RADIOLOGY & PRINCIPLE

OF IMAGES
For radiographer

Specialized degree
1st year – 1st term
Prepared by
Dr. Shaimaa Fathy
MD of radiodiagnosis
Under supervision of

PROFF. DR. AHMED FARID YOUSIF

‫مكتبة‬
 RADIOLOGY & PRINCIPLE OF images

CONTENTS
Chapter 1: Radiology 3

Chapter 2: Diagnostic Imaging Techniques 7

Axial Tomography (X-Ray) 7

Computed Tomography (Ct) 19

Ultrasound 29

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Chapter 1: RADIOLOGY

Introduction
 Radiology is a branch of medicine that uses medical imaging techniques.
 Interventional radiology is a new branch of this science
 Two type of radiology is considered:
o Radiodiagnosis:
Is used for diagnosis of different body lesions included conventional
x- ray, ultrasound, CT, MRI and advanced images.
o Radiotherapy:
is a type of radiology considered with using of radiology science for
treatment of multiple lesion (intervention radiology) such as trans
arterial chemoembolization (TACE), angioplasty, high intensity focus
ultrasound (HIFU)
History of Radiology
 Radiology began with the discovery of the German scientist Wilhelm
Röntgen for x rays, in 1895, and the world was awarded the Nobel Prize in
physics in 1905.
 In the early decades of radiation detection, the risk of radiation exposure to
technicians and doctors not realize. Many of the early radiologists were
diagnosed with various cancers of the skin, bone and thyroid, as well as
cataract and leukemia. At present, all workers are monitored continuously
and monthly to detect the early effect of radiation on their bodies.

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Radiologist
 The radiologist works on diagnostic or therapeutic radiology devices,
through which he contributes to the diagnosis of various diseases, and is
used in the treatment of some types, such as tumors and cancers.
 The radiologist works on the following devices:
o X-ray machine
o Computed tomography (CT scan)
o Magnetic Resonance System (M.R.I)
o Cobalt device 60
o Gamma Camera Device
o Ultrasonic device
Role of radiological science technologists
 A Radiologic technologist performs all types of imaging procedures, most
commonly x-rays.
 They also administer non-radioactive isotopes known as contrast media for
diagnostic purposes.
 Radiologic technologists are also known as radiographers or x-ray techs.
 They provide a high standard of patient care, prepare patients for
examinations, and explain procedures.
 Radiologic technologists have a thorough understanding of anatomy,
positioning, radiographic exposure, patient care and radiation protection
 Radiologic technologists follow physician’s orders and conform to the
regulations concerning the use of radiation to protect themselves, the patients
and co- workers. With experience radiographers perform complex
procedures such as fluoroscopy, which is a real time x-ray procedure used by
physicians.
 Radiologic technologists can also specialize either in computed tomography
(CT) or magnetic resonance imaging (MRI).

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 CT scans use ionizing radiation, while MRI scans use non-ionizing radio
frequency to generate images.
 Radiographers may also specialize in mammography, angiography, surgery,
trauma, and bone density to name a few.
Some quantitative measures for assessing image quality are important to a
clinician for making his diagnosis. The three most important of these criteria
are:
1. The spatial resolution:
The spatial resolution of an imaging system is related to the smallest feature
that can be visualized or, more specifically, the smallest distance between
two features such that the features can be individually resolved rather than
appearing as one larger shape.
For planar radiography, the major contributions are:
1. The size of the effective X-ray focal spot and the relative distances
between the X-ray tube and the patient, and the X-ray tube and the
detector. The finite size of the effective focal spot of the X-ray tube
results in ‘geometric un-sharpness’ of the image,
2. The properties of the X-ray detector. The spatial resolution depends
upon the physical construction of the phosphor layer of the detector,
whether it is single- or double-sided, and the number of pixels in the
image.
2. Signal-to-noise ratio (SNR):
Noise refers to any signal that is recorded, but which is not related to the
actual signal that one is trying to measure.
Factors that affect the SNR include:
1. The tube current and exposure time: the SNR is proportional to the
square root of the product of these two quantities,
2. The tube kVp: the higher the kVp value the greater the tissue
penetration of the higher energy X-rays, and so the higher the SNR.

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3. The patient size and part of the body being imaged: the greater the
thickness of tissue through which the X-rays have to travel, and the
higher the X-ray attenuation due to bone, the lower the SNR,
4. The geometry of the anti-scatter grid: an anti-scatter grid with a
large grid ratio attenuates a greater degree of Compton scattered X-
rays than one with a smaller ratio, and therefore reduces the image
SNR (but improves the CNR)
3. Contrast-to-noise ratio (CNR):
Is a high enough CNR to be able to distinguish between different tissues,
and in particular between healthy and pathological tissue
Factors affect the contribution of Compton-scattered X-rays:
1. The X-ray energy spectrum. For low kVp values, the photoelectric
effect dominates, and the values of μbone and μtissue, for example,
are substantially different. If high energy X-rays are used, then
Compton scattering is the predominant interaction, and the contrast is
reduced considerably. However, the dose of low-energy X-rays must
be much greater than that of high-energy X-rays for a given image
SNR,
2. The field-of-view (FOV) of the X-ray image – for values of the FOV
between approximately 10 and 30 cm, the proportion of Compton
scattered radiation reaching the detector increases linearly with the
FOV, and therefore the CNR is reduced with increasing FOV. Above
a FOV of 30 cm, the proportion remains constant,
3. The thickness of the body part being imaged – the thicker the
section, then the larger the contribution from Compton scattered X-
rays and the lower the number of X-rays detected. Both factors reduce
the CNR of the image,
4. The geometry of the anti-scatter grid –there is a trade-off between
the SNR of the image and the contribution of Compton scattered X-
rays to the image

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Chapter 2: DIAGNOSTIC IMAGING TECHNIQUES

I. Axial tomography (X-ray)

A. X ray: Are artificial electromagnetic waves that are produced by x ray
machine.
B. X ray machine: is the machine that produces the x ray,
C. Principally it consists of: -
1. Generator:
It transforms the usual current to high voltage current.
2. X ray tube:
It transforms the high voltage current to x ray which emerges from the x
ray tube.
3. The diaphragm (collimator):
placed in contact with the x ray tube through which the x ray pass
through.
Its function is to collimate the x ray beam according to the size of the part
to be examined, to prevent unnecessary exposure to other parts of the
body.
The diaphragm contains light source which helps us to control the size of
the emerging x ray.
4. X ray filter:
is a metal sheet present in the diaphragm. Immediately below the x ray
tube. It absorbs the weak x -ray waves, to avoid its absorption by the
human body. It is usually made of aluminum sheet 2 mm; other material
may be used.

Fig. 1 Showing x ray tube, x ray production diaphragm, filter

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5. X ray table:
It is the table where the patient lies down to be examined. The patient lies
on the table top, it allows passage of the x ray through it. The x ray table
may be stationary (not moving) or moving (called floating top)
6. Grid, OR Bucky:
The grid is thin sheet of special material, it, s present in the table, just
below the table top.
 Function:
it filters the x ray beam and prevent scatter radiation from reaching
the x- ray film.
 Generally:
no grid is used while examining peripheral thin parts (hands, feet).
And grid should be used in thicker parts (hip, obese knee,
abdomen, chest…).
7. Bucky stand:
It is a metal stand put at the wall; it has a Bucky put in it. It is used to x
ray examination for the patients while standing. It is sometimes called
chest stand
8. Control panel;
Controls the function of the x ray, mainly it contains the switch button
Buttons controlling the x ray output (e.g., kilovoltage (KV), milliampere
seconds (MAS) which is the product of the milliampere and seconds.
Other functions may also, be included according to the machine power
and function.

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Fig. 2: x - ray machine

D. While doing radiographic examination the following items should be

fulfilled; -
1. Position of the body part to be examined in relation to the x ray table
or standing.
2. Examination technique including:
 Exposure parameters: exposure factors: kilovolt age (kvp),
milliamp ere seconds (MAS), (milliamp ere x seconds),
 Focal film distance (FFD): is the distance between the focus (or
central part of the x- ray tube (anode) and x ray film. The usual
distance is 100 cm to avoid magnification.
3. Object film distance; is the distance between the part to examined
(object) and the x ray film. If you want to magnify the examined part
the object film distance increased.
4. Central ray (CR): Is the center of the x ray beam, and its site on the
part to be examined. e.g., in chest x-ray the center will be on thoracic
four vertebra
5. X ray film: is the material on which the x ray picture is produced.

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E. The X-ray tubes

1. X-ray production
The X-ray source is a specialized piece of equipment known as an X-ray
tube.
All of the components of the X-ray system are contained within an
evacuated vessel.
The evacuated vessel is surrounded by oil for both cooling and electrical
isolation.
The whole assembly is surrounded by a lead shield with a glass window,
through which the X-ray beam is emitted.
X-rays are produced when a beam of high energy electrons strikes the
surface of a metal target.
A negatively-charged cathode acts as the source of these electrons, and
consists of a small helix of thin tungsten wire, through which an electric
current is passed.
When the temperature of the wire reaches ~2200o C, electrons have
sufficient energy to leave the metal surface. In order to produce a tight
beam of electrons, a negatively-charged ‘focusing cup’ surrounds the
cathode.
A large positive voltage is applied to a metal target, which thus forms an
anode. A potential difference between the anode and cathode of between
25 and 140 kV (depending upon the particular type of clinical study) is
applied, such that the electrons produced at the cathode are attracted to
the anode, striking it at high velocities. This potential difference is known
as the accelerating voltage, or kVp.
When the high energy electrons strike the anode surface, part of their
kinetic energy is converted into X-rays. The metal anode must be able to
produce X-rays efficiently, and also be able to withstand the very high
temperatures generated. In terms of efficiency, the higher the atomic

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number of the metal in the target, the higher the efficiency of X-ray
production. The most commonly used metal is tungsten due to the
following reasons:
 Has a high atomic number of 74,
 Has a high melting point of 3370o C.
 Has good thermal conductivity and a low vapor pressure, which
allows a strong vacuum to be established within the X-ray tube,
thus providing the electrons with an unimpeded path between
cathode and anode.
F. Even with the high efficiency of tungsten only ~1% of the energy of the
electrons is converted into X-rays:
The remainder is dissipated in heat.
The tungsten target of the anode is about 0.7 mm thick and forms a
cylindrical disk which rotates at high speed, ~3000 rpm, in order to
reduce the localized heating.
The power for rotation comes from a set of induction rotors and stators.
In practice, a tungsten– rhenium (2–10% rhenium) alloy is used for extra
mechanical stability of the target.
In order to produce a narrow beam of electrons, a negatively-charged
focusing cup is constructed around the cathode filament.
For achieving a well-defined small area in which the X-rays are created,
the anode is beveled at an angle between 8 and 17o, with 12–15o being
the usual range.
The smaller the angle, the smaller the effective focal spot size (f)

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Figure 3: (left) An X-ray tube enclosed in an evacuated glass enclosure. (right) The
individual components of an X-ray tube.

In practice, the X-ray beam has a higher intensity at the ‘cathode-end’

than at the ‘anode-end’, a phenomenon known as the Heel effect.
This effect is due to differences in the distances that X-rays have to travel
through the target itself. This distance is longer for X-rays produced at
the anode-side of the target than at the cathode-side, and results in greater
absorption of X-rays within the target itself.
This means that the signal intensity on one side of a planar radiograph is
different from that on the other.
Radiographic clarity is often reduced by voluntary or involuntary motion
of the patient.
Consequently, many X-ray tubes contain two cathode filaments of
different lengths, each with a focusing cup. These dual-focus tubes
furnish two apparent focal spots.
One for fine-focus radiography produced with a smaller filament to
obtain radiographs with greater detail. Another for course-focus
radiography produced with a larger filament where short, high-intensity
exposures are necessary to limit the blurring effects of motion.

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G. X- Ray imaging parameters

There are three parameters that can be chosen by the operator for X-ray
imaging:
1. The accelerating voltage (kvp)
2. The tube current (ma)
3. The exposure times
H. Instrumentation for planar radiography
In addition to the X-ray tube, the other basic components of a planar
X-ray radiography system are:
1. A collimator to reduce the patient dose and amount of Compton
scattered X-rays,
2. An anti-scatter grid to reduce further the contribution of scattered X-
rays to the image,
3. A digital detector which converts the energy of the transmitted X-rays
into light. The light is then converted into voltage using photodiodes,
and this voltage is digitized using an analogue-to digital converter
I. Interactions of X-rays with the body
In order to produce images with high SNR and high CNR, three basic
criteria should be satisfied:
1. Sufficient X-rays must be transmitted through the body for a high
SNR,
2. X-ray absorption must be sufficiently different between different
tissue-types in order to produce high contrast, and
3. There must be a method for removing X-rays which are scattered
through unknown angles as they pass through the body.
J. X-ray detectors
Traditional X-ray film is essentially a thing of the past, with current
diagnoses being performed almost exclusively from digital images displayed
on high resolution computer screens. In addition to the higher quality images
made possible using digital detectors, the ability to store and transfer images

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easily through large medical data centers via so-called picture archiving and
communication systems (PACS) has become extremely important. There are
two basic digital detector technologies currently used: computed radiography
and digital radiography, described in the following.
K. Computed radiography
Computed radiography (CR) instrumentation consists of a detector plate and
a CR reader which digitizes the plate after the X-ray image has been
acquired. The CR plate consists of a thin layer of phosphor crystals, most
commonly barium fluor halide activated with europium ions (BAFX: Eu+2),
where the halide X is a mixture of bromine and iodine.
L. Digital radiography
There are two types of digital radiography (DR) detectors: indirect- and
direct conversion.
Indirect-conversion is most commonly used, where X-ray energy is first
converted into light by a CsI:Tl scintillator, and then the light is converted
into a voltage using a two-dimensional array of photodiodes.
A large flat-panel detector (FPD), which lies directly underneath the CsI:Tl
layer, consists of thin-film transistor (TFT) arrays. A typical commercial DR
system has flat-panel dimensions of 43 x 43 cm, with a TFT array of 3001 x
3001 elements corresponding to a
pixel sampling interval of 143 μm. When an X-ray is absorbed in a CsI rod,
the CsI scintillates and produces light in the green part of the spectrum. The
light undergoes internal reflection within the fiber and is emitted on to the
TFT array
The other type of DR detectors using direct conversion, as the name
suggests, eliminate the intermediate step of converting X-ray energy into
light, and use direct absorption of the X-ray photons to produce an electrical
signal plate size ranges from 18 x 24 cm for mammography to 35 x 43 cm
for chest radiography. The plates can be categorized as either high resolution
(HR), usually used for mammography, or standard for general applications.

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HR plates have smaller and thinner crystals, and therefore higher spatial
resolution.
The CR plates convert the X-rays which pass through the patient and the
anti-scatter grid into light. When X-rays strike the plate, they release
electrons in the phosphor layer: these electrons are trapped for a timescale of
hours in sites formed by dislocations in the phosphor crystal lattice. This
effectively forms a ‘latent’ image, i.e., one which is present but is not
immediately visible. The CR plate is protected by a light-tight cassette which
is transparent to X-rays.
M. Indication
1. Detect teeth and bones and fractures
2. Locate the objects such as solid fragments or bullets in the body.
3. The detection of tumors in the body.
4. Possibility to see the fractures of bone with high accuracy, where these
rays penetrate the soft bodies such as the skin.
5. The most important characteristic is the lack of collateral damage
6. Doctors also use these rays to treat and eliminate malignant tumors.
7. X-rays kill cancer cells, and healthy body cells regain their vitality after a
short period of time and return healthy
N. X-ray disadvantage:
1. X-rays belong to ionizing radiation. Which caused the ionization of the
medium through which the separation of some electrons in the atoms and
molecules.
2. They can cause changes in living cells that may lead to cancer. Therefore,
governments shall establish instructions and regulations concerning the
use of X-rays, whether in medicine or in industry, and shall observe the
instructions and punish those who violate the instructions in accordance
with the laws established in this regard.
3. X-rays are also used to fight cancer in the way X-rays are focused on
cancer cells. DNA is a highly deoxyribonucleic acid in living organisms
that is highly sensitive to x-rays, and is increasingly damaged by

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increased absorption of radiation. That is to say, exposure to a small dose

of radiation, however small, is the possibility of turning one of the living
cells into a cancer cell.
4. The risk of cancer is therefore taken into account when X-rays are used in
diagnosis or treatment
5. In general, women should not be exposed to X-rays on the body, and
must be very careful to use on children, and may cause infertility in men
and women if exposed to reproductive organs.

O. Fluoroscopy (Fluoroscopy)
X-ray radiography and vascular imaging are special X-ray applications
where the fluorescent and image magnification are connected to a closed-
circuit television system.
This allows for real-time imaging of moving structures or increased
radioactivity.
Radioactive radiation agents are usually given by swallowing or injecting
into the patient's body to diagnose the dissection of the blood vessels,
reproductive system or gastrointestinal tract.

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Digital fluoroscopy uses continuous X-ray imaging, and can monitor

interventional surgery, for example the placement of catheters, guide-wires,
and pacemakers in cardiac catheterization laboratories, as well as for
dynamic studies of the GI tract and cardiovascular system using contrast
agents.
Until very recently, the traditional detector was a digital image intensifier
television system (IITV), in which the images produced by an X-ray image
intensifier were digitized using a CCD-based device. However, this type of
detector is now being replaced by solid state detectors, which are very
similar to indirect-detection digital radiography technology.
An example is a neurovascular interventional laboratory.
Solid-state digital fluoroscopy systems use very short pulses of X-rays of
~5–20 ms duration depending upon the type of examination and patient size.
Fluoroscopic images are typically acquired at rates of up to 30 frames per
second.
The X-ray dose per frame during fluoroscopy can be as low as one /one-
thousandth of that used during serial image acquisition

Figure 4: (left) A cardiac catheterization laboratory which uses a digital fluoroscopy unit to
monitor placement of stents and pacemakers. (right) A neurointerventional unit, with a C-arm
digital fluoroscopy unit.

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P. There are now two radio signal devices in common use.

1. Barium Sulphate (BaSO4) is given orally or in a straight line to assess the
digestive system.
2. Iodine, in multiple forms of ownership, is given by mouth, rectum, vagina
or intra-arterial or intravenous routes.
These radiation factors strongly tolerate or dispersion of x-rays, and in
conjunction with real-time imaging, allows for the presentation of dynamic
processes, such as peristalsis in the gastrointestinal tract or blood flow in the
arteries and veins.
The variation in iodine may also be concentrated in abnormal areas more or
less than the normal tissues and more pronounced deformities (tumors,
abscesses, inflammation) occur.
In addition, under certain conditions air can be used as a contrast agent for
the digestive system and carbon dioxide can be used as a contrast agent in
the venous system. In these cases, the contrast factor reduces X-ray less than
the surrounding tissue.

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II. Computed Tomography (CT)

A. Introduction
The introduction of CT in the early 1970s led to a revolution in diagnostic
radiology by providing doctors with real anatomical 3D images. CT has
become a test in the selection of some urgent and emergency cases, such as
cerebral hemorrhage, pulmonary embolism (pulmonary embolism), aortic
dissection (appendicitis), appendicitis, spleen, kidney blockage stones.
Continuous improvements in CT technology, including scanning speed and
improved accuracy, have increased the accuracy and usefulness of the CT
scan, which may partially explain the increased use of medical diagnostics.
A bank of solid-state detectors is situated opposite the X-ray tube and
together they record a one-dimensional projection of the patient.
The X-ray source and detectors are rotated through one complete revolution
around the patient, with data being acquired essentially continuously.
Most commercial scanners are so called ‘third generation scanners’ which
use a wide X-ray fan-beam and between 512 and 768 detectors.
Two separate collimators are used in front of the source:
1. The first collimator restricts the beam to an angular width of 45–60o.
2. The second collimator, placed perpendicular to the first, restricts the
beam to the desired slice thickness, typically 1–5 mm, in the patient
head/foot direction.
Typical operating conditions are a rotation speed of once per second, a data
matrix of the reconstructed image of either 512 x 512 or 1024 x 1024 and a
spatial resolution of ~0.35 mm.

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Figure 5: (left) The physical principle of computed tomography involves synchronous

rotation of the X-ray tube and multiple detectors to record a series of one-dimensional
projections. The CT image (right) is produced by the process of filtered backprojection.

B. Spiral / helical CT
Acquiring a single axial slice through a particular organ is of very limited
diagnostic use, and so a volume consisting of multiple adjacent slices is
always acquired.
This is necessary medical imaging Technologies to view a full three-
dimensional image for a particular region of the body.
For head trauma patients, for example, the location and size of the trauma
must be determined very accurately.
One way to do this is for the X-ray source to rotate once around the patient,
then the patient table to be electronically moved a small distance in the
head/foot direction, the X-ray source to be rotated back to its starting
position, and another slice acquired.
This is clearly a relatively slow process. The solution is to move the table
continuously in a horizontal direction as the data are being acquired: this
means that the X-ray beam path through the patient is helical.
Such a scanning mode is referred to as either ‘spiral’ or ‘helical’.

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Figure 6: The principle of helical computed tomography.

The X-ray tube and bank of detectors (typically several hundred, aligned
parallel to one another) rotate together while the patient table is slowly slid
along the head/foot axis. Use of multiple detector rows (numbers of detectors
are shown for a typical 64-slice scanner) enables CT images to be acquired
much more rapidly.
C. Multi-slice spiral CT
The efficiency of spiral CT can be increased further by incorporating an
array of detectors, rather than having just a single detector, in the head/foot
direction. Many detector rows (up to 320) are currently used.
D. Instrumentation for CT
Several components of the CT system such as the X-ray tube, collimator and
anti-scatter grid are very similar to the instrumentation described previously
for planar X-radiography.
The tube and detectors have to be fixed to a heavy gantry, which rotates very
rapidly, generating large gravitational forces.
High power cables are used to deliver power to the X-ray tube, and a large
parallel cable is used to transfer data from the scanner to the central
computer.

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E. Image reconstruction in CT
The mathematical basis for reconstruction of an image from a series of
projections is the inverse Radon transform, which is performed using filtered
back projection.
The CT number, with values expressed in Hounsfield units (HU),
Table 3.1: CT numbers of different tissues at 70 keV
Tissue CT number (Hounsfield units)
Bone 1000 – 3000
Muscle 10 – 40
Water 0
Lipid - 50 to – 100
Air - 1000
Brain (white matter) 20 to 30
Brain (grey matter) 35 to 45
Blood 40

CT scans are obtained in the axial plane, with coronal and soft images
produced by the computer reconstruction.
Radiation factors are often used with computed tomography (CT) for
improved autopsy. Although radiographs provide higher spatial resolution,
CT scans can detect more subtle variations in x-ray attenuation (higher
contrast resolution).
CT scans expose the patient to much more ionized radiation than
radiography.
The multidetector spiral CT use 16, 32, 64, up to 320 or more detectors
during continuous motion of the patient through the beam of radiation to
obtain accurate images in a short time for testing.
With the rapid management of venous contrast during CT, these detailed
images can be reconstructed in three-dimensional (three-dimensional)
images of the carotid, cerebral, coronary or other arteries.

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F. Characterization of CT
There are many characteristics that make this method of scanning better than
other methods of medical scanning.
First, CT can show a clear picture of a member being photographed without
showing the members around him. For example, when the lungs are
photographed, the heart or viscera does not appear in the picture.
Second, the chromatic contrast between the tissues in the picture helps
doctors know the difference in mass density. In addition, this mechanism can
produce high-quality images without producing a large amount of radiation.
What distinguishes this mechanism is the need not to put any gas or device
directly within the body as in the catheter.
G. How long does this examination take?
The modern CT cameras allow us to get the pictures in a matter of minutes.
If intravenous injection of colored material is required, this will require an
additional time of not more than a few minutes and usually the duration of
the test is between 15-20 minutes.
H. Usage
The use of CT has increased over the past two decades. In 1980, only 3
million CT scans were performed on patients. In 2007, approximately 70
million CT scans were performed in the United States. Approximately 6% of
the imaging operations were performed on children.
This great turnout is not only in America, but in most countries of the world.
The main reason is that most physicians prefer to have a CT scan of patients
who are admitted to the hospital to assess their health status accurately.
One of the main reasons why photography is so common is its ease and
speed. The process of photography alone takes a few minutes.
I. How photography works
The X-ray device circulates around the section to be photographed, and
sensors or receptors receive radiation at the opposite end of the circuit. These

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receptors contained Xeon gas but were later replaced by more efficient
receptors.
The old imaging equipment would move the object, which is slightly
photographed after the X-ray device is in full cycle, and the new devices
allow the body to move while the source of the source of radiation around it.
CT is used in medicine as a diagnostic tool especially before surgery.
Images taken must be processed before obtaining high-resolution cross-
sectional images of the photographed person.
J. How to print the image
Pixel is a point of a certain color in the two-dimensional image resulting
from CT. Foxel is like a pixel but in a 3D image. Color pixels or pixels
depend on X-ray permeability across the tissues being photographed.
One transmittance is the Hounsfield unit. The more permeable tissue is given
the value of 3070 units of Hounsfield, the least permeable-1024 Hounsfield
unit.
When images are printed, tissues with more than 80 Hounsfield permeability
are shown in white, tissue with a permeability of less than 0 Hounsfield is
shown in black, and tissues with a range of between 0 and 80 Hounsfield
units appear in gray, the range of gray scale is related to permeability.
Also, when printing the picture appears upside down, the left part of the
image represents the right part of the patient, and vice versa.
K. Pre-imaging preparations
Before starting the imaging process, there are many procedures to take. First,
the patient should tell the doctor if he is allergic to certain substances
because he will be injected with a contrasting substance.
Second, the patient should tell the doctor if he or she has previous heart
disorders, asthma or other illnesses because these diseases may increase the
side effects of x-rays.

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Third, the patient should stop eating several hours before the examination. It
is preferable to wear comfortable and wide clothing prior to CT.
Finally, the patient is required to take off jewelry, ornaments, shoes and pins
as they may adversely affect the examination.
L. How to do CT scan?
The patient will be asked to lie down on a solid, moving table. Then, by
moving the mobile table, the part of the body is placed in a donut-like
device.
The patient will be asked to stay still as less movement may affect image
quality.
The imaging technician may ask him to lock himself up to preserve the
image quality. Throughout the examination, the imaging technician monitors
the patient through a small window.
There is also an internal communication device that allows the patient to
communicate with the photographer. At the end of the examination, the
patient can return immediately to follow up his normal work.
Sometimes a CT specialist may decide to give the patient a venereal
injection of dye to illustrate what is seen in the pictures. The imaging
technician then puts a venous needle to inject the dye. When injected, the
patient may feel a general feeling of warmth and a metallic taste in his
mouth.
In some cases of gastrointestinal (gastrointestinal) imaging, another type of
dye may be requested by drinking to obtain a more accurate diagnosis as
appropriate. This dye is drunk before the examination for an hour to four
hours according to its type
M. Cross-sectional images
The two-dimensional images are often collected and processed by special
software to obtain 3D images. For example, when photographing the spine,
the two-dimensional picture shows only one vertebra of the spine. The three-

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dimensional image shows the position of the paragraph relative to the

surrounding vertebrae, as well as the cartilages that link the paragraphs to
each other.
After processing the resulting image, the colors are added to it to make it
easier to distinguish between different members.
The aim of these images is to help doctors when performing surgeries.
Members close to the viewer are usually semi-transparent until they are done
After processing the resulting image, the colors are added to it to make it
easier to distinguish between different members.
The aim of these images is to help doctors when performing surgeries.
Members close to the viewer are usually semi-transparent so they can see the
other half of the image.
N. Negative effects of computed tomography
The radiographs used in tomography damage cells in the body and nucleic
acids, which causes various cancers. The CT scan used to diagnose cancer
tumors may cause cancer.
The amount of radiation produced by these devices exceeds the amount of x-
ray produced more than 1,000 times. Too many patients are subject to
imaging too much, which increases their risk of cancer.
Scientists estimate that about 5% of cancers in the future will be caused by
medical imaging of all kinds. The risk of cancer varies according to the age
of the person.
The amount of radiation produced can be reduced when children are
photographed to protect them as children are more likely to develop cancer
than adults. Although CT has side effects, it cannot be dispensed with or
replaced by other imaging methods

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O. Generations Scanning System

Cross-sectional scanning devices are classified into several generations
according to the evolution of the scanning mechanism, its speed and the
time it takes to form the image:
1. First generation
The first generation of CT scanners uses a beam of pencil thickness
directed to the body and is monitored by only one or two detectors. The
images are collected through a rotary and transitional scan where the
source of the X-ray and the detector are installed in a device called the
gantry and rotate to each other so that the human body in the axis of
rotation for them, and the duration of the image is about 4 minutes where
the Gantry has a full 360 degree The gantry then moves to clear another
part of the human body, and the use of this generation requires immersion
of the patient's body in a water basin to reduce its exposure to X-rays.
2. Second generation
The scanning device was developed so that the number of reagents
increased and the x-ray beam became more extensive to cover the
corresponding reagents. The scanning method is still similar to the
scanning method used in the first generation. It is by circular and
transient scanning around the human body, increasing the number of
reagents, the scanning cycle for each section of the body covers 180
degrees by moving 30 degrees instead of one degree as in the first
generation, thus reducing the scanning time.
3. Third generation
There has been a marked improvement in the third generation in terms of
speed in obtaining the image, by canceling the transition movement and
make the movement circular only, making the survey time only one
second. To eliminate transient movement during third-generation
scanning, reagents that monitor X-rays from the human body are
designed in the form of an arch, maintaining a fixed distance between the

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X-ray source and the reagents during rotation. Patient and X-ray barriers
were added between the patient and the reagents to ensure a thin beam of
X-ray that is carried out to the human body, thereby reducing its exposure
to radiation.

4. The fourth generation

Is similar to the third generation in terms of scanning with circular motion
only, and the addition of the detectors that were installed on the entire
perimeter of the Gantry, which has 1000 detectors, making the movement
limited to the source of X-ray only with the stability of reagents because
it surrounds the entire Gantry. This design make scanning a full section of
the body does not take more than one second, and in this way the device
has been photographed using X-ray each region.

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III. Ultrasound
A. Introduction
Medical ultrasound imaging uses ultrasound (high frequency sound waves)
to visualize soft tissue structures in the body in real time.
The ultrasonic imaging technique is based on the projection of a sound
package and the reflection of the reflector from the organ, forming an image
ranging from black to white due to the difference of acoustic resistance
between the tissues of the body, so that the tissue shows high resistance
white and non-resistant tissues black.
There is no ionizing radiation, but the quality of the images obtained by
ultrasound depends largely on the person's skill (ultrasound) that performs
the examination and the size of the patient's body.
Larger patients with extra weight may be low in image quality because
subcutaneous fat absorbs more sound waves.
This results in fewer sound waves that penetrate the devices and return to the
power adapter, resulting in loss of information and a lower quality image.
Ultrasound is also limited because it cannot take pictures through the air
pockets (lungs, bowel rings) or bones. Its use in medical imaging has
evolved in the past 30 years.
B. Ultrasonic device components:
1. Ultrasonic Imaging System
2. SIP
3. Display Screen
4. Control Panel
5. CD player
6. Storage unit
7. Printer

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 RADIOLOGY & PRINCIPLE OF images

C. Definition of the probe (US-Transducer)

The sensor is a device used to convert the electrical energy of the sound
energy to send it in the form of pulse PW or continuous pulse PW, and on
the contrary receives this sound energy reflected from the tissues of the body
in the form of waves to convert the electrical energy and sends to the camera
in the form of electrical pulses to be processed and analyzed.
There are different types and shapes vary depending on the use and there are
multi-frequency types.
Based on the above, we find that the sensor is the most important part of the
ultrasound
D. Types of probe
1. Linear probe
The probe uses several different shapes and features to suit the imaging of
many parts of the body, uses a high frequency sound 7 MHz Hertz,
produces parallel linear sound waves to photograph the surface parts of
the body such as thyroid.
2. Curved probe:
Frequency of sound waves used from 2 - 5 MHz to be able to enter
deeper areas of the body as members of the abdominal region of liver and
kidney
The probe used for three-dimensional imaging: -
The wave frequency is between 1-3 MHz, which shoots in two different
directions at high quality at the same time, or stereoscopic images of the
body or fetal organs at the same
The first ultrasound images were fixed and 2D, but with modern ultrasound,
real-time 3D reconstruction can be seen as "4D" effectively.
Since ultrasound techniques do not use ionizing radiation to create images
(other than radiography and tomography), they are generally considered
safer and are therefore more common in photodetector imaging.

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The progress of the load can be accurately assessed with less concern about
the damage caused by the techniques used, allowing the detection and
diagnosis of many fetal anomalies.
Growth can be assessed over time, which is important in patients with
chronic disease or pregnancy-related illnesses, and in multiple pregnancies
(twins, triplets, etc.).
The Doppler ultrasound measures the flow of color from the severity of
peripheral vascular disease and is used by cardiologists to dynamically
evaluate the heart, heart valves and major vessels.
Stenosis, for example, of carotid arteries may be a warning sign for
impending stroke.
A submerged clot can be found in one of the inner veins of the legs via
ultrasound before it is excreted and travels to the lungs, leading to possible
pulmonary embolism.
Ultrasound is useful as a guide to the performance of biopsies to minimize
damage to surrounding tissues and to discharges such as thrombosis.
Small and portable ultrasound devices replace the peritoneal membrane in
the trauma wards through a non-surgical evaluation of internal bleeding and
any internal organ damage.
Comprehensive internal bleeding or injury in the main organs may require
surgery and repair.
E. Principle of ultrasound work
When connecting the ultrasonic device with electricity will pass the electric
current to the crystals of the component of the probe, which leads to
vibration, creating a so-called "piezoelectric" electrode, depending on the
pressure.
Ultrasonic waves are produced as a result of the pressure that leads to the
expansion and contraction of the crystals after the passage of electricity at a

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frequency between 2-15 MHz and pass through the body and pass one of
these interactions with the body's internal tissues:
1. Mitigation: Reduce the intensity of waves
2. Refraction: Change in direction and speed of waves

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IV. Magnetic Resonance images

A. Introduction:
Magnetic resonance imaging (MRI) uses strong magnetic fields to align
atomic nuclei (usually hydrogen protons) within the tissues of the body, then
uses a radio signal to disturb the spin axis of these nuclei and notes the RF
signal from the nucleus's return to baseline states.
Radio signals are collected by small antennas called coils, placed near the
area of interest.
The MRI feature is its ability to produce images in axial, ellipsoid, sagittal,
and many oblique planes with equal ease.
Magnetic resonance imaging (MRI) gives the best contrast to soft tissue
between all imaging modalities.
With advances in scanning speed and spatial space, improvements in
computer algorithms and 3D devices, MRI has become an important
radiology tool in diagnosis of soft tissue lesions.
Recent improvements in magnet design including stronger magnetic fields (9
teslas), shortening test times, shorter and shorter magnet arcs and more open
magnetic designs, have led to some comfort for patients suffering from
indoor fear. However, for magnets with equivalent field strength, there is
often a tradeoff between image quality and open design.
Magnetic resonance imaging (MRI) has great utility in imaging the brain,
spine and musculoskeletal system.
Areas of potential advancement include functional magnetic resonance
imaging, cardiovascular magnetic resonance imaging
B. Types
There are many different types today with many ideas for MRI, in general
there are three main types of MRI:
1. Permanent
2. Resistant
3. Superconducting magnet

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The MRI device generally contains a part that gives a strong magnetic field
& part emits the radio waves to stimulate the protons and picks up the
signals coming from them & the stratified system part
The survey used in medical fields costs one million dollars per Tesla and
several hundred thousand dollars are spent annually in maintenance.
Computers are used primarily in MRI tests and advanced programs that
effectively help to give the best results.
C. Uses of Magnetic Resonance
Use of magnetic resonance imaging is for diagnostic purposes such as
imaging of veins and arteries, or imaging of neurological changes in the
brain, and MRI is considered the best imaging in clarifying tissues and body
fluids, Plan treatment plans based on radiation therapy.
Before magnetic resonance imaging, the history of the disease should be
reviewed and the complete absence of previous surgery or accidents leading
to the presence of minerals in the body such as shrapnel is confirmed.
This is confirmed by routine general radiography and passage of the patient
through a metal detector. The patient usually gives a special dye injected into
the body to increase contrast and clarify the close parts.
D. Two types of MRI magnet:
1. Closed magnet
2. Open magnet

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E. Magnetic resonance imaging (MRI)

Is the most recently developed of the four major clinical imaging modalities.
The first images were acquired in 1973 by Paul Lauterbur, who shared the
Nobel Prize for Medicine in 2003 with Peter Mansfield for their shared
contribution to the invention and development of MRI.
MRI provides a spatial map of the hydrogen nuclei (water and lipid) in
different tissues.
The image intensity depends upon the number of protons in any spatial
location, as well as physical properties of the tissue such as viscosity,
stiffness and protein content.
F. In comparison to other imaging modalities, the main advantages of MRI
are:
1. No ionizing radiation is required,
2. The images can be acquired in any two- or three-dimensional plane,
3. There is excellent soft-tissue contrast,
4. A spatial resolution of the order of 1 mm or less can be readily achieved,
5. Images are produced with negligible penetration effects.
6. Pathologies in all parts of the body can be diagnosed, with neurological,
cardiological, hepatic, nephrological and musculoskeletal applications all
being widely used in the clinic.
7. In addition to anatomical information, MR images can be made sensitive
to blood flow (angiography) and blood perfusion, water diffusion, and
localized functional brain activation.

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G. The main disadvantages of MRI are:

1. MR image acquisition is much slower than CT and ultrasound, and is
comparable to PET
2. a typical clinical protocol might last 30–40 minutes with several different
types of scan being run, each having a slightly different contrast, with
each scan taking between five and ten minutes.
3. A significant percentage of patients are precluded from MRI scans due to
metallic implants from previous surgeries, Magnetic resonance imaging
(MRI) is not currently used for patients with pacemakers, industrial
cochlea implantation, some sedative pumps; certain types of cerebral
vasodilation, metal fragments in the eye and some metal devices due to
strong magnetic fields and strong, open
4. Systems are much more expensive than CT or ultrasound units.
5. One disadvantage is that the patient must remain steadfast for long
periods of time in a tight, noisy place during imaging.
6. Indoor fear (claustrophobia) has been reported to be severe enough to
terminate the MRI scan in up to 5% of patients.

Figure 7: (a) A high-field clinical magnet with patient bed. (b) The three major
components of an MRI system, including the superconducting magnet which produces a
strong magnetic field (B0) in the horizontal direction. Only one of the three gradient coils
is shown for clarity

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RADIOLOGY & PRINCIPLE OF images

H. Effects of a strong magnetic field on protons in the body

The MRI system comprises three major hardware components: a
superconducting magnet, a set of three magnetic field gradient coils, and a
radiofrequency transmitter and receiver.
The patient lies on a bed which slides into the very strong superconducting
magnet.
A typical value of the magnetic field, B0, is 3 Tesla (30 000 Gauss), roughly
60 000 times greater than the earth’s magnetic field of ~50 μT (0.5 Gauss).
This magnetic field causes the protons to precess at a frequency proportional
to the strength of the magnetic field, i.e., there is a ‘resonance’ frequency.
The magnetic field gradients make this resonance frequency dependent upon
the spatial location of each proton in the body, thus enabling an image to be
formed.
A tuned radiofrequency coil transmits energy into the body at ~128 MHz for
a 3 Tesla magnet, and the MRI signal is induced in the same or other RF
coils which are placed close to the body.
Numerous studies have shown no detrimental effect of such a high magnetic
field, but patients must undergo a thorough check to ensure that they have no
magnetic metal implants or surgical clips.

Figure 8 : (a) The internal rotation of a proton creates a magnetic moment, and so the
proton acts as a magnet with north and south pole. (b) In the absence of a strong magnetic
field, the orientations of the magnetic moments are completely random. (c) When there is a
strong magnetic field present the magnetic moments must align at an angle θ = ±54.7o
with respect to the direction of B0

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I. MRI instrumentation
There are three major hardware components which constitute the MRI
scanner: the magnet, an RF coil and three magnetic field gradient coils.
In addition to these three components, there are electronic circuits used to
turn the gradients on and off, to produce RF pulses of pre-determined length
and amplitude, and to amplify and digitize the signal.
J. Superconducting magnet design
The vast majority of MRI magnets are superconducting. Since the early
2000s many 1.5 Tesla scanners have been replaced by 3 Tesla systems, with
almost universally better image quality.

The two major aims of magnet design are:

1. Produce the most homogeneous magnetic field over the sample to give
the longest T2* relaxation time.
2. Produce a stable magnetic field in which the drift is of the order of 1 part
per billion (1 ppb) over the course of an MRI scan.

Figure 9: (a) A commercial knee coil for a 3 Tesla magnet, formed from twelve rungs in a
birdcage geometry. (b) Similar structure for a head coil.
K. Magnetic resonance angiography
Unlike X-ray angiographic techniques, magnetic resonance angiography
(MRA) does not require the use of contrast agents, although they can be used

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to increase the signal difference between flowing blood and tissue. The most
common technique is called time-of-flight (TOF) angiography, which is
based on the much shorter effective T1 (T1,eff) of blood due to its flow
through the imaging slice (or volume) that is oriented perpendicular the
direction of flow.
Multi-slice or three-dimensional angiography is normally performed to
obtain flow images throughout a given volume of the brain.
Images are usually displayed using a maximum intensity projection (MIP)
algorithm. For observation of very small vessels, contrast agents can be used
to reduce further the effective T1 of blood, and increase the contrast between
flowing spins and stationary tissue.

Figure 10: Maximum intensity projection from a three-dimensional brain angiography.

Flowing blood shows up as the bright signal

L. Positron emission tomography–computed tomography (better known as

PET-CT or PET/CT)
Is a nuclear medicine technique which combines, in a single gantry, a
positron emission tomography (PET) scanner and an x-ray computed
tomography (CT) scanner, to acquire sequential images from both devices in

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the same session, which are combined into a single superposed (co-
registered) image.
Thus, functional imaging obtained by PET, which depicts the spatial
distribution of metabolic or biochemical activity in the body can be more
precisely aligned or correlated with anatomic imaging obtained by CT
scanning.
Two- and three-dimensional image reconstruction may be rendered as a
function of a common software and control system.
PET-CT has revolutionized medical diagnosis in many fields, by adding
precision of anatomic localization to functional imaging, which was
previously lacking from pure PET imaging.
For example, many diagnostic imaging procedures in oncology, surgical
planning, radiation therapy and cancer staging have been changing rapidly
under the influence of PET-CT availability, and centers have been gradually
abandoning conventional PET devices and substituting them by PET-CTs.
Although the combined/hybrid device is considerably more expensive, it has
the advantage of providing both functions as stand-alone examinations,
being, in fact, two devices in one.
The only other obstacle to the wider use of PET-CT is the difficulty and cost
of producing and transporting the radiopharmaceuticals used for PET
imaging, which are usually extremely short-lived (for instance, the half-life
of radioactive Fluorine-18 (18F) used to trace glucose metabolism (using
fluorodeoxyglucose, FDG) is two hours only. Its production requires a very
expensive cyclotron as well as a production line for the
radiopharmaceuticals .PET-MRI, like PET-CT, combines modalities to
produce co-registered images.

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RADIOLOGY & PRINCIPLE OF images

M. History
PET-CT systems were initially proposed by David Townsend (at the
University of Geneva at the time) and Ronald Nutt (at CPS Innovations in
Knoxville, TN) with help from colleagues.
The first PET-CT prototype for clinical evaluation was funded by the NCI
and installed at the University of Pittsburgh Medical Center in 1998. The
first commercial system reached the market by 2001, and by 2004, over 400
systems had been installed worldwide.
N. Procedure for FDG imaging
Before the exam, the patient fasts for at least 6 hours
On the day of the exam, the patient rests lying for a minimum of 15 min, in
order to quiet down muscular activity, which might be interpreted as
abnormal metabolism.
An intravenous bolus injection of a dose of recently produced 2-FDG or 3-
FDG is made, usually by a vein in one of the arms.
Dosage ranges from 3.7 to 7.4 megabecquerels (0.1 to 0.2 mCi) per kilogram
of body weight.
After one or two hours, the patient is placed into the PET-CT device, usually
lying in a supine position with the arms resting at the sides, or brought
together above the head, depending on the main region of interest (ROI)
An automatic bed moves head first into the gantry, first obtaining a
topogram, also called a scout view or surview, which is a kind of whole body
flat sagittal section, obtained with the X-ray tube fixed into the upper
position.
The operator uses the PET-CT computer console to identify the patient and
examination, delimit the caudal and rostral limits of the body scan onto the
scout view, selects the scanning parameters and starts the image acquisition
period, which follows without human intervention.

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 RADIOLOGY & PRINCIPLE OF images

The patient is automatically moved head first into the CT gantry, and the x-
ray tomogram is acquired.
Now the patient is automatically moved through the PET gantry, which is
mounted in parallel with the CT gantry, and the PET slices are acquired.
The patient may now leave the device, and the PET-CT software starts
reconstructing and aligning the PET and CT images.
A whole-body scan, which usually is made from mid-thighs to the top of the
head, takes from 5 minutes to 40 minutes depending on the acquisition
protocol and technology of the equipment used.
FDG imaging protocols acquires slices with a thickness of 2 to 3 mm.
Hypermetabolic lesions are shown as false color-coded pixels or voxels onto
the gray-value coded CT images.
Standardized Uptake Values are calculated by the software for each
hypermetabolic region detected in the image.
It provides a quantification of size of the lesion, since functional imaging
does not provide a precise anatomical estimate of its extent.
The CT can be used for that, when the lesion is also visualized in its images
(this is not always the case when hypermetabolic lesions are not
accompanied by anatomical changes).
FDG doses in quantities sufficient to carry out 4-5 examinations are
delivered daily, twice or more per day, by the provider to the diagnostic
imaging center.
For uses in image-guided radiation therapy of cancer, special fiducial
markers are placed in the patient's body before acquiring the PET-CT
images. The slices thus acquired may be transferred digitally to a linear
accelerator which is used to perform precise bombardment of the target areas
using high energy photons (radiosurgery).

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O. Single-photon emission computed tomography (SPECT, or less

commonly, SPET):
Is a nuclear medicine tomographic imaging technique using gamma rays?
It is very similar to conventional nuclear medicine planar imaging using a
gamma camera (that is, scientigraphy) but is able to provide true 3D
information.
This information is typically presented as cross-sectional slices through the
patient, but can be freely reformatted or manipulated as required.
The technique requires delivery of a gamma-emitting radioisotope (a
radionuclide) into the patient, normally through injection into the
bloodstream.
On occasion, the radioisotope is a simple soluble dissolved ion, such as an
isotope of gallium (III). Most of the time, though, a marker radioisotope is

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attached to a specific ligand to create a radioligand, whose properties bind it

to certain types of tissues.
This marriage allows the combination of ligand and radiopharmaceutical to
be carried and bound to a place of interest in the body, where the ligand
concentration is seen by a gamma camera.
P. Principles
Instead of just "taking a picture of anatomical structures", a SPECT scan
monitors level of biological activity at each place in the 3-D region analyzed.
Emissions from the radionuclide indicate amounts of blood flow in the
capillaries of the imaged regions.
In the same way that a plain X-ray is a 2-dimensional (2-D) view of a 3-
dimensional structure, the image obtained by a gamma camera is a 2-D view
of 3-D distribution of a radionuclide.
SPECT imaging is performed by using a gamma camera to acquire multiple
2-D images (also called projections), from multiple angles.
A computer is then used to apply a tomographic reconstruction algorithm to
the multiple projections, yielding a 3-D data set. This data set may then be
manipulated to show thin slices along any chosen axis of the body, similar to
those obtained from other tomographic techniques, such as magnetic
resonance imaging (MRI), X-ray computed tomography (X-ray CT), and
positron emission tomography (PET).
SPECT is similar to PET in its use of radioactive tracer material and
detection of gamma rays.
In contrast with PET, the tracers used in SPECT emit gamma radiation that
is measured directly, whereas PET tracers emit positrons that annihilate with
electrons up to a few millimeters away, causing two gamma photons to be
emitted in opposite directions.

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RADIOLOGY & PRINCIPLE OF images

A PET scanner detects these emissions "coincident" in time, which provides

more radiation event localization information and, thus, higher spatial
resolution images than SPECT (which has about 1 cm resolution).
SPECT scans are significantly less expensive than PET scans, in part
because they are able to use longer-lived and more easily obtained
radioisotopes than PET.
Because SPECT acquisition is very similar to planar gamma camera
imaging, the same radiopharmaceuticals may be used. If a patient is
examined in another type of nuclear medicine scan, but the images are non-
diagnostic, it may be possible to proceed straight to SPECT by moving the
patient to a SPECT instrument, or even by simply reconfiguring the camera
for SPECT image acquisition while the patient remains on the table.
SPECT machine performing a total body bone scan. The patient lies on a
table that slides through the machine, while a pair of gamma cameras rotate
around her.
To acquire SPECT images, the gamma camera is rotated around the patient.
Projections are acquired at defined points during the rotation, typically every
3–6 degrees. In most cases, a full 360-degree rotation is used to obtain an
optimal reconstruction. The time taken to obtain each projection is also
variable, but 15–20 seconds is typical. This gives a total scan time of 15–20
minutes.
Multi-headed gamma cameras can accelerate acquisition. For example, a
dual-headed camera can be used with heads spaced 180 degrees apart,
allowing two projections to be acquired simultaneously, with each head
requiring 180 degrees of rotation. Triple-head cameras with 120-degree
spacing are also used.
Cardiac gated acquisitions are possible with SPECT, just as with planar
imaging techniques such as multi gated acquisition scan (MUGA).

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 RADIOLOGY & PRINCIPLE OF images

Triggered by electrocardiogram (EKG) to obtain differential information

about the heart in various parts of its cycle, gated myocardial SPECT can be
used to obtain quantitative information about myocardial perfusion,
thickness, and contractility of the myocardium during various parts of the
cardiac cycle, and also to allow calculation of left ventricular ejection
fraction, stroke volume, and cardiac output.
Q. Application
SPECT can be used to complement any gamma imaging study, where a true
3D representation can be helpful, such as tumor imaging, infection
(leukocyte) imaging, thyroid imaging or bone scientigraphy.
Because SPECT permits accurate localization in 3D space, it can be used to
provide information about localized function in internal organs, such as
functional cardiac or brain imaging.

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