MEDICAL IMAGING TECHNIQUES

 Medical imaging is a means of obtaining images of the interior of the human body
in order to provides functional information of the human body.

 Six common medical imaging techniques will be discussed in this module

 Theirprinciple of operation, use in clinical imaging, side effects/safety issues,

strengths, as well as their weaknesses, will also be discussed.
 ULTRASOUND
 INTRODUCTION
Ultrasound has made tremendous impact to patient care as it allowed imaging of the fetus
and placenta in obstetrics and maternal internal organs in gynecology.
It gives clarity to allow for advanced diagnosis and also to guide various life saving
interventions.
 Therefore, it is important to understand the physical principles of ultrasound and its
application in the medical field.
 PHYSICAL CHARACTERISTICS OF SOUND
 Sound is a mechanical wave that travels in a medium in a longitudinal and straight-line
fashion.
 Sound cannot travel in a vacuum; thus, requires a medium for transmission
Since sound wave is a mechanical energy, it transmission is from one molecule to another in
the medium through which its propagates.
Itis important to note that, the molecules do not move as the sound wave passes through
them, but oscillate back and forth, forming zones of compression and rarefaction in the
medium.
 The acoustic parameters that describe the characteristics of a sound wave are;
 Frequency
 Period
 Amplitude
 Power
 Intensity
 Wavelength
 Propagation speed
 SPEED OF SOUND IN VARIOUS MEDIA
Medium Type Speed (m/s)
Air 330
Fat 1450
Water 1450
Soft tissue 1540
Bone 3500
Metals Up to 7000
 In ultrasound, the transducer determines the frequency, period, amplitude, power and
intensity of the sound produced.
 The wavelength is determined by both the sound source and the medium and the propagation
speed is a function of the medium only.
 The propagation speed of sound in soft tissue is constant at 1,540 m/s.
 WHAT IS ULTRASOUND?
 Sound is classified based upon the ability of the human ear to hear.
 Sound that a healthy adult human ear can accommodate ranging from 20Hz to 20,000 Hz,
is termed audible sound.
Thus, sound with frequency less than 20 Hz, cannot be heard by humans and term as
infrasonic or infrasound.
 For sound with frequency above the audible sound range (i.e. > 20 KHz) can not be heard
by humans is called ultrasonic or ultrasound
 Typically, sound frequencies used in diagnostic ultrasound are in the range of 1-10 MHz
 For obstetrics and gynecology, the commonly used ultrasound frequencies are between 3
and 10 MHz
 HOW IS ULTRASOUND GENERATED?
Ultrasound waves are generated from tiny material (i.e., piezoelectric crystals) packed within
an ultrasound transducers.

Piezoelectric crystals shown within a transducer.

 When an alternate current (AC) is applied to these crystals, they contract and expand at the
same frequency at which the current changes polarity and generate an ultrasound beam.
 The piezoelectric crystals within the transducer transform electric energy into mechanical
energy (ultrasound) and vice-versa.
One crystal is not sufficient to produce an ultrasound beam for clinical imaging and modern
transducers have large number of crystals arranged in parallel rows.
The rubber-like damping material behind the crystals absorbs excess vibrations to improve
image clarity, while the matching layer in front reduces impedance mismatch, allowing
efficient transmission of ultrasound waves into the body.
The ultrasound beam traverses the body at the same frequency generated.
Conversely, when the ultrasound beam returns to the transducer, these crystals change in
shape and the change in shape generate a tiny electric current that is amplified by the
ultrasound machine to generate an ultrasound image on the monitor.
 Ultrasound travels at a constant speed of about 1540 m/s in all tissue types, and so the
time taken to receive a reflected wave from a given tissue type indicates its depth in the
body, and hence the strength of the signal received.
 High frequency sound generated by a transducer do not travel well through air,
 So, to facilitate their transfer from the transducer to the skin of the patient, a watery gel is
normally used to increase coupling contact between the transducer and skin so that air is
completely excluded and permits the sound to go back and forth.
 The inability of ultrasound to travel through air is the reason why it is not a good imaging
modality for imaging of the lungs and areas around the bowel (e.g., the pancreas).
 HOW IS ULTRASOUND IMAGE FORMED?
 Ultrasound image is created by sending multiple sound pulses from a transducer at slightly
different directions and analyzing the returning echoes received by the crystals.
 it is important to note that tissues that are strong reflectors of the ultrasound beam, such as
bone or air will result in a strong electric current generated by the piezoelectric crystals
which will appear as a hyper-echoic image on the monitor
 where as weak reflectors of ultrasound beam, such as fluid or soft tissue, will result in a
weak current, which will appear as a hypo-echoic or anechoic image on the monitor.
The ultrasound image created is from a sophisticated analysis of returning echoes in a grey
scale format.
If the ultrasound beam travels in a longitudinal format, in order to get the best possible
image, keep the angle of incidence of the ultrasound beam perpendicular to the object of
interest, as the angle of incidence is equal to the angle of reflection.
 ULTRASOUND DISPLAY MODE
 A-mode (amplitude) displays depth on the horizontal axis and echo intensity (pulse
amplitude) on the vertical axis.
Ophthalmology is the only diagnostic application of A-mode imaging.
T-M mode (time-motion) displays time on the horizontal axis and depth on the vertical
axis. T-M mode is also known as M-mode (motion).
T-Mmode thus displays time-dependent motion, which is valuable for studying rapid
movement (e.g., cardiac valve motion).
 B-mode stands for “Brightness mode”, known also as two-dimensional imaging,
It is commonly used to describe any form of grey scale display of an ultrasound image.
In B-mode the image is created based upon the intensity of the returning ultrasound beam,
which is reflected in a variation of shades of grey that form the ultrasound image.
 B-mode is obtained in real-time, and an important and fundamental characteristic of
ultrasound imaging.
USE OF ULTRASOUND IN MEDICINE
 In obstetrics for the following;
pregnancy dating,
determination of fetal viability,
sex and/or physical abnormalities
 Also for imaging of the following
heart

blood flow
tendons

muscles

nerves

ligaments, arteries, veins, soft tissue masses, and bone surfaces.

 SIDE EFFECTS/SAFETY ISSUES
Ultrasound is considered as a safe imaging modality with no known side-effects. However,
low power is required in contrast imaging to prevent bursting of contrast bubbles (called
cavitation, which can cause tissue damage), which normally occurs at high powers.

 STRENGTHS:
 Shows clear boundaries between solid and fluid-filled spaces
Generates real-time images, making it easy for region-specific diagnosis, image-guided
biopsies and injections
Has no long-term side effects nor causes any discomfort to patient
Relatively cheap
Some scanners are potable and can be used at patient’s bedside
Shows structure of organs
 WEAKNESSES:

Ultrasound doesn’t penetrate bone very well

Performs poorly in the presence of gas between transducer and organ to be imaged (e.g.,
image of the pancreas with ultrasound is poor due to overlying gas in the gastrointestinal
tract)
Depth of penetration of ultrasound is limited to operating frequency (it might thus be difficult
to image obese patients)
Image quality and diagnostic utility depends on operator’s skill
Does not produce an initial test image of the body part to be imaged
X-rays
 X-rays generally are produced when a beam of high-energy electrons emitted from a
heated filament are accelerated across a vacuum by applying a high voltage to bombard a
positively charged heavy metal (tungsten) target (anode) producing x-radiation.
Most of the electron energy (about 99%) is converted into heat through interactions with
orbital electrons. The remaining ~1% is responsible for x-ray production through two
processes:
Bremsstrahlung radiation, from electron deceleration near the nucleus (continuous spectrum),
and Characteristic radiation, from interactions with inner-shell electrons (discrete spectrum).
The x-ray photon energy from the tube can be controlled by varying the electrical supply’s
high voltage.
The high calcium (with high atomic number) content of bones makes them absorb x-rays and
so less radiation is detected (on a black film) after passing through bones; thus bones are
clearly visible on a radiograph (the x-ray image).
Depending on the depth of penetration, x-rays can be classified into hard and soft x-rays.
 Hard x-rays have photon energies above 5-10 keV, and are mostly used in diagnostic imaging
of internal organs.
Soft x-rays on the other hand have lower energies of about 600 eV, and are easily absorbed in
air.
 CLINICAL IMAGING IMPORTANCE OF X-RAYS:
 Detection of pathology of the skeletal system
Useful for the detection of pneumonia, lung cancer, and pulmonary edema
Dental radiography is very useful in detecting oral problems such as cavities.
Abdominal x-ray is useful for detecting bowel obstruction, free air and free fluid
Detection of gallstones and kidney stones
 SIDE EFFECTS/SAFETY ISSUES
 Increased cancer risk and developmental problems among those exposed
Risk of radiation exposure could be high to developing fetus when a pregnant mother is scanned
 Could increase background radiation to harmful levels if not monitored.
 STRENGTHS:
 Ionizing capability can be useful in radiotherapy
High quality images can be produced with good contrast
Potable x-ray machines are now available
Relatively cheap

 WEAKNESSES

 Not good for imaging soft tissue

 Utility in some cases might be limited due to radiation exposure
 Requires good institutional monitoring practices to keep background radiation low.
 X-ray Computed Tomography


An x-ray CT scanner left and trans axial brain CT images right

 The word tomography originates from the Greek words tomo (which means slice) and
graphy (means to write).
 So, X-ray computed tomography is an imaging modalities that produce images representing
the X-ray attenuation properties of the body.
 A CT system consists of an X-ray source‚ a movable table, a series of detectors (about 800,
around the source) that measure x-ray intensity attenuation along multiple beam paths, a
rotational geometry with respect to the patient being imaged and a data processing unit for
computation, visualization and data analysis of measurement results.
 In principle, CT creates cross section images by projecting a beam of emitted photons through
one plane of an object from defined angle positions performing one revolution.
 As the X-rays (emitted photons) pass through the object, some of them are absorbed‚ some
are scattered and some are transmitted.
 Photons transmitted through the object at each angle are collected on the detector and
visualized by computer, creating a complete reconstruction of the scanned object.
Schematic depiction of a single projection transmitted through the patient,
consisting of ∼700 individual rays
 CLINICAL USE OF CT
Brain scans to detect infarction, tumors, haemorrhage
Investigation of lung disorders
Diagnosis of pulmonary embolism
Heart imaging
Investigation of abdominal cancer and pain
Imaging of complex fractures and bone dislocations
 SIDE EFFECTS/SAFETY ISSUES
May cause radiation-induced cancer (e.g., leukemia, breast, lung, brain, and stomach
cancers)
 Contrast agents are sometimes used which may have some mild reactions including nausea,
vomiting and itching rashes; severe reactions are also likely.
 STRENGTHS
Images of regions of interest are not obstructed by images of neighboring organs
Different tissues are easily distinguishable by their density differences
Image generated from one scan can be viewed in the axial, coronal, or sagittal planes
depending on diagnostic task (this is known as multiplanar reformatted imaging)
More accurate than x-ray in evaluating anterior interbody fusion
Images are of high-resolution, eliminating the need for a catheter in some imaging procedures
(e.g., CT angiography).
 WEAKNESSES

Images are susceptible to different forms of artifacts (e.g. due to patient motion), making
accurate diagnosis difficult
Image quality is influenced by radiation dose given to the patient.
To minimize dose to patient, its use may sometimes be limited by health condition, age, and
body build of the patient.