Pengantar Radiologi

dr. Arlavinda A. Lubis, SpRad(k)OnkRad

Bagian Radiologi RSUD ULIN Banjarmasin

 What is Radiology?
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 Radiology is the branch or specialty of medicine that deals with the study

and application of imaging technology using ionizing and nonionizing
radiation to diagnosing and treating diseases
 History of Radiography
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X-rays were discovered in 1895 by Wilhelm Conrad

Roentgen (1845-1923) who was a Professor at
Wuerzburg University in Germany

Roentgen observed a fluorescent glow of

crystals on a table near his cathode-ray
tube

Hystory
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  One of Roentgen's first experiments late in 1895 was a film of the hand of his wife, Bertha
 In June 1896, only 6 months after Roentgen announced his discovery, X-rays were being
used by battlefield physicians to locate bullets in wounded soldiers

Hystory
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 A Second Source of Radiation

  In 1896, Henri Becquerel ( French scientist ) discovered natural radioactivity

 Becquerel concluded that the uranium compound gave off a type of radiation that could
penetrate heavy paper and expose photographic film.
 Bacquerel's discovery was, unlike that of the X-rays, virtually unnoticed by scientists .
Relatively few scientists were interested in Becquerel's findings.

 It was not until the discovery of radium (shining element) by Pierre and Marie Curie in
1898 that interest in radioactivity became widespread
  In 1946, man-made gamma ray sources such as cobalt and iridium became available

Hystory
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 X-rays and Gamma rays are electromagnetic radiation of exactly the

same nature as light, but of much shorter wavelength.
 Wavelength of visible light is on the order of 6000 angstroms while the
wavelength of x-rays is in the range of one angstrom and that of gamma
rays is 0.0001 angstrom.
 This very short wavelength is what gives x-rays and gamma rays their
power to penetrate materials that light cannot.

Hystory
 Properties of X-Rays and Gamma Rays
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 They are not detected by human senses (cannot be seen, heard,

felt, etc.).
 They travel in straight lines at the speed of light.
 Their paths cannot be changed by electrical or magnetic fields.
 They can be diffracted to a small degree at interfaces between two
different materials.
 They pass through matter until they have a chance encounter
with an atomic particle.
 Their degree of penetration depends on their energy and the
matter they are traveling through.
 They have enough energy to ionize matter and can damage or
destroy living cells.

characteristic
 Radio-diagnostic
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 Radiology is a medical specialty that employs the use of imaging to both

diagnose and treat.

For diagnostic, a radiologist use:

 X-ray radiography:
 Plain radiograph
 Fluoroscopy with Contrast radiograph: invasive- non invasive

 Ultrasound
 Computed tomography (CT),
 Nuclear medicine, 
 Positron emission tomography (PET) and
 Magnetic resonance imaging (MRI) to diagnose or treat diseases. 
 Interventional radiology is the performance of (usually minimally invasive)
medical procedures with the guidance of imaging technologies.

Radio-diagnostic
 Radio-diagnostic
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X-ray radiography
 Plain photo of:
 Skull AP-Lat ; Waters and Caldwell (paranasal sinuses); Schuller and Law
(mastoid); TMJ (temporomandibular joint)
 Thorax AP_Lateral_ Top Lordotik
 Abdomen, Abdomen 3 position
 Bony extremities

Radio-diagnostic
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Conventional x-ray unit Fluoroscopy unit

X-ray
Plain Photo thorax
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Plain x-ray
Plain Abdomen
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 An abdominal x-ray is an x-ray of the abdomen. It is sometimes abbreviated to AXR,

or KUB (for kidneys, ureters, and urinary bladder) or BNO .
 The abdominal x-ray is a test that can be carried out quickly and easily in an emergency
department. The test can help diagnose some abdominal conditions. Small and large
bowel obstructions, volvulus and malrotations, stones of urinary tract can be diagnosed
 It is not a useful investigation for most abdominal conditions

Plain x-ray
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Plain abdomen
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 Fluoroscopy
Fluoroscopy and angiography are special applications of X-ray imaging, in
which a fluorescent screen and image intensifier tube is connected to a closed-
circuit television system.
This allows real-time imaging of structures in motion or augmented with a
radiocontrast agent.
 radiocontrast agent:
 Barium sulfate (BaSO4) is given orally or rectally for evaluation of the GI tract
 Iodine, in multiple proprietary forms, is given by oral, rectal, intra-arterial or intravenous
routes

fluoroscopy
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Abdominal fluoroscopy:
 Barium swallow (Oesophagus )
OMD (Oesophagus Maag Duodenography)
 Barium meal (Gaster- Duodenum)
 Barium follow through (small intestines)
 Barium enema (Colon inloop)

fluroscopy
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Urinary Tract Fluoroscopy:

 Antegrade Pyelography
 Retrograde pyelography
 Urethrocystography

Non fluoroscopy:
Intra Venous Pyelography (IVP)
 Radio-diagnostic
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Interventional radiology

 The basic concept behind interventional radiology is to diagnose or

treat pathologies, with the most minimally invasive technique possible.
 Interventional radiologists diagnose and treat several disorders,
including peripheral-cerebral vascular disease,renal artery stenosis, inferior vena
cava filter placement, gastrostomy tube
placements, biliary stents and hepatic interventions. Images are used for guidance,
and the primary instruments used during the procedure are needles and catheters

Ex/ Angiography, ERCP (Enteropatic Retrograde Cholangio Pancreatography)

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Cardio-angiography Cerebral angiography

Interventional rad
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 Computed tomography

CT scan
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Ct scan
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Magnetic resonance imaging (MRI):

  is a medical imaging procedure that uses strong magnetic fields and radio
waves to produce cross-sectional images of organs and internal structures in
the body.
 the signal detected by an MRI machine varies depending on the water content
and local magnetic properties of a particular area of the body  different
tissues or substances can be distinguished from one another .
 MRI exam of a joint can provide detailed images of ligaments and cartilage,
which are not visible using other study types

MRI
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Uses of MRI scans:

 Abnormalities of the brain and spinal cord
 Tumors, cysts, and other abnormalities in various parts of the body
 Injuries or abnormalities of the joints
 Certain types of heart problems
 Diseases of the liver and other abdominal organs
 Causes of pelvic pain in women (e.g. fibroids, endometriosis)
 Suspected uterine abnormalities in women undergoing evaluation for
infertility

MRI
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MRI
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 Ultrasound
 Using a high-frequency sound waves to visualize soft tissue structures in the body in real time.
 No ionizing radiation
 The quality of the images is highly dependent on the skill of the person (ultrasonographer)
performing the exam and patient body habitus.
 Larger patients may have a decrease in image quality due to sound wave absorption in the
subcutaneous fat layer.
 Ultrasound is also limited by its inability to image through air (lungs, bowel loops) or bone
 The first ultrasound images were static and two-dimensional (2D), but with modern
ultrasonography, 3D reconstructions can be observed in real time, effectively becoming "4D"

USG
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 Types of usg examination:

 Doppler ultrasound (to visualize blood flow through a blood vessel)
 Bone sonography (to diagnose osteoporosis)
 Echocardiogram (to view the heart)
 Fetal ultrasound (to view the fetus in pregnancy)
 Ultrasound-guided biopsies
 Doppler fetal heart rate monitors (to listen to the fetal heart beat)

USG
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USG
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USG
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Nuclear medicine
 Nuclear medicine imaging involves the administration into the patient of
radiopharmaceuticals consisting of substances with affinity for certain
body tissues labeled with radioactive tracer.
 The most commonly used tracers are technetium-99m, iodine-123, iodine-
131, gallium-67, indium-111, thallium-201 and fludeoxyglucose (18F) (18F-
FDG).
 The heart, lungs, thyroid, liver,gallbladder, and bones are commonly
evaluated for particular conditions using these techniques

RN
 Bone scan
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Radio-nuclear
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Positron emission tomography (PET) scanning

 also a nuclear medicine procedure, deals with positrons.

 The positrons annihilate to produce two opposite traveling gamma rays to
be detected coincidentally, thus improving resolution.
 In PET scanning, a radioactive, biologically active substance, most often
18F-FDG, is injected into a patient and the radiation emitted by the patient
is detected to produce multiplanar images of the body. Metabolically more
active tissues, such as cancer, concentrate the active substance more than
normal tissues

PETscan
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PET scan
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PET scan
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Mammography
  is the radiographic examination of the breast utilizing low energy x-rays
and fine detail film-screen or digital imaging.
 Mammograms may be a screening examination, aimed at detecting early
breast cancer or a diagnostic study, to better define abnormalities on a
screening, follow-up a previously found abnormality or to evaluate a
palpable mass or other symptoms. Early breast cancer may be seen as a
mass, a focal asymmetric density or as clustered microcalcifications (<
1 mm)

Mammography
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 Radiotherapy
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For teraphy, radio-oncologist use:

External Radiation
Teletherapy: Cobalt60 ; Linear Accelerator (Linac); IMRT; SBRT

Brachiterapy: Intracavitare, Implant

Internal Radiation:
Cobalt 60
Caesium137
Irridium192

Radio- Therapy
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Thank you