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29. Remote sensing Content 29.1 Production and use of X-rays 29.2 Production and use of ultrasound 29.3 Use of magnetic resonance as an imaging technique Learning outcomes Candidates should be able to: (a) explain in simple terms the need for remote sensing (non-invasive techniques of diagnosis) in medicine (b) explain the principles of the production of X-rays by electron bombardment of a metal target (c) describe the main features of a modern X-ray tube, including control of the intensity and hardness of the X-ray beam (d) show an understanding of the use of X-rays in imaging internal body structures, including a simple analysis of the causes of 1 sharpness and contrast in X-ray imaging
(e) show an understanding of the purpose of computed tomography or CT scanning (f) show an understanding of the principles of CT scanning (g) show an understanding of how the image of an 8-voxel cube can be developed using CT scanning (h) explain the principles of the generation and detection of ultrasonic waves using piezo-electric transducers (i) explain the main principles behind the use of ultrasound to obtain diagnostic information about internal structures (j) show an understanding of the meaning of acoustic impedance and its importance to the intensity reflection coefficient at a boundary (k) recall and solve problems by using the equation I = I0ex for the attenuation of X-rays and of ultrasound in matter (l) explain the main principles behind the use of magnetic resonance to obtain diagnostic information about internal structures (m) show an understanding of the function of the non-uniform magnetic field, superimposed on the large constant magnetic field, in diagnosis using magnetic resonance.
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Remote Sensing
Remote sensing is the investigation of an object using equipment that has no direct contact with the object being investigated e.g. an orbiting satellite may be designed so that it can detect small changes in mean sea level. These small changes can then be interpreted to determine the nature of the rocks under the sea-bed. This investigation enables information to be gathered without actually drilling into the sea-bed Medical diagnosis for over 100 years used 2 risky techniques Observe the patient externally for fever, pulse-rate, breathing, vomiting, skin condition etc. This was part science and part art Carry out investigative invasive surgery which involved a high risk causing many patients to die either from trauma of surgery or infection Although there is some risk versus benefit with any procedure, now diagnostic imaging techniques have been developed that enable externally placed equipment to obtain detailed information about internal body structures without surgery i.e. non-invasive, from under the skin i.e. a form of remote sensing Some of the techniques make use of
X-rays Ultrasound Magnetic resonance imaging(MRI)
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The vet rolled his eyes, turned around and left the room. ?????????????
cont
He returned a few minutes later with a black Labrador Retriever. As the duck's owner looked on in amazement, the dog stood on his hind legs, put his front paws on the examination table and sniffed the duck from top to bottom. He then looked up at the vet with sad eyes and shook his head. The vet patted the dog on the head and took it out of the room. !!!!!!!!!!!!!!!!! A few minutes later he returned with a cat. The cat jumped on the table and also delicately sniffed the bird from head to foot. The cat sat back on its haunches, shook its head, meowed softly and strolled out of the room.
Verdict
The vet looked at the woman and said, "I'm sorry, but as I said, this is most definitely, 100% certifiably, a dead duck." The vet turned to his computer terminal, hit a few keys and produced a bill, which he handed to the woman. The duck's owner, still in shock, took the bill. "$250?" she cried, "$250 just to tell me my duck is dead?"
Verdict justified
The vet shrugged, "I'm sorry. If you had just taken my word for it, the bill would have been $20, .
but with the Lab Report and the Cat Scan, it's now $250."
X-rays
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X-ray machine
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Dental X-ray
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Properties of X-rays
Produce fluorescence in materials e.g. zinc sulphide Produce latent image (developed to give visible image) Penetrate substances opaque to light Ionize and excite atoms and molecules Have biological effects in living organism
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Not all of the energy of the electrons is emitted as X-rays as the majority is transferred as thermal energy in the target rotating metal anode and cooling is necessary
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X-ray spectrum
A typical X-ray spectrum of the variation with wavelength of the intensity has 2 distinct components: A continuous distribution of wavelengths with a sharp cut-off at the shortest wavelength, 0 Sharp peaks may be observed corresponding to the emission line spectra of the target material and therefore a characteristic of the target
Continuous X-rays
Characteristic X-rays
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Continuous spectrum
The continuous distribution comes about because the electrons when incident on the metal target, will not all have the same decelerations but will instead have a wide range of values. Since the wavelength of the emitted spectrum is dependent on the deceleration, there will be a distribution of wavelengths The cut-off wavelength corresponds to an electron that is stopped in one collision in the target so that all of its kinetic energy is given up as one X-ray photon KE energy is lost in the form of X-ray photons Energy of photon depends on how much KE lost hence a continuous range Max energy of photon occurs when all KE of electrons is converted to X-rays.
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Characteristic/discrete X-rays
Superimposed on the continuous spectrum Produced when an incident electron knocks electrons out of the Kshell(lowest shell) of the target atom An electron from the L or M shell may move into the vacancy in the K-shell, emitting characteristic X-rays
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X-ray spectra
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Discrete X-rays
M shell K
L
L shell
K shell
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A discrete wavelength
Produced by electron transition from higher shell to inner shell
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Quality of beam
Quality of beam describes how penetrating the beam is For monochromatic radiation, the quality is completely described by the wavelength High quality refers to a very penetrating beam. High quality beam is also known as hard X-ray while low quality is called soft X-ray. Quality is specified/measured by HVT (half-value thickness)
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Hardness/penetration
The kinetic energy Ek of an electron is equal to the energy gained by the electron when it is accelerated from the cathode to the anode i.e. Ek = eV where e is the charge of an electron and V the accelerating potential difference Using E = hc/ at the cut-off wavelength, eV = hc/0 hence 0 = hc/(eV) i.e. the accelerating potential V thus determines the cut-off wavelength The larger the potential difference, the shorter the wavelength Therefore the hardness(penetration) of the X-ray beam is controlled by variation of the accelerating potential difference between the cathode and the anode A continuous distribution of wavelengths implies that there will be X-ray photons of long wavelengths that would not penetrate the person being investigated and hence would not contribute towards the X-ray image Such X-rays would add to the radiation dose received by the person without serving any purpose, so the X-ray beam emerging from the tube frequently passes through aluminium filters that absorb these long-wavelength photons
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Intensity
The intensity of the beam depends on the number of photons emitted per unit time and hence the number of electrons hitting the metal target per unit time Since the electrons are produced by thermionic emission, increasing the heater or filament current in the cathode will increase the rate of production of electrons and hence increase the intensity of the X-ray beam
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Example
The accelerating potential difference between the cathode and the anode of an X-ray tube is 30 kV. Given that the Planck constant is 6.6 x 10-34 J s, the charge on the electron is 1.6 x 10-19 C and the speed of light in free space is 3.0 x 108 m s-1, calculate the minimum wavelength of photons in the X-ray beam. Solution For the minimum wavelength, Energy gained by electron = energy of photon eV = hc/0 Therefore 0 = 4.1 x 10-11 m
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X-ray images
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X-ray images
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X-ray images
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Quality of imaging
Quality of an X-ray image is described by sharpness and contrast Sharpness refers to a clear boundary between different tissues or the ease with which the edges of structures can be determined A shadow image where the bones and other organs are clearly outlined is said to be a sharp image But although an image may be sharp, it may still not be clearly visible because there is little difference in the degree of blackening between e.g. bone and surrounding tissue An image having a wide range of degrees of blackening is said to have good contrast Contrast refers to different intensity (brightness) in the image of various parts of the internal organ.
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Sharpness
Image is sharp if the boundary is clearly visible A sharp image requires a parallel X-ray beam which can be achieved by
(1) reducing the area of the target anode in the X-ray tube (2) limiting the size of the aperture through which the X-ray beam passes (3) reducing scattering of the emergent beam
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Sharpness (1) reducing the area of the target anode in the X-ray tube
Secondary/partial shadows/penumbra can cause images to be blur The full shadow produces an area that is white on the film Where there is no shadow, the image will be black In the region of partial shadow or greyness, the image gradually changes from white to black If the image is to be sharp, this area of greyness must be reduced as much as possible The area of the target anode should be kept to a minimum
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Sharpness (2) limiting the size of the aperture through which the X-ray beam passes
A reduction in the grey area at the edge of the image can also be achieved by limiting the size of the aperture through which the X-ray beam passes This is achieved by using overlapping metal sheet plates, through which the X-ray beam passes after leaving the tube
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Contrast
Good contrast is achieved when neighbouring body organs and tissues absorb the X-ray photons to very different extents e.g. bone and muscle Not the case e.g. if stomach or blood vessels are being investigated In such a case to improve contrast, especially for soft tissues, a contrasting medium is used The patient is asked to swallow a solution of barium sulphate(barium meal taken orally) which is a good absorber of X-ray photons, causing the outline of the stomach to show up clearly Blood vessels can be made to show up visibly by injecting a radio-opaque dye into the bloodstream
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Contrast
Contrast also depends on other factors such as increasing exposure time and the use of intensifying cassettes or backing the film with fluorescent materials
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Example
The linear absorption coefficient of copper is 0.693 mm-1. Calculate: (a) the thickness of copper required to reduce the incident intensity by 50% (b) the fraction of the incident intensity of a parallel beam that is transmitted through a copper plate of thickness 1.2 cm
Solution (a) using I = I0 e-x or I = I0 exp(-x) I/I0 = 0.50 = exp(-0.693x) ln 0.50 = - 0.693x therefore x = 1.0 mm
(b) I/I0 = exp(-0.693 x 12) I/I0 = 2.4 x 10-4
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The image of each voxel would have a particular intensity, known as a pixel. The pixels are built up from measurements of X-ray intensity made along a series of different directions around the section of the body The number on each voxel is the pixel intensity that is to be reproduced Pixel(picture element) is actually a two dimensional unit based on the matrix size and the field of view. When the CT slice thickness is also factored in, the unit is known as a Voxel, which is a three dimensional unit.
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Final pattern
In order to obtain the original pattern of pixels, two operations must be performed. - 1. The background intensity must be removed. The background
intensity is the total of each set of detector readings. In this case, 14 is deducted from each pixel. - 2. After deduction of the background, the result must be divided by three to allow for the duplication of the views of the section since 4 sets of readings were taken
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CT cont
In practice, the image of each section is built up from many small pixels, each viewed from many different angles. The greater the number of voxels, the better the definition, similar to a digital camera In order to build up an image of the whole body, the procedure would be repeated for further sections through the body. All the data for all the sections can be stored in the computer memory to create a three-dimensional image. Views of the body from different angles may constructed The collection of the data and its construction into a display on a screen requires a powerful computer and complicated software programming and programs. In fact, the reconstruction of each pixel intensity value requires more than one million computations. The computer allows for the contrast and brightness of the image to be varied so that an optimum image can be obtained
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Advantages/disadvantages
CT scan is expensive but is indispensable in todays medical practice Although historically the images generated were in the axial or transverse plane, orthogonal to the long axis of the body Modern scanners allow this volume of data to be reformatted in various planes or even as volumetric (3D) representations of structures. The image of the organ can be viewed in any direction. You can look at the organ from the front, top, back, and side. Hence a 3 D image of the organ Higher resolution compared to Ultrasound Excellent for bone imaging
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Exercise
1. Compare the image produced during an X-ray investigation and that produced in CT scanning 2. The principles of CT scanning have been understood for some time. However scanners could not be developed until large powerful computers were made available. By reference to the image produced in a CT scan, suggest why such a computer is necessary 3. A simple object consists of 4 voxels out of 8 voxels (i.e. cube can be thought of as 2 slices). The object is scanned from 4 different directions, each at 45 to the next. The detector measurements for each individual voxel are summed and the result is as shown here. The total of the readings of the detectors in any one position is 22. Determine the pattern of the pixels in the voxels
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Ultrasound
Incident wave
Reflected wave
Boundary between media
Transmitted wave
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Piezo-electric transducer
A piezo-electric device is a sensor that detects differences in pressure (sound wave) Variation in pressure will result in an ac voltage The magnitude of the voltage generated depends on the magnitude of the pressure on the crystal and the polarity depends on whether the crystal is compressed or expanded i.e. whether the pressure is greater than or less than the ambient pressure A transducer is any device that converts energy from one form to another The piezoelectric transducer converts mechanical energy (vibration) into electrical energy in the form of ac voltages It also can convert electrical voltages back to vibration. Hence it acts as a receiver as well as an emitter. To detect the voltages, opposite faces of the crystal are coated with a metal (silver) and electrical connections are made to these metal films and since the voltages are very small they are amplified The crystal and its amplifier may be used as a simple microphone for converting sound signals into electrical signals Ultrasound waves may be generated using a piezo-electric crystal such as quartz, as it can convert electrical voltages to vibrations
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Ultrasound
When a potential difference is applied between the electrodes of the crystal, an electric field is set up in the crystal which causes forces to act on the ions Quartz has a tetrahedral silicate structure with the oxygen ion negatively charged and the silicon ion positively charged, and as these ions are not held rigidly in position, they will be displaced slightly when an electric field is applied The positive ions will be attracted to the negative electrode, and the negative ions will be attracted to the positive electrode and depending on the direction of the electric field, the crystal will become slightly thinner or thicker An ac voltage applied across the electrodes will cause the crystal to vibrate with a frequency equal to that of the applied voltage with a small amplitude If the frequency of the applied voltage is equal to the natural frequency of vibration of the crystal, resonance will occur and the amplitude of vibration will be a maximum The dimensions of the crystal can be such that the oscillations are in the ultrasound region(> 20 kHz) and this will give rise to ultrasound waves in any medium surrounding the crystal In the medical field the ultrasound frequency is in the megahertz region 56 Human range of hearing is from 20 Hz to 20,000 Hz
The specific acoustic impedance Z is defined as the product of the density of the medium and the speed c of the wave in the medium i.e. Z = c
Material Density 3 r/kg m 1.3 1060 1075 1600 Speed of sound 1 c/m s 330 1570 1590 4000 Acoustic impedance 2 1 Z/kg m s
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Example
Calculate the intensity reflection coefficient for a parallel beam of ultrasound incident normally on the boundary between: (1) air and soft tissue, specific acoustic impedances of 430 kg m-2 s-1 and 1.6 x 106 kg m-2 s-1 respectively (2) muscle and bone, specific acoustic impedance of 1.7 x 106 kg m-2 s-1 and 6.5 x 106 kg m-2 s-1 respectively
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Example
A parallel beam of ultrasound is incident on the surface of a muscle and passes through a thickness of 3.5 cm of the muscle. It is then reflected at the surface of a bone and returns through the muscle to its surface. Calculate the fraction of the incident intensity that arrives back at the surface of the muscle given that the linear absorption coefficient for muscle is 0.23 cm-1 and the fraction reflected at bone-muscle interface is 0.34(from the last example) Solution The beam passes through a total thickness of 7.0 cm of muscle For the attenuation in the muscle, using I = I0 exp(-kx) = I0 exp(-0.23 x 7.0) = 0.20I0
Given that the fraction reflected at the bone-muscle interface i.e. is 0.34, therefore the fraction received back at surface = 0.34 x 0.20 = 0.068 = 1/15
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A-scan
A short pulse of ultrasound is transmitted into the body through the coupling medium At each boundary some of the energy of the pulse is transmitted and some is reflected The transducer(generator/detector) detects the reflected pulses as it now acts as a receiver The signal is amplified and displayed on a c.r.o. Reflected pulses received at the transducer from deeper in the body tend to have lower intensity than those reflected from boundaries near the skin This is due not only to the energy being absorbed by the various media but also on the return of the reflected pulse to the transducer, some of the energy of the pulse will again be reflected at intervening boundaries To allow for this, echoes received later at the transducer are amplified more than those received earlier A vertical line is observed on the c.r.o. corresponding to the detection of each reflected pulse The time-base of the c.r.o. is calibrated so that knowing the speed of the ultrasound wave in each medium, the distance between boundaries can be 65 determined
B-scan
This consists of a series of A-scans all taken from different angles so that a 2-D image can be formed The ultrasound probe consisting of a generator/detector, for a B-scan does not consist of a single crystal, but rather an array of smaller crystals each one at a different angle to its neighbours The separate signals received from each of the crystals in the probe is processed and a pattern of spots is built up to create a 2-D image for immediate viewing, photographing or to be stored in computer memory
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MRI
Magnetic resonance imaging
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Proton spin
Many atomic nuclei have a property known as spin which causes the nuclei to behave as if they were small magnets Such nuclei have an odd number of protons and/or neutrons e.g. hydrogen, carbon, phosphorus The proton is not stationary but spins about an axis and the spinning acts like a tiny current loop which generates a magnetic field along the spin axis The spinning proton behaves like a spinning top When perfectly balanced, it spins about a vertical axis
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Hydrogen atoms
The magnetic fields of hydrogen atoms are random if there is no external magnetic field around. Their individual fields tend to cancel out
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Precession
When a proton is slightly displaced, it wobbles or precesses about the vertical axis. When a external magnetic field Bo is applied to these spinning proton nuclei, they tend to line up along the field but this alignment is not perfect and the nuclei rotate about the direction of the magnetic field due to their spin The alignment is either parallel or anti-parallel. Parallel alignment: lower energy states, E1 Anti-parallel alignment: higher energy state, E2 This motion can be modelled as the motion of a top spinning about the direction of a gravitational field and this rotation is known as precession The spinning about the direction of the magnetic field i.e. the precess about the external field has a frequency of precession known as the Larmor frequency which depends on the nature of the nucleus and the strength of the magnetic field which is the natural frequency of the precessing proton. The frequency is directly proportional to the external magnetic field strength, Bo and is given by f = 42.57 Bo for the hydrogen atom For large magnetic fields like 1 T or 2 T, f is of the order of 50 MHz, 71 which is in the radio frequency range.
Precession
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MRI scanner
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Slice selection
Larmor frequency is proportional to Bo. If a slightly different Bo is applied to different sections of the body, each section will have its own individual Larmor frequency f. Hence, if a pulse of specific RF frequency is sent to the body, only those protons having exactly the same precession frequency f will resonate. Protons in neighbouring slices will be relatively unaffected The variation in the value of external field applied is achieved by using a gradient field coil. Btotal = Bo + B
(fixed) (spatially varying)
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MRI Image
Rf signals from the body are used to build up an image. Their origins are located using three perpendicular gradient fields. The signal strength depends on:
(i) Proton density (hydrogen concentration) (ii) tissue type (structure and surroundings) (iii) pulse sequence (iv) relaxation
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Resolution
Resolution can be improved using
(a) large and uniform main magnetic field B (b) Large gradient fields (c) Small receiver coils close to the body
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Advantages/disadvantages of MRI
Advantages
Safe since no ionising radiations are used Any selected plane and orientation can be imaged Excellent soft tissue contrast, no contrast agent needed Versatile since image varies with many parameters Body function and chemistry investigated besides structure
Disadvantages
High capital and running costs Image selection and interpretration is complex Examination can be claustrophobic, noisy and long Hazards with implants, (pacemaker) Practical problems associated with large superconducting magnets. Takes time For children it may not be possible as the patient has to be very still
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