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X-rays are generated from the interaction of accelerated e-s & a target metal (tungsten) Patient is placed between

X-ray tube and silver halide film X-rays passed through the body are absorbed in direct proportion to tissue density X-rays penetrating the body strike the silver halide film and turn it dark the more x-rays that penetrate, the darker the area inscribed on the film ones & metal absorb or reflect X-rays r inscribed film is !lighter" or !more white" #oft tissues allow more X-rays to penetrate r inscribed film is !darker" $isuali%ing tissues of similar density can be enhanced using !contrast agents" Contrast agents: dense fluids containing elements of high atomic number (barium, iodine) Contrast agents absorbs more photons than the surrounding tissue r cavity appears lighter These contrast agents can be in ected, s!allo!ed, or given by enema

X- Rays

electron beam generator tungsten target metal resultant "-ray beam

silver halide film

&or 'mma()) *e *ill +lways Remember ,,

3omputed -omography (!3- #can" or !3at #can")

-he scanner device incorporates a moving table & a revolving X-ray tube

-he table moves the patient back and forth through the revolving X-ray emissions -he X-ray emitter moves (revolves) in a ./0o arc around the patient

1nstead of film2 the 3- scanner collects emitted X-rays via a collector -his collector is called a #314-155+-6R #cintillator transforms X-rays into a proportionally strong electric current -he electric current is then converted into a number of images (!slices")

3ontrast dyes may be used for image enhancement

CT scan

"-ray collector bank rotates around patient

"-ray tube

4ormal 3- scan (abdominal slice)

3- scan color enhancement

Purple area denotes destruction of normal brain tissue (green)

.-dimensional modeling using 3- scan

7agnetic Resonance 1maging

#agnetic nuclei are abundant in the human body ($,C,%a,&,') and spin randomly

(ince most of the body is $)*, the $ydrogen nucleus is especially prevalent

&atient is placed in a static magnetic field #agneti+ed protons (spinning $ nuclei) in the patient align in this field like compass needles ,adio fre-uency (,.) pulses then bombard the magniti+ed nuclei causing them to flip around The nuclei absorb the ,. energy and enter an excited state /hen the magnet is turned off, excited nuclei return to normal state 0 give off ,. energy The energy given off reflect the number of protons in a 1slice2 of tissue 3ifferent tissues absorb 0 give off different amounts of ,. energy (different resonances) The ,. energy given off is picked up by the receiver coil 0 transformed into images #,4 offers the greatest 1contrast2 in tissue imaging technology (knee, ankle diagnosis) cost: about 56)78 - 56988 time: :8 minutes - ) hours, depending on the type of study being done

Closed (traditional) #,4 scanner

*pen #,4

7agnetic Resonance 1maging tissues composition & signal intensity


-issue .at #uscle $yaline Cartilage ;igaments 0 Tendons Cortical <one =ranulation Tissue .ibrous Tissue $emorrhage > ?dema 4mmature (car #ature (car #ignal 1ntensity -8 high (!hitish) intermediate (gray) intermediate lo! (dark gray) lo! intermediate lo! high - intermediate intermediate - lo! lo! #ignal 1ntensity -9 intermediate intermediate intermediate - lo! (dull gray) lo! lo! high lo! high lo! to high lo!

one #can

7easures the rate of bone formation +ny disease that in:ures bone will cause new bone to form -his process is a very sensitive measure of disease processes

6ften used for detecting cancer mets (breast2 prostate)2 fractures2 & infection 3an be used to detect avascular necrosis of bone

Procedure is done by first in:ecting a technetium labeled phosphate Pictures are taken using a gamma camera;

=ose of radiation is small -akes about an hour to complete

immediately after in:ection2 . hours post2 & 9< hour post

one #can of 4on-malignant 6steoid one -umor

!hot spot" indicating u uptake of isotope in right femur

one #can of Prostate 3aner 7etastases

Positron 'mission -omography (P'-) #can

7easures metabolism via the decay of radioactive tracers in tissues with higher than normal metabolic activity (cancer) Patient in:ected with &luordeo>yglucose

=iseased organs & tissues process &=? at


a higher rate than normal tissues making &=? concentration higher in diseased tissue Positrons are emitted by &=? and collide with electrons2 emitting radiation

?lucose bound to &luorine 8@ (radioactive)

into . dimensional images Procedure performed as outpatient -akes about 9 hours Results available to physician within <@ hours

Radiation picked up by camera 3omputer reconstructs the radioactivity

P'- scan showing +l%heimerss =isease

P'- #can showing 4on Aodgkins 5ymphoma before & after / months of chemotherapy

=ual 'nergy X-ray +bsoprtometry (=X+ or ='X+)

Bsed to test for bone mineral density ( 7=) ie) 6steoperosis -hin X-ray beam is passed through the hip and lower spine regions 3omputer calculates how much X-ray energy is absorbed by the bones

3omputer compares results with average 90 year old (--score) and average age2 race and gender peer (C-score) Results are plotted on a graph and given to the radiologist

=ual 'nergy X-ray +bsoprtometry (=X+ or ='X+) =? ;@%A, &rodigy 3?"ABBBat the $uffines 4nstitute for (ports #edicineB *ur ne! toyC

='X+ #tandards
--score (sds)
(*A6 standard reference)

&racture Risk

7edical +ction
;ifestyle advice ;ifestyle advice, $,T in !omen 78 E 98 , Calcium and Fitamin 3 supplementation All of above plus consider <isphosphonate 3rugs (.*(*#A", ACT4%?;HB) All of above plus consider possible pain control and referral to specialist

%ormal Test: T D -6B8

5ow +bove +verage Aigh $ery Aigh

d<one #ass: T -6B8 to -)B7 (&ossible *steopenia)

Osteoperosis: T G -)B7 ?stablished *steoperosis plus the occurrence of one or more fractures

='X+ Report ?raph; /0 yr old female

3olor enhanced ='X+ #can; --score; -8)@

The more dense regions are red>orange>yello!