DIAGNOSTIC IMAGING

INTRODUCTIONCONVENTIONAL RADIOLOGY

Dr. M. Yusri

Departemen Radiologi RSMHPALEMBANG

What is Radiology? 

The use of X-rays and radioactive substances in the diagnosis and treatment of disease

What is Radiology? 

• Radiology is the study of images of the human - body.

Although Radiology began with the use of X-Rays and photographic films, the modern Radiologist now has a variety of tools for "taking pictures" of patients.

Many of these newer tools create an image with a compu- ter (CT–computed tomography) and some do not use any X-Rays, such as MR and Ultrasound.

Discovery of X-RAYS

• Wilhelm Conrad Rontgen, Professor of Physics at University of Wurzgburg, first made the discovery of

X ray on 8th November,1895.

He was investigating the phenomenon caused by the passage of an electric-current, through a partially evacuated glass tube.

The strange light appeared from a paper screen covered with barium platinocyanide,

a fluorescent substance, whenever electrical charges were passed through the glass tube.

Discovery of X-RAYS

He was investigating the phenomenon caused by the

passage of an electric-current, through a partially evacuated

glass tube.

The strange light appeared from a paper screen (a fluorescent

substance), whenever electrical charges were passed through

the glass tube.

Discovery of X-RAYS

Rontgen discovered that these rays could pass through all sort of objects

Moreover he could see the shadow of bones and soft tissues of his own hand on the fluorescent screen, when his hand was placed between the glass tube and the screen.

To document these rays, he replaced the fluorescent screen with photographic plate, to make a photographic record.

The photograph of his wife hand, was widely believed to be first ever radiograph (X-ray picture) of a human.

[Courtesy: Deutsche Rontgen Museum , Lennep]

Tabung Sinar-X

• Tabung luar– Tabung (gelas) sinar-x berada didalam

tabung luar (pembungkus)

• Tabung (gelas) sinar-x– Dua dioda

• Katoda• Anoda

Sinar-X

• Hasil benturan elektron dengan katoda

• Produksi radiograf (gambar)– Kilovoltase– Miliamper– Waktu– Ukuran “focal spot”

SIFAT SINAR X

• Daya penetrasi• Memancar secara garis lurus.• Dapat diserap, dipantulkan dan dibias• Dapat menghitamkan emulsi film.• Fluorosensi.• Ionisasi.

• Bayangan pada foto terjadi akibat perbedaan densitas tubuh yang dilalui sinar X.

• Densitas tubuh manusia terdiri dari:- Tulang- Jaringan lunak- Udara/gas

BAYANGAN PADA FOTO

• Tulang : bayangan putih/radio-opak

• Jaringan lunak: bayangan putih ringan

• Udara/gas: bayangan hitam/radio-lusen

X RAY PRODUCTION

When electrons traveling at very high speeds are made to penetrate the atom target, transfer of energy from electron to the atom target causes internal derangement and release of X rays.

X-RAYS

• 1. A Form of radiant electromagnetic energy• 2. Invisible to human eye• 3. Passes through all of objects • 4. Causes fluorescence• 5. Exposes film etc..

FORMATION OF THE X RAY IMAGE

The formation of a X ray image depends on ; 1. Intensity (strength) of the X ray beam 2. Physical properties of the structure through which it passes. thickness, density and atomic number of structures.

FORMATION OF THE X RAY IMAGE

If two adjacent structures are of similar density and X-rays passing difficulty indistinguishing these twostructures.

Structures with greatly differing densities and atomic number are seen clearly.

Diagnostic Radiology

• The discovery of X rays was not only an important scientific event (Nobel Prize), but more significantly heralded a new era in medical practice. The concept of diagnostic imaging: To visualize internal body structures and organs and hence detect diseases.

RADIOLOGIC TECHNIQUES

• Plain Radiographs• Fluoroscopy• Contrast Radiography• Angiography• Computed Tomography• Magnetic Resonance Imaging• Nuclear Medicine• Ultra Sound

PLAIN RADIOGRAPHS

• The images created by X-rays. Often called "plain X-rays"

• The image or picture is basically a shadow of the parts of the patient that absorb or block the X-rays.

• The image can be collected on photosensitive film, on a digital imaging plate, or on a fluoroscopic screen.

DIAGNOSTIC RADIOLOGY

• In the early years, the main indication for the X ray examinations were to diagnose fractures and dislocation, locate foreign bodies, to visualize congenital deformities, and to examines specific diseases affecting bone.

These clinical indications still remain valid in today’- practice.

2 y/o fell on outstretched hand

Lateral plain radiograph of skull.

Nasal Cavity & Paranasal Sinuses

• The paranasal sinuses are air filled cavities and include the frontal, ethmoid, sphenoid and maxillary sinuses.

Cervical Spine AP-Lat.

PA. Chest

Plain Abdomen

FLUOROSCOPY

• Fluoroscopy is a technique for obtaining "live“ X-ray images of a living patient

• The Radiologist can watch the images "live" (moving) structures on a TV monitor.

• Fluoroscopy is often used to observe the digestive tract (Upper GI series - Barium Swallow, Lower GI series - Barium Enema ).

CONTRAST IMAGING

• Many structures within human body are invisible to X rays due to similarity in density to the surrounding tissues

To outline the otherwise “invisible” organs within the abdomen/brain, contras agents, administered by various means, are required.

Most of the contras agents in conjunction with X rays are densely opaque, in order to enable maximum differentiation from the surrounding soft tissue structures.

CONTRAST RADIOGRAPHY

• 1. Barium studies (BAS/UGI, LGI/BE)• 2. Cholecystography (Gall Bladder)• 3. Urography (Kidney function) (IV)• 4. Angiography/Venography• 5. Arthrography• 6. Hysterosalpingography• 7. Lymphangiography (Rare)

Barium Meal

• Radiographic examination of the stomach and duodenum using contras medium ( Barium Sulphate)

• May be done as single contrast (barium only as contrast ) or double contrast ( barium and gas ) examination.

• The study aims to show the mucosal pattern in all part of stomach and duodenum.

Barium Enema

• Radiographic examination of the colon using contras medium, to define the anatomy of the large intestine and rectum

• The two examination techniques are single contras and double contras.

• DC technique : Barium is combined with in- sufflation of air, much better than the SC.

Cholecystography

• Radiographic examination of the gall bladder and common bile duct using oral contras medium.

• Has been largely replaced by modern imaging techniques s.a ULTRASONOGRAPHY and CT.

Urography /Intravenous Pyelography (IVP)

• Radiographic examination of the urinary tract with intravenous injections of contras medium.

• Serial radiographs should be obtained to demonstrate the kidney, ureters and bladder.

Urography /Intravenous Pyelography (IVP)

Hysterosalpingography (HSG)

• A radiographic procedure that uses contrast material injected into the uterus and fallopian tubes.

• May be used to diagnose infertility problems and anomalies of the female genital tract.

What is a Radiologist ?

• Use of imaging techniques, such as X ray, US or CT Scan, in the diagnosis and treatment of disease

• Role of Radiologist: 1. Identify abnormality (Nl or Abnl)

2. Characterize abnormality

3. Extent of disease (Staging)

4. Differential diagnosis

5. Suggest further work up

Subcapsuler Renal hematoma

• RADIOLOGIST:

An in Vivo Gross Macroscopist

• PATHOLOGIST:

An in Vitro Microscopist

What is a Radiologist ?

• Use of imaging techniques, such as X ray, US or CT Scan, in the diagnosis and treatment of disease

The • 1. Identify abnormality (Nl or Abnl)• 2. Characterize abnormality• 3. Extent of disease (Staging)• 4. Differential diagnosis• 5. Suggest further wor

ROLE OF RADIOLOGIST

• 1. Identify abnormality (Nl or Abnl)• 2. Characterize abnormality• 3. Extent of disease (Staging)• 4. Differential diagnosis• 5. Suggest further work up

TERMINOLOGY

• 1. Direction of beam (e.g. PA chest).

X-Rays pass from P to A

• 2. Body Part Closest to Film (e.g. Left Lateral Chest)

Joint

Discovery of X-RAYS

Rontgen discovered that these rays could pass through all sort of objects Moreover he could see the shadow of bones and soft tissues of his own hand on the fluorescent screen, when his hand was placed between the glass tube and the screen To document these rays, he replaced the fluorescent screen with photographic plate, to make a photographic record.

The photograph of his wife hand, was widely believed to be first ever radiograph (or X-ray picture) of a human.

[Courtesy: Deutsche Rontgen Museum ,

Lennep]

TERIMA KASIH