BASIC PRINCIPLES OF RADIOLOGY

Bachtiar Murtala
Department of Radiology Medical Faculty Hasanuddin University Makassar

BASIC PRINCIPLES OF RADIOLOGY

Bachtiar Murtala

General objective
To introduce basic principles of radiology modalities as a tool of diagnosis ( and therapy )

Specific objectives : - Types of radiation - Equipments ( X-ray, CT, MRI, Nuclear medicine, US ) - Basic of interpretation - Biologic effects of radiation - Radiation protection

History in brief
Radiology started when Prof.Wilhelm Conrad Roentgen discovered of a new kind of rays (x-rays) in November 8,1895 in Germany He made a first photograph of his wifes (Bertha) hand in Dec 22, 1895 using the rays, signed the true birthday of radiology as a medical specialty. He was awarded Nobel Prize in Physics in 1901 Later, CT (Computed Tomography) and US (Ultrasonography) introduced in the seventies dan MRI ( Magnetic Resonance Imaging ) in the eighties. CT was discovered by Sir Godfrey Hounsfield, and together with Allen Cormack , awarded Nobel Prize in 1979.

Radiology can be categorized as

Diagnostic radiologyRadiations (ionizing and nonionizing ), used as a tool to make diagnosis of diseases. Radiotherapy or radiation oncology -radiation used as an agent to eradicate/to kill tumor/cancer

Types of radiation source

Radiations can be categorized into two main forms : (1) Electromagnetic
X-rays,gamma-rays, uv, infra red, visible light, radio waves.

(2) Particles
Electron, positron,etc

X-ray
To produce x-ray beam, we need :
A vacuum tube Electrons Focusing cup Metal filament Target

Characteristic of X-ray/gamma ray

Ionizing effect Biologic effect Penetrate object Attenuation Scattering photographic

Some distinguishes of the two rays:

X-Ray 1. Source 2.Wave length 3. Method of activation X-ray tube/machine Heterogen Should be generated by electric generator (-) Diagnostic and Therapy Gamma ray Radioisotop Homogen Spontaneous and continue

4. Half-life 5. Purpose

(+) Therapy and diagnostic

 In conventional radiography, after passing the body, x-ray will create an image directly on photographic film. The film is covered by a thin emulsion of Silver Bromide (AgBr), which is very sensitive to x-rays and visible light, blackening the film after having developed in liquid developer ( washing processing )

Terms in conventional radiography

Darkness to brightness Hyperradioluscent : free-air Radioluscent : lung, fat tissue Intermediate : soft tissues,water/fluid Radiopaque : Calsium, bone Hyperrariopaque : metal

CT-Scan
(Computerized Tomography Scan )
The greatest step forward since the discovery of X-rays. First CT-Scan was introduced in 1972. X-rays pass the patient and reach detectors ( not on the film ) Only thin tissue slices are exposed by X-rays high contrast resolution, no superimposition/ blurring of structures Tissue and water/fluid can be distinguished ( in conventional radiography can not be )

Terms in CT
Hyperdense : blood, calcification, bone Isodense/normodense : normal soft tissues such as; brain, liver, spleen,etc Hypodense : fluid, edema, fat, abscess, tumor, etc.

HU=Hounsfield Unit

CT-axial

MRI ( Magnetic Resonance Imaging )

The latest newcomer of radiological modalities Exploits hydrogen nuclei (proton) of the human body to develop signal Images in any plane of any part of the body No ionizing radiation No biologic effects Contraindication for patients with using ferromagnetic material such as pacemaker More expensive, theoretically more difficult, and technically more advanced

Main Components
A very strong magnet ( 0.1-1.5 Tesla or > ) A radio transmitter A radio frequency receiver coil A computer

Terms in MRI
T1WI, T2WI, DWI, etc (T1 Weighted Image) Hyperintense : brightness Isointense : same with normal adjacent tissue Hypointense : darkness

Coronal view Sagittal view

Arteriografi

CT Scan
MRI sagittal/samping

T1WI T2WI

Radionuclide Imaging ( Nuclear medicine )

Radioactive introduced into the body of the patients orally or intravenously Detection of radiation emitted from radioactive tracer inside the patient Radioactive tracers, termed radiopharmaceuticals emit gamma rays. Gamma camera is used to detect the rays and produce image.

Two major tomographic methods :

(1) SPECT ( single photon emission computed tomography) (2) PET ( positron emission tomography )

PETPET

Ultrasonography
Ultrasound (US) sound wave freq >20 KHz (above the human hearing range) Commonly used : 2-10 MHz No biologic effects

Components
Transducer/probe which contain piezoelectrical crystals ( the main component ) These crystals act as both transmitter/produce ultrasound and receiver (of echo) Computer and dysplay Printer

 The most important part is transducer Transducer contains piezoelectric crystals with two functions : transmitter of US and receiver of echo Echo returning to transducer generates electrical signalscomputer image

Terms in US
Hyperechoic = echorich brightness : calcification, stone, gas Isoechoic= normoechoic : normal soft tissue; liver, spleen, etc Hypoechoic = echopoor : tumor, abscess Free-echoic = unechoic : fluid ;water,etc

Positioning in radiography
In conventional radiography, we should familiar with the routine positions PA : Postero-anterior AP : Anterio-posterior RLD : Right lateral decubitus LLD : Left lateral decubitus etc

Foto2

Biologic effects
Come from X-rays and gamma-rays since they can ionize atoms/molecules of human tissue Can be grouped into : immediately effects, latent somatic effects, and manifest genetic damage

Principles of radiation protection

Should be apply to : patient, personnel, and environment / around people Work with : - shorten time, - appropriate distance, - use protective tools Avoid and reduce somatic and genetic doses to as low as possible ( ALARA, As Low As Reasonably Achievable )

Thank you