Who is it?

1
•
2

3
1the dog
2 the cat

4
1
What is the name for this Image?

1
2

1. Plain film of the pelvis

3
1
2. Computed axial Tomogramm of the chest
4
2
What is the name for this Image?

1
2

2
1. Magnetic Resonance Tomogram of the chest
2. Computed axial Tomogramm of the chest
4
3
What is the name for this Image?

1
2

1. Sonogram of the head

2
2. Magnetic Resonance Tomogram of the head
4
4
What is the name for this Image?

1
2

3
1
1. Liver Sonogram
2. Liver MRI
4
5
What is the name for this Image?

1
2

1. Bone radionuclide image

2. The hole body MRI
4 1 6
 Which of techniques uses Ionizing
radiation?

1
2

1. Radionuclide imaging
2. MRI
4 1 7
8
Which of imaging techniques can’t
cause damage to human?

1
2

1. Roentgenogrphy
2. Ultrasound imaging
4 2 9
 What is the source of radiation in X ray
examination?

1
2

3 1
1. Roentgen tube
2. Radiopharmaceutical agent in human body
4
10
11
 Roentgen tube is source of
radiation in X ray examination

12
 What is the source of radiation in
radionuclide examination?

1
2

3 2
1. The human body itself
2. Radiopharmaceutical agent in human body
4
13
 Nuclear Medicine Imaging

• Radioactive isotopes concentrated in certain tissues emit gamma radiation, that is a source
of radiation in radionuclide imaging.

14
 What is the source of radiation in
thermography?

1
2

3 1
1. The human body itself
2. Roentgen tube
4
15
Infrared Imaging or Thermography

16
 What is the name for this roentgenogram
projection?

1
2

3 1
1. Lateral view
2. Direct view
4
17
What is the name for projection of this emission
radionuclide image of abdomen ?

1
2

3 2
1. Lateral view
2. AP or direct view
4
18
Is it panoramic or tomographic radionuclide
image of abdomen ?

1
2

3 2
1. Panoramic
2. Tomographic
4
19
Is it panoramic or tomographic image of head?

1
2

1. Panoramic 1. this is vertebral artery angiogram,

2. Tomographic
panoramic
4 lateral view
20
21
 The planes of section define three ways to ‘slice' the
Z body as follows:

x
22
Transverse (X-Y)
• Transverse (or axial) sections
form a series of
circumferential slices - rather
like slicing the body into a
series of pancakes and
stacking them atop one
another.
• In the transverse (or axial)
plane, where right and left
should go depends on if we
are looking from the head
down or the feet up.

23
 Coronal (X-Z)

Coronal sections follow front to back, as though cutting through a corona,

or halo, around the head.

24
Sagittal (Y-Z)
• Sagittal sections
follow from one side
of the body to the
other - left to right, or
right to left

25
 Is this image illustrate spatial or contrast
resolution?

1
1. Spatial
2. Contrast

26
What square illustrates the best resolution?

2
3

1. first
2. third
2
27
 What square illustrates the best contrast
resolution?
1

2
3

1. first
2. third
1
28
 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.

29
 Two projections are necessary!
Fracture of the distal end of the radius (Colle's fractures).
lateral view –the angulation in a
AP view shortening or compression
dorsal direction
the distal end of the radius
v = volarly, d = dorsally

30
 Two projections (views)

• PA • Lateral 31
 1. As the two units (tube (T) and film (F)
move horizontally, simultaneously,
only body structures that lie in a specific
geometric plane will allow X- rays to
consistently pass through to the
detector.
2. In this way, those structures that lie in a
specific geometric plane show up
clearly on the film, while structures
outside the plane are blurred.
film
3. The image produced by this type of
radiology is parallel to the long axis of
the body.
33
• Blurred undesirable slices present in tomogram as unclear
gray shadows lines that are parallel to the long axis of image

34
At lateral plane film enlarged aerated sinus sphenoidalis with
thin bony walls superimposed by other bony structures of face
skeleton

conventional tomogram clarify the image making the

diagnosis easy - Pneumocele of sinus sphenoidalis
35
Conventional tomography of the chest
Tumor of right main bronchus

Tomographic motion minimizes

x-ray intensity fluctuations in
the bones shadows, thereby
increasing both contrast and
overall visibility of the desired
image.

36
 Conventional Radiography (CR )
• Also called “plain films” or “standard films”, X-ray,
• CR can produced real time imaging to watch moving
structures that called fluorography
• Image forms using broad beam ionizing radiation (X rays)!
• The image formation is related to the subject density!
• CR may involve the use of contrast agents!
• The use of contrast agents in combine with fluorography is
the GE radiology imaging
• To improve image contrast to remove superimposition effect
CR may involve conventional tomography technique!

37
 Advantages Disadvantages
☺Cheap ☹Ionizing radiation
☺Rapid ☹Superimposition-
☺Panoramic view summation of
☺Good spatial shadows
resolution ☹Bad contrast
resolution

38
 Computerized Tomography (CT)

Computed axial tomography has been one of the biggest

breakthroughs in diagnostic radiology.
The first clinical CT scanner was developed by G.N. Hounsfield
for examination of head and was installed in 1974 at Atkinson
Morley’s hospital in Wimbledon, England.
 CT scanner for examination of head installed in
1974 at Atkinson Morley’s hospital in Wimbledon,
England

Copyright Oleh Tretiak, 2004 40

Computed axial • The first body CT scanner was installed in
1974 and before the end of 1970s the basic
technical evolution of CT was complete.
tomography • Technical details were refined during 1980’s
and CT technology remained on a plateau
until early 1990’s when the advent of spiral
(helical) CT scanning made a further rapid
evolution leading to improve diagnostic
capability, 3 D imaging techniques and CT
angiography.

41
Helical CT
 Computed spiral
tomography
3D reconstruction

43
Computed spiral tomography
angiography

44
Computed multi slice tomography
• The latest innovation is the
introduction of multi slice CT
in 1998.
• This new technology is vastly
expended the performance
of CT scanners.

45
 Computed multislice
tomography
• It truly transforms CT from a
transaxial imaging modality
to a 3 D technique that
yields high quality images in
arbitrary planes and forms
the basis for an expending
variety of 3 D visualisation
technique including virtual
endoscopy.

46
 CT Bronchoscopy

Path View

47
 CT Colonoscopy

Path View

48
 Comparison

Left: A polyp seen with optical endoscopy.

Right: View in virtual endoscopy.
49
 Computer Tomography:
How It Works

The images are produced by rotating the x-ray tube and

detectors around the patient in a circle.
 Computer Tomography:
How It Works

X-ray beam passes through a thin axial section

of patient from various directions.
51
 Computer Tomography:
How It Works

Parallel collimation is used to

shape the x ray beam to a thin fan
which define the thickness of the
scan plan
 Fan-Beam Computer Tomography
• Detectors measures the
intensity of attenuated
radiation as it emerges Detectors
from the body.

53
• A mathematical image reconstruction (inverse Radon
transformation) calculates the local attenuation at each point
within the CT section.
• These local attenuation coefficient translated into CT numbers
and are finally into shades of gray that are displayed as in
image.

54
• The computer then runs a series of complex algorithms
to reconstruct the image, which can then be displayed
on a monitor. 55
Computed axial tomography (CAT)

Unlike conventional tomography, the image produced by

computerized transaxial tomography is a cross section of the
body and is called a transaxial image because it is perpendicular
to the body's long axis
 Computer Tomography:
How It Works

•A CT image is composed of a square

image matrix that ranges in size from
256x 256 to 1024x1024 picture element
or pixels.
•Every pixel has his one attenuation
number or density of according body
slice point.
 These CT numbers are translated into
shades of gray that are displayed as in
image on monitor.

58
• Human eye can distinguish only a limited number of gray levels (16-100).
• The complete diagnostic range of CT numbers is 4000.

59
• So there is no point in assigning the
complete diagnostic range of
numbers to the available range of
gray levels (from white to black)
because discrimination between
structures with small differences in CT
number would no longer possible.
• It is there for better to display just a
portion of CT scale. This so called
window is defined by its width which
affect image contrast and by its level
(centre) which determines image
brightness.

60
Example of Contrast

Window for low

12 bit image, full densities
contrast range.

61
 More Contrast Operations

Window for high

densities_
Soft tissues window
62
 Compare
Lung window Soft tissues window

63
Compare

64
At hard copy (film) you can’t change the window
and have to read it complete!!!

65
 Advantages CAT Over Projection
Radiography
Advantages
☺ Only thin tissue slices are exposed to X -rays.
☺ There is no disturbing superimposition or blurring of
structures located outside the selected tissue planes as in
conventional tomography.
☺ The result is a good contrast resolution far superior to
conventional X -ray techniques.
 There is no disturbing superimposition or blurring of
structures located outside the selected tissue planes as in
conventional tomography
The small tumor in the right lung on
plain film The same tumor on CAT imaging
The result is a good contrast resolution far
superior to conventional X -ray techniques

Give a visualization of differences between tissues that

differ in physical density by less than 1%.

CAT is the best method for evaluation of renal stone

 The images of patient with
The Advantages Aneurism of abdominal aorta with dissection

Over Projection
Radiography A
• Data from a single CT
imaging procedure
consisting of either
multiple contiguous or one V
helical scan can be viewed
as images in the axial (A),
coronal (C), or sagittal (S)
planes, depending on the
diagnostic task in programs
of multiplanar
reconstruction C S
 The Advantages Over Projection
Radiography
• Data from a single CT A

imaging procedure
consisting of either
multiple contiguous
or one helical scan V
can be viewed as
images in volume
rendering model (V).

C
Special terms used on CT reports:

– Low density
– High density
 In conventional roentgenlogy to make some
organ to be visible we use contrast agents

Barium sulfate meal per os in Barium sulfate emulsion in enema

upper GE series in low GE series 72
Intravenously IODINE (J2) contrast agents to
make be visible parenchyma and vessels ore
only vessels

pyelography angiography 73
Native CAT images of abdomen
intravenously IODINE contras medium have done
intravenously IODINE contras medium have done
Contrast media intravenously and per oral

80
 Contrast for CT
• Iodine injected into an arm vein during the scan
• Iodine or Barium diluted in water given orally
for abdomen scans
• Enhances the blood vessels and organs and
makes them much easier to see
• Enhances cancerous tissue in many cases

81
CAT images of the liver in
different step of contrast exam
There are some risks
Allergic reaction
Kidney damage

• 5% of the
patient have a
mild ore severe
reaction to
iodine contrast
agent!!!
 Diagnostic use of CAT:
Cranial CT
Epidural hemorrhage
Diagnosis of
cerebrovascular
accidents and
intracranial
hemorrhage is the
most frequent
reason for a "head
CT" or "CT brain".
 Cranial CT

CT generally does not Hemorrhage in left hemisphere of brain

exclude infarct in the
acute stage of a
stroke, but is useful to
exclude a bleed so
anticoagulant
medication can be
commenced safely
only after CAT of
cranium
 Cranial CT

For detection of brain Meningioma on postcontrast CAT of

head
tumors, CT scanning
with IV contrast is
occasionally used
but is less sensitive
than magnetic
resonance imaging
(MRI).
 Cranial CT also be used
Volume rendering of CAT scan
• to detect increases in intracranial
pressure,
• for evaluating facial and skull
fractures,
• for surgical planning for
craniofacial and dentofacial
deformities,
• evaluation of cysts and some
tumors of the jaws/sinuses/nasal
cavity/orbits,
• diagnosis of the causes of
chronic sinusitus,
• for planning of dental implant
reconstruction.
 Chest CT

CT is excellent:
Pneumonic infiltration in low right
• For detecting both acute and lobe
chronic changes in the lung
parenchyma,
• For detection of airspace
disease (such as pneumonia
or cancer).

• Ordinary non-contrast scans

are adequate.
 Chest CT

CT is excellent:
Diffuse emphysema
• For evaluation of chronic
interstitial processes
(emphysema, fibrosis).

• Thin (0.5-2 mm) sections

with high spatial frequency
reconstructions are used.
 Chest CT

CT is used:
Mediastinal lymph node hyperplasia
• For evaluation of the
mediastinum and hilar
regions for
lymphoadenopathy.
• In this cases we need IV
contrast administration!!!
 MSHCT in acute chest pain/ dyspnea

CT angiography of the chest

• Becoming the primary
method for detecting PE
pulmonary embolism (PE)
and aortic dissection.
• Rquires accurately timed
rapid injections of contrast
and high-speed helical
scanners!!!
CT is the standard method of evaluating abnormalities seen
on chest film and of following findings of uncertain acute
significance
High density shadow on PA plain
film of chest Tumor nodule on CT image
 Abdominal and pelvic CT

The most common uses diagnosis Abdominal aortic aneurysm, postcontrast

of CT
• Renal or urinary stones,
• Appendicitis,
• Pancreatitis,
• Diverticulitis,
• Abdominal aortic aneurysm,
• Bowel obstruction.
 Abdominal and pelvic CT
Appendicitis the appendix lies behind the
caecum and has a light thickened wall in
Renal stones. contrast image.
There is the stone in appendix (arrow).
 Abdominal CT

Acute pancreatitis.
Axial contrast-enhanced CT scan shows
fluid collection in peripancreatic space and
minimal necrosis of pancreas parenchyma
 CT is also the first line for detecting solid
organ injury after trauma
CT shows a subcapsular hematoma Deep laceration with a large
with a splenic laceration extending perinephric haemorrhage with
from the capsule to the hilum with haemorrhagic extension into
posterior pararenal space.
an intraparenchymal hematoma
(blue arrow). 
 The usefulness of contrast
administration

Renal abscess without contrast Renal abscess after contrast

administration administration
 In most cases it is necessary intravenous contrast
administration

Liver tumor without contrast Liver tumor after contrast

administration administration
 Extremities
CT is often used to image complex fractures, especially ones around
joints, because of the ability to reconstruct the area of interest in
multiple planes.
 Computed Axial Tomography

• Also called CAT scanning or “CT”

• Image formed using a rotating thin beams of
ionizing radiation
• Image “slices” reconstructed by computation
• The image formed is related to the subjects
density
• Image display on computer or multiple films
 Computed Axial Tomography

Advantages Disadvantages
☺Eliminates the ☹Ionizing radiation
superimposition of ☹Expensive
images of structures
☺Rather rapid
☺Good contrast
resolution
 Some cool things we can do with
CT these days
• CT Angiography - Scan rapidly during Iodine injection
in vein
• Colonography - Scan colon after filling with air
• Bronchoscopy - Scan chest air is already in bronchi
• 3D Images Computer reconstruction

102
 CT Angiography
Aorta

Iliac arteries
Femoral arteries
3D Images Computer
reconstruction
 CT Bronchoscopy

Path View

105
Path View

106
107
108
Colonoscopy

109
Colonoscopy

110
111
112
113
114
115
116
117
118