Imaging

Tecniques
(X-Rays and CT)
Asst. Prof. Nazlı EZER ÖZER
[Link]@[Link]
InternationalSchoolofMedicine
DepartmentofBiophysics
 The basic concept of a medical
imaging system
• Image: It is a temporary and permanent projection of any
object on suitable materials.
• Common characteristics of imaging methods; energy source,
patient and image recorder.
• But the common goal of all is to cause the least harm to the
patient, and to obtain the most accurate diagnosis as soon as
possible.
The basic concept of a medical imaging system
 The basic concept of a medical
imaging system

• Sensor or source of energy that can penetrate the

human body,
• The energy pass through the body, absorbed or
attenuated at differing levels, according to the density
and atomic number of the different tissues, creating
signals,
• These signals are detected by special detectors,
• Then mathematically manipulated to create an image.
 Objective

• The overall objective of medical imaging is

to acquire useful information about
physiological processes or organs of the
body by using external or internal sources of
energy.
 Major Modalities
• Radiography
• Computed Tomography (CT)
• Nuclear Medicine Imaging
➢Single Photon Emission Computed Ionized
Tomography (SPECT)
➢Positron Emission Tomography (PET)
• Magnetic Resonance Imaging (MRI)
• Ultrasound Imaging
Non-ionized
  SPECT scan

Imaging Techniques A form of radionuclide

scanning, SPECT produces
images that show the
function of cells. This brain
scan shows the pattern of
MRI scan →
activity of brain cells.
This technique
uses radio waves
and a magnetic
field to produce
detailed images, Doppler ultrasound scan →
as in this vertical In Doppler scanning, sound waves are used to
section through create an image of blood flow, as in this scan of
the head. the blood vessels of the neck, to detect
abnormal flow.

Radionuclide scan CT scan →

→ In CT scanning, X-
This technique ray beams are
measures levels of cell used to create
activity to detect an detailed cross-
abnormality, such as sectional images,
an area of increased as in this
cell activity in this horizontal section
scan of the pelvis. of the upper
abdomen.
Ultrasound scan →
This type of scan uses Contrast X-ray →
sound waves to produce In contrast X-rays, an opaque
images and is used for substance, such as barium, is
imaging fluid-filled introduced into the body to
structures such as the visualize hollow structures
bladder. such as the colon.

X-ray →
Ordinary X-rays produce two-
dimensional images showing
 Angiogram
dense tissue, such as bone,
A special contrast X-ray, called
most clearly. This view of a
an angiogram, can be used to
normal foot clearly shows
detect an abnormality in a blood
the bones.
vessel, such as this narrowing of
a large artery.
 Development
• The development of imaging in medicine, by the
advances in the electronics and computing technologies,
aims to monitor the physiological conditions, aid
diagnosis, and to track the pathological states of the
body through the images of the body parts.
 Technique Selection
• Medical imaging cannot replace clinical history-taking and
examination. It’s a tool, a supplementary, and is selected
according to the:
(1) imaging purpose (whether it’ll provide morphological or
functional, microscopic or macroscopic information);
(2) susceptibility of the patient;
(3) rapidity, cost, availability of the imaging technique to be used.

Medical imaging modalities and their

range of detection: Tests can identify
the biological
➢ CT/X-ray: Computed Tomography/X-ray and/or biochemical
➢ US: Ultrasound markers of disease
➢ MRI: Magnetic Resonance Imaging
➢ PET/NM: Positron Emission
Tomography/Nuclear Medicine
 Radiography
❖ X-rays, or the Roentgen radiation,
were first discovered by Wilhelm
Röntgen in 1885 and received the
Nobel Prize in physics in 1901.

❖ These invisible, ionizing rays appear

between the UV and gamma
radiation of the EM spectrum.

❖ Soft tissues are permeable to these Hand with Rings

A print of one of the first X-rays by
rays but the hard tissues like bones Wilhelm Röntgen (1845–1923) of
are impermeable. the left hand of his wife Anna
Bertha Ludwig.
 Radiography An example of
X-rays are extremely dangerous double contrast
and metabolic information cannot barium enema.
be obtained through radiography; Barium sulfate is
however, fast processing times, mainly used in the
affordable prices, ease, and being imaging of the
digestive system.
an established profession, along
with improvements that are aided
by the advancing technologies
make the technique attractive,
popular, and widely in use.
The images can be processed as
films or obtained in digital media.
Digital imaging roentgen devices
allows surgical operations to be
performed during imaging (invasive
imaging). This kind of simple Example
operations are aided using the iodine-based
contrast in
contrast agents. Use of contrast cerebral
agents allows distinction among angiography.
soft tissues as well.
 Nature of X-rays
• Two theories to describe nature

1. Wave theory (Propagate as waves)

2. Corpuscular theory (Involved in interactions as

particles)
 Characteristics of X-Rays
1. X-rays are invisible.
2. X-rays are electrically neutral.
3. They cannot be accelerated or made to change direction by a
magnet or electrical field.
4. X-rays have no mass.
5. X-rays travel at the speed of light in a vacuum.
6. X-rays can cause chemical and biologic damage to living tissue.
7. X-rays can be absorbed or scattered by tissues in the human
body.
How light-dark areas appear on an
X-ray
• When a monochromatic X-ray beam traverses
a homogeneous object with absorption
coefficient μ, according to Lambert-Beer’s law,
the observed intensity I is related to the
intersection length of the object x and the ray:
• Here, I0 is the X-ray intensity at the X-ray
source.
• I=I0⋅e−μx
X-ray attenuation
General Principles of Radiography

➢ The part is placed between the

radiation source and a piece of film.
The part will stop some of the
radiation. Thicker and more dense
area will stop more of the radiation.

➢ The film darkness (density) will

vary with the amount of radiation
reaching the film through the test
object.
General Principles of Radiography
• The energy of the radiation affects its penetrating power.
Higher energy radiation can penetrate thicker and more
dense materials.
• The radiation energy and/or exposure time must be
controlled to properly image the region of interest.
Thin-Walled Area

Low Energy Radiation High Energy Radiation

 Production of X-rays
X-rays are produced in an X-ray tube by
two processes:
1. Deceleration of fast-moving electrons either
by stopping, reducing speed or by changing
its direction.
2. The transfer of an electron between two
inner orbits of an atom.
 Production of X-rays
➢ X-rays are produced
by collision of a
beam of electrons,
accelerated by a
high voltage in a
vacuum tube.

“Coolidge X-ray tube, from

~1917. The heated cathode is
on the left, and the anode is
right. The X-rays are emitted
downwards.”
 Production of X-rays
• They are produced by the x-ray tube, using the
high voltage to accelerate the electrons
produced by the cathode.
• The produced electrons interact with the
anode.
 Bremsstrahlung
• "Bremsstrahlung" means "braking radiation"
and is retained from the original German to
describe the radiation which is emitted when
electrons are decelerated or "braked" when
they are fired at a metal target.
 X-rays are produced in a
standard way
• If the electrons have high energy, they can expel an
electron out of the atomic shell of the bombarded
atom.
• Electrons from a higher energy level fill the place of
the expelled electron, emitting x-ray photons with
quantized (precise) energies, determined by the
respective electron energy levels. The x-rays produced
in this way are called “characteristic x-rays”.
 Characteristic X-rays

• Characteristic X-rays are emitted when outer-

shell electrons fill a vacancy in the inner shell
of an atom, releasing X-rays in a pattern that
is "characteristic" to each element.
• After the electron has been ejected, the atom
is left with a vacant energy level, also known
as a core hole.
 What is the difference between
Bremsstrahlung and characteristic X-rays?

• Characteristic radiation produces a line

spectrum with several discrete
energies,
• whereas Bremsstrahlung produces a
continuous spectrum of photon
energies over a specific range.
 X-Ray Radiography Benefits

• Noninvasive, quick, and painless.

• Support medical and surgical treatment
planning.
• Guide medical personnel as they insert
catheters or stents inside the body to treat
tumors or remove blood clots.
 X-Ray Radiography Risks

• Exposure to ionizing radiation, this increase

the possibility of developing cancer later in
life.
• Tissue effects such as cataracts, skin
reddening, and hair loss, which occur at
relatively high levels of radiation exposure.
 X-Ray Radiography Medical
Applications
• For showing the movement of organs, such as
the stomach, intestine, and colon
• Type and extent of a fracture
• Used for detecting pathological changes in the
lungs
• Mammography used for diagnosing and
screening of the breast tissue
 slice picture

Computed Tomography

(CT)

tomos = slice;
graphein = to write = picture
definition - imaging of an object by analyzing its slices
 Tomography

• Reflected and transmitted X-rays are detected

with photomultiplier tubes around the body
and the received signals are computed.
• CT has applications in neurology, cardiology,
pulmonology, gastroenterology; and used for
the diagnosis of brain tumors, kidney, liver and
lung diseases.
X-ray projection imaging X-ray tomographic imaging
‘Overlay‘ of all information (non-quantitative) True cross-sectional image

Orbiting source + detector

Data for all angles
VOXEL
Modern CT Scanner
 CT Scan
X-ray tube
➢ CT scan produces axial
sections/cuts/slices
➢ The CT image is
recorded through a
scan.
➢ A scan is made up of
multiple X-ray
attenuation
measurements around
objects periphery.
Detector
 Slice / Cut
◼ The cross-sectional
portion of the body
which is scanned to
produce CT image is
called a slice.
◼ The slice has width and
therefore volume.
◼ The width is
determined by the
width of the x-ray
beam.
 What is a CT contrast agent?
• Contrast agents are developed that are
highly visible in an X-ray or CT scan and are
safe to use in patients.
• Contrast agents contain substances that
can stop X-rays and are therefore more
visible on an X-ray image.
• For example, to examine the circulatory
system, an intravenous contrast agent
CT scan of the abdomen
based on iodine is injected into the
bloodstream to help illuminate blood
vessels. This type of test is used to look for Oral contrast agents, such as
barium-based compounds, are
possible obstructions in blood vessels,
used for imaging the digestive
including those in the heart. system, including the esophagus,
stomach, and gastrointestinal (GI)
tract.
 Advantages Disadvantages

Computed tomography (CT scans)

Uses multiple X-rays to produce cross-sectional layers that show detailed images
inside the body, including bones, organs, tissues, and tumours
•Quick and painless •Small increased risk of cancer in future
•Can help diagnose and guide from exposure to ionizing radiation (X-
treatment for a wider range of rays). Risk is greater for children
conditions than plain X-rays •Uses higher doses of radiation, so the
•Can detect or exclude the presence of risks (while still small) are in general
more serious problems greater than other imaging types

•Can be used to check if a previously •Injection of a contrast medium (dye)

treated disease has recurred can cause kidney problems or result in
allergic or injection-site reactions in
some people
•Some procedures require anaesthesia
 Diagnostic Applications
• Most common procedures: head, chest,
abdomen, pelvis

– CT is the exam of choice for head trauma

– CT can evaluate the CNS for infarctions,

hemorrhage, disk herniation, craniofacial and
spinal fractures, tumors and other cancers
 CT Angiography
• CTA: Uses three-dimensional (3D) imaging
techniques to evaluate the vascular system

• Advantages over conventional angio:

– Image reconstruction without the use of more
patient exposure to radiation or IV (Intravenous)
contrast
– Overlying structures can be eliminated (post
processing)
– Does not require an arterial puncture
 Key Takeaways

✓ Energy source, patient, and image recorder are common

features of imaging techniques.
✓ CT and radiography operate on a fundamental principle: an X-ray
beam traverses the body, with some X-rays being absorbed or
scattered by internal structures, while the remaining X-ray
pattern is transmitted to a detector.
✓ Soft tissues are permeable to X-rays but the hard tissues like
bones are impermeable.
✓ CT scan use radiation to take slices of the body.
✓ Two physical interactions contribute to x-ray generation:
bremsstrahlung (braking radiation), and characteristic radiation
(peaks in energy spectrum).
Which of the following sentences is false?
I. Metabolic information cannot be obtained through radiography.
II. X-rays are produced when the electrons are suddenly
decelerated upon collision with the metal target. These are called
characteristic X-rays.
III. Soft tissues are permeable to X-rays but the hard tissues like
bones are impermeable.
IV. The cross-sectional portion of the body which is scanned to
produce Computed Tomography (CT) image is called a slice.
V. Computed Tomography (CT) has applications in neurology,
cardiology, pulmonology, gastroenterology; and used for the
diagnosis of brain tumors, kidney, liver, and lung diseases.
A. I
B. II
C. III
D. IV
E. V
Which of the following sentences about X-rays are false?
I. X-rays have longer wavelength than radio waves.
II. X-rays have no mass.
III. As an X-ray beam passes through the body, the body
tissues absorb the beam in varying amounts depending
on its density.
IV. Imaging with X-rays involves exposing a part of the
body to a small dose of ionizing radiation to produce
pictures of the inside of the body.
V. Bone structures appear darker on the film than other
tissues.
a) II, III, IV, V
b) I, V
c) I, II, IV
d) III, V
e) I, II, III
Which is/are advantage(s) of CT scan?
I. Quick and painless
II. Small increased risk of cancer in future from exposure to
ionizing radiation
III. Can help diagnose and guide treatment for a wider range
of conditions than plain X-rays
IV. Risk is greater for children
V. Uses higher doses of radiation, so the risks, while still
small, are in general greater than other imaging types

a) III,IV
b) III
c) I,III
d) I,IV,V
e) I,III,V
Choose the wrong one for the radiography method.
a) Very small increased risk of cancer in future from
exposure to ionizing radiation (X-rays).
b) Soft tissues are impermeable but the hard tissues like
bones are permeable.
c) Quick, non-invasive and painless.
d) Can help diagnose various diseases and injuries,
including broken bones, cancer and infections.
e) Used for detecting pathological changes in the lungs.