Diagnostic radiology

BY
DR.ABDUSELAM H. (MD)
 2

Medical imaging remains a vital part of the

diagnostic process.

 Traditionally radiology divided into

 Diagnostic and

 Therapeutic

 Ionizing radiation is common for both

 Modalities of imaging in Diagnostic Radiology
3

1. Plane film radiography

2. Contrast enhanced radiography

3. Computed tomography (CT)

4. Magnetic resonance imaging (MRI)

5. Diagnostic Ultrasonography (US)

 1, 2 & 3  utilize x-rays

 4 & 5  do not utilize x-rays

 Historical prospective
4

 1895 Roentgen physicist discovered X-ray

 He was doing experiment with cathode ray

tube studying their behaviour in completely

dark room
 When tube was operating he discovered

glow caused by fluorescence of plate left on

the bench.
 when he reached for the plate he was shocked

to see the images of bones of his hand cast on

the plate.
 Cont…
5

He called this unknown radiation which was

invisible, could penetrate objects, and caused

fluorescence - x-ray because initially he did not
understand its nature

The first recorded use of diagnostic X rays was in

1896
 X-rays
6

 Utilize electromagnetic radiation

 Commonest form of medical imaging
 Image illustrates the variations in radiodensity of
tissues to X-rays
Process of image formation
7
 Radiography
8

 X -rays are a form of EMR/energy of extremely short

wave length

 The shorter the wave length of an EMR, the greater its

energy and as rule the greater the ability to penetrate
the various materials
 ...cont
9

An atom is ionized when it has lost an electron

Any photon that has about 15 or more electron volt of

energy is capable of producing ionization in atoms or

molecules
X rays, gamma rays and certain type of Uv

radiation are typical of ionizing radiations

 Production of images
10

Image production by x-ray result from attenuation

of those x –ray by the materials through which they
pass
 The greater the density of the material the greater
its ability to absorb and scatter.

 Absorption is influenced by density of structures

 Con...
11

The denser the structure the greater the

attenuation/absorbtion, which results in less blackening

of the film which means fewer x-rays strike the film

Less dense structures attenuate the beam to a lesser

degree & result in more blackening of the film which

means more x rays strike the film
 Terms
12

 Structures that produce more blackening on a film are

referred to as being Radiolucent and

 those that produce less blackening are called radio

opaque or radio dense
 Cont....
13

 There are four types radiographic densities:

 in increasing order physical density; gas(air), fat,

water, & bone ( metal)

 Radio graphically these appear as black, gray- black,

gray and white respectively

 air < fat < water < bone < metal
X-ray cont..
14
 Contrast studies
15

Introduction of radio-opaque contrast

Outlines hollow organs, e.g. barium
swallow

Water-soluble contrast substances

allow
 Examination of vasculature containing the
agent, e.g. angiography
 Excretion of the contrast agent, e.g.
intravenous urogram
16
17
 Flouroscopy
18

Is a term used when continuous low power x-ray beam passed through

patient to produce a dynamic image that can be viewed on TV monitor

A continuous x-ray beam passes through the patient& falls on

fluoroscopic screen.

The faint light pattern emitted by the fluorescent screen is amplified

electronically by an image intensifier image displayed on TV monitor.

 19

On the fluoroscopic image, black and white are

reversed so that bone and contrast agents appear
dark and radiolucent structures appear light

advantages: allows for real-time visualization of

structures
disadvantages: increased radiation dose; however,
the use
Fluoroscopy
20
 Uses of flouroscopy
21

GI peristalsis
Movement of diaphragm with respiration
Cardiac action
Valve calcification
Localization of chest mass.

 Fluoroscopy also used to perform & monitor

continuously radiographic procedures such as
barium studies ,catheter placements.
 Computed Tomography (CT)
22

Computerized tomography (CT)

 Utilizes X-rays
 Integrates large quantities of data
 Allows computerized reconstruction of cross-sectional images or slices
 contraindications: pregnancy (relative), contraindications to contrast agents
(e.g. allergy, renal failure)
23
24
 Uses
25

1. Any region of the body can be scanned; brain

neck,abdomen,pelvis &limb
2. Staging primary tumours such as colon and lung

secondary spread determine operability or a

baseline for chemotherapy.

3. Radiotherapy planning

4. Exact anatomical detail when US is not successful

 Advantages
26

1. Good contrast resolution

2. Precise anatomical detail

3. Rapid exam technique, so valuable for ill patients

4. In contrast to US, diagnostic images are obtained in obese patient as fat

separates the abdominal organ

5. may be used to guide biopsies,

6. spiral/helical multidector CT has fast data acquisition and allows 3D imaging

 Disadvantages
27

1) High cost of equipment & scan

2) High dose of ionizing radiation for each exam.

3) Produce image in transverse plane

28
 Magnetic Resonance Imaging
29

http://psyphz.psych.wisc.edu/
 Magnetic resonance imaging
30

MRI is none invasive technique that does not use

ionizing radiation.

Magnetic resonance uses radiofrequency radiation in

the presence of high magnetic field to produce high
quality images in any plane
 31

Magnetic fields used to induce ‘proton spin’

No radiation exposure
Data reconstruction allows detailed images
Signal depends on water content of tissue
 Uses of MRI
32

technique of choice for brain and spinal imaging

accurate imaging of joints, tendons, ligaments, and

muscular abnormalities.
Thorax
Abdomen
Pelvis
 Advantages
33

Can image in any plane-axial, sagital,coronal.

Non-ionizing & hence believed to be safe to use even
in pregnancy.
Excellent anatomical detail especially of soft tissues.
Visualize blood vessels without contrast; Magnetic
resonance angiography(MRA)
 Disadvantages
34

High cost.
Poor image of lung fields
In ability to show calcification with accuracy
Fresh bl00d in recent haemorrhage not as well
visualized as by CT
MRI more difficult to tolerate with examination time
longer than CT
Contraindicated in patient with metallic pacemaker
MRI image
35
 ULTRASONOGRAPHY
36

Use high frequency sound wave which very high to

be heard by human ear to produce image
Produce white color for dense structures and black
color for liquid
 37

Utilizes high-frequency sound

Measures reflection of sound waves.
Non-invasive and no radiation exposure

CLINICAL USES
Obstetric ultrasound
Renal, hepatic and pancreatic imaging
Doppler studies of blood vessels
 38

reflection (or echos) occurs when the sound waves

pass through tissue interfaces of different accoustic
densities
structures are described based on their echogenicity;
 hyperechoic structures appear bright (U/S reflected) whereas
 hypoechoic structures appear dark (U/S waves not reflected back
but pass through)
 39

Advantages:
 relatively low cost,
 non-invasive,
 no radiation,
 real time imaging,
 may be used for guided biopsies, many different imaging planes (axial,
sagittal), determines cystic versus solid
Disadvantages:
 highly operator-dependent,
 air in bowel may prevent imaging of midline structures in the abdomen,
 may be limited by patient habitus,
 poor for bone evaluation
40
41
42