_ RADIOLOGY _ AND IMAGING ' FOR MEDICAL STUDENTS Churchill Livingstone iRadiology and Imaging for Medical Students David Sutton MD FRCP FRCR DMRD M Consulting Radiologist, St Ms Consulting Radiologist, National Hospitals for Neurology and Neurosurgery (Queen Square and Maida Vale), London SIXTH EDITION CHURCHILL LIVINGSTONE EDINBURGH LONDON MADRID MELBOURNE NEW YORK AND TOKYO 19941. Introduction Modern imaging departments use a variety of different techniques to provide images of human internal organs and to demonstrate pathological lesions within them. These techniques can be clas- sified as: 1, Methods using ionising radiation a. Simple X-rays b. Computed X-ray tomography — generally referred to as computed tomography or CT c. Radioisotope scanning — also referred to as nuclear medicine, radionuclide scanning or scintiscanning. 2. Other methods a, Ultrasound b. Magnetic resonance imaging (MRD. Tonising radiation in large doses has well-known dangers, in- cluding carcinogenesis and local tissue damage, but the amounts used in modern imaging practice are minimal and innocuous. X-rays were discovered in 1895 by Conrad Roentgen who was then an obscure German physicist. For some 60 years (until the middle of this century) they provided the only practical method of medical imaging. Isotope scanning was introduced into medical practice in the 1950s and ultrasound in the 1960s. CT was de- veloped in the 1970s and MRI in the 1980s. All these methods advanced rapidly and are now important subspecialties in their own right. X-rays X-rays are part of the so-called electro-magnetic spectrum (Fig. 1.1). ‘These range from wireless waves at the long end of the spectrum to cosmic rays at the short end. Because of their short 1