Faculty of Medecin

Biophysics (M 1029)

Chapter 38

MEDICAL IMAGING

Prof. Dr. Khalil Thabayneh

Hebron University - Palestine
 38.2. X-ray Imaging
• X-ray images are widely used in medicine and dentistry, and
have been used to produce images of the internal structure
of objects that are opaque to visible light since soon after
the discovery of X-rays was announced by Röentgen on
1895.
• To produce an X-ray radiograph of the human body, the
area of interest is exposed to X-rays while a photographic
film is placed beneath the body. This produces an image
where the areas of greatest exposure correspond to the areas
of the body that are the most transparent to X-rays. Instead
of recording reflected light, as in a photograph, it records
degree of transmission of X-rays as a shadowgraph.
■ Contrast agents‫باين‬,,,‫املت‬,‫ ع‬can be used to improve the contrast
of an X-ray image. Introducing high-Z elements such as
barium and iodine will make those organs which absorb them
more opaque to X-rays. Iodine is used for imaging the
circulatory system ‫لدموية‬,,‫لدورة ا‬,,‫ا‬. Barium is used as a contrast
agent in imaging the gastrointestinal tract‫لهضمي‬,,‫از ا‬,‫لجه‬,,‫ا‬.
38.3. CT Scan
■ CT stands simply for Computed Tomography ‫ي‬ ( ‫صوير مقطع‬,,,‫ت‬.
Sometimes the word ‘Axial’ is added and the term CAT scan is
used). The word tomography is used to describe any imaging
technique that produces cross-sectional images. While there
are several techniques that are a kind of computed
tomography.
■ A limitation of X-ray radiography is the projection of a three-
dimensional structure onto a two-dimensional film. In
CT scanning, the orientation of the path of the X-rays through
the body is varied, and a computer is used to reconstruct a
picture of the cross section from the transmission data.
■ The patient dose for a CT scan is higher than for a traditional
X-ray. A scan involves an effective radiation dose of about
2 – 10 mSv.
■ Modern CT scanners use instead a fan X-ray-beam geometry and a
circular array of 600–700 fixed detectors to reduce scan times for a
single slice to about 1 s. The more recent generations of scanners also
use a helical path of the X-ray source about the patient, rather than a
slice-by-slice approach.
 38.4. PET scan
■ PET stands for Positron Emission Tomography‫لمقطعي‬,,‫لتصوير ا‬,,‫ا‬
‫لبوزيتروني‬,,‫إلصدار ا‬,,‫ا‬,,,‫ب‬. When a nucleus undergoes positive β decay,
a positron is emitted. With ordinary matter being very full of
electrons, the positron quickly collides with an electron and both
are annihilated. This produces two photons, and for momentum
conservation these two photons are emitted in nearly exactly
opposite directions as shown in Figure 38.3.
■ One of the great benefits of PET scanning is that it can be used to
get information on metabolic‫ئي‬,‫ذا‬,‫لغ‬,,‫لتمثيلا‬,,‫ ا‬processes.
■ For example, fluorine-18 can be included in the glucose-
analogue molecule fluoro – deoxy -glucose (FDG). The
molecule is taken up ‫محاصر‬by cells . The resulting molecule is
trapped inside the cell. Because cancer cells have elevated
hexokinase, tumors will collect more of the molecules and show
up strongly on the PET scan.
■ Another commonly used isotope is Nitrogen-13, where can be
used to study the supply of blood and nutrients ‫ئية‬,‫ذا‬,‫لغ‬,,‫لمواد ا‬,,‫ا‬to
tissues . The use of PET to study blood flow is not limited to
medical studies. For example, it is being used by researchers in
clinical psychology ‫لسريري‬,,‫لنفسأ‬,,‫ ا‬,‫علم‬to measure blood flow to the
brain to determine levels of activity in studies of memory and
post-traumatic stress disorder ‫لصدمة‬,,‫د ا‬,‫ع‬,,,‫بما ب‬,‫ضطرا‬,‫(وا‬PTSD).
■ The biggest limitation ‫لقيود‬,,‫بر ا‬,‫ك‬,‫ا‬on the use of PET is the need for
short-lived radioisotopes that have to be produced in a cyclotron.
Most hospitals and many countries do not have the facilities to
produce isotopes for medical use and have to import ‫ستوردها‬,,,‫ت‬
these on a regular basis ,‫شكلمنتظم‬,,,‫ب‬.
The dose from a single PET scan is similar to that from a CT scan.
38.5. Gamma Camera and SPECT
■ The gamma camera (also called a scintillation camera ) is used
for detection of radiation in nuclear medicine studies.
■ Nuclear medicine involves inhaling, injecting or ingesting
radionuclides that emit γ radiation. Several different
radionuclides are used. One example is gallium-67is useful for
cancer diagnosis. Radio-isotopes of iodine are used for thyroid
studies. Technetium-99 is the most widely used γ-emitter; there
are about 30 radiopharmaceuticals into which it is included for
imaging studies for many areas of the body (the brain,
myocardium‫لقلب‬,,‫عضلة ا‬, liver , lungs, kidneys, skeleton‫لعظمي‬,,‫لا‬,‫يك‬,‫له‬,,‫ا‬
and gallbladder ‫لمرارة‬,,‫ا‬.
■ The function of the gamma camera is to detect the γ radiation
from the radionuclides that have been introduced into the
patient’s body and to pinpoint the point of origin of the radiation
in the body.
• SPECT stands for single-photon emission computed
tomography, which is similar in many respects to X-ray
transmission computed tomography. An image is reconstructed
by computer from information gathered at multiple times and
locations showing the distribution of the radionuclide that was
administered. However, in SPECT the detector is rotated about
a stationary radiation source – the patient.
38.6. Ultrasound Sonography
■ Sonography using ultrasound is a medical diagnostic imaging
technique that does not use ionising radiation. Instead it utilises
high-frequency acoustic vibrations, above the limit of human
hearing (which is about 20 kHz). When a wave is travelling
through a medium and it reaches a boundary with another
medium, some of the wave is transmitted through the boundary
and some is reflected. In the case of sound waves, the amount
of reflection depends on the difference in a property of the
media called the acoustic impedance – the greater the
impedance mismatch‫طابق‬,,,‫ ت‬,‫دم‬,‫ع‬between two media, the more
reflection of ultrasound there will be. Acoustic impedance
depends on the speed at which sound travels through a medium,
and this in turn depends on the density of the material.
■ Because the impedances of air and skin are so different, if there
is an air gap between the skin and the sensor then most of the
intensity is lost by the waves being reflected before penetrating
the body. It is possible to resolve this problem using a gel layer
between the probe and the skin. This procedure, ensuring a small
difference in impedance to ensure minimal reflections, is called
impedance matching ‫اومة‬,‫لمق‬,,‫يا‬,,,‫طابقف‬,,,‫ت‬.
• Ultrasonography is generally considered to be safe, and in
many countries it is used routinely to monitor pregnancy
‫لحمل‬,,‫ا‬. However, the ultrasound signal consists of mechanical
pressure waves, which can have a heating effect on the
tissue.
38.7. Magnetic Resonance Imaging (MRI)
• MRI is an imaging technique utilising radio-frequency EM
radiation and magnetic fields to produce images of the body
for medical diagnostic purposes.
• The essential practice of MRI is as follows: A patient, to be
investigated, is placed in a large magnetic field. This
magnetic field is of constant magnitude and is pointed in a
single direction, i.e., it is uniform and homogeneous. This
field is often called the longitudinal field and is about 0.5–
1.5 T in magnitude in most machines currently used,
although machines with a longitudinal field of 3 T are
beginning to appear
• With the patient lying in the magnetic field, an oscillating
electromagnetic field is turned on. This field is oscillating
in the radio-frequency range of the electromagnetic
spectrum and is tuned to transfer energy to the protons
which are the nuclei of hydrogen atoms in the patient. The
energy of the RF field is absorbed by the hydrogen nuclei
and this energy is then re-radiated by these nuclei as
another RF electromagnetic field. This second RF field is
detected by antennas in the MRI machine and the signal
produced is analyzed by powerful computers to produce
images like those shown in Figure 39.11.