Introduction to Diagnostic

Imaging & Radiology

Prof. Dr. İsmet TAMER
İstinye University, Faculty of Medicine
Dept.of Family Medicine
Liv Hospital Bahçeşehir
 Learning objectives

• Understand sources of radiation exposure

• Understand mechanisms of protecting patients and
the public from inappropriate radiation exposure
• Discuss medical application of radiation and common
diagnostic imaging modalities
• Discuss radiological approach to common diagnostic
imaging modalities
 How does radiology work?

Radiology is the science;

• that uses medical imaging to diagnose and
• sometimes also treat diseases within the
body.

Radiology often uses X-rays!

 Sources of Radiation
Natural (70-85%, 2.4 milisielvert/year)
• Inhalational (Radon gas)
• Radionuclide from rocks
• Ingestion
• Cosmic radiation

Man-made (15-30%, 0.6 milisilviert/year)

• Diagnostic medical exposure
• Atmospheric nuclear testing
• Occupational exposure
 Radiation Exposure

• 70-85% (2.4msV) natural background radiation

• 15-30% (0.6msv) medical radiation exposure
• Overall exposure : 3msV /Year

• CT scan contributes for 4% of all diagnostic

imaging modality,
but shares 40% of all medical radiation exposures!
Hazards of radiation exposure

• Carcinogenesis
• Teratogenesis (congenital malformations to fetus)
• Abortion
• Burn
Integrative Health Care
Major causes of inappropriate patient
exposure
1. Repeating investigations
2. Investigation when results are unlikely to affect patient
management
3. Investigating too often
4. Doing the wrong investigation
5. Failing to provide appropriate clinical information and
questions that the imaging investigation should answer.
6. Over-investigating
 What did radiology add to
medicine?
• Imaging difficult organs (organs like brain, mediastinum,
retroperitoneum)
• Better surgical planning
• Staging cancers
• Interventional radiology
• Radiotherapy
 Radiation emitting modalities
– Radiographs (analogue, computed radiography and digital)
– Fluoroscopy
– Mammography
– Computed Tomographic (CT) Scan
– Nuclear Medicine Imaging
Non-radiation emitting modalities

• Ultrasound

• Magnetic Resonance Imaging(MRI)

 Mode of imaging

• Anatomical imaging • Functional Imaging

– Radiographs – Nuclear medicine (PET,SPECT)
– Mammography – Functional MRI
– Ultrasound
– CT scan
– MRI
• Combined
– PET-CT
– PET-MRI
Conventional Radiography
 Conventional Radiography (X-ray)
• Conventional radiography involves the use of x-rays;
• the term “plain x-rays” is sometimes used to distinguish x-rays used alone
from x-rays combined with other techniques (eg, CT).
• For conventional radiography, an x-ray beam is generated and passed
through a patient to a piece of film or a radiation detector, producing an
image.
• Different soft tissues attenuate x-ray photons differently, depending on
tissue density; the denser the tissue, the whiter (more radiopaque) the
image.
• The range of densities, from most to least dense, is represented by metal
(white, or radiopaque), bone cortex (less white), muscle and fluid (gray),
fat (darker gray), and air or gas (black, or radiolucent).

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 How X-ray works;
• Makes use of x-rays projected on the patient.
• X-rays exit the patient and reach the image receptor.
• X-rays are attenuated according to the body part density.
 Conventional Radiography (X-ray)
• Radiography is the most readily available imaging method.
• Typically, it is the first imaging method indicated to evaluate the
extremities, chest, and sometimes the spine and abdomen. These areas
contain important structures with densities that differ from those of
adjacent tissues.

• For example, radiography is a first-line test for detecting the following:

– Fractures: White bone is well seen because it is adjacent to gray soft
tissues.
– Pneumonia: Inflammatory exudate that fills the lungs is well seen
because it contrasts with adjacent, more radiolucent air spaces.
– Intestinal obstruction: Dilated, air-filled loops of intestine are well
seen amidst the surrounding soft tissue.

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 Radiographic Densities
• Air : blackest on a radiograph
• Fat; which is shown in a lighter shade of gray than air
• Soft tissue or fluid (because both soft tissue and fluid appear
the same on conventional radiographs, it’s impossible to
differentiate the heart muscle from the blood inside of the
heart on a chest radiograph)
• Calcium (usually contained within bones)
• Metal : appears the whitest on a radiograph
 PLAIN RADIOGRAPHY
• is used routinely for initial assessment of the patient
• but it has low specificity and sensitivity as compared
to other newer modalities.

• There are many disease entities in which the classic

diagnosis is obtained by plain radiographs;
➢various types of arthritis
➢pneumonia,
➢bone tumors (especially benign bone tumors),
➢fractures and congenital skeletal anomalies, etc.
Conventional Radiography (X-ray)

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Disadvantages of Conventional
Radiography
• Diagnostic accuracy is limited in many
situations.

• Other imaging tests may have advantages,

such as providing better detail or being
safer or faster.

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X-ray radiography of skull
 Sinusitis

Multipl myeloma
(lytic lesions)
Chest X-ray
Pneumonia
Abdomen X-ray (erect position)
Foreign body in
Chronic pancreatitis
abdomen
 Computed Tomography (CT)
In CT, an x-ray source and x-ray detector housed in a doughnut-shaped
assembly move circularly around a patient who lies on a motorized
table that is moved through the machine.
Usually, multidetector scanners with 4 to 64 or more rows of detectors are
used because more detectors allow quicker scanning and higher-
resolution images, which are particularly important for imaging the
heart and abdominal organs.
Data from the detectors essentially represent a series of x-ray images
taken from multiple angles all around the patient. The images are not
viewed directly but are sent to a computer, which quickly reconstructs
them into 2-dimensional images (tomograms) representing a slice of
the body in any plane desired.
Data can also be used to construct detailed 3-dimensional images.

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 Uses of CT
• CT provides better differentiation between various soft-tissue
densities than do x-rays.

• Because CT provides so much more information, it is

preferred to conventional x-rays for imaging most intracranial,
head and neck, spinal, intrathoracic, and intra-abdominal
structures.

• Three-dimensional images of lesions can help surgeons plan

surgery.

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 Magnetic Resonance Imaging
(MRI)

• MRI uses magnetic fields and radio waves to

produce images of thin slices of tissues
(tomographic images).

• Computer algorithms analyze these signals

and produce detailed anatomic images.

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 Uses of MRI

• MRI is preferred to CT when soft-tissue

contrast resolution must be highly detailed!

• (e.g., to evaluate intracranial or spinal cord

abnormalities, inflammation, trauma,
suspected musculoskeletal tumors, or internal
joint derangement).

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 Disadvantages of MRI
• MRI is relatively expensive, requires longer
imaging times than CT and may not be
immediately available in all areas.

• Other disadvantages include problems related

to:
– The magnetic field
– Patient claustrophobia
– Contrast reactions
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 Ultrasonography (US or USG)
• In ultrasonography, a signal generator is combined with a transducer.
• Piezoelectric crystals in the signal generator convert electricity into
high-frequency sound waves, which are sent into tissues.
• The tissues scatter, reflect, and absorb the sound waves to various
degrees.
• The sound waves that are reflected back (echoes) are converted into
electric signals.
• A computer analyzes the signals and displays an anatomic image on a
screen.
• Ultrasonography is portable, widely available, relatively inexpensive,
and safe.
• No radiation is used.

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 Uses of Ultrasonography
• Ultrasonography can identify superficial growths and foreign bodies (eg, in
the thyroid gland, breasts, testes, limbs, and some lymph nodes).
• With deeper structures, other tissues and densities (eg, bone, gas) can
interfere with images.

• Ultrasonography is commonly used to evaluate the following:

• Heart (echocardiography): For example, to detect valvular and chamber
size abnormalities and to estimate ejection fraction and myocardial strain
• Gallbladder and biliary tract: For example, to detect gallstones and biliary
tract obstruction.
• Urinary tract: For example, to distinguish cysts (usually benign) from solid
masses (often malignant) in the kidneys or to detect obstruction such as
calculi or other structural abnormalities in the kidneys, ureters, or bladder.

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 Uses of Ultrasonography
• Female reproductive organs: For example, to detect tumors and
inflammation in the ovaries, fallopian tubes, or uterus.

• Pregnancy: For example, to evaluate the growth and development

of the fetus and to detect abnormalities of the placenta (eg,
placenta previa)

• Musculoskeletal: To evaluate muscles, tendons, and nerves.

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Disadvantages of Ultrasonography
• Quality of images depends on the skills of the operator.

• Obtaining clear images of the target structures can be

technically difficult in overweight patients.

• Ultrasonography cannot be used to image through bone or

gas, so certain images may be difficult to obtain.

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Thank you for joining!
☺
ismet.tamer@istinye.edu.tr
: 0(532)332 09 29
@profdrismettamer