Radiology Diagnostic Imaging

7/28/2019 Radiology Diagnostic Imaging

1/17

Imaging

Patricia Moser, MDPatricia Moser, MD

Ass is tant Profess or, Diagnost ic Radio logyAss is tant Profess or, Diagnost ic Radio logy

University of Flori da College of MedicineUniversity of Flori da College of Medicine

Introduct ion to

WE ARE HER

Radiologic

Radiolog

Diagnostic Imaging

Angiography and InterventionalRadiology

Not to be confused withRadiation OncologyRadiation Thera

Different specialty

Diagnostic Imaging

Electromagnetic RadiationElectromagnetic Radiation

XX--ray & Computed Tomography (CT)ray & Computed Tomography (CT)

Magnetic Resonance Imaging (MRI)Magnetic Resonance Imaging (MRI)

NuclearNuclear ScintigraphyScintigraphy(Nuclear Medicine)(Nuclear Medicine)

Sound Waves (not radiation)Sound Waves (not radiation)

UltrasoundUltrasound

Wilhelm Conrad RoentgenWilhelm Conrad Roentgen

18451845--19231923

January 1896January 1896 -- First xFirst x--rayray

made in publicmade in public

Routine xRoutine x--ray current technologyray current technology


2/17

Xray Plain Radiography

inherent contrast

digital

on ras a ograp y

barium

o ne

Fluoroscopy

CT (Computed Tomography)

ELECTRONSELECTRONS

1. Electrons generated at filament2. Negatively charged electrons move toward anode

an s r e arge a g spee3. 99% result in heat dissipated by the rotating target

4. 1% create x-rays which are directed through the

5. X-rays pass through patient to a receptor (film,digital, fluorescent screen, etc.)

of differences in contrast between tissue

which result fromdifferences in radiation interaction

in the tissues

Tissue Thickness

LESS GET THROUGH>>MORE GET THROUGHLESS GET THROUGH>>MORE GET THROUGH

The thickness of the tissue affects the attenuation

WHITE GRAY BLACKWHITE GRAY BLACK

of the x-rays.


3/17


INHERENT CONTRAST

digital / PACS

on ras a ograp y

barium

o ne

Fluoroscopy


Tissue type

MORE GET THROUGH>>LESS GET THROUGHMORE GET THROUGH>>LESS GET THROUGH

BLACK GRAY WHITEBLACK GRAY WHITE

-

Radiographs are summation shadows created by differences incontrast between tissues. Tissue thickness and tissuecomposition affect the attenuation and therefore, the shade(s)

of gray in the final shadow image.

Inherent Contrast

Tissue Appearance on XRAY

Air

Fat

ac

Dark Gray o ssues

Bone, Calcium

White

Reall White

BONEBONE

SOFTSOFT

FATFAT


4/17

BONEBONE

SOFTSOFTTISSUETISSUE

AIRAIR

METALMETAL


inherent contrast

digital / PACS

on ras a ograp y

barium

o ne

Fluoroscopy CT (Computed Tomography)

Film Radiography

NOTE THAT MOST OFTHE DARKENING OF THE

BUT BY VISIBLE LIGHTPHOTONS PRODUCEDBY XRAYS HITTING A

SCREEN

FILM

INSIDE OF A CASSETTE

Film RadiographyFILM CASSETTEFILM CASSETTE DEVELOPING TANKSDEVELOPING TANKS

SAFE LIGHTSAFE LIGHTPASS BOXPASS BOX

Film Radiography

XRAY VIEWERSXRAY VIEWERS


5/17

Film RadiographyXRAY FILM STORAGEXRAY FILM STORAGE


inherent contrast

DIGITAL / PACS

on ras a ograp y

barium

o ne

Fluoroscopy


Digital Radiograph

Two types

Computed radiography, called CR

Uses existing equipment to make exposures

Film cassette is replaced with a charged metal plate

After exposure, plate is read in a special device

g ta ra ograp y, ca e

Requires conversion of the entire xray room

digital camera or video camera)

Computed Radiography CR

HERE ARETHE PLATES

PACS=Picture Archiving andommunca on ys em

Film --> Computer Viewing

Awareness braceleAwareness bracele

Windows XPWindows XP

2020THTH CENTURYCENTURY

Bad haircutsBad haircuts

FilmsFilms

View boxView box

Whats with theWhats with the

tt--shirts dudes?shirts dudes?


6/17

Contrast A ent

Anything that enhances the differences

For XRAY there are TWO commonly usedcontrast a ents:

Barium Iodine

Various ways they are introduced Swallowed: barium swallow, upper GI

y enema: arum enema

In vein: Intravenous urogram

In arter : Arterio ram

PLAINRADIOGRAPH

BARIUM

OF THE CHEST

PLAIN RADIOGRAPHBARIUM ENEMA

Barium: upper GI

STOMACH

Iodine:Intravenous urogram

Intravenous pyelogram(IVU or IVP)

KIDNEYS

BLADDER

Iodine:Arteriogram through

a catheter (tube)in the leg

RENAL ARTERY

ILIAC ARTERY


7/17


inherent contrast

digital / PACS

on ras a ograp y

barium

o ne

FLUOROSCOPY


image intensifiers to make

moving (real time) XRay pictures

Diagram of

fluoroscopic unit

Photograph of a

fluoroscopic unit


inherent contrast

digital / PACS

on ras a ograp y

barium

o ne

Fluoroscopy CT (COMPUTED TOMOGRAPHY)

Com uted Tomo ra h (CT)

EMI

$$$$

Tube spins around patient Detector spins around patient

opposite the tube

Detector output and angular position fedinto a compute

Computer performs calculations toestimate densit of tissues in each s uareof a slice


8/17

Computed Tomography (CT) Contrast for CT

Iodine injected into an arm vein during the

Iodine or Barium diluted in water given orally

There are some risks

Kidney damage

makes them much easier to see

Enhances cancerous tissue inman cases

CONTRASTCONTRAST

IODINEIODINE

Evolution of CT First used clinically in late 1970s and

early 1980s

Quite slow: 1 minute per slice

Still was revolutionary Generations: 1st, 2nd, 3rd, 4th,

s iral, multi slice

Now have detectors up to 320 sliceswide

Can scan the whole body in


9/17

CT Images from modern CT WINDOWS

Soft tissue

Bone Lung

Some cool things we can dowith CT these days

Scan rapidly during Iodine injection in vein

Scan colon after filling with air

ronc oscopyScan chest air is already in bronchi

3D Images

Computer reconstruction

CT Angiograms

CT Colonography CT Bronchoscopy


10/17

3D CT of the heart 3D CT of the knee and leg

Ultrasound Uses high frequency sound to make

ima es

The sound is produced and detectedwith the same device: TRANSDUCER

Transducer S eaker: sound into atient

Microphone: sound coming back frompatient

Analogous to SONAR used in undersea

warfare

TRANSDUCERTRANSDUCER


11/17

Ultrasound Machines

TRANSDUCERTRANSDUCER

Ultrasound Pictures Used

Not Any More

Ultrasound


12/17

Ultrasound Of Breast Benign Ultrasound Of Breast Cance

Magnetic Resonance Imaging(MRI)

Magnetic Resonance Imaging Starts with a really strong magnet

Su ercooled with Li uid Helium Nitro en

Transmit radio wave pulses into patient

interaction with protons (water) in theatients bod

Process the frequency and phase of thereturned si nals b com ute

Different tissues give differentintensities of returned radio waves >image


13/17

MRI Contrast

Gadolinium solution injected into vein

Same idea as the Iodine contrast usedfor CT

Gadolinium alters the interaction ofradio waves with the rotons in water sothat it gives MORE signal

Magnetic Resonance


14/17

Nuclear Scintigraphy

Nuclear Medicine

Nuclear Scintigraphy

Often called NUCLEAR MEDICINE

Uses radioactive tracers that emitradiation

Electromagnetic OR particulate Often these are inected into the vein

Different tracers go to different organs

Images are made by detecting the

NORMAL BONE SCANNORMAL BONE SCAN ABNORMAL BONE SCANABNORMAL BONE SCANNORMAL LUNG SCANNORMAL LUNG SCAN

BLOOD FLOW (TOP) & VENTILATION (BOTTOM)BLOOD FLOW (TOP) & VENTILATION (BOTTOM)

ABNORMAL LUNG SCANABNORMAL LUNG SCAN

BLOOD FLOW (TOP) & VENTILATION (BOTTOM)BLOOD FLOW (TOP) & VENTILATION (BOTTOM)

Angiography AndInterventional Radiology


15/17

Interventional Radiology

Radiologists do invasive procedures guided

Basically anything that breaks the skin

Catheters to make angiograms

Catheters with balloons to open blood vessels

Stents to hold blood vessels open

Coils and material to block blood vessels

Catheters to drain abscesses

Tubes for feeding

e c e c

Drawing of normal kidney

FranNetter,

this gu

the timeare finis

Angiogram of normal kidney

SPINESPINE1111THTH RIBRIB

CATHETERCATHETERCOMINGCOMING

THE LEGTHE LEGARTERYARTERY

Angiogram of kidney cancer

THIS IS THETHIS IS THECANCER MASSCANCER MASS

Angiogram after embolization

FLOW TOFLOW TO

THE MASSTHE MASS

BE REMOVEDBE REMOVEDWITHOUTWITHOUT

BLEEDINGBLEEDING

Non Surgical Biopsy


16/17

Non Surgical Shunting For Angioplasty Balloon

Angioplasty & Stent

Irregular renal arteryreduced bloodflowto

Post angioplasty, flowis restored and the patient

kidney, produces

hypertension

becomes normotensive

XX--rayray

ra ograp y, contrast stu es,ra ograp y, contrast stu es,

UltrasoundUltrasound Magnetic Resonance ImagingMagnetic Resonance Imaging

MRAMRA

An io ra h And

Nuclear ScintigraphyNuclear Scintigraphy

Interventional Radiology


17/17

Knee - MRI SagittalANATOMY

ANTERIOR

CRUCIATE

POSTERIOR

CRUCIATE

LIGAMENT

IMAGING IS

ESSENTIAL TO

MODERN HEALTH

GROWTH OF IMAGING

Rothenberg, Korn. The Opportunities and Challenges Posed by the Rapid Growth of Diagnostic Imaging.

J Am Coll Radiol 2005;2:407-410.

ONE REASON FOR GROWTH

Percenta e of internists sa in that the loss of an innovation

Fuchs VR , Sox HC J r. Physicians views of the relative importance of thirty medical innovations.Health Aff 2001;20:30-42.

would have the most adverse effect on their patients.

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Radiology Diagnostic Imaging