International day of Medical Physics (07.11.2020)/Radiology & Radiography (08.11.2020)

1. Dr. C. Senthamil Selvan, Mahatma Gandhi Medical College & Research Institute, Puducherry
Medical X-Ray Imaging Equipments in Healthcare
India

2. Outline
What is Healthcare?
Radiology - Basic Physics & Principles
Commonly using Imaging Equipments
Radiation Regulatory Bodies

3. The set of services provided by a country or an organization for the treatment of
the physically and the mentally ill
What are Healthcare Services?
 Mental health care
 Dental care
 Laboratory and diagnostic care
 Substance abuse treatment
 Preventative care
 Physical and occupational therapy
 Nutritional support
 Pharmaceutical care
 Transportation
 Prenatal care

4. https://www.uclahealth.org/medical-services
Anesthesiology & Perioperative Medicine
Dental Services
Emergency Medicine
Family Medicine
Head and Neck Surgery
Medicine
Neurology
Neurosurgery
Obstetrics and Gynecology
Ophthalmology
Cardiology
Orthopaedic Surgery
Pathology & Laboratory Medicine
Pediatrics
Psychiatry & Biobehavioral Sciences
Radiation Oncology
Radiology
Rehabilitation Services
Surgery
Urology

5. On November 8, 1895, physicist
Wilhelm Conrad Roentgen
(1845-1923)

6. A beam of x-rays may be:
Transmitted: pass through unaffected or with a
lower energy
Absorbed: transfer all energy to matter and
not pass through the patient to the film
Scattered: diverted with or without energy loss
Photons Interaction Mechanisms
Photoelectric Effect
Compton Scattering
Pair Production

7. Radioactive
Waste
Radon
X-Rays
Consumer
Products
Nuclear
Power
Nuclear
Medicine
Solar Radiation
Cosmic Rays
Terrestrial
Radiation
Food &
Drink
Each
Other



8. Radiography Nuclear Medicine
Diagnostic
Teletherapy Brachytherapy
Radiotherapy Nuclear Medicine
Therapy
Radiation in Medicine

11. Radiographic images are recorded on a sheet of X-
ray film.
Composition of Film:
Film consists of polyester base which is coated on
both side by emulsion. Emulsion is suspension in
gelatine of silver iodobromide crystals.
Bromide (90%)
Iodide (10%)

12. It is a process of capturing radiographic data from a
conventional X-ray machine and processing the data
digitally to produce high quality radiographic images.
CR also commonly known as Photostimulable
phosphor (PSP) imaging, employs reusable imaging
plates and associated hardware and software to acquire
and to display digital projection radiographs.
It involves the PSP plate detector handling between two
sequential stages of exposure and data acquisition.
Imaging plate in a cassette must be processed in CR
reader after X-ray exposure for conversion to digital
images in raster pattern.

13. Direct radiography (DR) the image is produced directly
from the image detector and is displayed on the screen.
The image is divided into a matrix of individual cells
and pixels. Each pixel has an assigned value that is
related to the intensity of the signal in the
corresponding part of the image.
Digital radiographic images visible and storable on a
personal computer or a hospital-wide system

14. Mobile radiography is bedside radiography examination
performed on patients who are unable to be transported to the
radiology
These machines are self propelled and battery dependent
Chest X-ray is the most requested mobile radiography
examination
Mobile imaging equipments offer less processing speed and
eliminate long wait-times.

15. Bone fractures due to Road Traffic Accident (RTA)
Infections (such as pneumonia)
Calcifications (like kidney stones or vascular calcifications)
Some tumors
Bone loss (such as osteoporosis)
Dental issues
Heart problems (such as congestive heart failure)
Blood vessel blockages
Digestive problems
Foreign objects (such as items swallowed by children)

16. 1890’s - Thomas Edison
An imaging technique used to obtain real time moving
images of the internal structure of a patient
Components of Fluoroscope
 x-ray generator
 x-ray tube collimator
 filters
 patient table
 grid
 image intensifier
 optical coupling
 television system
 image recording

18. DIGITAL FLUROSCOPY - Dynamic flat panel
 Indirect detector - cesium iodide phosphor
 Direct detector - amorphous selenium TFT
 Barium X-rays and enemas (to view the gastrointestinal tract)
 Catheter insertion and manipulation
 (to direct the movement of a catheter through blood vessels, bile ducts or the urinary system)
 Placement of devices within the body, such as stents
 (to open narrowed or blocked blood vessels)
 Angiograms (to visualize blood vessels and organs)
 Orthopedic surgery (to guide joint replacements and treatment of fractures)

19. X-ray was first used to examine the breast by German
surgeon Albert Salomon in 1913
Modern mammography came into existence since late 1960.
Mammography is a radiographic examination that is
designed for detecting breast pathology (particularly breast
cancer).
Breast cancer screening with mammography assists in
detecting cancer at an earlier, and is an important clinical
procedure because approximately one in eight women will
develop breast cancer over their lifetime.

20. Mammography machine mainly constructed to examine the breast tissues
Heel effect place an major role into it
• Generator
• Support system
• X-Ray tube
• Collimator / cone
• Breast compressor
• Anti- scatter grids
• Cassette holder
• Automatic exposure control
• Photo timers
• Detector system

21. Screening mammography Non-symptomatic patients with above 40 years
Diagnostic mammography Symptomatic patients undergoes examination
 Digital detector technology affects cancer
detection rate, dose and image quality.
 Digital detectors have facilitated new
technologies such as tomosynthesis.
 3-D techniques reduce superimposition and
increase cancer detection in dense breasts.
 Contrast-enhanced mammography
demonstrates improved sensitivity and
specificity.
Digital Mammography
J.L. Diffey A comparison of digital mammography detectors and emerging technology, Published:July 17, 2015

22. CT is a well accepted imaging modality for evaluation
of the entire body.
CT has undergone several evolutions and nowadays
dual CT scanners have been evolved which have
better application in clinical field.
Godfrey Hounsfield and Cormack got the 1979
Nobel Prize for their contribution to CT

27. 3-D imagines of CT and recently advanced retro processing techniques for
accurate diagnosis.
Unlike other imaging technique such as conventional x-ray imaging and CT
enable direct imaging and differentiation of soft tissue structure such as liver,
lung tissue, fat
Therefore CT is valuable tools, for instance in searching for large space
occupying lesion, tumors, and metastasis
CT scan can not only reveal the presence but also the size spatial location and
extent of tumor

28. Gantry can be used without the table to scan the head
It is a multisection CT scanner intended for imaging in ear, nose, and throat
settings and can be used to assess bone and soft tissue of the head.

29. Interventional Radiology
I. C- Arm
II. Catheterization Laboratory
III. Digital Subtraction Angiography

30. C-arm is an imaging scanner intensifier
C-shaped arm used to connect the X-ray source &
X-ray detector to one another
C-arms have radiographic capabilities,
though they are used primarily for fluoroscopic intraoperative
imaging during surgical, orthopedic and emergency care procedures.
It provide high-resolution X-ray images in real time, thus allowing the physician
to monitor progress and immediately make any corrections.

32. Angiography studies (peripheral, central and cerebral)
Therapeutic studies (Line placements, transjugular biopsies, TIPS stent, embolizations)
Cardiac studies
Orthopedic procedures
If there is a need to place needles or stents during a complicated surgery, C-Arm will be
a handy choice.
During surgeries, the real-time view of the gallbladder, liver, bone and several structures
can be obtained. Multiple views of the same part are possible, thus enabling the systems
to reconstruct a 3D model of the inner parts later.
Surgical navigation is one of the primary applications and they aid in verifying the
placement of all types of implant devices in the patient.
C-Arm systems can also guide a needle placement procedure mainly while injecting
anesthetic medicines. They can identify the joints and medication can be inserted
perfectly onto the required shoulders and knees without damaging the other structures.

33. Not all heart problems require open-heart surgery
Involve tiny and flexible tubes called catheters, which
can be use instead of surgery, to access the heart and
blood vessels
Procedures performed in Cath Lab
Balloon angioplasty
Coronary and left ventricular digital angiography
Coronary intravascular ultrasound
Right and left heart catheterization
Stent implantation
Left Main Coronary Artery Stenosis – Angiogram, courtesy: Ivan Stankovic MD

34. Dental Radiography
Orthopantamography (OPG) Intraoral X-ray

35. Intraoral X-rays are the most common type of dental X-ray
These X-rays provide a lot of detail and allow your dentist to find
cavities, check the health of the tooth root and bone surrounding
the tooth, check the status of developing teeth, and monitor the
general health of your teeth and jawbone.

36. Components of Intraoral X-ray
Machine
X-Ray tube
Beam restriction devices
(Cone and cylinders)
Control panel
Extension arm
Miniature x-ray film

37. Ortho – straight
Panoramic - complete view of the object in every
direction
Tomography – X-ray technique for making radiographs
of layers of tissue in depth, without the interference of
tissue above and below that level
Film and x-ray tube head move around the patient in
opposite directions in panoramic radiography
Panoramic X-ray procedure
requires less time
causes no discomfort
is radiation hygienic
is painless and non-traumatic
OPG was first described in Japan
and Finland

38. X-Ray tube head
Patient head rester
Chin rest
Bite rod
Forehead rest
Lateral head support
Exposure controls

40. Lithotripsy is a medical procedure that uses
shock waves or a laser to break down stones in
the kidney, gallbladder, or ureter.
The remaining particles of small stone will exit
the body when a person urinates.
Sound waves break down the stones into small
pieces.
Waves only affect stones & will not harm
muscle, bone, or skin.
1st locate the stone with
Fluoroscopy

41. A bone densitometry scan is an enhanced form of X-ray
technology used to measure the bone mineral (calcium)
content or bone loss and density of specific skeletal sites
or whole body.
Examination is also called a DEXA Scan
DEXA is mostly performed on the lower spine and hips

42. What is Healthcare?
Radiology - Basic Physics & Principles
Commonly using Imaging Equipments
Radiation Regulatory Bodies
Radiation Safety

43. INTERNATIONAL
International Commission on Radiation Units and Measurements (ICRU)
International Commission on Radiological Protection (ICRP)
National Council on Radiation Protection and Measurements (NCRP)
International Atomic Energy Agency (IAEA)
Atomic Energy Regulatory Board (AERB)

44. AERB was constituted on November 15, 1983 by the
President of India by exercising the powers conferred by
Section 27 of the Atomic Energy Act, 1962.
Mission of the AERB is to ensure the use of ionizing
radiation and nuclear energy in India does not cause
undue risk to the health of people and the environment.
Chairman : Shri. G. Nageswara Rao
Headquarters : Anushaktinagar, Mumbai

45. Develop safety policies in nuclear, radiation and industrial safety areas.
Develop Safety Codes, Guides and Standards
Grant consents for siting, construction, commissioning, operation and
decommissioning etc.
Prescribe the acceptance limits of radiation exposure to occupational workers and
members of the public and acceptable limits of environmental releases of radioactive
substances.
Review the training program, qualifications and licensing policies for personnel of
nuclear and radiation facilities and prescribe the syllabi for training of personnel in
safety aspects at all levels.
Promote research and development efforts in the areas of safety.

46. AERB is the regulatory control authority on,
Approval of new models of x-ray equipment and layout of any new proposed x-
ray installation.
Registration and commissioning of new x-ray equipment.
Inspection and decommissioning of x-ray installation.
Certification of a RSO and of service engineers and imposing penalties on any
person contravening these rules

47. Prof. Sarah J Lewis, et. al. (2019) Artificial Intelligence in medical imaging practice: looking to the future
AI
in
Medical Imaging

48. I wish all my colleagues around the
World a Advance Happy
Medical Physics Day (07.11.2020)
&
World Radiography Day (08.11.2020)
Medical Physicist as a Health Professional

49. senthamilselvan@gmail.com
+91-9047783116