Sunil Mathew ,

SJMC
Anatomy Dep:

Imagin
g.

You can image anything , Just find

the way
YOU DONT AGREE .Guess what ?
Imagine something that you cant image

Objective
Principle of device used for visualization ?
How each device works ?
What each device can visualize ?
Beyond scope
Indications of each of them in diseases

Medical imaging
Visual representations
Inside of body ( anatomy )
Function of organs or tissues ( physiology )

For clinical analysis andmedicalintervention

( diagnosis and treatment )

Lecture Structure ( NOTICE

SLIDE COLOUR )

Overview of
imaging
techniques based
on underlying
principle

Each of the
principles more
in detail ,
Other rare
medical imaging
techniques

Future of
medical imaging

Overview

Did you know ?

We all are exposed to radiation , it comes
from the space , from the earth and its in
the air we breath .

What is radiation ?
Radiationis energy
It comes from a source
Travels through some material or through space.

Examples :
Light, heat and sound are types of radiation

Forms of Radiation?

Character of radiation
Determined by
Wavelength or its frequency
Energy it bears

[Link]

Ionizing Radiation
Electromagnetic waves with
energy for electrons to
become detached from atoms
and molecules
Cause
change in structure ionization

Electrically charged

Examples
X rays, gamma rays, electrons,
protons and neutrons , radon
gas ( naturally occurring )

Ionizing radiation cont:

Measuring is easy

Concentration is measured
US scale : milli rem
Int: Sys : Sv ( Sieverts ) and mSv ( milliSv)
1 Sievert = 100 millirem

Naturally occurring ionizing radiation is measured by Half life ( time

taken for radiation to become 50% of what it is now )
Cause different degree of ionization in material as the power
increases
Ionizing radiation penetrates according to its type and energy
[Link]

Non-ionizing Radiation
Less energy than ionizing
radiation
Limited to generating light or
heat.

[Link]
ation-all-around-us

Natural radiation
Naturally occurring radiation is found
in the food we eat, the water we drink
and the construction materials used in
our buildings,
Terrestrial radiation also comes from
soils enriched in naturally occurring
uranium and natural forms of energy.

Man Made Radiation

People have benefited in
medicine and industry.
Today, man-made sources of
radiation is 21%

Overview of X-Ray
based imaging techniques

Most commonly used X-ray

based devices
X-ray radiography
CT ( computed tomography )
Mammography
Angiography
Fluoroscopy

How does X-ray machines work

basically ?
X-ray production : X-ray is produced from X-ray tubes

X-ray attenuation : Parts of X-ray beam is absorbed

by
X-rays are
body
Carcinogenic

X-ray capturing : Detectors capture image of X-ray

Radiography (Plain X-Rays)

One click capture of
image
Digital X-rays are now
replacing films

The CT Setup
X-ray production ,
attenuation and
capturing
In Cross sectional
scanning
(tomography )

Process is finished in few

seconds

Valuable in Emergencies
!!

Images of same area computed

for 3D visuals

Example of 2D vs 3D
(Conventional X-ray vs CT)
Conventional radiography
2D
Only one image of same area

CT

3D
Tube rotation can give multiple images of same area
Assimilated to give a 3D visualization

Mammography

X-ray of breast
Detailed X-ray
Used for screening of
breast cancer

MASS

CALCIFICATIO
N

ASYMMETRIC
BREAST
FINDINGS

INTRAMAMMA
RY
LYMPHNODE

TUBULAR
DENSITY

ARCHITECTUR
AL
DISTORTION

OTHER
ASSOCIATED
FINDINGS

Angiography

X-ray of Vessel
Contrast is added

Fluoroscopy
X-ray for moving parts
During medical
procedures
Monitor viewed

Overview Molecular
Imaging based techniques

How does Molecular Imaging

work basically ?
Radioactive markers : Targets specific tissues radiopharmaceuticals are given to
patient

If Pregnant Do inform
radiopharmaceutical use
Positron ejection: Seen in target tissues , they act with surrounding elections and
produce gamma rays

Much lower radiation than X-ray

based devices
Gamma ray capturing device : Gamm rays are ejected in 180 degree angle , the
detectors on either side detects this emission and position the active cells .( SPECT
radiomarkers directly ejects gamma )

Why use Molecular Imaging ?

As diagnostic tool
Identifies disease in early stages before CT or MRI
Non Invasive : Avoids the need of biopsy ,

Can be used as treatment

Eg: Thyroid ablation

Dx and Mg the treatment of brain and bone , cancer ,

GI , lung and thyroid disorders

Change in body to be detected

by Molecular imaging
Biochemical activity changes in cell
Eg :cancer cell increase in metabolism and protein production

Molecular Imaging and Nuclear Medicine

Activity of body in a cellular

level ,
SPECT or PET imaging is main
type

Uses of molecular imaging & Nuclear

medicine
Visualization of the structure and function of organs,
tissue, bones or other systems of the body
Locating lymph nodes before surgery , evaluating bone
fracture , infections and tumor or investigating
abnormalities in brain
Treat cancer and metastases,
Eg : thyroid gland, blood disorders and adrenal gland tumors
in adults and nerve tissue tumors in children.

Combined Modalities

Molecular imaging devices are

integrated with CT and MRI
scanners
Correlate the biological process
with anatomical PET
location
in the
& CT exposes
the patient to a
small amount of ionizing
body
radiation.

Comparison of typical effective

dosesin molecular imaging and
medical examinations using X-rays

Effective dose
Different body tissues have different sensitivity to
radiation
Different body parts have different risk depending up on
composure

Effective dose is a parameter of the dose absorbed by

the entire body that takes account of differing
sensitivities.

Overview of other
common types of
Imaging

Ultrasound imaging
(sonography)
High-frequency sound waves
used to image ( no ionizing
radiation )
Live imaging

Magnetic Resonance Imaging

Magnetic field and
radiofrequency pulses
produced ( no ionizing )
Higher contrast without even
contrast medium

How does Molecular Imaging

work basically ?
Magnetic pole creation : Magnetic waves make hydrogen atoms to
align , different tissue have different concentration of hydrogen

Energy released by hydrogen : realignment produce some

energy , hydrogen acts like radio transmitter

Hydrogen energy release concertation capturing device : Denser

tissue gives off slower (white) and softer ones gives off faster (dark)

Detailed look

X-rays

What is X-ray
There are different ones , its all radiation produced by
unstable nuclei of atoms
alpha (),
beta () and
gamma ()

Penetration power < <

The alpha particles can be blocked by a sheet of paper,
The beta particles by a few millimeters of plexiglass,
High energy gamma radiation requires dense materials to be
attenuated (e.g. lead, concrete).

What can I see with X ray ?

Some soft tissues and hard tissues , Denser tissues are
whiter
If more spectrum of visuals contrast is needed
Genetic material can be split by X-ray ( Watson and
crick used x-ray to find DNA structure )

X-ray tube
Vacuum tube converting electric power to X-rays
Accelerating of electrons from cathode(-) to anode(+) using
electric power
Electrons give up energy at cathode
Most of them as heat and
Some as X-rays ( bremstrolling / breaking radiation )

X-ray tube uses

X-ray tubes are also used
in

CAT scanners
Airport luggage scanners,
X-ray crystallography
Material and structure
analysis, and for industrial
inspection.

Coolidge X-ray tube, from around 1917. The

heated cathode is on the left, and the anode is
right. The X-rays are emitted downwards.

Types of cathode ( each gen

have less heat )
Anode off centered of cathode ejecting e Beveled anode instead of off centered ,
less heat / less electron energy wastage

Boiling cathode and election production ,

more elections

Anode rotation ,
Less anode pitting / less heat concentration

History
Accidental discovery by
Wilhelm Rntgen
8th Nov 1895

Paper published On a New

Kind Of Rays
Dec 1895

Nobel in physics
1901

[Link]
Rntgen W. Ueber eine neue Art von Strahlen. Sitzungsberichte der
Wuerzburger Physik.-medic. Gesellschaft, Wuerzburg, 1895.

Radiographic Contrast
Influenced by
Radiation Quality (KVP)
Film Contrast
Radiographic object
(Patient)
Fat = 6.46
Water = 7.51
Muscle = 7.64
Bone = 12.31

Contrast agents
Enhance thecontrastof
structures orfluidswithin
the body in medical
imaging
Denser than normal tissue
Absorbs more rays

Types contrast media (review)

Negative contrast

Positive contrast

(AIR OR CO2)

(all others)

Radiolucent

Radiopaque

Low atomic # material

High atomic # material

Black on film

White on film

2 basic types of contrast

materials
BARUIM Z# 56
NON WATER SOLUABLE
GI TRACT ONLY INGESTED
OR RECTALLY

IODINE

WATER SOLUABLE

Powder / Liquid / IV / Intrathecal / OIL based

GI TRACT

Z# 53

The contrast injected o-grams

Venogram
Arthrogram
Sialogram
Myelogram
Arteriogram
Angiogram
Galactogram
Hystersalpingogram..
etc

HIP Arthrogram ( double contrast )

Hystosalpingography (HSG)
Contrast media showing
Uterus and uterine tubes
To check fertility use oil or
water based contrast

Myelogram
Look for problems in the

spinal canal,
spinal cord,
nerve roots,
other associated tissues

Contrasts
Pantopaque
Metrizamide (Amipaque) , the first
low-osmolar contrast medium

Oils are not completely

reabsorbed

Sialogram / Ptyalogram.
Dx a blocked salivary
gland or duct in your
mouth.

Galectography ( Breast Duct )

Mammography based
contrast visualization of
breast ducts

Cerebral angiogram /
arteriogram
Finds blockages in the
blood vessels of your head
and neck

Lymphangiogram

Now largely replaced by

PET

ERCP
Endoscopic Retrograde Cholangiopancreatography
Used for colangiography
Therapeutic also

MRCP
Magnetic Resonance Cholangiopancreatography
MRCP is becoming a more
viable imaging technique,
as MRI technology
improves.
MRCP is gradually
replacing PTC and ERCP
for diagnostic purposes

RGU or ASU
Radio Diagnosis Ascending Urethrogram
Urethra evaluation for
strictures

Micturationg cystogram (MCU)

Evaluate the bladder and the
urethra
Checks bladder neck,
narrowing of the urethra, or
reflux of urine into the kidneys

Other X-ray based

CT contrast
Oral/Rectum
Barium or Iodine
IV: Iodine

Positrons

Gamma rays
Positron is antimatter of electron
Particle of matter with the same
mass as an electron
But opposite charge.

When apositron hits electron,

they yield energy ( energy
sometimes = gamma rays is
detected in PET scan )
DONT CONFUSE positron with
proton ( hydrogen ) in MRI

Most common Radiotracers

PET CT and PET MRI

Nuclear Magnetic
Resonance

Magnetic Resonance
Magneticdipole
Cause Protons to align

Protons are all aligned all over the body , and relaxation cause
release of energy from each proton
More proton there is more the radiation

Proton / Hydrogen / One + charge

Has a diploe ( 2 poles )

(T1 /Spin-latex/Longitudinal)
Relaxation MRI

Relaxation time to recover to static position after magnetic

field hits the proton

(T2/ Spin-Spin/Transverse)
Relaxation MRI

Relaxation time taken to slow down the rotation after

magnetic field hits the proton

Closed MRI
More tesla than open MRI
( magnetic field power )
As tesla increase the
resolution increases

Closed MRI
Lower tesla
Used in claustrophobics
and is cost effective
machine

MRI contrast
Gadolinium
There are many other
contrasts also but used
less frequently , only in
specific condition

Gadolinium

z# 64

Once injected, gadolinium

accumulates in abnormal
tissues of the brain and
body
Provides a greater
contrast between normal
and abnormal tissues

Gadolinium
On its own gadolinium is
toxic to the human body,
But when coated in a
special chelating agent, it
is safe to use

Ultrasonography

Ultrasound
Ultrasounds arehigh
frequency sound waves
above audible sound
Ultrasound devices have
frequencies from 20kHz up
to several gigahertz.
Medical ultrasound(also
known asdiagnostic
sonographyor
ultrasonography )

Pros and Cons

Pros

Real time images

Portability
Low cost
No ionizing radiation

Cons
Patient physique and corporation
Structures behind bone and air difficult to visulalize

Obstetric ultrasound
Practice of examining
pregnant women using
ultrasound is called so

Doppler
Used to estimate your
blood flow through blood
vessels by bouncing highfrequency sound waves
(ultrasound) off circulating
red blood cells

NSG ( Neurosonography )
Intracranial assessment of
preterm neonate as
fontanels are not closed
early

Elastography
Based on ultrasound
Maps the elastic properties of
soft tissue.
Elasticity can change in
healthy from unhealthy tissue
for specific organs/growths
E.g.: cancerous tumours will
often be harder than the
surrounding tissue,

Photoacoustic imaging
Hybrid biomedical imaging
modality based on the
photoacoustic effect.
Combines the advantages of
optical absorption contrast with
ultrasonic spatial resolution
May be useful in : tumor
angiogenesis monitoring, blood
oxygenation mapping, functional
brain imaging, and skin melanoma
detection, etc.

Infrared

Functional near-infrared
spectroscopy
FNIR technique is non
invasive
NIRS ( near infrared
spectro-scopy ) is used
for the purpose
offunctional neuroimagingand has been
widely accepted as abrain
imagingtechnique.

Temperature

Thermography
Used for breast imaging.
Based on the principle
that metabolic activity
and vascular circulation
Not established as a
standard

FUTURE