Basic Concepts of Other Imaging Modalities

Dr. Anita Gohel

Imaging the maxillofacial complex

Conventional Tomography CT Cone Beam CT MRI

Conventional Tomography
Tomo = cut, section or layer slice Image which provides just a slice of the whole structure Focused image without superimposition of structures with thick image layer

Conventional Tomography
Film based tomography Blurring of structures outside plane of interest X-ray tube moves about a fulcrum Tube and film opposite sides of fulcrum Tube and film move in opposite directions Angle determines thickness of the slice

Conventional Film Tomography

Wider angle = thinner section Narrow angle = thicker section Objective is to blur objects not of interest Accomplished by many different types of movements
Linear, Circular, Trispiral, Elliptical, Hypocycloidal More complex movement = less likely to image an unwanted structure

Tomography Movements

Linear Tomography

Spiral Tomography

Hypocycloidal Tomography

Computed Tomography
Introduced in 70s Principle: Internal structures of an object can be reconstructed from multiple projections of the object

CT Scanner

CT Movement/Geometry

CT Geometry
Early scanners involved few detectors with the tube and the detectors moving Newer scanners use spiral or helical movement to create overlapping images

Mechanism of CT
Detectors

X-ray tube is rotated around the patient Radiation transmitted through the patient is absorbed by a ring of detectors Absorbed radiation is converted to an image

Image construction
X-ray hits detector which consists of an ionization chamber or scintillation crystals Scintillation crystals
Cadmium tungstate most common Crystals convert x-rays to light Photodiode converts light to electric current

Ionization chamber detector w/ Xe gas creates current Analog information digitized and sent to the computer for reconstruction

Ionization Chamber
X-ray ionizes xenon gas Electrons move towards anode Generates small current Converted to electrical signal

Image Construction

CT Image Construction

Pixel - Voxel
Pixel - picture element Voxel - volume element

Image construction CT
The image consists of a matrix of individual pixels representing the face of a volume called a voxel A single-plane image is constructed and displayed as differences in optical density
Range is from 1000 to +1000 Hounsfield units

-1000 is air, 0 is water and +1000 is bone

Windowing
Usual CRT can display ~256 gray levels Approx. 60 shades are visually discernible 2000 CT numbers Assign 8 CT numbers to one shade Or, select the CT number of the tissue of interest, then range of 128 shades

Windowing
Center CT number is the window level Range of CT number above and below the window level is window width Window level determines brightness Window width determines contrast

Window Width & Level

Center CT number is the window level Range of CT number above and below the window level is window width Window level determines brightness Window width determines contrast

Windowing
Manipulation allows customization of visibility
soft tissues
brain

dense structures
bone

200

WL = 0 WW = 400

400

-200

CT Number
Tissues Air Lung Fat Water Muscle Bone Typical CT values Range (Hounsfield unit) -1000 -200 to 500 -50 to 200 0 +25 to +45 +200 to +1000

CT

Advantages of CT over Film Radiography

Elimination of superimposition of structures outside area of interest High contrast resolution
Differences of <1% can be detected Conventional = 10% difference needed

Can reformat the information to see images in different planes

Axial, Sagittal, Coronal

1. 2. 3. 4. 5.

Temporalis m Masseter m Lat pterygoid m Med pterygoid m Carotid canal

1. 2. 3. 4. 5.

Superior rectus m. Optic nerve Inferior rectus m. Lateral rectus m. Zygomatic bone

Magnetic Resonance Imaging

Three steps of MRI MRR
Magnetic Field Radio-frequency Pulse Relaxation

Philips Gyroscan Intera

Philips Gyroscan Intera

Spin or Angular Moment

1H, 14N, 31P, 13C,

spin They spin around their axes similar to earth spinning around its axis Elements with nuclear spin has odd number of protons, neutrons

and

23Na

has nuclear

Magnetic Moment
When a nucleus spins, it has angular momentum When the spinning nucleus has a charge, it has magnetic dipole moment Moving charges produce magnetic fields

Hydrogen Nucleus
Most abundant Yields strongest MR signal

Spinning Hydrogen Nucleus

Applied magnetic field

N Spin

Precession of a Top

Radiofrequency Pulse
RF pulse is an electromagnetic wave Caused by a brief application of an alternating electric current

Receiver Coils
Send or broadcast the RF pulse Receive or pick up the MR signals Types: Body coils, head coils, and a variety of surface coils

Relaxation
This is the process that occurs after terminating the RF pulse The physical changes caused by the RF pulse revert back to original state

Magnetic Field Strengths

Measured in Tesla or Gauss Usual MRI field strength ranges from 0.02 to 2.0 tesla

Advantages of MRI
Higher resolution of tissues No ionizing radiation Multiplanar imaging

Disadvantages of MRI
Long imaging time Hazards with ferromagnetic metals (pacemakers, vascular clips, etc) Claustrophobia Higher cost

Relative Brightness of Tissues

Fat Marrow Brain Muscle Body Fluid TMJ Disk Cortical Bone Air White

Gray

Black

1.

2. 3. 4.

Tensor veli palatini Mastoid air cells Temporalis m. Medulla oblongata

1. 2. 3. 4. 5. 6.

Infratemporal sp. Masticator space Parotid space Parapharyngeal sp Int. carotid Carotid space

Nuclear Medicine
radioactive compounds target tissues radioactive agents pools in the target tissues detected and imaged by external detectors

Nuclear Medicine
Shows structure and function of the target tissues Static and dynamic conditions Scintigraphy scans or RN (radionuclide) scans Bone scans or salivary gland scans

Technetium
99mTcO - - thyroid and salivary 4 99Tc phosphate - bone scan 99mTc

gland scan

with sulfur-colloid - liver and spleen

scan

Case 1
Is this an active disease?

Use Modality Conventional TMJ, Implant, Bony Tomography Pathology CT TMJ, Implant, Bony Pathology, Some soft tissue Cone Beam TMJ, Implant, Bony CT Pathology MRI TMJ, Soft tissues, Pathology, Sinus

Advantage Simple Technique, Low radiation Great resolution, images many structures Low Radiation, resolution,images many structures Soft tissue visualization, Nonionizing radiation Detecting Metastases, Active infection

Nuclear Med. Bone scan