10/5/2015

RADIOLOGY
and
MEDICAL IMAGING

Ioana G.Lupescu

Monday Course: 15-17

WS: 17-19

Course
Prof. Dr.Ioana Lupescu (Introduction to Imaging, Gastro-
intestinal +HBP region, pelvis, neuro)
Lecturer Dr.Razvan Capsa (thorax, CV)
Lecturer Dr.Mihai Lesaru (reno-urinary system)
Lecturer Dr.Mugur Grasu (MSK)

WS
Gr.145+146-S.L.Dr.R.Capsa (Amph B)
Gr.147+148- Dr.G.Popa ( Dem room-A)
Gr.149+150- Dr.Cristina Dumitrescu (Dem room-B)
Gr.151+152 -Dr.Cristina Nicolae (old MR-A)
Gr.153+154- Dr.A Dijmarescu (PACS-A)
Gr.155+156- Dr.R.Dumitru (Amph-A)

INTRODUCTION
into radio-imaging

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What imaging method to do?

OMS recommendations

Simple to complex
Non-invasive
Accessible
Sufficient information's for a correct diagnosis
Minimally invasive therapy

Liver ultrasound
Radio-imaging
methods Thoracic X-ray

CT
X-ray (without and with contrast) MRI

Ultrasound
Computed tomography
Magnetic resonance imaging
Angiography
Hybrid imaging: PET-CT, PET-MR Angiography

PET-CT

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X RAY FILMS

Chest X-ray- PA view

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Chest X-ray lateral view

Chest X ray PA view

Left lateral view

FLUOROSCOPY

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Esophagus: barium study

IMAGING

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Ultrasound Imaging
diagnosis; treatment

Ultrasound imaging, also called ultrasound scanning or

sonography, involves exposing part of the body to high-
frequency sound waves (2-7,5 MHz) to produce pictures
of the inside of the body.

Because ultrasound images are captured in real-time,

they can show the structure and movement of the body's
internal organs, as well as blood flowing through blood
vessels.

Doppler ultrasound is a special ultrasound technique that

evaluates blood as it flows through a blood vessel,
including the body's major arteries and veins in the
abdomen, arms, legs and neck.

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Ultrasound

HYPERECHOIC (air,
stones)
HYPOECHOIC
ANECHOIC (fluids)

VASCULAR STUDIES

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Abdominal Ultrasound
Pediatric Ultrasound
Breast Ultrasound
Carotid Ultrasound Imaging
Obstetric Ultrasound -
Musculoskeletal Ultrasound
Scrotal Ultrasound
Thyroid Ultrasound
Vascular Ultrasound
Biopsy, Ultrasound-Guided

Prostate US: PADK

MSK US: foreign body

What are some common uses of the procedure?

Abdominal ultrasound imaging is performed to evaluate the:

liver
gallbladder
kidneys
pancreas
spleen
Abdominal aorta and other blood vessels of the abdomen

Ultrasound is used to help diagnose a variety of conditions:

abdominal pains
inflamed appendix
enlarged abdominal organ
stones in the gallbladder or kidney
aortic aneurym

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Liver ultrasound. Power doppler

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Liver and the kidney

Angio-power Doppler

Air

Stone Lipoma

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Doppler ultrasound images can help the physician to see and

evaluate:

blockages to blood flow (such as clots)

narrowing of vessels (which may be caused by plaque)
tumors and congenital malformation

Color Doppler

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Power Doppler

Cholangiocarcinoma

Portal cavernoma

HYPOECHOGENI C

FLUI D lesion

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HYPERECHOGENI C

Artifacts

What are the benefits vs. risks?

Benefits

Ultrasound scanning is noninvasive (no needles or injections) and is usually

painless.
Ultrasound is widely available, easy-to-use and less expensive than other imaging
methods.
Ultrasound imaging uses no ionizing radiation.
Ultrasound scanning gives a clear picture of soft tissues that do not show up well
on x-ray images.
Ultrasound causes no health problems and may be repeated as often as is
necessary if medically indicated.
Ultrasound provides real-time imaging, making it a good tool for guiding minimally
invasive procedures such as needle biopsies and needle aspiration of fluid in
joints or elsewhere.

Risks
For standard diagnostic ultrasound there are no known harmful effects on
humans.

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What are the limitations of

Abdominal Ultrasound Imaging?

Ultrasound waves are reflected by air or gas; therefore ultrasound is not an

ideal imaging technique for the bowel.
Barium exams and CT scanning are the methods of choice for bowel-related
problems.

Ultrasound waves do not pass through air; therefore an evaluation of the

stomach, small intestine and large intestine may be limited. Intestinal gas may
also prevent visualization of deeper structures such as the pancreas and aorta.

Patients who are obese are more difficult to image because tissue attenuates
(weakens) the sound waves as they pass deeper into the body.

What is CT Scanning
Computed tomography (CT)sometimes called CAT scanuses special x-ray
equipment to obtain image data from different angles around the body then uses
computer processing of the information to show a cross-section of body tissues
and organs.

CT imaging is particularly useful because it can show several types of tissue with
great clarity, including the mediastinum, lungs, vessels, head, spine and organs
like the liver, spleen, pancreas and kidneys.

Using specialized equipment and expertise to create and interpret CT scans of

the lower gastrointestinal (GI) tract, the colon and the rectum, an experienced
radiologist can accurately diagnose many causes of abdominal pain such as an
abscess in the abdomen, tumors, appendicitis, diverticulitis, aneurysms,
dissection of the aorta

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How does the procedure work?

In many ways CT scanning works very much like other x-ray
examinations. Very small, controlled amounts of x-ray
radiation are passed through the body while different tissues
absorb the radiation at different rates. With plain radiology, an
image of the inside of the body is captured when special film
is exposed to the absorbed x-rays.

With CT, the film is replaced by an array of detectors that

measure the x-ray profile.

Inside the CT scanner is a rotating gantry that has an x-ray

tube mounted on one side and an arc-shaped detector
mounted on the opposite side. During each full rotation, as the
fan-shaped x-ray beam is emitted through the patient's body,
an image of a thin section is acquired.

With conventional CT, small lesions may frequently go undetected

when a patient breathes differently on consecutive scans, as a lesion
may be missed by unequal spacing between scans.

With spiralor helicalCT, refinements in detector technology

support faster, higher-quality image acquisition with less radiation
exposure. The current spiral CT scans are called multidetector CT
and are most commonly four-/ 16/31/64/ 128/320 -slice systems.

Using 16-slice scanner systems the radiologist can scanning the

chest or abdomen in 10 seconds or less. Such speed is beneficial in
all patients but especially in populations in which the length of
scanning was often problematic, such as elderly, pediatric or
critically-ill patients.

The multidetector CT also allows applications like CT angiography to

be more successful.

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- 1000 UH air-----------------0 UH water-------------------+1000 UH bone

Calcification: more than 100 UH

Acute Haematoma: 60-80 UH
Lipoma: - 20/ -80 UH

CT with non ionic iv.contrast

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CT -Lung window

CT-Bone window

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MIP CTA

Trauma

HYPERDENSE LESIONS

Haematoma

HYPERDENSE LESIONS

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Brain Trauma

HYPODENSE LESIONS-
Lacunar infarcts

Aortic dissection

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Abdominal aortic aneurysm rupture and RP haematoma

Polycystic Kidneys
HYPODENSE lesions

Liver fracture

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CT
A contrast agent (e.g., iodine-based ) may be
administered prior to CT scan to allow organs and
structures to be seen more easily. Contrast agents can be
administered through a vein (IV), by injection, or taken
orally.

Patients usually are instructed not to eat or drink for a few

hours prior to contrast injection or IV because the dye may
cause stomach upset. Patients may be required to drink an
oral contrast solution 12 hours before CT scan of the
abdomen or pelvis

CT without and with nonionic contrast

Hemorrhage and calcifications

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What are the benefits vs. risks?

Benefits

CT scanning offers detailed views of many types of tissue, including

the lungs, bones, soft tissues and blood vessels.

CT scanning is painless, noninvasive, fast and accurate.

CT examinations are simple. For example, in emergency cases they

can reveal internal injuries and bleeding quickly enough to help save
lives.

Diagnosis made with the assistance of CT can eliminate the need for
invasive exploratory surgery and surgical biopsy.

CT scanning can identify normal and abnormal structures, making it a

useful tool to guide radiotherapy, needle biopsies and other minimally
invasive procedures.

CT has been shown to be a cost-effective imaging tool for a wide

range of clinical problems.

What are the benefits vs. risks?

Risks

CT does involve exposure to radiation in the form of x-ray, but the benefit
of an accurate diagnosis far outweighs the risk. The effective radiation
dose from this procedure is about 10 mSv, which is about the same as
the average person receives from background radiation in three years.
See the Safety page for more information about radiation dose.

Women should always inform their doctor or x-ray technologist if there is

any possibility that they are pregnant. See the Safety page for more
information about pregnancy and x-rays.

Nursing mothers should wait for 24 hours after contrast material (iodine)
injection before resuming breast feeding.

The risk of serious allergic reaction to iodine-containing contrast material

is rare, and radiology departments are well-equipped to deal with them.

What are the limitations of CT

Scanning

The exam is not indicated for pregnant women !!!!.

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What is MRI
Magnetic resonance imaging (MRI) uses radiofrequency
waves and a strong magnetic field to provide remarkably
clear and detailed pictures of internal organs and tissues.

The technique has proven very valuable for the diagnosis of

a broad range of pathologic conditions in all parts of the body
including cancer, heart and vascular disease, stroke, and
joint and musculoskeletal disorders.

MRI requires specialized equipment and expertise and

allows evaluation of some body structures that may not be as
visible with other imaging methods.

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What are some common uses

of the MRI procedure?
Because MRI can give such clear pictures of soft-tissue structures
near and around bones, it is the most sensitive exam for spinal and
joint problems. MRI is widely used to diagnose sports-related
injuries, especially those affecting the knee, shoulder, hip, elbow
and wrist.

In addition, MRI of the heart, aorta, coronary arteries and blood

vessels is a fast, noninvasive tool for diagnosing coronary artery
disease and heart problems.

Organs of the chest and abdomenincluding the lungs, liver,

kidney, spleen, pancreas and abdominal vesselscan also be
examined in high detail with MRI, enabling the diagnosis and
evaluation of tumors and functional disorders.

MRI is growing in popularity as an alternative to traditional x-ray

mammography in the early diagnosis of breast cancer.

Because no radiation exposure is involved, MRI is often the

preferred diagnostic tool for examination of the male and female
reproductive systems, pelvis and hips and the bladder.

T2 weighted
CSF-
HYPERINTENSE

T1 weighted

CFS-
HYPOINTENSE

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T1 SE

T1 FSPGR

HYPERINTENSE

Abdominal aneurysm

MRA- MIP

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Portal
Cavernoma

Gadolinium

MR angiography

Brest MRI

What are the benefits vs. risks?

Benefits

MRI can help physicians evaluate the function as well as the structure of
many organs.

The detail makes MRI an invaluable tool in early diagnosis and evaluation of
tumors.

MRI contrast material is less likely to produce an allergic reaction than the
iodine-based materials used for conventional x-rays and CT scanning.

MRI enables the detection of abnormalities that might be obscured by bone

with other imaging methods.

MRI provides a fast, noninvasive alternative to x-ray angiography for

diagnosing problems of the heart and cardiovascular system.

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What are the benefits vs. risks?

Risks

An undetected metal implant may be affected by the strong

magnetic field.

MRI is generally avoided in the first 12 weeks of pregnancy.

Doctors usually use other methods of imaging, such as

ultrasound, on pregnant women unless there is a strong
medical reason to use MRI.

What are the limitations of MRI ?

Bone is better imaged by conventional x-rays and CT is preferred for
patients with severe bleeding.

MRI may not always distinguish between tumor tissue and edema fluid and
does not detect calcium when this is present within a tumor.

In most cases the examination is safe for patients with metal implants, with
the exception of a few types of implants, so patients should inform the
technician of an implant prior to the test.

The examination must be used cautiously in early pregnancy.

MRI typically costs more than CT scanning

Pancreatic pseudokyst

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NHL

Liver cirrhosis.

Duodenal diverticulum

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Cerebral malformation

Lacunar infarction

Intrasellar adenoma

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Vertebral TBC

Multiple sclerosis

MRI Contraindications

Absolute

- cardiac pacemaker
- metallic implants
- fat people (130 Kg)

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