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Lecture-1 Introduction to Roentgenology (9.12.16).ppt

  1. Lecture №1 Introduction to Roentgenology Compiled by: Prof. Kulayev Michael Timofeevich – Chair of Oncology with course of radiation diagnostics and radiation therapy, Saransk city
  2. The discovery of X rays in 1895 was the beginning of a revolutionary change in our understanding of the physical world.
  3. Issues: 1.History of X-ray detecting; 2.Biography of Wilhelm Conrad Roentgen; 3.Development of roentgenology in Germany and Austria; 4.Development of roentgenology in Russia; 5.X-ray tube. Construction and principles of working; 6.Properties of X-rays; 7.Principles of radiation protection; 8.Radiology (X-ray) department; 9.Construction of x-ray apparatus.
  4. Medical abbreviations 1. R (Ro)– roentgenological, roentgenology 2. Ca – cancer 3. Bl – blastoma (usually meaning cancer) 4. Tr – (tumor) 5. Neo – neoplasma 6. Sa – sarcoma 7. Ds – diagnosis 8. Met (Mts) – metastasis 9. Susp. – suspicion 10. Tbc - tuberculosis
  5. In the winter of the year of his fiftieth birthday, and the year following his appointment to the leadership of the University of Würzburg, Rector Wilhelm Conrad Roentgen noticed a barium platinocyanide screen fluorescing in his laboratory as he generated cathode rays in a Crookes tube some distance away. Leaving aside for a time his duties to the university and to his students, Rector Roentgen spent the next six weeks in his laboratory, working alone, and sharing nothing with his colleagues.
  6. It was at this point that Röntgen noticed a faint shimmering from a bench a few feet away from the tube. To be sure, he tried several more discharges and saw the same shimmering each time. Striking a match, he discovered the shimmering had come from the location of the barium platinocyanide screen he had been intending to use next. Röntgen speculated that a new kind of ray might be responsible. 8 November was a Friday, so he took advantage of the weekend to repeat his experiments and make his first notes.
  7.  In the following 6 weeks he ate and slept in his laboratory as he investigated many properties of the new rays he temporarily termed "X-rays", using the mathematical designation ("X") for something unknown. The new rays came to bear his name in many languages as "Röntgen Rays" (and the associated X-ray radiograms as "Röntgenograms").
  8. Nearly two weeks after his discovery, he took the first picture using X-rays of his wife Anna Bertha's hand. When she saw her skeleton she exclaimed "I have seen my death!" Signature of Röntgen Bertha’s hand radiogram
  9. Philipp Edward von Lenard (1862-1947). Nobel Prize winner on physics for his work on cathode rays (1905). He hated W.C. Roentgen due to the fact that the whole world’s glory went to Roentgen but not to him.
  10. Roentgen’s laboratory
  11. Crooks tube.
  12. Würzburg. Roentgen's museum.
  13. Würzburg. Roentgen’s museum.
  14. Roentgen’s report in the Society of physics and medicals. Würzburg, 23.01.1896.
  15. Stamps for the 100 anniversary of X-ray discovery. First X-ray made in public. Hand of the famed anatomist, Albert von Kölliker, made during Roentgen's initial lecture before the Würzburg Physical Medical Society on January 23, 1896.
  16. Wilhelm Conrad Röntgen was born on March 27, 1845, at Lennep in the Lower Rhine Province of Germany, as the only child of a merchant and manufacturer of cloth. His mother was Charlotte Constanze Frowein of Amsterdam, a member of an old Lennep family which had settled in Amsterdam. House where Wilhelm Conrad Röntgen was born at Lennep.
  17. When he was three years old, his family moved to Apeldoorn in the Netherlands, where he went to a boarding school. He did not show any special aptitude, but showed a love of nature and was fond of roaming in the open country and forests. He was especially apt at making mechanical contrivances, a characteristic which remained with him also in later life. In 1862 he entered a technical school at Utrecht, where he was however unfairly expelled, accused of having produced a caricature of one of the teachers, which was in fact done by someone else.
  18. He then entered the University of Utrecht in 1865 to study physics. Not having attained the credentials required for a regular student, and hearing that he could enter the Federal Polytechnic Institute at Zurich by passing its examination, he passed this and began studies there as a student of mechanical engineering. He wasn’t always sedulous student. He attended the lectures given by Clausius and also worked in the laboratory of Kundt. Both Kundt and Clausius exerted great influence on his development. In 1869 (24 y.o.) he graduated Ph.D. at the University of Zurich, was appointed assistant to Kundt and went with him to Würzburg in the same year, and three years later to Strasbourg.
  19. In 1874 he qualified as Lecturer at Strasbourg University and in 1875 he was appointed Professor in the Academy of Agriculture at Hohenheim in Württemberg. In 1876 he returned to Strasbourg as Professor of Physics, but three years later he accepted the invitation to the Chair of Physics in the University of Giessen.
  20. After having declined invitations to similar positions in the Universities of Jena (1886) and Utrecht (1888), he accepted it from the University of Würzburg (1888), where he succeeded Kohlrausch and found among his colleagues Helmholtz and Lorenz. In 1899 he declined an offer to the Chair of Physics in the University of Leipzig, but in 1900 he accepted it in the University of Munich, by special request of the Bavarian government.
  21. Here he remained for the rest of his life, although he was offered, but declined, the Presidency of the Physikalisch-Technische Reichsanstalt at Berlin and the Chair of Physics of the Berlin Academy. Röntgen's first work was published in 1870, dealing with the specific heats of gases, followed a few years later by a paper on the thermal conductivity of crystals. Among other problems he studied were the electrical and other characteristics of quartz etc.
  22. Röntgen's name, however, is chiefly associated with his discovery of the rays that he called X-rays. In 1895 he was studying the phenomena accompanying the passage of an electric current through a gas of extremely low pressure. Previous work in this field had already been carried out by J. Plucker (1801- 1868), J. W. Hittorf (1824-1914), C. F. Varley (1828- 1883), E. Goldstein (1850-1931), Sir William Crookes (1832-1919), H. Hertz (1857-1894) and Ph. von Lenard (1862-1947).
  23. By the work of these scientists the properties of cathode rays - the name given by Goldstein to the electric current established in highly rarefied gases by the very high tension electricity generated by Ruhmkorff's induction coil - had become well known. Röntgen's work on cathode rays led him, however, to the discovery of a new and different kind of rays. He was the first in the world, who won the Nobel Prize in physics (1901).
  24. Numerous honors were showered upon him. On the 13th of January (1896), Roentgen presented himself to the Kaiser and was awarded the Prussian Order of the Crown, Second Class. In several cities, streets were named after him, and a complete list of Prizes, Medals, honorary doctorates, honorary and corresponding memberships of learned societies in Germany as well as abroad, and other honors would fill a whole page of this book. In spite of all this, Röntgen retained the characteristic of a strikingly modest and reticent man.
  25. Throughout his life he retained his love of nature and outdoor occupations. Many vacations were spent at his summer home at Weilheim, at the foot of the Bavarian Alps, where he entertained his friends and went on many expeditions into the mountains.
  26. He was a great mountaineer and more than once got into dangerous situations. Amiable and courteous by nature, he was always understanding the views and difficulties of others. He was always shy of having an assistant, and preferred to work alone. Much of the apparatus he used was built by himself with great ingenuity and experimental skill.
  27. Röntgen married Anna Bertha Ludwig of Zürich, whom he had met in the café run by her father. She was a niece of the poet Otto Ludwig. They married in 1872 in Apeldoorn, The Netherlands. They had no children, but in 1887 adopted Josephine Bertha Ludwig, then aged 6, daughter of Mrs. Röntgen's only brother. Four years after his wife, Röntgen died at Munich on February 10, 1923, from carcinoma of the intestine.
  28. O, Röntgen, then the news is true, And not a trick of idle rumor, That bids us each beware of you, And of your grim and graveyard humor. We do not want, like Dr. Swift, To take our flesh off and to pose in Our bones, or show each little rift And joint for you to poke your nose in. We only crave to contemplate Each other’s usual full-dress photo; Your worse than “altogether” state Of portraiture we bar in toto! The fondest swain would scarcely prize A picture of his lady’s framework; To gaze on this with yearning eyes Would probably be voted tame work! No, keep them for your epitaph, these tombstone-souvenirs unpleasant; Or go away and photograph Mahatmas, spooks, and Mrs. B- s-nt! —Punch, January 25, 1896
  29. Christmas time. Würzburg
  30. Photo of Roentgen and his wife Bertha.
  31. Wilhelm Conrad von Röntgen
  32. Monument devoted to Roentgen Giessen where Roentgen was buried. Monument on his grave.
  33. After the opening of R-rays Germany became a kind of "Mecca" for all those who would like to learn a new discovery. A year after discovery of X-rays, company “Siemens” starts commercial production of X-ray machines. Of course, in Germany radiology became most developed. It began to form the so called “Berlin School” of radiologists. Its feature was the preferring of X-ray radiograms versus to fluoroscopy. However, there was the last method in their arsenal too.
  34. The first medically indicated radiograph was taken on January 1896 together by E. Haschek at the physics institute. The patient’s hand showed trauma to the middle phalanx. S. Exner presented a second x-ray image on January 17 (1896), which was important to the development of radiology. The anatomist Tandler placed the hand of a corpse at the disposal of Haschek at the physics institute. The arterial vessels were filled with iodine solution. After 57 minutes of exposure, the first angiogram was created.
  35. In 1936 the German Roentgen Society erected a monument to the x-ray and radium martyrs of all nations. The monument stands beside the radiological department of St. George’s Hospital, Hamburg – the hospital of Albers- Schoenberg, the German radiology pioneer who succumbed to his radiation injuries in 1921. Much of the martyrs’ Memorial is inscribed with the names of 169 x-ray and radium martyrs from 15 countries, who by then had died; the highest tolls recorded were 14 British, 20 German, 39 American, and 40 French citizens. Many other names were later added.
  36. Heinrich Ernst Albers- Schönberg (January 21, 1865 – June 4, 1921) was the “king” of German Röntgenology. He was among the first scientists to explore the clinical possibilities of x-rays. He was appointed the first professor of radiology in Germany in 1919. He co-founded the still existing journal “Fortschritte auf dem Gebiet der Röntgenstrahlen“ in 1897 and was the initiator and co-founder of the Deutsche Röntgengesellschaft in 1905.
  37. Painting “X-Ray examining”
  38. Privet doctor examines a patient. (No any protection). Development of roentgenology in Germany
  39.  Prof.Guido Holzknecht – famous Austrian roentgenologist (1872-1931) Development of Roentgenology in Austria Die röntgenologische Diagnostik der Erkrankungen der Brusteingeweide (1901). Holzknecht was introduced to x-rays by Vienna's first radiologist Gustav Kaiser (1871-1954). In 1899, Holzknecht was offered working in the department of H. Nothnagel, a professor of medicine in Vienna. Holzknecht set to work, and he particularly devoted himself to the study of the chest. His first major observation was on bronchial obstruction; he made the classic observation that the mediastinum shifted on expiration secondary to the air-trapping. He made measurements of the cardiac contour, and emphasized the usefulness of the oblique views. On the basis of this work, in 1901 he published the first book devoted to radiology of the chest.
  40. Radioscopy (fluoroscopy) of the chest in times of W.C. Roentgen (painting). Fluoroscopy of the chest in the early 20th century (photo).
  41. Development of Roentgenology in Austria Whilst his apparatus looks primitive to us today, it was the high- tech equipment of his time. As can be seen, there is an absence of protection, with no shielding around the x-ray tube seen centrally, and also no protection around the fluorescent screen. The operator would be exposed to both primary and secondary radiation, and this is why there were so many injuries in this first generation of radiologists. There was also the pernicious habit of using one's own hand to test the quality of the x-ray beam.
  42.  Prof.Guido Holzknecht – famous Austrian roentgenologist (1872-1931) Development of Roentgenology in Austria As was the case in those days, Holzknecht was interested in both diagnosis and therapy, and in 1902 he described his well-known chromoradiometer, which was the first device designed to measure radiation dose. This was a major advance. In addition, Holzknecht was probably the first person to suggest that radiology should be a medical specialty in its own right. In 1903, along with his Viennese colleague R. Kienböck, he proposed that there was more to radiology than just simply the use of a helpful technique.
  43.  Prof.Guido Holzknecht – famous Austrian roentgenologist (1872-1931) Development of Roentgenology in Austria He was actively involved in the training of young radiologists and emphasized the need for radiologists in training to be familiar with physiology, anatomy, and pathology, as well as the clinical features of the disease, in order to make an accurate and helpful radiological diagnosis. The Viennese school of radiology became hugely influential and attracted many foreign students. Holzknecht was also the first to describe gastric cancer using radiology.
  44.  Prof.Guido Holzknecht – famous Austrian roentgenologist (1872-1931) Development of Roentgenology in Austria
  45.  Wien, A. Karlsson’s Park. Monument  in honor of Guido Holzknecht Development of Roentgenology in Austria The urn with his ashes and three more victims of radiolody. There is poignancy about the figure, with his poor damaged hands held in front of him.
  46. Development of Roentgenology in Austria Antoine Béclère said of Holzknecht that, "No one brought more passionate ardor and inspiration to the pursuit of a good and high ideal, no one had a deeper zeal, was more indefatigable, had more courage, dedication or selflessness.“ As we remember this amazing pioneer, may we all have a similar dedication in our daily service to our patients. The retro-cardiac space is also known as the Holzknecht’s space.
  47.  France has made enormous contributions to world culture and science, and one of the greatest of her sons is the doctor and radiologist Antoine Béclère (1856-1939).  Development of Roentgenology in France
  48. His father was a physician, and it was therefore natural that in 1873 he entered the Hôpital Lariboisière to start his studies.  In 1897 he created first laboratory of radiology in Paris. He organized library on roentgenology consisting of more than 400000 volumes. Béclère is one of the greats of radiology. Development of Roentgenology in France A commemorative medal from 1936. The International Society of Radiology still awards the Béclère Medal.
  49. The first X-ray apparatus in Russia were delivered from Germany by physicians who managed to practice in Germany. A.S. Popov (inventor of radio) has built the working X-ray machine - according to the drawings of the magazine - in February 1896 (St. Petersburg). Soon, the military understood the exceptional value of this discovery, and many large warships were equipped with X- ray apparatus. St. Petersburg. Military cruiser AURORA. A.S. Popov
  50. Thus, on the military cruiser "Aurora" X-ray examinations were performed in more than 100 of the patients and the wounded. Before the October Revolution radiology was developed poorly. It was dealt with enthusiasts or private practitioners. Prof. P.N. Lebedev showed a picture with the preparation of an ectopic pregnancy in February 1, 1896. Two weeks later V.N. Tonkov (author of a textbook on anatomy) said about the possibilities of bone study in vivo.
  51. Ioffe Abram (1880-1960) technical director of world’s first institute of roentgenology in Saint Petersburg (1918 г.). He was an assistant of Roentgen in 1903-1906. Nemionv Mikhail (1880- 1950) – co-founder of above mentioned institute. Development of roentgenology in Russia
  52. Scheme X-ray tube. Cathode (К) has a split where is filament of heating. The electrons are rushing to positively charged anode (А). Cathode and anode are charged with high voltage up to 30 000- 120 000 volts and more. The anode is edged and rotated around its own axis. (kv) (rays)
  53. Simplified picture of the X-ray tube.
  54. Picture of the X-ray tube.
  55. Modern X-ray tube. Coolidge X-ray tube, from around 1917. The heated cathode is on the left, and the anode is right. The X-rays are emitted downwards.
  56. Simplified schematic of a rotating anode X-ray tube envelope and housing. The rotating anode (A), spins via the rotor (R) and its bearings, creating a focal area of X-ray production around the anode target (T). The cathode (C), is shown with the filament circuit in green. All of these components are contained within the evacuated tube envelope (E). Just outside of the envelope is the stator (S), which induces rotation of the rotor. The tube envelope is surrounded in a dielectric cooling oil (O), with an expansion bellows (B). X-ray beam leaves through the tube window (W), typically Aluminum or Beryllium while the rest of the housing will be lead or copper to attenuate stray X-rays.
  57. As with any vacuum tube, there is a cathode, which emits electrons into the vacuum and an anode to collect the electrons, thus establishing a flow of electrical current, known as the beam, through the tube. A high voltage power source, for example 30 to 150 kilovolts (kV), is connected across cathode and anode to accelerate the electrons. The X-ray spectrum depends on the anode material and the accelerating voltage.
  58. Properties of X-rays X-rays are the type of wave energy (0,00001-1000 nm) with spectrum between ultraviolet and gamma-rays. It is their nature and main property.
  59. Properties of X-rays
  60. Properties of X-rays
  61. Properties of X-rays Physical properties: 1. X-rays are electromagnetic radiation having a wavelength between 10 A to 0,01 A and speed – 300000 km/sec (same as that of visible light) 2. In free space they travel in a straight line, invisible to Eye 3. Showing effects of Interference, Diffraction and Refraction 4. They produce electric and magnetic field at right angles to their path of propagation; don’t require any medium for propagation 5. They can penetrate liquids, solids and gases 6. They cause Ionization 7. They cause effect of Fluorescence ( method of Fluoroscopy) 8. They have Heating effect 9. The X-Rays have the property of Attenuation, Absorption and Scattering
  62. Properties of X-rays
  63. Three of the most basic and easy to follow principles of radiation protection are time, distance, and shielding. Time: As the length of time a tech is exposed increases, the dose received increases in direct proportion. During fluoroscopic exams a technologists should only be in the room when needed to assist.
  64. Otherwise they should be behind the lead wall, dressed in lead apron and thyroid collar in case their assistance is needed. In most cases this is not feasible but there are some exams; such as modified barium swallows that the techs assistance during the exam is rarely needed. Another way to reduce the time we are exposed is to avoid holding patients during exams if possible. If there is another person available to hold such as a patient relative or even a nurse who is rarely exposed utilize them in restraining a patient.
  65. Distance: The most effective of the principles is distance. The further a person is from the source the less intense the radiation source is. When the distance from the source is doubled the intensity at the new distance is only 1/4 the original intensity. When performing portable x- ray exams a tech should be at least six feet from the source of the radiation.
  66. Shielding: When the use of the time and distance principles are not possible shielding should always be used. Wearing protective lead shielding and thyroid collars can protect the radiosensitive areas of the body when it is required for the technologist to be near the source of radiation. Protective aprons, gloves and thyroid collars are usually made of lead impregnated vinyl. The most widely used and recommended is a 0.5 mm lead equivalent for protective apparel.
  67. Radiology is a specialty that uses Medical imaging to diagnose and treat diseases seen within the body. A variety of imaging techniques such as X- ray radiography, ultrasound, computed tomography (CT), nuclear medicine including positron emission tomography (PET), and magnetic resonance imaging (MRI) are used to diagnose and/or treat diseases. Interventional radiology is the performance of (usually minimally invasive) medical procedures with the guidance of imaging technologies.
  68. The acquisition of medical images is usually carried out by the Radiographer, often known as a Radiologic Technologist. Depending on location, the Diagnostic Radiologist, or Reporting Radiographer, then interprets or "reads" the images and produces a report of their findings and impression or diagnosis. This report is then transmitted to the Practitioner who requested the imaging, either routinely or emergently. Imaging exams are stored digitally in the picture archiving and communication system (PACS) where they can be viewed by all members of the healthcare team within the same health system and compared later on with future imaging exams.
  69. Every X-ray department consists of: 1.X-ray machines rooms 2. Control panel room. 3.X-ray staff room (doctor’s room) with light boxes and monitors. 4. Photo laboratory. 5. WC 6. Waiting room.
  70. 1. X-ray tube (usually two – for roentgenography and fluoroscopy) 2. The stand with table 3. X-ray generator 4. Control panel 5. Transformer 6. Fluoroscopic screen
  71. First X-ray device (schematic). Photo of Roentgen’s X-ray device.
  72. Modern X-ray devices.
  73. Thanks for your attention!
  74. Some questions?