Copyright @ 2068. Academic Press. a 3 : 2 E 3 Medical Imaging Dr. Xiaofeng Zhang, Ll Introduction... 3 Prof. Nadine Smith, and 1.2 Digital Radiography : 4 Prof. Andrew Webb 1.21 Formation and Charactrinies of X-rays » 1.22’ Seater and Atewaton of Perm State University Xraysin Tisue + 1.23 Instrumentation for Digital Radiography 1.3 Computed Tomography. . we sete -6 13, Principles of Computed Tomography » 132 Spiral and Mulsice Computed Tomography 14 Nuclear Medicine 7 1.4.1 Radioactive Nucides in Nuclear Medicine » 14.2 Nodear Medicine Detectors » 14.3 Single Photon Emission Computed -omography « 144 Positron mision Tomography + 1-45 Combined Poston Emission Tomography/Computed Tomography Scanners 1.5 Ultrasonic Imaging... . 1 151 Fancamentalof Uso 12 Tranadacers and Beam Characteristics «153 Image Acquistion and Display 1.6 Magnetic Resonance Imaging 15 1.6.1 Bass of Magnetic Resonance + 162 Magnetic eld adios « 1.63 Wourier Imaging Techniques + 64 Magnetic Resonance Imaging Contras Agents 17. Diffuse Optical Imaging. 18 1.74 Propagation of Light Through Tissue « 17.2 Measurement of Blood Onygsration » 123 Image Reconstruction + 1:74 Measurement Techniques 18° Biosignals . cee ceeeee a 181 Hletroencepbalogaphy » 182 Hectrcadiogans 19. Appendix : cee eveneeeee mu AL Fourier ‘Transorns »/A2 Fred Backprojection « A Reratve Image Reconstruction 1.10 Exercises « 235 LAL References and Bibliography a 1.1 Introduction Medical imaging forms a key part of clinical diagnosis, and improvements in the quality and type of information available from such images have extended the diagnostic accuracy and range of new applications in health care. Previously seen as the domain of hospital radiology departments, recent techno- logical advances have expanded medical imaging into neurol- gy, cardiology, and cancer centers, to name a few. ‘The past decade, in particular, has seen many significant advances in each of the imaging methods covered in this chapter. Since there area large numberof texts (see Bibliography) that deal in ‘cat detail with the basic physics, instrumentation, and cl ical applications of each imaging modality, this chapter sum- Tena Oy AM tee edt fem ‘marizes these aspects in a succinct fashion and emphasizes recent technological advances. State-of-the-art instrumenta- tion for clinical imaging now comprises for example, 61-slice spiral computed tomography (CT); multi-element, multidi- mensional phased arrays in ultrasound; combined positron ‘emission tomography (PET) and CT scanners; and rapid par- allel imaging techniques in magnetic resonance imaging (MRI) using large multidimensional coil arrays. Furthermore, on the horizon are developments such as integrated diffuse optical tomography (DOT)/MRI. Considered together with signifi- cant developments in new imaging contrast agents—so-called “molecular imaging agents’—the role of medical imaging looks likely to continue to expand in modern-day healthCopyright @ 2068. Academic Press. a 3 : 2 E 3 4 1.2 Digital Radiography Planar X-ray imaging has traditionally been film-based and is used for diagnosing bone breaks, lung disease, a number of gastrointestinal (Gl) diseases (fluoroscopy), and conditions of the genitourinary tract, such as kidney stones (pyelography). Increasingly, images are being formed and stored in digital format for integration with picture archiving and communi- cation systems (PACSs), ease of storage and transfer and image ‘manipulation in, for example, digital subtraction angiography. ‘Many of the components of conventional film-based systems (Xray source, collimators, anti-scater grids) are essentially identical to those in digital radiography, the only difference being the detector itself. 1.2.1 Formation and Characteristics of X-rays ‘A schematic of an X-ray source is shown in Figure Ll (a). A potential difference, termed the accelerating voltage (kVp), typically between 90 and 150 RV, is applied between a small helical cathode coil of tungsten wire and a rotating anode consisting of a tungsten target embedded in a rotating copper disc. When an electric current is passed through the cathode, clectrons are emitted via thermionic emission and accelerate toward the anode target; X-rays are then created by the inter- action of these electrons with the target: This electron flow is termed the tube current (mA). X-rays then pass through a “window” in the X-ray tube. In order to create the desired thin X-ray beam, a negatively charged focusing cup is placed around the cathode. A broad spectrum of X-ray energies is emitied from the X-ray tube, as shown in Figure 1.1 (b). Characteristic lines are produced when the accelerated elec- trons knock out a bound electron inthe K-shell ofthe tungsten anode, with the resulting hole being filed by an electron from the L-shell, and the difference in binding energy of the two electrons being transferred to an X-ray. The broad “hump” component of the X-ray spectrum arises from “general radi- Glassimetal envelope Induction stator frase tungsten aod Induction stator le- Focusing cup xrays (a) FIGURE Li with an accelerating voltage of ~100 kVp. 1 Technological Fundamentals ation,” which corresponds to an accelerated electron losing part ofits kinetic energy when it passes close to a tungsten atom in the target and this energy being emitted as an X-ray. Overall, the number of X-rays produced by the source is proportional to the tube current, and the energy of the X-ray beam is proportional to the square of the accelerating voltage. ‘The collimator, also termed a beam restrictor, consists of lead sheets that can be slid over one another to restrict the beam dimensions to match those of the area of the patient to be imaged. 1.2.2 Scatter and Attenuation of X-rays in Tissue ‘The two dominant mechanisms for the interaction of X-rays with tissue are photoelectric absorption and Compton scatter- ing, Photoelectric interactions in the body involve the energy of an incident X-ray being absorbed by an atom in tissue, with a tightly bound electron emitted from the K- or L-shell: The incident X-ray is completely absorbed and does not reach the detector. The probability (Fpino) of photoelectric absorption occurring is given by: Prose ay where Zar is the effective atomic number, and Eis the X-ray energy. Since there isa large difference inthe values of Zr for bone (Zr = 20 due to the presence of Ca) and soft tissue (Za = 7.4), photoelectric absorption produces high contrast between bone and soft tissue. ‘Compton scattering involves the transfer ofa fraction of an incident X-ray’s energy to a loosely bound outer shell of an atom in tissue. The X-ray is deflected from its original path but typically maintains a substantial component of its original nergy. The probability of Compton scattering is essentially independent of the effective atomic number of the tissue, linearly proportional to the tissue electron density, and weakly Felative number of X-rays 0 0 4 8 100 Xray energy (e) (a) Schematic ofan X-ray tube. (b) Typical energy spectrum from a tungsten anodestructure of a fluid due to a propagating wave, and different ‘mechanisms are characterized by different relaxation times. An example of how a wave is attenuated and the significance of the relaxation time is exhibited when the period of the acoustic cyde is greater than the time required for a portion of the compression energy of the fluid to be converted into internal energy of molecular vibration. During the expansion cycle, some of this energy will be delayed in its restoration, resulting ina tendency toward pressure equalization and an attenuation of the wave, When a sound wave encounters a small (relative to the ultrasound wavelength) solid obstacle, a fraction of the wave is scattered. Scattering can be defined as the change of ampli- tude, frequency, phase velocity, or direction of propagation as the result of an obstacle or nonuniformity in the medium. Different behavior is seen for a scattering volume consisting of a single scatterer or a statistical distribution of scatterers. The degree and directionality of scattering are affected by the physical properties of the scatterer, such as its density, com- pressibility, roughness, and thermal conductivity. 1.5.2 Transducers and Beam Characteristics When polarized crystalline or ceramic materials are subjected to mechanical stress, they produce an electrical voltage. The converse is also true, such that an oscillating electrical voltage causes the material to vibrate, thereby producing a pressure wave in @ medium in direct contact with the material. This phenomenon, known as the piezoelectric effect, forms the basis of an ultrasound transducer. Transducers are usually made from polarized ferroelectric ceramics such as lead zirconate titanate (PZT). The resonance frequency, of the transducer is defined as: co] has (un) Where Gaus is the speed of sound in the piezoceramic (% 4000 mis for PZT) and 1 is the ceramic thickness (Figure 1.11). The ceramic itself is often represented as a disk that i electrically driven by slver-coated electrodes attached to ‘opposite faces of the disk. Applying a sinusoidal voltage at frequency f, causes the disk to vibrate and produce a pressure ‘wave at fe Since the spatial resolution in the axial direction is proportional tothe length of the pulse in tissue the transducer is mechanically damped to produce a short pulse of energy. The radiation or spatial intensity field from a circular piston is a complicated three-dimensional pattern (Figure 1.11). Close to the face of the transducer, the pressure field oscillates between a series of maxima and null points. The final oscilla- tion is known as the last axial maximum, located at last axial maximum © (112) For a plane piston, this location also forms the boundary between the near field (“Fresnel zone”) and the far field (“Fraunhofer zone”) of the transducer. Beyond the far field, the beam diverges at an angle @ = sin~! (0.61A/a) Similar toa radiating radio antenna, the off-axis field pattern also has a series of much smaller pressure field lobes and nulls (not shown). The null between the main lobe and the first side lobe is at @ = sin! (0.614 a) Image formation (see the next section) using a single-cle- ‘ment transducer requires mechanical movement over the re- gion of interest. The vast majority of transducers used in clinical practice are transducer arrays, consisting of a large ‘number of much smaller elements, which can be driven inde- pendently. These arrays can be one dimensional or two dimen- sional, as shown in Figure 1.1L 1.5.3 Image Acquisition and Display Single lines of pulse-echo ultrasound are termed A-mode lines. Knowing the speed of sound in tissue, the time delay between transmission and signal reception defines the depth of the reflected or backscattered signal. The beam can be swept through the region of interest by varying the excitation times \\,