DIAGNOSTIC RADIOLOGY I
IMAGING MODALITIES
PLAIN FILMS
FLUOROSCOPY
ULTRASOUND
COMPUTED TOMOGRAPHY
MRI
NUCLEAR MEDICINE(RNI)
INTERVENTIONAL RADIOLOGY
CXR TECHNIQUE
PLAIN FILMS
Involve passing x-rays through a patient’s body to expose a
photographic plate(conventional x-ray film).
In addition, this information can be digitized(with
appropriate equipment) to acquire the image
digitally(digital imaging).
CLINICAL USES
- chest
- abdomen
- bones
- mammography
FLUOROSCOPY/SCREENING
Involves continuous radiation in low doses to view
the part of the body being examined dynamically on a
screen monitor
CLINICAL USES
- Barium studies of the GIT
- angiography
- interventional procedures Eg hip replacement.
CONTRAST STUDIES
Involve use of contrast media- substances that are
introduced into the body to help visualize the structures
being examined radiologically.
Examples include:
- Barium for GIT
- Iodinated contrast agents e.g iopamidol
- intravenous agents to visualize the renal tract- IVP
- intra-arterial agents for angiography
Note:I.V agents may cause allergic reactions
THE STOMACH ON BARIUM MEAL
ULTRASOUND
Uses very high frequency sound waves, which are inaudible to the
human ear. These frequencies are in the 2.5-15 megaHertz range.
These sound waves when reflected back from body structures can be
converted into a grey scale image
The sound waves are produced by a transducer that generates
mechanical vibrations which are usually transmitted as discrete bursts
or pulses.
The transducer is also able to receive returning sound waves,
resulting in pulsed-wave ultrasound.
US is a real-time exam, which means that a moving image of the body
is seen on a screen
Doppler US is used to measure blood flow in vascular structures
ADVANTAGES OF US
Non ionizing(no radiation)
Safe
Can be used to follow up patients
Images in real time
Relatively cheap
Portable, can be performed at the bedside
DISADVANTAGES OF US
Difficult in obese patients
Views are often obscured by air/bowel gas
USES OF US
Abdomen/pelvis
Thyroid
Testes
Breast
Soft tisues
Vascular
Cranial in infants
COMPUTED TOMOGRAPHY(CT)
CT uses x-rays to generate cross sectional, 2 dimensional
mages of the body
The x-ray tube is rapidly rotated 360 degrees round the
patient and x-rays pass through them and are detected by
a ring of sensitive radiation detectors at the opposite end
of the beam
Different body tissues absorb or attenuate the x-ray beam
by different amounts
A computer processes the information about attenuation
in each picture element into an axial image of the area
being examined
USES OF CT
Body imaging
Trauma assessment
Guiding biopsies
Oncology staging
Vascular imaging
ADVANTAGES OF CT
A rapid imaging modality with excellent image
resolution
Readily available
Data acquired in axial scans can subsequently be
manipulated to provide multi-planar and 3-D
reconstructions
Disadvantages of CT
Associated with relatively high doses of ionizing
radiation
Relatively high cost and limited portability
There can be contrast media related complications,
e.g allergic reactions and renal toxicity
Magnetic resonance
imaging(MRI)
Involves the use of powerful magnetic fields and radio-waves to create
an image of the body
Does not involve use of ionizing radiation
The patient is placed in a powerful magnet and a radio-wave applied
The nuclei of hydrogen atoms in body water and fat absorb these
waves and emit radiofrequency energy and this can be manipulated by
computer to produce images of the body parts
Images can be produced in multiple planes, e.g coronal, axial,saggital
Imaging depends on the fact that pathological tissues return a
different signal to normal tissue and this property is utilized in trying
to make a diagnosis from the images
USES OF MRI
Brain
Spinal cord/spine
Musculoskeletal
Orbits
Knee
Shoulder
Abdomen/pelvis
Liver
Vascular
Advantages of MRI
No ionizing radiation
Multi-planar imaging
Extremely high contrast resolution
Dis-advantages
Metallic implants or foreign bodies a high risk
Claustrophobia- 5 to 10 % of patients cannot tolerate MRI exam
Relatively expensive and less available
Contra-indications
Metallic cardiac pacemakers or aneurysm clips
Metallic foreign bodies
Claustrophobia
NUCLEAR MEDICINE(RNI)
This branch of radiology uses radio-isotopes for imaging
The radio-isotopes produce gamma rays which are emmited by the
patient fllowing i.v injection of the isotope
The rays are detected by a gamma camera
RNI allows the assesment of function as well as structure
Examples of RNI
Bone scan to look for metastases
Thyriod – iodine or technetium scan to assess thyriod function or
nodules
Lung ventilation and perfusion for investigation of pulmonary
embolism
Interventional Radiology
Involves use of radiological techniques to conduct therapeutic procedures
under image guidance
Examples
Vascular system
Angioplasty- dilating arteries using baloon catheters
Stents- inserting stents to keep narrowed vessels open
Embolization-to stop bleeding vessels
Respiratory system
Lung biopsy – under CT guidance or fluoroscopic control
GIT
Liver biopsy, Oesophageal stent
Urinary tract : Nephrostomy –to relieve obstructed kidneys, ureteric stent to
bypass narrowed ureters , renal biopsy
