Introduction to

Radiology
MIRANDA GOGUA MD
TBILILSI
2024
 Etymolo
gy

The term radiology comes from the Latin word – Radius -

meaning ray.
Radiology is a branch of medicine that uses imaging technology to
diagnose and treat disease.

In geometry, a radius means any line from circle

center to perimeter.

In anatomy, a radius is a name of lateral bone of the

forearm.
WHY IS RADIOLOGY SO IMPORTANT?
 Radiology

Treatment Diagnostic

X-Ray, CT, MRI,

Radiation Interventional
Ultrasound,
Oncology Radiology
Nuclear Medicine
Types of imaging tests:
1) Computed Tomography (CT)
2) Magnetic Resonance Imaging (MRI)
3) Positron Emission Tomography (PET)
4) X-Rays
5) Ultrasound (US)
6) Endoscopy
7) Fluoroscopy
8) Radiotherapy and Nuclear Medicine
What are the focused tools?

X-rays
CT
MRI
Ultrasound
α β

• The ionizing radiation symbol.

• Three arrows indicate - alpha,
beta and gamma rays.

�
Ionizing radiation:
� Non-Ionizing radiation:
• X-rays • Visible light
• Alpha rays • Micro-waves
• Beta rays • Radio waves
• Gamma rays
 • Radiographs, which are commonly
called ‘X-rays’, are two-dimensional
images of the body that are displayed as
white, black, or varying shades of gray.

X-
• X-rays are faster, easy to get, and cost
less than other scans, so they may be
used to get information quickly.

RAY
-OBJECTIVES:
• 1. How images are obtained
• 2. Principles of X-ray
• 3. What anatomical structures are well
seen?
 X –ray tube working principle

An x-ray tube functions as a specific The x-ray tube contains two principal
energy converter, receiving electrical elements:
energy and converting it into two other -filament (also acts as cathode): boils
forms of energy: x-radiation (1%) and off electrons by thermionic emission
heat (99%). -target (also acts as anode): electrons
strike to produce x-rays

x-rays are produced in a standard way: by heating a filament, which releases

electrons by thermionic emission, accelerating electrons with a high voltage and
allowing them to collide with the focal spot on the target/anode. X-rays are
produced via two interactions in the anode.
X-rays arise from the target disc at right angles and are focused by a collimator
 How images are obtained?
• Radiographs are images that are obtained
using ionizing radiation.
• The X-rays are emitted from the generator as a
beam and travel through a patient. Tissues
absorb (attenuate) some of the x-rays, while
others pass through and hit the cassette. The
attenuation properties vary among different
tissue types, resulting in a heterogeneous
distribution of X-rays emerging from the patient
to hit the detector (historically called a cassette)
What Anatomical Structures Are Demonstrated Well on Radiography?
• Radiodense structures: bone, calcium, barium and metal.
• Radiolucent structures: air and fat.
• Structures of intermediate density: Fluid and soft tissues like organs and
muscles
Harder to evaluate and differentiate.
They all appear a similar shade of gray
Radiographic
projections:

• AP - Anteroposterior

• PA - Posteroanterior

• Lateral -

• Obliques:- X-rays pass through the body at an angle, neither straight

• nor side-to-side.
 Radiation safety
• Effects of X rays.

• Absorption of photons by biological material leads to breakage of chemical bonds.

• The principal biological effect results from damage to DNA caused by either the direct or
indirect action of radiation.
• Tissue/Organ radiosensitivity
• Gonads
• Fetal cells
• Lymphoid and hematopoietic tissues; intestinal epithelium
• Epidermal, esophageal, oropharyngeal epithelia
• Interstitial connective tissue, fine vasculature
• Neural tissue
• Renal, hepatic, and pancreatic tissue
• Muscle tissue
Radiation safety
• The guiding principle of radiation safety i
s"
ALARA."
ALARA stands for "as low as reasonably
achievable."
• If there is no direct benefit from
receiving a dose, even a small one, it
should be avoided. To do this, you can
use three basic protective measures in
radiation safety: time, distance, and
shielding.
Contrast agents :
-A contrast agent (or contrast medium) is a substance used to increase
the contrast of structures or fluids within the body in medical imaging.
-Iodine and barium are the most common types of contrast agent for X-
ray.
- mostly used for Gastro-intestinal tract imaging
Barium Sulphate (BaSO4) is used during a swallowing test to make certain areas of the body show up
more clearly on an X-ray. Barium is a dry, white, chalky, powder that is mixed with water to make
barium liquid

• Barium sulfate is insoluble in water

 Mammography
• Mammography is dedicated radiographic technique for imaging of breast.
• Screening and diagnostic
• Breast tomosynthesis – 3D mammography , advanced form of breast imaging
where multiple images of the breast from different angles are captured and
reconstructed ("synthesized") into a three-dimensional image set.
• 3 positions : craniocaudal , mediolateral and mediolateral oblique
Cranio-caudal Medio-lateral oblique
The first Computed Tomography scanner was
created by Godfrey Hounsfield and Allan
M.Cormack
The first patient brain-scan was done in 1971.

Godfrey Hounsfield Allan M.Cormack

Both Godfrey Hounsfield and Allan

M.Cormack shared the Nobel Prize in
Medicine in 1979.
Computed tomography - CT
Computed tomography, more commonly known as "cat
scans" or "CT scans", are cross sectional, two
dimensional gray scale images
• They are very commonly used in the practice of
clinical medicine.
• The image shows the bones, organs, and soft tissues
more clearly than standard x-rays and all at the same
time.
• CT scans can show a tumor’s shape, size, and location,
and even the blood vessels that feed the tumor.
-OBJECTIVES:
• 1. How images are obtained
• 2. Factors affecting appearance
• 3. What anatomical structures are well seen
• 4. Indications for use
• 5. Contrast Used
 How images are obtained?
• CT images use x- rays to obtain a thin axial image of the patient- a “slice”.
• To obtain CT images, the beam of x-rays and the x-ray detector circle around the patient,
continuously producing and detecting a thin beam of x-rays that pass through the patient.
• THE CT SCANNER:
I. The patient lies on a table that slowly moves through a circular tube, called the gantry.
II. The gantry houses the generator that produces the x-rays as well as a specialized x-ray
detector. The two are located 180 degrees apart from one another.
III. The generator and detector move in unison around the patient, continuously
transmitting a thin beam of x-rays through the patient.
IV. Those that are not absorbed by the patient are sensed by the detector and transmitted
to a computer.
V. A specialized computer interprets the information from the detector and transforms it
into images, which represent sequential “slices” of the patient.
Etymolog
y of
Imaging
Planes
Axial plane

• The axial plane, also known as the

transverse plane, is a horizontal
plane that divides the body into
superior (upper) and inferior (lower)
sections. The term “axial” comes
from the Latin word “axis”, meaning
“axle” or “pivot”. The axial plane is
named so because it is perpendicular
to the long axis of the body.
Coronal Plane
• The coronal plane, also known as
the frontal plane, is a vertical plane
that divides the body into anterior
(front) and posterior (back)
sections. The term “coronal” comes
from the Latin word “corona”,
meaning “crown” or “garland”.
Sagittal plane
The sagittal plane, also known as the median
plane, is a vertical plane that divides the body
into right and left parts. The term “sagittal”
comes from the Latin word “sagitta”,
meaning “arrow”.
 What anatomical structures are well seen?
• Most anatomic structures are visualized on CT scans, including bone, air,
fluid, fat, and soft tissues.
• All of these structures are better demonstrated on CT than on radiography.

 Indications for Use of CT:

• Brain, chest, bones, abdomen, neck , spine , angiography
• Screening
• Biopsy
 CT – imaging terminology
Densities
• hyperdense
• hypodense
• Isodense

• Hounsfield unit
• Scale -1000 to 1000

• -1000 - is Air
• 0 - is water
• 1000 - is cortical bone
CT windowing
 Contrast Used in CT:
Non-contrast ct scan CT with per-os and IV contrast
coronal slice Coronal slice
 CT – cerebral angiography

with Contrast agent -

ultravist
CT-enterography
Virtual colonoscopy
Ultrasound
• Other names include ultrasonography, sonography, or sonogram.
• Uses high frequency sound waves to create images. ULTRASOUND
• Does not use ionizing radiation, so is low risk to the patient. (US)
• It is non-invasive, relatively inexpensive and portable.
• Allows one to perform "real-time" or "live" imaging and to observe
motion.
• Ultrasound images are not as detailed as those from CT or MRI
scans

• Used for:
I. Any Symptoms such as: pain, swelling and infection.
II. Body's internal organs. In infants  brain, hips, and spine.
III. Guiding procedures such as needle biopsies, in which needles
are
used to sample cells from an abnormal area for laboratory
testing.
IV. Diagnose a variety of heart conditions
-OBJECTIVES:
• Doppler ultrasound images can help the physician to see and
• 1. How images are obtained
evaluate:
• 2. Factors affecting appearance
I. Blockages to blood flow (such as clots) • 3. What anatomical structures are well seen
II. Narrowing of vessels • 4. Indications for use
III. Tumors and congenital vascular malformations • 5. Terms used in US
IV. Reduced or absent blood flow to various organs
 How are the images obtained?
• An ultrasound transducer is placed onto the
patients skin with the gray area in full contact
with the skin. Gel is used between the skin and
transducer to prevent air from intervening
between the two.
• The transducer emits a narrow beam of sound
waves of a specific high frequency. Depending
on the frequency, the sound penetrates the
patient's tissues to a variable depth and are
refracted, scattered, absorbed or reflected. The
reflected waves (called an echo) bounce from
tissues back to the transducer, which also acts
as a sensor, or detector, and are used to
generate the image.
• High frequency sound waves provide high
resolution images, but don't penetrate deeply
into tissues, so are best for superficial
structures. Lower frequency sound waves are
used to image deeper structures, but create
What anatomical structures are well seen?
• The solid organs of the abdomen, including the liver, kidneys and spleen, can
be evaluated well with US.
• Superficial structures (like the thyroid and testicles) can also be evaluated with
ultrasound, with production of high resolution images.
• Deeper structures can't be seen with the same level of resolution
Indications for use?
• Pregnancy  Confirms the presence of an embryo.
In mid pregnancy, a "screening" ultrasound is performed to evaluate for fetal
anomalies.
 Terms used in US:
• Echogenicity:
The characteristic ability of a tissue or substance to reflect sound waves and produ
ce echoes.
Bone and gas are the most echogenic, fluids (such as urine and bile) the least.
Organ parenchyma and soft tissues are intermediate.
• Doppler flow:
-Type of ultrasound that uses sound waves to measure the flow of blood through
a blood vessel.

-Often used when a fetus has intrauterine growth restriction (IUGR), which means
the fetus is smaller than normal for his or her gestational age.
• Structures which in echo appear bright – hyperechoic.

• Structures which in echo appear dark – hypoechoic.

• Structures which in echo appear same as the organ - isoechoic.

Hyperechoic Stones in
Urinary bladder filled with Gallbladder
hypoechoic fluid
MRI
• Called Magnetic Resonance Imaging
• Is a sophisticated method of imaging the body which, unlike CT and
radiography, does not use ionizing radiation.
• MRI scanners use strong magnetic fields, magnetic field gradients, and radio
waves to generate images of the organs in the body
• Images can be obtained directly in the axial, coronal, or sagittal planes, and 3
dimensional volumes of data can also be obtained.
• MRI is better at visualizing soft tissue pathology than CT scan because:
1 ) Minor contrast deviations in soft tissues in the body can be imaged
effectively.
2) Reduces the need for intravenous contrast enhancement.
• MRI is very good at finding and pinpointing some cancers.
• Gadolinium is the contrast material used for MRI.
-OBJECTIVES:
• 1. Factors affecting appearance
• 2. What anatomical structures are well seen
• 3. Indications for use and specialized techniques
• 4. General MRI Terms
• Hydrogen atoms provide the basis for MRI imaging of the body.
Tissues which are abundant in hydrogen atoms, such as water
and fat, are responsible for producing most of the MR signal.
• Tissues which emit a strong MRI signal will appear white on
MRI images and are termed "high signal intensity" and those
which emit a weak MRI signal appear blacker and are termed
"low signal intensity".

What anatomical structures are NOT well seen?

• Air does not give off an MRI signal and produces a void on MRI.
• Air containing structures such as the lung appear black.
• MRI of the bowel is limited due to the presence of intestinal
gas.
 Magnetic Resonance Imaging
ADVANTAGES
These images can be acquired in virtually any plane, although sagittal, coronal,
and axial images are commonly obtained.

 Head and neck angiography

 Pathologies of abdominal organs. (MR cholangiography)
 Pathologies of musculoskeletal system
 Pathologies of pelvic organs (gynecological pathologies, prostate
gland)
 Breast MRI
 Cardiac MRI
• Less risk of contrast allergic reactions.
MRI
Contraindications

• Heart Pacemaker
• Aneurismal Clip
• Cochlear Implant
MRI Sequences:

• T1 weighted sequence
• T2 weighted sequence
• PD weighted sequence
• Gradient & spin echo
sequence
• Fat suppression
• MRI contrast
• Diffusion weighted
image
• In/out-of-phase
Comparison of the sequences
T2
? T1
CAN AI REPLACE A RADIOLOGIST?
Artificial intelligence in radiology
In medical imaging, AI tools are being used to analyze CT scans, x-rays,
MRIs and other images for lesions or other findings that a human
radiologist might miss.
 AI can not replace a radiologist, but
A radiologist who uses AI can replace
The radiologist who doesn’t !
Required Literature :

• Grainger and Allison’s diagnostic radiology , a textbook of medical

imaging , edited by Andreas Adam , Adrian K. Dixon , Jonathan H.
Gillard, Cornelia M. Schaefer-Prokop, 2020. 1-2 volumes
THANK YOU