Imaging Technology

MEDICAL IMAGING
Medical imaging is the technique and process used to create

images of the human body (or parts and function thereof) for
clinical purposes (medical procedures seeking to reveal,
diagnose or examine disease) or medical science (including the
study of normal anatomy and physiology).
Medical imaging is often perceived to designate the set of

techniques that noninvasively produce images of the internal
aspect of the body. In this restricted sense, medical imaging
can be seen as the solution of mathematical inverse problems.
This means that cause (the properties of living tissue) is
inferred from effect (the observed signal). In the case of
ultrasonography the probe consists of ultrasonic pressure
waves and echoes inside the tissue show the internal structure.
In the case of projection radiography, the probe is X-ray
radiation which is absorbed at different rates in different tissue
types such as bone, muscle and fat.
Imaging technology Page 1

Medical radiography
X-radiation is a form of electromagnetic radiation. These 2D

techniques are still in wide use despite the advance of 3D
tomography due to the low cost, high resolution, and
depending on application, lower radiation dosages. This
imaging modality utilizes a wide beam of x rays for image
acquisition and is the first imaging technique available in
modern medicine.
History
Wilhelm Conrad Röntgen is usually credited as the discoverer of

X-rays because he was the first to systematically study them,
though he is not the first to have observed their effects. He is
also the one who gave them the name "X-rays", though many
referred to these as "Röntgen rays" for several decades after
their discovery.
X-rays were found emanating from Crookes tubes,

experimental discharge tubes invented around 1875, by
scientists investigating the cathode rays, that is energetic

electron beams, that were first created in the tubes. Crookes
tubes created free electrons by ionization of the residual air in
the tube by a high DC voltage of anywhere between a few
kilovolts and 100 kV. This voltage accelerated the electrons
coming from the cathode to a high enough velocity that they
created X-rays when they struck the anode or the glass wall of
the tube. Many of the early Crookes tubes undoubtedly
radiated X-rays, because early researchers noticed effects that
were attributable to them, as detailed below. Wilhelm Röntgen
was the first to systematically study them, in 1895.
Among the important early researchers in X-rays were Ivan

Pulyui, William Crookes, Johann Wilhelm Hittorf, Eugen
Goldstein, Heinrich Hertz, Philipp Lenard, Hermann von
Helmholtz, Nikola Tesla, Thomas Edison, Charles Glover Barkla,
Max von Laue, and Wilhelm Conrad Röntgen.
Johann Hittorf
German physicist Johann Hittorf (1824–1914), a coinventor and

early researcher of the Crookes tube, found when he placed
unexposed photographic plates near the tube, that some of
them were flawed by shadows, though he did not investigate
this effect.
In 1877 Ukranian-born Pulyui, a lecturer in experimental

physics at the University of Vienna, constructed various designs
of vacuum discharge tube to investigate their properties. He
continued his investigations when appointed professor at the
Prague Polytechnic and in 1886 he found that that sealed
photographic plates became dark when exposed to the
emanations from the tubes. Early in 1896, just a few weeks
after Röntgen published his first X-ray photograph, Pulyui
published high-quality X-ray images in journals in Paris and
London. Although Pulyui had studied with Röntgen at the
University of Strasbourg in the years 1873–75, his biographer
Gaida (1997) asserts that his subsequent research was
conducted independently.
Nikola Tesla

In April 1887, Nikola Tesla began to investigate X-rays using
high voltages and tubes of his own design, as well as Crookes
tubes. From his technical publications, it is indicated that he
invented and developed a special single-electrode X-ray tube,
which differed from other X-ray tubes in having no target
electrode. The principle behind Tesla's device is called the
Bremsstrahlung process, in which a high-energy secondary X-
ray emission is produced when charged particles (such as
electrons) pass through matter. By 1892, Tesla performed
several such experiments, but he did not categorize the
emissions as what were later called X-rays. Tesla generalized
the phenomenon as radiant energy of "invisible" kinds. Tesla
stated the facts of his methods concerning various experiments
in his 1897 X-ray lecture before the New York Academy of
Sciences. Also in this lecture, Tesla stated the method of
construction and safe operation of X-ray equipment. His X-ray
experimentation by vacuum high field emissions also led him to
alert the scientific community to the biological hazards
associated with X-ray exposure.
Fernando Sanford
X-rays were generated and detected by Fernando Sanford

(1854–1948), the foundation Professor of Physics at Stanford
University, in 1891. From 1886 to 1888 he had studied in the
Hermann Helmholtz laboratory in Berlin, where he became
familiar with the cathode rays generated in vacuum tubes when
a voltage was applied across separate electrodes, as previously
studied by Heinrich Hertz and Philipp Lenard. His letter of
January 6, 1893 (describing his discovery as "electric
photography") to The Physical Review was duly published and
an article entitled Without Lens or Light, Photographs Taken
With Plate and Object in Darkness appeared in the San
Francisco Examiner.
Philipp Lenard
Philipp Lenard, a student of Heinrich Hertz, wanted to see

whether cathode rays could pass out of the Crookes tube into
the air. He built a Crookes tube (later called a "Lenard tube")
with a "window" in the end made of thin aluminum, facing the
cathode so the cathode rays would strike it. He found that
something came through, that would expose photographic

plates and cause fluorescence. He measured the penetrating
power of these rays through various materials. It has been
suggested that at least some of these "Lenard rays" were
actually X-rays. Hermann von Helmholtz formulated
mathematical equations for X-rays. He postulated a dispersion
theory before Röntgen made his discovery and announcement.
It was formed on the basis of the electromagnetic theory of
light. However, he did not work with actual X-rays.
Wilhelm Röntgen
On November 8, 1895, German physics professor Wilhelm

Conrad Röntgen stumbled on X-rays while experimenting with
Lenard and Crookes tubes and began studying them. He wrote
an initial report "On a new kind of ray: A preliminary
communication" and on December 28, 1895 submitted it to the
Würzburg's Physical-Medical Society journal. This was the first
paper written on X-rays. Röntgen referred to the radiation as
"X", to indicate that it was an unknown type of radiation. The
name stuck, although (over Röntgen's great objections) many
of his colleagues suggested calling them Röntgen rays. They
are still referred to as such in many languages, including
German. Röntgen received the first Nobel Prize in Physics for
his discovery.
There are conflicting accounts of his discovery because

Röntgen had his lab notes burned after his death, but this is a
likely reconstruction by his biographers: Röntgen was
investigating cathode rays with a fluorescent screen painted
with barium platinocyanide and a Crookes tube which he had
wrapped in black cardboard so the visible light from the tube
wouldn't interfere. He noticed a faint green glow from the
screen, about 1 meter away. He realized some invisible rays
coming from the tube were passing through the cardboard to
make the screen glow. He found they could also pass through
books and papers on his desk. Röntgen threw himself into
investigating these unknown rays systematically. Two months
after his initial discovery, he published his paper.

Röntgen discovered its medical use when he saw a picture of
his wife's hand on a photographic plate formed due to X-rays.
His wife's hand's photograph was the first ever photograph of a
human body part using X-rays.
Thomas Edison
In 1895, Thomas Edison investigated materials' ability to

fluoresce when exposed to X-rays, and found that calcium
tungstate was the most effective substance. Around March
1896, the fluoroscope he developed became the standard for
medical X-ray examinations. Nevertheless, Edison dropped X-
ray research around 1903 after the death of Clarence Madison
Dally, one of his glassblowers. Dally had a habit of testing X-ray
tubes on his hands, and acquired a cancer in them so tenacious
that both arms were amputated in a futile attempt to save his
life. At the 1901 Pan-American Exposition in Buffalo, New York,
an assassin shot President William McKinley twice at close
range with a .32 caliber revolver. The first bullet was removed
but the second remained lodged somewhere in his stomach.
McKinley survived for some time and requested that Thomas
Edison "rush an X-ray machine to Buffalo to find the stray
bullet. It arrived but wasn't used . . . . McKinley died of septic
shock due to bacterial infection."
Frank Austin and the Frost brothers
The first medical X-ray made in the United States was obtained
using a discharge tube of Pulyui's design. In January 1896, on
reading of Röntgen's discovery, Frank Austin of Dartmouth
College tested all of the discharge tubes in the physics

laboratory and found that only the Pulyui tube produced X-rays.
This was a result of Pulyui's inclusion of an oblique "target" of
mica, used for holding samples of fluorescent material, within
the tube. On 3 February 1896 Gilman Frost, professor of
medicine at the college, and his brother Edwin Frost, professor
of physics, exposed the wrist of Eddie McCarthy, whom Edwin
had treated some weeks earlier for a fracture, to the X-rays and
collected the resulting image of the broken bone on gelatin
photographic plates obtained from Howard Langill, a local
photographer also interested in Röntgen's work.
The 20th century and beyond
A male technician taking a x-ray of a female patient in 1940.

This image was used to argue that exposure to radiation during
the x-ray procedure would be a myth.
The many applications of X-rays immediately generated

enormous interest. Workshops began making specialized
versions of Crookes tubes for generating X-rays, and these first
generation cold cathode or Crookes X-ray tubes were used until
about 1920.
Crookes tubes were unreliable. They had to contain a small

quantity of gas (invariably air) as a current will not flow in such
a tube if they are fully evacuated. However as time passed the
X-rays caused the glass to absorb the gas, causing the tube to
generate "harder" X-rays until it soon stopped operating. Larger
and more frequently used tubes were provided with devices for
restoring the air, known as "softeners". These often took the
form of a small side tube which contained a small piece of
mica: a substance that traps comparatively large quantities of
air within its structure. A small electrical heater heated the
mica and caused it to release a small amount of air, thus
restoring the tube's efficiency. However the mica had a limited
life and the restore process was consequently difficult to
control.
In 1904, John Ambrose Fleming invented the thermionic diode

valve (vacuum tube). This used a hot cathode which permitted
current to flow in a vacuum. This idea was quickly applied to X-
ray tubes, and heated cathode X-ray tubes, called Coolidge

tubes, replaced the troublesome cold cathode tubes by about
1920.
Two years later, physicist Charles Barkla discovered that X-rays

could be scattered by gases, and that each element had a
characteristic X-ray. He won the 1917 Nobel Prize in Physics for
this discovery. Max von Laue, Paul Knipping and Walter
Friedrich observed for the first time the diffraction of X-rays by
crystals in 1912. This discovery, along with the early works of
Paul Peter Ewald, William Henry Bragg and William Lawrence
Bragg gave birth to the field of X-ray crystallography. The
Coolidge tube was invented the following year by William D.
Coolidge which permitted continuous production of X-rays; this
type of tube is still in use today.
ROSAT image of X-ray fluorescence of, and occultation of the X-
ray background by, the Moon
The use of X-rays for medical purposes (to develop into the
field of radiation therapy) was pioneered by Major John Hall-
Edwards in Birmingham, England. In 1908, he had to have his
left arm amputated owing to the spread of X-ray dermatitis.
The X-ray microscope was invented in the 1950s.
The Chandra X-ray Observatory, launched on July 23, 1999, has

been allowing the exploration of the very violent processes in
the universe which produce X-rays. Unlike visible light, which is
a relatively stable view of the universe, the X-ray universe is
unstable, it features stars being torn apart by black holes,
galactic collisions, and novas, neutron stars that build up layers
of plasma that then explode into space.
An X-ray laser device was proposed as part of the Reagan

Administration's Strategic Defense Initiative in the 1980s, but
the first and only test of the device (a sort of laser "blaster", or
death ray, powered by a thermonuclear explosion) gave
inconclusive results. For technical and political reasons, the
overall project (including the X-ray laser) was de-funded
(though was later revived by the second Bush Administration as
National Missile Defense using different technologies).
Technology

X-rays are generated by an X-ray tube, a vacuum tube that
uses a high voltage to accelerate the electrons released by a
hot cathode to a high velocity. The high velocity electrons
collide with a metal target, the anode, creating the X-rays.
To make an X-ray image of human or animal bones, short X-ray

pulses illuminate the body or limb, with radiographic film
placed behind it. Any bones that are present absorb most of the
X-ray photons by photoelectric processes. This is because
bones have a higher electron density than soft tissues. Bones
contain a high percentage of calcium (20 electrons per atom),
potassium (19 electrons per atom) magnesium (12 electrons
per atom), and phosphorus (15 electrons per atom). The X-rays
that pass through the flesh leave a latent image in the
photographic film. When the film is developed, the parts of the
image corresponding to higher X-ray exposure are dark, leaving
a white shadow of bones on the film.
To generate an image of the cardiovascular system, including

the arteries and veins (angiography) an initial image is taken of
the anatomical region of interest. A second image is then taken
of the same region after iodinated contrast material has been
injected into the blood vessels within this area. These two
images are then digitally subtracted, leaving an image of only
the iodinated contrast outlining the blood vessels. The
radiologist or surgeon then compares the image obtained to
normal anatomical images to determine if there is any damage
or blockage of the vessel.
Variations
Two forms of radiographic images are in use in medical

imaging; projection radiography and fluoroscopy, with latter
useful for intraoperative and catheter guidance
* Fluoroscopy produces real-time images of internal

structures of the body in a similar fashion to radiography, but
employs a constant input of x-rays, at a lower dose rate.
Contrast media, such as barium, iodine, and air are used to
visualize internal organs as they work. Fluoroscopy is also used
in image-guided procedures when constant feedback during a

procedure is required. An image receptor is required to convert
the radiation into an image after it has passed through the area
of interest. Early on this was a fluorescing screen, which gave
way to an Image Amplifier (IA) which was a large vacuum tube
that had the receiving end coated with cesium iodide, and a
mirror at the opposite end. Eventually the mirror was replaced
with a TV camera.
* Projectional radiographs, more commonly known as x-rays,

are often used to determine the type and extent of a fracture
as well as for detecting pathological changes in the lungs. With
the use of radio-opaque contrast media, such as barium, they
can also be used to visualize the structure of the stomach and
intestines - this can help diagnose ulcers or certain types of
colon cancer.
Contrast studies: When the density of adjacent tissues is

similar, a radiopaque contrast agent is often added to one
tissue or structure to differentiate it from its surroundings.
Structures typically requiring a contrast agent include blood
vessels (for angiography) and the lumina of the GI, biliary, and
GU tracts. Gas may be used to distend the lower GI tract and
make it visible. Other imaging tests (eg, CT, MRI) have largely
replaced contrast studies as their tomographic images provide
better anatomic localization of an abnormality.
Disadvantages
Diagnostic accuracy is limited in many situations. Other
imaging tests may provide better image detail, be safer or
faster, or have other advantages.
Contrast agents such as barium and gastrografin, if used, have

disadvantages, and IV contrast agents have risks Fluoroscopy
may involve high doses of radiation.

Images
Pulmonary fibrosis may have many appearance. In this case, it

is curvi-linear and runs parallel to the dome of the right hemi-
diaphragm.
2) Colle’s fracture

3) Pneumonia
4)Degenerative knee jt.

Dual-Energy X-Ray Absorptiometry (DEXA)
DEXA stands for 'dual energy X-ray Absorptiometry'. It is a test
that measures the density of bones. Density means how much
of something there is in a certain amount of space. The denser
the tissues, the less X-rays pass through. Air and water are less
dense than solid things such as bone. This is because the
particles which make air and water are not held closely
together. In general, the more dense the bone, the stronger it
is, and the less likely it is to break.
There are two different types of DEXA scanning devices:

• Central DEXA devices are large machines that can
measure bone density in the centre of your skeleton, such
as your hip and spine.
Peripheral DEXA devices are smaller, portable machines that
are used to measure bone density on the periphery of your
skeleton, such as your wrist, heel or finger
Technology
A DEXA scan uses low energy X-rays. A machine sends X-rays
from two different sources through the bone being tested. Bone

blocks a certain amount of the X-rays. The more dense the
bone is, the fewer X-rays get through to the detector. By using
two different X-ray sources rather than one it greatly improves
the accuracy in measuring the bone density.
The amount of X-rays that comes through the bone from each
of the two X-ray sources is measured by a detector. This
information is sent to a computer which calculates a score of
the average density of the bone. A low score indicates that the
bone is less dense than it should be, some material of the bone
has been lost, and is more prone to fracture.
Indication
• A fracture following a minor fall or injury.

• Loss of height due to fracture of a vertebra (back bone).
• Taken steroid tablets for three months or more.
• An early menopause (aged less than 45).
• A history of periods stopping (amenorrhoea) for more than
one year before the menopause.
• Other disorders associated with osteoporosis such as
rheumatoid arthritis or coeliac disease.
• A family history of hip fracture on your mother's side.
• A body mass index of less than 19. (That is, if you are very
underweight.)
Digital radiography

Digital radiography is a form of x-ray imaging, where digital
X-ray sensors are used instead of traditional photographic film.
Advantages include time efficiency through bypassing chemical
processing and the ability to digitally transfer and enhance
images. Also less radiation can be used to produce an image of
similar contrast to conventional radiography.
Digital Radiography (DR) or (DX) is essentially filmless X-ray
image capture. In place of X-ray film, a digital image capture
device is used to record the X-ray image and make it available
as a digital file that can be presented for interpretation and
saved as part of the patient’s medical record. The advantages
of DR over film include immediate image preview and
availability, a wider dynamic range which makes it more
forgiving for over- and under-exposure as well as the ability to
apply special image processing techniques that enhance overall
display of the image. The largest motivator for healthcare
facilities to adopt DR is its potential to reduce costs associated
with processing, managing and storing films. Typically there are
two variants of digital image capture devices. These devices
include Flat Panel detectors (FPDs), and High Density Line Scan
Solid State detectors.
Historical milestones for Digital Panoramic Systems

• 1995 - DXIS, the world wide first dental digital panoramic
X-rays system available on the market, introduced by
Signet (France). DXIS targets to retrofit all the panoramic
models.
• 1997 - SIDEXIS, of Siemens (currently Sirona, Germany)
offered for Ortophos Plus panoramic unit, DigiPan of
Trophy Radiology (France) offered for the OP100
panoramic made by Instrumentarium (Finland).
• 1998-2004 - many panoramic manufacturers offered
their own digital system.
• 2005 - SCAN300FP, of Ajat (Finland) is the last one
offered. It shows the feature to acquire many hundreds of
mega bytes of image information at high frame rate and
to reconstruct the panoramic layer by intensive post
acquisition computing like a computed tomography. The
main advantage is the ability to reconstruct focused

differently. The drawback is the low signal/noise ratio of
primary information which involves much software work
for correction. Also the ability to reconstruct various layers
raises the importance of the geometrical distortions
already high in dental panoramic radiography.
Currently there are several digital systems for panoramic digital
radiology. Some of them are rebranded. Examples: SCAN300FP
of Ajat was or is sold as SuniPan or RetroPan or Panoramic
Corporation pan, DXIS of Signet was or is sold also as of
LightYear, Sigma Biomedics, Panoramic Corporation, AFP Digital
or Bluex, iPan of Schick was or is sold as of Bluex or Panoramic
Corporation, I-MAX of Owandy sold as of Villa, etc.
Magnetic resonance imaging
Magnetic resonance imaging (MRI), or nuclear magnetic

resonance imaging (NMRI), is primarily a medical imaging
technique most commonly used in radiology to visualize
detailed internal structure and limited function of the body. MRI
provides much greater contrast between the different soft
tissues of the body than computed tomography (CT) does,
making it especially useful in neurological (brain),
musculoskeletal, cardiovascular, and oncological (cancer)
imaging.

History
Magnetic resonance imaging is a relatively new technology.
The first MR image was published in 1973 and the first cross-
sectional image of a living mouse was published in January
1974. The first studies performed on humans were published in
1977. By comparison, the first human X-ray image was taken in
1895.
Technology
Unlike CT, it uses no ionizing radiation, but uses a powerful
magnetic field to align the nuclear magnetization of (usually)
hydrogen atoms in water in the body. Radio frequency (RF)
fields are used to systematically alter the alignment of this
magnetization, causing the hydrogen nuclei to produce a
rotating magnetic field detectable by the scanner. This signal
can be manipulated by additional magnetic fields to build up
enough information to construct an image of the body.
The body is largely composed of water molecules which each

contain two hydrogen nuclei or protons. When a person goes
inside the powerful magnetic field of the scanner, the magnetic
moments of these protons align with the direction of the field.
A radio frequency electromagnetic field is then briefly turned

on, causing the protons to alter their alignment relative to the
field. When this field is turned off the protons return to the
original magnetization alignment. These alignment changes
create a signal which can be detected by the scanner. The
frequency at which the protons resonate depends on the
strength of the magnetic field. The position of protons in the
body can be determined by applying additional magnetic fields
during the scan which allows an image of the body to be built
up. These are created by turning gradient coils on and off which
creates the knocking sounds heard during an MR scan.

Diseased tissue, such as tumors, can be detected because the
protons in different tissues return to their equilibrium state at
different rates. By changing the parameters on the scanner this
effect is used to create contrast between different types of
body tissue.
Contrast agents may be injected intravenously to enhance the

appearance of blood vessels, tumors or inflammation. Contrast
agents may also be directly injected into a joint in the case of
arthrograms, MR images of joints. Unlike CT, MRI uses no
ionizing radiation and is generally a very safe procedure.
Patients with some metal implants, cochlear implants, and
cardiac pacemakers are prevented from having an MRI scan
due to effects of the strong magnetic field and powerful radio
frequency pulses.
Uses
MRI is preferred to CT when soft-tissue contrast resolution must

be highly detailed (eg, to evaluate intracranial or spinal cord
abnormalities, inflammation, trauma, suspected
musculoskeletal tumors, internal joint derangement). MRI is
also useful for evaluating the following:
• Vascular imaging: Magnetic resonance angiography

(MRA) is used to image arteries with good accuracy and is
less invasive than conventional angiography. Gadolinium
contrast is sometimes used. MRA can be used to image the
thoracic and abdominal aorta and arteries of the brain, neck,
kidney, and lower extremities. Venous imaging (magnetic
resonance venography) can also be done.
• Hepatic and biliary tract abnormalities: Magnetic
resonance cholangiopancreatography (MRCP) is particularly
valuable as a noninvasive, highly accurate method of
imaging the biliary and pancreatic duct systems.
• Masses in the female reproductive organs: MRI is
used to characterize adnexal masses and to stage uterine
tumors.

• Certain fractures: For example, MRI can provide
accurate images of hip fractures in patients with osteopenia.
• Lytic bone metastases
MRI can also be substituted for CT with contrast in patients with
a high risk of contrast reactions.
Contrast: With MRI, contrast agents may be used to highlight

vascular structures (for magnetic resonance angiography) and
to help characterize inflammation and tumors. The most
commonly used agents are gadolinium derivatives, which have
magnetic properties that affect proton relaxation times. MRI of
intra-articular structures may include injection of a gadolinium
derivative into a joint.
Variations
Diffusion (diffusion-weighted) MRI: Signal intensities are

related to diffusion of water molecules in tissue. This type of
MRI can be used to detect early cerebral ischemia and
infarction and to differentiate intracranial cysts from solid
masses.
Echo planar imaging: This ultrafast technique (images

obtained in > 1 sec) is used for diffusion, perfusion, and
functional imaging of the brain and heart. Its potential
advantages include showing brain and heart activity and
reducing motion artifacts. However, its use is limited because it
requires special technical hardware and it is susceptible to
other artifacts.
Functional MRI: Functional MRI is an imaging technique that

assesses brain activity by location. In the most common type,
the brain is scanned at low resolution very frequently (eg,
every 2 to 3 sec). The change in oxygenated Hb can be
discerned, which estimates metabolic activity. Mechanisms of
various neural mechanisms can be studied in research settings.
Gradient echo imaging: Gradient echo is a pulse sequence

that can be used for fast imaging of moving blood and CSF (eg,
in magnetic resonance angiography). Because this technique is
fast, it can reduce motion artifacts (eg, blurring) during imaging
that requires patients to hold their breath (eg, during imaging
of cardiac and abdominal structures).
Magnetic resonance spectroscopy (MRS): MRS combines

the information obtained by MRI (mainly based on water and fat
content of tissues) with that of nuclear magnetic resonance, or
NMR; NMR provides information about tissue metabolites.
Information on metabolites can help differentiate certain
abnormalities (eg, certain types of tumors).
Perfusion MRI: Perfusion MRI is a method of assessing

relative cerebral blood flow. It can be used to detect an area of
ischemia during imaging for stroke.
Disadvantages
MRI is relatively expensive and may not be available or

available immediately.
Magnetic field: MRI is relatively contraindicated in patients

with implanted materials that can be affected by powerful
magnetic fields. These materials include ferromagnetic metal
(containing iron), magnetically activated or electronically
controlled medical devices (eg, pacemakers, implantable
cardioverter defibrillators, cochlear implants), and
nonferromagnetic metal electronically conductive wires or
materials (eg, pacemaker wires, certain pulmonary artery
catheters). Ferromagnetic material may be moved by the
strong magnetic field and injure a nearby organ; movement is
more likely if the material has been in place < 6 wk (before
scar tissue forms). Ferromagnetic material can also cause
imaging artifacts. Magnetically activated medical devices may
malfunction when exposed to magnetic fields. Magnetic fields
may induce current in conductive materials; this current may
produce enough heat to burn tissues. Whether a specific device
is compatible with MRI depends on the type of device, its
components, and its manufacturer. Also, MRI machines with
different magnetic field strengths have different effects on
materials, so safety in one machine does not ensure safety in
another. The MRI magnetic field is very strong and always on.

Thus, a ferromagnetic object (eg, an O2 tank, a metal pole) at
the entrance of the scanning room may be pulled into the
magnet bore at high velocity and injure anyone in its path. The
only way to separate the object from the magnet may be to
turn off the magnetic field.
Claustrophobia: The imaging tube of an MRI machine is a

tight, enclosed space that can trigger claustrophobia even in
patients without preexisting phobias or anxiety. Also, some
obese patients do not fit on the table or within the machine.
Premedication with an anxiolytic (eg, alprazolam
or lorazepam 1 to 2 mg po) 15 to 30 min before scanning is
effective for most anxious patients. MRI scanners with an open
side can be used. Its images may be inferior to those of
enclosed scanners depending on the field strength of the
magnet, but they are usually sufficient for making a diagnosis.
Patients should be warned that the MRI machine makes loud,
banging noises.
Contrast reactions: Gadolinium derivatives, if used, can

cause headache, nausea, and pain, as well as sensation of cold
at the injection site. However, serious contrast reactions are
rare and much less common than with iodinated contrast
agents. However, in patients with impaired renal function,
nephrogenic systemic fibrosis is a risk. Nephrogenic systemic
fibrosis is a rare but life-threatening disorder that involves the
skin and probably internal organs, resulting in severe disability
or death. For patients with impaired renal function, the
following is recommended:
• Gadolinium should be used only when necessary.

• Before this agent is used, renal function should be
checked (eg, based on patient history or laboratory tests
such as GFR).
• The dose should be as small as possible, and the number
of tests done should be limited if possible. If a second test is
required, it should be delayed about 1 wk.

Images
Normal Anatomy

]

Magnetic resonance cholangiopancreatography (MRCP)
image showing a dilated duct upstream to an intraductal stone
(arrow
Herniated disc

Medical ultrasonography
Introduction
Diagnostic sonography (ultrasonography) is an ultrasound-
based diagnostic imaging technique used to visualize
subcutaneous body structures including tendons, muscles,
joints, vessels and internal organs for possible pathology
or lesions. Obstetric sonography is commonly used
during pregnancy and is widely recognized by the public. There
is a plethora of diagnostic and therapeutic applications
practiced in medicine.
History
United States
Ultrasonic energy was first applied to the human body for

medical purposes by Dr. George Ludwig at the Naval Medical
Research Institute, Bethesda, Maryland in the late 1940s.
English born and educated John Wild (1914-2009) first used
ultrasound to assess the thickness of bowel tissue as early as
1949: for his early work he has been described as the "father of
medical ultrasound".
In 1962, after about two years of work, Joseph Holmes, William

Wright, and Ralph Meyerdirk developed the first compound
contact B-mode scanner. Their work had been supported by
U.S. Public Health Services and the University of Colorado.
Wright and Meyerdirk left the University to form Physionic
Engineering Inc., which launched the first commercial hand-
held articulated arm compound contact B-mode scanner in
1963. This was the start of the most popular design in the
history of ultrasound scanners.
The first demonstration of color Doppler was by Geoff

Stevenson, who was involved in the early developments and
medical use of Doppler shifted ultrasonic energy.

Sweden
Medical ultrasonography was used 1953 at Lund University by

cardiologist Inge Edler and Carl Hellmuth Hertz, the son of
Gustav Ludwig Hertz, who was a graduate student at the
department of nuclear physics.
Edler had asked Hertz if it was possible to use radar to look into
the body, but Hertz said this was impossible. However, he said,
it might be possible to use ultrasonography. Hertz was familiar
with using ultrasonic reflectoscopes for nondestructive
materials testing, and together they developed the idea of
using this method in medicine.
The first successful measurement of heart activity was made on

October 29, 1953 using a device borrowed from the ship
construction company Kockums in Malmö. On December 16 the
same year, the method was used to generate an echo-
encephalogram (ultrasonic probe of the brain). Edler and Hertz
published their findings in 1954.
Scotland
Parallel developments in Glasgow, Scotland by Professor Ian

Donald and colleagues at the Glasgow Royal Maternity Hospital
(GRMH) led to the first diagnostic applications of the technique.
Donald was an obstetrician with a self-confessed "childish
interest in machines, electronic and otherwise", who, having
treated the wife of one of the company's directors, was invited
to visit the Research Department of boilermakers Babcock &
Wilcox at Renfrew, where he used their industrial ultrasound
equipment to conduct experiments on various morbid
anatomical specimens and assess their ultrasonic
characteristics. Together with the medical physicist Tom Brown
and fellow obstetrician Dr John MacVicar, Donald refined the
equipment to enable differentiation of pathology in live
volunteer patients. These findings were reported in The Lancet
on 7 June 1958[23] as "Investigation of Abdominal Masses by
Pulsed Ultrasound" - possibly one of the most important papers
ever published in the field of diagnostic medical imaging.
At GRMH, Professor Donald and Dr James Willocks then refined

their techniques to obstetric applications including foetal head
measurement to assess the size and growth of the foetus. With
the opening of the new Queen Mother's Hospital in Yorkhill in
1964, it became possible to improve these methods even
further. Dr Stuart Campbell's pioneering work on foetal
cephalometry led to it acquiring long-term status as the
definitive method of study of foetal growth. As the technical
quality of the scans was further developed, it soon became
possible to study pregnancy from start to finish and diagnose
its many complications such as multiple pregnancy, foetal
abnormality and placenta praevia. Diagnostic ultrasound has
since been imported into practically every other area of
medicine.
Medical ultrasonography uses high frequency broadband sound

waves in the megahertz range that are reflected by tissue to
varying degrees to produce (up to 3D) images. This is
commonly associated with imaging the fetus in pregnant
women. Uses of ultrasound are much broader, however. Other
important uses include imaging the abdominal organs, heart,
breast, muscles, tendons, arteries and veins.
While it may provide less anatomical detail than techniques

such as CT or MRI, it has several advantages which make it
ideal in numerous situations, in particular that it studies the
function of moving structures in real-time, emits no ionizing
radiation, and contains speckle that can be used in
elastography. It is very safe to use and does not appear to

cause any adverse effects, although information on this is not
well documented. It is also relatively inexpensive and quick to
perform. Ultrasound scanners can be taken to critically ill
patients in intensive care units, avoiding the danger caused
while moving the patient to the radiology department. The real
time moving image obtained can be used to guide drainage
and biopsy procedures. Doppler capabilities on modern
scanners allow the blood flow in arteries and veins to be
assessed.
Technology
1. The ultrasound machine transmits high-frequency
(1 to 5 megahertz) sound pulses into your body using a
probe.
2. The sound waves travel into your body and hit a
boundary between tissues (e.g. between fluid and soft
tissue, soft tissue and bone).
3. Some of the sound waves get reflected back to the
probe, while some travel on further until they reach
another boundary and get reflected.
4. The reflected waves are picked up by the probe
and relayed to the machine.
5. The machine calculates the distance from the
probe to the tissue or organ (boundaries) using the
speed of sound in tissue (5,005 ft/s or1,540 m/s) and the
time of the each echo's return (usually on the order of
millionths of a second).
6. The machine displays the distances and intensities
of the echoes on the screen, forming a two dimensional
image like the one shown below.
In a typical ultrasound, millions of pulses and echoes are sent
and received each second. The probe can be moved along the
surface of the body and angled to obtain various views.
Uses
Medical sonography is used in the study of many different
systems:
Cardiology

Echocardiography is an essential tool in cardiology, to diagnose
e.g. dilatation of parts of the heart and function of heart
ventricles and valves
Emergency Medicine
Point of care ultrasound has many applications in the

Emergency Department, including the Focused Assessment
with Sonography for Trauma (FAST) exam for assessing
significant hemoperitoneum or pericardial tamponade after
trauma. Ultrasound is routinely used in the Emergency
Department to expedite the care of patients with right upper
quadrant abdominal pain who may have gallstones or
cholecystitis.
Gastroenterology
In abdominal sonography, the solid organs of the abdomen

such as the pancreas, aorta, inferior vena cava, liver, gall
bladder, bile ducts, kidneys, and spleen are imaged. Sound
waves are blocked by gas in the bowel; therefore there are
limited diagnostic capabilities in this area. The appendix can
sometimes be seen when inflamed eg: appendicitis.
Neurology
For assessing blood flow and stenosis in the carotid arteries

(Carotid ultrasonography) and the big intracerebral arteries
Obstetrics
Obstetrical ultrasound is commonly used during pregnancy to

check on the development of the foetus.
Ophthalmology
A-scan ultrasonography, B-scan ultrasonography
Urology

To determine, for example, the amount of fluid retained in a
patient's bladder. In a pelvic sonogram, organs of the pelvic
region are imaged. This includes the uterus and ovaries or
urinary bladder. Men are sometimes given a pelvic sonogram to
check on the health of their bladder and prostate. There are
two methods of performing a pelvic sonography - externally or
internally. The internal pelvic sonogram is performed either
transvaginally (in a woman) or transrectally (in a man).
Sonographic imaging of the pelvic floor can produce important
diagnostic information regarding the precise relationship of
abnormal structures with other pelvic organs and it represents
a useful hint to treat patients with symptoms related to pelvic
prolapse, double incontinence and obstructed defecation.
Musculoskeletal
Tendons, muscles, nerves, and bone surfaces
Cardiovascular system
To assess patency and possible obstruction of arteries Arterial

sonography, diagnose DVT (Thrombosonography) and
determine extent and severity of venous insufficiency
(venosonography) Intravascular ultrasound
Other types of uses include:
* Intervenional; biopsy, emptying fluids, intrauterine

transfusion [disambiguation needed] (Hemolytic disease of the
newborn)
* Contrast-enhanced ultrasound
A general-purpose sonographic machine may be able to be

used for most imaging purposes. Usually specialty applications
may be served only by use of a specialty transducer. Most
ultrasound procedures are done using a transducer on the
surface of the body, but improved diagnostic confidence is
often possible if a transducer can be placed inside the body. For

this purpose, specialty transducers, including endovaginal,
endorectal, and transesophageal transducers are commonly
employed. At the extreme of this, very small transducers can
be mounted on small diameter catheters and placed into blood
vessels to image the walls and disease of those vessels.
Therapeutic applications
Therapeutic applications use ultrasound to bring heat or

agitation into the body. Therefore much higher energies are
used than in diagnostic ultrasound. In many cases the range of
frequencies used are also very different.
* Ultrasound may be used to clean teeth in dental hygiene.
* Ultrasound sources may be used to generate regional

heating and mechanical changes in biological tissue, e.g. in
occupational therapy, physical therapy and cancer treatment.
However the use of ultrasound in the treatment of
musculoskeletal conditions has fallen out of favor.
* Focused ultrasound may be used to generate highly

localized heating to treat cysts and tumors (benign or
malignant), This is known as Focused Ultrasound Surgery (FUS)
or High Intensity Focused Ultrasound (HIFU). These procedures
generally use lower frequencies than medical diagnostic
ultrasound (from 250 kHz to 2000 kHz), but significantly higher
energies. HIFU treatment is often guided by MRI.
* Focused ultrasound may be used to break up kidney stones

by lithotripsy.
* Ultrasound may be used for cataract treatment by

phacoemulsification.
* Additional physiological effects of low-intensity ultrasound

have recently been discovered, e.g. its ability to stimulate
bone-growth and its potential to disrupt the blood-brain barrier
for drug delivery.
* Procoagulant at 5-12 MHz

Variations
A-mode: This display mode is the simplest; signals are
recorded as spikes on a graph. The vertical (Y) axis of the
display shows the echo amplitude, and the horizontal (X) axis
shows depth or distance into the patient. This type of
ultrasonography is used for ophthalmologic scanning.
B-mode (gray-scale): This mode is most often used in

diagnostic imaging; signals are displayed as a 2-dimensional
anatomic image. B-mode is commonly used to evaluate the
developing fetus and to evaluate organs, including the liver,
spleen, kidneys, thyroid gland, testes, breasts, and prostate
gland. B-mode ultrasonography is fast enough to show real-
time motion, such as the motion of the beating heart or
pulsating blood vessels. Real-time imaging provides anatomic
and functional information.
M-mode: This mode is used to image moving structures;

signals reflected by the moving structures are converted into
waves that are displayed continuously across a vertical axis. M-
mode is used primarily for assessment of fetal heartbeat and in
cardiac imaging, most notably to evaluate valvular disorders.
Doppler: This type of ultrasonography is used to assess blood

flow. Doppler ultrasonography uses the Doppler effect
(alteration of sound frequency by reflection off a moving
object). The moving objects are RBCs in blood.
Direction and velocity of blood flow can be determined by

analyzing changes in the frequency of sound waves:
• If a reflected sound wave is lower in frequency than the

transmitted sound wave, blood flow is away from the
transducer.
• If a reflected sound wave is higher in frequency than the
transmitted sound wave, blood flow is toward the transducer.
• The magnitude of the change in frequency is proportional
to blood flow velocity.

Changes in frequency of the reflected sound waves are
converted into images showing blood flow direction and
velocity.
Duplex Doppler ultrasonography combines the graphic display

of spectral ultrasonography with the images of B-mode. For
color Doppler ultrasonography, color is superimposed on a
gray-scale anatomic image. The color indicates direction of
blood flow. By convention, red indicates flow toward and blue
indicates flow away from the transducer.
Doppler ultrasonography is also used to evaluate vascularity of

tumors and organs, to evaluate heart function (eg, as for
echocardiography), to detect occlusion and stenosis of blood
vessels, and to detect blood clots in blood vessels (eg, in deep
venous thrombosis).
Disadvantages
Quality of images depends on the skills of the operator.
Obtaining clear images of the target structures can be
technically difficult in overweight patients.
Ultrasonography cannot be used to image through bone or gas,

so certain images may be difficult to obtain.

Images
Large bladder stone
50 year-old male patient referred for ultrasound due to

difficulty passing urine and macroscopic haematuria.
Ultrasound showed a 3.5cm bladder calculus.

Multiple gallstones
45 year old female, a Hepatitis B carrier. Routine scan showed

normal liver but multiple gallstones.

Large BPH and bladder stone

CT Scan
Introduction
CT scanning—sometimes called CAT scanning—is a noninvasive
medical test that helps physicians diagnose and treat medical
conditions.
CT scanning combines special x-ray equipment with

sophisticated computers to produce multiple images or pictures
of the inside of the body. These cross-sectional images of the
area being studied can then be examined on a computer
monitor or printed.
History
CT was discovered independently by a British engineer named
Sir Godfrey Hounsfield and Dr. Alan Cormack. It has become a
mainstay for diagnosing medical diseases. For their work,
Hounsfield and Cormack were jointly awarded the Nobel Prize in
1979.
CT scanners first began to be installed in 1974. Because of

advances in computer technology, CT scanners have vastly
improved patient comfort because they are now much faster.
These improvements have also led to higher-resolution images,
which improve the diagnostic capabilities of the test. For
example, the CT scan can show doctors small nodules or
tumors, which they cannot see on an x-ray.
Technology
CT images are produced by x-ray beams that penetrate a
patient and to varying degrees, strike a detector.
The placement of the x-ray tube relative to the detectors

determines the generation scanner.
The CT process is broken down into three segments: data

acquisition, image reconstruction, and image display.

To acquire data, a generator, gantry, and table are
necessary.
The generator supplies the energy source to the gantry.
The x-ray tube, data acquisition system, collimators, and

detectors are housed in the gantry.
Because the number of exposures typical of a CT scanner

and the high x-ray energy output of those scans, tubes must
be designed to withstand huge amounts of heat.
The amount of heat that the tube can withstand and the
rate at which heat is dissipated are key factors in the cost
specific scanners.
Bean hardening artifacts occur because x-ray beams are not

uniform in energy.
These artifacts alter the image’s Hounsfield values.
Filters are included in most systems to reduce the amount of

low energy x-ray beams to reach the patient.
Source collimators operate like tiny shutters to allow only

thin slivers of x-ray beams to emerge.
The collimators can be adjusted by the operator.
The low scatter radiation in CT scanning is attributed to this

fine collimation.
Detectors are of two general types: pressurized xenon gas

and solid-state crystals.
When a solid-state crystal is struck by x-ray beams it emits

light.
There are advantages and disadvantages to both types of

detectors.

Raw data include all measurements obtained from the
detector array.
Some of these raw data are used in the creation of image

data.
After the raw data are averaged and each pixel is assigned a
Hounsfield number, an image can be reconstructed.
The data that form this image are then referred to as image
data.
These same principles of tomographic imaging can also be

applied to radionuclide scanning, in which the sensors for
emitted radiation encircle the patient and computer techniques
convert the sensor data into tomographic images; examples
include single-photon emission CT (SPECT) and positron-
emission tomography (PET).
Uses
Compared with plain x-rays, the tomographic slices of CT
provide more spatial detail and can better differentiate
between various soft-tissue densities. Because it provides so
much more information, CT is preferred to plain x-rays for
imaging most intracranial, head and neck, spinal, intrathoracic,
and intra-abdominal structures. Three-dimensional images of
lesions can help surgeons plan surgery. CT is the most accurate
study for detecting and localizing urinary calculi.
CT may be done with or without IV contrast. Noncontrast CT is

used to detect acute hemorrhage in the brain, urinary calculi,
and lung nodules, as well as to characterize bone fractures and
other skeletal abnormalities. IV contrast is used to improve
imaging of tumors, infection, inflammation, and trauma in soft
tissues and to assess the vascular system, as when pulmonary
embolism, aortic aneurysm, or aortic dissection is suspected.
Oral or occasionally rectal contrast is used for abdominal

imaging; sometimes gas is used to distend the lower GI tract
and make it visible. Contrast in the GI tract helps distinguish
the GI tract from surrounding structures. Standard oral contrast
is barium-based, but low-osmolar iodinated contrast should be

used when intestinal perforation is suspected or when risk of
aspiration is high.
Variations
Virtual colonoscopy: After gas is introduced into the rectum

via a flexible, thin-diameter rubber catheter, CT of the entire
colon is done. Virtual colonoscopy produces high-resolution 3-
dimensional images of the colon that somewhat simulate the
appearance of optical colonoscopy, hence the name. This
technique can show colon polyps and colon mucosal lesions as
small as 5 mm. It is an alternative to conventional colonoscopy.
CT IV pyelography (CT IVP) or urography: IV contrast is

injected. The procedure produces detailed images of the
kidneys, ureters, and bladder. It is an alternative to
conventional IV urography.
CT angiography: After a rapid bolus injection of IV contrast,

thin-slice images are rapidly taken as the contrast opacifies
arteries and veins. Advanced computer graphics techniques are
used to remove images of surrounding soft tissues and to
provide highly detailed images of blood vessels similar to those
of conventional angiography. CT angiography is a less invasive
alternative to conventional angiography.
Disadvantages
CT accounts for most diagnostic radiation exposure to patients
collectively. If multiple scans are done, the total radiation dose
may be high, placing the patient at potential risk Patients who
have recurrent urinary tract stones or who have had major
trauma are most likely to have multiple CT scans. The risk of
radiation exposure vs benefit of the examination must always
be considered, as the effective radiation dose of one abdomen
CT is equal to 500 chest x-rays.
Some CT scans use IV contrast, which has certain risks If

barium extravasates outside the GI tract lumen, it can induce
severe inflammation; if aspirated, barium can induce severe
pneumonia. Barium can also become hard and inspissated,
potentially precipitating intestinal obstruction. Gastrografin is

safer, but the contrast and images of the GI tract it provides
are not as good.
Images
Normal CT scan
It is worth spending a few minutes familiarising yourself with

the appearances of a normal CT scan. It is much easier to
detect abnormalities once you are accustomed to normal
appearances. The scan below is a slice through the human
brain and you should imagine that you are viewing it as if
looking up from the patient's feet. Therefore, the patient's left
is to the right of the screen. The shape of the ventricles is quite
distinctive and they are shown outlined in green and orange.
The presence of the third ventricle in the midline is one of the
first things to look for. If the third ventricle is either not visible,
or shows signs of shift away from the midline, this suggests
that there is an abnormality. The basal cisterns is the fluid filled
space around the back of the midbrain outlined here in purple.
Blood clots, or swelling of the brain may cause this to become
narrowed, or not visible altogether. Note in this scan, that the

frontal horns of the lateral ventricles are symmetrical, with the
septum between them in the midline
Acute Subdural Hematoma Demonstrating Midline Shift:

Midline shift >5mm
Intracranial haematoma - non evacuated
Cortical contusion >1cm in diameter
Obliteration of 3rd Ventricle (not seen - refer to normal
CT scan)

Acute Subdural Haematoma
Intracranial haematoma - non-evacuated
This scan demonstrates a left sided acute subdural

haematoma. The scan is taken through a slightly higher part of
the brain and shows the bodies of the lateral ventricles. The left
lateral ventricle has been compressed and the midline is
deviating to the right. The right lateral ventricle is actually
slightly larger than normal and this is because the increased

pressure is preventing escape of the cerebrospinal fluid from
that ventricle. Dilatation of the contralateral ventricle like this
indicates that there is very significant pressure on the brain.
This scan would be classified as "Intracranial haematoma - non
evacuated" on the Early Outcome Form
Acute Extradural Haematoma:

Intracranial haematoma - non-evacuated
This scan shows another intracranial haematoma, namely an

extradural. You will note that this haematoma has a concave
shape, a bit like the human lens and this is because it is
occurring between the bone and the dura and is not actually
lying on the surface of the brain itself. The points of attachment
of the dura limit the extension of this haematoma anteriorly
and posteriorly. You can see that there is shift of the midline.
Look at the frontal horns in their relation to the falx cerebri (falx
cerebri is outlined on the normal scan). This scan would be
classified "Intracranial haematoma - non evacuated."
Diffuse Axonal Injury:

One or more petechial haemorrhages within the brain
The presence of petechial haemorrhages is usually an

indication of a very severe primary brain injury. Petechial
haemorrhages tend to occur at the interface of grey and white
matter. It can also occur in the dorsolateral quadrant of the
midbrain at the middle orange arrow, as well as elsewhere

within the brain substance. Note on this scan, that the lateral
ventricles and the third ventricle are visible and there is no
midline shift. It is often a characteristic of diffuse axonal injury,
in which there are numerous petechial haemorrhages that
there is no evidence of brain swelling, or midline shift. This scan
would be classified as showing one, or more, petechial
haemorrhages within the brain.
Cerebral Contusion:
Cortical contusion >1cm in diameter
This is a scan of a patient who has sustained a severe head

injury. There is extensive bruising of the right side of the brain,
showing up as a large, diffuse grey area. You can also see that

there are patches of white within the grey area. This represents
bleeding. The grey area represents swelling (oedema). The
area of the cortical contusion is outlined in purple. You will
normally find a centimetre scale at the right hand side of a CT
scan. This scan would be classified on the Early Outcome Form
as "Cortical contusion - greater than 1cm in diameter.

PET scan
A positron emission tomography (PET) scan is an imaging test
that uses a radioactive substance (called a tracer) to look for
disease in the body.
Unlike magnetic resonance imaging (MRI) and computed
tomography (CT) scans, which reveal the structure of and blood
flow to and from organs, a PET scan shows how organs and
tissues are working.
A PET scan uses radiation, or nuclear medicine imaging, to
produce 3-dimensional, color images of the functional
processes within the human body. PET stands for positron
emission tomography. The machine detects pairs of gamma
rays which are emitted indirectly by a tracer (positron-emitting
radionuclide) which is placed in the body on a biologically
active molecule. The images are reconstructed by computer
analysis. Modern machines often use a CT X-ray scan which is
performed on the patient at the same time in the same
machine.
PET scans can be used to diagnose a health condition, as well

as for finding out how an existing condition is developing. PET
scans are often used to see how effective an ongoing treatment
is.
Technology
Radiotracer - Before carrying out a PET scan, a radioactive
medicine is produced in a cyclotron (a type of machine). The
radioactive medicine is then tagged to a natural chemical. This
natural chemical could be glucose, water, or ammonia. The
tagged natural chemical is known as a radiotracer. The
radiotracer is then inserted into the human body.
When it is inside the radiotracer will go to areas inside the body

that use the natural chemical. For example, FDG
(fluorodeoxyglucose - a radioactive drug) is tagged to glucose
to make a radiotracer. The glucose goes into those parts of the
body that use glucose for energy. Cancers, for example, use
glucose differently from normal tissue - so, FDG can show up
cancers.
Detecting positrons - A PET scan detects the energy emitted
by positively-charge particles (positrons). As the radiotracer is
broken down inside the patient's body positrons are made. This
energy appears as a 3-dimensional image on a computer
monitor.
Indication
PET scans are generally used alongside X-rays or MRI (magnetic
resonance imaging) scans. Doctors use PET scans as a
complementary test to these main ones. They are used to
make a diagnosis or to get more data about a health condition.
As mentioned above, they are also useful in finding out how
effective current treatment is. The use of combined imaging
technologies may hold the key to stopping - and even
preventing - heart attacks, a study revealed.
The biggest advantage of a PET scan, compared to an MRI scan

or X-ray, is that it can reveal how a part of the patient's body is
functioning, rather than just how it looks. Medical researchers
find this aspect of PET scans particularly useful.
PET scans are commonly used to investigate the

following conditions:
• Epilepsy - it can reveal which part of the patient's brain is
being affected by epilepsy. This helps doctors decide on
the most suitable treatments.MRI and/or CT scans are
recommended for people after a first seizure, this study
explains.
• Alzheimer's disease - it is very useful in helping the
doctor diagnose Alzheimer's disease. A PET scan that
measures uptake of sugar in the brain significantly
improves the accuracy of diagnosing a type of dementia
often mistaken for Alzheimer's disease.
• Cancer - PET scans can show up a cancer, reveal the
stage of the cancer, show whether the cancer has spread,
help doctors decide on the most appropriate cancer
treatment, and give doctors an indication on the
effectiveness of ongoing chemotherapy. A PET scan
several weeks after starting radiation treatment for lung

cancer can indicate whether the tumor will respond to the
treatment. This article looks at whether PET scans are
beneficial during cancer diagnosis, staging and
monitoring.
• Heart disease - a PET scan helps detect which specific
parts of the heart have been damaged or scarred. Any
faults in the working of the heart are more likely to be
revealed with the help of a PET scan. A study revealed
how comprehensive diagnosis of heart disease based on a
single CT scan is possible.
• Medical research - researchers, especially those
involved in how the brain functions get a great deal of
vital data from PET scans.
What is difference between a PET scan and CT or MRI
scans?
A CT or MRI scan can assess the size and shape of body organs
and tissue. However, they cannot assess function. A PET scan
looks at function. In other words, MRI or CT scans tell you what
is looks like, while a PET scan can tell you how it is working.
Who should not have a PET scan?

Pregnant women and women who are breastfeeding should not
have a PET scan as there is a risk for the baby. Any woman who
is pregnant should tell her doctor straight away (before the
scan).
Anybody who has just had a PET scan should stay away from
pregnant women, babies and young children for a few hours
after the scan.

Images

PET scan and PET-CT Fusion
PET scan, or Positron Emission Tomography, is a powerful tool

for detecting several types of cancer. It is useful for the
accurate detection of cancer spread in patients with an
established diagnosis of cancer, or for the noninvasive
evaluation of nodules detected by chest x-ray or CT. PET works
by having the ability to detect sites of high metabolic activity.
Since many cancers have significantly higher metabolism than
normal tissues or noncancerous masses, PET allows sensitive
detection of even small cancers.
PET-CT Fusion is a newer refinement of the technique that
allows the most accurate correlation of anatomic information
(from the CT) and metabolic information (from the PET scan)
and helps to ensure the highest degree of accuracy for the
exam.

Biopsy
Removal of tissue for examination under a microscope for the
purpose of diagnosis or therapeutic measure.
Tissue samples for biopsy can be obtained by either surgery or

needle. The doctor should decide the type of biopsy technique

depending on the nature and location of the lump, as well as
the patient’s general health.
Surgical biopsies can be either excisional or incisional
An excisional biopsy removes the entire lump or suspicious

area. Excisional biopsy is currently the standard procedure for
lumps that are smaller than an inch or so in diameter. In effect,
it is similar to a lumpectomy, surgery to remove the lump and a
margin of surrounding tissue. Lumpectomy is usually used in
combination with radiation therapy as the basic treatment for
early breast cancer.
An excisional biopsy is typically performed in the outpatient

department of a hospital. A local anesthetic is injected into the
woman's breast. Sometimes she is given a tranquilizer before
the procedure. The surgeon makes an incision along the
contour of the breast and removes the lump along with a small
margin of normal tissue. Because no skin is removed, the
biopsy scar is usually small. The procedure typically takes less
than an hour. After spending an hour or two in the recovery
room, the woman goes home the same day.
An incisional biopsy removes only a portion of the tumor (by

slicing into it) for the pathologist to examine. Incisional biopsies
are generally reserved for tumors that are larger. They too are
usually performed under local anesthesia, with the woman
going home the same day.
Whether or not a surgical biopsy will change the shape of your

breast depends partly on the size of the lump and where it is
located in the breast, as well as how much of a margin of
healthy tissue the surgeon decides to remove. You should talk
with your doctor beforehand, so you understand just how
extensive the surgery will be and what the cosmetic result will
be.

Needle biopsies
Performed with either a very fine needle or a cutting needle

large enough to remove a small nugget of tissue.
• Fine needle aspiration (FNAC)uses a very thin needle and

syringe to remove either fluid from a cyst or clusters of cells
from a solid mass. Accurate fine needle aspiration biopsy of a
solid mass takes great skill, gained through experience with
numerous cases.
• Core needle biopsy uses a somewhat larger needle with a

special cutting edge. The needle is inserted, under local
anesthesia, through a small incision in the skin, and a small
core of tissue is removed. This technique may not work well
for lumps that are very hard or very small. Core needle
biopsy may cause some bruising, but rarely leaves an
external scar, and the procedure is over in a matter of
minutes.
At some institutions with extensive experience, aspiration

biopsy is considered as reliable as surgical biopsy; it is trusted
to confirm the malignancy of a clinically suspicious mass or to
confirm a diagnosis that a lump is not cancerous. Should the
needle biopsy results be uncertain, the diagnosis is pursued
with a surgical biopsy. Some doctors prefer to verify all
aspiration biopsy results with a surgical biopsy before
proceeding with treatment.
Localization biopsy
Also known as needle localization,this is a procedure that uses

mammography to locate and a needle to biopsy breast
abnormalities that can be seen on a mammogram but cannot
be felt (nonpalpable abnormalities). Localization can be used
with surgical biopsy, fine needle aspiration, or core needle
biopsy.

For a surgical biopsy, the radiologist locates the abnormality on
a mammogram (or a sonogram) just prior to surgery. Using the
mammogram as a guide, the radiologist inserts a fine needle or
wire so the tip rests in the suspicious area -- typically, an area
of microcalcifications. The needle is anchored with a gauze
bandage, and a second mammogram is taken to confirm that
the needle is on target.
The woman, along with her mammograms, goes to the

operating room, where the surgeon locates and cuts out the
needle-targeted area. The more precisely the needle is placed,
the less tissue needs to be removed.
Sometimes the surgeon will be able to feel the lump during

surgery. In other cases, especially where the mammogram
showed only microcalcifications, the abnormality can be neither
seen nor felt. To make sure the surgical specimen in fact
contains the abnormality, it is x-rayed on the spot. If this
specimen x-ray fails to show the mass or the calcifications, the
surgeon is able to remove additional tissue.
Stereotactic localization biopsy
This is a newer approach that relies on a three-dimensional x-

ray to guide the needle biopsy of a nonpalpable mass. With one
type of equipment, the patient lies face down on an examining
table with a hole in it that allows the breast to hang through;
the x-ray machine and the maneuverable needle "gun" are set
up underneath. Alternatively, specialized stereotactic
equipment can be attached to a standard mammography
machine.
The breast is x-rayed from two different angles, and a computer

plots the exact position of the suspicious area. (Because only a
small area of the breast is exposed to the radiation, the doses
are similar to those from standard mammography.) Once the

target is clearly identified, the radiologist positions the gun and
advances the biopsy needle into the lesion.
Tissue Studies
The cells or tissue removed through needle or surgical biopsy

are promptly sent (along with the x-ray of the specimen, if one
was made) to the pathology lab. If the excised lump is large
enough, the pathologist can take a preliminary look by quick-
freezing a small portion of the tissue sample. This makes the
sample firm enough to slice into razor-thin sections that can be
examined under the microscope. A "frozen section" provides an
immediate, if provisional, diagnosis, and the surgeon may be
able to give you the results before you go home.
The results of a frozen section are not 100 percent certain,

however. A more thorough assessment takes several days,
while the pathologist processes "permanent sections" of tissue
that can be examined in greater detail.
When the biopsy specimen is small--as is often the case when

the abnormality consists of mammographic calcifications only--
many doctors prefer to bypass a frozen section so the tiny
specimen can be analyzed in its entirety.
The pathologist looks for abnormal cell shapes and unusual

growth patterns. In many cases the diagnosis will be clear-cut.
However, the distinctions between benign and cancerous can
be subtle, and even experts don't always agree. When in doubt,
pathologists readily consult their colleagues. If there is any
question about the results of biopsy, make sure your biopsy
slide has been reviewed by more than one pathologist.

Images
In this prostate biopsy, malignant glands are seen surrounded

by adipose tissue. This is an example of extraprostatic
extension (EPE). Other examples of EPE that may be
encountered in needle biopsies include tumor adjacent to
pigmented epithelium of seminal vesicle or within skeletal
muscle.

The photomicrograph shows metastatic medullary carcinoma of
breast in an axillary lymph node. Patients with medullary
carcinoma have axillary lymph node metastases less frequently
than those with infiltrating ductal carcinoma of breast.

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MEDICAL IMAGING

Medical imaging is the technique and process used to create

Medical imaging is often perceived to designate the set of

Imaging technology Page 1

X-radiation is a form of electromagnetic radiation. These 2D

Wilhelm Conrad Röntgen is usually credited as the discoverer of

X-rays were found emanating from Crookes tubes,

Imaging technology Page 2

Among the important early researchers in X-rays were Ivan

German physicist Johann Hittorf (1824–1914), a coinventor and

In 1877 Ukranian-born Pulyui, a lecturer in experimental

Imaging technology Page 3

X-rays were generated and detected by Fernando Sanford

Philipp Lenard, a student of Heinrich Hertz, wanted to see

Imaging technology Page 4

On November 8, 1895, German physics professor Wilhelm

There are conflicting accounts of his discovery because

Imaging technology Page 5

In 1895, Thomas Edison investigated materials' ability to

Frank Austin and the Frost brothers

Imaging technology Page 6

The 20th century and beyond

A male technician taking a x-ray of a female patient in 1940.

The many applications of X-rays immediately generated

Crookes tubes were unreliable. They had to contain a small

In 1904, John Ambrose Fleming invented the thermionic diode

Imaging technology Page 7

Two years later, physicist Charles Barkla discovered that X-rays

The Chandra X-ray Observatory, launched on July 23, 1999, has

An X-ray laser device was proposed as part of the Reagan

Imaging technology Page 8

To make an X-ray image of human or animal bones, short X-ray

To generate an image of the cardiovascular system, including

Two forms of radiographic images are in use in medical

* Fluoroscopy produces real-time images of internal

Imaging technology Page 9

* Projectional radiographs, more commonly known as x-rays,

Contrast studies: When the density of adjacent tissues is

Contrast agents such as barium and gastrografin, if used, have

Imaging technology Page 10

Pulmonary fibrosis may have many appearance. In this case, it

Imaging technology Page 11

4)Degenerative knee jt.

Imaging technology Page 12

There are two different types of DEXA scanning devices:

Imaging technology Page 13

• A fracture following a minor fall or injury.

Imaging technology Page 14

Historical milestones for Digital Panoramic Systems

Imaging technology Page 15

Magnetic resonance imaging

Magnetic resonance imaging (MRI), or nuclear magnetic

Imaging technology Page 16

The body is largely composed of water molecules which each

A radio frequency electromagnetic field is then briefly turned

Imaging technology Page 17

Contrast agents may be injected intravenously to enhance the

MRI is preferred to CT when soft-tissue contrast resolution must

• Vascular imaging: Magnetic resonance angiography

Imaging technology Page 18

Contrast: With MRI, contrast agents may be used to highlight

Diffusion (diffusion-weighted) MRI: Signal intensities are

Echo planar imaging: This ultrafast technique (images

Functional MRI: Functional MRI is an imaging technique that