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Cluster V - SIR MEYNARD NOTES

Radiologic Technology (Liceo de Cagayan University)

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COMPUTED TOMOGAPHY DEFINITION Computed Tomography (CT) – x-ray

OF TERMS tube detector assembly rotating 360
degrees around specified areas of the body;
Air calibration – scan of air in gantry; also called CAT (computed axial
based on a known value of -1000 for air, tomography) scan
the scanner calibrates itself according to
this density value relative to actual density CT angiography – use of volumetric CT
value measured. scanning with spiral technique to acquire
image data that are constructed into 3
Algorithm – mathematics formula dimensional CT angiograms
designed for computers to carry out
complex calculation required for image CT number – arbitrary number assigned
reconstruction; designed for enhancement by computer to indicate relative density
of soft tissue, bone and edge resolution. of a given tissue: CT number varies
Also referred to as KERNEL proportionately with tissue density: high
CT numbers indicate dense tissue, and low
Anisotropic spatial resolution – spatial CT numbers indicate less dense tissue. All
resolution of a voxel in which all three CT numbers are based on the density of
axes of voxel element are not equal. Slice water, which is assigned a CT number of 0.
thickness is not equal to pixel size. Also referred to as Hounsfield Unit

Aperture – opening of the gantry through Contrast resolution – ability to

which patient passes during scan differentiate between small differences in
density within the image.
Archiving – storage of CT images on
long term storage device such as cassette Curved planar reformations – post
tape, magnetic tape and optical disk. processing technique applied to stacks of
axial image data that can be constructed
Artefact – distortion or error in image into irregular or oblique planes.
that is unrelated to subject being studied.
Data Acquisition System (DAS) – part of
Attenuation – coefficient CT numbers detector assembly that converts analog
assigned to measure remnant radiation signal to digital signals that can be used by
intensity after attenuation by tissue the CT computer.
density
Detector – electronic component used for
Axial – describes plane of image as radiation detection; made of either high
presented by CT scan; same as transverse. density photo reactive crystals or pressurized
stable gases.
Bolus – preset amount of radiopaque
contrast medium injected rapidly per IV Detector assembly – electronic
administration to visualize high flow component of CT scanner that measures
vascular structure, usually in conjunction the remnant radiation exiting the patient,
with dynamic scan; most often injected converting the radiation to an analog
using a pressure injector. signal proportionate to the radiation
intensity measured.
Channel – in multidetector CT, multiple
rows of detector assembly rotating
Prepared By: RC CARREON, RRT, MA
ED ©
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Direct coronal – describes position use to visualization of high flow of vascular

obtain images in coronal plane; used for structures; can be use to scan a
head scans to provide images at the right uncooperative patient rapidly.
angle to axial images.
Dose length product (DLP) – commonly Field of view (FOV) – area of anatomy
reported dose descriptor on CT scanners. displayed on the monitor; can be adjusted
Dynamic scanning – process by which raw to include the entire body section or a
data are obtained by continuous scanning; specific part of the patient anatomy being
images are not reconstructed but are saved scanned.
for later reconstruction; most often used for
Gantry – part of CT scanner that houses x- Isotropic spatial resolution – spatial resolution of
ray tube, cooling system, detector assembly a voxel in which all three axes of the volume element
and DAS; often referred to as the re equal. Slice thickness is equal to pixel size.
<doughnut= by patients
Generation – description of significant levels Mapping – assignment of appropriate gray level to
of technologic development of CT scanners; each pixel in an image.
specifically related to tube/detector
movement Matrix – mathematical formula for calculation
Gray-scale image – analog image whereby made up of individual cells for number
each pixel in the image corresponds to assignment; CT matrix stores a CT number relative
particular shades of gray to the tissue density at that location
Helical CT – data acquisition method that
combines continuous gantry rotation with Maximum intensity projection (MIP) –
continuous table movement to form a reconstruction of brightness pixels from stack of
helical path of scan data; also called spiral image data into a 3D image
CT.
High resolution scans – use of scanning Multiplanar reconstruction (MPR) – post
parameters that enhance contrast resolution processing technique applied to stacks of axial image
of an image, such as thin slices, high data that can be reconstructed into other orientations
matrices, high spatial frequency algorithms or imaging planes.
and small display FOV
Host computer – primary link between Multiple scan average dose (MSAD) – dose
system operator and other components of descriptor that calculates dose resulting from a
imaging system. series of scans over an interval length of scans

Hounsfield units (HU) – number used to Noise – random variations of CT numbers around
describe average density of tissue; term is some mean value within a uniform object; noise
used interchangeably with CT number; produces a grainy appearance in the image.
named in honor of Hounsfield, who is
generally given credit for development of the Partial volume averaging – calculated linear
first clinicaly viable CT scanner attenuation coefficient for a pixel that is weighted
average of all densities in the pixel
Image misregistration – image
distortion cost by combination of table Pixel (picture element) – one individual cell
indexing and respiration. surface within an image matrix used for image
display
Index – table movement; also referred
to as table increments Post processing techniques – specialized
Prepared By: RC CARREON, RRT, MA
ED ©
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COMPUTED TOMOGRAPHY
reconstruction techniques that are applied to CT Scan time – x-ray exposure time in
images to display the anatomic structures from seconds
different perspective
Segmentation – methods of cropping or editing
Primary data – CT number assigned to the target objects from image data
matrix by the computer; the information required
reconstructing an image Shaded surface display (SSD) – processed used to
generate 3D images that show the surface of a 3D
Protocol – instruction for CT examination object
specifying slice thickness, table increments, contrast
administration, scan diameter, and any other Shading – post processing technique used in 3D
requirements specified by the radiologist. reconstruction to separate tissues of interest by
applying a threshold value to isolate the
Quantum noise – any noise in the image that is a structure of interest
result of random variation in the number of x-ray
photons detected Slice – one scan through a selected body part; also
referred to as a cut; slice thickness vary from
Real time – ability to process or reconstruct incoming 0.35mm to 1 cm, depending on the examination
data in milliseconds.
Slip ring – low voltage electrical contacts within
Reconstruction – process of creating a digital image the gantry designed to allow continuous rotation of
from raw data. an x-ray tube without the used of cables connecting
internal and external components
Region of interest (ROI) – measurement of CT
within a specified area for evaluation of average Spatial resolution – ability to identify visibly
tissue density. anatomic structures and small objects of high
contrast
Rendering – process of changing the shading of a
3D image; commonly used to increase depth Spiral CT – scanning method that combines a
perception of an image. continuous gantry rotation with a continuous
table movement to form a spiral path of scan data;
Retrieval – reconstruction of images stored on also called helical CT
long term device; can be done for extra film copies
or when films are lost. Streak artifacts – artifacts created by high density
objects that result in an arc of straight lines
Scan – actual rotation of x-ray tube around the projecting across the FOV from a common point.
patient; used as generic reference to one slice or an
entire examination. System noise – inherent property of a CT
scanner; the difference between the measured CT
Scan diameter – also referred to as the zoom or number of a given tissue and the known value for
focal plane of a CT scan; predetermined by the that tissue; most often evaluated through the use
radiographer to include the anatomic area of of water phantom scans.
interest; determines FOV
Table increments – specific amount of table travel
Scan duration – amount of time used between scans; can be varied to move at any
to scan an entire volume during a specified increment; most protocols specify from
single spiral scan. 1mm to 20 cm, depending on type of examination;
also referred to as indexing.
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COMPUTED TOMOGRAPHY
Table speed – longitudinal distance travelled by image contrast; window level (center) control subtle
the table during one revolution of the x-ray tube gray images within a certain width range and
ultimately affects the brightness and overall density
Temporal resolution – ability of CT system to of an images
freeze motion of the scanned object; the shortest
amount time needed to acquire a complete data set
.
Threshold value – CT number used in defining
the corresponding anatomy that comprises a 3D
object

Useful patient dose – radiation dose received by

the patient that is actually and converted into an
image.

Voxel (volume element) – individual pixel with the

associated volume of tissue based on the slice
thickness

Window – arbitrary numbers used for image

display based on various shades of gray; window
width controls the overall gray level and affects

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COMPUTED TOMOGRAPHY
COMPUTED TOMOGRAPHY 1930’S – ALLESANDRO VALLEBONA
 Creation of a cross-sectional tomographic  Proposed a method to represent a single
section of the body with a rotating fan beam, slice of the body on the radiographic film
a detector array and computed (TOPOGRAPHY)
reconstruction
 Other Names: Computed Axial 1970 – GODFREY NEWBOID HOUNSFIELD
Tomography (CAT), Computed Transaxial  First demonstrated the CT technique
Tomography (CTAT), Computed
Reconstruction Tomography (CRT), Digital 1972-1974
Axial Tomography (DAT), Body Section  First clinical CT scanners were installed
Roentgenography
 Greek Word: <Tomos= = slice/section; 1979
<Graphia= = describing  Hounsfield & Allan Mcleod Cormack
shared the Nobel Prize in Physics
CT SCANNER
 Consists of an x-ray source emitting finely
1980
collimated x-ray beam and a single detector
 CT scan machine became widely available
both moving synchronously in a translate or
rotate mode or a combination of both
EMI SCANNER
 1st CT scan machine
 180 translation/1o rotation
INTRODUCTION

ACTA
COMPUTERS
 1st CT system that could make images of any
 Used Binary System
part of the body
 Did not require water tank
BINARY DIGIT/BIT
 Can code for 2 values or 2 shades of gray
which correspond to white and black
PRINCIPLES OF OPERATION
 8 bits=1 byte
 2 bytes=1 word
CONVENTIONAL/AXIAL TOMOGRAPHY
 16 bits=1 word
 Plane of the image is parallel to the long
axis of the body
STORAGE REQUIREMNENT
 Produces sagittal and coronal images
 Kilobytes, megabytes, gigabyte or terabytes

COMPUTED TOMOGRAPHY
 Plane of image is perpendicular to the long
axis of the body
 Produces a transverse image

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COMPUTED TOMOGRAPHY

CT IMAGE 2ND GENERATION

 A transaxial/transverse image  Has a narrow fan beam and multiple
detectors
TRANSLATION/SWEEP
 It refers to movement of source-detector 3RD GENERATION
assembly across the patient  Has a wide fan beam
 Results in a projection
 Projection: represents the attenuation 4TH GENERATION
pattern of patient profile  Equipped with a detector ring
 Detector signal: has a dynamic range of 12
bits (4096 gray levels) 5TH GENERATION
 The electron beam tomography CT
PROJECTION
 An intensity profile 6TH GENERATION
 The helical (or spiral) CT scanner
ALGORITHM
 Computer-adapted mathematical calculation 7TH GENERATION
applied to raw date during image  The multi-detector row CT.
reconstruction
SEVEN GENERATIONS
RECONSTRUCTION
 Creation of an image from date FIRST GENERATION
 A demonstration project
RECONSTRUCTION TIME  Characteristic: translate/rotate (Bushong )
 Time needed for the computer to present a or rotate/translate (Reveldez)
digital image after an examination has been  X-ray Beam Shape: pencil beam
computed  Detector: single detector
 Time between the end of imaging and the  Imaging Time: 5-minute imaging time
appearance of an image
SECOND GENERATION
 Characteristic: translate/rotate (Bushong )
GENERATIONS OF COMPUTED or rotate/translate (Reveldez)
TOMOGRAPHY  X-ray Beam Shape: narrow fan beam
 Detector: multiple detector (5-30)
GENERATION OVERVIEW  Imaging Time: 30 seconds
 Advantage: speed
1ST GENERATION o Rationale: consist of multiple
 Has a pencil beam and one detector detectors
 Disadvantages:
o Increased scattered radiation

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COMPUTED TOMOGRAPHY

o Increased radiation intensity toward rotation of the x-ray source, proving a self-
the edges of the beam calibrating system. Third generation system are
 Compensation: used of bow- calibrated only once every few hours.
tie filter
 Bow-tie Filter: equalize the radiation FIFTH GENERATION (early 1980’s)
intensity that reaches the detector array  Electron beam CT
 Ultrafast CT scanner
THIRD GENERATION  X-ray tube rotation is mechanical
 Characteristic: rotate/rotate  No moving parts
 X-ray Beam Shape: wide fan beam  Electron Gun: produces a focused electron
 Detector: curvilinear detector array (30) beam that generates a rotating x-ray fan
 Imaging Time: <1 second beam after being steered along tungsten
 Advantages: target rings
o Better x-ray beam collimation
o Decreased scattered radiation SIXTH GENERATION (early 1990’s)
o Good image reconstruction  Helical/Spiral CT
 Disadvantage: ring artifacts  Volumetric scanners
o Compensation: software connected  Introduced by Will Kalender and Kazuhiro
image reconstruction algorithm
Katada
 Uses slip ring technology
NOTE: Third generation designs have the
 Excels in 3D multiplanar reformation
advantage that thin tungsten SEPTA can be place
 Slip Ring: electromechanical device that
between each detector in the array and focused on
conduct electricity and electric signals
the x-ray source to REJECT SCATTERED
through rings and brushes across a rotating
RADIATION
surface onto a fixed surface
FOURTH GENERATION
SEVENTH GENERATION
 Characteristic: rotate/stationary
 64-Slice CT
 X-ray Beam Shape: wide fan beam
 Multiple detector array
 Detector: fixed circular detector array
IMAGING SYSTEM DESIGN
(4000) with detector ring
 Imaging Time: <1 second
3 MAJOR COMPONENTS
 Advantage: no ring artifacts 1.) Gantry
 Disadvantage: 2.) Operating Console
o Increased patient dose 3.) Computer
o High cost
GANTRY
NOTE: The detectors are no longer coupled to the
 Largest component
x-ray source and hence cannot make used of
focused SEPTA to reject scattered radiation.
However, detectors are calibrated twice during each
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COMPUTED TOMOGRAPHY

 Subsystems: x-ray tube, detector array, high and change them to electronic
voltage generator, patient couch and signals
mechanical support o Low or no after glow
 A brief, persistent flash of
X- RAY TUBE scintillation that must be
 Special requirements: taken into account &
o Power capacity: must be high subtracted before image
 >120 kVp reconstruction
 400 mA o High scatter suppression
o High speed rotors: for heat o High stability
dissipation  Allows a system to be used
o Anode heat capacity: 7 MHU without interruption of
(Spiral CT) frequent calibration
o Heat storage capacity: 8 MHU o Types:
o Anode cooling rates: 1MHU/min o Gas-filled detector – previously used
o Focal spot size: small o Scintillation & solid-state detectors –
 Takenote: CT scanners recently used
designed for high spatial o Gas detector:
resolution imaging not for o Basis: ionization of gas
direct projection imaging o Three types:
o Limiting characteristics:  Ionization chamber
 Focal spot design: must be  Proportional counter
robust or strong  Geiger-Muller counter
 Heat dissipation o Characteristics:
o X-ray tube life: approx. 5000  Excellent stability
exposures (Conventional CT)  Large dynamic range
 Focal-Spot Cooling Algorithms:  Low quantum efficiency
o Design to predict the focal spot o Scintillation detector:
thermal state o Characteristic: high x-ray detection
o To adjust the mA setting accordingly efficiency (90%)
 Reduces patient dose
DETECTORY ARRAY  Allows faster imaging time
o The entire collection of detectors  Improves image quality
o Group of detectors o Crystals used: Sodium iodide
o The image receptor in CT o Replaced by:
o Detector: absorbs radiation and converts it  Bismuth germinate (BGO)
to electrical signal  Cesium iodide (CsI)
o Optimal Characteristics: o Current crystal of choice:
o High detector efficiency  Cadmium tungstate (CdWO4)
 The ability of the detector to  Special ceramics
capture transmitted photons

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o Photodiode: converts light into electrical  Value <1: non ideal detector system
signal o Result: increased in patient dose to
o Characteristics: maintain image quality
 Small,
 Cheap CAPTURE EFFICIENCY
 Does not require power  Refers to the ability with which the detector
supply obtains photons that have passed through the
patient
THREE IMPORTANT FACTORS
CONTRIBUTING TO DETECTOR ABSORPTION EFFICIENCY
EFFICIENCY  Refers to the number of photons absorbed
by the detector
1.) GEOMETRIC EFFICIENCY  Depends on: physical properties of the
 The area of the detectors sensitive to detector face
radiation as a fraction of the total exposed o Thickness
area o Material
 The amount of space occupied by the
detector collimator plates relative to the RESPONSE TIME
surface area of the detector  The time required for the signal from the
2.) QUANTUM EFFICIENCY detector to return to zero after stimulation of
 The fraction of incident x-rays on the the detector by x-ray radiation so that it is
detector that are absorbed and contribute to ready to detect another x-ray event
the measured signal  A function of the detector design

3.) CONVERSION EFFICIENCY DYNAMIC RANGE

 The ability to accurately convert absorbed x-  The ratio of the maximum signal measured
ray signal to electrical signal to the minimum signal the detectors can
measure
OVERALL/DOSE EFFICIENCY
 The product of geometric, quantum and DATA ACQUISITON SYSTEM (DAS)
conversion efficiency  Computer-controlled electronic amplifier
 The product of the following factors and switching device
o Stopping power of the detector  Where signal from each radiation detector is
material connected
o Scintillator efficiency (in solid-state  Consists of:
types) o Preamplifier
o Charge collection efficiency (in o Integrator
xenon types) o Multiplexer
o Geometric efficiency o Logarithmic
o Scatter rejection o Amplifier
 Normal value: b/n 0.45-0.85 o Analog-to-digital converter

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COMPUTED TOMOGRAPHY

 Patient dose
HIGH VOLTAGE GENERATOR  Predetector/Post Patient Collimator
o High frequency power o Restricts the x-ray beam viewed by
o High voltage step-up transformer the detector array
o Power: 50 kW o Purpose:
o Accommodates higher x-ray tube rotor  To decrease scattered
speeds radiation
o Accommodates instantaneous power surges  To improved contrast
characteristic of pulsed system o Determines:
 Slice thickness
PATIENT COUCH  Sensitivity profile
o Supports the patient comfortably
o Construction: low-Z material (Carbon OPERATING CONSOLE
fiber)
 Contains meters and controls
o Rationale: it does not interfere with o For selection of proper imaging
x-ray beam transmission & patient technique factors
imaging o For proper mechanical movement of
o Features: should be the gantry and patient couch
o Smoothly and accurately motor o For the use of computer commands
driven  Allow image reconstruction
 Rationale: precise and transfer
positioning is possible
 2-3 operating consoles
o Capable of automatic indexing
o 2 for CT radiologic technologists
 Rationale: operator does not  1st: To operate imaging
have to enter the room
system
between each scan
 2nd: to post-process images
for filming and filing
COLLIMATION
o 1 for physician
 Restricts the volume of tissue irradiated  To view the images
 Purpose:  To manipulate contrast, size
o Reduces patient dose & general visual appearance
o Improved image contrast  Accepts the reconstructed
 Types: post patient & prepatient collimator image from operator’s
 Prepatient Collimator console
o Limits the area of the patient that  Displays reconstructed image
intercepts the useful beam for viewing and diagnosis
o Mounted on the x-ray tube housing
 Two monitors:
or adjacent to it
o 1st: provided for operator
o Purpose: to decrease patient dose  To annotate patient data on
o Determines:
the image (e.g. hospital
 Dose profile

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COMPUTED TOMOGRAPHY

identification, name, patient  Central Processing Unit (CPU): performs

number, age, gender) calculations and logical operations under
 To provide identification for control of software instruction
each image (e.g. number, o Heart of the computer
technique, couch position)

nd
o 2 : allows the operator to view the Special requirements:
resulting image before transferring it o Controlled environment
to hard copy or physician’s viewing o Relative Humidity: <30%
console o Temperature: <20oC
 Technique factors: o High humidity and temperature:
o kVp: <120 contribute to computer failure
o mA: 400 (maximum)
 varied according to SLIP-RING TECHNOLOGY
 patient thickness to reduce  Slip ring: electromechanical device that
patient dose conducts electricity and electrical signals
o Slice thickness: 0.5-5 mm through rings and brushes
 Physician’s work station: allows the o Allows the gantry to rotate
physician continuously without interruption
o To call up any previous image o Made MSCT possible
o To manipulate image to optimize  Brushes: transmit power to the gantry
diagnostic information components
 Scan time: length of time required per scan o Composition: silver graphite alloy
 Used as sliding contact
COMPUTER o Replacement of brushes:
 Unique subsystem of the CT imaging system  Every year
 Microprocessor & primary memory: heart  During preventive
of the computer maintenance
o Determine reconstruction time
 Array processors:
o Mostly used in CT instead of IMAGE CHARACTERISTICS
microprocessors
o Rationale: IMAGING MATRIX
 Does many calculations  Layout of cells in rows and columns
 Faster than microprocessors  Original EMI: 80x80 matrix
(<1 sec reconstruction time) o 6000 cells of information
 Computer memories: ROM & RAM  Current system: 512x512 matrix
 Random access memory: temporary o 262,144 cells of information
memory that stores information while  Pixel: a picture element
software is used o Each cell of information
 Read only memory: for storage data only o Two-dimensional
and cannot be overwritten  Pixel Size = FOV ÷ matrix size

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COMPUTED TOMOGRAPHY

 Voxel: a volume element Blood 20

o The tissue volume CSF 15
 Voxel (mm3) = pixel size (mm2) x slice Water 0
thickness (mm) Fat -100
 CT number/Hounsfield unit: the numeric Lungs -200
Air -1000
information contained in each pixel
 Matrix: rows and columns of pixels
displayed on a digital image
IMAGE RECONSTRUCTION
 Field of view (FOV): the diameter of image
reconstruction
FILTER BACK PROJECTION
o FOV increased, fixed matrix size
 Process by which an image is acquired
 Result: increase/larger pixel
during CT and stored in computer memory
size
is reconstructed
o Fixed FOV, increase matrix size
 Result: decrease/smaller  Filter: refers to mathematical function
pixel size
MULTIPLANAR REFORMATION (MPR)
 A method for generating coronal, sagittal, or
oblique images from the original axial image
CT NUMBER/HOUNSFIELD UNIT (HU) data
 Used to assess the nature of tissue  MSCT: excels in 3D MPR
 HU: scale of CT number  3D MPR Algorithm: most frequently used
 Range: -1000 – +3000
THREE 3D MPR ALGORITHMS
 Formula: CT Number = k (µ t-µ w/ µ w)
o k: constant that determines the scale
factor for the range of CT number 1.) MAXIMUM INTENSITY PROJECTION
o µt: attenuation coefficient of the (MIP)
tissue in the pixel under analysis  Reconstruct an image by selecting the
o µw: x-ray attenuation coefficient of highest value pixels along the arbitrary line
water  Widely used in CT Angiography
2.) SHADED SURFACE DISPLAY (SSD)
CT NUMBER FOR VARIOUS TISSUES  Computer-aided technique that identifies
APPROXIMATE CT narrow range of values as belonging to the
TISSUES
NUMBER object to be imaged
Dense bone 3000 3.) SHADED VOLUME DISPLAY (SVD)
Bone 1000  Very sensitive to the operator-selected pixel
Liver 40-60 range
Muscle 50
 Previously: applied to bone imaging
White matter 45
Gray matter 40  Recently: applied to virtual colonoscopy
Kidney 30
IMAGE QUALITY
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COMPUTED TOMOGRAPHY

SPATIAL FREQUENCY
FIVE PRINCIPAL CHARACTERISTICS OF  Used to describe CT spatial resolution
CT IMAGE  Low SF: represents large objects
1.) Spatial resolution  High SF: represents small objects
2.) Contrast resolution
3.) Noise EDGE RESPONSE FUNCTION (ERF)
4.) Linearity  Mathematical expression of the ability of the
5.) Uniformity CT scanner to reproduced a high-contrast
edge with accuracy
SPATIAL RESOLUTION
 Ability to image small object that have high MODULATION TRANSFER FUNCTION
subject contrast (MTF)
 Expressed in: linepairs/millimeter (lp/mm)  Mathematical expression for measuring
 A function of pixel size resolution
 Takenote: SR for a CT image is limited to  The ratio of the image to the object as a
the size of the pixel function of spatial frequency
 Image reconstruction and postprocessing  Used to describe CT spatial resolution
tasks: powerful way to affect SR  MTF = 1: faithfully represents the object
 Formula: SR (cm) = ½ {1/SF (lp/cm)}  MTF = 0: image is blank and contain no
information
FACTORS AFFECTING/INFLUENCING  MTF = intermediate values: intermediate
SPATIAL RESOLUTION levels of fidelity
1.) Pixel size
2.) Slice thickness CHARACTERISTICS OF CT IMAGING
3.) Voxel size SYSTEM CONTRIBUTING TO IMAGE
4.) Design of prepatient and predetector collimators DEGRADATION
5.) Detector size 1.) Collimation
2.) Detector size and concentration
EFFECT IN SPATIAL 3.) Mechanical/electrical gantry control
FACTORS
RESOLUTION 4.) Reconstruction algorithm
Thick slice thickness Poor SR
Thin slice thickness Better SR
IMAGE FIDELITY
Large pixel size Poor SR
 Measured by determining the optical density
Small pixel size Better SR
Large voxel size Poor SR along the axis of the image
Small voxel size Better SR
Large detector size Poor SR LIMITING RESOLUTION
Small detector size Better SR  Spatial frequency at MTF equal to 0.1

LINE PAIR IMPORTANT MEASURES OF IMAGING

 One bar and its interspace of equal width SYSTEM PERFORMANCE
1.) Artifacts generation
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COMPUTED TOMOGRAPHY

2.) Contrast resolution Equal 0

3.) Spatial resolution Large variation High
Small variation Low
CONTRAST RESOLUTION
 The ability to distinguish one soft tissue FACTORS AFFECTING NOISE
from another without regard for size or 1.) kVp and filtration
shape 2.) Pixel size
 Takenote: CR is superior to CT 3.) Slice thickness
o Rationale: better x-ray beam 4.) Detector efficiency
collimation 5.) Patient dose – primary control of noise
 Ability to image low-contrast objects:
o Limited by: LINEARITY
 Size and uniformity of the  Describes the amount to which the CT
object number of a material is exactly proportional
 Noise of the system to the density of this material (in Hounsfield
units)
X- RAY ABSORPTION IN TISSUE  Evaluation test: five-pin performance test
 Determined by the mass density of the body object
part  Frequency: daily
 Characterized by x-ray linear attenuation UNIFORMITY
coefficient  The consistency of the CT numbers of an
image of a homogeneous material across the
X- RAY LINEAR ATTENUATION scan field
COEFFICIENT
 A function of x-ray energy and atomic SPATIAL UNIFORMITY
number of the tissue  Constancy of pixel values in all region of the
reconstructed image
NOISE  Evaluation test: plotting the CT number in
 The percentage standard deviation of a histogram/line graph
large number of pixels obtained from a  Acceptable value: +/- 2 mean value
water bath image (Standard Deviation)
 The variation in CT number above or below
the average values
 Appears as graininess MULTISLICE SPIRAL CT IMAGING
 Takenote: the resolution of low-contrast PRINCIPLES
objects is limited by the noise of the CT
imaging system ADVANTAGE OF MSCT
o Evaluation test: 20-cm water bath  Increases the volume of tissue that can be
o Frequency: daily imaged at a given time

PIXEL VALUE NOISE

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o Rationale: it has the ability to image  Z-axis location and

a larger volume of tissue in a single reconstruction width can be
breath-hold selected after imaging
 Helpful in:  CTA Pitch: <1:1
o CT Angiography  Pitch >1:1:
o Radiation therapy treatment o Decreases Z-axis resolution
o Imaging uncooperative patients o Rationale: a wide section sensitivity
profile
INTERPOLATION ALGORITHMS
 A special computer program VOLUME IMAGING
 1st interpolation algorithm: used 360o  Formula:
linear interpolation o TISSUE IMAGED = Beam width x
o Disadvantage: caused prominent Pitch x Imaging time
blurring of the reconstructed image  For 360o gantry rotation/sec
 Solution for blurring: 180o linear o TISSUE IMAGED = (Beam width
interpolation x Pitch x Imaging time) ÷ gantry
o Results: rotation
 Improved Z-axis resolution  If gantry rotation is not
 Improved sagittal and coronal 360o/sec
reformatted views
o It allows imaging at a pitch <1 SENSITIVITY PROFILE
 Interpolation:  Full Width at Half Maximum (FWHM):
o Estimation of value between two o The width of sensitivity profile at
known values one half of its maximum value
o A mathematical method of creating
missing data  If MSCT pitch=1:1:
 Extrapolation: estimation of value beyond o Sensitivity profile: 10% wider than
the range of known values conventional CT
 Data interpolation: performed by  If MSCT pitch=2:1:
interpolation algorithm o Sensitivity profile: 40% wider than
conventional CT
PITCH/SPIRAL PITCH
 The relationship between patient couch
movement and x-ray beam width IMAGING TECHNIQUES
 Spiral Pitch Ratio:
o PITCH = Couch movement each TWO PRINCIPAL DISTINGUISHING
360o ÷ Beam width FEATURES OF MSCT
 MSCT Pitch: 1 1.) Several parallel detector arrays
o Rationale: 2.) Quickly energizing
 Multiple slices are obtained
MULTISLICE DETECTOR ARRAY

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 Early 1990’s: initial demonstration of dual- Improved lesion -Reconstructs at

slice imaging detection arbitrary z-axis intervals
 Recently: 320 slice imaging -Reconstructs at
overlapping z-axis
 Wider slice imaging: Reduced partial
interval
o Better contrast resolution (at same volume
-Reconstructs small than
mA setting) image interval
 Rationale: detected signal is -Date obtained during
larger peak of enhancement
Optimized IV contrast
o Slight decrease in spatial resolution -Reduces volume of
 Rationale: increased voxel contrast agent
size Multiplanar images -Higher quality
improved reconstruction
 Smaller detector size: better spatial
resolution

FEATURES OF MSCT
DUAL SOURCE MSCT
LIMITATIONS RATIONALE
 Has two x-ray tubes & two detector arrays -bigger x-ray tubes
 Principal advantage: speed Increased image noise needed
 Imaging time: 80 ms Reduced z-axis
-increases with pitch
resolution
DATA ACQUISITION RATE Increased processing -more data, more images
 Slice Acquisition Rate (SAR): one measure time needed
of the efficiency of the MSCT imaging
system
 Formula:
COMPUTED TOMOGRAPHY QUALITY
o SAR = Slice acquired/360o ÷
Rotation time CONTROL

Z-A XIS COVERAGE (Z) NOISE AND UNIFORMITY

 Assessment test: 20-cm water bath
 Formulas:
o Z = (N/R) x W x T x B  Frequency: weekly
o Z = SAR x W x T x B  Acceptable tolerance:
 N: number of slice acquired o Water: w/in +/- HU of 0
 R: rotation time o Uniformity: not > +/- 10 HU from
center of periphery
 W: slice width
 Assessment in quantitative CT: the
 T: time
following should be changed
 B: pitch
o CT scan parameters
o Slice thickness
FEATURES OF MSCT o Reconstruction diameter
ADVANTAGES RATIONALE o Reconstruction algorithm
-Removes respiratory
No motion artifacts
misregistration
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LINEARITY  Intended slice thickness of <5 mm: 0.5

 Assessment test: five-pin insert mm acceptable tolerance
performance
 Frequency: semiannually COUCH INCREMENTATION
 Analysis: should show relationship b/n the  Assessment test: noting the position of the
HU and electron density couch with tape measure & straightedge on
 Acceptable tolerance: the couch rails
o Correlation coefficient: at least  Frequency: monthly
0.96% or 2 standard deviation  Acceptable tolerance: w/in +/- 2 mm
 Assessment in quantitative CT: requires
precise determination of the value of tissue LASER LOCALIZER
in HU  For patient positioning
 Assessment test: specially designed test
GAMMEX 464 objects
 CT test object  Frequency: semiannually
 Used to evaluate noise, spatial and contrast
resolution, linearity and uniformity PATIENT DOSE
 Specified as CT dose index (CTDI)
SPATIAL RESOLUTION  High resolution: high patient dose
 Most important component of QC program  Monitored by: specially designed pencil
 Assessment test: imaging a wire/edge/hole ionization chamber/TLD
array/bar pattern  Frequency: semiannually
 Frequency: semiannually  Acceptable tolerance:
 Acceptable tolerance: w/in manufacture’s o Fixed technique: patient dose not
specifications vary from > +/- 10%
 Should follow replacement of the tube
CONTRAST RESOLUTION
 Assessment test: low-contrast test objects
with built-in analytic schemes CT SCAN ARTIFACTS
 Frequency: semiannually
 Acceptable tolerance: ARTIFACTS
o CT resolving power: should be 5  Systematic discrepancy in CT numbers/HU
mm objects at 0.5% contrast  Unintended optical density on a radiograph
 More common in CT than in conventional
SLICE THICKNESS/SENSITIVITY PROFILE radiographs
 Types:
 Assessment test: ramp, a spiral or a step
o Streaking - due to an inconsistency
wedged (specially designed test objects) in a single measurement
 Frequency: semiannually o Shading – due to a group of
 Acceptable tolerance: w/in 1 mm of the channels or views deviating
intended slice thickness gradually from the true measurement

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o Rings – due to errors in an Patient positioning

individual detector calibration Gantry tilting
o Distortion – due to helical Appropriate FOV selection
reconstruction Appropriate bowtie filter
 Four categories: Most commonly
o Physics-based artifacts Bone and metal implants
occur
 Caused: physical processes
involved in the acquisition of CUPPING ARTIFACT
CT data Beam is hardened more
o Patient-based artifacts in the middle portion of
 Caused: Description
an object than those in
 Patient movement the edges
 Presence of metallic Caused Beam hardening
materials
The middle of the
o Scanner-based artifacts, image appear darker
Effect
 Caused: imperfections in than the periphery
scanner function
Beam hardening
o Helical and multisection artifacts Avoidance
correction
 Caused: image
reconstruction process.

PHYSICS-BASED ARTIFACTS STREAK AND DARK BAND ARTIFACTS

 Beam hardening artifact Description
Appear between two
o Cupping artifact dense objects
o Streak artifact Metals (bullets,
 Partial volume pacemaker, dental
 Photon starvation fillings)
 Undersampling Caused Beam hardening
Poisson noise
BEAM-HARDENING ARTIFACT Patient motion
Edge effects
Increased mean energy of
Description the x-ray beam when it High CT number on the
Effect image
passes through object
Polychromatic nature of the Beam hardening
Caused Avoidance correction
x-ray beam
Cupping artifact Bony regions of the
Appearance of dark bands Most commonly occur body
or streak Used of contrast media
Effect
(b/n metal or bone)
Pseeudoenhancement of PARTIAL VOLUME ARTIFACTS
renal cysts Distortion of signal
BUILT-IN FEATURES: Description intensity from an
Filtration anatomy
Calibration correction Anatomy that doesn’t lie
Avoidance
Beam hardening correction Caused totally within the slice
software thickness
BY OPERATOR:
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Averaging the linear

attenuation coefficient in METAL ARTIFACTS
Effect a voxel that is Presence of metal object
heterogenous in Caused in the scan field
composition Incomplete attenuation
Thin slice selection Effect profile
Avoidance
Thin slice incrementation Severe streaking artifacts
Most critical region Posterior cranial fossa Asked patient to remove
metallic objects
PHOTON STARVATION ARTIFACTS Use gantry angulation
Potential source of Avoidance
Description (for nonremovable items)
streaking artifacts Increased kVp
High x-ray attenuation Thin slice thickness
Caused Highly attenuating
structures MOTION ARTIFACTS
Insufficient x-ray Patient motion
photons reaching the Caused
Effect (involuntary & voluntary)
detector Effect Misregistration artifacts
Very noise projections
By the operator:
Increase tube current
Use of positioning aids
Use of adaptive
Immobilization
Avoidance filtration
Sedation (infant)
Automatic tube current
Short scan time
modulation
Instruct patient to hold
Avoidance
UNDER SAMPLING ARTIFACTS breath
Two large an interval By built-in features:
Description Overscan & underscan
between projections
modes
Misregistration by the
Software correction
computer of information
Caused Cardiac gating
relating to sharp edges
and small objects
View aliasing (fine INCOMPLETE PROJECTION
stripes appearance) Presence of anatomy
Effect lying outside the scan
Ray aliasing (stripes Description
appearance) field produces severe
For view aliasing: artifacts
Slower rotation speed Portion of anatomy lies
Caused
Avoidance For ray aliasing: outside the field of view
Quarter-detector shift Incomplete information
Flying focal spot of the anatomy by the
Effect computer
Generation of streaking
PATIENT-BASED ARTIFACTS and shading artifacts
 Metallic materials Position patient so that
 Patient motion Avoidance no parts lying outside
 Incomplete projection the scan field
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sagittal reformats seen

with helical and
SCANNER-BASED ARTIFACTS multidetector row CT
 Ring artifacts Increased number of
section acquired per
RING ARTIFACTS rotation
Caused
Artifacts seen in third Wider collimation
Description Increase number of
generation CT scanner
Faulty detector detector rows
Caused Detector out of Artifacts similar to those
Effect
calibration caused by partial volume
Consistently erroneous Employing cone beam
Avoidance
reading at each angular reconstruction
Effect
position
Circular artifact ZEBRA ARTIFACTS
Detector calibration Periodic stripes of more
Selecting correct scan or less noise at the image
Avoidance FOV Description periphery seen on
(by using calibration coronal or sagittal
date) reformats
HELICAL AND MULTISECTION CT Caused Helical interpolation
ARTIFACTS Alternating high and low
 Cone beam effect (Helical) Effect
noise on image
 Stair-step artifacts (MSCT) Employing cone beam
Avoidance
 Zebra or windmill artifacts (MSCT) reconstruction

CONE BEAM EFFECT

The x-ray beam becomes -THE END-
Description cone-shaped rather than <There are no secrets to success. It is the result of
fan-shaped
preparation, hard work learning from failure=
Increased number of
05/29/14
section acquired per
rotation
Caused
Wider collimation
Increase number of
detector rows
Fundamental deficit in
Effect the acquired data
To acquire a more
complete data set
Avoidance
Employing cone beam
reconstruction

STAIR STEP ARTIFACTS

Description Serrations on coronal or
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DEFINITION OF TERMS MAGNETIC nearby equipment or personnel

RESONANCE IMAGING

Antenna – device used for transmitting or Gating – organizing data so that the
receiving radio waves. information use to construct the image
comes from the same point in the cycle of
Artefact – spurious findings in or distortion of
repeating motion, such as a heart beat. The
an image
moving object is frozen at that phase of its
Attenuation – reduction in energy or amount motion, reducing image blurring.
of beam of radiation when it passes through
tissue or other substance. Gauss (G) – unit of magnetic filed strength
(old unit)
Coil – single or multiple loops of wire (or
another electrical conductor such as tubing) Gradient echo – fast pulse sequence that
designed to produce a magnetic field from is often used with 3D imaging to
current flowing through the wire or to detect generate T2-weighted images
a changing magnetic field by voltage induced
in the wire.
Inversion recovery – standard pulse
sequence available on most MRI imagers,
Contrast – degree of difference between two
substances in some parameter, with the
usually used for T1- weighted images. The
parameter varying depending on the technique name indicates that the direction of
used (e.g. attenuation in radiographic longitudinal magnetization is reversing
techniques or signal strength in MRI) (inverted) before relaxation (recovery)
occurs.
Cryogenic – relating to extremely low
temperature Magnetic Resonance (MR) – process by
which certain nuclei, when placed in a
Diffusion – spontaneous random motion of magnetic field, can absorb and release energy
molecules in a medium; a natural and in the form of radio waves. This technique
continuous process. can be used for chemical analysis or for the
Echo planar imaging – fast pulse sequence production of cross sectional images of body
that can be used to create MR images within parts. Computer analysis of the radio-wave data
a few seconds. is required.
Fat-suppressed images – images in which the
fat tissue in the image is made to be lower, Noise – random contributions to the total
darker signal intensity than the surrounding signal that arise from stray external radio
structure. waves or imperfect electronic apparatus or
Frequency – number of times that a process other interference. Noise cannot be
repeats itself in a given period (e.g. the eliminated, but can be minimized; it tends to
frequency of radio waves is the number of degrade the images by interfering with accurate
complete waves per second) measurement of the true MRI signal, similar to
Fringe field – portion of the magnetic field the difficulty in maintaining a clear
extending away from the confines of the magnet conversation in a noisy room.
that
cannot be used for imaging but can affect Nuclear Magnetic Resonance (NMR) –
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another name for magnetic resonance; this Rapid Acquisition Recalled Echo –
term is not commonly used. commonly known as Fast or Turbo, Spine
Echo; a fast pulse sequence used to create spin
Nucleus – central portion of an atom, echo – like T2 weighted images rapidly.
composed of protons and neutrons Raw data – information obtained by radio
Paramagnetic – referring to material that reception of the MRI signals as stored by a
alter the magnetic field or nearby nuclei. computer. Specific computer manipulation of
Paramagnetic substance are not themselves these data is required to construct an image
directly imaged by MRI but instead change from them.
of signal intensity of the tissues where they Relaxation – return of excited nuclei to
localize, acting as MRI contrast agents. their normal, unexcited state by the
Paramagnetic agents shorten the T1 and T2 release of energy. Relaxation time –
of the tissues they affect, actions that tend measure of rate at which nuclei, after
to have opposing effects on signal stimulation, release their extra energy
intensity. In clinical practice, agent are Resistive magnet – simple
administered in a concentration in which electromagnet in which electricity
either T1 or T2 shortening predominates passing through coils of wire produces
(usually the former) to provide high signal a magnetic field
on T1 weighted images. Resonance – process of energy
Perfusion – flow of blood through the vessels absorption by an object that is turned to
of an organ or anatomic structure: usually absorb energy of a specific frequency only.
refers to blood flow in the small vessels (e.g. All other frequencies would not affect the
capillary perfusion). object (e.g. if one tuning forks is struck in a
Permanent magnet – object that room full of tuning forks, only the forks
produces a magnetic field without tuned to that identical frequency would
requiring an external electricity supply vibrate(resonate).
Precession – rotation of an object around the Signal – in MRI, induction of current
direction of force acting on that object. into a receiver coil by processing
Proton density – measure of proton (i.e. magnetization.
hydrogen, because its nucleus is single proton) Slice – cross sectional image; can also refer to
concentration (number of nuclei per given the thin section of the body from which data
volume); one of the major determinants of are required to produce the image.
MRI signal strength in hydrogen imaging. Spectroscopy – science of analysing the
Pulse sequence – series of radio waves pulses components of an electromagnetic wave,
designed to excite nuclei in such a way that usually after its interaction with some
their energy release has varying contributions substance (to obtain information about that
from proton density, T1 or T2 processes. substance).
Radiofrequency (RF) pulse – a short Spin Echo – standard MRI pulse sequence
burst of radio waves. If the radio waves that can provide T1 weighted, T2 weighted
are of appropriate frequency, they can give or proton density weighted images. The name
energy to nuclei that are within a magnetic indicates that a declining MRI signal is
field by the process of magnetic resonance. refocused to gain strength (similar to an echo)
Length of the pulse determines amount of before it is recorded as raw data
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Spin-Lattice relaxation – release of energy by one of the major determinants of MRI signal
excited nuclei to their general environment, strength
. T1 is a rate constant measuring spin-lattice relaxation.
Spin-Spin relaxation – release of energy by excited
nuclei as a result of interaction among themselves; one
of the major determinants of MRI signal strength. T2 is a
rate constant measuring spin-spin relaxation.
Superconductive magnet – material that has a greater
effect with a magnetic field; it can dramatically decrease
T2 of tissues, causing a total loss of signal by the
absorbing structure.

T1 – rate constant measuring spin-lattice relaxation

T2 – rate constant measuring spin-spin relaxation

Tesla (T) – unit of magnetic field strength; (SI unit) 1 tesla

equals 10,000 gauss or 10 kilogauss (other unit f magnetic
field strength). The earth’s magnetic field approximates 0.5
gauss.

Transverse plane – plane that extends across the axis of

the body from side to side, diving the body part into upper
and lower portions.

HISTORICAL DEVELOPMENT

1940’s – Bloch and Purcell first

discovered the properties of
magnetic resonance. 1952 –

Bloch and Purcell awarded the

Nobel Prize in Physics.
(Spectroscopy)

1973 – Lauterbur published the first cross

sectional images objects obtained with MRI
technique.

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DEFINITION MRI
 Provides sectional images
MAGNETIC RESONANCE IMAGING  No superimposition of structures
 A computer-based cross-sectional imaging
 Clearly demonstrates structures even
modality
without contrast media
 The use of magnetic field and radio waves to
 Can resolved relatively small contrast
obtain a mathematically reconstructed image
differences among tissue
 Originally called: Nuclear Magnetic
 Contrast depends on the interaction of
Resonance
matter with electromagnetic forces

ADVANTAGES OF MRI
CONVENTIONAL
 Best low contrast resolution
 Provides <flat= image
o Main advantage
 Structures are superimposed
o Rationale:
 X-ray attenuation coefficient  Contrast media is required to clearly
in soft tissue – differ by <1% distinguished one anatomic structure or
organ from one another
(in same tissue)
 Spin density & T1 – differ by  Limited in its ability to distinguish types of
20-30% (in same tissue) tissue
 T2 – differ by 40% (in same  Cannot detect small attenuation changes
tissue)  Can only distinguish air, fat, bone, soft
 No ionizing radiation tissue, and metal
 Direct multiplanar imaging  Contrast depends on differences of x-ray
 No bone or air artifact attenuation
 Direct flow measurements
BRIEF HISTORY
 Totally noninvasive
 Contrast media not required
1940’s
 Felix Bloch and Edward Purcell first
MRI CONTRAINDICATION
discovered the properties of magnetic
 Cardiac pacemaker
resonance
 Aneurysm clips
 MRI spectroscopy: technique they used for
 Claustrophobia
analysis of complex molecular structures
 Metallic fragments in the eye and dynamic chemical processes
 Cochlear implants 1952
 Internal drug infusion pumps  Bloch and Purcell shared a Nobel Prize in
 Neurostimulators Physics
 Bone growth stimulators 1971
 Raymond Damadian showed that the
MRI VS CONVENTIONAL RADIOGRAPHY relaxation time of water in a tumor differed

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from the relaxation time of water in normal tissue DIFFUSION

 Investigated excised rat tissue  Spontaneous random motion of molecules in
 He reported that there were significant a medium
differences between normal rat tissues and
tumors FAT SUPPRESSED IMAGES
1973  Fat tissue in the image is made to be of a
 Paul Lauterbur published the first cross- lower, darker signal intensity
sectional image of objects (two water-filled
capillary tubes) obtained with MRI FREE INDUCTION DECAY
technique  Signal emitted by tissue after RF excitation
1975
 Damadian obtained the first animal images GATING
1970s  Technique used in reducing motion artifacts
 MRI was progressing rapidly
1978 GRADIENT ECHO
 The first human head scans were obtained  Fast pulse sequence
 Followed by first human body scans  Often used with 3D imaging to generate T2-
weighted images
INDOMITABLE
 Original name of the first MRI machine GRADIENT MAGNETIC FIELD
 A change in the intensity of a magnetic field
DEFINITION OF TERMS in space
ANTENNA  Unit: mT/cm
 Device for transmitting or receiving radio
wave GYROMAGNETIC RATIO
ARTIFACTS  A constant, specific ratio for each nucleus
 Spurious finding in or distortion of an image  Half-life in MRI
ATTENUATION  Unit: MHz/T
 Reduction in energy or amount of a beam of  Hydrogen: 43 MHz/T
radiation when it passes through tissue or o Most abundant element in the body
other substances (60%)
COIL
 Single or multiple loops of wire designed to INVERSE RECOVERY
produce a magnetic field from current  Standard pulse sequence available in most
flowing through the wire MRI imagers
CLAUSTROPHOBIA  Used for T1-weighted images
 The fear of having no escape and being in
closed or small spaces or rooms LARMOR FREQUENCY
CRYOGENIC
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 The frequency at which a nucleus precesses  Returning to equilibrium

in the magnetic field
 Unit: MHz RELAXATION TIME
 The time required for return
MAGNETIC MOMENT
 A force created when magnetic dipole is in a RESONANCE
magnetic field  Transfer of vibrating energy from one
 The inherent magnetism system to another
 Unit: T

SPECIFIC ABSORPTION RATE (SAR)

MAGNETIZATION  The power absorbed during RF irradiation
 The large-scale macroscopic magnetic  Unit: W/kg
moment resulting from many nuclear
magnetic moments SPIN DENSITY (SD)
 Concentration of hydrogen nuclei in tissue
NET MAGNETIZATION  Principal determinants of MRI signal
 Magnetic moments of individual hydrogen
nuclei aligned in the external magnetic field T1 RELAXATION TIME
 Spin-lattice relaxation time
PERFUSION  Longitudinal relaxation time
 Flow of blood through vessels of an organ or  Decrease in signal: 63% of maximum value
anatomic structure
T2 RELAXATION TIME
PRECESSION  Spin-spin relaxation time
 The wobble of the rotational axis of a  Transverse relaxation time
spinning body about a stationary axis  Decrease in signal: 37% of maximum value
 Describes a cone
 Rate of precision: increases as MF strength TESLA
increase  SI unit of magnetic field strength
 1T = 10,000 G
RADIO FREQUENCY (RF)
 Electromagnetic radiation having a PHYSICAL PRINCIPLES
frequencies from 0.3kHz to 300 GHz
 RF range in MRI: 1-100 MHz SIGNAL PRODUCTION
 MRI depends on the properties of the
RAW DATA nucleus
 Information obtained by radio reception of  Hydrogen nuclei: element used in most
the MRI signal as stored by a computer MRI
o Rationale:
RELAXATION
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 Strongest nuclear magnets FAST SPIN-ECHO

 Create the strongest MRI  Known as rapid acquisition recalled echo
signal
 Most common element in the FLUID ATTENUATED INVERSION
body RECOVER (FLAIR)
 Suppresses signal from cerebrospinal fluid
PULSE SEQUENCES (CSF)
 Most applicable in the brain
SPIN ECHO SEQUENCE o For seizures disorders
 Classic imaging sequences o For spinal cord injuries
 Most widely use pulse suquence SHORT TAU INVERSION RECOVERY
 Used with timing parameters to yield T1-  Suppresses signal from fat
weighted images
 Also provide pro ton-density weighted FAST SPIN-LATTICE RELAXATION RATE
images  Short T1
 Time consuming  Produces high MRI signal in T1-weighted
 Slow patient <throughput= or productivity images

INVERSE RECOVERY SLOW SPIN-SPIN RELAXATION RATE

 A sequence that accentuates T1 information  Long T2
 Time consuming  Produces high MRI signal in T2-
 Slow patient <throughput= or productivity weighted images

FAT SAT FUNDAMENTAL CONCEPTS

 Pulse sequence used to saturate fat
3 PRINCIPAL INDEPENDENT
FAT SUPPRESSED IMAGES PARAMETERS
 Used to minimize the high signal intensity  Spin density
from fat tissue overwhelming small signal  T1
intensity in the tissue of interest  T2

GRADIENT ECHO FUNDAMENTAL PARTICLES

 Oldest imaging sequence CHARACTERISTICS
 Most common type of faster imaging  Charge
sequence  Spin

FAST GRADIENT ECHO CLASSIC MECHANICS

 Fast gradient imaging technique  Describes the motion of large object
 Good wherever there is turbulent flow
QUANTUM MECHANICS

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 Describes the motion of atoms and their PROPERTIES THAT INLUENCES IMAGE
constituents APPEARANCE
 Nuclear/spin density
MAGNETIC DIPOLE  Relaxation times – T1 and T2
 Small magnet created by the electron orbit  Flow phenomena

LARMOR EQUATION SPIN DENSITY

 Formula: ω = γBo  An indication of hydrogen concentration
o ω = Larmor frequency or frequency  Strength of signal is proportional to the
of precession (MHz) number of nuclei
o γ = gyromagnetic ration (MHz/T)
 constant value
o Bo = strength of external MF (T) T1 RELAXATION TIME
 Spins begin to precess at smaller and smaller
RESULTS OF RF ENERGY ABSORPTION BY angle (out of plane)
NUCLEI
 The return of net magnetization along the Z
 Nuclei will turn upside down or flip axis to its normal equilibrium state
(energized or excited)  A characteristic of tissue itself
 Nuclei are caused to precess in phase
T2 RELAXATION TIME
EQUILIBRIUM MAGNETIZATION VECTOR  Spins begin to precess out of phase with
(M0) each other
 Amplitude of the net magnetization vector at  Exponential loss of signal caused by
equilibrium dephasing in the XY plane
 Factors that determine the amplitude:  Always less than or equal to T1 relaxation
o Spin density time
o Gyromagnetic ratio
o Strength of the external magnetic
T1-WEIGHTED IMAGES (T1W)
field
 Useful for showing anatomical detail
 Larger M0:
o More intense MRI signal
o Brighter MR image T2-WEIGHTED IMAGES (T2W)
 Useful for showing pathology
FOURIER TRANSFORM
 Used to generate the spectrum of free FLOW PHENOMENA
induction decay (NMR spectrum)  Weak MRI signals: moving substances
 Essential to most imaging techniques (e.g. blood)
 High MRI signals: stagnant (immobile)
NMR PARAMETERS blood (blood clot)
o Short T1 and long T2

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IMAGING PRINCIPLES o Magnetic tape or optical disk

 For permanent storage and retrieval
GRADIENT MAGNETIC FIELD
 A magnetic field that changes in strength in MRI GANTRY
a given direction  Contains magnets, shim coils, gradient coils
 The only difference between NMR and RF transceiver coils
spectrometer and MR imager  Power supply:
 Functions: o High current power for magnet
o Used to localized MRI signal o Precision power for secondary coils
o Used for slice selection
o Used for encoding the location of CT GANTRY
MRI signal  Contains x-ray tube and detectors
 Power supply: high voltage generator
GRADIENT COILS IMAGING MAGNETS
 Current-carrying coils designed to produce a
desired gradient magnetic field MAGNET
BACK PROJECTION RECONSTRUCTION  Major component of MRI system
 The earliest and easiest to understand
THREE GROUPS
2D FOURIER TRANSFORMATION  Permanent
 Recently used technique  Resistive
 Requires a rigorous mathematical  Superconducting
development
PERMANENT MAGNET
MR EQUIPMENT AND IMAGES  The simplest in design and least expensive
to operate
OPERATING CONSOLE  Material: bricklike ceramics
 Used to control the computer o Inexpensive
 Laser or multiimage camera: used to print o Easy to magnetize
the image o Light weight
 Advantages:
COMPUTER ROOM o Low capital cost
 Houses the electronics o Low operating cost
o For transmitting the radiowave pulse o Negligible fringe file
sequences  Disadvantages:
o For receiving and analyzing the o Limited field strength (0.3 T)
MRI signal o Fixed field strength
 Storage of raw data/computer- o Very heavy
constructed images:
RESISTIVE MAGNET (0.15 T)
o Computer disk
 For temporary storage  Magnets have finite resistance

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o Rationale: conductor used in coils is SHIM COILS

not a perfect conductor  30 individual windings
 Can be turned off but requires continuous  For improving the homogeneity of the main
power and water cooling magnetic field
 Uses 4 large coils  Prevent degradation of image quality
 Advantages:  Shimming the magnet: the process
o Low capital cost
o Easy coil maintenance GRADIENT COILS
o Negligible fringe field  Produces gradient magnetic field
 Disadvantages:  3 coils:
o High power consumption o Z gradient coils – for transaxial slice
o Water cooling required o X gradient coils – for coronal slice
o Significant fringe field o Y gradient coils – for sagittal slice
SUPERCONDUCTING MAGNET
 Frequency-encoding gradient: X gradient
 A magnet containing coils made from a
 Phase-encoding gradient: Y gradient
superconducting metal alloy
 Requires no continuous power source but
RF COILS/PROBE
more difficult to maintain
 Transceiver coils
 No electrical resistance
 Used for transmitting RF signals and/or
 Dewar: a double-walled flask of metal with receiving MR signal
vacuum between the walls
 RF probe/Probe Assembly:
 Uses cryogens: o A rigid unit consisting of antenna col
o Cooling agents and support material (plastic, fiber
o Used to optimized superconductivity glass, insulators)
o Liquid nitrogen
o Functions:
 97 K
 Maintain the coil in its
 Filled in outermost chamber
intended shape
o Liquid helium
 Protect the coil from damage
 47 K
o Location:
 Filled in innermost chamber
 Inside the gradient coils
 Advantages:  Closest to the patient
o High field strength (2 T)
o High field homogeinity
COILS
o Lower power consumption
 Disadvantages:
RF COILS
o High capital cost
o High cryogen cost  Antenna of the MRI system
o Intense fringe field
SURFACE COILS
SECONDARY COILS  Simplest design of coil
 Applications: spines, shoulders, TMJs,
small body parts
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 Endocavitary Coil:  Polyvinyl chloride (PVC): structural

o Used for imaging the rectum concrete slab or walls
o Used for imaging the wall of the  Lighting: should be direct current
cavity
 Neurovascular Coil: FARADAY CAGE/RF SHIELD
o Used for imaging the brain and neck  A wire-mesh shield enclosing the MR
imager
PAIRED SADDLE COIL  Used to attenuate extraneous sources of RF
 Commonly used for knee imaging
 Used for X and Y gradient coils FRINGE MAGNETIC FIELD
 Magnetic field outside the patient aperture
 Must be considered in the design of MRI
facility
HELMHOLTZ PAIR COIL  Problems in fringe MF:
 Consists of two circular coils parallel to o Can interfere with the proper
each other operation of mechanical and
 Used for Z gradient coils electronic equipment
 Used as RF coils for pelvis and cervical o Any large mass of ferromagnetic
imaging material can distort the homogeneity
of the imaging volume by interacting
BIRD CAGE COIL with fringe MF
 Provides best RF homogeneity of all the RF  Takenote: distortion of fringe MF by a
coils ferromagnetic object will cause a
 Commonly used as transceiver coil for head compensating distortion of the imaging
imaging volume
 Occasionally used for extremity imaging
MR IMAGES
FACILITY DESIGN
FACTORS INFLUENCING SPATIAL
EXAMINATION ROOM DESIGN RESOLUTION
 Room must be shielded against Factors
Effect in Spatial
o Radio interference Resolution
Increase slice thickness Low
o Fringe magnetic fields
Decrease slice thickness High
 Only nonmagnetic materials are used for
Increase data collection High
the structure and finish
Decrease data collection Low
 Must have electric filters Increase MRI signal
o Rationale: to remove interfering High
acquisition
frequencies Decrease MRI signal
Low
 Plumbing: should be PVC or copper acquisition
Increase MRI signal
High
strength

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Decrease MRI signal o Rationale: to minimize the

Low
strength unsharpness caused by involuntary
and voluntary motion
SLICE THICKNESS
 Important in visualization of pathology BIOLOGICAL HAZARDS
 Large slice thickness:
o Provide less grainy images MRI MAGNETIC FIELDS
o Can’t visualize small pathologic  Exhibit threshold dose-response relationship
lesions
 Small slice thickness: THREE PHYSICAL FIELDS THAT MIGHT
o Provide more grainy images SUSPECT OF PRODUCING BIOLOGICAL
o Can visualize small pathologic lesion RESPONSE
1.) Strong static magnetic field (B0)
 Unit: Tesla (T)
CONTRAST RESOLUTION  Affects:
 Low contrast resolution structures o Membrane permeability
 Most tissues: <1% difference o Enzymes kinetics
 MR parameters and biologic tissues: o Nerve conduction
>30% difference 2.) Time-varying gradient magnetic field (B1)
 Gray and white matter: 30-40% difference  Unit: Tesla/second (T/s)
 Null regions: total loss of contrast  Affects:
o Rationale: improper RF pulse o Visual phosphenes
selection o Bone healing
o Cardiac fibrillation
APPEARANCE OF NORMAL TISSUES 3.) RF emission
SPIN  Unit: Watts/kilogram (W/kg)
TISSUES T1 T2  Causes tissue heating
DENSITY
Fat and
High/white Short/white Long/white  Heat: the principal result of the interaction
skin between RF field and tissue
Very Very
Bone Low/black  Heating: expressed as specific absorption
long/black long/black
White rate (SAR)
High/white Short/white Long/gray o Unit: W/kg
matter
Gray
High/white Long/gray Long/gray
matter MAXIMUM PERMISSIBLE DOSE (MPD)
CSF
Very Very Very  Not correct for MRI
high/white long/gray long/black
PHYSICAL HAZARDS
EXAMINATION TIME
 Keep as short as possible STRONG MAGNETIC FIELDS
 Physical Precautions:

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o Avoid any objects made from metal GATING

or iron inside the examination room  Technique used to organize the signal
o Patient must be free from metallic  Technique used for improving image quality
objects even internally
 Used to reduce motion artifacts from the
o Warnings signs are necessary
beating heart
 The moving object is <frozen= at that phase
QUENCHING
of its motion, reducing image blurring
 The events that occur when the liquid
cryogens that cool the magnet coils boil off
ARTIFACTS
rapidly
 Caused:
IMAGE ARTIFACT
o Activation of the magnet STOP
 A structure not normally present but visible
button
as a result of a limitation or malfunction in the
o A fault in the magnet itself
hardware or software of MRI device
 Results
o Helium escaping very rapidly from
the cryogen bath
o A loud bang or thundering or hissing MAGIC ANGLE ARTIFACT
or rushing sound with the cold gas Increase of the T2 time;
Description
bright signal in tendons
expulsion
Angle about 55o to the
o Patient asphyxiation and frostbite Cause
main magnetic field
 If quench does occur: Solution Angle not about 55o
o RT should evacuate immediately
o It takes 72 hrs to ramp magnet up to PARTIAL VOLUME ARTIFACT
full magnetic potential Loss of contrast between
Description
two adjacent tissues
CONTRAST MEDIA Cause Insufficient resolution
 Gadolinium-containing compounds Solution Thinner slices
 Gadolinium: a metal with paramagnetic
effect METAL ARTIFACT
o Lower toxicity Magnetic susceptibility
Same as
o Few side effects and clip artifact
 Teslascan: a new manganese-based Description
Signal dropouts; bright
paramagnetic liver contrast agent spots; spatial distortion
Cause Field inhomogeneity
o Used in detection, characterization,
Remove the metal; don’t
localization and evaluation of lesions
take a gradient echo
in the liver Solution
sequence; take a short
 Feridex: an iron oxide mixture and the only echo time
supramagnetic contrast agents available
o Used to detect and diagnose liver MOTION ARTIFACT
lesions Same as Phase encoded motion;
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phase effect; instability;

smearing artifacts ALIASING ARTIFACT
Description Blurring and ghosting Backfolding, phase
Movement of the Same as wrapping & wrap
Cause imaged object around artifacts
Compensation Description Image wrap around
Solution techniques; more Anatomy extends out of
averages; antispasmodic Cause the FOV within the
plane of the image
HERRINGBONE ARTIFACT Large FOV;
RF noise; Interference; Solution oversampling; foldover
Same as suppression
crisscross
Description Static on the image
Electromagnetic ZEBRA STRIPES ARTIFACT
Cause emissions Same as Zero fill artifact
Shielding; eliminate the Zebra stripes or other
Solution Description
factor of disturbance anomalies
Cause Signal changes
RF OVERFLOW/DATA CLIPPING Surface coil; change the
Solution
ARTIFACT sequence
Description Image non-uniform
Cause Signal too intense
ZIPPER ARTIFACT
Manually decrease of
Solution Same as Star artifact
the receiver gain
Bands through image
Description center
SHADY ARTIFACT Hardware or software
Cause problems
Localized
Description inhomogeneous Large FOV;
Solution
brightness oversampling
Cause Various causes
Check correct STAIRCASE ARTIFACT
Solution positioning; call the -
Description Staircase like nuance
service < Slices too thick; no
CauseT
overlapping
SLICE OVERLAP ARTIFACT h
Solution Overlapping slices
Description Slice overlap e
Cause Loss of signal
r
Solution Saturation
e

a
r
e

n
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Ed ©
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x-ray beam, preventing exposure of normal

RADTHERAPY DOF tissue

ABSORBED DOSE – amount of ionizing CHROMOSOME – unit of genetic

radiation absorbed per unit mass of irradiated information that guides cytoplasmic
material. activities of the cell and transmits hereditary
information
ACCELERATOR (particle) – device that
accelerates charged subatomic particles to COBALT 60 – radioisotope with the half-
great energies. These particles or rays may life of 5.26 years, average gamma ray
be used for direct medical irradiation and energy of 1.25 MeV (range 1.17 to 1.33
basic physical research. Medical units MeV) and ability to spare skin with build up
include LINAC, Betatrons and Cyclotrons. depth in tissue of 0.5 cm.

ASYMMETRIC JAWS – four independent COLLIMATOR – diaphragm or system of

x-rays collimators that are used to define diaphragm made of radiation absorbing
radiation treatment field. material that defines dimension and
ATTENUATION – removal of energy from direction of beam.
a beam of ionizing radiation when it traverses
matter, accomplished by disposition of CONFORMAL RADIATION – treatment
energy in matter and by deflection of energy designed to deliver radiation to the exact
out of the beam target volume as seen on any plane (e.g.
transverse, sagittal, vertex view) requires a
BETATRON – electron accelerator that three dimensional treatment planning system.
uses magnetic induction to accelerate
electrons in circular path; also capable of CONTOUR – reproduction of an external
producing photons. body shape, typically in the transverse plane
at the level in the central axis of the beam
BIOPSY – removal of a small piece of tissue
for examination under the microscope. CURE – usually a 5 year period after
completion of treatment during which time
BRACHYTHERAPY – placement of the patient exhibits no evidence of disease
radioactive nuclide or nuclides in or on
neoplasm to deliver a cancericidal dose DECAY or DISINTEGRATION –
transformation of radioactive nucleus,
CANCER – term commonly applied to
malignant disease; abnormal growth cells. resulting in emission of radiation

CANCERICIDAL DOSE – dose of DIFFERENTIATION – acquisition of

radiation that results in the death of cancer cellular function and structure that differs
cells
from function and structure of original cell
CARCINOGEN – any cancer producing type.
substance or material such as nicotine,
radiation, or ingested uranium. DIRECT EFFECT – radiation that
CARCINOMA – cancer that arises from interacts with an organic molecule such as
epithelial tissue, either glandular or squamous DNA, RNA or a protein molecule. This
epithelium. interaction may inactive the cell.
CERROBEND BLOCK – beam shaping DOSIMETRY – measurement of radiation
device made of lead alloy that attenuates the
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Ed ©
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dose in an absorbing medium. BRACHYTHERAPY– use of a high activity

radionuclide placed within the body for the
ETIOLOGY – study of causes of diseases treatment of cancer. Delivers more than 1200
cGy per hour.
EXTERNAL BEAM TREATMENT –
delivery of radiation to a patient from a unit IMAGE GUIDED RADIATION
such as linear accelerator in which the THERAPY (IGRT) – use of images to
radiation enters the patient from the external verify treatment isocenter, target and
surface of the body patient positioning before initial radiation
FIELD – geometric area defined by treatment
collimator or radiotherapy unit at skin IONIZATION – process in which one or
surface. more electrons are added to or removed from
atoms, creating ions; can be cause by high
FRACTIONATION – division of temperatures, electrical discharges or nuclear
total planned dose into numerous radiation.
smaller doses to be given over a
longer period. IONIZING RADIATION – energy emitted
and transferred through matter that results in
GAMMA RAY – electromagnetic the removal of orbital electrons.
radiation that originates from
radioactive nucleus and causes INTENSITY MODULATED
ionization in matter GRAY (Gy) – RADIATION THERAPY (IMRT) –
international unit for the quantity of modification of beam intensity to deliver
radiation received by the patient. 1 non-uniform exposure across radiation field.
cGy = 1 rad
ISOCENTRIC - referring to rotation around
GRENZ RAY – x-ray generated at a fixed point.
20 kVp or less
ISODOSE LINE CURVE – curve or line
HALF-LIFE – time required for radioactive drawn to connect points of identical amounts
of radiation in a given field.
HALF VALUE LAYER – thickness of ISOTOPE – atoms that have the same
attenuating material inserted in beam to atomic number but different mass number.
reduce beam intensity to half of the original
intensity LESION – morbid change in tissue; mass of
abnormal cells.
HIGH DOSE RATE
material to decay to half its initial activity.

LINEAR ACCELERATOR (LINAC) – device for accelerating charged particles such as electrons,
to produce high energy electron or photon beams.

LINEAR ENERGY TRANSFER (LET) - rate at which energy is deposited as it travels through
matter.

LOW DOSE RATE BRACHYTHERAPY – use of a low-activity radionuclide placed within the
body for treatment of cancer. Dose is slowly delivered, 40 to 500 cGy per hour, to a small volume of
tissue over a period of days.
Prepared by: RC CARREON, RRT, MA
Ed ©
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MALIGNANCY – cancerous tumor or lesion.

MEDICAL DOSIMETRIST – person responsible for calculation of proper radiation treatment dose
that assist the radiation oncologist in designing individual treatment plans

MEDICAL PHYSICIST – specialist in the study of law of ionizing radiation and their interactions
with matter

METASTASIS – transmission of cells or group of cells from primary tumor to sites elsewhere in
body.

MULTILEAF COLLIMATOR (MLC) - individual collimator rods within the treatment head of the
linear accelerator that can slide inward to shape radiation field
ONCOLOGIST – physician specializing in the study of tumors.
ONCOLOGY – study of tumors
PALLIATION – to relieve symptoms; not for cure

PATHOLOGIST – specialist in the study of the microscopic nature of disease

.
PATHOLOGY – study of nature of diseases.
PROPYLACTIC SURGERY – preventive surgical treatment

RADIATION ONCOLOGIST – physician specializing in use of ionizing radiation in treatment of

disease

RADIATION ONCOLOGY – medical specialty involving the treatment of cancerous lesion using
ionizing radiation

RADIATION THERAPIST – person trained to assist and take directions from the radiation
oncologist in the use of ionizing radiation for treatment of disease.

RADIATION THERAPY – older term used to define medical specialty of treatment with ionizing
radiation.
RADIOACTIVE – pertaining to atoms of elements that undergo spontaneous transformation,
resulting in emission of radiation.
RADIOCURABLE – susceptibility of neoplastic cells to cure (destruction) by ionizing radiation
RADIOSENSITIVITY – responsiveness of cells to radiation
RADIUM (Ra) – radionuclide used clinically for radiation therapy. Atomic number 88, half-life
1622 years.
REACTOR – cubicle in which isotopes are artificially produced.

RELATIVE BIOLOGIC EFFECTIVENESS (RBE) – compares radiation beam with different

LETs and their ability to produce a specific biologic response.

SIMULATOR – diagnostic x-ray machine that has the same geometric and physical characteristic as
radiation therapy treatment unit.

SKIN SPARING – in megavoltage beam therapy, reduced skin injury per centi-gray (cGy) exposure
SUMMARIZED BY: MINZHU YAP,
RXT, RRT
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because electron equilibrium occurs below skin; occurs ¼ to 2 inches deep, depending on energy.

STEREOTACTIC RADIATION THERAPY (SRT) – use of small focused radiation beams to

treat small extracranial or intracranial lesion; delivered with conventional fractionation or in 2 to 5
treatments instead of single treatment as in stereotactic radiosurgery. Rigid immobilization of
patient is required.

STEREOTACTIC RADIOSURGERY – use of multiple, narrow, highly focused radiation beams

to deliver a large dose in a single treatment to a small intracranial lesion. The patient is immobilized
with a fixed stereotactic head frame.

SURGICAL BED – area of excision and adjacent tissue manipulated during surgery.
SYSTEMIC – throughout the human body
TELETHERAPHY – radiation therapy technique for which source of radiation is at some distance
from patient.
TREATMENT FIELD – anatomic area outlined for treatment (e.g. AP or RL pelvis)
TUMOR/TARGET VOLUME – portion of anatomy that includes tumor or adjacent areas of
invasion.
UNDIFFERENTIATION – lack of resemblance of cells to cells of origin.

WEDGE FILTER – wedge shaped beam attenuating device used to absorb beam preferentially to
alter the shape of isodose curve.

SUMMARIZED BY: MINZHU YAP,

RXT, RRT
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SUMMARIZED BY: MINZHU YAP,

RXT, RRT
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Radiation Therapy/ Radiation Oncology

-medical use of ionizing radiation as part of cancer treatment
-treatment of malignant cancer and may be used as the primary therapy or common to combine
with
surgery, chemotherapy, hormone therapy or three.
- To kill a malignant tumor or to render them permanently incapable of further cell division.

RADIATION ONCOLOGY TEAM

1. Radiation Oncologist – Doctor of medicine specializing in use of ionizing radiation in

the treatment of disease.
- Makes most of the decision regarding the cancer patient’s treatment.
- Prescribes the quantity of radiation and determines the anatomic regions to
be treated
2. Medical Physicist – responsible for calibration and maintenance of the radiation-producing
equipment.
- Advises the physician about dosage calculations and complex treatment
techniques.
3. Medical Dosimetrist – devises a plan for delivering the treatments in a manner to best meet the
physician’s goals of irradiating the tumor while protecting vital normal structures.
4. Radiation Therapist – Responsible for obtaining radiographs or CT scans that localize the area
to be treated, administering the treatments, keeping accurate records of the dose delivered each
day, and monitoring the patient’s physical well-being.
 Educating Patients about potential radiation side effects and assisting patients with the
management of these side effects are often the responsibilities of the Oncology Nurse.

TYPES OF TREATMENT INTENT

1. CURATIVE TREATMENT
a. Adjuvant – (Additive) given to destroy left-over microscopic cells that
may be present after the known tumor is removed by surgery.
 Is given to prevent a possible cancer reoccurrence.
b. Neo Adjuvant – (primary) given prior to the surgical procedure.
 may be given to attempt to shrink the cancer so that the
surgical procedure may not need to be as extensive.
2. PROPHYLACTIC TREATMENT – (Preventive) to shrink any cancerous tumors and/or
stop the cancer from growing and spreading.
3. PALLIATIVE TREATMENT – may be used to relieve symptoms caused by the
cancer at an advance stage, extends the quality of life of the patient.

TYPES OF CANCER TREATMENT

1. SURGERY – used for small tumors.

2. CHEMOTHERAPY – uses drug. Prevents cancer cell production.
3. BIOLOGIC THERAPY – immunotherapy
4. HORMONE THERAPY – prevent of release of hormones consumed by cancer cells.
5. HYPERTHERMIA – least used
6. RADIATION THERAPY –

SUMMARIZED BY: MINZHU YAP,

RXT, RRT
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FACTORS FOR TREATMENT

1. TUMOR TYPE
2. TUMOR LOCATION
3. STAGE
4. GENERAL HEALTH OF THE PATIENT

CANCER – a malignant tumor that expands by invasion or systemically by metastasis.

- A disease process that involves an unregulated, uncontrolled replication of cells.

METASTASIS – spread of cancer from primary tumor to sites elsewhere in the body.

THREE PATHWAYS OF MALIGNANT NEOPLASM

1. SEEDING - The spread of a malignancy into body cavities can occur via penetrating the surface
of the peritoneal, pleural, pericardial, or subarachnoid spaces.
2. LYMPHATIC SPREAD - Lymphatic spread allows the transport of tumor cells to lymph nodes
and ultimately, to other parts of the body. This is the most common route of metastasis
for carcinomas.
3. HEMATOGENOUS SPREAD - This is typical route of metastasis for sarcomas, but it is also
the favored route for certain types of carcinoma, such as those originating in the kidney (renal
cell carcinoma). Because of their thinner walls, veins are more frequently invaded than are
arteries, and metastasis tends to follow the pattern of venous flow.

REMISSION - Stage or period of absence of cancer.

TYPES OF REMISSION
1. COMPLETE REMISSION – all signs and symptoms of Ca are gone.
2. PARTIAL REMISSION – the malignant tumor shrunk, but does not disappear.

 CURED – FREE OF SIGNS AND SYMPTOMS FOR FIVE (5) YEARS.

 SECOND PRIMARY CANCER – PATIENT IS DIAGNOSED WITH NEW CANCER THAT’S
COMPLETELY UNRELATED WITH THE PREVIOUS CANCER.

RECURRENCE - return of cancer after treatment and after a period of time during which
the cancer cannot be detected.

TYPES OF RECURRENCE
1. LOCAL – Ca returns at the original site.
2. REGIONAL - Ca returns at a lymph node or tissue located near the previous Ca.
3. DISTANT – at a farther site.

3 MAJOR SUBTYPES OF CANCER

1. CARCINOMA – originating from epithelial tissue.

2. SARCOMA – originating from connective tissue.
3. LYPHOMA – involves blood forming tissue.

SUMMARIZED BY: MINZHU YAP,

RXT, RRT
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CANCER RISK FACTORS

1. EXTERNAL
 EXPOSURE TO CHEMICALS
 VIRUSES
 IONIZING RADIATION
2. INTERNAL
 HORMONES
 GENETIC MUTATTION
 DISORDERS OF THE IMMUNE SYSTEM

GENERAL CANCER SYMPTOMS

 UNEXPECTED WEIGHT LOSS – about 10 lbs.
 FEVER
 FATIGUE
 PAIN
 SKIN CHANGES
 CHANGE IN BOWEL/BLADDER FUNCTION
 UNHEALING SORE

BIOPSY - medical removal of tissue from living subject to determine presence or extent of
disease.

TYPES OF BIOPSY
1. SURGICAL – a surgical procedure done at the o.r.
2. EXCISIONAL – entire lump removed
3. INCISIONAL – small sample tissue
4. FINE NEEDLE ASPIRATION – sample fluid
5. CORE NEEDLE – small solid sample

CLASSIFICATION OF TUMOR
 GRADING
 STAGING
 TNM
SYSTEM T
– tumor
N – has spread to NODES
M – meT1Ntastasis, has spread to other organs.

CLASSIFICATI DESCRIPTION OF TUMOR

ON
STAGE 0,
Occult lesion; no evidence clinically
T0N0M0
STAGE I, Small lesion confined to organ of origin with no evidence of vascular or lymphatic
T1N0M0 spread or metastasis
STAGE II, Tumor of less than 5cm. invading surrounding tissue and first-station lymph nodes
T2N1M0 but no evidence of metastasis
STAGE III, Extensive lesion greater than 5cm. with fixation to deeper structure and with bone
T3N2M0 and lymph invasion but no evidence of metastasis
STAGE IV,
More extensive lesion than above or with distant metastasis.
T4N3M1
SUMMARIZED BY: MINZHU YAP,
RXT, RRT
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MAGNETIC RESONANCE IMAGING

TUMOR LOCALIZATION SIMULATION

STEP 1. PATIENT IMMOBILIZATION

STEP 2. TUMOR TARGET VOLUME CENTER (ISOCENTRIC
DEFINITION) STEP 3. COMPUTE PLANNING AND
TREATMENT DELIVERY
STEP 4. PLANNING IMPORTANT TREATMENT ACTION VERIFICATION

 TREATMENT PLANNING – determines the volume of tissue that needs to be

encompassed within the radiation field.

IMMOBILIZATION DEVICES
1. THERMOPLASTIC MASK – (HEAD)made up of thermoplastic. When heated and
placed on patient, molds in shape.
2. ALPHA CRADLE – (HEAD AND EXTREMETIES) made of 2 chemicals that can be
mixed together to form a styro-like material that may take shape of the patient.

THREE TYPES OF RADIATION THERAPY

1. EBRT,XBRT OR TELETHERAPY
– for external beam treatment, the patient lies underneath machine that
emits radiation or generates a beam of x-rays
- long distance treatment

a. Superficial Machine – treating lesions on or near the surface of the skin.

- 50-70 cm. SSD
- 50-120 kVp
b. Orthovoltage – moderately superficial tissues
- 50-70 cm. SSD
- 250 kVp
c. Betatron – electron accelerator that uses magnetic induction to accelerate electrons in circular
path; also capable of producing photons.
- By Kerst in 1941
d. Cobalt 60 – artificially produced isotope formed in a nuclear reactor
- 1st skin-sparring machine80cm.
- Replaced orthovoltage in 1950’s
- SSD AT
- Unit known as <work horse=
- 1st RadThera unit to rotate 360° around a patient
- From Cobalt 59
- Emits two gamma ray beams with 1.17 and 1.33 MeV
e. Linac - accelerates electron in a straight line or linear path
- By Widroe in1925
- SSD AT 100cm.

SUMMARIZED BY: MINZHU YAP,

RXT, RRT
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MAGNETIC RESONANCE IMAGING

Types of treatment for LinAc

 2DXRT – Conventional External Beam RadioTherapy

 3DCRT – 3 Dimensional Conformal RadioTherapy
- Multi-leaf collimator
- Cerrobend blocks – fixed heavy custom made wedge filter dedicated for
each patient.
 4DXRT (IGRT) – Image-guided real time RadioTherapy
 IMRT – Intensity Modulation RadioTherapy
 STEREOTACTIC RADIOSURGERY – gamma knifes
 PARTICLE THERAPY –

2. BRACHYTHERAPY (SEALED SOURCE)

- A technique in which the radioactive material is placed within the
patient.

Types of BrachyTherapy

 Mould Technique – placement of Radioactive source on or in close proximity to the lesion

 Intracavitary – Placement of Radioactive source in a body cavity
 Interstitial – Placement of Radioactive directly into the tumor site and adjacent tissue.

Two Brachytherapy Systems

 LDR (Low Dose Rate)

- 40-500 cGy/hr.
- 3-4 days
 HDR (High Dose Rate)
- Greater than 1200 cGy/hr.
- 10-20 mins.

3. SYSTEMIC RADIOISOTOPE THERAPY (UNSEALED SOURCE)

- Delivered through infusion
- Or

ingestion CLINICAL

APPLICATIONS

1. LARYNGEAL CANCER
- Megavoltage radiation
- 6300 t0 6500 cGy over a 6-week period
- Delivered thru 5x5 or 6x6 opposed lateral fields
- Cobalt 60 4MV Photons
2. EPIGLOTTIS
- 120-125 cGy BID

SUMMARIZED BY: MINZHU YAP,

RXT, RRT
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MAGNETIC RESONANCE IMAGING

- Post op: 4000-4500 cGy

3. SUBGLOT
TIS - 4500 cGy

4. SKIN - Superficial radiation

CANCER - 4000-5000 cGy in a 3-4 weeks period
- 2-3 cm. in size
5. MEDULLOBLASTOMA
- 4500 cGy (brain)
- 3500-4500 cgY (spinal cord)
6. LUNG
CANCER - 5000-6000 CgY OF 10 MeV

7. PROSTATE - Megavoltage beam of 10 MV

- 7600 cGy

8. ORAL - 6000 cGy in 4weeks

CAVITY - orthovoltage

- 4500-5000 cGy in 5 weeks.

9. CERVICAL
10. HODGKIN’S DISEASE
- 3000-4000 cGy
- megavoltage
11. BREAST
- 5000 cGy in 5 weeks

 Hotspot – an area of excessive radiation dose.

SUMMARIZED BY: MINZHU YAP,

RXT, RRT
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PATHOLOGY

A. CHEST  EFFECT: difficulty in emptying the lungs of

ASPIRATION air
 A mechanical obstruction
 CAUSED BY: foreign objects are CYSTIC FIBROSIS
swallowed/aspirated into air passages of  Most common inherited diseases
bronchial tree  Secretion of heavy mucus cause progressive
 Most common in small children clogging of bronchi and bronchioles
 TREATMENT: Heimlich maneuver  CAUSED BY: faulty genes in chromosomes
No.7
ATELECTASIS
 Collapse of all or a portion of a lung DYSPNEA
 CAUSED BY: obstruction of the bronchus  A sensation of difficulty in breathing
or puncture or <blowout= of an air  Most common in older persons
passageway  CAUSED BY:
o Physical exertion
o Restrictive/obstructive defects within
BRONCHIECTASIS the lungs or airways
 Irreversible dilation or widening of bronchi o Pulmonary edema
or bronchioles
 CAUSED BY: repeated pulmonary infection EMPHYSEMA
or obstruction  Irreversible and chronic lung disease
 EFFECTS:  Air spaces in the alveoli become greatly
o Increased mucous production enlarge
o Coughing up sputum  CAUSED BY:
o Smoking
BRONCHITIS o Long-term dust inhalation
 Excessive mucous secretion into the bronchi  RESULTS:
 CAUSED BY: cigarette smoking o Alveolar wall destruction
 EFFECTS: o Loss of alveolar elasticity
o Cough  EFFECTS:
o Shortness of breath o Seriously labored breathing
o Serious impedance of gas exchange
CHRONIC OBSTRUCTIVE PULMONARY within the lungs
DISEASE (COPD)
 A persistent obstruction of the airways PLEURAL EFFUSION/HYDROTHORAX
 CAUSED BY:  Abnormal accumulation of fluid in the
o Smoking pleural cavity
o Emphysema  TYPES: empyema and hemothorax
o Chronic bronchitis

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PATHOLOGY

EMPYEMA  CAUSED BY: Streptococcus pneumonia

 Accumulation of pus in the pleural cavity
 CAUSED BY: VIRAL/INTERSTITIAL PNEUMONIA
o Chest wounds  Inflammation of the alveoli and connecting
o Obstruction of bronchi lung structures
o Ruptured lung abscess
o Pneumonia PNEUMOTHORAX
 Accumulation of air in the pleural space
HEMOTHORAX  CAUSED BY:
 Accumulation of blood in the pleural cavity o Trauma
 CAUSED BY: trauma/injury o Pathologic conditions
 EFFECTS:
PLURISY o Partial or complete collapse of lungs
 Inflammation of the pleura surrounding the o Severe shortness of breath
lungs o Chest pain
 CAUSED BY:
o Virus or bacterium PULMONARY EDEMA
o Visceral and parietal pleura  Excess fluid in the lungs
<rubbing= during respiration  CAUSED BY: coronary artery disease
o Pneumonia
o Trauma to the chest RESPIRATORY DISTRESS SYNDROME
 EFFECT: severe pain  Hyaline Membrane Disease in infant
 Adult Respiratory Distress Syndrome in
PNEUMONIA/PNEUMONITIS adult
 Inflammation of the lungs  The alveoli and capillaries of the lung are
 TYPES: aspiration pneumonia, injured or infected
bronchopneumonia, lobar pneumonia and  CAUSED BY:
viral/visceral pneumonia o Lack of lung development
 EFFECT:
ASPIRATION PNEUMONIA o Leakage in fluid and blood into the
 CAUSED BY: aspiration of foreign objects spaces between alveoli
or food in the lungs
 RESULT: irritation of the bronchi TUBERCULOSIS
 EFFECT: edema  A contagious disease
 CAUSED BY: Mycobacterium tuberculosis
BRONCHOPNEUMONIA  TYPES: primary and reactivation/secondary
 CAUSED BY: Streptococcus or
Staphylococcus bacteria PRIMARY TUBERCULOSIS
 It occurs in persons who have never had the
LOBAR PNEUMONIA disease before
 Confined to one or two lobes of the lungs
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PATHOLOGY

 INDICATORS: DYNAMIC (with power or force)/MECHANICAL

o Hilar enlargement BOWEL OBSTRUCTION
o Enlarged mediastinal lymph nodes  Complete or nearly complete blockage of
the flow of intestinal contents
REACTIVATION/SECONDARY  EFFECTS:
TUBERCULOSIS o Fibrous adhesions
 Develops in adult  Fibrous band of tissue
 INDICATORS: interrelates with the intestine,
o Irregular calcification in the upper creating a blockage
lobes bilaterally  Most common cause of
o Upward retraction of the hila mechanical obstruction
o Crohn’s disease
OCCUPATIONAL LUNG DISEASE  Chronic inflammation of
ANTHRACOSIS intestinal wall
 Black lung pneumoconiosis  CAUSE: unknown
 CAUSED BY: deposits of coal dust  EFFECT: bowel obstruction
 Most common in young
ASBESTOSIS adults
 CAUSED BY: inhalation of asbestos dust o Intussusception
(fibers)  Telescoping of a section of
 EFFECT: pulmonary fibrosis bowel into another loop
 Most common in ileum
SILICOSIS  Most common in children
 CAUSED BY: inhalation of silica (quartz) o Volvulus
dust  Twisting of a loop of
intestine
B. ABDOMEN  TREATMENT: surgery
ASCITES
 Abnormal accumulation of fluid in the ILEUS
peritoneal cavity  Non-mechanical bowel obstruction
 CAUSED BY:  TYPES:
o Cirrhosis of the liver o Adynamic Ileus
o Metastatic disease to the peritoneal  Without power or force
cavity  CAUSED BY: peritonitis
o Paralytic Ileus
PNEUMOPERITONEUM  Paralysis
 Free air or gas in the peritoneal cavity  CAUSED BY: lack of
intestinal motility
 CAUSED BY:
o Gastric or duodenal ulcer  Most common in postoperative patients
o Trauma

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PATHOLOGY

ULCERATIVE COLITIS COLLE’S FRACTURE

 Chronic disease involving inflammation of  Transverse fracture of distal radius with
the colon posterior displacement
 Most common in young adults
 Most frequently involves rectosigmoid colon SMITH’S FRACTURE
 Reverse Colle’s Fracture
C. UPPERLIMB  Transverse fracture of distal radius with
BONE METASTASES anterior displacement
 Transfer of disease or cancerous lesion from
one organ or part JOINT EFFUSION
 Most common bone malignant tumors  Accumulation of fluid in the joint cavity
 CAUSED BY:
BURSITIS o Fracture
 Inflammation of the bursae o Dislocation
 EFFECTS: o Soft tissue damage
o Pain o Inflammation
o Limited joint movement
OSTEOARTHRITIS
CARPAL TUNNEL SYNDROME  Degenerative Joint Disease
 Common painful disorder of the wrist and  Noninflammatory joint disease characterized
hand by gradual deterioration of articular cartilage
 CAUSED BY: compression of the median  Most common type of arthritis
nerve
 Most commonly in middle-aged women OSTEOMYELITIS
 Local or generalized infection of bone or
FRACTURES bone marrow
 Break in the structure of bone  CAUSED BY:
 CAUSED BY: direct or indirect force o Bacteria introduced by trauma or
surgery
BARTON’S FRACTURE o Diabetic foot ulcer
 Fracture and dislocation of posterior lip of
OSTEOPETROSIS
distal radius
 Hereditary diseased marked by abnormally
BENNETT’S FRACTURE dense bone
 Fracture of the base of the first metacarpal  CAUSED BY: fracture of affected bone
bone
OSTEOPOROSIS
BOXER’S FRACTURE  Reduction in the quantity of bone or atrophy
of skeletal tissue
 Transverse fracture of the fifth metacarpal
neck  Most common in postmenopausal women
and elderly men
5

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PAGET’S DISEASE BENIGN BONE/CARTILIGINOUS TUMORS

 Osteitis Deformans ENCHONDROMA
 Most common chronic skeletal diseases  Slow-growing benign cartilaginous tumor
 CAUSE: unknown  Most commonly found in small bones of the
 Most common in men older than age 40 hand and feet of adolescents and young
adults
RHEUMATOID ARTHRITIS
 Chronic systemic disease with inflammatory OSTEOCHONDROMA/EXOSTOSIS
changes throughout the body’s connective  Most common type of benign bone tumor
tissue  Most common in persons aged 10-20 years
 Most common in women  Most common at the knee

SKIER’S THUMB D. HUMERUS AND SHOULDER

 Sprain or tear in the ulnar collateral ligament ACROMIOCLAVICULAR JOINT SEPARATION
of the thumb  Partial or complete tear of the AC and/or
 CAUSED BY: injury coracoclavicular ligaments
 CAUSED BY: trauma to upper shoulder
MALIGNANT BONE TUMORS region
MULTIPLE MYELOMA
 Tumors that occur in various parts of the ACROMIOCLAVICULAR DISLOCATION
body, arising from bone marrow or marrow  Superior displacement of distal clavicle
plasma cells  CAUSED BY: fall
 Most common of the primary cancerous
bone tumors BANKART LESION
 an injury of the anteroinferior aspect of the
OSTEOGENIC SARCOMA/OSTEOSARCOMA glenoid labrum
 The second most common type of primary  CAUSED BY: anterior dislocation of the
cancerous bone tumor proximal humerus
 Most common in persons aged 10-20 years
 May develop in older persons with Paget’s BURSITIS
disease  Inflammation of the bursae

EWING’S SARCOMA HILL-SACHS DEFECT

 A common primary malignant bone tumor  A compression fracture of the articular
 Most common in children and young adults surface of the posterolateral aspect of the
humeral head
CHONDROSARCOMA  CAUSED BY: anterior dislocation of
 A slow-growing malignant tumor of the humeral head
cartilage

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PATHOLOGY

IDIOPATHIC CHRONIC ADHESIVE ENCHONDROMA

CAPSULITIS/FROZEN SHOULDER  Slow-growing benign cartilaginous tumor
 A disability of the shoulder joint  Most often in small bones of the hands and
 CAUSED BY: chronic inflammation in or feet in adolescents and young adults
around the joint
EWING’S SARCOMA
IMPINGEMENT SYNDROME  Common primary malignant bone tumor
 Impingement of the greater tuberosity and  Most common in children and young adults
on the coracoacromial ligamentous and  SYMPTOMS: low-grade fever and pain
osseous arch
EXOSTOSIS/OSTEOCHONDROMA
SUPRASPINATUS MUSCLE IMPINGEMENT  Benign, neoplastic bone lesion
 Most common injury of the rotator cuff  CAUSED BY: consolidated overproduction
 CAUSED BY: subacromial bone spur of bone at a joint

SHOULDER DISLOCATION GOUT

 Traumatic removal of humeral head from  A form of arthritis
the glenoid cavity  Excessive uric acid in the blood
 Common initial attacks occur in the first
TENDONITIS MTP joint
 Inflammation condition in the tendon  Most common in men

F. LOWER LIMB LISFRANC JOINT INJURY

BONE CYST  Sprains or dislocations-fractures of the bases
 Benign, neoplastic bone lesions filled with of the first and second metatarsals
clear fluid  CAUSED BY:
 Most common near the knee joint in o Motor vehicle crashes
children and adolescence o Twisting falls
o Falls from high places

CHONDROMALACIA PATELLAE/RUNNER’S MULTIPLE MYELOMA

KNEE  Tumor arises from the bone marrow or
 Softening of the cartilage under the patella marrow plasma cells
 Most common in cyclists and runners  Most common type of primary cancerous
bone tumor
CHONDROSARCOMAS
 Malignant tumors of the cartilage OSGOOD-SCHLATTER DISEASE
 Most common in the pelvis and long bones  Inflammation of the bone and cartilage of
of men older than 45 years the anterior proximal tibia
 Most common in boys ages 10-15

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PATHOLOGY

 CAUSED BY: large patellar tendon AVULSION/EVULSION FRACTURES OF THE

detaches part of the tibial tuberosity PELVIS
 Fractures experience after a sudden, forceful
OSTEOCLASTOMAS/GIANT CELL TUMORS or unbalanced contraction of the tendinous
 Benign lesions that occur in the proximal and muscular attachment
tibia or distal femur after epiphyseal closure  Most common in athlete adolescents
 Typically occur in the long bones of young
adults DEVELOPMENT DYSPLASIA OF THE
HIP/CONGENITAL DISLOCATION OF THE HIP
OSTEOID OSTEOMAS  CAUSED BY: conditions present at birth
 Benign bone lesions
 Most common in teenagers or young adults LEGG-CALVE-PERTHES DISEASE
 SYMPTOMS: localized pain that typically  Most common type of aseptic or ischemic
worsens at night necrosis
 Lesions typically involve one hip (head and
OSTEOMALACIA/RICKETS neck of femur)
 Bone softening  Most common in boys ages 5-10 years
 CAUSED BY: deficiency of calcium,
phosphorus and/or vitamin D PELVIC RING FRACTURES
 Rickets in children  CAUSED BY: severe blow or trauma to one
 Osteomalacia in adults side of the pelvis
 RESULT: fracture site away from the site of
REITER SYNDROME primary trauma
 Bony erosion at the Achilles tendon
insertion on the posterosuperior margin of PROXIMAL FEMUR (HIP) FRACTURES
the calcaneus  CAUSED BY: weakening or collapse of
 Affects the sacroiliac joints and lower limbs weight-bearing joints
of young men  Most common in older adults or geriatric
 CHARACTERISTIC: arthritis, urethritis and patients with osteoporosis or avascular
conjunctivitis necrosis
 CAUSED BY:
o Infection of the GI tract SLIPPED CAPITAL FEMORAL EPIPHYSIS
o Sexually transmitted disease  Epiphysis appears shorter and the epiphyseal
plate wider with smaller margins
G. FEMUR AND PELVIC GIRDLE  Most common in persons ages 10-16 years
ANKYLOSING SPONDYLITIS
 Rheumatoid arthritis variant involving the H. CERVICAL AND THORACIC SPINE
sacroiliac joints and spine CLAY SHOVELER’S FRACTURE
 Most common in males  Avulsion fractures on the spinous processes
of C6 through T1
 CAUSED BY: hyperflexion of the neck
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KYPHOSIS
COMPRESSION FRACTURE  Abnormal or exaggerated convex curvature
 Collapse of the anterior edge of the vertebral of the thoracic spine
body, changing its shape into a wedge  CAUSED BY: compression fractures of the
instead of block anterior edges of the vertebral bodies in
 CAUSED BY: osteoporotic patients
o Osteoporosis  RESULTS:
o Severe kyphosis caused by other o Stooped posture
diseases o Reduced height
o Injury of the spinal cord
LORDOSIS
HANGMAN’S FRACTURE  Abnormal or exaggerated concave lumbar
 Fracture extends through pedicles of C2 curvature
with or without subluxation of C2 upon C3  CAUSED BY:
 CAUSED BY: extreme hyperextension of o Pregnancy
the neck o Obesity
o Poor posture
JEFFERSON’S FRACTURE o Rickets or tuberculosis of the spine
 Comminuted fracture of anterior and
posterior arches of C1 SCOLIOSIS
 CAUSED BY:  Abnormal or exaggerated lateral curvature
o Landing on one’s head of the spine
o Landing on one’s feet  Most common in children ages 10-14 years
 Most common in girls
ODONTOID FRACTURE
 Fracture involving the dens and can extend SCHEUERMANN’S DISEASE
into the lateral masses or arches of C1  Osteochondritis involving one or more of
the verterbrae
TEARDROP BURST FRACTURE  RESULTS IN: abnormal spine curvature of
 Compression with hyperflexion in the kyphosis and scoliosis
cervical region  Most common in boys

HERNIATED NUCLEUS PULPOSUS TRANSITIONAL VERTEBRA

 Herniated lumbar disc/Slipped disk  Vertebra takes on a characteristic of the
 CAUSED BY: protrusion of nucleus adjacent region of the spine
pulposus (soft inner part) of an invertebral  Most often occurs in the lumbosacral region
disk through the annulus (fibrous cartilage  It also involves the cervical and lumbar ribs
outer layer) in the spinal canal

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PATHOLOGY

I. LUMBAR, SACRUM AND COCCYX  CAUSED BY:

CHANCE FRACTURE o Blunt trauma
 Fracture through the vertebral body and o Pulmonary injury
posterior elements (spinous processes,
pedicles, facets, transverse processes) STERNAL FRACTURE
 CAUSED BY: hyperflexion force  CAUSED BY: blunt trauma
METASTASES
 Primary malignant neoplasms that spread to CONGENITAL ANOMALIES
distant sites via blood and lymphatics PECTUS CARINATUM
 Pigeon breast
SPINA BIFIDA  Anterior protrusion of the lower sternum and
 Congenital condition in which posterior xiphoid process
aspects of the vertebrae fail to develop
 Most often at L5 PECTUS EXCAVATUM
 Funnel chest
SPONDYLOLISTHESIS  Characterized by a depressed sternum
 Forward movement of one vertebra in
relation to another K. SKULL
 CAUSED BY: SKULL FRACTURE
o Developmental defect in the pars  Disruptions in the discontinuity of bones of
interarticularis the skull
o Spondylolysis
o Severe osteoarthritis LINEAR FRACTURE
 It appears as jagged or irregular lucent lines
SPONDYLOLYSIS that lie at right angles to the axis of the bone
 Dissolution of a vertebra
 CAUSED BY: DEPRESSED FRACTURE
o Aplasia (lack of development) of the  Ping-pong fracture
vertebral arch  A fragment of bone that is separated and
o Separation of the pars interarticularis depressed into the cranial cavity
 Most common at L4 or L5
BASAL SKULL FRACTURE
J: BONY THORAX– STERNUM AND RIBS  Fracture through the dense inner structures
RIB FRACTURE of the temporal bone
 CAUSED BY:
o Trauma MULTIPLE MYELOMA
o Underlying pathology  It consists of one or more tumors that
originate in the bone marrow
FLAIL CHEST
 Skull is the common site
 Fracture of the adjacent ribs into two or
more places

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PITUITARY ADENOMAS
 Tumors of the pituitary gland
 FINDINGS:
o Enlargement of the sella
turcica
o Erosion of the dorsum sellae

MASTOIDITIS
Bacterial infection of the mastoid process
Mastoid air cells are replaced with a fluid- filled
abscess
RESULTS IN: hearing loss

ACOUSTIC NEUROMA
Benign tumor of the auditory nerve sheath
originates in the internal auditory canal
SYMPTOMS:
Hearing loss
Dizziness
Loss of balance

CHOLESTEATOMA
Benign cyst-like mass or tumor
Most common in the middle ear or mastoid region

POLYP
Growth arises from a mucous membrane and
projects into a cavity
CAUSES: chronic sinusitis

OTOSCLEROSIS
Hereditary disease involving excessive spongy
bone formation of the middle and inner ear
Most common cause of hearing loss in adults
without ear drum damage

Prepared by: RC CARREON, RRT, MA

Ed©
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PATHOLOGY

ULTRASOUND Continuous wave ultrasound – wave in

which cycles repeat indefinitely; consist of a
Acoustic impedance – resistance of sound as it separate transmit and receiver transducer
propagates through the medium housed within one assembly.

Acoustic window – ability of sonography to Coronal image plane – anatomic term used to
visualize a particular area. The full urinary describe a plane perpendicular to the sagittal
bladder is a good acoustic window to image and transverse plane of the body.
the uterus and ovaries in trans-abdominal
sonogram. The intercostal margins may be a Detail resolution – includes axial and lateral
good acoustic window to image the liver resolution
parenchyma.
Doppler Effect – shift in frequency or
Anechoic – property of being free of echoes or wavelength, depending on the conditions of
with out echoes
observation; caused by relative motions among
sources, receivers and medium.
Angle of incidence – angle at which the
ultrasound beam strikes an interface with Doppler ultrasound – application of Doppler
respect to normal (perpendicular) incidence Effect to ultrasound to detect movement of
reflecting boundary relative to the source,
Ankle/Brachial Index (ABI) – ratio of ankle resulting in a change of the wavelength of the
reflected wave
pressure to brachial pressure to provide a
general guide to help determine the degree of Duplex imaging – combination of gray-scale
disability of lower extremity. real-time imaging and color or spectral

Attenuation – weakening of the sound wave as Doppler Echo – reflection of acoustic energy
it propagates through a medium received from scattering elements or a specular
reflector.
Axial resolution – ability to distinguish two
Echogenic – refers to a medium that contains
structures along a path parallel to the sound
echo-producing structures.
beam
Embryo – term used for developing zygote
Biparietal diameter (BPD) – largest through the 10th week of gestation.
dimension of the fetal head perpendicular to
Endometrium – inner layer of uterine canal
the midsagittal plane; measured by ultrasonic
visualization and used to measure fetal
Endorectal transducer – high frequency
development
transducer that can be inserted into the
Color flow Doppler – velocity in each rectum and visualize the bladder and
direction is quantified by allocating a pixel to prostate gland.
each area; each velocity frequency change is
allocated a color. Endovaginal transducer – high frequency
transducer (and decreased penetration) that
Complex – containing anechoic and can be inserted into the vagina to obtain high
echogenic areas. resolution images of the pelvic structures.

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False pelvis – region above the pelvic brim

Fetus – term used for the developing embryo

from the 11th gestational week until birth.

Follicular cyst – functional or physiologic

ovulatory cyst consisting of an ovum
surrounded by a layer of cells.

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Frequency – number of cycles per unit, Myometrium

usually expressed in Hertz (Hz) or megahertz – thick layer
(MHz) a million cycles per seconds of the uterine
wall
Gestational age – length of time calculated Non-invasive technique – procedure that
from the first day of the last menstrual does not require the skin to be broken or an
period; also known as gestational weeks organ or cavity to be entered

Gestational sac – fluid filled Oblique plane – slanting direction or any

structure normally found in the variation that is not starting at a right angle to
uterus containing the pregnancy any axis

Parenchyma – functional tissue or cells of an

Gray scale – range of amplitude
organ or gland
(brightness) between black and
white
Piezoelectric effect – conversion of pressure
to electrical voltage or conversion of
Heterogeneous – having a mixed composition
electrical voltage to mechanical pressure
Homogeneous – having a uniform composition
Phasic flow – normal venous respiratory
Hyperechoic – producing more echoes than
variations
normal Hypoechoic – producing less echoes than
normal
Porta hepatitis – region in hepatic hilum
Intima – inner layer of the vessel; the middle containing common duct, proper hepatic
layer is the media and the outer layer is the artery and main portal vein
adventitia.
Posterior acoustic enhancement – increase in
Iliopectineal line – bony ridge on the inner reflection amplitude from structure s that lie
surface of ileum and pubic bones that behind a weakly attenuating structure.
divides the true and false pelvis
Posterior acoustic shadowing – reduction in
Ischemia – area of the cardiac myocardium reflection amplitude from reflectors lying
that has been damaged by disruption of the behind a strongly reflecting or attenuating
blood supply structure.
by the coronary artery
Isoechoic – having a texture nearly as same Pulse wave ultrasound – a transducer emits
as that of the surrounding parenchyma. short pulses of ultrasound into the human
Lateral resolution – ability to distinguish two body and receives reflection from the body
structures lying perpendicular to the sound before emitting another pulse of sound.
beam.
Leiomyoma – Real-time imaging – imaging with rapid
most common frame rate visualizing moving structures or
benign tumor scan planes continuously
of the uterine
myometrium Reflection – redirection (return) of a portion
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of the sound beam back to the transducer Resolution – measure the ability to display two
closely spaced structures as discrete targets
Refraction – phenomenon of bending wave
fronts as the acoustic energy propagates from
the medium of one acoustic velocity

Regurgitation – occurs when block leaks

from one high pressure chamber to a
chamber of lower pressure
Retroperitoneal cavity – area posterior to the Transverse – plane that passes
peritoneal cavity that contains the aorta, inferior through the width of the body in a
vena cava, pancreas, part of the duodenum and horizontal direction
colon, kidneys and adrenal glands.
Ultrasound – sound with a frequency
greater than 20 kHz (audible sound
Retrouterine pouch – pelvic space located anterior
– 20 kHz below) Velocity of sound –
to the rectum and posterior to the uterus; also
speed with direction of motion
known as pouch of Douglas
specified
Sagittal – plane that travels vertically from the top
to the bottom of the body along the y axis
HISTORICAL DEVELOPMENT
Scattering – diffusion or redirection of sound in
1940’s – Howry, Wild and Ludwig independently
several directions encountering a particle suspension
showed that when ultrasound waves generated by a
or rough surface
piezoelectric crystal transducer were transmitted
Sonar (sound navigation and ranging) –
into the human body, these waves would be
instrument used to discover objects underwater
returned to the transducer from tissue interfaces of
and to show their location
different acoustic impedances.
Sound wave – longitudinal waves
1947 – Dussick positioned two transducers on
of mechanical energy propagated
opposite sides of the head to measure ultrasound
through a medium transmission profiles.
Transducer/Probe – device that 1948 – Howry developed the first ultrasound
converts energy from one form to scanner, consisting of cattle watering tank with a
another. wooden rail anchored along the side.
1954 – Hertz and Edler developed
echocardiographic techniques
1957 – Brown and Donald built early
obstetric contact compound scanner

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HISTORY OF ULTRASOUND INFRASOUND

 1918 - Sound Navigation and  Below 16 Hz
Ranging was used
 Early 1950’s –Water bath ULTRASOUND GENERATORS
immersion technique
 Late 1950’s – First contact TYPES OF ULTRASOUND
compound B-scanner WAVES
 1970’s – Gray scale imaging  Longitudinal/Compression
 Mid 1970’s – Real time Waves
scanning systems  Transverse/Shear Waves
 1980’s – Doppler technique  Surface/Rayleigh Waves

SOUND ACOUSTIC VARIABLES

 A mechanical energy  Period (T): the time taken for
 Requires a vibrating object to one complete cycle to occur (s
produced or µs)
 Cannot travel through a  Wavelength (λ): length of
vacuum space over which one cycle
occurs (m or mm)
ULTRASOUND  Amplitude (Depth): the
 High frequency sound waves maximum displacement that
 Above 20,000 cycles per occurs in an acoustic variable
second (20 kHz)  Frequency: cycle per second
 Inaudible to humans (Hz)
 Used to scan tissues of the body  Velocity: frequency times
 Ultrasound Pulse: 2-10 MHz wavelength
 Pulse Duration: 1 microsecond
 Pulse Repetition: 1000 PIEZOELECTRIC CRYSTALS
times/second  Generate ultrasound waves
 Capable of changing electrical
AUDIBLE SOUND signals into mechanical
 16 Hz to 20,000 Hz (ultrasound) waves

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PIEZOELECTRIC CRYSTAL AS REAL-TIME

TRANSMITTER OF SOUND  Shows movement as it occurs
 Converting electrical energy
into mechanical energy (sound) M-MODE
 Shows movement as a function
PIEZOELECTRIC CRYSTAL AS of time
TRANSMITTER OF SOUND
 Used in cardiac scanning
 Converting mechanical energy
(sound) into electrical energy DOPPLER ULTRASOUND
 Demonstrates and measures
NOTE:
blood flow
 Small crystal diameter
o Increased beam DOPPLER EFFECT
divergence  The change in apparent
 Larger crystal diameter frequency of a wave as a result
o Decreased beam of relative motion between the
divergence observer and the source
 Stationary Reflector: reflected
DIFFERENT MODES OF
ULTRASOUND
echoes are the same as the
transmitted waves
A-MODE  Reflector that Moves Closer:
 Echoes are shows as peaks reflected echoes are higher than
 Distance between various the transmitted echoes
structures can be measured  Reflector that Moves Away:
 Used to build two-dimensional reflected echoes are lower than
B-mode image the transmitted echoes

BASIC TYPES OF DOPPLER

B-MODE
ULTRASOUND UNIT
 Two-dimensional images in
which the echo amplitude is
1.) Continuous Wave Doppler Unit
depicted as dots of different
 Ultrasound is continuous
brightness
 Measures high velocities
accurately

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 No depth resolution WAVELENGTH

 The length of a single cycle of
2.) Pulsed Wave Doppler Unit the ultrasound wave
 Ultrasound is transmitted in  Inversely proportional to the
pulses frequency
 With good depth resolution  Determines the resolution of
 Measures the speed of the the scanner
blood in a particular vessel  Higher the frequency, the
 Cannot measure high blood shorter the wavelength
velocities in deep vessels
 High velocities may be wrongly FOCUSING
displayed as low velocities  Adjustment of the ultrasound
beam
3.) Colour Doppler Unit  To improve resolution
 Shows different flow-velocities  May be electronic or by a lens
in different colours attached to the transducer

4.) Duplex Doppler System AMPLIFICATION

 Combination of a B-mode and  Done by the time-gain-
Doppler system compensation (TGC) amplier
 Allows the Doppler beam to be  To compensate for ultrasound
directed accurately at any attenuation in any part of the
particular blood vessels body
 To improve the quality of the
WAVE PROPAGATION final image
 The transmission and spread of
ultrasound waves to different BOUNDARIES
tissues  The line at the periphery of two
 Average Propagation for Soft tissues which propagate
Tissues: 1540 m/s ultrasound differently
 Average Propagation for Soft  The zone of echoes at the
Tissues: 4620 m/s interface

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PIEZOELECTRIC EFFECT  Low density substance – low

 Piezein – <press or pressure= acoustic impedance
 Ability of a material to generate  Formula: Z=pc
an electrical charge un response o p = density of material
to applied pressure (kg/m3)
o c = speed of sound (m/s)
PIEZOELECTRIC MATERIALS o Z = acoustic impedance
 Crystalline materials composed (rayls)
of dipolar molecules
 Quartz – naturally occurring SPEED
SUBSTANCE Z
crystals (m/s)
 Lead zirconate titanate – man Air 0.0004 330
made ceramic Fat 1.38 1450
Water 1.48 1480
 Natural Materials:
Blood 1.61 1570
o Quartz
Kidney 1.62 1560
o Tourmaline Soft Tissue 1.63 1540
o Rochelle Salt Liver 1.65 1550
 Synthetic Materials: Muscle 1.70 1580
o Lead zirconate titanate Bone 7.80 3500
(PZT) PZT (crystal) 30 3870
o Barium titanate
o Lead metaniobate ACOUSTIC IMPEDANCE AND
o Ammonium dihydrogen REFLECTION
phosphate  Substances with same
o Lithium sulphate acoustic impedance:
o 100% energy
ACOUSTIC IMPEDANCE transmission
 Property of a substance o No reflection
 Describes how the particles of  Substances with a small difference
that substance behave when in acoustic impedance:
subjected to pressure wave o 95% energy transmission
 High density substance – high o 5% reflection
acoustic impedance

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 Substances with a large difference  Best suited to image deep lying

in acoustic impedance: structures
o 1% energy transmission  3.5 MHz
o 99% reflection
3.) Convex Transducer
TRANSDUCER/PROBE  Wide fan-shaped
 A device which converts one  Useful for all parts of the body
form of energy to another
 Except for specialized
 Converts electrical energy into echocardiography
ultrasound waves and vice
versa 4.) Phased Array Transducer
 Contains piezoelectric crystals  Flat faced transducer
o Transmit ultrasound  Wide field of view
beam
 useful in cardiac and cranial
o Receive reflected echoes
ultrasound
TRANSDUCERS/SCANNING
COMPONENTS AND
PROBES
CONSTUCTION OF A TYPICAL
 The most expensive part of any TRANSDUCER
ultrasound unit
1.) PHYSICAL HOUSING
1.) Linear Array Transducer
 Contains all individual
 Parallel scan lines
components
 Rectangular field of view
 Provides the necessary
 Vascular, small parts and structural support
musculoskeletal applications
 Acts as an electrical and
 Above 4 MHz acoustic insulator

2.) Sector/Curvilinear Array

2.) ELECTRICAL
Transducer
CONNECTIONS
 Provides wide field of view
 Formed in front and back of the
 Most useful in abdominal and
crystal
obstetric scanning
 Made of thin film of gold or
silver

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3.) PIEZOELECTRIC  Controls the length of

ELEMENTS vibrations from the front face
 Crystalline minerals that  Improves axial resolution
generate voltages when
 Materials:
subjected to a mechanical force o Plastic or epoxy resin
 Piezein – <to press or squeeze= o Cork
 Piezoelectric Effect – o Rubber
discovered by Jacques and o Araldite loaded with
Pierre Curie tungsten powder
 Thinner Piezoelectric Materials
o Higher resonant 5.) ACOUSTIC LENS
frequencies  Reduce the beam width of the
transducer
FREQUENCY  Improve image resolution
 Affects the quality the  Width of the Beam:
ultrasound image determines lateral resolution
 Higher Frequency  Lateral Resolution: the ability
o Shorter wavelength to resolve structure across or
o Better Resolution perpendicular to the beam axis
o Lower Penetration  Materials:
o Higher Absorption o Aluminum
 Lower Frequency o Perspex
o Longer wavelength o Polystyrene
o Poor Resolution
o Higher Penetration 6.) IMPEDANCE MATCHING
o Lower Absorption LAYER
o Sandwich between the
4.) BACKING/DAMPING piezoelectric crystal and the
MATERIALS patient
 Shortens the ultrasound pulse o Chosen to improved
length transmission into the body
 Eliminates the vibrations from
the back face

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BANDWIDTH 3.) Pediatric Ultrasound

o The range of frequencies  5.0 MHz transducer: for
contained within an ultrasound children
pulse  Focused at 5-7 cm
o Wide Bandwidth:  Sector transducer of 7 MHz:
o Shorter spatial pulse o Neonatal brain scans
length o For adult testis and neck
o Wider range of  Focused at 4-5 cm
frequency
o Narrow Bandwidth:
ULTRASOUND BEAM
o Longer spatial pulse
 Area through which the sound
length
energy emitted from the
o Narrower range of
frequency ultrasound transducer
 Three dimensional and
CHOOSING THE APPOPRIATE symmetrical around its central
TRANSDUCER axis

1.) Obstetric Ultrasound TWO REGIONS OF

 Linear or convex transducer ULTRASOUND BEAM
1.) Near Field/Fresnel zone 2.) Far
 3.5 MHz: better in later Field/Fraunhofer zone
pregnancy  Increasing Frequency
 5.0 MHz: best during early o Longer near field
pregnancy o Less far field divergence
 Focused at 7-9 cm  Narrow Crystal Diameter
o Narrower near field
o More far field divergence
2.) General Purpose Ultrasound  Thin Crystal
 Sector or convex transducer o Decreased near field
 3.5 MHz o Increased far field
 Focused at 7-9 cm  Thick Crystal
o Increased near field
o Decreased far field

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BEAM INTENSITY SPATIAL RESOLUTION

 The power (measured in watts)  Detail Resolution
flowing through a unit area  The ability to display two
structures situated close
SIDE LOBES/GRATING LOBES together as separate images
 Lobes at various angles to the  Higher Frequency:
main beam o Better resolution
 Approximately 15% of the o Lower penetrability
energy in the beam o Higher absorption
 Cause a degradation of lateral  Lower Frequency:
resolution o Poor resolution
o Higher penetrability
BEAM WIDTH o Lower absorption
 The dimension of the beam in
the scan plane TWO COMPONENTS OF
SPATIAL RESOLUTION
 Affects the spatial resolution
 Narrow Beam Width
1.) AXIAL RESOLUTION
o Better spatial resolution
 Longitudinal, Linear, Depth or
Range
SLICE THICKNESS
 Three dimensional volume  The ability to distinguish two
displayed as a two dimensional objects parallel to the
image ultrasound beam
 Depends upon the spatial pulse
RESOLUTION length and wavelength
 The ability of an imaging  Short Spatial Pulse Length:
system to differentiate between good axial resolution

structures  Longer Spatial Pulse Length:

poor axial resolution
 Spatial Resolution: resolution
in space
2.) LATERAL RESOLUTION
 Contrast Resolution:
 Azimuthal, Transverse,
resolution of gray shades
Angular or Horizontal
 Temporal Resolution:
resolution in time

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 The ability to distinguish two waves as they pass through

objects perpendicular to the tissues
ultrasound beam  Unit: decibels per centimeter
 Depends upon the beam
FIVE MAIN PROCESSES THAT
diameter
CAUSE ATTENUATIONS
 Smaller Beam Width: better
lateral resolution 1.) ABSORPTION
 Larger Beam Width: poor  Occurs when ultrasound energy
lateral resolution is lost to tissues by its
conversion to heat
CONTRAST RESOLUTION
 Main factor causing attenuation
 The ability of the imaging
 Higher Frequency:
system to differentiate between
o Greater amount of
body tissue and display them as
absorption
different shades of gray
 Bone: higher absorption
 Optimized by using the correct
coefficient
overall gain
 Increasing protein content gives
increasing absorption
TEMPORAL RESOLUTION
o Blood –> Fat –> Nerve –
 Frame Rate
> Muscle –> Skin –> Tendon
 The ability of the imaging –> Cartilage –> Bone
system to display events which  Best Absorption: tendon,
occurs at different times as ligament, fascia, joint capsule
separated images & scar tissue
 Higher Frame Rate: better
temporal resolution 2.) REFLECTION
 Occurs when two large
ULTRASOUND INTERACTIONS AND structure of significantly
ATTENUATIONS
different acoustic impedance
form an interface
ATTENUATION
 Decrease in the intensity and
amplitude of the ultrasound

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 Occurs when a sound wave 1.) REVERBERATION

strikes an object that is larger  Comet tail
than the wavelength  The production of spurious or
false echoes due to repeated
3.) SCATTERING reflections between two
 Occurs when an ultrasound interfaces with a high acoustic
wave strikes a boundary or impedance mismatch
interface between two small  The presence of two or more
structures strong reflecting surfaces
 Occurs when a sound wave  Often occur at:
strikes an object that is equal to o Skin-transducer interface
or smaller than the wavelength o Gas surface and
transducer
4.) REFRACTION  Prevention/Elimination:
 Occurs when the beam o Increase the amount of
encounters an interface between gel used
two different tissues at an o Used a stand-off gel pad
oblique angle o Reduce the gain
 The beam will be deviated as it o Move the position of the
travels through the tissue transducer
 Occurs due to difference in
2.) ACOUSTIC SHADOWING
wave velocity across an
 Caused by highly attenuating
interface between two materials
structure
5.) DIVERGENCE  Often occur at:
 Occurs when the beam travels o Soft tissue and gas
o Soft tissue and bone or
through tissue and it will
calculus
diverge due to diffraction
o Calcified mass
effects
3.) ACOUSTIC ENHANCEMENT
ULTRASOUND ARTIFACTS
 Caused by weakly attenuating
 A structure in an image which
structures
does not directly correlate with
actual tissue being scanned
 Often occur at: bladder, gallbladder or
o Distal to fluid-filled cyst
Prepared by: RCurinary
CARREON, RRT, MA
o Fluid-filled mass
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have arisen form the central axis

4.) EDGE SHADOWING of the main lobe
 Combination of refraction and  Appearance can give
reflection occurring at the rise to a false diagnosis
edges of rounded structures  Inherent characteristic
of the transducer
5.) BEAM WIDTH ARTIFACT
 Variations of all 8.) MIRROR IMAGE ARTIFACT
echoes returning to the  Caused by specular
transducer reflection of the beam
 Prevention/Elimination: at a large smooth
o Correct positioning interface
of the focal zone  Often seen in:
o Fluid-air interface
6.) SLICE THICKNESS o Diaphragm
ARTIFACT
 Occurs due to the thickness of 9.) DOUBLE IMAGE ARTIFACT
the beam  Caused by refraction of
 Dependent upon the beam
beam angulation  Often occur at:
 Often seen in: o Rectus abdominis muscle
o Transverse view of the  Prevention/Elimination:
urinary bladder o Move the
 Inherent characteristic of the transducer
transducer slightly to one
side to avoid the
7.) SIDE LOBE ARTIFACT junction of
 Echoes generated by side lobes rectus abdominis
assumed by the transducer to muscle

10.) EQUIPMENT-
GENERATED ARTIFACT
 Caused by incorrect
use of the equipment
control

<Passing the Board

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Exam is your main

purpose to learn=
05/13/14

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