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Introduction to

Anatomy by Diagnostic
Radiologic
g g
Imaging WE ARE HERE
Anatomy

Patricia Moser, MD
Assistant Professor, Diagnostic Radiology
University
y of Florida College
g of Medicine

Radiology
gy Diagnostic
g Imaging
g g
• Diagnostic Imaging • Electromagnetic Radiation
• Angiography and Interventional – X-ray & Computed Tomography (CT)
Radiology – Magnetic Resonance Imaging (MRI)
– Nuclear Scintigraphy
(Nuclear Medicine)
• Not to be confused with
Radiation Oncology • Sound Waves (not radiation)
((Radiation
ad at o Therapy)
e apy) – Ultrasound
Different specialty

Wilhelm Conrad Roentgen


1845--1923
1845

January 1896 - First xx--ray Routine x-


x-ray current technology
made in public
Xray
• Plain Radiography
– X RAY PRODUCTION
– inherent contrast
– film
– digital
• Contrast Radiography
– barium
– iodine
i di
• Fluoroscopy
• CT (Computed Tomography)

ELECTRONS

XRAYS A diagnostic image is composed


of differences in contrast between tissues

which result from


1. Electrons generated at filament
differences in radiation interaction
2. Negatively charged electrons move toward anode
andd strike
t ik ttargett att high
hi h speed
d
in the tissues
3. 99% result in heat dissipated by the rotating target
4. 1% create x-rays which are directed through the
window
5. X-rays pass through patient to a receptor (film,
digital, fluorescent screen, etc.)

Tissue Thickness

LESS GET THROUGH>>MORE GET THROUGH


WHITE GRAY BLACK

The thickness of the tissue affects the attenuation


of the x-rays.
Xray Tissue type
• Plain Radiography
– X ray production
– INHERENT CONTRAST
– film
– digital / PACS
• Contrast Radiography
MORE GET THROUGH>>LESS GET THROUGH
– barium BLACK GRAY WHITE
– iodine
i di
• Fluoroscopy
• CT (Computed Tomography) The tissue type affects the attenuation of the xx-rays
rays

Radiographs are summation shadows created by differences in


contrast between tissues. Tissue thickness and tissue
composition affect the attenuation and therefore, the shade(s)
of gray in the final shadow image.

Inherent Contrast
• Tissue • Appearance on XRAY BONE
– Air – Bl k
Black
– Fat – Dark Gray SOFT
– Soft Tissues – Gray TISSUE
– Bone, Calcium – White
– Metal – Reallyy White
FAT

AIR
BONE

SOFT
TISSUE

FAT

AIR
METAL

Xray Film Radiography


• Plain Radiography
– X ray production
NOTE THAT MOST OF
– inherent contrast
THE DARKENING OF THE
– FILM FILM IS NOT BY XRAYS
– digital / PACS BUT BY VISIBLE LIGHT
PHOTONS PRODUCED
• Contrast Radiography BY XRAYS HITTING A
– barium SCREEN
IN FRONT OF THE
– iodine
i di
FILM
• Fluoroscopy INSIDE OF A CASSETTE
• CT (Computed Tomography)

Film Radiography Film Radiography


FILM CASSETTE DEVELOPING TANKS
XRAY VIEWERS

PASS BOX SAFE LIGHT


Film Radiography Xray
XRAY FILM STORAGE
• Plain Radiography
– X ray production
– inherent contrast
– film
– DIGITAL / PACS
• Contrast Radiography
– barium
– iodine
i di
• Fluoroscopy
• CT (Computed Tomography)

‘Digital’
g Radiography
g p y Computed Radiography CR
• Two types
– Computed radiography, called CR
• Uses existing equipment to make exposures
• Film cassette is replaced with a charged metal plate
• After exposure, plate is ‘read’ in a special device HERE ARE
THE PLATES
– Digital
Di it l radiography,
di h called
ll d DR
• Requires conversion of the entire xray room
• Film cassette is replaced by a CCD sensor (like in a
digital camera or video camera)

PACS=Picture Archiving and Film --> Computer Viewing


C
Communication
i ti S System
t 21ST CENTURY
•Awareness bracelet
•Flat screens
•Windows XP

20TH CENTURY
•Bad haircuts
•Films
•View box
•What’s
Wh ’ with i h the
h
t-shirts dudes?
PLAIN
Contrast Agent
g BARIUM
RADIOGRAPH
SWALLOW
OF THE CHEST
• Anything that enhances the differences
between tissues of similar densities
• For XRAY there are TWO commonly used
contrast agents:
– Barium
– Iodine
• Various ways they are introduced
– Swallowed: barium swallow, upper GI
– By enema: barium enema
– In vein: Intravenous urogram
– In artery:
y Arteriogram
g

PLAIN RADIOGRAPH
BARIUM ENEMA
Barium: upper GI
OF THE ABDOMEN
STOMACH

Iodine: Iodine:
Intravenous urogram Arteriogram through
Intravenous pyelogram
py g a catheter (tube)
( )
(IVU or IVP) in the leg

KIDNEYS RENAL ARTERY

URETERS AORTA

BLADDER ILIAC ARTERY


Xray
• Plain Radiography
– X ray production Fluoroscopy relies on
– inherent contrast
– film
image intensifiers to make
– digital / PACS moving (real time) XRay pictures
• Contrast Radiography
– barium
– iodine
i di
• FLUOROSCOPY
• CT (Computed Tomography)

Xray
• Plain Radiography
– X ray production
– inherent contrast
– film
– digital / PACS
• Contrast Radiography
– barium
Diagram of Photograph of a
– iodine
i di
fluoroscopic unit fluoroscopic unit • Fluoroscopy
• CT (COMPUTED TOMOGRAPHY)

Computed
p Tomography
g p y ((CT)) Computed Tomography (CT)
• Still uses XRAYS like radiography
$$$$
EMI • Tube spins around patient
• Detector spins around patient
opposite the tube
• Detector output and angular position fed
into a computer
p
• Computer performs calculations to
estimate density of tissues in each square
of a ‘slice’
Computed Tomography (CT) Contrast for CT
• Iodine injected into an arm vein during the
scan
• Iodine or Barium diluted in water given orally
for abdomen scans
• There are some risks
– Allergic reaction
– Kidney damage
• Enhances the blood vessels and organs and
makes them much easier to see
• Enhances cancerous tissue in many cases

CONTRAST
IODINE

CT Of The Entire Body


Evolution of CT
• First used clinically in late 1970s and In 2 Minutes
early 1980s
• Quite slow: 1 minute per slice
Still was revolutionary
• Generations: 1st, 2nd, 3rd, 4th,
• spiral,
p , multi slice
• Now have detectors up to 320 slices
wide
• Can scan the whole body in <1 minutes
Incredible detail possible
p
Essentially a whole new modality
Another revolution in the making
CT Images from modern CT WINDOWS
machine
Soft tissue

Bone Lung

Some cool things we can do CT Angiograms


with CT these days
• CT Angiography
Scan rapidly during Iodine injection in vein
• Colonography
Scan colon after filling with air
• Bronchoscopy
B h
Scan chest air is already in bronchi
• 3D Images
Computer reconstruction

CT Colonography CT Bronchoscopy
3D CT of the heart 3D CT of the knee and leg

Ultrasound
• Uses high frequency sound to make
g
images
• The sound is produced and detected
Ultrasound with the same device: TRANSDUCER
• Transducer
– Speaker: sound into patient
– Microphone: sound coming back from
patient
• Analogous to SONAR used in undersea
warfare

TRANSDUCER
Ultrasound Machines
Getting Much Smaller

TRANSDUCER

Ultrasound Pictures Used


Not Any More
To Be Hard To See

Obstetric
Ultrasound
Ultrasound Of Breast Benign Ultrasound Of Breast Cancer

Magnetic
g Resonance Imaging
g g
• Starts with a really strong magnet
– Supercooled with Liquid Helium / Nitrogen
• Transmit radio wave pulses into patient
Magnetic Resonance Imaging
• Listen for return radio waves caused by
(MRI) interaction with protons (water) in the
patient’s
patient s body
• Process the frequency and phase of the
e u ed ssignals
returned g a s by co
computer
pu e
• Different tissues give different
intensities of returned radio waves >
image
MRI Contrast
• Gadolinium solution injected into vein
• Same idea as the Iodine contrast used
for CT
• Gadolinium alters the interaction of
radio waves with the p
protons in water so
that it gives MORE signal
• Shows up as white on images

Magnetic Resonance
Angiography
Nuclear Scintigraphy
• Often called NUCLEAR MEDICINE
• Uses radioactive tracers that emit
Nuclear Scintigraphy radiation
Nuclear Medicine – Electromagnetic OR particulate
• Often these are injected
j into the vein
• Different tracers go to different organs
or parts of the body
• Images are made by detecting the
radiation coming out of the patient

NORMAL BONE SCAN ABNORMAL BONE SCAN


NORMAL LUNG SCAN
BLOOD FLOW (TOP) & VENTILATION (BOTTOM)

ABNORMAL LUNG SCAN


BLOOD FLOW (TOP) & VENTILATION (BOTTOM)

Angiography And
Interventional Radiology
Interventional Radiology Drawing of normal kidney
• Radiologists do invasive procedures guided
by images for either diagnosis or treatment
• Basically anything that breaks the skin
– Needles for biopsy or fluid removal
– Catheters to make angiograms Frank
Netter, MD
– Catheters with balloons to open
p blood vessels you will love
– Stents to hold blood vessels open this guy by
the time you
– Coils and material to block blood vessels are
a e finished
s ed
– Catheters to drain abscesses
– Tubes for feeding
– etc
t etc
t

Angiogram of normal kidney Angiogram of kidney cancer

SPINE
11TH RIB

THIS IS THE
CANCER MASS
THIS IS THE
CATHETER
COMING
UP FROM
THE LEG
ARTERY

Angiogram after embolization Non Surgical Biopsy

NO BLOOD
FLOW TO
THE MASS
NOW IT CAN
BE REMOVED
WITHOUT
EXCESSIVE
BLEEDING
Non Surgical Shunting For Angioplasty Balloon
Cirrhosis of Liver TIPS Vascular Stent

Angioplasty & Stent

AFTER

Irregular renal artery Post angioplasty, flow


reduced blood flow to is restored and the patient
kidney, produces becomes normotensive
hypertension
BEFORE

Diagnostic Imaging WHY DO I NEED TO KNOW THIS?

• X-ray
– radiography,
di h contrast
t t studies,
t di CT
• Ultrasound
• Magnetic Resonance Imaging
– MRA
• Nuclear Scintigraphy
Angiography And
Interventional Radiology
ANATOMY Knee - MRI Sagittal
PATHOLOGY

ANTERIOR POSTERIOR
CRUCIATE CRUCIATE
LIGAMENT LIGAMENT

IMAGING IS
GROWTH OF IMAGING
ESSENTIAL TO
MODERN HEALTH
CARE DELIVERY

Rothenberg, Korn. The Opportunities and Challenges Posed by the Rapid Growth of Diagnostic Imaging.
J Am Coll Radiol 2005;2:407-410.

ONE REASON FOR GROWTH

Percentage
g of internists saying
y g that the loss of an innovation
would have the most adverse effect on their patients.
Fuchs VR, Sox HC Jr. Physicians’ views of the relative importance of thirty medical innovations.
Health Aff 2001;20:30-42.