Imaging Modalities Notes

Imaging Modalities (Other Than Ultrasound)

Introduction

  • Looking inside the body involves:
    • Determining how to do it.
    • Identifying what we are looking for (bone vs. soft tissue, structural vs. functional anomalies).
    • Assessing patient risk (harm or death).
    • Considering cost.

Medical Imaging Techniques

  • Uses Ionizing Radiation and/or Radioactive Agents:
    • X-Ray
    • Fluoroscopy
    • CT: Computed Tomography
    • Nuclear Medicine
    • PET: Positron Emission Tomography
  • Does NOT use Radiation:
    • Surgical Dissection
    • Ultrasound
    • MRI: Magnetic Resonance Imaging

Radiation

  • Refer to uploaded videos on Canvas for a summary about radiation, including ionizing radiation and radioactivity.

X-Ray

  • An x-ray image results from the differential absorption of x-rays.
  • Differential Absorption: The contrast in x-ray images arises from the varying degrees to which different tissues absorb x-rays.
  • X-rays that are totally absorbed by a structure:
    • Stop radiation from reaching the receptor.
    • Produce bright areas on the image.
    • Are referred to as radiopaque.
  • X-rays that penetrate the body and are transmitted with no interaction:
    • Allow radiation to pass through and blacken the film.
    • Result in dark areas on the image.
    • Are referred to as radiolucent; air is radiolucent.
  • Example:
    • A radiograph of bony structures results from the differential absorption between bone and soft tissue.

Fluoroscopy

  • Fluoroscopy is a continuous X-Ray image of the internal structure.
  • Contrast media is usually used during the exam, barium and iodine compounds.
    • Contrast media, such as barium and iodine compounds, can be used to help visualize organs by filling them.
    • Barium is used for the GI tract.
    • Iodine compounds are used for vascular structures.

Computed Tomography (CT)

  • CT adds a new dimension to your X-Ray. "Tomo" or "Tomography".
  • A conventional X-ray image is basically a shadow:
    • You shine a "light" on one side of the body, and a piece of film on the other side registers the silhouette of the bones
  • With a CAT scan machine, the X-ray beam moves all around (spirals) the patient, scanning from hundreds of different angles (multiple slices from multiple axis 8,16, 32, 64, 128…)

Magnetic Resonance Imaging (MRI)

  • Does not involve ionizing radiation.
  • Advantage: superior ability to differentiate tissues.
  • Images are constructed from signals from the tissues themselves (as a result of hydrogen atom stimulation).
  • The human body is up to 75% water. Water = H_2O. There are more Hydrogen atoms than oxygen atoms in the composition of water.
  • The protons in Hydrogen atoms are affected by magnetic fields.
    • In the presence of a magnetic field, the protons in your body line up (SPIN) parallel to the direction of the magnetic field that they are sitting in
    • It takes less energy for a proton to line up with (spin with) the field than against it
  • The protons within each of the tissues of the body relax at a unique rate after the RF energy is turned off.
    • This is what allows us to differentiate the tissues on the MR images
  • How MRI Works:
    • Atoms spin in random directions, like tops, around their individual magnetic fields. About half the atoms go each way, but there are a few unmatched atoms.
    • In magnetic field produced by MRI, atoms line up either north or south.
    • When radio frequency pulse is applied, the unmatched atoms spin the other way.
    • When the radio frequency is turned off, the extra atoms return to normal position, emitting energy. The energy sends a signal to a computer. The computer uses a mathematical formula to convert the signal into an image.
  • WARNING! THE MAGNETIC FIELD IN THE MRI SUITE IS ALWAYS ACTIVE!
  • MRI Safety: Important Patient History.
    • brain aneurysm clips
    • cardiac pacemaker
    • pregnancy
    • implanted medication pumps
    • intrauterine device (IUD)
    • any other surgically implanted or metallic object in the body
    • tattoos

Nuclear Medicine

  • Evaluates physiology – not anatomy.
  • The nuclear part is the radiation part.
  • PET also looks at physiology but we are able to also see the metabolism of the cells (positron emission tomography).
  • The radiotracer, injected into a vein, emits gamma radiation as it decays.
    • A gamma camera scans the radiation area and creates an image.

Cardiac Catheterization

  • Evaluates blood flow & pressure within the cardiac chambers.
  • Also evaluates the coronary arteries for disease.
  • A blend of fluoroscopy and angiography
  • A catheter is inserted in the groin, arm or neck
    • Fed into the right or left side of the heart
    • Contrast agent injected (coronary angiogram)