radiology diagnostic imaging
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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
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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.
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Xray Plain Radiography
INHERENT CONTRAST
digital / PACS
on ras a ograp y
barium
o ne
Fluoroscopy
CT (Computed Tomography)
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
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BONEBONE
SOFTSOFTTISSUETISSUE
AIRAIR
METALMETAL
Xray Plain Radiography
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
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Film RadiographyXRAY FILM STORAGEXRAY FILM STORAGE
Xray Plain Radiography
inherent contrast
DIGITAL / PACS
on ras a ograp y
barium
o ne
Fluoroscopy
CT (Computed Tomography)
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?
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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
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Xray Plain Radiography
inherent contrast
digital / PACS
on ras a ograp y
barium
o ne
FLUOROSCOPY
CT (Computed Tomography)
image intensifiers to make
moving (real time) XRay pictures
Diagram of
fluoroscopic unit
Photograph of a
fluoroscopic unit
Xray Plain Radiography
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
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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
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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
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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
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Ultrasound Machines
TRANSDUCERTRANSDUCER
Ultrasound Pictures Used
Not Any More
Ultrasound
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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
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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
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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
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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
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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
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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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