Introduction to Radiology I

ž Objectives:
 Explain the basic principle of X-ray production, image formation and use
 Contrast agents
 Principle and use of Fuoroscopy
 Principle and use of Tomography

Radiology is a medical speciality using medical imaging technologies to

diagnose and treat patients.
Imaging Modalities:
ž - Ionizing Radiation:
Diagnostic Radiology (X-rays)
Digital subtraction angiography
Computed Tomography (CT)
Radionuclide imaging
Positron Emission Tomography (PET)/SPECT
- No Ionizing Radiation:
Diagnostic Ultrasound (Ultrasonography)
Magnetic Resonance Imaging (MRI)
X-rays
ž High energy electromagnetic radiation
ž No mass , No charge, Energy.
ž They are produce when high energetic electrons interact with the matter. Kinetic
energy of the electrons converted in to electromagnetic energy by atomic
interaction.
How X-rays produced:
 Features of X-rays:
Penetration effect used for imaging and therapy
Fluoscent effect used for Fluoroscopy
Photosensitive effect used for filming
Ionizing effect for Radiotherapy and radiation injuries
Production of Image:
ž X-ray pass through tissue to expose detector ( either pass all the way, be
scattered or deflected or absorbed.
ž Passage depends on
- Tissue characteristics
– - Density
– - Atomic Number
– - Number of electrons per gram
– - Thickness
– The detector might be a film, CR plate or others.
 Materials of low density appear darker.
 An object will be seen with conventional radiography if its borders lie beside
tissues of different density.
 Differential absorption of X-ray by the tissues is the cardinal feature of image
formation
 Special terms used on x-ray reports
Radiopaque, Radiolucent, High attenuation, Low attenuation, Water density
ž Five principal radiographic densities:
ž 1- Air/gas: Black.
ž 2- Fat: dark grey.
ž 3- Soft tissue/water: light grey.
ž 4- Bone: off- white.
ž 5- contrast material/metal: bright white.
Getting the images:
Hard copy ( film ) or software copy
PACS
ž A picture archiving and communication system (PACS)
aims to replace conventional analogue film and paper clinical request forms and
reports with a completely computerized electronic network whereby digital
 images are viewed on monitors in conjunction with the clinical details of the
patient and the associated radiological report displayed in electronic format.
NOTES
 Projections are usually described by the path of X-ray beam, PA, AP,..
 The image on the film is two dimentional.
 Horizontal ray films (Erect or lateral decubitus): The way to see air-fluid level.
 Portable X-ray for patient can not be moved safely or in operation theater.
 All X-ray images show some magnification.
Use of contrast agents
ž Contrast material (radio-opaque or radio-lucent) administered to see structures
or pathologic processes that would not be seen otherwise
ž Some useful contrast agents
Barium sulfate in the GI tract
Iodine compounds :
- Low osmolar compound in urography, Angiography
- High osmolar (eg gastrographin ) for GIT
Carbon dioxide in the vessels or GI tract
Lipiodol for fistulography.
Most of adverse effects of iodinated are related to osmolality of the agents.
Bronchospasm, laryngeal oedema and shock. Patient with asthma is more likely to
have these.
Renal function deterioration in diabetics, Renal failure
X-ray in summary:
ž - Ionizing radiation : so need Exposure concerns
ž - Somewhat limited discrimination between structures of similar density: eg.
Tumor vs. normal organs
ž - Inexpensive
ž - Readily available
ž - First line imaging tool
Conventional Tomography
 Cross sectional radiography
 Used when an object obscured by overlying or underlying structures, e.g.
during IVU.
 X-ray tube and the film move about a pivot set at a desired level of interest.
 Is used less with the introduction of CT.
 Fluoroscopy
 Utilizes X-ray
 Examine the anatomy and motion of internal structures by constant
stream of X-rays.
 Using image intensifier.
 May involve the use of contrast agents
Uses :
ž Barium studies of the GIT
ž Angiography and IR
ž General surgery: cholangiography,..
ž Orthopedic surgery: reduction and fixation of fractures, ..
ž Airway screening on tracheomalacia and diaphragm screening

Advantages disadnatages
Widely available Time consuming
Inexpensive Need patient cooperation
Shows functional and anatomical High radiation dose especially with
details ingestion/injection of contrast
No sedation required
 Computed Tomography
 Ionizing radiation: Requires concern and careful utilization
 Excellent discrimination between subtle tissue density differences
 Moderately expensive
 Readily available
 Growing spectrum of applications across a broad spectrum of diseases
and body parts. CT urography, CT colonography, CT Angiography,..
Computed tomography differs from conventional radiography in that
 More sensitive x-ray detection system is used.
 The x-ray tube and detectors rotate around the patient.
 X-ray beam traces a spiral path to create a‘volume of data’ within the
computer memory.
 Multidetector (multislice) CT acquires multiple slices (64, 128, 256 or 320
depending on the machine) during one rotation of the x-ray
tube. Multidetector CT enables the examination to be performed in a few
seconds.
 Dual source (or dual energy) CT allows a virtual non-contrast CT image to be
derived from CT acquired with intravenous iodinated contrast medium.
 The computer calculates the attenuation (absorption) value of each picture
element (pixel). Each pixel is 0.25–0.6 mm
in diameter. The resulting images are displayed on a monitor and can be
stored electronically. The attenuation values are expressed on scale
(Hounsfield)
 Attenuation values or HU: zero - 20 for water or cyst. Down to -100 for fat. -
100 to – 1000 for air. 20 – 100 for soft tissue. 1000 for bone
ž Examples of Primary applications:
› First line evaluation in suspected cerebral vascular events –
hemorrhagic vs. ischemic
› First line evaluation in soft-tissue and skeletal trauma
› First line evaluation in suspected pulmonary embolism
› First line evaluation in suspected urinary calculi

Limitations and disadvantages:

 Main disadnatages related to its use of ionizing radiation.
 Hazards of IV contrast
 Lack of portability
 Relatively high cost
 A number of areas of the body are imaged relatively poorly with CT;
include: Pituitary fossa, posterior intracranial fossa, and the spine.

References:
- Peter Armstrong- Diagnostic imaging
- Imaging for students