IMAGENOLOGY

ESSENTIAL ELEMENTS OF THE EFFECTIVE USE OF

MEDICAL IMAGING MODALITIES

CONCEPT AND PURPOSES

BASIC PRINCIPLES

MEDICAL IMAGING MODALITIES

METHOD FOR
INTERPRETATION OF IMAGES
RADIOGRAPHIC SIGNS OF COMMON DISEASES
 IMAGENOLOGY
Wilhelm Conrad Roentgen
1895 Nobel laureate in physics 1901
APPLICATION OF X-RAYS TO MEDICINE
X-rays pass through the body and are
detected on photographic film or detector
plate placed opposite the X-ray source

X-rays absorbed or scattered to varying

degrees by different tissues in the body

Differential absorption or scatter of X-rays

by different tissues is the basis for
radiographic image formation and contrast
 IMAGENOLOGY
BASIC PRINCIPLES
Radiographic density and radiographic contrast of the image in the film
BASIC DENSITIES
More radiolucent Gas (air) Less radiopaque
Fat
Fluid and soft
tissues
Bone
Less radiolucent Metal More radiopaque

Overexposure Too Underexposure Too light

 IMAGENOLOGY
Radiographs are photographic negative
A radiograph is a superimposition of shadows of many different structures
Images Basically shadows of different structures that absorb or block the X-rays
Denser tissues absorb more X-ray
Few X-rays reach the silver salt / gelatin emulsion in the film
Few silver grains develop when the film is processed
Appear white (radiopaque) on the film
Less dense tissues allow most of the x-ray to pass through
Appear gray / dark (radiolucent) on the film

Density interface
Margins between structures of different densities that abut one another
 BASIC PRINCIPLES OF IMAGE INTERPRETATION
Identification (Labels)
Correspondence Patient-Film (Name, sex,
age)
Markers Right / Left Date

Standard orientation of an x-ray As if you’re facing the patient

The abnormal gas outline on the left is the right kidney
Projection (view) Right / Left, PA, AP, Lateral, Supine, Upright, Decubitus
Quality (degree of penetration) Overexposure Underexposure
 IMAGENOLOGY
PURPOSES
DIAGNOSTIC Electromagnetic radiation Soundwaves Magnetic fields
THERAPEUTIC Cure, control or alleviate symptoms associated with
cancer
EXTERNAL BEAM THERAPY

Ionizing radiation (X-rays, gamma rays) delivered externally from a machine

to cancer inside the body
BRACHYTHERAPY

Radiation is delivered inside the body with isotopes

DIAGNOSTIC AND THERAPEUTIC Nuclear medicine and nuclear imaging
Based on the selective uptake of a given radiopharmaceutical by an organ
Radioactive isotope is labeled to a bio-molecule and administered to patient
Emitted rays are recorded by a gamma camera and converted to an image
Diagnostic purposes Small doses Therapeutic purposes Larger
doses
INTERVENTIONAL

Use of imaging techniques for insertion and guidance of small instruments /

tools through the body without conventional surgery
Needle biopsy, foreign body extraction, angioplasty, stent placement
 IMAGENOLOGY
DIFFERENT IMAGING MODALITIES
TRANSMISSION IMAGING
Images are produced by transmission of radiation through the
patient
X-rays, fluoroscopy, CT scans
Image is collected on photosensitive film, digital imaging plate, fluoroscope

REFLECTION IMAGING
High frequency sound waves are reflected back from body tissues
Reflected soundwaves are processed by ultrasound machine to create images
Ultrasound

EMISSION IMAGING
Changes in magnetic properties of a tissue after application of a magnetic field
Emission of nuclear particles from radioisotopes administered to patients
Detected by a scanner and analyzed by a computer to form images
Magnetic Resonance Imaging (MRI) Positron Emission Tomography (PET)
 ESSENTIAL ELEMENTS OF THE EFFECTIVE USE OF
MEDICAL IMAGING MODALITIES
A CLEARLY DEFINED CLINICAL QUESTION
The diagnostic test should provide important information that will make a
significant difference to patient care
The risks and costs of the proposed investigation

KNOWLEDGE OF ANATOMY AND PATHOLOGY OF THE DISEASE PROCESS

Anatomy Disease process alters normal anatomy
Pathology Expected pathology determines modality selection, anatomical
region to be examined

AN UNDERSTANDING OF HOW TO INTERPRET THE TEST RESULTS

Clinical scenario on imaging requisitions and predictive value of the test result
Equivocal or unexpected test result

AVAILABILITY OF IMAGING MODALITIES AND WHICH ONE IS THE BEST

Strengths Weaknesses Risks and costs
 METHOD FOR
INTERPRETATION OF IMAGES

“You won’t see it if you don’t know what to look for”

“You see what you look for”

“You recognize what you know”

RADIOGRAPHIC SIGNS OF COMMON DISEASES

MODALITIES USING X-RAY
 PLAIN RADIOGRAPH
TYPE OF PROJECTION (VIEW) AND IMAGE INTERPRETATION
THORAX STANDARD VIEWS Minimize cardiac magnification
POSTEROANTERIOR (PA) LATERAL
Patient's chest is placed against the film cassette
Inspiration Lungs must span rib 9
Exposure Spine should be seen behind the heart
Rotation Equal distance between medial ends of clavicles
Hilum Vessels of the lungs should be seen
Right hilar shadow Inferior to the level of the left (70 % of the population)

LATERAL Left side of the chest against the film cassette

Right hilum
Anterior to a line drawn through the tracheal air column
Left hilum
Posterior to a line drawn down the trachea air column
IVC Best seen in lateral projection
 PLAIN RADIOGRAPH
TYPE OF PROJECTION (VIEW) AND IMAGE INTERPRETATION
THORAX Special view
Anteroposterior (AP) Film cassette is placed under patient's back
A portable x-ray machine is positioned over the patients chest

Magnification refers to the sharpness of the

Cardiac magnification
image
Oblique Occasionally used to better localize abnormalities
Apicordotic To evaluate upper lobe pathology
Removes the clavicular shadows seen in the PA view
Lateral decubitus For effusions, pneumothorax
 PLAIN RADIOGRAPH
TYPE OF PROJECTION (VIEW) AND IMAGE INTERPRETATION
Airways are not normally seen

Air bronchogram sign

Large bronchi become visible
When alveoli fill with fluid density material

If you see this, a lesion must be present in the lung

 PLAIN RADIOGRAPH
IMAGE INTERPRETATION
THORAX
BASIC PULMONARY PATHOLOGY
“Silhouette sign”
Loss of margins between structures of
similar densities that abut one another
Pneumonia
Atelectasis (Lung collapse)
Pleural effusions
Meniscus and the silhouette sign

Right middle lobe collapse

A triangular ‘pancake’ shaped density
 PLAIN RADIOGRAPH
IMAGE INTERPRETATION
THORAX BASIC PULMONARY PATHOLOGY
Radiopacity Lung neoplasm
Granuloma (calcified)
Mediastinal masses
Superior mediastinum Goiter
Anterior Snowball sign
mediastinum Calcified 1st rib
Thymoma simulates a nodule

Tracheal deviation
Anterior
mediastinum Normal Metastatic Disease
The 4 T’s Thyroid (goiter) Thymoma Teratoma Terrible
 PLAIN RADIOGRAPH
IMAGE INTERPRETATION Tracheal deviation
THORAX BASIC PULMONARY PATHOLOGY
Hyperlucency
Pneumothorax
(primary)
Diagnostic criteria
Pleural line
(collapsed lung)
No lung markings A fat fold
Tension Pneumothorax COPD Hyperinflation

Deep sulcus sign

Inverted
diaphragm Inspiration Expiration
 PLAIN RADIOGRAPH
IMAGE INTERPRETATION
THORAX (Cardiac shadow)
Heart Size (measured as ratio)
Normal (PA upright view)
≤ 50% of thoracic diameter Cardiac diameter

BASIC CARDIAC PATHOLOGY

Thoracic diameter
Left ventricle enlargement
Rigler's rule (on lateral view)
A line from the point where IVC meets the heart boarder up 2 cm
A line posterior from this point
(2 cm)
Cardiac boarder beyond this point
Coarctation of aorta
Left ventricular enlargement
Aortic knob less prominent than
normal
 PLAIN RADIOGRAPH
IMAGE INTERPRETATION
THORAX BASIC CARDIAC PATHOLOGY
Right ventricular enlargement Tetralogy of Fallot

Narrow base (Boot shoe appearance)

Concave main pulmonary artery segment
Apical shadow above the diaphragm Higher than normal
Increased cardiac size can be cardiac or pericardial
Echocardiography Best imaging modality to differentiate one from another

Dextrocardia
 PLAIN RADIOGRAPH
IMAGE INTERPRETATION
High risk areas for missed diagnosis of chest films
Most commonly missed pathology occurs in the right upper lobe

Other high risk areas

Retrocardiac area, the peripheral lung margins, and posterior costophrenic sulci
 PLAIN RADIOGRAPH
IMAGE INTERPRETATION
ABDOMEN
Acute abdominal series (supine and upright positions)
Plain X-ray is often the starting point for the work up of abdominal problems

BOWEL-GAS PATTERN (Normal)

Colon A moderate amount of gas throughout the entire colon

(usually)
Small bowel Very little gas
Stomach Small amount of gas (usually)

THE OUTLINE OF SOFT TISSUES

Liver
Spleen
Kidneys
Psoas muscles

Diaphragm Not seen usually It is obscured by the liver

 PLAIN RADIOGRAPH
IMAGE INTERPRETATION
CAUSES OF ABNORMAL GAS-PATTERN
ABNORMAL BOWEL-GAS PATTERN (supine / upright position)
Paralytic (Adynamic) ileus
Increased gas everywhere in GI tract, air-fluid levels
Small bowel obstruction (mechanical) Gas / fluid levels within dilated loops
(stair step or stacked coin
Large bowel obstruction (mechanical)
appearance)
Gas Proximal to obstruction
Very little or absent gas in the colon
Dilation of the loops > 3 cm (abnormal)

Distended colon (air is around the outside)

Absence of gas in rectum and/or distal colon
+/- small bowel distension
 PLAIN RADIOGRAPH
IMAGE INTERPRETATION
CAUSES OF ABNORMAL GAS-PATTERN
Perforation of hollow organ (Pneumoperitoneum)
Subdiaphragmatic air (as little as 5 ml can be detected)
Left lateral decubitus (if patient cannot sit up)

Abdominal Abscess

Gas does not conform to a bowel loop in appearance or location

Persistent over time and with change of position
 PLAIN RADIOGRAPH
IMAGE INTERPRETATION
ABNORMAL OUTLINE OF SOFT TISSUES
Renal outlines (on side of VC)
Right kidney is smaller
Renal ultrasonography
More reliable to determine
kidney size and shape

Absence of expected soft tissue

Loss of the right psoas shadow
Retroperitoneal hematoma

IV pyelogram
Displacement of the right kidney
Partial obstruction of the right ureter
 PLAIN RADIOGRAPH
IMAGE INTERPRETATION
ABNORMAL CALCIFICATIONS Renal and ureteral Aortic Aneurysm
stones

Leiomyoma or
Uterine Fibroid
Appendicitis (calcified)
Cholelithiasis (calcified fecalith)

Chronic
Pancreatitis
 MAMMOGRAPHY
Enable us to make one of four diagnoses: normal, benign, suspicious, carcinoma

Screening mammogram detect 90% of breast cancer before

they become large enough to feel or cause symptoms
Microcalcifications (early cancer)
Masses (spiculated margins,
distortion of adjacent architecture)
Asymmetrical density

Diagnostic mammogram
Diagnosis of unusual breast
 FLUOROSCOPY
Study of moving body structures (real time imaging)
A continuous X-ray beam (controlled with a switch)
Strike a fluorescent plate coupled to and image intensifier and a TV camera
Images are transmitted to a TV
monitor

Study of gastrointestinal tract Interventional procedures

 ADVANTAGES OF X-RAY
Readily available
Useful for evaluation of bone detail
Cheap
Noninvasive
Portable
Fluoroscopy Excellent tool for image based interventional procedures

DISADVANTAGES OF X-RAY
Limited density resolution (Poor soft tissue contrast)
Radiation exposure

Contraindicated in pregnancy
 CONTRAST AGENTS
Improve image contrast of structures that do not have inherent differences in
radiographic density
BARIUM SULPHATE Gastrointestinal studies
Single contrast studies shows prominent abnormalities
Mucosal details, mural changes well seen as well as intraluminal abnormalities
BARIUM SWALLOW (Upper GI series)
Esophagus and stomach

Normal Normal
 CONTRAST AGENTS
BARIUM SMALL-BOWEL ENEMA (Enteroclysis)
A controlled amount of barium is passed into the small intestine through a
nasojejunal tube
Excessive luminal distension can be avoided

Normal Crohn’s disease

 CONTRAST AGENT
BARIUM ENEMAS (Lower GI series) Colon and rectum

Normal Malignant Tumor (Apple core sign) Diverticula

Double-contrast image Detection of small surface abnormalities of the intestine

Polyps
 CONTRAST AGENT
IODINATED CONTRAST AGENT IV Catheter administration
Angiography

LAO view Narrow area of proximal end of

Normal Circumflex and Anterior descending

Portal
venogram
 CONTRAST AGENT
IODINATED CONTRAST AGENT Intravenous pyelogram
Urinary tract obstruction

Congenital anomaly

Renal vascular occlusion

 ADVANTAGES OF USE OF CONTRAST AGENTS
Delineates intra-luminal anatomy (patency, lumen integrity, filling defects)
Functional information of a given organ (under fluoroscopy)
DISADVANTAGES OF USE OF CONTRAST AGENTS
Invasive procedure Radiation exposure
RISKS ASSOCIATED WITH USE OF CONTRAST AGENTS
BARIUM IODINATED
Severe desmoplastic reaction Allergic reaction (asthmatics)
Contraindications to Oral barium Idiosyncratic anaphylactoid reactions
Small Bowel obstruction Induced renal failure
( risk of barium impaction)
Contraindications
Bowel perforation Signs of peritonitis
Previous reaction to contrast agent,
severe heart failure, diabetes,
multiple myeloma
Iodine water soluble agents (Gastrograffin, Hypaque)
Useful for large bowel obstruction (left colon), Post op-GI studies, cystograms
Contraindicated if there is any danger of aspiration into the lungs
 COMPUTED TOMOGRAPHY (CT / CAT SCAN)

SPIRAL (HELICAL) and MULTISLICE

CT SCAN
An X-ray beam source rotate around the longitudinal axis of the patient’s body
A fan-shaped X-ray beam passes through given region of the patient’s body
X-ray detectors on the opposite side measure the amount of radiation
X-ray data collected from multiple angles are sent to a computer
A computer processes the X-ray data
Calculate the density (Hounsfield units) of the different tissues that form the
CT slice to create a three-dimensional image on a monitor
Multiplanar images resemble transverse sections (cross-sections) of the body
 COMPUTED TOMOGRAPHY (CT / CAT SCAN)
Radiographic contrast of images results from X-ray beam
attenuation
Attenuation Loss of power of X-ray beam as it travels through tissues
The higher the atomic number of the substance the more x-rays it will
absorb
The higher it’s Hounsfield number
Barium Bone Muscle Liver/kidney Water/CSF Fat Air
Voxel

Pixel
Higher attenuation of X-ray beam Lower attenuation of X-ray beam
White to light gray Gray to black

CT can differentiate many different densities

Radiographic / pathologic correlation

 COMPUTED TOMOGRAPHY (CT / CAT SCAN)

With contrast agent Without contrast agent

CT Main further imaging of Chest X-Ray

abnormalities
Thymoma Most lung lesions are better assessed by CT
 Normal CT SCAN
L1 vertebra level S1 vertebra level
 COMPUTED TOMOGRAPHY (CT / CAT SCAN)

Normal Liver metastases extending to R kidney

 ULTRAFAST CT SCAN / ELECTRON BEAM CT (EBCT)
Specifically developed for imaging of the heart
Multiple images of the heart within the time of a single heartbeat
Indications
People who have no symptoms of the disease but significant risk factors for the
disease
Noninvasive detection and quantification of very small calcification of coronary
arteries, assessing risk for significant coronary arterial disease
Assessment of patency of coronary artery bypass grafts
Diagnosis of congenital and acquired diseases of the aortic arch
Heart tissue damage after myocardial infarction or heart attack
HIGH RESOLUTION CT SCAN
Provides detailed images of lung morphology
Specific indication Detection of diffuse interstitial lung disease
Valuable in localizing specific sites for biopsy and focal lung lesions
Preoperative assessment of temporal bone and air space anatomy
 COMPUTED TOMOGRAPHY (CT / CAT SCAN)

ADVANTAGES

Rapid Low cost Available

Detailed images of any part of the body (bones, muscles, fat, and organs)
Diagnoses and evaluation of the extent of tumor, masses, nodules
Evaluation of size, shape and contour of organs
Evaluation of joint dislocation and fracture Shadows do not overlap
Location and extent of emphysematous bullae,
bronchiectasis
To determine pattern of calcification of pulmonary nodules
Detection of intracranial abnormalities

DISADVANTAGES
X-rays used to create images Contraindicated in
pregnancy
Claustrophobia
 ULTRASOUND

High frequency sound waves are transmitted

from a transducer

Reflection (echoes)
Sound waves bounce back from tissue
interfaces of different echogenicity
(acoustic density )
Reflected sound waves are picked up by the transducer and transformed into
electrical signal
Electrical signals are recorded and processed to create the image
 ULTRASOUND TERMINOLOGY
Anechoic No echoes or sound wave reflection Appear black Amniotic fluid
Fluid Simple cysts, vessels, ascites

Breast ultrasound
Sharp cystic walls

Hypoechoic Dark on the film with some low grade echoes

Tumors, complex fluid

Hyperechoic (Echogenic) Bright on the film with significant

echoes
Fat, bone
The greater the difference in acoustic impedance between two adjacent
tissues The more reflective are their boundaries
Very reflective interfaces Bone / soft tissue Air / soft
Poorly reflective interfaces tissue
Soft tissue interfaces
Unable to image of or through bone or gas (lung and bowel)
 DIFFERENT ULTRASOUND IMAGING MODALITIES
A-Mode Amplitude mode employed for
Ophtalmology, echoencephalography
To differentiate cystic from solid masses
TM-Mode Show time / motion relationship of structures
Echocardiography (heart chamber size, wall motion, valve movements,
effectiveness of the heart pumping ability)

3-D ultrasound
More accurate volumetric measurements

B-Mode Images are cross section of the tissue volume under investigation
Real-time Morphological and functional information (peristalsis)
Faster than B-mode scanning (8- 40 frames / sec)
Able to direct interventions (needle biopsy guidance)
Doppler
 ULTRASOUND APPLICATIONS
Determination of cystic from solid masses (kidney, breast, liver)
Evaluation of size and shape of organs (abdominal, pelvic, thyroid)
Detection / evaluation of nodules, masses, aneurysm, stones (gallbladder, renal)
Renal calculus Hydronephrosis

Evaluation of joint / muscle pain

Transvaginal ultrasound
Early diagnosis of ectopic pregnancies and pelvic conditions
Better detection of congenital anomaly
Useful in early diagnosis of pregnancy in obese
patients
 DOPPLER ULTRASOUND
DOPPLER EFFECT
Change in frequency between emitted ultrasonic waves
and their echoes
Allows measurement of the velocities of moving objects
DOPPLER ULTRASOUND
Measures a change in the detected frequency of an ultrasound beam reflected
from a moving surface
Quantitative measurement/imaging of blood flow (major reflector is
erythrocytes)
Detection of blocked blood vessels
Flow velocity is elevated
Normal triphasic waveform is lost in the stenotic
left profunda femoral artery
 DOPPLER ULTRASOUND

Blood flow in umbilical cord Urine

A two-dimensional image of the flow is constructed by displaying the

detected Doppler shifts as the transducer is moved across the scanning area

Doppler signals are displayed a different colors

depending on the magnitude of the frequency
shift
 ULTRASOUND
ADVANTAGES
DOES NOT UTILIZE IONIZING RADIATION
No confirmed adverse biological effects on patients or instrument operators
Monitor fetal development PROVIDES QUANTITATIVE MEASUREMENT

REAL-TIME MODALITY (14 weeks)

Sound waves cause no discomfort Noninvasive, inexpensive, quick, portable
Vascular evaluation (Doppler)
DISADVANTAGES
Operator dependence
 MRI
Mysterious Radiology Imaging
More Radiology Income

MAGNETIC RESONANCE IMAGING

 MAGNETIC RESONANCE IMAGING
Atoms in our body are at random
Excitation phase: A vertical magnetic field created by MRI
machine around the patient causes alignment of the atoms with it

A radio frequency pulse applied in a horizontal direction makes the protons

wobble (precess)
Pulse is turned off the rotating protons quickly "dephase” (Relaxation phase)
The MRI signal is weak The time constant of this decay is T2
Recording phase: As protons realign with the vertical magnteic field they emit
energy (signals) as a radiofrequency pulse

The MRI signal is strong

The time constant of the recovery of
longitudinal magnetization is T1
 MAGNETIC RESONANCE IMAGING
Manipulation of The excitation pulse frequency and energy
Time delay before the signal from tissue is recorded

TISSUE CONTRAST
The weighted sequences (proton density) T1 and T2

The spin of the proton of Hydrogen atoms produce a signal at a characteristic

frequency that form the basis of MRI

The emitted frequency varies from one to another tissue depending on proton
environment

The differential emitted frequency is the origin of MR image formation and soft
tissue contrast

The greater the hydrogen intensity , the more intense the MR signal will be
 MAGNETIC RESONANCE IMAGING
MRI IMAGE CONTRAST T1 CSF
BRIGHT (HYPERINTENSE) ON T1 DARK (HYPOINTENSE) ON T1

Fat in marrow and Water (intermediate)

subcutaneous Muscle (intermediate)
tissue
Blood Bone and fibrous tissue
Contrast
Air (very dark)
Melanin
Metal and hemosiderin
Protein rich fluid
Fast moving blood in
vessels
MRI IMAGE CONTRAST T2
BRIGHT ON T2 Bone DARK ON T2

Water Air Cortical Bone / tendons

Fat
Edema Hemosiderin
Blood Air
Tumor CSF Fast moving blood in
vessels
The greater the hydrogen intensity , the more intense the MR signal will be
 MAGNETIC RESONANCE
ANGIOGRAPHY
Noninvasive method to evaluate the patency of blood vessels
Extremely detailed picture of blood vessels
Performed either with no dye or with intravenous injection in an arm vein
To detect stenoses, aneurysms, dissection and AV-malformations
Gadolinium IV instead of iodine
No allergic reaction No nephrotoxic (can be used in the setting of renal
failure)

Carotid arteries stenoses Middle cerebral artery aneurysm

(Internal and external)
 MAGNETIC RESONANCE IMAGING
Axis conventions
ADVANTAGES
Coronal Axial
No ionizing radiations No invasive
Excellent soft tissue contrast
(More detailed anatomical images)
Sagittal

Multiplanar imaging from any desired angle and at any level

DISADVANTAGES
High cost
Availability
Time Claustrofobia Static
No good identification of cortical bone lesions
Ferromagnetic metals (Risk of complications related
to pacemakers, heart valve replaced, aneurysm clips,
metallic ear implant)
Contraindicated in pregnancy
 MAGNETIC RESONANCE IMAGING
INDICATIONS
“Normal” Computed Tomography
Tumors of musculoskeletal system
Excellent for assessment of bone marrow and soft tissue surrounding joints
Evaluation of renal, pancreatic, pelvic masses (gynecological, prostate tumors)

Study of choice for:

Intracranial abnormalities / masses, acute brain infarction, progression of stroke
Spinal cord pathology (disk herniation, tumors, multiple sclerosis)
Excellent delineating white from gray matter
 FUNCTIONAL MAGENTIC RESONANCE IMAGING (fMRI)
Refers to mapping of brain activity using MRI
Blood oxygen level detection (BOLD)
A method that reflects changes in the ratio of oxyhemoglobin to deoxyhemoglobin
More tissue
activity of oxygenated blood is greater than its consumption
Supply
Deoxyhemoglobin concentration is reduced
Ratio of oxygenated to deoxygenated blood is higher than
normal
Increased proportion of deoxyhemoglobin More dephasing / Weak MRI signal
Hypointense (dark) image
Indications
Evaluation of neural activity by examining regional blood flow in the brain
Help to asses the effects of tumors, stroke, trauma, multiple sclerosis, Alzheimer's
To document brain abnormalities related to dementia or seizures
Often used in planning brain surgery
 NUCLEAR MEDICINE
Nuclear imaging methods
Based on the selective uptake of some compounds by different organs
Radioisotopes (injected, swallowed or inhaled) are tagged to these compounds

Camera

Radioactivity concentrates in organ of

biological activity and emits photons
which are detected by a camera

Common markers
Iodine isotopes I-123 Technetium 99 Gallium-67 Thallium-201
 NUCLEAR MEDICINE
ADVANTAGES
Evaluation of physiological activity of
organs
Assessment of flow rates and turnover rates of specific tissues
DISADVANTAGES
Radiation exposure Limited facilities for radioactive substances
Relatively long procedures due to uptake times High cost procedures
CLINICAL USE
Diagnose of pulmonary thromboembolism
Evaluation of thyroid nodules Functional / hot Nonfunctional / cold
(Malignant)
Staging and therapy planning in patients with thyroid carcinomas which
metabolize iodine (papillary and follicular carcinoma)
Evaluation of thyroid function to define the therapeutic dose
Diagnose of renal artery stenosis, acute cholecystitis
Evaluation of degenerative and/or arthritic changes in the joints
Detection of bone diseases (osteomyelitis, tumors, fractures)
Detection of the cause of bone pain, inflammation
 NUCLEAR MEDICINE
Bone scan
Osteomyelitis

bladder

Increased uptake

Normal bone scan Increased uptake

R intertrochanteric fracture
Stress Fracture
A focus of increased activity
in the proximal tibia on the
left
Normal Plain film x-ray
 NUCLEAR MEDICINE
Ventilation / Perfusion scan

Normal Pulmonary thromboembolism

Distribution of radiotracer is (at least 8 segments not perfused)
homogeneous and non-interrupted
 NUCLEAR MEDICINE
POSITRON EMISSION TOMOGRAPHY
A type of nuclear medicine that measures metabolic activity of cells
Glucose combined with a radioisotope will show where glucose is being
used
Permit to visualize The biochemical changes in the metabolism of glucose
The regional changes in blood
flow
Pictures can be used
To find cancer cells in the body (Cancer cells use more glucose than normal cells)

To locate seizure focus for surgical treatment of uncontrolled epilepsy

Glucose consumption and oxygen utilization increase in the focus during seizures
Local change in blood flow is linearly related to glucose consumption indicating
local neural activity
 POSITRON EMISSION TOMOGRAPHY

Normal brain perfusion Right parietal-temporal epilepsy

Decreased glucose metabolism in the
right parietal and temporal lobes