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Medical Physics

Contextual Outline
The use of other advances in technology, developed from our understanding of the electromagnetic spectrum, and
based on sound physical principles, has allowed medical technologists more sophisticated tools to analyse and interpret
bodily process for diagnostic purposes. Diagnostic imaging expands the knowledge of practitioners and the practice of
medicine. It usually uses non-invasive methods for identifying and monitoring diseases or injuries via the generation of
images representing internal anatomical structures and organs of the body.

Technologies, such as ultrasound, compute axial tomography, positron emission tomography and magnetic resonance
imaging, can often provide clear diagnostic pictures without surgery. A magnetic resonance image (MRI) scan of the
spine, for example, provides a view of the discs in the back, as well as the nerves and other soft tissues. The practitioner
can look at the MRI films and determine whether there is a pinched nerve, a degenerative disc or a tumour. The greatest
advantage of these techniques are their ability to allow the practitioner to see inside the body without the need for
surgery.

This module increases students’ understanding of the history of physics and the implications of physics for society and
the environment.

1. The properties of ultrasound waves can be used as diagnostic tools

The use of

This is the 2002 syllabus update

Option 9.6 page 1 G Pitt  gregphy@tpg.com.au

Medical Physics

References
http://www.khwarzimic.org/biomed/us.html
http://www.med.sc.edu:1000/5ultsd.html
http://uwscat.radiology.wisc.edu/tutorial/b­mode_imaging
http://www.ob­ultrasound.net/history.html
http://www.ob­ultrasound.net/history2.html
http://www.ob­ultrasound.net/history3.html
http://www.ob­ultrasound.net/lineararrays.html
http://physicsweb.org/articles/world/15/6/7/1/pw1506071 [PET]

Option 9.6 page 2 G Pitt  gregphy@tpg.com.au

Medical Physics

Why is Ultrasound Done?
[The following notes in blue arial font are directly quoted from the website at the end – they need to be edited]
Ultrasound imaging (also called ultrasound scanning or sonography) is a relatively inexpensive, fast
and   radiation­free   imaging   modality.   Ultrasound   is   excellent   for   non­invasively   imaging   and
diagnosing a number of organs and conditions, without X­ray radiation. Modern obstetric medicine
(for guiding pregnancy and child birth) relies heavily on ultrasound to provide detailed images of
the foetus and uterus. Ultrasound can show fetal development, and bodily function like breathing,
urination,  and movement. Ultrasound is also extensively used for evaluating the kidneys, liver,
pancreas, heart, and blood vessels of the neck and abdomen. Ultrasound can also be used to guide
fine needle, tissue biopsy to facilitate sampling cells from an organ for lab testing (for example, to
test for cancerous tissue). 

Ultrasound imaging and ultrasound angiography are finding a greater role in the detection, diagnosis and
treatment of heart disease, heart attack, acute stroke and vascular disease which can lead to stroke.
Ultrasound is also being used more and more to image the breasts and to guide biopsy of breast cancer.

What A Person Experiences, What to Expect During an Ultrasound Study

1. Patient preparation involves removing any articles of clothing or jewellery surrounding the area to be
imaged. In some cases, the patient may be asked to wear a patient gown.

2. The patient is positioned by the technologist on an examination table. A clear gel (which helps "connect" the
ultrasound transducer to the skin) is applied to the area to be examined, for example the abdomen

3. The technologist then brings the transducer into contact with the skin and sweeps it back and forth to image
the area of interest (e.g the foetal baby). The patient is simply required to relax and stay calm during the
examination.

4. The technologist will ask the patient to get dressed and wait while the ultrasound images are reviewed,
either on film or a TV monitor. In many cases, the technologist or physician reviews the ultrasound images in
real time as they are acquired.

5. After the ultrasound images are reviewed, the patient will be released from the imaging department or
center. In some cases, more images will need to be taken. For more information see "what happens during a
diagnostic imaging examination?"

Option 9.6 page 3 G Pitt  gregphy@tpg.com.au

which can be measured and transformed into an image. for example. high frequency sound waves. These waves are received by the ultrasound machine and turned into live pictures with the use of computers and reconstruction software. liver. Ultrasound is good at non-invasively imaging a number of soft tissue organs without X-rays: * heart * pelvis and reproductive organs * kidneys. 2000 http://imaginis. This transducer produces a stream of inaudible. causing a signature.au . The transducer detects sound waves as they bounce off or echo back from the internal structures and contours of the organs.com. particularly the following points:  Sound is a form of energy produced by vibration in  a medium  A sound wave produces periodic pressure variations in the medium through which it travels  An elastic medium is necessary for the propagation of sound  Sound   propagates   as   a  longitudinal   wave  consisting   of   alternating  compressions  and rarefactions  The speed of sound is different in different media Option 9. gall bladder * eye * thyroid * blood vessels * fetus Updated: November 10. which penetrate into the body. Different tissues reflect these sound waves differently. Color ultrasound image of the kidney What is Ultrasound Good at Imaging? Because high-frequency sound waves cannot penetrate bone or air. The ultrasound process involves placing a small device called a transducer. against the back to image the kidneys. and bounce off the organs inside. against the skin of the patient near the region of interest.6 page 4 G Pitt  gregphy@tpg. pancreas. they are especially useful in imaging soft tissues and fluid filled spaces. The ultrasound transducer combines functions like a stereo loudspeaker and a microphone in one device: it can transmit sound and receive sound. Medical Physics How Does Ultrasound Work? In the 1960's the principles of sonar (developed extensively by the US Defense Department during the Second World War) were applied to medical diagnostic imaging.com/ultrasound/ Background Review the nature and properties of sound from the preliminary course.

 The intensity of the returning echo. The transducer transmits for pulses of ultrasound for only 1% of the time and receives for 99% of the time. mechanical wave with compression and rarefaction of the tissues through which it is travelling. A piezoelectric transducer is used to emit and detect the ultrasound waves. The velocity of propagation of the ultrasound wave depends on the tissue type through which the sound travels. which is beyond the range of audible sound. Ultrasound travels as a longitudinal. The speed of sound in air is 331 m/s and bone is 4080 m/s. Echoes are produced from any tissue interface where a change in acoustical impedance occurs. The speed of sound varies in soft tissue from 1450 to 1540 meters per second (m/s). On these images. Sound frequencies in the range of 2 to 10 megahertz (MHz) are used for diagnostic ultrasound. is determined by (1) the magnitude of the change in the acoustical impedance at the echoing interface Option 9. Frequencies of from 2 MHz to 10 MHz are typically used. Ultrasound is very useful for imaging structures in the body.com.au . the film density is proportional to the intensity of the echo (a more energetic echo would produce a darker or lighter dot on the film). that is the energy returned to the transducer. Medical Physics Introduction and Principles of Ultrasound Ultrasonography is a non­invasive diagnostic procedure used to examine internal organ and soft tissue structure.6 page 5 G Pitt  gregphy@tpg.

6 page 6 G Pitt  gregphy@tpg.com. Option 9. frequencies as high as 10 MHz are commonly used. cells and tissues  It is relatively cheap (compared with other scanning technologies) Disadvantages of using ultrasound  It operates in many planes but not simultaneously and is therefore operator dependent  It is less intuitively interpretable  It is difficult to produce clear images with obese patients (attenuation and reflection from fat)   The presence of air and bone pose problems because their acoustic impedances are so different from soft tissue Describe the properties and production of ultra sound and compare it to sound in normal hearing range Ultrasound is defined as sound having frequencies exceeding 20 kHz (the effective limit of human hearing). Advantages of using ultrasound  It is non­invasive – does not require surgical procedures  Ill patients can be examined without sedation.au . Ultrasound propagates as a longitudinal wave consisting of alternating compressions and rarefactions. In biomedical ultrasound instrumentation. Medical Physics (2) the characteristics of the intervening tissue (3) the normality (perpendicularity) of the interface to the transducer. until the wave passes. The appearance of the echo on the film is also determined by the degree of amplification (gain) applied after the echo has been received by the transducer. and relatively quickly and conveniently  Since sound is non­ionising it does not damage DNA. It is a non­ionising form of energy that propagates through a medium as pressure waves. If the pressure variations were measured they would be seen as very small pressure disturbances rapidly alternating above and below the normal background pressure as the ultrasound wave propagates through the tissue.

  and   this   becomes   more   severe   as   the   ultrasound   frequency   is increased. For examples. and (b) obtain adequate “penetration” in the tissue.6 page 7 G Pitt  gregphy@tpg. Medical Physics One property of a sound wave is its frequency. Medical ultrasound applications have been described that use frequencies from 500 kHz to 30 MHz. tiny catheter tipped probes operating at frequencies as high as  30 MHz. ultrasound devices operate between 3. bats and dolphins utilise ultrasound waves that have frequencies as high as 125 kHz for navigating and sonar visualisation. and ultrasound refers to sound waves whose frequency is above this level. Imaging depth into tissue is limited by attenuation of   the   ultrasound   waves. Other mammals are not nearly as limited as man in terms of the useful sonic frequency range. The exception is for intravascular imagers.com.5 MHz and about 10 MHz.000 cycles per second (20 kHz). The upper limit of human hearing is usually taken to be 20 kHz.   The optimal  ultrasound frequency for any application  represents  a trade off between the need to (a) acquire ultrasound images with a high degree of spatial resolution. For most imaging applications. Audible sounds have frequencies between about 15 cycles per second (15 hertz. the number of oscillations or fluctuations per second in the medium.au . dictating use of higher frequencies. Hz) and 20. Option 9.

 as is generally the case with   diagnostic   devices   (e. Describe the piezoelectric effect and the effect of using an alternating potential difference with a piezoelectric crystal An   ultrasonic   transducer   is   a   generator   of   acoustic   waves   by   converting   magnetic.com.0004 Fat 1450 1. The passage of low­intensity sound through a medium does not affect the medium itself. (2) Linear­sequential arrays that are designed to electronically focus the beam over a rectangular image section. In order to be able to map moving targets.6 page 8 G Pitt  gregphy@tpg.7 Lens of eye 1620 NA Skull Bone 4080 7.   High   intensity   signals.g. New types of transducers have been developed to rapidly scanning beams including (1) Piston­shaped transducers that rotate or move about fixed axes to mechanically steer the beam through a shaped sector. In order to obtain ultrasound images.   thermal   or electrical energy into mechanical energy. such as a beating heart. Even faster scanners required considerable time to generate an ultrasound image.   echocardiograph   sensors.65 Kidney 1560 1.   as   is   the   case   with therapeutic devices. Conversely. An example is the use of ultrasound to heat sore muscles or to disintegrate kidney stones. (3) Linear phased array transducers that are designed to electronically steer and focus the beam at high speed in a sector image format.   and   other   imaging apparatus).62 Blood 1570 1.38 Water 1480 1. Medical Physics The speed of ultrasound is different in different media Velocity of sound in some Biological Materials Velocity of Sound Impedance Material (m/s) (Rayl x 10–6) Air 330 0.   on   the   other   hand.   foetus   monitors. it can also function as a sensor by converting Option 9.63 Brain 1540 NA Liver 1550 1.48 Average Human Soft Tissue 1540 1. it was necessary to manually move the transducer across the specimen area.61 Muscle 1580 1.   affect   the   medium.8 Ultrasound can be classified into two categories: low intensity and high intensity. and consequently only static targets could be effectively scanned. it was necessary to develop rapid means of scanning and to develop real time techniques which would provide instantaneous feedback to the clinical technician of the transducer position and the system settings.au .

 an electric potential occurs across opposite faces of the crystal. The most efficient type of transducer for medical  ultrasound uses  the piezoelectric  effect (discovered by the  brothers  Jacques  and Pierre Curie in 1880).   which carries the advantage if high electromechanical conversion efficiency and low intrinsic losses. thermal or electrical energy.au .com. It is by this principle that a piezoelectric transducer converts an oscillating electric signal into an acoustic wave and vice versa. The properties of PZT can be altered by modifying the ratio of zirconium to titanium and doping with small amounts of other materials such as lanthanum.    Option 9. An   inverse   effect   also   occurs   when   an   electric   field   is   applied   across   the   crystal   to   induce   a mechanical deformation.6 page 9 G Pitt  gregphy@tpg. When a mechanical stress is applied to a quartz crystal.   A   standard   material   is   the   ferroelectric   ceramic   lead­zirconate­titanate   (PZT). The   most   principal   materials   used   for   transducers   in   medical   ultrasound   are   the   ferroelectric materials. Medical Physics acoustic waves into magnetic.

com. The image display is rectangular in shape (Achilles tendon in the lower leg shown in this ultrasound image.au . Disadvantage  –   Wide. These display a wedge or pie shaped image. Curvilinear (Convex Array) Transducers These are curved on their scanning surface. An aperture containing as many as 128 elements is selected to function at a given time. Electronic focusing is used.   flat   contact   surface   requiring   the   acoustic   window   (contact   point   with patient) to be equal in size to the transducer face. This type of transducer is good for scanning the abdomen. produced using a linear array transducer). Advantage – Wide field of view for more superficial structures.  The   curvilinear   or   convex   sector   array   became   popular   and   completely   replaced   the   linear configuration in the late 1980s. while still providing a wide angle deep to the skin. resulting in a slightly divergent beam. Similar to the linear arrays the acoustic beams are focused but not steered. Medical Physics Transducer Types Linear array & curvilinear transducers Linear Array Transducers These have a number of rectangular transducer elements arranged in a line. and the hearts of all animals. Option 9.6 page 10 G Pitt  gregphy@tpg. They have a good ability to scan liver and prostate. The curvilinear array operates in the   same   manner   as   the  linear   array  in   that   the   scan   lines   are   directed   perpendicular   to   the transducer face. The required acoustic window depends on the degree of convexity of the transducer surface but generally has a narrow window at the skin surface. Because of its convex shape. the curvilinear or convex sector array fits better on the abdomen and scans a wider field of view than does a linear­array configuration. Electronic focusing is used. As many as 512 elements constitute a convex sector array in currently available scanners. prostate and thorax of small animals (veterinary ultrasound).

 Lateral resolution of less than 0. a different delayed pulse sequencing of the whole array of elements is required to form the unique interference pattern. Note the small acoustic window – the area through which the ultrasound enters the body at the top Complex ultrasound transducers are being developed for producing real­time 3­D images.au . which moves the transducer away from the skin but provides appropriate acoustic impedance matching. The use of a stand­off pad.com. can help view these structures. Since a unique delay pattern for all the elements is required to produce each scan line. A “wide aperture” array design means that pulses from a large number (say 128) or all the elements are used to form each scan line. At each line. Disadvantage – narrow field of view close to the transducer making structures near the transducer difficult to view. Advantage  – small acoustic window (region through which the ultrasound enters the body) at the skin surface. These simultaneously produce sector scans in many planes.6 page 11 G Pitt  gregphy@tpg. Medical Physics Convex sector systems  are capable  of lateral  resolution on the order of less than 1 mm. Axial resolution of 1 mm is always possible depending on the frequency of the system. Option 9. resulting in a highly focused ultrasound beam perpendicular to the transducer face. Examples of 3­D ultrasound images are shown below.5 mm can be achieved. They also have poorer image resolution than linear transducers due to the divergence of the beam as it travels deeper into the tissues.   Shown  below   are   three examples of the scanning pattern produced by such transducers. while still providing wide angle deep to the skin. High speed digital signal processing permits the   large   amount   of   gathered   data   to  be   assembled   into   a  3­D   image. highly sophisticated computer­controlled electronics are required.

The time difference between each signal element is called a phase difference. The phase difference can also be adjusted to produce a beam that is curved at the transducer face and so a sector shaped scan image may be produced.mov] Reference: http://www. The timing of the signal from each transducer can be altered to steer the beam. suitable for small acoustic windows. Medical Physics Examples of 3­D ultrasound images are shown above Mechanical sector transducers These are the simplest mechanism where a single transducer crystal element oscillates in front of a window or a group of crystals are rotated in a cylinder past a window. Each individual crystal is connected to its own transmitter and receiver channel.html Option 9. [See movie Steering[ultrasound].   however   they   are   more   expensive. Phased array sector transducers Phased arrays are arranged in a similar manner to the linear array.monash. This technique produces a strong reflection from the focus depth. The crystals are stimulated out of phase and consecutively  form a wave front that  propagates  at an angle to the transducer array [figures A­C below]. This permits a clearer image of the target organ to be produced. A liquid coupling medium is in contact with both the crystal and the window. The beam angle and size is controlled electronically. These transducers are focused mechanically and each transducer usually has a single focal range.au/1302www/Lectures/Imaging/Beamsteering. This produces a smaller scan head.com.ecse. and weaker reflections from other depths. except that the elements are much smaller.au . Phased arrays result in better resolution and they have no moving parts compared with   the   mechanical   transducer. or the beam can be focussed to a specific depth.6 page 12 G Pitt  gregphy@tpg.edu.

Option 9. The above diagram shows an end view of a 2­dimensional 96­element ultrasound phased array transducer   suitable   for   3­D   ultrasound   scanning   [NC   indicates   that   no   electrical   connection   is present].6 page 13 G Pitt  gregphy@tpg.   computer­controlled   pulsing   of   the   individual   elements   circuitry.au . the array is like 96 individual ultrasound scanners. focussing in the direction at right angles to the scan plane determines the slice thickness and is accomplished by the use of an acoustic lens. Similar to linear array designs. Each element is a piezoelectric transducer with its own channel. The complexity of the newer designs requires sophisticated. the direction (vector) of each beam can be selected individually. Since the beam path is electronically controlled. Medical Physics The “steered­beam. The panel structure is flat. phased­array” system produces a sequence of pulses along the transducer array producing a beam from each element of the array which has its own unique angle with respect to the transducer face resulting in a sector format.com. This unique advantage over mechanical designs allows the system to perform “simultaneous” B­mode imaging and M­mode or Doppler functions. i. Electronic focussing on both transmit and receive provides a longer focal zone with a narrower beam width than conventional single element designs.e. To produce an image using the data from such an array requires considerable digital signal processing.   high­speed.

com.6 page 14 G Pitt  gregphy@tpg.au . Medical Physics Define acoustic impedance: Acoustic impedance is the product of density and acoustic velocity Z =   is density ( kg m—1) v is velocity of sound in the tissue ( m s—1) Z is acoustic impedance (kg m—2 s—1) Example (from ultrasound ppt) Option 9.

com.6 page 15 G Pitt  gregphy@tpg.drgdiaz.au .com/tables. Medical Physics Identify that different materials have different acoustic impedances http://www.shtml Substance density (kg m –3) Ultrasound velocity Impedance (rayl) (m s –1) water 1000 1540 1540000 Fat 920 1450 1334000 Bone 1810 4080 7384800 White matter (brain) 1040 1541 1602640 Grey matter (brain) 1040 1541 1602640 Muscle 1040 1585 1648400 Blood 1060 1570 1664200 Liver 1065 1549 1649685 Kidney 1040 1561 1623440 Lens of eye 1100 1620 1782000 Skull bone 1910 4080 7792800 Nerve tissue 1040 Cartilage 1100 Bone marrow 1810 Skin 1010 CSF 1010 Option 9.

 For this reason. Some ultrasound penetrates the skull of a foetus. The law of conservation of energy requires that the sum of the reflected and transmitted energies must be equal to the original energy incident on the boundary.   this   can complicate the analysis of the data. the reflected intensity by Ir and the transmitted intensity by It. Medical Physics Ir Z2  Z1  2 Identify that the ratio of reflected to initial intensity is  2 : Io Z2  Z1  When ultrasound meets a boundary between two media with different acoustic impedances. Note that for any reflection to occur. The greater the difference in acoustic impedance. the acoustic impedances of the two media. the greater the proportion of the ultrasound that is reflected (and the lesser the amount that is transmitted through the boundary). Explain that the greater the difference in acoustic impedance between two materials the greater the reflected proportion of the incident pulse Application  of the equation  above to different  pairs of media demonstrates  that the greater the difference in acoustic impedance between two materials the greater the reflected proportion of the incident pulse. The ratio of the reflected intensity of ultrasound at a tissue boundary to the original intensity of the ultrasound at the boundary is equal to the ratio of the square of the acoustic impedance differences to the square of the sum of the acoustic impedances. Because   ultrasound   is   also   refracted   at   a   boundary   between   two   different   tissues.com. The reflection of ultrasound at a boundary is illustrated in the following diagram. must be different. This is shown in the follow two examples of the application of this equation. This is represented by the equation Ir Z2  Z1  2  Io Z2  Z1  2 Describe how the principles of acoustic impedance and reflection and refraction are applied to ultrasound Ultrasound   is   only   reflected   when   it   encounters   a   boundary   between   tissues   having   different acoustic impedances.6 page 16 G Pitt  gregphy@tpg. Option 9. most of the ultrasound energy that encounters bone is reflected back. ultrasound cannot be used to examine internal structure of bone. The incident ultrasound intensity is represented by Io.au . some of the ultrasound energy will be reflected and some will be transmitted. Z 1 and Z2. because the bone of the skull has not calcified – it is a tissue called cartilage (similar to the tissue that gives ears their semi­rigid nature). Because bone has such a high acoustic impedance compared to other tissues. nor can it be used effectively to examine the brain inside an adult skull.

 which produce different data and images.au .com. B scans and phase and sector scans would be used and the reasons for the use of each The   size   of   an   object   that   can   be   imaged   using   ultrasound   depends   on   the   frequency   of   the ultrasound. when an ultrasound is being carried out. Impedance matching between two media results in most of the energy being transmitted through the interface. then most of the ultrasound energy is reflected. For this reason. Ultrasound Scanning Modes Ultrasound can be used in different ways. called modes. If the size of the object is less than about a wavelength. a gel is placed on the skin and the ultrasound probe is moved over this gel. All waves have the property of being diffracted by objects that are opaque to the wave. Clearly the final choice is a compromise between these conflicting criteria. a high frequency needs to be used. low frequency waves should be chosen over high frequency waves. However to obtain a clearer image of smaller structures. the diffraction becomes so significant that very little of the wave reflects back from the surface. with almost no reflection. The gel has an acoustic impedance similar to human tissue. Describe the situations in which A scans. when considered with the diffraction limited resolution results in a dilemma for ultrasonography. Medical Physics   It should be noticed here that if ultrasound strikes a soft tissue boundary of any type travelling from air. In order to produce a clear image of an object deep in the body. or other gas. The term used to describe this process is  impedance matching.6 page 17 G Pitt  gregphy@tpg.   This   limit   experienced   with   ultrasound   is summarised in the following table. The outcome of this is a limit to the resolving ability   when   using   any   wave   to   look   at   an   object. This fact. Option 9. The most important function of the gel is to exclude any air from the region between the transducer and the skin.  Low frequency waves are more effective in penetrating human tissue.

  Principle of A mode Returning echoes produce a vertical displacement of a horizontal time base line displayed on an oscilloscope.6 page 18 G Pitt  gregphy@tpg. This was the first use of ultrasound as it is relatively simple. which is 1540 metres per second. only a single dimension can be recorded.com. A typical A mode (or A scan) is shown in the image below (left) and the central portion of the image on the right. This distance  is  calculated  by determining  the  length  of time  required  for the  echo to return  to the transducer after the transducer sends the original pulse of sound energy. The calculation is based on the average speed of sound in tissue.au . That dimension is the distance of the echoing interface from the transducer. Medical Physics A mode Scans When a single element transducer is used and the transducer is stationary. The amount of displacement is proportional to the amplitude. requiring little signal processing to display the data. Option 9.

After all the echoes are picked up from along the first beam.   delay   between   when   the   transducer   first launched the ultrasound pulse and when it picked up an echo allows the machine to calculate how far the reflecting interface is from the transducer. or to guide biopsy and amniocentesis needles. Another method of creating a two­dimensional image in B mode is the  real time  method. directly over the region to be imaged. If the transducer is moved across the patient's body while all echoes are recorded and maintained on a video screen. very much like the beam of a searchlight. Option 9.   The   exact.  An ultrasound transducer is placed against the patient’s skin surface. and so forth. an array of multiple transducer elements is held in contact with the patient’s body. abnormal fluid accumulation around the heart or lungs.   Interfaces along the way reflect some of the ultrasound   energy  back   to  the   transducer. a two­dimensional image ("B" scan) will be generated (see below) B Mode Scans The most commonly used modality in medical ultrasound is called B­mode imaging.  The transducer sends a very brief pulse of ultrasound into the tissue.   in  turn. As the operator holds the transducer in contact with the skin.   converts  the   energy  of  the reflected   echo   into   electrical   signals.au .     The  transducer. the pulsed beam from an ultrasound transducer is swept throughout the body. solid or cystic structures. Medical Physics When is A Mode used? Typically the A scan is used to examine midline structures in the brain. foreign bodies in the eye. or tomographic views of the plane that the beam was swept across in.6 page 19 G Pitt  gregphy@tpg. the transducer sends a second pulse along a slightly different beam direction into the tissue. In this method.  B scan images are sometimes referred to as contact compound scanning because the transducer is in contact with the patient’s body and the technologist must use a compound or “rocking” motion to create an adequate anatomical display. the image appears live on a video monitor. The pulse travels into the body as a beam.  Like the beam of a searchlight is swept across the night sky. allowing a two­dimensional image to be created. given the known speed of ultrasound in the tissue. essentially in “real­time.   Then another pulse is launched in still a different direction. mapping out reflecting surfaces and forming 2­ dimensional images.com. By   moving   and   manipulating   the   transducer   different   internal   views   are   provided.   which   are   sent   into   amplifiers   and   signal   processing components   of   the   ultrasound   machine.   The   images represent cross­sectional. Echoes are picked up the same way and sent for processing to produce an image. Beams are swept and ultrasound images are formed very rapidly.

 Sometimes it is difficult   to   obtain   this   view   because   of   the   configuration   of   the   patient’s   chest   wall.au .   observe   which   were   made   with   the   contact compound   scanner  and   which   were  made   with  the   “real   time”  machine. When used B scans are used widely with the following investigations being typical applications  Obstetrics/Gynaecology  Urinary system  Liver and other abdomen  Cardiovascular  Breast. which is continuously imaged.   As   you   look   at   the   images. Medical Physics Principle of B mode The   majority   of   scanning   is   performed   in   the   B   Mode   or   Brightness   mode. but the field of view is not as wide as with the contact compound   scanner.   This   produces   a   two   dimensional   representation   of   the   pattern   of returning echoes showing a section through the patient with the dot position relating to the position of the tissue boundary from which the ultrasound was reflected.   Real   time   images   are usually made with a sector scanner so the images will be pie shaped. and this allows evaluation of the movement of some organs.   In   most individuals there is an area in which the heart is in direct contact with the anterior chest wall and Option 9.6 page 20 G Pitt  gregphy@tpg. Real Time or Compound B Mode The B Scan is continuously updated and displayed in real time. Image Examples Cross-sectional image of the heart (real time B mode) This image is a view of the heart sometimes referred to as a four­chamber view. The movement of the object being scanned can be monitored on the image. It is typically used to examine foetal movements and the veins and arteries in the abdomen.   The   returning echoes are displayed on the oscilloscope as dots rather   than   time   related vertical deflections  as   with   an   A   scan.com.   The   intensity   or   brightness   of   the   dot   is   proportional   to   the returning   echo   amplitude. thyroid and spleen The real time display produces a usefully large area. with the image changing as the tissues move in the field of the ultrasound beam.

(real time B mode) Notice the A mode display along the left margin of the image.com. Above is an image of the gall bladder ­ (real time B mode) This has been made with a sector scanner on real time equipment.     The cyst has a relatively flat amplitude   tracing   (A   mode). which produces a strong echo since its acoustic impedance is significantly different from that of the surrounding tissue. if this image were displayed in real time it would be possible to evaluate ventricular wall motion as well as valve dynamics. An untrained observer would make no sense of the image without explanation. This image is made with the echoes being displayed as white spots on a dark background. The cyst is the area showing no internal echoes – this is due to its homogeneous structure.6 page 21 G Pitt  gregphy@tpg. Interpreting ultrasound images requires considerable skill and knowledge. Option 9. Medical Physics this provides an acoustic window through which the sound beam can be directed without being obstructed by intervening. air bearing lung. The image below shows a longitudinal representation of the kidney with a large cyst. As you can see.  Renal cyst . The gall bladder in this study has an abnormally thick wall.au . as the following image demonstrates.   indicating   very   little   reflection   of   the   ultrasound   within   the homogenous cyst.

com.6 page 22 G Pitt  gregphy@tpg. Medical Physics Base of the tongue (B-Scan) The base of the tongue (TO) examined in a sagittal plane (section viewed from the patient’s side) including “landmarks” such as the myelohyoid muscle (MH) and the hyoid bone (HB) used by the doctor to help interpret the image. Option 9.au . The surface (arrows) of the base of the tongue can only be detected using a low frequency ultrasound.

gather. This is an ideal imaging situation since the object of interest is surrounded by fluid. whether they need it or not. Then there is a clear space with no echoes which is the fluid surrounding the foetus. When is echocardiography used? Echocardiography   is   used   to   investigate   the   heart   valve   function. cardiac tumours and obstructions in cardiac blood vessels. A person may not realise they have osteoporosis until they suffer a vertebral fracture when doing ordinary activities such as lifting a bag of groceries. process and analyse information to describe how ultrasound is used to measure bone density Osteoporosis literally means “porous bones”.   The   problem   is   common   in   post­menopausal   women. Bone Density Measurements Syllabus • identify data sources.   although   an   excellent exercise is not weight bearing. The image (above right) shows the entire foetus and is a good demonstration of the clarity with which foetal parts can be shown.6 page 23 G Pitt  gregphy@tpg. In this image you can see the placenta along upper wall of the uterus.   Swimming.au . Echocardiography Principle Pulsed   ultrasound   from   a   transducer   is   used   and   continuous   recording   is   made   of   the   echoes received from the various parts of the heart. running and sports involving running as well as the use of   weights   all   significantly   reduce   the   risk   of   osteoporosis. To determine if a person has osteoporosis it is necessary to measure bone density directly. or break a hip in a fall. Option 9. walking.     Notice the sidewalls of the foetal head marked with crosses. The image below (left) is a trans­axial image through the foetal head. congenital heart diseases including holes in the septum. Lifelong weight bearing exercises. The distance between the marks can be measured and compared to a chart to determine stage of gestation.   but   a   significant number of men also suffer from a loss of bone density. Bones that once were strong typically become fragile as   a   person   gets   older.   Most pregnancies have ultrasound imaging at some time during the gestation. Medical Physics Obstetrics Probably   the   best   known   use   of   medical   ultrasound   imaging   is   related   to   obstetrics.   left   ventricular   function. A. The well­defined foetus is lying on the posterior wall of the uterus with his feet propped up on the placenta.com.

X­ray based methods usually take a bone density measurement of the hip. two soft rubber pads come in contact  with either  side of the  heel. High frequency sound waves are passed through the heel. the better the benefits.  Ultrasound – measurements are taken at the heel Testing Bones With Ultrasound There are several ways to measure bone density. Option 9. with little apparent cause. with the foot placed and comfortably secured in the ultrasound   unit. The earlier and more consistent the load bearing exercise is carried out by a person. The  ultrasound  systems   for testing   osteoporosis  are  smaller   and  less  expensive  than  traditional DEXA systems. Medical Physics Bone mineral density measures the amount of calcium in regions of the bones.com.  The test takes about one minute and is performed in a seated position. especially the hip. During an ultrasound exam. Regular load­bearing exercise is an important way of maintaining healthy bone density levels – even in patients over 60. Two methods are currently used to measure bone density  X­rays (Called DXA or DEXA – “Dual X­ray absorption”) – Measures spine.   It   can   lead   to   bone fractures. Both men and women benefit from such exercise when it comes to maintaining bone density. Bone density decreases in both men and women over the age of 35.au . most of which involve the use of X­ray radiation. spine. Ultrasound is also used to estimate the bone density of the heel. forearm or heel.   No   injections   or   invasive   procedures   are necessary.   The   test   results   are   processed immediately. hip or total body. and the bone density is estimated from the sound waves   transmitted. Loss   of   bone   density   is   a   common   problem   in   post­menopausal   women.  These pads  send and receive high­frequency sound waves through the heel bone.6 page 24 G Pitt  gregphy@tpg. as the heel bone contains a high percentage of the kind of bone most affected by osteoporosis. Bone density testing can measure the amount of bone in different parts of the skeleton and can predict the risk of future fractures and monitor changes in bone mineral density due to medical conditions or therapy.

 DEXA better able to predict bone strength  References http://www.html Option 9.htm http://www.6 page 25 G Pitt  gregphy@tpg.  Ultrasound requires no exposure of the body to ionising radiation (although levels are very low with DEXA – similar to a trans­Australian airline flight during which exposure to X­rays of cosmic origin takes place)  Reproducibility of results using ultrasound however is not quite as good as DEXA   Relative risk for hip fracture predicted as well by ultrasound of the calcaneus as by DEXA of the hip   Fracture prediction is independent of DEXA.spinalman.edu/bonephys/opultra.uk/heelscanning.au .com/imaging/bone.asp http://courses. Medical Physics Assessing the value of ultrasound bone density measurement.htm http://imaginis.  Ultrasound is cheaper than DEXA or quantitative CT.freeserve.washington.com.co. but adding ultrasound to DEXA does not improve prediction   studies show that ultrasound is mainly measuring the bone mass.com/osteoporosis/osteo_diagnose.bonsecours.

Outline some cardiac problems that can be detected through the use of the Doppler effect Blood flow characteristics in the foetal blood vessels can be examined using Doppler ultrasound. Diminished flow.com.  Various ratios of the systolic to diastolic flow are used as a measure of this foetal heart function. The   Doppler   shift   effect   has   been   used   for   a   long   time   in   foetal   heart   rate   detectors. Foetal   blood  flow  is   shown in  the  following  colour   Doppler  image. particularly in the diastolic phase of a pulse cycle (as the heart muscle relaxes) is associated with blood circulation problems in the foetus.au .  Different  colours  and  shades  of  colour  are  further  used  to  show   graphically  the velocity of movement. there is a shift in the frequency. Medical Physics Describe the Doppler effect with respect to sound and how it is used in ultrasonics to obtain flow characteristics of blood flow through the heart Doppler ultrasound scanning is used to image any structure or tissue that pulsates or moves It is based on the principle that whenever the reflector surface moves with respect to the transducer.6 page 26 G Pitt  gregphy@tpg. The blood vessels commonly examined Option 9.   Further developments in Doppler ultrasound technology in recent years have resulted in its increased use in obstetrics in assessing and monitoring the well­being of the foetus. Colour Doppler uses red to show flow or movement towards the transducer and blue to show flow away  from  it.   with  a  schematic   diagram showing the area being scanned.

Medical Physics include the umbilical artery.au .   the direction   and   velocity   of   the   flow   being   represented   by   different   colours.com.   Colour   Doppler   is particularly indispensable in the diagnosis and assessment of congenital heart abnormalities.   The use of colour flow mapping   can   clearly   depict   the   flow   of   blood   in   foetal   blood   vessels   in   a   real   time   scan.6 page 27 G Pitt  gregphy@tpg. the aorta and the middle cerebral arteries. Option 9.

com. Medical Physics Option 9.6 page 28 G Pitt  gregphy@tpg.au .

 However these pictures are far away from being a perfect image of the real body. Option 9. This means information is lost during the process.au .com. A normal X­ray image is a 2­dimensional  projection  of the real three­dimensional object.6 page 29 G Pitt  gregphy@tpg.  it   is   possible  to   look  inside  the human body without cutting it open. Medical Physics The physical properties of electromagnetic radiation can be used as diagnostic tools This is the 2002 syllabus update Introduction In 1895 Wilhelm Roentgen discovered the X­rays. making it difficult to distinguish between different parts of the anatomy on the photograph. This laid the foundation for one of the most important   diagnostic  tools  in   modern  medicine.  Using  X­rays.

 such as barium sulfate (the Option 9. where they were used for both diagnosis and therapy.com. detect foreign objects in the body. is developed. there are many dense tissues. a negative image is produced. which absorb them. When the radiograph. Medical Physics Since   their   discovery   in   1895. They penetrate soft tissues but are stopped by bones. Thus if a photographic plate that is sensitive to X­rays is placed behind a part of the body and an X­ray source is placed in front.  One of the earliest applications of X­rays was in medicine. X­Ray exposure will result in an image of the bones and internal organs. and diagnose diseases. or plate.au . Hip broken as a result of a motor cycle accident [above] To use X­rays for the investigation of other. Images   produced   using   X­rays   can   be   used   to   study  damaged   or  broken   bones. Generally. the tissues must first be made opaque to X­rays. that can also show up unusually light in radiographs.   x­radiation   has   been   a   vital   medical   and   industrial   tool. Tissues that are easily penetrated by X­rays appear dark. less dense tissues of the body. while bones and dense tissues show up as light or white regions. X­rays can also be used to study the structure of living organisms.   inspect   dental cavities. Because of their great penetrating power. patients are asked to drink a mixture containing an opaque substance.6 page 30 G Pitt  gregphy@tpg. such as the gastrointestinal tract. Although bones are the most opaque structures. such as tumours.

Characteristic X-Rays Characteristic X­rays are emitted from the atoms of heavy   elements   when   their   electrons   make transitions   between   inner   electron   shells. Hence engineers have serious problems removing the heat. compared to 2. In modern X­ray tubes the current between the anode and cathode varies from 1 to 500 mA.  X­rays are produced by the rapid deceleration of the electrons when they strike the anode. The X­rays have a range of energies.com.   The characteristic X­rays emission which shown as two Option 9. Exposure times are generally a fraction of a second for conventional  X­rays.6 page 31 G Pitt  gregphy@tpg. A high potential (50 kV ­ 120 kV) is applied between the   anode   and   cathode.e. i.5 A gives 50 kW dissipation in the anode. the maximum energy of an X­ray equals that of the incident electrons.   The   cathode   contains   a   heated   filament. the maximum energy is 80 keV* when 80 kV is applied to a tube.   These   are   accelerated   by   the   high voltage and strike the anode.au . A schematic diagram below shows the relationship between the electric field direction and the direction of the acceleration and velocity of the electrons in the vacuum tube. * An electron volt (eV) is the energy acquired by one electron when it is accelerated across a potential of 1 volt in a vacuum.4 kW maximum from a typical domestic power point. The anode is made from copper to conduct the heat away and it contains a tungsten insert because tungsten has a very high melting point.6 x 10–19 joules. Two schematic views of an X­ray tube are shown in the images above. depending on the application. Medical Physics barium absorbs X­rays strongly).  Only a few percent of the energy of the electrons is converted to X­rays and the remainder is converted to heat. so that the outline of the digestive tract becomes visible with X­rays [above right – notice the spine of the patient] Describe how X-rays are currently produced Modern X­ray tubes consist of a highly evacuated glass or metal tube containing an anode (positive electrode) and a cathode (negative electrode). (Note that 100 kV times 0. It is equivalent to 1.   which   that   produces thermoelectrons   (by   thermionic   emission)   into   the   vacuum.

5 keV. which have been accelerated using potential differences between a few tens to hundreds of kilovolts. and those for the n=3 1 transition are called K­beta X­rays. It is characterised by a continuous distribution of radiation that becomes more intense and shifts toward higher frequencies as the energy of the bombarding electrons is increased. in mammography. that radiation is in the X­ray region of the electromagnetic spectrum. Bremsstrahlung Radiation “Bremsstrahlung” means “braking radiation” and is retained from the original German to describe the radiation which is emitted when electrons are decelerated or “braked” when they are fired at a metal target. Those vacancies will be quickly filled by electrons dropping down from higher levels. For tungsten (W) the characteristic X­ray energy is 69. The bombarding electrons can eject electrons from the inner shells of the atoms of the metal target. the K shell binding energy is 20 keV. which is makes it useful for imaging soft tissue e. X­ray production typically involves bombarding a metal target in an X­ray tube with high­energy electrons. Medical Physics sharp peaks in the illustration in the graph occur when vacancies are produced in the n=1 (or K­ shell) of the atom and electrons drop down from a higher energy­level shell to fill the gap. The graphs show features of Bremsstrahlung radiation from tungsten targets bombarded with electrons of four different energies.6 page 32 G Pitt  gregphy@tpg. and when the energy of the bombarding electrons is high enough. emitting X­rays with sharply defined frequencies associated with the difference between the atomic energy levels of the target atoms. The X­ rays produced by transitions from the n=2 to n=1 levels are called K­alpha X­rays.g.com.au .   Option 9. Accelerated charges give off electromagnetic radiation.  The continuous distribution of X­rays forming the base for the two sharp peaks in the graph is called bremsstrahlung radiation. For molybdenum (Mo).

6 page 33 G Pitt  gregphy@tpg.au . which in turn determines the kinetic energy with which the electrons strike the tungsten anode in the tube. The term “soft X­rays” is applied to X­rays closer to the UV spectrum and “hard X­rays” are those closer to the gamma ray spectrum. These correspond to X­rays produced using an accelerating potential of 12 kV. Option 9. The nature of X­rays produced by an X­ray tube depends on the voltage applied to the tube.com. There is no sharp dividing line within the X­ray spectrum or between soft and hard components and the UV and gamma radiation on either side. Medical Physics     Compare the differences between ‘soft’ and ‘hard’ X-rays X­rays cover a range of the electromagnetic spectrum from ultraviolet to gamma rays. (Many sources state that soft X­rays are produced using potentials up to 20 kV. Sometimes hard X­rays are referred to as gamma rays and vice versa. rather than an intrinsic property of the X­rays such as frequency or wavelength. There is no sharp dividing line or agreed standard.1 nm (frequency less than 3 x 1018 Hz). Higher voltages thus give rise to hard X­rays and lower voltages produce soft X­rays. depending on the context – and the user of the terms. Radiologists often speak about the voltage used in the X­ray tube when categorising X­rays. Soft X­rays are usually defined as X­rays having a wavelength greater than 0. Soft X­rays have longer wavelengths and lower frequencies than hard X­rays.

Medical Physics Gather information to observe at least one image of a fracture on an X-ray film and X-ray images of other body parts    A good broken wrist – of an extreme bike rider! Not only humans get X­rayed though. Note that it is not possible to tell that the tool is inside the patient from this X­ray. on the outside. In this case a second X­ray was used to confirm that it was indeed inside the patient. The same image could be produced if it was lying above or below the patient. Things weren’t going exactly as expected. The big question remains… how could this happen? Option 9.com. This is an interesting image because the surgical tool is inside the patient – who had been stitched back up and was recovering after the surgery.au . and this x– ray showed why. The patient was returned to the operating theatre to have the tool removed.6 page 34 G Pitt  gregphy@tpg.

6 page 35 G Pitt  gregphy@tpg. in which three dimensions have been projected into two. Option 9. A good knowledge of anatomy is needed to interpret X­rays.au . Medical Physics The depth perception problem is also evident in this X­ray.com.

“He’ll joke around with his glass eye and pop it out. After weighing their options.” said Dr Paul Ludlow.” Ben Hunt told the Sierra Sun newspaper of Truckee. Chris Hunt.au . and put my other hand in the back of my head and felt it coming through the back of my head. Ben Hunt said. but after a few minutes of drilling. “We would have cut it off. And so we just put down our blade and twisted the bit. and nephew. lost   an   eye   but   survived   the   freak   accident   on August 15 with no brain damage after falling from a ladder and onto the drill.” his nephew Ben Hunt said.” Doctors explained that the drill bit pushed his brain aside rather than pushing into it. the surgeon who performed the operation. “It’s just going to be one of those stories. up to my eye. we noticed that it was loose. The Sydney Morning Herald. The construction worker from Truckee.” he said. Option 9. the two­metre ladder Ron Hunt was standing on started to wobble so he tossed the drill aside ­ as construction workers are trained to do. Ben. Nevada. met him in a hospital emergency room in Reno. His nephew thinks he’ll be able to laugh about it some day.  While drilling above his head on August 15. Medical Physics An Unusual Case X-ray of Ron Hunt's head.” AP Copyright © 2003. seeing him with a drill bit through his head.” Ron Hunt told ABC’s “Good Morning America” TV show today. “It didn’t seem possible for him to be alive. “And that’s where pretty much the shock set in. Photo: AP Ron   Hunt’s   friends   and   family   have   been   calling him the “Miracle Man” ever since an 45­centimetre­ long drill bit poked through his eye and out the back of his skull.6 page 36 G Pitt  gregphy@tpg. and I let the drill go down.” Ben Hunt told the Sierra Sun. I wasn’t sure what to feel. “By the time I was falling.8 cm diameter chip auger drill bit was still in his head when his brother. California. The 3.com. “The nurses braced us for it before we saw him. “It didn’t seem real ­ it seemed like a movie. He then fell off the ladder face­first and onto the drill.” He was taken by helicopter to Washoe Medical Centre in Reno. I was already on top of it. “I ran my hands up the drill bit. doctors essentially unscrewed the bit to remove it. which likely would have caused serious brain damage or death.

edu/dmg/projects/alligator/html/ct_info.html The invention of the X­ray provided medicine with a non­destructive means of studying the interior of the body. During the 1970s. Unfortunately.edu/synapsids/rowe/thrinax. In this technique.geo.ctlab.htm http://www.com/Procedures/3DCT/ http://www. a specific plane of the patient is traversed by a narrow sector­shaped x– ray beam.bocaradiology.au . http://www.   Option 9.6 page 37 G Pitt  gregphy@tpg. which show a 2­D image perpendicular to the propagation direction of the X­rays.ucmp.berkeley. this problem was solved by the development of computed tomographic or “CT” scanning.utexas. because objects in 3D are layered one on top of the other in the 2D image. Medical Physics Explain how a computed axial tomography (CAT) scan is produced NB The HSC syllabus uses the acronym CAT.com. as opposed to conventional X­ ray images.  The word “tomography”  relates  to the formation of a “slice”  or 2­D image produced parallel to the plane in which the X­ray beam propagates. but CT (Computerised Tomography) is the more common  acronym. the conventional radiograph images are difficult to interpret in three dimensions.

 and hence construct a two­dimensional image of the corresponding slice through the patient’s body. Compare the resulting CT X­ray image with a photograph of a chest cross­section (from the visible human project website). Sequential sections can be linked by means of animation software to simulate the passage of the specimen through a fixed plane. Medical Physics The   Computerised   Tomography   Scanner   (CT)   produces   a   sector­shaped   X­ray   beam. A series of cross­sectional images is usually produced   by   moving   the   patient   in   small increments through the scanner.   which   is rotated around the body. [see movie file] Option 9. The original intensity of the X­ray beam is compared with the collected data. CT uses the effect of differential absorption of X­rays in tissues of different density. collecting data via the detectors from many different angles as the X­ray source rotates around the target. which are scattered and attenuated as they pass through the body.au . By measuring the attenuation at different angles and using a mathematical algorithm. The images are   often   displayed   simply   as   consecutive slices as shown in the following image. The beam is very narrow in the direction perpendicular to the sector being scanned.com. Digitised information on the attenuation of the X­rays passing through the illuminated plane at various angles. Absorption of the X­rays varies as the angle is changed. and at various times during rotation  is collected and stored. An X­ray source emits photons. it is possible to calculate the distribution of tissue density.6 page 38 G Pitt  gregphy@tpg. On the opposite side an array of detectors measures the X­ ray intensity. CT is an accurate and valuable imaging technique. The CT Scanner is about 100 times more sensitive than a conventional X­ray machine.

 Compare this image with the conventional X­ ray of a patient’s skull.au .    Check out the website indicated for a movie showing the rotation of this 3­D image created using computerised digital image manipulation. Consequently.uk/mgi/vis­ct. A   sequence   of   images   can   be   digitally   processed   to   produce   a   three­dimensional   image. The image below [left] shows the lungs of a patient.ac.e.htm Option 9. the brain). Observe that the conventional X­ray shows no soft tissue detail (i.   or sometimes the X­ray beam scans the patient so that it follows a path having the shape of a helix. Further examples of 3­D CT can be seen at http://www. data obtained in this way may be manipulated and transmitted to facilities or medical personnel outside the scanning facility.com. Digital   information   generated   by   these   machines   is   stored   in   standard   exportable   file   formats.6 page 39 G Pitt  gregphy@tpg.medphys.     Many such images can be combined using computer image manipulation techniques to produce a 3­ dimensional image. Medical CT scanning facilities generally obtain slice widths of 700 microns or 1400 microns. Medical Physics The usefulness of CT scans is influenced by two issues: image resolution and the ease with which data can be exported and analysed. Images of objects smaller than the slice width are generally poorly resolved.ucl. Resolution is a function of the thickness of the slice illuminated by the X­ray beam. CT also has the advantage over conventional X­rays of being able to produce images of soft tissues.

Just for general interest Option 9. Medical Physics The image above (left) shows a number of different tissue types (soft tissue.com.au . muscle and bone) in a single image produced by selective analysis of the gathered data to produce different sections through the patient. A CT X-ray machine is shown on the right.6 page 40 G Pitt  gregphy@tpg.

  a   3–D analogue of a pixel Option 9.e.au .com. Medical Physics Shaded   surface   rendering   (left)   only   uses   the first defined voxel* as the surface of the bone (adjacent   images   –   left)   producing   an   image [below left] that  shows external 3D relationships well  fails   to   show   features   hidden   beneath   the bone surface Shaded   volume   rendering   (adjacent   images right) uses the entire data set.6 page 41 G Pitt  gregphy@tpg.  The image conveys more information   The contributions of each data set voxel are summed   May  be  viewed   in  any   plane  or  projection and in a range of opacity from transparent to opaque  *   a   voxel   is   a   volume   element   –   i.

 which lies between these two extremes.au . A clear understanding of anatomy is required to correctly  interpret this  picture. The CT image shows a thin slice through the body. which ultrasound cannot do because the relatively high acoustic impedance of bone results in the ultrasound being almost totally reflected from the bone. In contrast. its use is a clear advantage when doctors need to make an assessment of soft tissue in the body. Structures overlying others are seen as being superimposed on the underlying structures in the final image. conventional X­rays always show 2­D image of everything that the X­rays pass through. since ribs at the front of the body and the back are superimposed on the photograph. CT and Ultrasound can both produce true 2­D images representing slices through the body. A second advantage of CT over a conventional X­ray is the true 2­D nature of the CT image. Conventional X­rays do not produce useful images of soft tissue. Medical Physics Describe circumstances where a CAT scan would be a superior diagnostic tool compared to either X-rays or ultrasound Since CT can produce images of soft tissue. The following chest X­rays shows this feature.com.6 page 42 G Pitt  gregphy@tpg. The benefits of CT over ultrasound are that  CT can be used to image bone. so that no internal features of the bone are discernible  CT can be used to image tissue underlying bone. whereas ultrasound is reflected from the bone surface and nothing beyond it is visible  CT has better resolution that ultrasound. This can be clearly seen in preceding X–ray images. along with the heart. so finer detail is visible using CT than US Option 9.

fig (I) fig (II) fig (III) fig (IV) fig (V) fig (VI) In the following diagram. the light in the prism meets the interface at the critical angle ic. This situation commonly applies to light travelling in a transparent liquid or solid medium when it meets an interface of that medium with air. For light travelling from a medium into a vacuum (or air as a close approximation). the critical angle is defined as: Option 9. exceeds the critical angle. Medical Physics Explain how an endoscope works in relation to total internal reflection Total Internal Reflection Review from Preliminary Module: The World Communicates Recall the path of light travelling from one medium to another.au . all of the light will be reflected back into the medium.com. If the angle of incidence is other than zero (perpendicular to the boundary surface). in which case. with none passing through the interface. the light’s velocity changes. the angle at which the refracted ray travels parallel to the interface after refraction. Note that each of the paths in figures I–III are reversible as indicated below.6 page 43 G Pitt  gregphy@tpg. The critical angle is also defined for light passing from one transparent medium to another of lower refractive index (n1). causing refraction to occur. i. the critical angle is calculated from the relationship: 1 Sin(ic) =  n Note   that   a   critical   angle   only   exists   when   a   ray   of  light   is   travelling   in   a   medium   of  higher refractive index when it meets a boundary with a medium of lower refractive index. If the angle of incidence.

Option 9. [Watch Quantum video – Ulcer] Basics of Fibre Optics The structure of a typical optical fibre is shown in the diagram above (right). A bundle of optical fibres is used to both transmit light to the site of the examination. Core the inner light­carrying member. Light rays travel straight lines between optical elements.6 page 44 G Pitt  gregphy@tpg. Medical Physics n1 sin(ic) =  n2 [note that the sine ratio must bde less than 1 and hence critical angle only has meaning if light is travelling from a medium of higher to a medium of lower refractive index.  Light entering one end of the optical fibre is transmitted along the optical fibre by total internal reflection. which can reflect or bend (refract) them. as well as transferring the image back from inside the patient. Cladding the middle layer. It is a picture of a gastric ulcer. It must have a lower refractive index than the core. Buffer the outer layer serving to protect the core and cladding from damage. The following image (below left) is a typical example of an image produced using this technique. This is illustrated in the following diagram. which serves to confine the light to the core. the cladding and the protective buffer.com.au . The concentric layers of an optical fibre include the light­carrying core. Fibre Optics The phenomenon of total internal reflection is the basis of endoscopy. This is the process by which medical practitioners are able to use visible light to conduct an internal examination of a patient’s body.

Refractive Index and Total Internal Reflection in Optical Fibres The most important optical measurement for any transparent material is its refractive index (n). Minimally invasive surgery is conducted using optical fibre instruments to see inside the body. Optical   fibre   technology   is   used   extensively   as   a   means   of   communication   for   cable   TV. Although light travels in straight lines through homogeneous optical materials. so the refractive index has a value greater than 1. light is bent at the surface. Medical Physics Most optical fibres used for communications purposes transmit light in the near infrared light at wavelengths   of   800–1600 nm. homogeneous.au . high transparency glass. and computer data. The speed of light in a material is always slower than in vacuum. It is this phenomenon of total internal reflection that keeps light confined in optical fibres and is the basic principle underlying the operation of an optical fibre.0. Homogeneity is an important property of the fibre because any irregularities would distort and degrade the image. Fibres   used   in   medical   endoscopy   must   be   able   to   transmit   light   in   the   visible   region   of   the spectrum. Optical fibres are also used in a variety of medical instruments used for visual examination inside the body through a bundle of optical fibres inserted through a small opening.com. the light will undergo total internal reflection and be bounced back into the glass.  being internally reflected each time. This happens because of the refractive index change at the interface between the media. telecommunications. nevertheless endoscopic fibres are made from high quality. the fibres do not have to have the same transparency as fibres used for communication technology. Option 9. Medical instruments using optical fibres include endoscopes. The refractive index is the ratio of the speed of light in vacuum to the speed of light in the medium:  c n vm where c is the speed of light in vacuum and vm is the speed of light in the medium. arthroscopes and laproscopes. Because of the short distances involved (usually less than about two metres). A common example is the replacement of the anterior cruciate ligament in the knee. where the sine of the angle equals 1.6 page 45 G Pitt  gregphy@tpg.   The   silica   glass   used   for   most   fibres   is   transparent   at   these wavelengths. The  light   will  thus   propagate  along  the  fibre. When the angle of incidence exceeds a critical value.0. as shown in the figure below.  bouncing  from  side  to  side  as  it  does   so.

Medical Physics

  

   
Images showing a normal anterior cruciate ligament (ACL) and a repaired ACL
This part of the anatomy is frequently torn in sports such as netball and football, which involve
vigorous twisting forces on the knees.
Discuss differences between the role of coherent and incoherent bundles of fibres
in an endoscope
If, in an optical fibre bundle, all of the fibres are parallel along the full length of the bundle, so that
there is a one­to­one correspondence between the positions of the fibres at one end of the bundle
and the positions of the opposite ends of each fibre at the other end of the bundle, then the fibre
bundle is said to be coherent.
The light from an object projected onto the ends of the fibre bundle by a simple lens will travel
along the fibres, emerging as a corresponding image of the object, visible at the other end of the
bundle. This is the principle of the medical endoscope.
In a non­coherent fibre bundle, one or more of the fibres swap positions relative to each other at
opposite ends of the fibre. Typically, the arrangement of fibres along the bundle is random, so
although the light travels along each fibre, as with a coherent bundle, no image is produced at the
exit end.

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Medical Physics

The arrangement of fibres in a coherent bundle The   arrangement   of   fibres   in   a   non­coherent
is   represented   schematically   in   the   diagram bundle   is   represented   schematically   in   the
below. diagram below.

A non­coherent fibre bundle is used to transmit light to the point where observations are being made
with the endoscope.
White light is used so that the doctor can observe the tissues in real colour.

Explain why different types of optical fibres will affect the image produced by an
endoscope
A coherent bundle of fibres is essential in the transmission of the image. A lens at the distal end (the
end opposite to the eyepiece, or camera) focuses an image of the area being observed onto the end
of the fibre. The coherent bundle sends this image to the other end of the fibre through the process
of total internal reflection. The coherent bundle is necessary to ensure that the integrity of the image
is maintained from one end to the other.  Each fibre in the bundle effectively transmits a pixel from
one end to the other.

Explain how an endoscope is used in observing internal organs:
The endoscopic tube that is inserted into the patient typically has the following components.
 Fibres to transmit light to the point of observation. This may be a non­coherent bundle since the
light is being used only to illuminate the observation site.
 Fibres to carry the image back to the observer from the tissue being observed
 A system of lenses – the part that is inserted into the patient has a lens system to focus an image
of the tissues under examination onto the optical fibre bundle. At the other end of the optical
fibre bundle, more lenses allow direct viewing of the image with the eye, or connection to a
video/computer monitor.
 Suction tube to remove blood and other loose tissue material from the area under inspection so
that the desired tissue can be clearly seen.
 A salt water inlet and outlet permitting the area under observation to be flushed with clear saline
solution to increase visibility

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Medical Physics
 Control lines to manipulate the tube inside of the patient. These vary in complexity depending
on   the   task   undertaken.   A   simple   gastroscopy   may   not   require   complex   controls   however
endoscopes used for surgical procedures may require fine control over the position of the lens at
the tissue end.
 Miniature remote controlled surgical instruments may be present, ranging from simple suction
tools (below) to more elaborate surgical tools used in operative procedures.

Advantages of Endoscopy
 The tissues are seen in real colours
 The process takes place  in real time, enabling the doctor to intervene in the process at any
time
 The process is minimally invasive compared with open surgery
 The process uses non­ionising radiation, namely light, an advantage over X­rays
 Used   in   conjunction   with   remotely   operated   miniature   surgical   instruments,   minimally
invasive surgical procedures can be performed and this is safer for the patient and allows
them to leave hospital in a shorter time than with conventional surgery
Disdvantages of Endoscopy
 The process must be done in real time and is time consuming compared with ultrasound, X­
rays
 The process presents minor risks to the patient, especially if surgical endoscopy is used and
an anaesthetic is required
 Only the surface of tissues is visible
Explain how an endoscope is used in obtaining tissue samples of internal organs
for further testing
A   common   use   for   endoscopes   is   the   removal   of   tissue   samples   for   testing,   for   example   to
determine whether a growth is malignant or not. This is called a biopsy. Typical examples include
the removal of polyps or other growths from the intestine. The endoscope is used particularly for
the removal of tissue samples from the abdomen. Surgery in this part of the body has a significant
risk associated with it because of the chance of intestinal bacteria infecting the abdomen if the

Option 9.6 page 48 G Pitt  gregphy@tpg.com.au

Either suction or pumping methods are used to clear the Option 9. thousands of fibres are fused into a solid block. temperature. and light hitting that material is reflected back into the core. These optic plates are used for image transfer from a cathode-ray tube to a permanent photographic recording. Other applications include the simple transmission of light for illumination in awkward places. The following image shows a cutting device inserted into the abdomen to obtain a biopsy. as in medical endoscopes. Endoscope An endoscope is a tubular instrument equipped with optical viewing and lighting systems. and image guiding which involves fibre bundles that are aligned from end to end. Medical Physics intestine is perforated. or to perform surgery. fluid flow. structures or living things. The light is prevented from escaping the fibre by total internal reflection – a process that takes place when a light ray travels through a medium with an index of refraction higher than that of the medium surrounding it. One commonly used tool consists of a hollow tube with a diagonal cutting blade at the end. flexible and rigid fibres. Other flexible fibre applications concern high-intensity illumination in general. Fibre-optic technology has been applied in many areas. instrument illumination for automotive and avionic systems. power transmission for use with robotics. In this case the fibre core has a higher refractive index than the material around the core. video. The following information about endoscopy is quoted from the Grolier Encyclopedia CD­ROM Fibre optics is the channelled transmission of light through hair-thin glass fibres. and data information as coded light pulses. rotation.6 page 49 G Pitt  gregphy@tpg. where it continues to travel down the fibre. The tissue sample is pushed or sucked into the hollow tube and the blade cuts it and slides across the tube entrance ensuring that the specimen is not lost as the endoscope tube is withdrawn. It is used for examining the inside of certain cavities or hollow organs of the body. The picture was taken with a camera attached to an endoscope. image guiding for remote viewing.au . Endoscopy reduces this risk because the incisions and amount of cutting is minimised. Other Applications of Fibre Optics Non-communication advances in fibre optics have fallen into two main areas. and sensing – the measurement of various properties of materials. surgical and dental procedures.com. An endoscope often uses a fibre optic telescope that provides excellent visibility of minute internal structures. although its greatest impact has come in the field of telecommunications. and electric current. and uses include the measurement of pressure. Sensors are a major flexible fibre application. The technique is used for direct viewing of otherwise inaccessible areas. where optical fibre offers the ability to transmit audio. The suction tube to clear the area is visible on the left of the image. In rigid fibre optics.

 deuterium and tritium. An endoscope can also be equipped with a laser that can vaporise. 3.fr/molaire1/e_plan. Different  isotopes of the same element  have the same chemical  properties. and the laparoscope to view the female reproductive structures. Common types of endoscopes are the cytoscope to view the bladder. the otoscope to view the ear. Endoscopy is visual examination of the interior of the body by inserting an endoscope through a natural body opening. hydrogen. technetium 99 etc – the number being the mass number of the nuclide. fluorine 18. often with more ease and flexibility than a more rigid cutting knife. The nucleus is represented by the symbol for the element. Many isotopes occur naturally and some are made artificially.au . the bronchoscope to view the lungs.html Outline properties of radioactive isotopes and their half lives Isotopes Isotopes are atoms of the same element having the same number of protons but different numbers of neutrons in the nuclei. Radioactivity can be used as a diagnostic tool This is the 2002 syllabus update References http://perso.   In   the   case   of   isotopes   other   than   those   of   hydrogen.com. phosphorus 31. with the mass number (total number of protons and neutrons) as a superscript and the atomic number (number of protons)   as   a   subscript. coagulate.6 page 50 G Pitt  gregphy@tpg.club­internet. or cut structures. Hydrogen is the only element having special names for its three isotopes. Several million endoscopy procedures are performed in the United States each year at a total cost of several billion dollars. The most common surgery performed through endoscopy is biopsy. the arthroscope to view the knee and other joints. This  fact is  of key importance in using radioisotopes in medical applications. Option 9. the removal of tissue for microscopic study to detect a malignancy. carbon 14. Medical Physics visual pathway to the target organ. All other elements have more isotopes than hydrogen. It is a less invasive method that causes less scarring and a quicker recovery time than other surgical techniques.   the   nuclide i  is represented in the same symbolic manner but named as follows: carbon 12. or through a small incision into the body cavity. iodine 131. such as the throat.

What are radioisotopes? Reference: Material under this heading is quoted substantially from the following web site.  Radioactive products used in medicine are referred to as radiopharmaceuticals. The nucleus of a radioisotope usually becomes stable by emitting an alpha and/or beta particle (or positron).au/nip26.htm There are 82 stable elements and about 275 isotopes of these elements. This process is known as radioactive decay. Option 9. the atom will be unstable and is called a radioactive isotope or radioisotope. A distinct advantage of nuclear imaging over X­ray techniques is that both bone and soft tissue can be imaged very successfully.com.6 page 51 G Pitt  gregphy@tpg.   The   most   common   is   by   neutron activation in a nuclear reactor. is produced artificially. Some radioisotopes are manufactured in a cyclotron in which protons are introduced to the nucleus resulting in a deficiency of neutrons (proton rich).au . Radioisotopes   can   be   manufactured   in   several   ways. When a combination of neutrons and protons.uic.com. These particles may be accompanied by the emission of energy in the form of electromagnetic radiation known as gamma rays. which does not already exist in nature. http://www. Medical Physics Protons and neutrons are collectively called nucleons. This involves the capture of a neutron by the nucleus of an atom resulting in an excess of neutrons (neutron rich).

 Nuclei having too few or too many neutrons are unstable and undergo radioactive decay. radioactive  Uranium­238  emits an alpha ray and thus loses 4 nucleons (2 protons + 2 neutrons): U 238 thereby transforms itself into Thorium­234 (because 2 protons less ­ that changes the atom to that of a different element). 238 92U 234 4 90Th 2 He This reaction is the source of most of the helium on Earth.6 page 52 G Pitt  gregphy@tpg. In a nuclear reaction. For example. depending on the nature of the decay. both mass number and charge are conserved. Liquid helium is used in MRI imaging   machines   for   the   operation   of   the   superconducting   electromagnets   essential   in creating the very strong magnetic field needed for this imaging process. For the first 30 or so elements. the number of protons is roughly the same as the number of neutrons in the natural isotopes. This particle is called an alpha particle – it is in fact a helium nucleus.com. The remaining nucleus thus has a mass number reduced by 4 and an atomic number reduced by 2. which produces four types of radiation. Principal Radiation Types Emitted by Radionuclides Alpha Radiation Some unstable nuclei decay by emitting two protons and two neutrons emitted from the nucleus. and the decay process can be written as an equation.g.au . Medical Physics Isotopes and radioactivity The stability of an atomic nucleus depends on the ratio of protons to neutrons. Option 9. e.

 In radioactive nuclei that undergo beta decay.   It   is   not radioactive! The range of a 5­MeV alpha particle in air is about 3. a neutron changes into a proton. Carbon 14 decays by beta decay.   An   alpha   particle   is   a   perfectly   stable   helium   nucleus.5 cm and in tissue its range is about 3 mm in tissue. Option 9. the atomic number of the decaying nucleus increases by one but the mass number does not change – there is one less neutron but one more proton – the total number of nucleons does not change.   the   atomic   number   of   the   decaying nucleus increases by one and the mass number remains the same. The reaction is as follows 14 0 6 C174N –10 e where  –1 e  represents a beta particle Beta Radiation – Positron Production A positron is the antiparticle of the electron.  Beta Radiation An electron emitted from the nucleus. A proton changes into a neutron and a positron in this process. The average range of a 1­MeV beta particle is about 3 m in air but only about 3 mm in tissue.6 page 53 G Pitt  gregphy@tpg. Medical Physics Misconception: It is incorrect to call an alpha particle a radioactive particle – only unstable nuclei can   be   called   radioactive.(cool!) and a high energy electron is formed in the process.com. It has the same magnitude charge as the electron. As a result of beta decay. but it is positive. When   a   radioactive   nucleus   decays   to   produce   a   positron. Hang on a minute… nuclei don’t have electrons! Here’s what happens.au . It has the same mass as an electron. It is ejected from the nucleus with such a high velocity that it totally escapes the atom from which it came.

For environmental dosimetry. X rays originate in the electrons surrounding the nucleus.6 page 54 G Pitt  gregphy@tpg. Medical Physics Positrons are used in PET scanning (Positron Emission Tomography) Gamma and X rays These are forms of electromagnetic radiation. emitted as energy packets called photons. important both for internal and external exposure. Gamma emitters deposited in one organ of the body can significantly irradiate other organs.  No particles are emitted during gamma radiation. or 33 cm of concrete would be needed. Gamma rays are emitted from the nucleus.  however g radiation is often emitted  during. To absorb 95% of the gamma energy from a  60Co source. Option 9.com.    or    radioactive decay. 10 cm of iron. 6 cm of lead. similar to light and radio waves but having much greater energy. and simultaneous  to.au .

6 page 55 G Pitt  gregphy@tpg. Medical Physics Source: National Geographic  (January 1987) Option 9.au .com.

The following graph shows how the activity of radioactive americium decreases over time.   appropriately   chosen compounds are broken down and excreted as a part of the normal body chemistry.au . Factors governing the choice of radioisotopes used in medicine include  Having a half­life long enough to examine metabolic processes. yet short enough to minimise the radiation dose to the patient.6 page 56 G Pitt  gregphy@tpg. Medical Physics Penetrating Capacity of Radiation Half-Life The time it takes for half the mass (or atoms) of the parent isotope to turn into its daughter isotope is called the half­life.com. Americium­242 has a half­life of 16.  Rapid   excretion   from   the   body   –   this   is   again   a   chemical   choice. Option 9.  Rapid uptake into the desired tissue – this is achieved by incorporating the radioisotope into an appropriate compound which is metabolised by the target tissue in the body. a direct result of the decreasing number of americium atoms remaining in the sample.02 hours.

 an unusual pattern or rate of isotope movement could indicate malfunction in the organ. inhalation or orally. Positioning of the radiation source within the body makes the fundamental difference between nuclear medicine imaging and other imaging techniques such as X­rays. usually by injection.com. which emit gamma rays from within the body. This is typically used to carry out a bone scan. They can be given by injection. and accumulates in the target tissue. This has led to its common use in Australia where the probability of anyone having such a test is about one in three and rising.  A distinct advantage of nuclear imaging over X­ray techniques is that both bone and soft tissue can be imaged very successfully.au/nip26.uic. bones.   In   some   cases   radiation   can   be   used   to   treat   diseased   organs   or tumours. The camera builds up an image from the points from which radiation is emitted. Diagnosis  Diagnostic techniques in nuclear medicine use radioactive tracers.   A   positron­ emitting radionuclide is introduced. which promptly combines with a nearby electron resulting in the simultaneous emission of two identifiable gamma rays in opposite directions. heart. The first type are where single photons are detected by a gamma camera which can view organs from many different angles. Gamma imaging by either method described provides a view of the position and concentration of the radioisotope within the body. If a series of images is taken over a period of time. As it decays it emits a positron.   X­ray   procedures   are   generally   non­functional. A   more   recent   development   is  Positron   Emission   Tomography  (PET)   which   is   a   more precise   and   sophisticated   technique   using   isotopes   produced   in   a   cyclotron. Organ malfunction can be indicated if the isotope is either partially taken up in the organ (cold spot). liver and many other organs can be easily imaged. The thyroid.au .  Option 9. These are detected by a PET camera and give very precise indication of their origin.   they   demonstrate anatomy. this image is enhanced by a computer and viewed by a physician on a monitor for indications of abnormal conditions.  We   describe   nuclear   medicine   studies   as   functional   studies   because   they   demonstrate physiological   function.6 page 57 G Pitt  gregphy@tpg. Nuclear Medicine is a branch of medicine that uses radiation to provide information about the functioning of a person’s specific organs.com. Medical Physics Radioisotopes used in Nuclear Medicine Reference: http://www. and disorders in their   function   revealed. or taken up in excess (hot spot).htm The following material is substantially quoted from the above URL. These tracers  are generally  short­lived isotopes  linked  to chemical compounds permit ting specific physiological processes (functional) to be examined.

Since some chemical elements concentrate naturally in certain parts of the body—as iodine does in the thyroid— the chemical takes the isotope directly to a specific site. Department of Energy (DOE) currently provides 5 percent of the market. as well as medication to ease pain and promote healing. of which the U. lungs. a radioactive tracer relays changes in blood volume as the heart contracts. During brain scans. that requires inserting a tube into the heart. One technique is called “labeling” in which a chemical is bonded to an isotope and injected into the body. A technician prepares a young girl for Positron Emission Tomography scanning. Department of Energy’s Isotope Program. Some of the more frequent uses of medical radioisotopes include diagnosis and treatment of several major diseases. hospitals undergoes a nuclear medical procedure for diagnosis or therapy. and other organs without the use of dangerous and expensive exploratory surgery. These alternative methods cause the patient some discomfort and require a recovery period. and many others. such as palladium-103 and iridium-192. Radioisotopes such as thallium-201 and rubidium-82 are used for cardiac imaging to diagnose heart disease. Technetium-99m also is used in bone scans to identify the spread of cancer to the skeletal system or to spot stress fractures that cannot be seen in x-rays.000 medical procedures each day in the United States. In nuclear cardiology. a medical diagnostic tool that uses isotopes produced by the U. sterilization of medical products. By detecting the location of the isotope. bone scans. can be avoided. and cardiac catheterisation. Because technetium-99m imaging is not a surgical procedure. and cancer. providing pictures of alterations caused by disease in a body part. Isotope sales to support these procedures are more than $100 million per year. a procedure in which an imaging device is inserted into a large vein. The same process can be used to send radioisotopes to destroy cancer cells in a certain location or to send antibodies or other chemical compounds to a tumor site. tissue grafts. and diagnosis of diseases such as AIDS.S. such as the spread of bone cancer. Many of these procedures employ radioactive isotopes (radioisotopes). nuclear medicine is a $7-$10 billion per year industry. Molybdenum- 99 is a radioactive isotope that decays to form technetium- 99m. and biomedical research into cellular processes. Technetium-99m allows physicians to diagnose many conditions in the brain. Medical Physics ISOTOPES FOR MEDICINE AND SCIENCE PROGRAMS Isotopes Save Lives and Reduce Health Care Costs One of every three persons admitted to U.com. nutrition research. Several of the isotopes produced by the DOE. an isotope used in about 36. Alternative diagnostic methods include an arteriogram. As a result. arthritis. medical technicians can detect and photograph an otherwise unseen tumor.S. Alzheimer’s. Other radioisotopes are used for brain scans. Radioisotopes also play an important role in effectively treating diseases such as heart disease. a radioisotope traces activity to give doctors a clear picture of whether the brain is functioning normally. technetium-99m imaging is used to diagnose poor blood flow in the lungs and heart. a patient can be given a specific radioisotope in a chemical vehicle called a radiopharmaceutical. costs for surgical facilities and personnel.au . are used for various types of cancer therapy. The chemical-isotope reagent is called a radiopharmaceutical. The diagnostic uses of radioisotopes are many.S. A gamma camera can then trace the radiopharmaceutical through the body. For example. heart.6 page 58 G Pitt  gregphy@tpg. Option 9. For example.

6 page 59 G Pitt  gregphy@tpg. Other isotopes are being used for medical research that may lead to new breakthroughs in the diagnosis and treatment of disease. and technologies. Also. Option 9.gov/isotope/lives.html In Australia. hospital stays are usually shorter. Thousands of lives and millions of dollars are saved every year because of medical isotope procedures. radioisotopes are prepared for medical purposes at Lucus Heights reactor in Sydney and through the use of two medical cyclotrons – one of these is at Prince Alfred hospital in Sydney and there is one in Melbourne. treatments. and patients often recover quicker than when a disease or condition is diagnosed in its later stages. By producing isotopes needed by the U. Reference: http://www.au . The earlier a disease can be diagnosed and treated. Medical Physics Scanning technique using radioisotopes (This is a PET scanner) The use of medical isotopes also reduces health care costs.doe. health care industry and medical researchers. the lower the cost.com.S. DOE supports and promotes the continued health and well being of the American people. Radioisotopes help medical specialists diagnose and treat diseases early—when they are most treatable.ne.

using PET. gall bladder. The non­invasive nature of this technology. The radiation dose received is medically insignificant. F-18 in FDG has become very important in oxygen-15 2.   radiopharmacists   are   able   to   attach   various   radioisotopes   to   biologically active   substances.03 m  detection of cancers and the monitoring of progress in their fluorine-18 109.uic.  A radioisotope used for diagnosis must emit gamma rays of sufficient energy to escape from the body  and it must  have a half­life short enough for it to decay away soon after imaging is completed. lungs (perfusion and ventilation).3 y  Used for external beam radiotherapy iodine-131 8d  Used in functional imaging and therapeutic applications for the thyroid problems and carcinoma diagnosis phosphorus-32 14.com.3 m  These are used in PET for studying brain physiology and nitrogen-13 pathology. The patient experiences no discomfort during the test and after a short time there is no trace that the test was ever done.htm Radioisotopes Produced in a Reactor Isotope Half-life Emission Uses cobalt-60 5. for example. They also have a useful role in cardiology. together with the ability to observe an organ functioning from outside the body. spleen. salivary and lacrimal glands.au/nip26. bone marrow. liver.5 d  Used to investigate cancer Every organ in our bodies acts differently from a chemical point of view.8 m  treatment. With   this   knowledge.  Technetium-99m The radioisotope most widely used in medicine is technetium­99m.   Once   a   radioactive   form   of   one   of   these   substances   enters   the   body. heart blood pool.au . for investigating epilepsy.  The amount of the radiopharmaceutical given to a patient is just sufficient to obtain the required information before its decay. the brain consumes quantities of glucose. makes this technique a powerful diagnostic tool.com. The thyroid. the most widely used isotope in nuclear medicine technetium-99m 6h  Used to image the skeleton and heart muscle in particular.3 d  Used in the treatment of excess red blood cells molybdenum-99 Used as the 'parent' in a generator to produce technetium- 99m. It is an isotope of the artificially produced element technetium and it has almost ideal characteristics for a nuclear medicine scan.6 page 60 G Pitt  gregphy@tpg.   it  is incorporated into the normal biological processes and excreted in the usual ways. takes up iodine. used in over half of all nuclear medicine procedures. but also for brain. kidney (structure and filtration rate). thyroid. Iodine-124 4. infection and numerous specialised medical studies Radioisotopes Produced in a Cyclotron Isotope Half-life Emission Uses carbon-11 20. and so on. These are:  Option 9. Medical Physics Identify radioisotopes that are used to obtain scans of organs http://www. Doctors and chemists have identified a number of chemicals absorbed by specific organs.

 The generator contains molybdenum­99. with a half­life of 66 hours.au . Describe how radioactive isotopes may be metabolised by the body to bind or accumulate in the target organ The chemistry of technetium is so versatile it can form tracers by being incorporated into a range of biologically active substances to ensure that it concentrates in the tissue or organ of interest. Tc­99 is produced in the nuclear reactor at Lucas heights near Sydney. A further advantage of Tc­99 is that it has several valence states. It contains a scintillating crystal. Technetium­99has a half­life of six hours.6 page 61 G Pitt  gregphy@tpg. Examples are shown in the following table from a brochure produced by ANSTO. Gamma ray cameras are used to produce a bone scan.   A gamma camera is an instrument that produces a computerised picture of the distribution of radioactive material in a patient.  The  low  energy gamma  rays  it  emits  easily  escape  the human  body and are accurately detected by a gamma camera. a process called  elution.   This   produces   light   when   irradiated   with   X­rays   and   the   light   is   detected   and converted to an image. After about two weeks   the   generator   is   returned   for   recharging. yet short enough to minimise the radiation dose to the patient.  A   technetium   generator   consisting   of   a   lead   pot   enclosing   a   glass   tube   containing   the radioisotope   molybdenum­99   is   supplied   to   hospitals   from   the   nuclear   reactor   where   the isotopes are made. Option 9. Other radioisotopes are administered which have the capacity to target specific organs because they are metabolised specifically by the targeted organ. It is usually delivered as an injection. Once again the radiation dose to the patient is minimised. Medical Physics  The most common radioisotope used in nuclear medicine is Technetium­99. This isotope has a half­life of 6 hours and when it decays it emits a single gamma­ray with energy of 140 keV. which progressively decays to technetium­99m by normal beta decay.   Lucas   Heights   Reactor   supplies   these   in Australia and for export to Asia. when it is required. which is long enough to examine metabolic processes.com. The Tc­99m is washed out of the lead pot by saline solution.  Pharmaceuticals are chosen so that when they are injected into a vein they will circulate around the body and be absorbed by the organ of interest. hence it can be used for labelling a variety of pharmaceuticals. It does not emit any alpha or beta particles – an advantage since these cause biological damage. which is the size of the image.

Another important use is to predict the effects of surgery and to assess changes after treatment.com.   which   are   not   generally   visible   in   X­rays. to assess bone damage. The radioisotopes listed in the above table are produced in a medical cyclotron. heart or kidneys. and to confirm   other   diagnostic   procedures. lungs.   They   are   increasingly   being   used   in   sports medicine   to   diagnose   stress   fractures. to assess functioning of the liver. Radiopharmaceuticals   are   used   in   very   small   quantities   for   diagnostic   work   ­   just enough   is   administered   to   obtain   the   required   information   before   the Option 9.au . Medical Physics The radioisotopes listed in the above table are produced in a nuclear reactor. Radiopharmaceuticals are used in very small “Diagnostic radiopharmaceuticals can be used to examine blood flow to the brain.6 page 62 G Pitt  gregphy@tpg.

Medical Physics radiopharmaceutical   decays. 1   Option 9.”1 Whenever possible radioisotopes that are rapidly metabolised and excreted are chosen to minimise exposure   to   radiation.   Medical   isotopes   have   short   half­lives.6 page 63 G Pitt  gregphy@tpg.   again   to   minimise   exposure   to radiation.com.au .   The   radiation   dose   received   is   similar   to   that   from diagnostic X­rays.

  which   emit   positrons   (rather   than   photons   produced   by   conventional nuclear medicine tracers). [1 eV = 1.au .com. Positrons travel a short distance (1 to 2 mm) in the tissue before colliding with an electron.6 x 10—19 J] Option 9. Medical Physics Identify that during decay of specific radioactive nuclei positrons are given off 11 6C115 B 10 e 15 8 O15 0 7 N 1 e 18 9 F18 0 8 O 1 e Discuss the interaction of electrons and positrons resulting in the production of gamma rays PET   radioactive   tracers. are administered just prior to the PET imaging procedure.6 page 64 G Pitt  gregphy@tpg. The positron and the electron annihilate each other and in the process their mass is converted to energy which is emitted as two gamma rays having an energy of 511 keV and travelling in opposite directions to each other.  A positron created  in the body by the decay of the radioactive  positron tracer interacts  almost immediately with an electron to produce a pair of gamma ray photons as shown in the following graphic.

6 page 65 G Pitt  gregphy@tpg.au . A valid “event” occurs when two detectors record photons within a few nanoseconds of each   other. and others. nitrogen and fluorine.camosun. regional blood flow and glucose metabolism can be imaged.com.ca/~tonks/courses/psyc110/PET. ammonia and water) to be labelled with radioactive tracers and by imaging the distribution of these tracers. PET is thus a functional imaging technology. oxygen.bc. Describe how positron emission tomography (PET) technique is used for diagnosis [patient in a PET scanner . Positron emitting isotopes exist for carbon. Medical Physics   In a PET scanner these annihilation photons are detected by arrays of detectors surrounding the patient.http://ccins.   To   compute   the   3­D   distribution   of   the   radionuclide   requires   a   large   number   of measurements from many different angles (hence the ring design of many PET scanners). which allows many naturally occurring substances used by the body (such as glucose.gif ] Option 9.

In other words. or MRI scan PET is painless and relatively non-invasive (i.htm What is a PET scan? PET is one of the newest.com.au . Medical Physics [reference] http://neurocog.. How does it work? Steps in the PET process:  production of positron emitting isotope in a cyclotron  substance of interest is labelled with the positron emitter  transport of labelled substance to PET camera area  administration (injection) of tracer compound & data acquisition with PET camera  processing of data from PET camera to extract information related to the tracer’s activity in the body  interpretation of results In PET a chemical substance the investigator would like to follow through the brain is “labelled” with radioactive atoms. Like an X-ray. most advanced methods for studying organs in the body such as the brain. PET does not produce a picture of the “structure” or anatomy of the brain. Option 9.6 page 66 G Pitt  gregphy@tpg. Unlike X-rays and traditional MRI.e. no surgery or opening of the body is required). but rather it gives an image of brain “function” or physiology.tufts. The labelled substance (called a radiotracer) is introduced into the body. it can be used to image what the brain is doing.psy. The following shows PET images of which reveal the different parts of the brain that are active when a person is reading (seeing) written words or hearing the same words spoken by person.edu/images/positron_emission_tomography.

Labelling is a process whereby a “tag” is attached to a substance that the investigator wants to follow. The radioactive atoms created by the cyclotron decay by “emitting” particles called “positrons” which can be monitored with a special array of detectors called a PET camera. The real power of PET is that atoms which naturally comprise the organic molecules utilized in the body can be labelled (turned into positron emitters). these harder working regions have a higher oxygen concentration and hence a more intense PET signal than areas which are not working as hard. Areas of the brain which emitted the most photons will produce a more intense PET signal and areas which emitted few photons will produce a weak signal.com. the less time between injection and scanning). Since these atoms occur naturally in organic compounds.au . A computer is then used to assemble an image from all of the pairs of coincidental photons detected by the scanner. and oxygen found in our bodies. When the body’s chemistry concentrates a positron emitter in a particular location. Option 9. where it migrates to the structures of interest. carbon and nitrogen. PET   stands   for  positron   emission   tomography. called ‘tracers.6 page 67 G Pitt  gregphy@tpg. and uses the data to calculate an image of cellular biological activities.   allowing physicians or researchers to assess chemical or physiological changes related to metabolism. water. The PET system detects the gamma radiation emitted from the radioactive tracer inside the body. The basic idea is that areas of the brain that are working relatively harder tend to get increased blood flow relative to areas that are not working as hard. In most cognitive studies using PET the labelled compound is oxygen (O 15) and it is injected into the body in the form of radioactive water. PET radiotracers emit positrons. more gamma radiation is emitted from that region than regions where the emitter is not as concentrated. Positrons travel a short distance in the brain before colliding with an electron. radioactive tag.’ to obtain images. PET tracers are similar to the natural sugars. Medical Physics usually by injection. V below. but carry a weak.  It   is   a   functional   imaging   technique. proteins. replacing the naturally occurring atoms with labelled versions leaves a compound that will behave in a manner identical to its unlabeled sibling. Gamma rays associated with positron emission from these areas can be detected and analysed to provide a functional map of brain activation.that is. These tracers are injected into a patient and collect in various tissues and organs. The substances that can be labelled for PET scanning are limited only by the imagination of the investigators and the physical half-life of the positron-emitting label (half-life is the amount of time it takes for half of the label to decay—the faster the decay. These atoms include oxygen. The photons are detected as “pairs in coincidence” by a series of specialized detectors arranged in a ring around the subject. With PET labelling is accomplished by using a (very expensive) device called a cyclotron. The positron and the electron annihilate each other and in the process emit two photons at 180 degrees to each other. but which will be traceable in the body. PET imaging utilises a variety of radiopharmaceuticals. This results in more labelled oxygen migrating to these areas -.

6 page 68 G Pitt  gregphy@tpg. In the diagram above. is given to the Option 9. PET and the Images it Produces     PET imaging can analyse sugar metabolism. If glucose labelled with fluorine­18. than detector 2. oxygen utilisation and a long list of other vital physiological activities. a positron emitter. d1 and d2 in the patient’s body. detector 1 will receive more gamma radiation from the voxel.au . V.com. blood flow. Signals reaching opposite detectors are analysed by a computer calculates the position of the annihilation event from the differences in the attenuation of the gamma rays travelling through different distances. Medical Physics Gamma ray detectors are arranged in pairs opposite each other around the patient.

 and Parkinson’s disease.ca/welcome/petscan. Glucose is well metabolised by growing cancer cells. brain and heart muscle. such as solving maths or work puzzles. Medical Physics patient. schizophrenia. PET scanning can reveal information about the function in particular regions of the brain. but is rather emitted by a radionuclide.triumf. and then they are asked to do something. injected into the patient’s body. Brain activity shown in the coloured PET images below compared with the corresponding anatomical MR images.com. The structure of the molecule is shown below. 18F­FDG offers the longest half­life time (110 m) among all the PET radioisotopes and can therefore be distributed in all nearby hospitals.html ] As a result.6 page 69 G Pitt  gregphy@tpg. In contrast to CT for example. This explains why 18F­FDG is so successful in nuclear medicine. the regions in the brain in which the radioactivity is collecting is the region that is actively involved in that behaviour.au . [ http://www.   PET   is   commonly   used   to   determine   what   parts   of   the   brain   are   involved   in   different neurological illnesses including seizures. Two examples of such a radionuclides is fluorine­18 and oxygen­11. and injected into the patient intravenously. as well as which parts are active during specific activities. radiation that is used to examine the object doesn’t come from an exterior source. What is FDG? 18F­FDG (fluoro­deoxy­glucose) is a sugar labelled with the isotope fluorine–18. Option 9. In PET the processes are very different from other imaging methods so far discussed.

6 page 70 G Pitt  gregphy@tpg. Medical Physics Because the radionuclides are absorbed differently in the various tissues depending on physiological processes. Option 9.   as   opposed   to   structural.   i.com. The following image shows a comparison between PET and CT scans in diagnosing a tumour.e.   PET   is   used   to investigate physiological behaviour of the body as opposed to anatomical features. PET   is   thus   a  functional  imaging   technology. The use of false colour enhancement increases the diagnostic capabilities of PET.au . we can visualise those processes by monitoring the distribution of the radionuclides in the body.

Medical Physics

A whole body colour PET scan of a woman 40 years old two years after mastectomy. PET found
multiple metastases extending throughout the body, including multiple liver metastases.

Perform an investigation to compare a bone scan with an X-ray
A bone scan is performed to obtain a functional image of the bones. A bone scan can be used to
detect   abnormal   metabolism   in   the   bones,   which   may   be   an   indication   of   cancer   or   other
abnormality. Because cancer involved a higher than normal rate of division of cells (thus producing
a rapidly growing tumour), chemicals involved in metabolic processes in bone tend to accumulate
in higher concentrations in cancerous tissue.
What are Bone Scans?
Reference:
http://medicine.wustl.edu/~ippolitj/anatomy/cases/cow1.htm
A radioactive agent called Technetium­99M Methylene diphosphonate (Tc99m­MDP) is injected
into the patient. The radioactive phosphate travels through the blood and is incorporated into the
bone (Remember that bone is made out of calcium and phosphate).
The patient lies under a gamma ray camera. The gamma rays coming from the radioactive tracer in
the body travel out of the body in all directions. Only those travelling parallel to the small holes
passing from the bottom to the top of the lead collimator reach the detector, a crystal of sodium
iodide.
Sodium iodide detectors consist of a single crystal of NaI with trace amounts of thallium. The
thallium impurity causes the crystal to scintillate (i.e. emit a small flash of light) when an X­ray or
gamma ray interacts with the crystal. The light is then detected electronically. They are used in
whole body gamma counters, gamma cameras and (with some variations) in some CT machines.

Option 9.6 page 71 G Pitt  gregphy@tpg.com.au

Medical Physics
When a gamma ray strikes the detector, a flash of light is produced. The flash is very faint, and so
sensitive   devices   called   photomultipliers   are   used   to   detect   the   flash   and   amplify   its   effects,
converting the result into an electrical signal.
The signals are processed by a computer and an image is produced. It may be viewed directly on a
screen, printed or stored electronically, since the information is all digitally encoded.

If you have areas with high ‘bone activity’ (from cancer spreading to bone, fracture, arthritis, etc),
there will be more of this radioactive phosphate taken up into the bone, appearing darker on the
bone scan.
Typical images of healthy bone and cancerous bone are shown in the following image.

Option 9.6 page 72 G Pitt  gregphy@tpg.com.au

Medical Physics

Question:  In the normal scan, why do you think the patient’s left elbow has an intense focus of
radioactivity? (Hint: How did they give the patient the MDP?)
Question: In the normal scan, the lower pelvis has a region of high intensity. Why is this? (Hint: It
may be soft tissue, not bone...looking at the PET might help you with this question.)
Discussion of Bone Scan
Although our patient’s  image is a little “overexposed”, note that there are numerous intense spots
(although small) along the spine that indicate that the breast cancer has metastasised, or spread to
the bone. One can also pick out multiple spots on the left pelvis, left and right shoulders, as well as
the first four ribs. This is an extremely bad finding and the only treatment is pain relief. Note that
breast   cancer   does   metastasise   to   bone.   The   bone   metastases   in   breast   cancer   can   either   be
osteoblastic (increased bone deposition) or osteolytic (increased bone resorption). It is tough to say
determine the nature of the mets in this case. X­Rays would be good for figuring this out. 

Option 9.6 page 73 G Pitt  gregphy@tpg.com.au

com. Medical Physics Option 9.6 page 74 G Pitt  gregphy@tpg.au .

com.6 page 75 G Pitt  gregphy@tpg. Medical Physics 4.au . The magnetic field produced by particles can be used as a diagnostic tool This is the 2002 syllabus update Option 9.

Some 22. the spine. science correspondent Tuesday October 7.000 are in operation.” Prof Mansfield. and the prize money of nearly £800.” Magnetic resonance imaging scanners are now commonplace in hospitals around the world.” said Sir George Radda. but then I began to realise it was for real. whether it’s the brain. it would have been a crime if his work had not been recognised.” said Peter Jezzard. The award puts the total number of Nobel laureates working in British science at 14. I just feel greatly honoured. Diseases often change the water content of different organs so the technique can reveal illnesses as well as damage caused by accidents. a physicist at the University of Nottingham. Medical Physics Nobel prize for medicine awarded to British scanner pioneer by Ian Sample. “Peter did such a huge amount of work on this.com. “When I got the call from Sweden. MRI scanners measure how the ions respond and use that to piece together a picture of the organs and tissues. “This award is long overdue. MRI scanners work because two-thirds of the human body is made up of water. it is believed to be less risky than other imaging techniques such as Cat scans. He was first to work out how to turn signals from the scanners into meaningful images. “MRI scanners can be used to look at just about any part of the body. a physiologist at Oxford University. 2003 The Guardian A British scientist was awarded the Nobel prize for medicine yesterday for his pioneering work on medical scanners. the joints or the heart. a technique which gives doctors an unprecedented view of the insides of the human body. I didn’t believe it at first. an MRI expert. Because it does not use X-rays. Option 9. The prize came as an early birthday present for Professor Mansfield. The scanners have become popular because they are so versatile.000.6 page 76 G Pitt  gregphy@tpg. “I wasn’t planning to do anything special for my 70th. but it was his fundamental work in the 1970s that really made MRI a valuable medical tool. who turns 70 on Thursday. Paul Lauterbur. who won the Nobel prize for medicine last year. with an American scientist.au . an intense but harmless magnetic field makes charged ions in the water line up like so many microscopic compass needles. When a patient lies down in an MRI scanner. They can take detailed three-dimensional images of organs and bones and reveal if they are diseased or damaged. so much so that he could take snapshots of a heart in a fraction of a heartbeat. but I suppose I may have to change my mind now. The scanner then uses pulses to give the ions a gentle flick. Sir Peter Mansfield played a vital role in developing magnetic resonance imaging. He shares the award. Sir Paul Nurse.” he said. he developed a way of making the scanners much faster. taking about 60 million pictures a day. is due to leave the country next month to take up a position as president of the Rockefeller University in New York. was one of the first scientists to produce images of human organs using the technique. Later.

  the   scanners   have   a   superconducting magnet   that   requires   liquid   helium   cooling. MR had been used as a tool for studying atomic structure since 1946. compared with 50 microteslas   for   Earth's   field   and   40 T   for   the   strongest   sustained   man­made   field). To   produce   the   strong   magnetic   field   required   for   MRI.au .0 tesla. like   CT  can  be used  to  produce  tomographic   images  (slices).com. Magnetic resonance imaging (MRI).6 page 77 G Pitt  gregphy@tpg. Medical Physics Introduction to Magnetic Resonance Imaging (MRI) The potential application of magnetic resonance (MR) to medical imaging was suggested in 1973. (0.   Entry   to   the   MRI   area   is   restricted   to   ensure   that ferromagnetic materials are kept at a safe distance from the magnet. although it was 15 years before clinically useful images were obtained using magnetic resonance.    MRI scans of the neck and head MRI uses the interaction between the magnetic properties of hydrogen nuclei and external magnetic fields and electromagnetic radiation.2 to 2. Digitising the image and applying false colour can be used to highlight specific areas of interest.  MRI has   the  capacity   to produce high­resolution images of both bone and soft tissue as can be seen in the following MRI images.   Some extraordinary accidents have occurred through a failure to appreciate the strength of the magnets in an MRI machine! Option 9.

 This spin property can have one of two possible directions for any given nucleon. The combined effect of doctors’   fears   of   legal   claims   against   them. As of October 2003. Another characteristic of MRI is that images can be obtained of soft tissue very close to bone. patients were kept in suspense sometimes for many years awaiting a positive diagnosis. They cost more than 2 million dollars to purchase and about one million dollars per year to operate and staff them. Prior to MRI.au . One of the initial successes of MRI is that images were obtained of the plaque that is characteristic of multiple sclerosis (MS).   and   the   patients’   desire   to   always   use   the   best technology available to diagnose disease has caused a well­publicised blowout in medical insurance costs. giving a much earlier diagnosis of MS. CT has many artefacts in soft tissue close   to   bone. there were about 150 MRI machines in Australia. then their spins align in opposite directions so that the net spin of the pair is zero.   Hence   MRI   gives   excellent   images   of   deformed   disks   in   the   spine   and   of abnormalities at the base of the base ñ both of which cannot be imaged satisfactorily with CT. If there are even numbers of protons or neutrons. Identify that protons and neutrons in the nucleus have properties of spin and describe how net spin is obtained Both protons and neutrons in the nuclei of atoms have a property called spin.com.6 page 78 G Pitt  gregphy@tpg. Option 9. A metal oxygen cylinder pulled into the machine did this damage! All major hospitals and many private imaging businesses in Australia now have magnetic resonance imaging machine. Medical Physics The “phantom” is a device placed in the MRI machine when it is not in use.

phosphorus 31. This can be thought of as a magnetic effect caused by the rotation of the proton.com. Phosphorus 31 is a relatively common nuclide in the human body. Medical Physics    [Image source: National Geographic January 1987] If there is an odd number of protons or neutrons. The magnetic properties of hydrogen are not   normally   evident   because   in   the   gaseous   state.   Nuclei   having   a   net   spin   include   hydrogen. Because there is an odd number of protons.   the   magnetic   properties   of   the   nuclei   are randomly aligned (above right). Identify that the nuclei of certain atoms behave as small magnets Nuclei with a net spin due to unpaired protons have a property called magnetic moment. one must be unpaired and this unpaired proton produces the net spin for this nuclide. The hydrogen nucleus is one such nucleus with a net spin. fluorine 19. resulting in a zero net magnetic effect. The net spin of hydrogen is used in MR imaging because it is found in the body in relatively large amounts.6 page 79 G Pitt  gregphy@tpg. nitrogen 15 and carbon 13. given the high proportion of water making up the body. which acts like a circulating electric current loop. The neutron number being even results in pairing of their spins producing a net spin of zero.au . it therefore has 16 neutrons. resulting in the formation of a magnetic dipole shown (below left). Explanation: Phosphorus 31 has a mass number of 31 and an atomic number of 15. Option 9. then the nucleus must possess a net spin since pairing   cannot   occur   with   one   of   the   nucleons.

  of   about   0. in the opposite directions to each other.   hydrogen   atoms   align themselves with the applied field because of the interaction between the nuclear magnetic dipole and the external field.   and   if   the   nucleus   is   exposed   to   electromagnetic   radiation   at   specific frequencies (see below). This is notably so if the external field   is   very   strong. a consequence of its rotation on its own axis. The angular momentum of the proton. the magnetic moments may assume one of two possible alignments.5   to   2   teslas.0004% more protons favour the parallel alignment over the antiparallel alignment. About 0. the atoms resume a random orientation. particularly hydrogen. Medical Physics Explain that the behaviour of nuclei with a net spin. external magnetic fields and electromagnetic radiation affect the nucleus of hydrogen. however hinders it from doing so. Option 9.6 page 80 G Pitt  gregphy@tpg.com. (see below) The alignment is analogous to the behaviour of a compass needle in a magnetic field. This occurs due to the random motion of atoms associated with thermal vibrations at any temperature above 0 K. is related to the magnetic field they produce Because of the magnetic field the hydrogen nucleus produces due to its spin. the axis of rotation of the proton is not exactly parallel to the external field and the proton will precess.      When the applied external field is removed. As a result. Describe the changes that occur in the orientation of the magnetic axis of nuclei before and after the application of a strong magnetic field When   placed   in   a   very   strong   magnetic   field. however unlike compass needles.au . (Note that the term parallel in this context is not exactly literal) Protons that are aligned parallel to the applied field have a slightly lower energy than the ones with an antiparallel alignment.

† Resonance occurs between two oscillating systems if they have the same natural vibrational frequency and if there is some means by which energy can be transferred from one system to the other.au . This occurs because the two strings under these conditions have the same natural frequency and the energy can be transferred from one string to the other via the body of the guitar. The frequency of precession is called the Larmor frequency. they re­emit the energy absorbed from the radio wave over a period varying from 0. Medical Physics Define precession and relate the frequency of the precession. For a proton in a 2 T magnetic field. This causes the proton’s magnetic alignment to flip from the parallel to the antiparallel state. The hydrogen nuclei prefer to return to their original state in the magnetic field and as they do so. the first string will also vibrate. This motion is similar to a spinning top with its axis of rotation tilted at an angle to the vertical. This corresponds to a radio frequency electromagnetic wave. ie Larmor frequency. the Larmor frequency is 85. If the guitar is tuned correctly. This motion is called precession. The Larmor frequency is dependent on the composition of the nucleus and the magnitude of the external field. a phenomenon sometimes referred to as spin flip.1 of a Option 9. Precession is a consequence of the law of conservation of angular momentum.com. Discuss the effect of subjecting precessing nuclei to pulses of radio waves When protons in a strong magnetic field radio are exposed to radio waves with a frequency equal to the Larmor frequency. Precession is the motion that results in the axis of rotation of a body sweeping out a conical motion when a torque acts to affect a change in the axis of rotation of that body. to the composition of the nuclei and the strength of the applied external magnetic field       The direction of the axis of the magnetic moment rotates about an axis parallel to the external magnetic field as shown in the diagram (above centre and right). their energy is absorbed by the protons in a process called resonance†.6 page 81 G Pitt  gregphy@tpg. This can be observed using a guitar pressing down on the fifth fret of the first string and plucking the adjacent string.2 MHz.01 to 0.

Explain that the amplitude of the signal given out when precessing nuclei relax is related to the number of nuclei present With   magnetic   resonance   imaging   it   is   possible   to   produce   a   map   of   the   hydrogen   density throughout a volume of the patient because increases in the density of hydrogen nuclei produces a signal associated with their relaxation having a greater amplitude. Unlike many other medical imaging techniques.htm  if you really want to know. Medical Physics second. [reference for above 2 paragraphs: “MRIPrinciples. The   emission   of   the   energy   from   the   hydrogen   nuclei   returning   to   the   lower   energy   state   is described by two time constants. See “Nuclear Magnetic Resonance”  http://www. other suitable contrast mechanisms  must be employed. T1 relates to an interaction between precessing protons and the   other   atoms   in   the   material.com. T1 and T2 associated with two different electromagnetic processes (not necessary to discuss these here!).rzuser. These signals emitted by the proton are used to create the MR image.uni­heidelberg. Images.de/~slange_expired/imaging/chap3. and by careful choice of timings.pdf”. images can also be obtained using the values of T 1 and T2.   Since   there   is   such   a   small   difference   in   proton   spin   density between most other tissues in the body. The low proton spin density of bone makes MRI a less suitable choice for skeletal imaging than X­ ray   shadowgraphs   or   X­ray   CT. These are generally based on the variation in the values of T1 and T2 for different tissues. the contrast in an MR image is strongly dependent upon the way the image is acquired. In the sequence descriptions that follow it is assumed that the imaging method used is EPI. Proton spin densities depend on water content. however identical or similar methods can be used with the other MR imaging techniques outlined above. whose contrast is dominated by differences in the T1 values are called T1 weighted.   T2  relates   to   an   interaction   between   the   precessing   nuclei themselves.6 page 82 G Pitt  gregphy@tpg. By adding RF or gradient pulses. If there are no spins present in a region it is not possible to get an NMR signal at all. The emitted energy is a radio wave that is detected with the same coil that emitted the RF waves to flip the protons. it is possible to highlight different components in the object being imaged.au . Alternatively. those dominated by T2 differences Option 9. RF signal flips the hydrogen nucleus The nucleus emits a radio signal as it flips back The return of the proton to the less excited state after absorbing the RF energy is called relaxation. The basis of contrast is the spin density throughout the object.

 they typically have a higher percentage of water and similar non­cancerous tissue. and affect signal magnitude from the given region. and T2.  These protons have properties   known   as   T1   and   T2   relaxation   times. Another very powerful tool which can enhance the images contrast is to vary the values of the time between two repetitions of a sequence of applied RF signals. MRI is very sensitive to variations in water content of tissues and this is a significant factor in its being able to produce high resolution high contrast images.     Contrast media in MRI Magnetic resonance (MR) contrast agents are unique in radiology because it is not the chemical that is detected. Option 9. because of the high growth rates.  The reason that different anatomic structures can be seen on an MRI is largely due to differences in T1 and T2 relaxation times between different tissues. These processes are used to distinguish the various tissues. T1  and T2  is significantly greater for tissues containing relatively large amounts of water.  MR imaging relies on signal originating from hydrogen nuclei in water and fat. as this changes the weighting of the relaxation times which can then be used to improve selective contrast between different tissues.com. and so MRI is an effective diagnostic tool for cancerous tissue. Because tumours are characterised by rapid cell division and high growth rates. and can thus be clearly imaged using MR. This is often greater in cancerous tissue. Explain that large differences would occur in the relaxation time between tissue containing hydrogen bound water molecules and tissues containing other molecules The difference in relaxation parameters.  MR imaging uses magnetic field changes to accentuate the difference in signal magnitudes from different regions. Excellent soft tissue resolution can also be seen in the MRI of the chest (right). Medical Physics therefore T2 weighted. All three types of images are used clinically.   which   vary   depending   on   the   immediate surroundings. Haemoglobin molecules in red blood cells also provide a clearly identifiable resonance signal and so MRI can be used to compare the blood content of different tissues. but rather the effect that the chemical has on surrounding molecules that is detected.6 page 83 G Pitt  gregphy@tpg. MRI scans of the brain show more contrast and detail than conventional X­ray or CT scans because of the differences in water content of the grey matter and white matter of the brain. Furthermore each tissue or tissue group has its own specific set of values for T1. as opposed to some other molecule. A typical brain MRI is shown below (left).au .

25­1. Medical Physics Gadolinium (chelated to a carrier molecule) is an intravenously­injected MR contrast agent which shortens the T1 of protons near it. [2005 HSC] Option 9. highly vascular tissues.6 hours. making the tissues appear brighter.com.6 page 84 G Pitt  gregphy@tpg. Gadolinium is excreted through the kidneys. with a half­life of 1. Because gadolinium normally stays in blood vessels. it has the effect of making vessels.au . and areas of blood leakage appear brighter.

au . January 1987 Option 9.6 page 85 G Pitt  gregphy@tpg. Medical Physics Magnetic Resonance Imaging – Spin and Relaxation Reference: National Geographic Article.com.

 Data is thus gathered connecting the location of the voxel to the hydrogen atom concentration.T. and unique Larmor frequency. Medical Physics Magnetic Resonance Imaging – Putting it all Together References: Health Physics.K. The pulse of radio waves is transmitted through the patient’s body from the RF coils. The   relaxation   data   from   each   voxel   are   what   really   provides   the   key   information   for   the computation of the image. From this data one type of MR image is computed. This means that the hydrogen atoms at each point have a known.au . The gradient coils produce small variations in the magnetic field across the patient’s body so that the magnetic field intensity has a unique value at every point in the patient’s body. The frequency of the RF is varied and the hydrogen nuclei within each voxel resonate at their characteristic Larmor frequency. This flips the magnetic axes of the hydrogen nuclei. Both the exact position and the corresponding Larmor frequency are accurately known. McCormick. National Geographic Article. and Elliot.6 page 86 G Pitt  gregphy@tpg. January 1987 The   patient   is   placed   in   the   strong   magnetic   field   inside   the   MR   scanner   tunnel. As they flip back (relaxation) the atoms within each volume element (voxel) emit radio waves with a intensity proportional to the number of hydrogen atoms in the voxel. A. chemical agents that concentrate in specific organs and which respond uniquely to MR are introduced into the body to provide an enhanced image.com.   The   field   is produced by liquid helium cooled (4 K) superconducting electromagnets. A. In some cases. similar to the use of contrast agents in x­radiography. Option 9.

6 page 87 G Pitt  gregphy@tpg. Medical Physics Option 9.au .com.

 Some MR machines use an open design that makes some patients less anxious about the procedure Disadvantages of Using MRI  Cost – MRI is a very expensive imaging process. and to keep them in Australia. there is no discomfort to the patient.au . The capital cost of the machines is high. rather than work overseas where their skills attract higher salaries. as well as the running costs. a factor contributing to higher costs since higher salaries are needed to attract more people into the industry.6 page 88 G Pitt  gregphy@tpg. as these may be attracted into the machine at high speed.  MRI data can be processed to produce a tomographic image or a 3­D image  Except in the case of a few patients who experience anxiety in the MR tube because of the confined space. injuring the patient or damaging the machine  The strong magnetic field produced can interfere with nearby electronic equipment Option 9.com. Medical Physics Advantages of Using MRI  MR does not involve the use of ionising radiation with which there are associated risks for the patient and the medical staff. The liquid helium typically has to be topped up weekly.  It is non­invasive  MRI provides excellent soft tissue imaging providing better contrast than CT or conventional x– rays and much better resolution than ultrasound.  There is currently a shortage of skilled people in the medical imaging industry in Australia (2001).  The MRI machines are very sensitive and must be screened from outside radio and magnetic interference adding to the capital costs of installing such machines  Patients with heart pacemakers or metal parts in their bodies cannot be imaged  Great care must be taken to avoid introducing ferromagnetic materials into the MR imaging room.

com. we have made a choice.   patients   are   demanding   from   the   outset. MRI is one of the more expensive imaging technologies.   As   a   result   of   the   growing   use   of   MRI   especially. Medical Physics Social Implications of Using MRI Medical   imaging   technologies   increase   people’s   chance   of   surviving   medical   problems.   Doctors   are   also   coming   under   increasing   pressure   from   litigants   who   pursue compensation when a doctor fails to pursue every possible avenue that technology has to offer.   is   a   diagnostic   tool   that   often   outperforms   other   procedures. As a society. The cost however must be met. it is often used as a last resort when those other technologies fail. The result is that some doctors now routinely order an MRI if there is the slightest reason for suspecting that it may reveal what other technologies will not. Increasingly   however. since the hospitals and private practices using imaging technologies must   factor   in   capital   and   ongoing   costs. Because it has better resolving capabilities than ultrasound and CT.   Technology   improves quality of life in many cases. Option 9.   MRI especially.   access   to   the   best   available technology.au . Costs have increased. both economic and social. insurance costs have increased substantially.6 page 89 G Pitt  gregphy@tpg. Quality of life has improved. But it comes at a cost. The economic cost is very high because   our   system   of   medical   insurance   means   that   few   patients   pay   the   full   cost   of   such procedures.

au .com.6 page 90 G Pitt  gregphy@tpg. Medical Physics Comparing MRI and CT Option 9.

Examine the images below. 6. but nitrogen 14 does not.com.au . 7. Explain carefully why these nuclides must have a net spin. Medical Physics Questions 1. 3. Nuclei having a net spin include hydrogen. 5. Explain why fluorine 19 has a nuclear magnetic moment. Option 9. 4. phosphorus 31and carbon 13.6 page 91 G Pitt  gregphy@tpg. 2.    Image 1 Image 2    Image 3 Image 4 Identify the imaging technology used to produce each of the images.

i  Definition: A nuclide is the particular nucleus with a given number of protons and neutrons in a given energy state .