W.C.

Røntgen (1845-1923) = discoverX-rays CT SCAN VS MRI

… radiation could be used in therapy and diagnostics in pathological conditions • CT scans use radiation (X-rays), and MRIs do not.
• MRIs provide more detailed information about the inner organs (soft tissues)
such as the brain, skeletal system, reproductive system and other organ systems
LOW CONTRAST DETECTABILITY than is provided by a CT scan.
Ability of an imaging modality to distinguish between two object with similar properties • CT scans are quick, painless, and noninvasive.
• MRI scans are not invasive, but they are noisy, take more time, and may cause
claustrophobia (anxiety due to being in the enclosed space of the machine).
MEDICAL IMAGING MODALITIES • MRI scans are costlier than CT scans.
To acquire images of the internal organs of the body • MRI scanners may cause a safety issue because of the strong magnet
Dr: identify features, patterns, interrelationships, details subtle changes

X-rays
– Mammography
– Fluoroscopy
X-ray computed tomography (CT)
Nuclear Medicine
– SPECT
– PET
Ultrasound
Magnetic Resonance Imaging
Hybrid Imaging

NB Perceptions vary from person to person

 X-RAY IMAGING
3D object projected onto 2D plane

- View of internal structure of the body without making incisions

EXAMPLES: Skeletal fracture, metastatic disease, ingested foreign bodies, urrethral obstruction, tooth root abscess

Digital images: High-frequency electromagnetic rays pass through soft parts of body tissue.
viewed immediately & X-rays generated in vacuum tubes by bombarding metal target (anode) with high speed electrons (from cathode)
Peak energy of X-rays: 20 - 140 kVp
enhanced as needed.
Object of interest (patient) is positioned between X-ray sensitive detector & X-ray source
Digital images:
manipulation of the Transmission of X-rays through the body is dependent on the composition of the body (region of interest)
final digital image Different densities = different intensities in image (eg. Ribs vs lungs; higher density - lighter grey)
(enlarge or enhance: Transmitted X-ray fluence can be recorded, captured by image receptor
colour, contrast darker,
lighter, superimpose
textures ) Images are produced on photographic plate (film) or digital recorder = RADIOGRAPH
= fewer retakes ,
improved ability to
detect disease + faster
diagnosis
Digital images: stored
in database from any
networked computer,
images can be easily
shared with other
departments..
Cost saving (no film
processing )
Special type of X-ray imaging to image internal structures of
breast to detect mamma cancer @ early stage Continous X-ray image is displayed on a monitor

Uses low energy x-rays since breast tissue is very sensitive. Allows real-time monitoring of procedure/passage of contrast agent
20- 30kVp vs 80-140 kVp routinely
* Long exposure time due to complex interventional procedures =
Breasts are compressed (compact) to increase density for good high radiation doses
image resolution.
Eg. Cardiology lab = placing stents pacemaker etc inside the body,
Left & right breasts are compared Coronary angiography

X-rays impinging on the image-intensifier are

transformed into a distribution of electrons,
which produce an amplified light image
on a smaller fluorescent screen after acceleration.
– Easy to acquire – Projection images (2D)
– Equipment is affordable – Superimposed information
– High resolution (higher tha CT, MRI) – Poorer contrast resolution than CT
– Widely available (even rural) – Only one form of contrast generation
– Quick – Uses ionising radiation (exposure patients & personnel)
– Anatomical information – Movement artefacts in non-compliant patients

– Allows a physician to see a live image of the body's - Radiation risk - eg. skin injury due to radiation overexposure
internal organs in order to observe their size, shape and (radiation burn)
movement. - May display overlapping anatomy.
– Provide dynamic and functional information. - May be limited by patient mobility and ability to comply.
– Readily available. - Poor soft tissue resolution.
– Inexpensive. - Use ionizing radiation
– Allow real time interaction.
– Good for visualized bony structure.
X-RAY COMPUTED TOMOGRAPHY IMAGING
computerised axial tomography (CAT)
Diagnostic imaging procedure that uses X-rays to build cross-sectional images ("slices") of the body.
Obtains 3D informatton

X-ray tube is mounted on rotating gantry along with digital detector

Peak energy: 80-140 kVp
Contrast agents
with high density Images are formed as patient moves through rotating gantry while it rotates ( @1-3 revolutions/s)
are often used to Large axial stack of images (2D) acquired @ different projection angles -
increase contrast Converted into 3D slices through patient through IMAGE RECONSTRUCTION
in soft tissue
 – Good density contrast – High ionising radiation dose
– Widely available (rural limited) – Fairly Expensive
– Transaxial images - 3D image information – Moderate resolution
– Moderate resolution – Only measures tissue attenuation
– Fast
– Anatomical information

Refers to the initial X-ray image that is captured from a specific angle during a CT
scan. It is essentially a 2D projection of the 3D structure being scanned. (one of
many images taken from different angles around the body part being examined.)

These multiple shadowgrams are then processed by a computer to create detailed

3D images of the inside of your body, allowing doctors to see things like bones,
organs, and tissues more clearly than with a single X-ray image.

Creates a measurable attenuation profile

for the cross section and then uses a computer program
called filter back projection to create the image of the cross section
In a CT image, overlapping structures are determining when surgeries are
eliminated, making the internal anatomy necessary
more apparent. reducing the need for exploratory
surgeries
In CT ,multiple images are collected from improving cancer diagnosis and
many angles. These images are stored in a treatment
computer that analyzes them to create a reducing the length of hospitalizations
new image with the overlying structures guiding treatment of common
removed. conditions such as injury, cardiac
disease and stroke
CT images allow radiologists and other improving patient placement into
physicians to identify internal structures and appropriate areas of care, such as
see their shape, size, density and texture. intensive care units
This detailed information can be used to
determine if there is a medical problem as
well as the extent and exact location of the
problem, and other important details.
The images can also show if no abnormality
is present.
 NUCLEAR MEDICINE IMAGING
Uses radionuclides to produce a physiological image of the internal organ of a patient

Gamma cameras map

the function & processes
SPECT Single Photo Emission Computed Tomography
(most general)

of the body rather than

Administer radiopharmaceutical (a radionuclide labeled to a pharmaceutical) as tracer
anatomical structure
The radiopharmaceutical concentrates in the desired locations technetium-99m
Source of radiation is Nucleus of the radionuclide decays to emit photons
injected into patient;
not generated in an The gamma camera rotates around the body to acquire projection data (from photons’
X-ray tube signals) at several angles around the patient.
These projections data are then reconstructed (similar to CT) to produce a 3 D volume of
information that can be displayed as trans axial views = SPECT

• long half life of 6 hours

• can be bonded to
different molecules in
order to target different
PET Positron Emission Tomography

organs of the body Detection & spacial reconstruction of injected tracer

Eg. Tc99m-Sestamibi Annihiliation : two photons travel 180' apart
(MIBI) - imaging Detecting photons in coincidence = reconstructs 3D
thyroid, tumour , volume of data of radioactive distribution in patient
breast,myocardial
– High contrast – Requires work with isotopes (personnel exposure)
– Moderate radiation dose – Ionising radiation dose to patients
– Images physiological functions – Imaging takes several minutes
– Many tracers can be used to image any organ – Resolution is poor
systems or tumour – Relatively expensive
– 3D information which improves contrast – Available in most SA cities, not all
– Large field of view

– Highest contrast
– Mostly uses one isotope, but many more are available – Very expensive
and can be made specific – Few in SA ; in Major cities only
– Potentially quantitative – Requires great technical support
– Excellent for tumour imaging – Poor resolution, better than SPECT
– Physiological information – Poor anatomical visualisation
– When combined with CT gives good anatomical – radionuclides have short half-life - need to be close to
information too production site
 ULTRASOUND
Used for effective imaging of soft tissues of the body

The transducer
Piezo electric effect: the crystal expands and contracts when connected to an alternating voltage
converts one type of
hence Ultrasound waves are produced
energy into another
(electrical E to
mechanical/sound E)
Gel is used as a coupling medium
Sound waves, originating from a transducer, is transmitted through the body, which has tissue of different densities,
it will be reflected at every given interface along the path of transmission, reflection is proportional to the difference in
No ionising impedance (resistance due to density)
radiation risk, thus The returned echoes (reflected waves) are converted back into electrical impulses by the transducer crystals to form
no danger to the ultrasound image presented on the screen.
developing fetus
The computer notes
• the intensity of the echoes
• the position of the probe
• the elapsed for the returning echoes
TO construct an image
– Real time scanning – User dependent
– Highly interactive – Limited depth penetration
– No ionising radiation risk – Limited regional field of view only
– Widely available – Poor resolution
– Relatively cheap
– Measures more than one physical parameter
– Very safe and acceptable to patients
 MAGNETIC RESONANCE IMAGING
Magnetic resonance imaging (MRI) is a type of scan that uses strong magnetic fields and radio waves to produce
detailed images of the inside of the body, including anatomical structure AND biological processes. An MRI scanner
contains large, powerful magnets.

@Patients with
metallic implants
@ Metallic
The human body is mostly water & Water molecules (H2O) contain hydrogen nuclei (protons).
components into
An MRI scanner applies a very strong magnetic field (about 0.2 to 3 teslas, or roughly a thousand times the
pt's body-eg. Knife
strength of a typical fridge magnet), protons align their spins along the applied field.
The scanner also produces a radio frequency current that creates a varying magnetic field, disturbing protons.
The protons’ spin direction are then changed.
> Some diagnosis When the RF field is turned off, the protons gradually return to their normal spin,
can be done with less
this process produces a radio signal, RF waves, that can be measured to form an image
expensive imaging
modality

> availability of
personnel & MRI units Image contrast of MRI depends on
• (a) the longitudinal relaxation time-T1 ( time taken for the displaced nuclei to reach equilibrium)
• (b) the transverse relaxation time= T2 ( time taken for the FID signal of a particular tissue type to decay)
– Excellent contrast – Expensive
– Many different types of contrast can be generated – Requires highly qualified users
– Functional and Anatomical imaging possible – Time consuming
– Very safe – Can cause claustrophobia
– Detection of small lesions – Moderate resolution
– Mostly non invasive contrast is possible – Many artefacts (holding one’s breath)
– Available only in cities

MRI imaging gives excellent contrast between soft tissue,

greatly used by neurosurgeon ; brain aneurysm, stroke,
tumors of the brain, inflammation of the spine , integrity of the
spinal cord, soft tissue injury
HYBRID IMAGING
Fusion of two or more imaging technologies into a single, new form of imaging. (Synergestic - more powerful as Data
is overlayed)

SPECT + CT
biological processes + anatomy of organs

PET+ CT
cellular level changes + anatomy of organs

PET+ MRI
cellular level changes + anatomy & physiological processes
(A) Discuss why all medical examinations are no done
using MRI.
(i) Patients with metallic implants ( not acceptable)
(ii) some of these diagnosis can be done with a least
expensive imaging modality (eg, a small facture on the
waist, hands , -X-ray is cheaper)
(iii) availability of personnel and MRI units.

MRI imaging gives excellence contrast between soft

tissue, greatly used by neurosurgeon ; brain aneurysm,
stroke, tumors of the brain, inflammation of the spine ,
integrity of the spinal cord, soft tissue injury
WHAT ARE THE ADVANTAGES OF DIGITALLY BASED IMAGING
MODALITIES
(i) Digital radiography typically reduces radiation exposure by
(ii)Digital X-ray systems let you control the exposure of each
image in real time by manipulating the image : make images
darker or lighter or enlarge images, make enhancements to
colour and superimpose textures hence improve your ability to
detect disease and its current state.. All this adds up to faster
diagnosis and greater treatment plan acceptance.
(iii)digital images are stored in a database from any networked
computer, directly from the software you use to view the images
can be easily shared with other departments..
(iv) No harmful developing chemicals and fixing solutions for
processing of image. Cost saving because the darkroom for film
processing is eliminated.
(v) Fewer retakes. Images may be viewed immediately and
enhanced as needed.
WHAT WOULD BE THE BEST METHOD OF DETERMINING IF A
PATIENT HAD A VERY SMALL PARTIAL FRACTURE

Imaging of suspected fracture usually begins with plain

radiography (x-ray). Although x-ray will reveal most
fractures, subtle fractures, including those in skeletally
immature children, and some stress fractures may not be
visible immediately on x-ray.
If symptoms of fracture persist, an occult (or hidden)
fracture is suspected. Follow-up x-rays may show a fracture
due to loss of bone around the fracture site during the
healing process. However, if plain x-rays continue to be
negative but clinical suspicion remains, further imaging
tests (i.e., bone scintigraphy, magnetic resonance imaging
[MRI], or computed tomography [CT]) are warranted.