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Clinical history and patient examination are mandatory to correctly order shoulder imaging. The choice of the imaging modality will depend on different factors. Is the shoulder stable or instable? Was there a traumatic history or simply repetitive microtraumas? Is the A-C joint electively tender? Generally, plain X-rays is the first step in the shoulder imaging. However different views will be adapted to the clinical examination. Double oblique standard view in neutral position and rotations with associated profile is the basis of the examination. In the case of a painful stable shoulder, ultrasound is usually the second step. MRI is only necessary in case of deficient ultrasound. If surgery is an option, CT-scan or MRI without any contrast media are useful because ultrasound cannot correctly predict the eventual fatty degeneration of the muscles that contra-indicates the surgical treatment. In the case of shoulder instabilities, there is no place for ultrasound. The best choice is always an intra-articular injection of contrast medium followed by CT-scan or MRI. Only these examinations are able to depict labrum lesions or bicipital desinsertion. Finally, the AC joint must be evaluated separately from the rest of the shoulder with special radiological and ultrasound incidences. Stress or dynamic maneuvers can be added either with X-rays or ultrasound.

Despite the introduction 30 years ago of the CT scan and more recently of the MRI, the number of plain radiographs of the spine showed very little erosion during the last decade in Belgium. The reasons can be understood and found some good or false explanations. CT scanner is much more irradiating than plain radiographs. However it gives to the clinician much more relevant information considering the diagnosis and the medical outcome of the patient. MRI, which is equivalent to CT scan in terms of information, had, until now, very little access for the patients, with some delays up to 7 weeks. Moreover, the general idea in the perscriptor's mind and among the patients is that the price of the modern examinations (i.e. CT scan and MRI) are much higher than plain radiograph, which is in some way, correct, but perhaps in a smaller account than imagined. The precise indications of all these examinations have been published in 2004 either in Europe and Belgium. However the information about these guidelines among the general practitioners and specialists was not perfectly done. We will see that, by following these guidelines, a substantial drop off the prices can be obtained without decreasing the efficiency of the diagnostic tools and of the medical outcome of our patients.

The internet has experienced tremendous growth over the past few years and has currently many resources in the field of medicine. However, many physicians remain unaware of how to gain access to this powerful tool. This article briefly describes the World Wide Web and its potential applications for physicians. The basics of web search engines and medical directories, as well as the use of advanced search with boolean operators are explained.

Renal angiography is certainly not the first examination to be done in case of hypertension. Its interest remains however high. It allows to demonstrate without doubt the reality of a significant stenosis. It can also be associated with a therapeutic procedure. The indications, with practical modalities, results and eventual complications are described below in two different parts: diagnostic and therapeutic.

Medical imaging, less than 105 years after the invention of X-rays in medicine, shows signs of extraordinary and almost exponential rise. Among the new techniques, the stress is laid on the last developments of echography like the imaging in three dimensions or the harmonic imaging. The helical scanner currently allows imaging in real time, from incredibly short times of acquisition and launches out in the virtual endoscopy. The MRI and particularly angio MR allows the visualization of small arterial or venous malformations as for soon the study of the coronary vessels with a reliability which will compete with the coronarography. The diagnostic angiography is undoubtedly destined for disappearing as of many other techniques which will be one day obsolete, or superfluous compared with such relevant and less invasive methods.

The diagnosis of lower limb deep vein thrombosis requires to use of complementary diagnostic tests. For a long time phlebography has been the only reliable examination and is always regarded as the gold standard by many people. In recent years, non invasive diagnostic modalities have been developed. Most significantly scintigraphy, plethysmography, color Doppler ultrasound and MR imaging. MRI is as reliable as venography but, at the present time, it is time-consuming and far less available than the other modalities. Scintigraphy and plethysmography may be useful but are less accurate and yield a somewhat higher rate of false positive and negative examinations. Color Doppler ultrasound has proved its effectiveness and is currently recommended as the diagnostic modality of choice. Venography is still a significant diagnostic tool for questionable cases or for technically inadequate Doppler ultrasound examinations.

The authors try to define the relative place of conventional radiology, ultrasound, arthrography, computerized tomography and magnetic resonance imaging in the diagnosis of shoulder impingement syndrome. The above mentioned types of examinations are analysed and commented one by one with their respective advantages and drawbacks. A global approach is described at the end of this article.

A careful physical examination is absolutely necessary as a first evaluation of all disorders of the shoulder before performing any imaging technique that must be chosen according to the kind of suspected pathology. The best indications for performing an arthroscanner are the intraarticular lesions such as injuries of the glenoid labrum and of the articular capsule. Echography is the most performing technique for bicipital and rotator cuff tendinitis. CT scan helps to understand the antero-internal retro-coracoidal impingment syndromes as well as uninterpretable bone lesions at standard radiography. Arthrography and arthro-pneumo-tomography are very useful for presurgical assessment of rotator cuff tears.