Introduction to Medical Imaging

Noushad Aliar
Disclaimer !!!

▪ This is high level introductory session meant for basic orientation

▪ Most of the contents/images are sourced from Google ☺
▪ Contents prone to errors or inaccuracy …

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What is Medical Imaging ?

▪ Medical imaging is the technique and process of creating visual representations of the internal
structures of a body

▪ Used for clinical analysis and medical intervention, as well as visual representation of the function of
some organs or tissues (physiology)

▪ Medical imaging seeks to reveal internal structures hidden by the skin and bones, as well as to
diagnose and treat disease

▪ It also establishes a database of normal anatomy and physiology to make it possible to identify
abnormalities

▪ Popular medical imaging techniques - Radiography, CT, MRI, Ultrasound, PET, SPECT, Endoscopy,
Elastography, Thermography etc.

▪ Radiology: A branch of medical science concerned with the use of radiant energy (such as X-rays)
or radioactive material in the diagnosis and treatment of disease

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Medical Imaging outside Radiology
▪ Although imaging of removed organs and tissues can be performed for medical reasons, such
procedures are usually considered part of pathology instead of medical imaging
▪ Endoscopy, Elastography, Thermography etc. are some forms of medical imaging techniques, but
they are not considered as part of Radiology

Thermography
Endoscopy 4
Types of Medical Imaging
Medical Imaging

Structural Imaging Functional Imaging

(Imaging of Anatomy) (Imaging of Physiology or Functioning)

Magnetic Resonance Positron Emission

Ultrasound
Imaging (MRI) Tomography (PET)

X-ray Radiography Computed

SPECT
& Fluoroscopy Tomography (CT)

Interventional /
Mammography ECG
Vascular Imaging

Dental X-ray
Surgery (C-Arm) EEG
Imaging
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X-ray Imaging
▪ X-ray Imaging is a Shadow Imaging technique, where X-ray is passed through the body part
under investigation and a shadow is created on X-ray Film or Detector
▪ Body tissue will absorb X-ray Photons form the X-ray beam, in proportion to the density of
the tissue – e.g. bone absorbs more X-ray than soft tissue
▪ The remaining portion of X-ray Beam, which passes through the body and comes out,
creates a shadow on X-ray film or detector
▪ The resulting shadow is a two-dimensional projection of a three-dimensional structure

Contrast Ratio

100% 75% 50% 25% 1%

Shadow from a normal visible light Shadow from X-ray

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What is X-ray ?
X-ray is basically photon energy like ‘light’, but at higher energy levels !!!

▪ Similar to microwaves, visible light and

gamma rays
▪ X-ray → Electromagnetic radiation of very
short wavelength and very high energy, hence
high penetrating power
▪ X-rays have higher frequency than ultraviolet
light, but lesser frequency than cosmic rays
▪ Higher Frequency → Higher Penetration →
Lower Travel Distance (e.g. X-ray and Gamma
Ray for Medical/Industrial application)
▪ Lower Frequency → Lower Penetration →
Higher Travel Distance (e.g. Radio Frequency
used for Communication and Broadcast)

Photons (packets of energy) traveling at the speed of light 7

What is X-ray ?

▪ X-rays have higher energy and are able to penetrate denser objects
▪ They can travel through human flesh

▪ X-rays are ionizing radiation

▪ Possess sufficient energy to strip off electrons from neutral atoms, thus creating
ions and high energy electrons

▪ X-rays cannot be sensed or felt unless an instrument is used

▪ Heavy dosage of X-rays result in adverse effects on living tissues
▪ Like light, X-rays can be scattered, reflected or refracted
▪ Characteristic X-ray can be used for detecting elements

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 Application of X-ray Imaging

Basic Imaging (Radiography or RAD) Surgery (C-Arm) - Fluoroscopy Vascular Imaging (Cathlab)
http://www.youtube.com/watch?v=q0cKhkJk30A https://www.youtube.com/watch?v=GhNT2G1fkJg

Computed Tomography (CT) Mammography Dental Imaging

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Magnetic Resonance Imaging
▪ Magnetic Resonance Imaging (MRI) uses a powerful magnetic
field (e.g 1.5T or 3.0T), radio waves and a computer to produce https://www.youtube.com/watch?v=djAxjtN_7VE
detailed pictures of the internal organs of your body

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Ultrasound Imaging
▪ Ultrasound imaging (sonography) is a diagnostic medical procedure that uses high-frequency sound waves to produce
dynamic visual images of organs, tissues or blood flow inside the body
▪ The sound waves are transmitted to the area to be examined and the returning echoes are captured to provide the
physician with a ‘live’ image of the area
▪ Ultrasound does not require the use of ionizing radiation, nor the injection of nephrotoxic contrast agents
▪ Because of its non-ionizing nature, it is a good choice for imaging when radiation-sensitivity is a concern, such as in
pediatrics or in women of child-bearing age

https://www.youtube.com/watch?v=I1Bdp2tMFsY

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Comparison of Imaging Techniques

Ultrasound X-ray/CT MRI

Imaging Technique Ultrasound Waves X-ray Radiation Magnetic / Radio-Frequency Fields

Cost Low High Very High

RAD – No, Fluoro – Yes

Live/Dynamic Image Yes No
CT - No

Image resolution Low Medium High

Not suitable for newborn, Not suitable for patient with pace-
Limitations for Patient Almost Nil
pregnant ladies etc. maker, steel implants etc.

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Hybrid Imaging
▪ Hybrid imaging refers to the fusion of two (or more) imaging modalities to form a new imaging
technique
▪ Some hybrid imaging modalities are synergistic solely in anatomical details, while others
combine anatomical and functional imaging
▪ The potential to reveal function in-vivo while simultaneously depicting their anatomic location
has been a groundbreaker
▪ Examples of Hybrid Imaging:
CT-PET | CT-SPECT | MRI-PET | MRI-SPECT | US-MRI | US-CT | MRI-CT …. etc.

▪ Benefits of hybrid imaging include:

• Increased diagnostic accuracy
• A further step towards individualized medicine
• Precise monitoring of interventional procedures
• Reduced radiation exposure, e.g. dynamic US after obtaining CT map

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Hybrid Imaging - Examples

PET-MR PET-CT

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Digital Subtraction Angiography (DSA)
▪ Digital subtraction angiography is a fluoroscopy technique used in interventional radiology to clearly
visualize blood vessels in a bony or dense soft tissue environment
▪ In traditional angiography, images are acquired by exposing an area of interest x-rays while injecting
contrast medium into the blood vessels
▪ The image obtained includes the blood vessels, together with all overlying and underlying structures.
The image is useful for determining anatomical position and variations, but doesn’t help visualizing
blood vessels accurately
▪ In order to remove the distracting structures and see the vessels better, first a mask image is
acquired, which is an image of the same area before the contrast is administered
▪ After contrast medium is administered, each subsequent image gets the original "mask" image
subtracted out

Mask Image (A) – Created before Image (B) – Created after injecting Subtracted Image (C)
injecting contrast medium contrast medium Image C = Image B – Image A 15