Imaging Techniques <ul><li>Utilize Ionizing  Don’t Utilize Radiation  Ionizing Radiation </li></ul><ul><li>Plain Films MR ...
X-Rays <ul><li>High energy photons </li></ul><ul><li>Similar to visible light </li></ul><ul><li>But … have a higher energy...
Plain Films <ul><li>X-ray tube shoots high energy electrons at a target (Tungsten) </li></ul><ul><li>When the electrons go...
Plain Films <ul><li>Finally, x-rays are collected on: </li></ul><ul><li>Photosensitive film (permanent) </li></ul><ul><li>...
X-Rays <ul><li>Can’t see the x-rays, only the images </li></ul><ul><li>Image seen is that part of the patient that blocks ...
X-ray Exposure <ul><li>Not all x-rays that enter the body leave it! </li></ul><ul><li>Absorbed x-rays can damage DNA, affe...
X-ray Exposure continued <ul><li>X-ray exposure is cumulative </li></ul><ul><li>It is important to assess the Risk/Benefit...
 
Densities <ul><li>Air  -  Lungs, Bowel gas </li></ul><ul><li>Fat  -  Omentum </li></ul><ul><li>Soft tissue  -  Muscle, Sol...
 
 
 
Inspiration   Expiration
Chest X-Ray Features <ul><li>Symmetry  -  unilateral vs. bilateral </li></ul><ul><li>Location  -  upper, middle, lower, pe...
 
 
 
Fluoroscopy <ul><li>Live images obtained while a procedure or maneuver is being performed. </li></ul><ul><li>X-ray beam   ...
 
 
Ultrasound <ul><li>High frequency sound waves sent into tissue and the reflected echoes create an image. </li></ul><ul><li...
Ultrasound Continued <ul><li>Thorax  -  Heart-wall thickness, motion, valves </li></ul><ul><li>Abdomen  -  Liver, spleen, ...
Ultrasound Continued <ul><li>Densities: </li></ul><ul><li>Black  -  anechoic  -  low density  -  fluid </li></ul><ul><li>G...
 
 
 
 
 
 
CT <ul><li>In the gantry, there’s a series of small x-ray sensors which rotate. They take multiple x-ray pictures from var...
CT continued <ul><li>Advantages </li></ul><ul><li>Almost all anatomic areas visible </li></ul><ul><li>Use with or without ...
CT continued <ul><li>Disadvantages </li></ul><ul><li>Ionizing Radiation </li></ul><ul><li>Cost </li></ul><ul><li>Not avail...
CT continued <ul><li>Densities- Hounsfield Units </li></ul><ul><li>Low Attenuation  -  black (air) </li></ul><ul><li>High ...
 
 
 
 
CT/MR <ul><li>Key Features to Assess </li></ul><ul><li>Asymmetry </li></ul><ul><li>Masses or mass effect </li></ul><ul><li...
CT/MR continued <ul><li>MR Advantages </li></ul><ul><li>Multiplanar images (axial, coronal, sagittal, oblique) </li></ul><...
MR <ul><li>MR utilizes a magnetic field and radiofrequency antennas (coils) to obtain an image </li></ul><ul><li>The magne...
MR <ul><li>TR/TE </li></ul><ul><li>Marrow </li></ul><ul><li>CSF/H20/Disc </li></ul><ul><li>TR - Repetition Time - length o...
MR <ul><li>Bright (  SI ) </li></ul><ul><li>Fat </li></ul><ul><li>Hemorrhage </li></ul><ul><li>H2O/ Edema (T2) </li></ul><...
MR Precautions <ul><li>Strong Magnetic Field- </li></ul><ul><li>Determine whether patients have: </li></ul><ul><li>aneurys...
 
 
 
 
Interventional Radiology <ul><li>Can be diagnostic or therapeutic  </li></ul><ul><li>Procedures: </li></ul><ul><li>Angiogr...
Interventional Radiology continued <ul><li>Radiopaque dye (absorbs the x-ray beam) is administered via a catheter.  </li><...
Interventional Radiology continued <ul><li>  Contrast </li></ul><ul><li>Same dye used in other x-ray studies, IVP’s, CT’s ...
 
 
Nuclear Medicine <ul><li>A small amount of a radioactive isotope is administered to the patient – injected intravenously, ...
Nuclear Medicine continued <ul><li>Bone scan Tec 99m – 4 hours </li></ul><ul><li>Same amount of radiation as a CXR </li></...
Nuclear Medicine continued <ul><li>Bone Scan  Increased uptake in: </li></ul><ul><li>Acute Fractures </li></ul><ul><li>Met...
Nuclear Medicine continued <ul><li>Scans </li></ul><ul><li>Gallium – infection </li></ul><ul><li>Hepatobiliary – evaluate ...
Nuclear Medicine continued <ul><li>V/Q scan  evaluate air and blood flow to lungs </li></ul><ul><li>TC99m-MAA  injected in...
 
 
Mammography <ul><li>Film/Screen Technique - lower radiation dose </li></ul><ul><li>2 views – craniocaudal, cephalad </li><...
 
 
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Spom Imaging

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Spom Imaging

  1. 1. Imaging Techniques <ul><li>Utilize Ionizing Don’t Utilize Radiation Ionizing Radiation </li></ul><ul><li>Plain Films MR </li></ul><ul><li>Fluoroscopy US </li></ul><ul><li>CT </li></ul><ul><li>Nuclear Medicine </li></ul><ul><li>Mammography </li></ul>
  2. 2. X-Rays <ul><li>High energy photons </li></ul><ul><li>Similar to visible light </li></ul><ul><li>But … have a higher energy and a shorter wavelength </li></ul>
  3. 3. Plain Films <ul><li>X-ray tube shoots high energy electrons at a target (Tungsten) </li></ul><ul><li>When the electrons go around the nucleus of the Tungsten atom, the electrons lose energy </li></ul><ul><li>This occurs by 2 processes: Bremmstrahlung and K shell Knockout </li></ul><ul><li>Change in the energy of the electron results in radiation and x-ray formation </li></ul>
  4. 4. Plain Films <ul><li>Finally, x-rays are collected on: </li></ul><ul><li>Photosensitive film (permanent) </li></ul><ul><li>Digital Imaging Plate (permanent) </li></ul><ul><li>Fluoroscope (temporary) </li></ul>
  5. 5. X-Rays <ul><li>Can’t see the x-rays, only the images </li></ul><ul><li>Image seen is that part of the patient that blocks the x-ray beam. </li></ul><ul><li>The denser the material, the more difficult it is for the beam to penetrate the anatomic area </li></ul>
  6. 6. X-ray Exposure <ul><li>Not all x-rays that enter the body leave it! </li></ul><ul><li>Absorbed x-rays can damage DNA, affecting future cells, causing mutations or cell death </li></ul><ul><li>Keep in mind, x-rays can be diagnostic or therapeutic </li></ul>
  7. 7. X-ray Exposure continued <ul><li>X-ray exposure is cumulative </li></ul><ul><li>It is important to assess the Risk/Benefit ratio </li></ul><ul><li>1. Does the patient really need the study? </li></ul><ul><li>2. Can the study be done with other non-x-ray diagnostic studies? </li></ul><ul><li>3. Can non-vital areas be shielded? </li></ul>
  8. 9. Densities <ul><li>Air - Lungs, Bowel gas </li></ul><ul><li>Fat - Omentum </li></ul><ul><li>Soft tissue - Muscle, Solid Organs </li></ul><ul><li>Bone - Skeleton, Calcifications </li></ul><ul><li>Metal - Hardware, Contrast </li></ul>
  9. 13. Inspiration Expiration
  10. 14. Chest X-Ray Features <ul><li>Symmetry - unilateral vs. bilateral </li></ul><ul><li>Location - upper, middle, lower, peripheral, central, anterior, posterior </li></ul><ul><li>Size </li></ul><ul><li>Number - Single, Multiple </li></ul><ul><li>Borders - Smooth, Irregular </li></ul><ul><li>Density - Solid, Air, or Fluid filled, or Combination </li></ul>
  11. 18. Fluoroscopy <ul><li>Live images obtained while a procedure or maneuver is being performed. </li></ul><ul><li>X-ray beam patient </li></ul><ul><li>X-ray strikes </li></ul><ul><li>coupled Fluorescent Plate </li></ul><ul><li> Image Intensifier </li></ul><ul><li>coupled TV Camera </li></ul>Image
  12. 21. Ultrasound <ul><li>High frequency sound waves sent into tissue and the reflected echoes create an image. </li></ul><ul><li>Real time images-demonstrate motion –ex. fetal heart beat </li></ul><ul><li>Doppler images-demonstrate speed and direction of flow in a vessel – ex. carotid artery </li></ul>
  13. 22. Ultrasound Continued <ul><li>Thorax - Heart-wall thickness, motion, valves </li></ul><ul><li>Abdomen - Liver, spleen, pancreas, kidneys, masses, solid, cystic, stones </li></ul><ul><li>Pelvis - Female-Ovaries, uterus, fetus, </li></ul><ul><li> Male-Prostate, masses </li></ul><ul><li>Vasculature - Aorta-Aneurysms </li></ul><ul><li> Peripheral vessels-DVT </li></ul>
  14. 23. Ultrasound Continued <ul><li>Densities: </li></ul><ul><li>Black - anechoic - low density - fluid </li></ul><ul><li>Gray - echogenic - medium density - soft tissue </li></ul><ul><li>White - hyperechoic - high density - calcium </li></ul>
  15. 30. CT <ul><li>In the gantry, there’s a series of small x-ray sensors which rotate. They take multiple x-ray pictures from various angles. Computers interpret the data, compiling the many images obtained. The images appear as cross-sectional slices obtained at many levels. </li></ul>
  16. 31. CT continued <ul><li>Advantages </li></ul><ul><li>Almost all anatomic areas visible </li></ul><ul><li>Use with or without oral/IV contrast </li></ul><ul><li>Quick </li></ul><ul><li>Can differentiate different densities-air/fluid/soft tissue/bone </li></ul>
  17. 32. CT continued <ul><li>Disadvantages </li></ul><ul><li>Ionizing Radiation </li></ul><ul><li>Cost </li></ul><ul><li>Not available at all institutions </li></ul><ul><li>May be hampered by metal/star artifact </li></ul>
  18. 33. CT continued <ul><li>Densities- Hounsfield Units </li></ul><ul><li>Low Attenuation - black (air) </li></ul><ul><li>High Attenuation - white (bone) </li></ul>
  19. 38. CT/MR <ul><li>Key Features to Assess </li></ul><ul><li>Asymmetry </li></ul><ul><li>Masses or mass effect </li></ul><ul><li>Midline shift </li></ul><ul><li>Fluid collections </li></ul>
  20. 39. CT/MR continued <ul><li>MR Advantages </li></ul><ul><li>Multiplanar images (axial, coronal, sagittal, oblique) </li></ul><ul><li>Greater gray/white differentiation </li></ul><ul><li>More detailed anatomy </li></ul><ul><li>Better visualization of subacute and chronic bleeds and spinal cord compression (trauma or mets) </li></ul><ul><li>CT Advantages </li></ul><ul><li>Availability </li></ul><ul><li>Speed </li></ul><ul><li>Cost </li></ul><ul><li>Can detect calcium and acute bleeds more easily </li></ul><ul><li>Accommodates patient monitoring equipment </li></ul>
  21. 40. MR <ul><li>MR utilizes a magnetic field and radiofrequency antennas (coils) to obtain an image </li></ul><ul><li>The magnetic field causes all of the protons in the patient’s body to line up </li></ul><ul><li>Then, a high frequency magnetic pulse shifts them from their straight positions </li></ul><ul><li>A special antenna listens for the resonance signal each proton gives off </li></ul><ul><li>Characteristically, they go back to their original positions </li></ul>
  22. 41. MR <ul><li>TR/TE </li></ul><ul><li>Marrow </li></ul><ul><li>CSF/H20/Disc </li></ul><ul><li>TR - Repetition Time - length of time needed for protons to realign </li></ul><ul><li>TE - Echo Time - measure of time for energy absorbed from the radiowave pulse to be reabsorbed </li></ul>T2 Long Dark Bright T1 Short Bright Dark
  23. 42. MR <ul><li>Bright ( SI ) </li></ul><ul><li>Fat </li></ul><ul><li>Hemorrhage </li></ul><ul><li>H2O/ Edema (T2) </li></ul><ul><li>Dark ( SI ) </li></ul><ul><li>Air </li></ul><ul><li>Cortical Bone </li></ul><ul><li>Flowing Blood </li></ul><ul><li>Fibrous Tissue </li></ul><ul><li>H2O/ Edema (T1) </li></ul>
  24. 43. MR Precautions <ul><li>Strong Magnetic Field- </li></ul><ul><li>Determine whether patients have: </li></ul><ul><li>aneurysm clips-head </li></ul><ul><li>pacemakers </li></ul><ul><li>artificial valves </li></ul><ul><li>exposure to metal shards </li></ul>
  25. 48. Interventional Radiology <ul><li>Can be diagnostic or therapeutic </li></ul><ul><li>Procedures: </li></ul><ul><li>Angiography-vessel visualization </li></ul><ul><li>Tube, line, stent, device placement </li></ul><ul><li>Biopsy </li></ul><ul><li>Complications: </li></ul><ul><li>Hemorrhage, embolus, infection </li></ul>
  26. 49. Interventional Radiology continued <ul><li>Radiopaque dye (absorbs the x-ray beam) is administered via a catheter. </li></ul><ul><li>X-ray images reveal the anatomy to be normal or abnormal. </li></ul><ul><li>Abnormal features include stenosis (blockage), abnormal vessels (AVM), and Tumor Blush </li></ul>
  27. 50. Interventional Radiology continued <ul><li> Contrast </li></ul><ul><li>Same dye used in other x-ray studies, IVP’s, CT’s </li></ul><ul><li>Dye-clear </li></ul><ul><li>Metallic taste </li></ul><ul><li>Warm flush feeling </li></ul><ul><li>Nausea </li></ul><ul><li>Ask about prior administration, allergies, and renal function </li></ul>
  28. 53. Nuclear Medicine <ul><li>A small amount of a radioactive isotope is administered to the patient – injected intravenously, inhaled or swallowed. These isotopes attach themselves to certain molecules in the body. Images are obtained to determine the abnormality. </li></ul>
  29. 54. Nuclear Medicine continued <ul><li>Bone scan Tec 99m – 4 hours </li></ul><ul><li>Same amount of radiation as a CXR </li></ul><ul><li>Isotope excreted in urine </li></ul><ul><li>Images obtained initially and then 3 hours later. Actual scanning time 30-40 minutes </li></ul>
  30. 55. Nuclear Medicine continued <ul><li>Bone Scan Increased uptake in: </li></ul><ul><li>Acute Fractures </li></ul><ul><li>Metastatic Disease </li></ul><ul><li>Growth Plates </li></ul>
  31. 56. Nuclear Medicine continued <ul><li>Scans </li></ul><ul><li>Gallium – infection </li></ul><ul><li>Hepatobiliary – evaluate liver and gallbladder function and anatomy </li></ul><ul><li>Liver/Spleen – shape, size, position of organs </li></ul><ul><li>Thyroid scans – special instructions- </li></ul><ul><li>discontinue thyroid medication, no I.V. contrast, no seafood or Iodine containing products </li></ul>
  32. 57. Nuclear Medicine continued <ul><li>V/Q scan evaluate air and blood flow to lungs </li></ul><ul><li>TC99m-MAA injected intravenously </li></ul><ul><li>Xenon-133 inhaled via mask </li></ul><ul><li>Test for PE, acute or chronic, pre-op lung reserves, effects of granulomatous lung disease, post-op complications, emphysema, heart shunts, congenital abnormalities </li></ul>
  33. 60. Mammography <ul><li>Film/Screen Technique - lower radiation dose </li></ul><ul><li>2 views – craniocaudal, cephalad </li></ul><ul><li>Initial screening at age 40 unless high risk or symptomatic </li></ul><ul><li>Follow up with Ultrasound, MR (?) </li></ul>

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