Introduction to Clinical Radiology

Dr Joyce Nayiga
Department of Radiology and Radiotherapy
MAK,CHS
Outline
• Define Radiology

• Imaging modalities

• Advantages and disadvantages of the different imaging modalities

• Radiological terminologies
 Radiological Imaging modalities
Radiology is a branch of medicine that uses imaging technology to diagnose
and treat disease.

Radiological Imaging modalities

Nuclear
Plain x-ray Ultrasound Fluoroscopy CT MRI
medicine
 Plain X-ray
( Plain Radiography)

• Imaging modality that uses

ionizing radiation to produce an
anatomical image in 2D: digital
or film.
• X-rays- 1st medical imaging
technology
• Discovered on Nov 8 in 1895
• Readily available in most units
• Affordable
• Quick to perform
 Radiographic densities
Name the radiographic densities 1-5
• 5 basic radiographic densities
• Due to differential absorption of X-
rays in the body tissues.
• Include:
1. Air (Black)
2. Fat (Dark)
3. Soft tissue/ fluid (Grey)
4. Bone/ calcifications: white
5. Metal (such as metallic implants,
FBs etc.)
X-ray
terminologies
• Opacity: WHITE

• Lucency: BLACK
 Plain radiography
Advantages Disadvantages

• Good for bones and chest • Ionising radiation

imaging • 2D image: superimposition of

structures
 Ultrasound
• AKA known as sonography or ultrasonography
• Real-time imaging
• Uses high-frequency sound to produce cross-sectional
images in 2D (most common) or 3D
Uses
• First line for imaging soft tissues
• Superficial structures (e.g., Eye, breast, thyroid etc.)
• Abdominal US
• Gynecological US
• Obstetric US
• Cardiac (echocardiography)
• Musculoskeletal US
• Vascular evaluation (doppler imaging).
• Used for guiding interventional procedures, e.g., biopsies
and fluid aspiration
Heavy duty Cart-based machine
 • Portable devices; Laptop, tablet or handheld
(phone)-based
Portable machines • Used in Point of Care Ultrasound (POCUS)
• Emergencies, ICUs, Community outreaches etc.
 Transducers (probes)
• Main component & very sensitive
1. Low frequency (2-5MHZ)
• Deep penetration, lower resolution
• Used in transabdominal /pelvic
ultrasound examinations

2. High-frequency Probes ( 7-13MHZ)

• High resolution but reduced penetration
• Used for superficial (breast, thyroid,
scrotal), transrectal and transvaginal US
 Ultrasound
Advantages
• No ionizing radiation
• Good for children/obstetrics
• Real-time imaging
• Portable so bedside
use/POCUS
• Readily available and
affordable

Disadvantages
• Hampered by air
• Maybe operator dependent
Ultrasound-Doppler imaging
 Interventional
Ultrasound
• Minimally invasive
diagnostic and therapeutic
procedures
• Biopsies, cyst aspiration
• Aseptic procedure
Ultrasound terminologies

1. Echogenicity

2. Echotexture
 Echogenicity
Echogenicity; the brightness of a structure
• Hyperechoic: High-intensity echoes
• Appears white

• Hypoechoic: Low-intensity echoes

• Appears Dark

• Anechoic: No internal echoes

• Appears black

• Isoechoic: Same intensity echoes

• Appears the same as surrounding structures

Echogenicity of a structure is described

relative to surrounding or adjacent tissue.
 Question
Describe the
echogenicity of the
masses shown in the
images:
A………………………….
B………………………….
C ………………………….
D ………………………….
 • It refers to the uniformity of echoes within a mass.
• Homogeneous: uniform echoes, fine, smooth texture
Echotexture
• Heterogeneous: non-uniform echoes, Irregular texture
 Mammography
• Mammography is a dedicated radiographic
technique (X-ray) for imaging breasts.
• Resultant images are known as
mammograms.
• Can be screening or diagnostic
• Usually complementary to breast ultrasound
• Two routine views; Craniocaudal (CC) and
Medio-lateral oblique views (MLO)
• Done in older women>35yrs in Uganda as
young breasts are dense & radiosensitive
Fluoroscopy Contrast media

• Fluoroscopy is a type of imaging that uses

x-rays to demonstrate continuous real-
time images on a monitor.
• Most contrast studies are performed
under fluoroscopy
• Examples: barium moving through the
GIT or the flow of contrast through blood
vessels.
Purpose:
• To perform dynamic studies. Fluoroscopy unit
• Visualize anatomical structures in real- Disadvantages:
time or motion. • Ionising radiation
• View the motion and function of anatomic • Higher dose than plain X-ray
organs
Fluoroscopy exam: Barium Enema

IBD – Ulcerative
colitis (loss of
haustral markings
in the sigmoid
and descending
colon)

Normal colon
Computed Tomography (CT)
• CT is a diagnostic imaging technique that uses ionizing radiation

(X-rays) to create cross-sectional images of the body.

• Used in diagnosing, staging, and follow-up of patients for various

disease conditions in various parts of the body.

• Excellent in imaging bony structures (fractures, bone lesions, etc.)

• CT can be coupled with other modalities such as PET/CT or SPECT

evaluating for metastases, staging & assessing response to
treatment etc.

• CT is used to guide interventional procedures such as biopsy,

drainage, aspiration, injection and ablation procedures
CT Image acquisition and
multiplanar reconstruction

• CT images are acquired in the

axial plane
• Reconstructed into other, i.e.,
axial, sagittal, coronal, oblique
and 3D reconstruction
Axial and 3D head reconstruction
Computed Tomography
Advantages
• Cross-sectional imaging
• Multiplanar and 3D reconstructions.
• No superposition → high contrast resolution
• Fast Exam: Quick to perform
• Available
• Can be used with metallic implants
• IV contrast allows for the assessment of organ
enhancement as well as blood vessels

Disadvantages
• 1. Higher radiation exposure: contraindicated in
pregnant women & should be used with caution in
children.
• 2. May require oral or IV contrast media contraindicated
in some patients
• 3. Relatively expensive
 CT images are manipulated to change the appearance of
particular structures of interest.
CT windowing Common windows include Bone, lung, soft-tissue,
mediastinal and abdominal windows
 Contrast Media use in CT imaging
• Intravenous contrast medium is essential for optimizing most CT examinations
• Inject iodinated contrast intravenously, and image
• The resulting differential contrast enhancement of the various tissues
• Improves the delineation of normal and abnormal structures
• Basic phases: Arterial (20-40sec) , Porto-venous (80sec), & delayed (6-10mins)

NECT CECT- Arterial phase CECT- Porto-venous phase

CT Angiography
CT terminologies
Based on CT density

• Isodense: similar in density

• Hypodense: less dense/grey/black

• Hyperdense: more dense/white

 Question

• Describe the CT appearance of

the lesion in the right lung
(arrowheads)
Magnetic Resonance Imaging
(MRI)
• Uses magnetic properties of the body
structures along with radiofrequency waves to
produce cross-sectional anatomical images on a
computer.
• The superconducting electromagnet is
responsible for the main permanent magnetic
field & It approx. 6 tonnes
• This magnetic field is permanently switched
on in the MRI scanner: BEWARE
• The magnetic field's strength is measured in
tesla (T).
• Most MRI scanners in clinical practice are 1.5
or 3T
• Excellent for soft tissue imaging and tumour
characterization
 • Parameters for different tissue contrast and spatial resolution are
optimized, resulting in a particular appearance at MRI.
• T1W, T2W, PD, FLAIR, GRE ETC.
MRI Pulse sequences • Multiple sequences are grouped into an MRI protocol.
 • The relative brightness of an MRI signal based on the strength
of the MRI signal.
• Hyperintense: a high signal intensity, appears white
MRI Image appearance: • Isointense: the same (intermediate) signal intensity as
Signal intensity organ of comparison, appears grey.
• Hypointense: a low signal intensity; appears dark (black)
T1WI and T2WI- Clinical applications
Magnetic Resonance Angiography (MRA)
 • Uses special T2 sequence (Heavily weighted T2)
MRI of Biliary Tree • No contrast is given
(MRCP)

Normal Biliary tree Stones in bile ducts

 Advantages and disadvantages of MRI
Advantages Disadvantages
• More expensive
• No ionising radiation
• Not easily available
• Multiplanar imaging; Image acquisition in multiple planes, • Longer scan time
3D reformats
• Not compatible with metallic
• Superior soft tissue contrast, compared to CT implants
• Expensive
• Some angiographic images can be obtained without contrast
• Claustrophobia, noise
media
• Risk of iodinated contrast allergy alleviated
• MRI is extremely versatile: it studies both structure and
function
• Excellent for soft tissues, tumours
• Best modality for evaluating the CNS (Brain and Spinal cord)
 Nuclear medicine
(SPECT/PET/hybrid)
• Uses radiopharmaceuticals in the
target organ and detects the emitted
radiation to produce an image.
• Excellent for physiological questions:
heart, hepatobiliary, renal,
• Used for the staging of malignancies
• Uses radiation
• May take a long time, depending on
body function PET CT (FDG) of a patient with primary lung
cancer also shows increased uptake in the left
• Not great anatomical detail adrenal gland, consistent with metastatic disease
Thank you