also happen as above when the patient fell onto a flexed knee.
Clinically look for positive posterior drawer test and sag sign.
Next step would be to do CT scan for surgical planning.
KLINIK LEE DAN SURGERI, JOHOR BAHRU, JOHOR, MALAYSIA.

Need someone to report your x-rays, ultrasounds, mammograms, CT scans, MRI, Echo & ECG? We have everything you need!Cont...
19/02/2026

Need someone to report your x-rays, ultrasounds, mammograms, CT scans, MRI, Echo & ECG? We have everything you need!
Contact us 03-50360607/ General inquiries 012-2441547

BONE ISLANDFomema medical check-up. CXR showing a sclerotic oval-shaped lesion at right 2nd anterior rib. This is a bone...
19/02/2026

BONE ISLAND
Fomema medical check-up. CXR showing a sclerotic oval-shaped lesion at right 2nd anterior rib. This is a bone island.
Bone island is a benign focus of compact cortical bone located inside the cancellous bone. Medical term is enostosis. It’s usually an incidental finding, asymptomatic & benign. Most common site pelvis, femur, ribs & spine. Appears as well-defined dense sclerotic focus with thorny or brush border margins blending with trabeculae. In the ribs, it follows the axis of the rib.
In patients with cancer, bone island can mimic osteoblastic metastasis. Commonest cancer with osteoblastic mets are prostate, breast & carcinoid. In osteoblastic mets, lesions are sclerotic but shapes are irregular, margins are poorly defined, may be multiple and often cause bone expansion or destruction. Repeat x-rays may show interval size increase.
A quick way to remember:
👉 Bone island = "Innocent dense spot"
👉 Metastasis = "Multiple + messy"
KLINIK PAKAR X-RAY NR, SHAH ALAM, SELANGOR, MALAYSIA

BLADDER STONE49M, p/w gross haematuria. Ultrasound showing a large 2.4cm large echogenic focus with posterior shadowing ...
18/02/2026

BLADDER STONE
49M, p/w gross haematuria. Ultrasound showing a large 2.4cm large echogenic focus with posterior shadowing (yellow arrow). This is bladder stone.
KUB x-ray of the same patient showing a large bladder stone (red arrow)

How do you recognise bladder stone on ultrasound? Look for strongly echogenic mobile lesion with posterior shadowing. If you turn on your Colour Doppler, you will get twinkling artifacts.
What else to look for on ultrasound? Features that suggest causes of bladder stones like foreign objects, BPH, neurogenic bladder, bladder diverticulum and cystocele. Also features suggesting complications like chronic cystitis.
Is x-ray KUB useful in bladder stone? Calcium-based stones account for 70-90% of bladder stones. Therefore, most are visible on our plain x-rays. This is unlike renal stones where most are missed on plain KUB x-ray.
What is the pathogenesis of bladder stone? Urinary stasis and supersaturation.
So, who gets bladder stone? Most are secondary stones in an abnormal bladder or from concretions on foreign material. Patients prone to bladder stones are those with bladder outlet obstruction, neurogenic bladder, bladder diverticulum, cystocele and foreign body like Foley’s catheter,
KLINIK PAKAR X-RAY NR, SHAH ALAM, SELANGOR, MALAYSIA

LOVER'S FRACTURE Construction worker, h/o slipped & fell down from 4th floor. Injured right ankle, pain & tender. Latera...
17/02/2026

LOVER'S FRACTURE
Construction worker, h/o slipped & fell down from 4th floor. Injured right ankle, pain & tender. Lateral view ankle showing extra-articular fracture body of calcaneum (yellow arrows) and fracture posterior process of talus (red arrow).

Lover's fracture, also known as Don Juan fracture or Casanova fracture refers to a type of calcaneal fracture where the mechanism has been a jump from a height. The name "lover's fracture" derives from the situation in which someone jumped or fell from a height while trying to escape from a lover’s window — hence the name. It is not a formal medical diagnosis. The fracture involves the body of calcaneum and can be intra- or extra-articular.

If bilateral calcaneal fractures are seen, then the spine should also be evaluated for burst fracture.
KLINIK PAKAR X-RAY NR, SHAH ALAM, SELANGOR, MALAYSIA

BLADDER VOLUMENormal full (pre-void) bladder volume: Adults: ~300 – 500 mLFirst urge to void usually appears around 150 ...
16/02/2026

BLADDER VOLUME
Normal full (pre-void) bladder volume: Adults: ~300 – 500 mL
First urge to void usually appears around 150 – 250 mL

Normal post-void residual (PVR) volume
< 50 mL → Normal
50 – 100 mL → Usually acceptable (especially in older adults)
100 mL → May suggest incomplete emptying
200 mL → Typically abnormal and clinically significant
How to measure bladder volume on ultrasound?
The bladder should ideally be adequately filled for accurate measurement.
Obtain the correct views - Sagittal & Transverse
Measure the height & length in sagittal view
Measure the width in transverse view
The bladder is assumed to be roughly ellipsoid
Some machines automatically calculate volume once measurements are entered
If not, apply bladder volume formula: Volume = length x width x height x 0.52
Bladder capacity in neurogenic bladder:
Can be very high (>600–800 mL) in flaccid/acontractile type
Can be very low (100–200 mL is common in neurogenic bladders
High PVR increases risk of UTI, stones, upper tract damage
KLINIK PAKAR X-RAY NR, SHAH ALAM, SELANGOR

SALTER HARRIS TYPE II EPIPHYSEAL INJURY10F, patient's friend accidentally stepped on her left hand x1/52, sustain pain a...
14/02/2026

SALTER HARRIS TYPE II EPIPHYSEAL INJURY
10F, patient's friend accidentally stepped on her left hand x1/52, sustain pain and swelling over left hand finger, limited ROM

X-ray hand showing fracture line traversing the physis and exits through the metaphysis with a triangular metaphyseal fragment. Epiphysis is spared. This is Salter–Harris type II epiphyseal injury.
Treatment depends on displacement and stability. In this case, the fragment is minimally displaced, perhaps immobilization with a splint is sufficient. Please consult your ortho.
Prognosis is generally good. There is a small risk of growth disturbance at that joint.
KLINIK ALAM MEDIC 24 JAM ELMINA EAST, SHAH ALAM, SELANGOR, MALAYSIA

ACUTE APPENDICITIS73M, p/w right lower abdominal discomfort x 1/52Ultrasound showed a sausage shaped lesion with transve...
14/02/2026

ACUTE APPENDICITIS
73M, p/w right lower abdominal discomfort x 1/52
Ultrasound showed a sausage shaped lesion with transverse diameter of 28mm. Ultrasound diagnosis is acute appendicitis.
Cases of acute appendicitis in elderly is increasing with increasing life expectancy. Diagnosis has to be made quickly because the risk of perforation is higher in elderly age group.
In elderly presenting with acute abdominal pain, ultrasound should be the 1st modality of choice. But as the differential diagnosis is wide and ultrasound is negative, please proceed to CT.
What do you see on ultrasound?
- aperistaltic, non-compressible, fluid-filled blind-ending tube
- >6 mm outer diameter
You can’t see normal appendix. What if you don’t see any abnormal appendix? Acute appendicitis cannot be ruled out - proceed to CT.
KLINIK PAKAR X-RAY NR, SHAH ALAM, SELANGOR, MALAYSIA

Advance Your Clinical Skills with the NR Mindray PoCUS Workshop Series!Available Modules:🔹 Module A: HBS & KUB📅 5 & 19 F...
13/02/2026

Advance Your Clinical Skills with the NR Mindray PoCUS Workshop Series!

Available Modules:
🔹 Module A: HBS & KUB
📅 5 & 19 February 2026

🔹 Module B: Antenatal & Female Pelvis
📅 4 & 18 February 2026

Why You Should Join:
✔ Hands-on, practical training
✔ Affordable course fee - RM880 per module only
✔ Live model and phantom practice
✔ Certificate and meals provided

📌 Register Now:
🔗 https://www.nrmedical4u.com.my/reg/cnl_registration.asp?id=1

📞 For enquiries, contact Pn. Azie at 012-970-1547

Seats are limited - secure your spot today and take your clinical practice to the next level!

EGGSHELL CALCIFIED PELVIC MASS48F, p/w low back pain for few years. Lumbar spine x-rays were done. Accidental finding of...
13/02/2026

EGGSHELL CALCIFIED PELVIC MASS
48F, p/w low back pain for few years. Lumbar spine x-rays were done. Accidental finding of a 6cm pelvic mass with eggshell peripheral calcification.

At 48 years old, this appearance becomes very characteristic of a calcified uterine fibroid 👍
🎯 Most likely diagnosis
✅ Degenerated / calcified uterine leiomyoma
Why this fits very well:
👩 Perimenopausal age → fibroids commonly undergo degeneration and calcification around this time
📍 Midline pelvic location → typical uterine origin
🥚 Dense peripheral (“eggshell”) calcification → classic dystrophic calcification pattern of long-standing fibroid
🔵 Large, well-circumscribed rounded mass → typical morphology

2nd most likely is ovarian dermoid cyst. Look for bone or teeth within it.
The next step is to do ultrasound and CT to characterise the mass further.
KLINIK D MELAWATI, KUALA LUMPUR, MALAYSIA

POLYCYSTIC OVARIAN MORPHOLOGY35F, referred for recurrent UTI. TV scan done and showed multiple small cysts in both ovari...
11/02/2026

POLYCYSTIC OVARIAN MORPHOLOGY
35F, referred for recurrent UTI. TV scan done and showed multiple small cysts in both ovaries. Both ovaries are also enlarged with sizes of 17cc on the right and 16cc on the left (normal

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