Medical Physics Course Notes (Greg Pitt)

Medical Physics
Contextual Outline
The use of other advances in technology, developed from our understanding of the electromagnetic spectrum, and
based on sound physical principles, has allowed medical technologists more sophisticated tools to analyse and interpret
bodily process for diagnostic purposes. Diagnostic imaging expands the knowledge of practitioners and the practice of
medicine. It usually uses non-invasive methods for identifying and monitoring diseases or injuries via the generation of
images representing internal anatomical structures and organs of the body.
Technologies, such as ultrasound, compute axial tomography, positron emission tomography and magnetic resonance
imaging, can often provide clear diagnostic pictures without surgery. A magnetic resonance image (MRI) scan of the
spine, for example, provides a view of the discs in the back, as well as the nerves and other soft tissues. The practitioner
can look at the MRI films and determine whether there is a pinched nerve, a degenerative disc or a tumour. The greatest
advantage of these techniques are their ability to allow the practitioner to see inside the body without the need for
surgery.
This module increases students understanding of the history of physics and the implications of physics for society and
the environment.
1. The properties of ultrasound waves can be used as diagnostic tools
The use of
Thisisthe2002syllabusupdate
Option9.6 page1 GPittgregphy@tpg.com.au

Medical Physics
References
http://www.khwarzimic.org/biomed/us.html
http://www.med.sc.edu:1000/5ultsd.html
http://uwscat.radiology.wisc.edu/tutorial/bmode_imaging
http://www.obultrasound.net/history.html
http://www.obultrasound.net/history2.html
http://www.obultrasound.net/history3.html
http://www.obultrasound.net/lineararrays.html
http://physicsweb.org/articles/world/15/6/7/1/pw1506071 [PET]

Medical Physics
Why is Ultrasound Done?

[The following notes in blue arial font are directly quoted from the website at the end they need to be edited]
Ultrasoundimaging(alsocalledultrasoundscanningorsonography)isarelativelyinexpensive,fast
and radiationfree imaging modality. Ultrasound is excellent for noninvasively imaging and
diagnosinganumberoforgansandconditions,withoutXrayradiation.Modernobstetricmedicine
(forguidingpregnancyandchildbirth)reliesheavilyonultrasoundtoprovidedetailedimagesof
thefoetusanduterus.Ultrasoundcanshowfetaldevelopment,andbodilyfunctionlikebreathing,
urination, andmovement.Ultrasoundisalsoextensivelyusedforevaluatingthekidneys,liver,
pancreas,heart,andbloodvesselsoftheneckandabdomen.Ultrasoundcanalsobeusedtoguide
fineneedle,tissuebiopsytofacilitatesamplingcellsfromanorganforlabtesting(forexample,to
testforcanceroustissue).
Ultrasound imaging and ultrasound angiography are finding a greater role in the detection, diagnosis and
treatment of heart disease, heart attack, acute stroke and vascular disease which can lead to stroke.
Ultrasound is also being used more and more to image the breasts and to guide biopsy of breast cancer.
What A Person Experiences, What to Expect During an Ultrasound Study
1. Patient preparation involves removing any articles of clothing or jewellery surrounding the area to be
imaged. In some cases, the patient may be asked to wear a patient gown.
2. The patient is positioned by the technologist on an examination table. A clear gel (which helps "connect" the
ultrasound transducer to the skin) is applied to the area to be examined, for example the abdomen
3. The technologist then brings the transducer into contact with the skin and sweeps it back and forth to image
the area of interest (e.g the foetal baby). The patient is simply required to relax and stay calm during the
examination.
4. The technologist will ask the patient to get dressed and wait while the ultrasound images are reviewed,
either on film or a TV monitor. In many cases, the technologist or physician reviews the ultrasound images in
real time as they are acquired.
5. After the ultrasound images are reviewed, the patient will be released from the imaging department or
center. In some cases, more images will need to be taken. For more information see "what happens during a
diagnostic imaging examination?"

Medical Physics
How Does Ultrasound Work?
In the 1960's the principles of sonar (developed extensively by the US Defense Department during the Second
World War) were applied to medical diagnostic imaging. The ultrasound process involves placing a small
device called a transducer, against the skin of the patient near the region of interest, for example, against the
back to image the kidneys. The ultrasound transducer combines functions like a stereo loudspeaker and a
microphone in one device: it can transmit sound and receive sound. This transducer produces a stream of
inaudible, high frequency sound waves, which penetrate into the body, and bounce off the organs inside. The
transducer detects sound waves as they bounce off or echo back from the internal structures and contours of
the organs. Different tissues reflect these sound waves differently, causing a signature, which can be
measured and transformed into an image. These waves are received by the ultrasound machine and turned
into live pictures with the use of computers and reconstruction software.
Color ultrasound image of the kidney
What is Ultrasound Good at Imaging?
Because high-frequency sound waves cannot

penetrate bone or air, they are especially useful
in imaging soft tissues and fluid filled spaces.
Ultrasound is good at non-invasively imaging a
number of soft tissue organs without X-rays:
* heart
* pelvis and reproductive organs
* kidneys, liver, pancreas, gall bladder
* eye
* thyroid
* blood vessels
* fetus
Updated: November 10, 2000

http://imaginis.com/ultrasound/
Background
Reviewthenatureandpropertiesofsoundfromthepreliminarycourse,particularlythefollowing
points:
Soundisaformofenergyproducedbyvibrationinamedium
Asoundwaveproducesperiodicpressurevariationsinthemediumthroughwhichittravels
Anelasticmediumisnecessaryforthepropagationofsound
Sound propagates as a longitudinal wave consisting of alternating compressions and
rarefactions
Thespeedofsoundisdifferentindifferentmedia

Medical Physics
Introduction and Principles of Ultrasound

Ultrasonographyisanoninvasivediagnosticprocedureusedtoexamineinternalorganandsoft
tissuestructure.Ultrasoundisveryusefulforimagingstructuresinthebody.
Soundfrequenciesintherangeof2to10megahertz(MHz)areusedfordiagnosticultrasound,
whichisbeyondtherangeofaudiblesound.Frequenciesoffrom2MHzto10MHzaretypically
used.Ultrasoundtravelsasalongitudinal,mechanicalwavewithcompressionandrarefactionofthe
tissuesthroughwhichitistravelling.
Apiezoelectrictransducerisusedtoemitanddetecttheultrasoundwaves.Thetransducertransmits
forpulsesofultrasoundforonly1%ofthetimeandreceivesfor99%ofthetime.
Thevelocityofpropagationoftheultrasoundwavedependsonthetissuetypethroughwhichthe
soundtravels.Thespeedofsoundvariesinsofttissuefrom1450to1540meterspersecond(m/s).
Thespeedofsoundinairis331m/sandboneis4080m/s.
Echoesareproducedfromanytissueinterfacewhereachangeinacousticalimpedanceoccurs.
Ontheseimages,thefilmdensityisproportionaltotheintensityoftheecho(amoreenergeticecho
wouldproduceadarkerorlighterdotonthefilm).Theintensityofthereturningecho,thatisthe
energyreturnedtothetransducer,isdeterminedby
(1)themagnitudeofthechangeintheacousticalimpedanceattheechoinginterface

Medical Physics
(2)thecharacteristicsoftheinterveningtissue
(3)thenormality(perpendicularity)oftheinterfacetothetransducer.
Theappearanceoftheechoonthefilmisalsodeterminedbythedegreeofamplification(gain)
appliedaftertheechohasbeenreceivedbythetransducer.
Advantages of using ultrasound
Itisnoninvasivedoesnotrequiresurgicalprocedures
Illpatientscanbeexaminedwithoutsedation,andrelativelyquicklyandconveniently
SincesoundisnonionisingitdoesnotdamageDNA,cellsandtissues
Itisrelativelycheap(comparedwithotherscanningtechnologies)
Disadvantages of using ultrasound
Itoperatesinmanyplanesbutnotsimultaneouslyandisthereforeoperatordependent
Itislessintuitivelyinterpretable
Itisdifficulttoproduceclearimageswithobesepatients(attenuationandreflectionfromfat)
Thepresenceofairandboneposeproblemsbecausetheiracousticimpedancesaresodifferent
fromsofttissue
Describe the properties and production of ultra sound and compare it to sound in
normal hearing range
Ultrasoundisdefinedassoundhavingfrequenciesexceeding20kHz(theeffectivelimitofhuman
hearing).Inbiomedicalultrasoundinstrumentation,frequenciesashighas10MHzarecommonly
used.
Itisanonionisingformofenergythatpropagatesthroughamediumaspressurewaves.Ifthe
pressurevariationsweremeasuredtheywouldbeseenasverysmallpressuredisturbancesrapidly
alternatingaboveandbelowthenormalbackgroundpressureastheultrasoundwavepropagates
throughthetissue,untilthewavepasses.Ultrasoundpropagatesasalongitudinalwaveconsisting
ofalternatingcompressionsandrarefactions.

Medical Physics
Onepropertyofasoundwaveisitsfrequency,thenumberofoscillationsorfluctuationspersecond
inthemedium.Audiblesoundshavefrequenciesbetweenabout15cyclespersecond(15hertz,Hz)
and20,000cyclespersecond(20kHz).Theupperlimitofhumanhearingisusuallytakentobe20
kHz,andultrasoundreferstosoundwaveswhosefrequencyisabovethislevel.Othermammalsare
notnearlyaslimitedasmanintermsoftheusefulsonicfrequencyrange.Forexamples,batsand
dolphinsutiliseultrasoundwavesthathavefrequenciesashighas125kHzfornavigatingandsonar
visualisation.
Medicalultrasoundapplicationshavebeendescribedthatusefrequenciesfrom500kHzto30MHz.
Formostimagingapplications,ultrasounddevicesoperatebetween3.5MHzandabout10MHz.
Theexceptionisforintravascularimagers,tinycathetertippedprobesoperatingatfrequenciesas
highas 30MHz. Theoptimal ultrasoundfrequencyforanyapplication represents atradeoff
betweentheneedto
(a) acquireultrasoundimageswithahighdegreeofspatialresolution,dictatinguseofhigher
frequencies,and
(b) obtainadequatepenetrationinthetissue.Imagingdepthintotissueislimitedbyattenuation
of the ultrasound waves, and this becomes more severe as the ultrasound frequency is
increased.

Medical Physics
Thespeedofultrasoundisdifferentindifferentmedia
Velocity of sound in some Biological Materials
Velocity of Sound Impedance
Material
(m/s) (Rayl x 106)
Air 330 0.0004
Fat 1450 1.38
Water 1480 1.48
Average Human Soft Tissue 1540 1.63
Brain 1540 NA
Liver 1550 1.65
Kidney 1560 1.62
Blood 1570 1.61
Muscle 1580 1.7
Lens of eye 1620 NA
Skull Bone 4080 7.8
Ultrasoundcanbeclassifiedintotwocategories:lowintensityandhighintensity.Thepassageof
lowintensitysoundthroughamediumdoesnotaffectthemediumitself,asisgenerallythecase
with diagnostic devices (e.g. foetus monitors, echocardiograph sensors, and other imaging
apparatus). High intensity signals, on the other hand, affect the medium, as is the case with
therapeuticdevices.Anexampleistheuseofultrasoundtoheatsoremusclesortodisintegrate
kidneystones.
Inordertoobtainultrasoundimages,itwasnecessarytomanuallymovethetransduceracrossthe
specimenarea.Evenfasterscannersrequiredconsiderabletimetogenerateanultrasoundimage;
andconsequentlyonlystatictargetscouldbeeffectivelyscanned.Inordertobeabletomapmoving
targets,suchasabeatingheart,itwasnecessarytodeveloprapidmeansofscanningandtodevelop
realtimetechniqueswhichwouldprovideinstantaneousfeedbacktotheclinicaltechnicianofthe
transducerpositionandthesystemsettings.
Newtypesoftransducershavebeendevelopedtorapidlyscanningbeamsincluding
(1) Pistonshapedtransducersthatrotateormoveaboutfixedaxestomechanicallysteerthebeam
throughashapedsector.
(2) Linearsequentialarraysthataredesignedtoelectronicallyfocusthebeamoverarectangular
imagesection.
(3) Linearphasedarraytransducersthataredesignedtoelectronicallysteerandfocusthebeamat
highspeedinasectorimageformat.
Describe the piezoelectric effect and the effect of using an alternating potential
difference with a piezoelectric crystal
An ultrasonic transducer is a generator of acoustic waves by converting magnetic, thermal or
electricalenergyintomechanicalenergy.Conversely,itcanalsofunctionasasensorbyconverting

Medical Physics
acousticwavesintomagnetic,thermalorelectricalenergy.Themostefficienttypeoftransducerfor
medical ultrasounduses thepiezoelectric effect(discoveredbythe brothers Jacques andPierre
Curiein1880).Whenamechanicalstressisappliedtoaquartzcrystal,anelectricpotentialoccurs
acrossoppositefacesofthecrystal.
An inverse effect also occurs when an electric field is applied across the crystal to induce a
mechanicaldeformation.Itisbythisprinciplethatapiezoelectrictransducerconvertsanoscillating
electricsignalintoanacousticwaveandviceversa.
The most principal materials used for transducers in medical ultrasound are the ferroelectric
materials. A standard material is the ferroelectric ceramic leadzirconatetitanate (PZT), which
carriestheadvantageifhighelectromechanicalconversionefficiencyandlowintrinsiclosses.The
propertiesofPZTcanbealteredbymodifyingtheratioofzirconiumtotitaniumanddopingwith
smallamountsofothermaterialssuchaslanthanum.

Medical Physics
Transducer Types
Linear array & curvilinear transducers
Linear Array Transducers
Thesehaveanumberofrectangulartransducerelementsarrangedinaline.Theimagedisplayis
rectangularinshape(Achillestendoninthelowerlegshowninthisultrasoundimage,produced
usingalineararraytransducer).
Disadvantage Wide, flat contact surface requiring the acoustic window (contact point with
patient)tobeequalinsizetothetransducerface.
AdvantageWidefieldofviewformoresuperficialstructures.Electronicfocusingisused.
Curvilinear (Convex Array) Transducers
Thesearecurvedontheirscanningsurface,resultinginaslightlydivergentbeam.Thesedisplaya
wedgeorpieshapedimage.Therequiredacousticwindowdependsonthedegreeofconvexityof
thetransducersurfacebutgenerallyhasanarrowwindowattheskinsurface,whilestillprovidinga
wideangledeeptotheskin.Thistypeoftransducerisgoodforscanningtheabdomen,prostateand
thoraxofsmallanimals(veterinaryultrasound),andtheheartsofallanimals.
Theyhaveagoodabilitytoscanliverandprostate.Electronicfocusingisused.
Becauseofitsconvexshape,thecurvilinearorconvexsectorarrayfitsbetterontheabdomenand
scansawiderfieldofviewthandoesalineararrayconfiguration.Thecurvilineararrayoperatesin
the same manner as the linear array in that the scan lines are directed perpendicular to the
transducerface.Asmanyas512elementsconstituteaconvexsectorarrayincurrentlyavailable
scanners.Anaperturecontainingasmanyas128elementsisselectedtofunctionatagiventime.
Similartothelineararraystheacousticbeamsarefocusedbutnotsteered.
The curvilinear or convex sector array became popular and completely replaced the linear
configurationinthelate1980s.

Medical Physics
Convexsectorsystems arecapable oflateral resolutionontheorderoflessthan1mm.Axial
resolutionof1mmisalwayspossibledependingonthefrequencyofthesystem.Awideaperture
arraydesignmeansthatpulsesfromalargenumber(say128)oralltheelementsareusedtoform
eachscanline.Ateachline,adifferentdelayedpulsesequencingofthewholearrayofelementsis
requiredtoformtheuniqueinterferencepattern,resultinginahighlyfocusedultrasoundbeam
perpendiculartothetransducerface.Sinceauniquedelaypatternforalltheelementsisrequiredto
produceeachscanline,highlysophisticatedcomputercontrolledelectronicsarerequired.Lateral
resolutionoflessthan0.5mmcanbeachieved.
Advantage smallacousticwindow(regionthroughwhichtheultrasoundentersthebody)atthe
skinsurface,whilestillprovidingwideangledeeptotheskin.
Disadvantagenarrowfieldofviewclosetothetransducermakingstructuresnearthetransducer
difficulttoview.Theuseofastandoffpad,whichmovesthetransducerawayfromtheskinbut
providesappropriateacousticimpedancematching,canhelpviewthesestructures.Theyalsohave
poorerimageresolutionthanlineartransducersduetothedivergenceofthebeamasittravels
deeperintothetissues.
Note the small acoustic window the area through which the ultrasound enters the
body at the top
Complexultrasoundtransducersarebeingdevelopedforproducingrealtime3Dimages.These
simultaneouslyproducesectorscansinmanyplanes.Highspeeddigitalsignalprocessingpermits
the large amount of gathered data to be assembled into a 3D image. Shown below are three
examplesofthescanningpatternproducedbysuchtransducers.Examplesof3Dultrasoundimages
areshownbelow.

Medical Physics
Examplesof3Dultrasoundimagesareshownabove
Mechanical sector transducers
Thesearethesimplestmechanismwhereasingletransducercrystalelementoscillatesinfrontofa
windoworagroupofcrystalsarerotatedinacylinderpastawindow.Aliquidcouplingmediumis
incontactwithboththecrystalandthewindow.Thesetransducersarefocusedmechanicallyand
eachtransducerusuallyhasasinglefocalrange.
Phased array sector transducers
Phasedarraysarearrangedinasimilarmannertothelineararray,exceptthattheelementsaremuch
smaller.Thisproducesasmallerscanhead,suitableforsmallacousticwindows.Eachindividual
crystalisconnectedtoitsowntransmitterandreceiverchannel.Thecrystalsarestimulatedoutof
phaseandconsecutively formawavefrontthat propagates atanangletothetransducerarray
[figuresACbelow].Thetimingofthesignalfromeachtransducercanbealteredtosteerthebeam.
Thetimedifferencebetweeneachsignalelementiscalledaphasedifference.Thephasedifference
canalsobeadjustedtoproduceabeamthatiscurvedatthetransducerfaceandsoasectorshaped
scanimagemaybeproduced,orthebeamcanbefocussedtoaspecificdepth.Thistechnique
producesastrongreflectionfromthefocusdepth,andweakerreflectionsfromotherdepths.This
permitsaclearerimageofthetargetorgantobeproduced.Thebeamangleandsizeiscontrolled
electronically.Phasedarraysresultinbetterresolutionandtheyhavenomovingpartscompared
with the mechanical transducer, however they are more expensive. [See movie
Steering[ultrasound].mov]
Reference: http://www.ecse.monash.edu.au/1302www/Lectures/Imaging/Beamsteering.html

Medical Physics
Thesteeredbeam,phasedarraysystemproducesasequenceofpulsesalongthetransducer
arrayproducingabeamfromeachelementofthearraywhichhasitsownuniqueanglewithrespect
tothetransducerfaceresultinginasectorformat.Thecomplexityofthenewerdesignsrequires
sophisticated, highspeed, computercontrolled pulsing of the individual elements circuitry.
Electronicfocussingonbothtransmitandreceiveprovidesalongerfocalzonewithanarrower
beamwidththanconventionalsingleelementdesigns.Similartolineararraydesigns,focussingin
thedirectionatrightanglestothescanplanedeterminestheslicethicknessandisaccomplishedby
theuseofanacousticlens.Sincethebeampathiselectronicallycontrolled,thedirection(vector)of
eachbeamcanbeselectedindividually.Thisuniqueadvantageovermechanicaldesignsallowsthe
systemtoperformsimultaneousBmodeimagingandMmodeorDopplerfunctions.
Theabovediagramshowsanendviewofa2dimensional96elementultrasoundphasedarray
transducer suitable for 3D ultrasound scanning [NC indicates that no electrical connection is
present].Thepanelstructureisflat.Eachelementisapiezoelectrictransducerwithitsownchannel.
i.e.thearrayislike96individualultrasoundscanners.Toproduceanimageusingthedatafrom
suchanarrayrequiresconsiderabledigitalsignalprocessing.

Medical Physics
Define acoustic impedance:

Acousticimpedanceistheproductofdensityandacousticvelocity
Z =
is density(kgm1)
vis velocityofsoundinthetissue(ms1)
Zis acousticimpedance(kgm2s1)
Example(fromultrasoundppt)

Medical Physics
Identify that different materials have different acoustic impedances

http://www.drgdiaz.com/tables.shtml
Substance density (kg m 3) Ultrasound velocity Impedance (rayl)

(m s 1)
water 1000 1540 1540000
Fat 920 1450 1334000
Bone 1810 4080 7384800
White matter (brain) 1040 1541 1602640
Grey matter (brain) 1040 1541 1602640
Muscle 1040 1585 1648400
Blood 1060 1570 1664200
Liver 1065 1549 1649685
Kidney 1040 1561 1623440
Lens of eye 1100 1620 1782000
Skull bone 1910 4080 7792800
Nerve tissue 1040
Cartilage 1100
Bone marrow 1810
Skin 1010
CSF 1010

Medical Physics
Ir Z2 Z1
2
Identify that the ratio of reflected to initial intensity is 2 :

Io Z2 Z1
Whenultrasoundmeetsaboundarybetweentwomediawithdifferentacousticimpedances,someof
theultrasoundenergywillbereflectedandsomewillbetransmitted.Thelawofconservationof
energyrequiresthatthesumofthereflectedandtransmittedenergiesmustbeequaltotheoriginal
energyincidentontheboundary.
Thereflectionofultrasoundataboundaryisillustratedinthefollowingdiagram.Theincident
ultrasoundintensityisrepresentedbyIo,thereflectedintensitybyIrandthetransmittedintensityby
It.Notethatforanyreflectiontooccur,theacousticimpedancesofthetwomedia,Z 1andZ2,must
bedifferent.
Theratioofthereflectedintensityofultrasoundatatissueboundarytotheoriginalintensityofthe
ultrasoundattheboundaryisequaltotheratioofthesquareoftheacousticimpedancedifferences
tothesquareofthesumoftheacousticimpedances.Thisisrepresentedbytheequation
Ir Z2 Z1
2

Io Z2 Z1
2
Describe how the principles of acoustic impedance and reflection and refraction are
applied to ultrasound
Ultrasound is only reflected when it encounters a boundary between tissues having different
acousticimpedances.
Thegreaterthedifferenceinacousticimpedance,thegreatertheproportionoftheultrasoundthatis
reflected(andthelessertheamountthatistransmittedthroughtheboundary).
Becausebonehassuchahighacousticimpedancecomparedtoothertissues,mostoftheultrasound
energythatencountersboneisreflectedback.Forthisreason,ultrasoundcannotbeusedtoexamine
internalstructureofbone,norcanitbeusedeffectivelytoexaminethebraininsideanadultskull.
Someultrasoundpenetratestheskullofafoetus,becausetheboneoftheskullhasnotcalcifiedit
isatissuecalledcartilage(similartothetissuethatgivesearstheirsemirigidnature).
Because ultrasound is also refracted at a boundary between two different tissues, this can
complicatetheanalysisofthedata.
Explain that the greater the difference in acoustic impedance between two materials
the greater the reflected proportion of the incident pulse
Application oftheequation abovetodifferent pairsofmediademonstrates thatthegreaterthe
differenceinacousticimpedancebetweentwomaterialsthegreaterthereflectedproportionofthe
incidentpulse.Thisisshowninthefollowtwoexamplesoftheapplicationofthisequation.

Medical Physics

Itshouldbenoticedherethatifultrasoundstrikesasofttissueboundaryofanytypetravellingfrom
air,orothergas,thenmostoftheultrasoundenergyisreflected.Forthisreason,whenanultrasound
isbeingcarriedout,agelisplacedontheskinandtheultrasoundprobeismovedoverthisgel.The
mostimportantfunctionofthegelistoexcludeanyairfromtheregionbetweenthetransducerand
theskin.Thegelhasanacousticimpedancesimilartohumantissue.Thetermusedtodescribethis
processis impedancematching.Impedancematchingbetweentwomediaresultsinmostofthe
energybeingtransmittedthroughtheinterface,withalmostnoreflection.
Describe the situations in which A scans, B scans and phase and sector scans
would be used and the reasons for the use of each
The size of an object that can be imaged using ultrasound depends on the frequency of the
ultrasound.Allwaveshavethepropertyofbeingdiffractedbyobjectsthatareopaquetothewave.
Ifthesizeoftheobjectislessthanaboutawavelength,thediffractionbecomessosignificantthat
verylittleofthewavereflectsbackfromthesurface.Theoutcomeofthisisalimittotheresolving
ability when using any wave to look at an object. This limit experienced with ultrasound is
summarisedinthefollowingtable.
Lowfrequencywavesaremoreeffectiveinpenetratinghumantissue.Thisfact,whenconsidered
withthediffractionlimitedresolutionresultsinadilemmaforultrasonography.Inordertoproduce
aclearimageofanobjectdeepinthebody,lowfrequencywavesshouldbechosenoverhigh
frequencywaves.Howevertoobtainaclearerimageofsmallerstructures,ahighfrequencyneeds
tobeused.Clearlythefinalchoiceisacompromisebetweentheseconflictingcriteria.
Ultrasound Scanning Modes
Ultrasoundcanbeusedindifferentways,calledmodes,whichproducedifferentdataandimages.

Medical Physics
A mode Scans
Whenasingleelementtransducerisusedandthetransducerisstationary,onlyasingledimension
canberecorded.Thatdimensionisthedistanceoftheechoinginterfacefromthetransducer.This
distance is calculated bydetermining the length oftime required forthe echotoreturn tothe
transducerafterthetransducersendstheoriginalpulseofsoundenergy.Thecalculationisbasedon
theaveragespeedofsoundintissue,whichis1540metrespersecond.AtypicalAmode(orA
scan)isshownintheimagebelow(left)andthecentralportionoftheimageontheright.

Principle of A mode
Returningechoesproduceaverticaldisplacementofahorizontaltimebaselinedisplayedonan
oscilloscope.Theamountofdisplacementisproportionaltotheamplitude.Thiswasthefirstuseof
ultrasoundasitisrelativelysimple,requiringlittlesignalprocessingtodisplaythedata.

Medical Physics
When is A Mode used?

TypicallytheAscanisusedtoexaminemidlinestructuresinthebrain,solidorcysticstructures,
foreignbodiesintheeye,abnormalfluidaccumulationaroundtheheartorlungs,ortoguidebiopsy
andamniocentesisneedles.
Ifthetransducerismovedacrossthepatient'sbodywhileallechoesarerecordedandmaintainedon
avideoscreen,atwodimensionalimage("B"scan)willbegenerated(seebelow)
B Mode Scans
ThemostcommonlyusedmodalityinmedicalultrasoundiscalledBmodeimaging.Anultrasound
transducerisplacedagainstthepatientsskinsurface,directlyovertheregiontobeimaged.The
transducersendsaverybriefpulseofultrasoundintothetissue.Thepulsetravelsintothebodyasa
beam,verymuchlikethebeamofasearchlight. Interfacesalongthewayreflectsomeofthe
ultrasound energy back to the transducer. The transducer, in turn, converts the energy of the
reflected echo into electrical signals, which are sent into amplifiers and signal processing
components of the ultrasound machine. The exact, delay between when the transducer first
launchedtheultrasoundpulseandwhenitpickedupanechoallowsthemachinetocalculatehow
farthereflectinginterfaceisfromthetransducer,giventheknownspeedofultrasoundinthetissue.
Afteralltheechoesarepickedupfromalongthefirstbeam,thetransducersendsasecondpulse
alongaslightlydifferentbeamdirectionintothetissue.Echoesarepickedupthesamewayandsent
forprocessingtoproduceanimage.Thenanotherpulseislaunchedinstilladifferentdirection,
andsoforth.Likethebeamofasearchlightissweptacrossthenightsky,thepulsedbeamfroman
ultrasoundtransducerissweptthroughoutthebody,mappingoutreflectingsurfacesandforming2
dimensionalimages.
Beamsaresweptandultrasoundimagesareformedveryrapidly,essentiallyinrealtime.Asthe
operatorholdsthetransducerincontactwiththeskin,theimageappearsliveonavideomonitor.
By moving and manipulating the transducer different internal views are provided. The images
representcrosssectional,ortomographicviewsoftheplanethatthebeamwassweptacrossin.
Bscanimagesaresometimesreferredtoascontactcompoundscanningbecausethetransducerisin
contactwiththepatientsbodyandthetechnologistmustuseacompoundorrockingmotionto
createanadequateanatomicaldisplay.
AnothermethodofcreatingatwodimensionalimageinBmodeisthe realtime method.Inthis
method,anarrayofmultipletransducerelementsisheldincontactwiththepatientsbody,allowing
atwodimensionalimagetobecreated.

Medical Physics
Principle of B mode
The majority of scanning is performed in the B Mode or Brightness mode. The returning
echoesare displayed on the oscilloscope as dots rather than time related vertical
deflections as with an A scan. The intensity or brightness of the dot is proportional to the
returning echo amplitude. This produces a two dimensional representation of the pattern of
returningechoesshowingasectionthroughthepatientwiththedotpositionrelatingtotheposition
ofthetissueboundaryfromwhichtheultrasoundwasreflected.
When used
Bscansareusedwidelywiththefollowinginvestigationsbeingtypicalapplications
Obstetrics/Gynaecology
Urinarysystem
Liverandotherabdomen
Cardiovascular
Breast,thyroidandspleen
Therealtimedisplayproducesausefullylargearea,whichiscontinuouslyimaged,andthisallows
evaluationofthemovementofsomeorgans,butthefieldofviewisnotaswideaswiththecontact
compound scanner. As you look at the images, observe which were made with the contact
compound scanner and which were made with the real time machine. Real time images are
usuallymadewithasectorscannersotheimageswillbepieshaped.
Real Time or Compound B Mode

TheBScaniscontinuouslyupdatedanddisplayedinrealtime,withtheimagechangingasthe
tissuesmoveinthefieldoftheultrasoundbeam.Themovementoftheobjectbeingscannedcanbe
monitoredontheimage.Itistypicallyusedtoexaminefoetalmovementsandtheveinsandarteries
intheabdomen.
Image Examples
Cross-sectional image of the heart (real time B mode)

Thisimageisaviewoftheheartsometimesreferredtoasafourchamberview.Sometimesitis
difficult to obtain this view because of the configuration of the patients chest wall. In most
individualsthereisanareainwhichtheheartisindirectcontactwiththeanteriorchestwalland

Medical Physics
thisprovidesanacousticwindowthroughwhichthesoundbeamcanbedirectedwithoutbeing
obstructedbyintervening,airbearinglung.Asyoucansee,ifthisimageweredisplayedinrealtime
itwouldbepossibletoevaluateventricularwallmotionaswellasvalvedynamics.
Aboveisanimageofthegallbladder(realtimeBmode)
Thishasbeenmadewithasectorscanneronrealtimeequipment.Thisimageismadewiththe
echoesbeingdisplayedaswhitespotsonadarkbackground.Thegallbladderinthisstudyhasan
abnormallythickwall,whichproducesastrongechosinceitsacousticimpedanceissignificantly
differentfromthatofthesurroundingtissue.
Theimagebelowshowsalongitudinalrepresentationofthekidneywithalargecyst.Thecystisthe
areashowingnointernalechoesthisisduetoitshomogeneousstructure.
Renal cyst - (real time B mode)

NoticetheAmodedisplayalongtheleftmarginoftheimage. Thecysthasarelativelyflat
amplitude tracing (A mode), indicating very little reflection of the ultrasound within the
homogenouscyst.
Interpretingultrasoundimagesrequiresconsiderableskillandknowledge,asthefollowingimage
demonstrates.Anuntrainedobserverwouldmakenosenseoftheimagewithoutexplanation.

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Base of the tongue (B-Scan)

Thebaseofthetongue(TO)examinedinasagittalplane(sectionviewedfromthepatientsside)
includinglandmarkssuchasthemyelohyoidmuscle(MH)andthehyoidbone(HB)usedbythe
doctortohelpinterprettheimage.Thesurface(arrows)ofthebaseofthetonguecanonlybe
detectedusingalowfrequencyultrasound.

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Obstetrics
Probably the best known use of medical ultrasound imaging is related to obstetrics. Most
pregnancieshaveultrasoundimagingatsometimeduringthegestation,whethertheyneeditornot.
Theimagebelow(left)isatransaxialimagethroughthefoetalhead.

Noticethesidewallsofthefoetalheadmarkedwithcrosses.Thedistancebetweenthemarkscanbe
measuredandcomparedtoacharttodeterminestageofgestation.
Theimage(aboveright)showstheentirefoetusandisagooddemonstrationoftheclaritywith
whichfoetalpartscanbeshown.Thisisanidealimagingsituationsincetheobjectofinterestis
surroundedbyfluid.Inthisimageyoucanseetheplacentaalongupperwalloftheuterus.Then
thereisaclearspacewithnoechoeswhichisthefluidsurroundingthefoetus.Thewelldefined
foetusislyingontheposteriorwalloftheuteruswithhisfeetproppedupontheplacenta.
Echocardiography
Principle
Pulsed ultrasound from a transducer is used and continuous recording is made of the echoes
receivedfromthevariouspartsoftheheart.
When is echocardiography used?
Echocardiography is used to investigate the heart valve function, left ventricular function,
congenitalheartdiseasesincludingholesintheseptum,cardiactumoursandobstructionsincardiac
bloodvessels.
Bone Density Measurements

Syllabus identify data sources, gather, process and analyse information to
describe how ultrasound is used to measure bone density
Osteoporosisliterallymeansporousbones.Bonesthatoncewerestrongtypicallybecomefragile
as a person gets older. The problem is common in postmenopausal women, but a significant
numberofmenalsosufferfromalossofbonedensity.A.Apersonmaynotrealisetheyhave
osteoporosisuntiltheysufferavertebralfracturewhendoingordinaryactivitiessuchasliftinga
bagofgroceries,orbreakahipinafall.
Lifelongweightbearingexercises,walking,runningandsportsinvolvingrunningaswellastheuse
of weights all significantly reduce the risk of osteoporosis. Swimming, although an excellent
exerciseisnotweightbearing.
Todetermineifapersonhasosteoporosisitisnecessarytomeasurebonedensitydirectly.

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Bonemineraldensitymeasurestheamountofcalciuminregionsofthebones.Bonedensity
testingcanmeasuretheamountofboneindifferentpartsoftheskeletonandcanpredicttheriskof
futurefracturesandmonitorchangesinbonemineraldensityduetomedicalconditionsortherapy.
Loss of bone density is a common problem in postmenopausal women. It can lead to bone
fractures,especiallythehip,withlittleapparentcause.Bonedensitydecreasesinbothmenand
womenovertheageof35.
Regularloadbearingexerciseisanimportantwayofmaintaininghealthybonedensitylevels
eveninpatientsover60.Theearlierandmoreconsistenttheloadbearingexerciseiscarriedoutby
aperson,thebetterthebenefits.Bothmenandwomenbenefitfromsuchexercisewhenitcomesto
maintainingbonedensity.
Twomethodsarecurrentlyusedtomeasurebonedensity
Xrays(CalledDXAorDEXADualXrayabsorption)Measuresspine,hiportotalbody.
Ultrasoundmeasurementsaretakenattheheel
TestingBonesWithUltrasound
Thereareseveralwaystomeasurebonedensity,mostofwhichinvolvetheuseofXrayradiation.
Xraybasedmethodsusuallytakeabonedensitymeasurementofthehip,spine,forearmorheel.
Ultrasoundisalsousedtoestimatethebonedensityoftheheel,astheheelbonecontainsahigh
percentageofthekindofbonemostaffectedbyosteoporosis.
Duringanultrasoundexam,twosoftrubberpadscomein
contact witheither sideofthe heel. Thesepads sendand
receivehighfrequencysoundwavesthroughtheheelbone.
Thetesttakesaboutoneminuteandisperformedinaseated
position,withthefootplacedandcomfortablysecuredinthe
ultrasound unit. No injections or invasive procedures are
necessary.Highfrequencysoundwavesarepassedthrough
theheel,andthebonedensityisestimatedfromthesound
waves transmitted. The test results are processed
immediately.
The ultrasound systems fortesting osteoporosis are smaller and less expensive than traditional
DEXAsystems.

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Assessing the value of ultrasound bone density measurement.

UltrasoundischeaperthanDEXAorquantitativeCT.
Ultrasoundrequiresnoexposureofthebodytoionisingradiation(althoughlevelsareverylow
withDEXAsimilartoatransAustralianairlineflightduringwhichexposuretoXraysof
cosmicorigintakesplace)
ReproducibilityofresultsusingultrasoundhoweverisnotquiteasgoodasDEXA
RelativeriskforhipfracturepredictedaswellbyultrasoundofthecalcaneusasbyDEXAof
thehip
FracturepredictionisindependentofDEXA,butaddingultrasoundtoDEXAdoesnotimprove
prediction
studiesshowthatultrasoundismainlymeasuringthebonemass;DEXAbetterabletopredict
bonestrength
References
http://www.bonsecours.com/imaging/bone.htm
http://www.spinalman.freeserve.co.uk/heelscanning.htm
http://imaginis.com/osteoporosis/osteo_diagnose.asp
http://courses.washington.edu/bonephys/opultra.html

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Describe the Doppler effect with respect to sound and how it is used in ultrasonics
to obtain flow characteristics of blood flow through the heart
Dopplerultrasoundscanningisusedtoimageanystructureortissuethatpulsatesormoves
Itisbasedontheprinciplethatwheneverthereflectorsurfacemoveswithrespecttothetransducer,
thereisashiftinthefrequency.
The Doppler shift effect has been used for a long time in foetal heart rate detectors. Further
developmentsinDopplerultrasoundtechnologyinrecentyearshaveresultedinitsincreasedusein
obstetricsinassessingandmonitoringthewellbeingofthefoetus.
Foetal blood flow is shownin the following colour Doppler image, with a schematic diagram
showingtheareabeingscanned.
ColourDopplerusesredtoshowflowormovementtowardsthetransducerandbluetoshowflow
away from it. Different colours and shades of colour are further used to show graphically the
velocityofmovement.
Outline some cardiac problems that can be detected through the use of the Doppler
effect
BloodflowcharacteristicsinthefoetalbloodvesselscanbeexaminedusingDopplerultrasound.
Diminishedflow,particularlyinthediastolicphaseofapulsecycle(astheheartmusclerelaxes)is
associatedwithbloodcirculationproblemsinthefoetus.Variousratiosofthesystolictodiastolic
flowareusedasameasureofthisfoetalheartfunction.Thebloodvesselscommonlyexamined
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includetheumbilicalartery,theaortaandthemiddlecerebralarteries. Theuseofcolourflow
mapping can clearly depict the flow of blood in foetal blood vessels in a real time scan, the
direction and velocity of the flow being represented by different colours. Colour Doppler is
particularlyindispensableinthediagnosisandassessmentofcongenitalheartabnormalities.

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Medical Physics
The physical properties of electromagnetic radiation can be used as diagnostic tools
Introduction
In1895WilhelmRoentgendiscoveredtheXrays.Thislaidthefoundationforoneofthemost
important diagnostic tools in modern medicine. Using Xrays, it is possible to look inside the
humanbodywithoutcuttingitopen.Howeverthesepicturesarefarawayfrombeingaperfect
imageoftherealbody.
AnormalXrayimageisa2dimensional projection oftherealthreedimensionalobject.This
meansinformationislostduringtheprocess,makingitdifficulttodistinguishbetweendifferent
partsoftheanatomyonthephotograph.

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Since their discovery in 1895, xradiation has been a vital medical and industrial tool.
Becauseoftheirgreatpenetratingpower,Xrayscanalsobeusedtostudythestructureof
livingorganisms.
OneoftheearliestapplicationsofXrayswasinmedicine,wheretheywereusedforbothdiagnosis
andtherapy.Theypenetratesofttissuesbutarestoppedbybones,whichabsorbthem.Thusifa
photographicplatethatissensitivetoXraysisplacedbehindapartofthebodyandanXray
sourceisplacedinfront,XRayexposurewillresultinanimageofthebonesandinternalorgans.
Whentheradiograph,orplate,isdeveloped,anegativeimageisproduced.Tissuesthatareeasily
penetratedbyXraysappeardark,whilebonesanddensetissuesshowupaslightorwhiteregions.
Althoughbonesarethemostopaquestructures,therearemanydensetissues,suchastumours,that
canalsoshowupunusuallylightinradiographs.
Images produced using Xrays can be used to study damaged or broken bones, inspect dental
cavities,detectforeignobjectsinthebody,anddiagnosediseases.
Hipbrokenasaresultofamotorcycleaccident[above]
TouseXraysfortheinvestigationofother,lessdensetissuesofthebody,suchasthe
gastrointestinaltract,thetissuesmustfirstbemadeopaquetoXrays.Generally,patients
areaskedtodrinkamixturecontaininganopaquesubstance,suchasbariumsulfate(the

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bariumabsorbsXraysstrongly),sothattheoutlineofthedigestivetractbecomesvisible
withXrays[aboverightnoticethespineofthepatient]
Describe how X-rays are currently produced
ModernXraytubesconsistofahighlyevacuatedglassormetaltubecontainingananode(positive
electrode)andacathode(negativeelectrode).Ahighpotential(50kV120kV)isappliedbetween
the anode and cathode. The cathode contains a heated filament, which that produces
thermoelectrons (by thermionic emission) into the vacuum. These are accelerated by the high
voltageandstriketheanode.InmodernXraytubesthecurrentbetweentheanodeandcathode
variesfrom1to500mA,dependingontheapplication.Exposuretimesaregenerallyafractionofa
secondforconventionalXrays.
Xraysareproducedbytherapiddecelerationoftheelectronswhentheystriketheanode.The
Xrayshavearangeofenergies;themaximumenergyofanXrayequalsthatoftheincident
electrons,i.e.themaximumenergyis80keV*when80kVisappliedtoatube.
OnlyafewpercentoftheenergyoftheelectronsisconvertedtoXraysandtheremainderis
convertedtoheat.Henceengineershaveseriousproblemsremovingtheheat.Theanodeis
madefromcoppertoconducttheheatawayanditcontainsatungsteninsertbecausetungsten
hasaveryhighmeltingpoint.(Notethat100kVtimes0.5Agives50kWdissipationinthe
anode,comparedto2.4kWmaximumfromatypicaldomesticpowerpoint.
* Anelectronvolt(eV)istheenergyacquiredbyoneelectronwhenitisacceleratedacrossa
potentialof1voltinavacuum.Itisequivalentto1.6x1019joules.
TwoschematicviewsofanXraytubeareshownintheimagesabove.Aschematicdiagrambelow
showstherelationshipbetweentheelectricfielddirectionandthedirectionoftheaccelerationand
velocityoftheelectronsinthevacuumtube.
Characteristic X-Rays
CharacteristicXraysareemittedfromtheatomsof
heavy elements when their electrons make
transitions between inner electron shells. The
characteristicXraysemissionwhichshownastwo

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sharppeaksintheillustrationinthegraphoccurwhenvacanciesareproducedinthen=1(orK
shell)oftheatomandelectronsdropdownfromahigherenergylevelshelltofillthegap.TheX
raysproducedbytransitionsfromthen=2ton=1levelsarecalledKalphaXrays,andthoseforthe
n=31transitionarecalledKbetaXrays.
ThecontinuousdistributionofXraysformingthebaseforthetwosharppeaksinthegraphis
calledbremsstrahlungradiation.
XrayproductiontypicallyinvolvesbombardingametaltargetinanXraytubewithhighenergy
electrons,whichhavebeenacceleratedusingpotentialdifferencesbetweenafewtenstohundreds
ofkilovolts.Thebombardingelectronscanejectelectronsfromtheinnershellsoftheatomsofthe
metaltarget.Thosevacancieswillbequicklyfilledbyelectronsdroppingdownfromhigherlevels,
emittingXrayswithsharplydefinedfrequenciesassociatedwiththedifferencebetweentheatomic
energylevelsofthetargetatoms.Fortungsten(W)thecharacteristicXrayenergyis69.5keV.For
molybdenum(Mo),theKshellbindingenergyis20keV,whichismakesitusefulforimagingsoft
tissuee.g.inmammography.
Bremsstrahlung Radiation
BremsstrahlungmeansbrakingradiationandisretainedfromtheoriginalGermantodescribe
theradiationwhichisemittedwhenelectronsaredeceleratedorbrakedwhentheyarefiredata
metaltarget.Acceleratedchargesgiveoffelectromagneticradiation,andwhentheenergyofthe
bombardingelectronsishighenough,thatradiationisintheXrayregionoftheelectromagnetic
spectrum.Itischaracterisedbyacontinuousdistributionofradiationthatbecomesmoreintenseand
shiftstowardhigherfrequenciesastheenergyofthebombardingelectronsisincreased.Thegraphs
showfeaturesofBremsstrahlungradiationfromtungstentargetsbombardedwithelectronsoffour
differentenergies.

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Compare the differences between soft and hard X-rays
Xrayscoverarangeoftheelectromagneticspectrumfromultraviolettogammarays.Theterm
softXraysisappliedtoXraysclosertotheUVspectrumandhardXraysarethosecloserto
thegammarayspectrum.ThereisnosharpdividinglinewithintheXrayspectrumorbetweensoft
andhardcomponentsandtheUVandgammaradiationoneitherside.SometimeshardXraysare
referredtoasgammaraysandviceversa,dependingonthecontextandtheuseroftheterms.
SoftXrayshavelongerwavelengthsandlowerfrequenciesthanhardXrays.
SoftXraysareusuallydefinedasXrayshavingawavelengthgreaterthan0.1nm(frequencyless
than3x1018Hz).ThesecorrespondtoXraysproducedusinganacceleratingpotentialof12kV.
(ManysourcesstatethatsoftXraysareproducedusingpotentialsupto20kV.Thereisnosharp
dividinglineoragreedstandard.
ThenatureofXraysproducedbyanXraytubedependsonthevoltageappliedtothetube,which
inturndeterminesthekineticenergywithwhichtheelectronsstrikethetungstenanodeinthetube.
HighervoltagesthusgiverisetohardXraysandlowervoltagesproducesoftXrays.
RadiologistsoftenspeakaboutthevoltageusedintheXraytubewhencategorisingXrays,rather
thananintrinsicpropertyoftheXrayssuchasfrequencyorwavelength.

Medical Physics
Gather information to observe at least one image of a fracture on an X-ray film and
X-ray images of other body parts

Agoodbrokenwristofanextremebikerider!NotonlyhumansgetXrayedthough.
Thisisaninterestingimagebecausethesurgicaltoolisinsidethepatientwhohadbeenstitched
backupandwasrecoveringafterthesurgery.Thingswerentgoingexactlyasexpected,andthisx
rayshowedwhy.Thepatientwasreturnedtotheoperatingtheatretohavethetoolremoved.Note
thatitisnotpossibletotellthatthetoolisinsidethepatientfromthisXray.Thesameimagecould
beproducedifitwaslyingaboveorbelowthepatient,ontheoutside.InthiscaseasecondXray
wasusedtoconfirmthatitwasindeedinsidethepatient.Thebigquestionremainshowcould
thishappen?

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ThedepthperceptionproblemisalsoevidentinthisXray,inwhichthreedimensionshavebeen
projectedintotwo.AgoodknowledgeofanatomyisneededtointerpretXrays.

Medical Physics
An Unusual Case
X-ray of Ron Hunt's head. Photo: AP
Ron Hunts friends and family have been calling
himtheMiracleManeversincean45centimetre
longdrillbitpokedthroughhiseyeandouttheback
ofhisskull.
Itdidntseempossibleforhimtobealive,seeing
himwithadrillbitthroughhishead,hisnephew
BenHuntsaid.
TheconstructionworkerfromTruckee,California,
lost an eye but survived the freak accident on
August15withnobraindamageafterfallingfroma
ladderandontothedrill.
The3.8cmdiameterchipaugerdrillbitwasstillinhisheadwhenhisbrother,ChrisHunt,and
nephew,Ben,methiminahospitalemergencyroominReno,Nevada.
Thenursesbracedusforitbeforewesawhim,BenHunttoldtheSierraSunnewspaperof
Truckee.
Itdidntseemrealitseemedlikeamovie.Iwasntsurewhattofeel.
Doctorsexplainedthatthedrillbitpushedhisbrainasideratherthanpushingintoit,whichlikely
wouldhavecausedseriousbraindamageordeath,BenHuntsaid.
WhiledrillingabovehisheadonAugust15,thetwometreladderRonHuntwasstandingonstarted
towobblesohetossedthedrillasideasconstructionworkersaretrainedtodo.
Hethenfellofftheladderfacefirstandontothedrill.
BythetimeIwasfalling,andIletthedrillgodown,Iwasalreadyontopofit,RonHunttold
ABCsGoodMorningAmericaTVshowtoday.
Iranmyhandsupthedrillbit,uptomyeye,andputmyotherhandinthebackofmyheadand
feltitcomingthroughthebackofmyhead,hesaid.
Andthatswhereprettymuchtheshocksetin.
HewastakenbyhelicoptertoWashoeMedicalCentreinReno.
Afterweighingtheiroptions,doctorsessentiallyunscrewedthebittoremoveit.
Wewouldhavecutitoff,butafterafewminutesofdrilling,wenoticedthatitwasloose.Andso
wejustputdownourbladeandtwistedthebit,saidDrPaulLudlow,thesurgeonwhoperformed
theoperation.
Hisnephewthinkshellbeabletolaughaboutitsomeday.
Itsjustgoingtobeoneofthosestories,BenHunttoldtheSierraSun.
Helljokearoundwithhisglasseyeandpopitout.
AP
Copyright2003.TheSydneyMorningHerald.

Medical Physics
Explain how a computed axial tomography (CAT) scan is produced

NBTheHSCsyllabususestheacronymCAT,butCT(ComputerisedTomography)isthemore
common acronym. Thewordtomography relates totheformationofaslice or2Dimage
producedparalleltotheplaneinwhichtheXraybeampropagates,asopposedtoconventionalX
rayimages,whichshowa2DimageperpendiculartothepropagationdirectionoftheXrays.
http://www.ctlab.geo.utexas.edu/dmg/projects/alligator/html/ct_info.htm
http://www.bocaradiology.com/Procedures/3DCT/
http://www.ucmp.berkeley.edu/synapsids/rowe/thrinax.html
TheinventionoftheXrayprovidedmedicinewithanondestructivemeansofstudyingtheinterior
ofthebody.Unfortunately,theconventionalradiographimagesaredifficulttointerpretinthree
dimensions,becauseobjectsin3Darelayeredoneontopoftheotherinthe2Dimage.
Duringthe1970s,thisproblemwassolvedbythedevelopmentofcomputedtomographicorCT
scanning.Inthistechnique,aspecificplaneofthepatientistraversedbyanarrowsectorshapedx
raybeam.

Medical Physics
The Computerised Tomography Scanner (CT) produces a sectorshaped Xray beam, which is
rotatedaroundthebody,collectingdataviathedetectorsfrommanydifferentanglesastheXray
sourcerotatesaroundthetarget.Thebeamisverynarrowinthedirectionperpendiculartothe
sectorbeingscanned.
AbsorptionoftheXraysvariesastheangleischanged.CTusestheeffectofdifferentialabsorption
ofXraysintissuesofdifferentdensity.AnXraysourceemitsphotons,whicharescatteredand
attenuatedastheypassthroughthebody.OntheoppositesideanarrayofdetectorsmeasurestheX
rayintensity.DigitisedinformationontheattenuationoftheXrayspassingthroughtheilluminated
planeatvariousangles,andatvarioustimesduringrotation iscollectedandstored.Theoriginal
intensityoftheXraybeamiscomparedwiththecollecteddata.Bymeasuringtheattenuationat
differentanglesandusingamathematicalalgorithm,itispossibletocalculatethedistributionof
tissuedensity,andhenceconstructatwodimensionalimageofthecorrespondingslicethroughthe
patientsbody.
ComparetheresultingCTXrayimagewithaphotographofachestcrosssection(fromthevisible
humanprojectwebsite).
Aseriesofcrosssectionalimagesisusually
produced by moving the patient in small
incrementsthroughthescanner.Theimages
are often displayed simply as consecutive
slicesasshowninthefollowingimage.
TheCTScannerisabout100timesmore
sensitivethanaconventionalXraymachine.
CTisanaccurateandvaluableimaging
technique.Sequentialsectionscanbelinked
bymeansofanimationsoftwaretosimulate
thepassageofthespecimenthroughafixed
plane.[seemoviefile]

Medical Physics
TheusefulnessofCTscansisinfluencedbytwoissues:imageresolutionandtheeasewithwhich
datacanbeexportedandanalysed.Resolutionisafunctionofthethicknessofthesliceilluminated
bytheXraybeam.MedicalCTscanningfacilitiesgenerallyobtainslicewidthsof700micronsor
1400microns.Imagesofobjectssmallerthantheslicewidtharegenerallypoorlyresolved.
Digital information generated by these machines is stored in standard exportable file formats.
Consequently,dataobtainedinthiswaymaybemanipulatedandtransmittedtofacilitiesormedical
personneloutsidethescanningfacility.
CTalsohastheadvantageoverconventionalXraysofbeingabletoproduceimagesofsofttissues.
Theimagebelow[left]showsthelungsofapatient.ComparethisimagewiththeconventionalX
rayofapatientsskull.ObservethattheconventionalXrayshowsnosofttissuedetail(i.e.the
brain).

Manysuchimagescanbecombinedusingcomputerimagemanipulationtechniquestoproducea3
dimensionalimage.
A sequence of images can be digitally processed to produce a threedimensional image, or

sometimestheXraybeamscansthepatientsothatitfollowsapathhavingtheshapeofahelix.

Checkoutthewebsiteindicatedforamovieshowingtherotationofthis3Dimagecreatedusing
computeriseddigitalimagemanipulation.
Furtherexamplesof3DCTcanbeseenathttp://www.medphys.ucl.ac.uk/mgi/visct.htm

Medical Physics
The image above (left) shows a number of different tissue types (soft tissue, muscle and bone) in a
single image produced by selective analysis of the gathered data to produce different sections
through the patient. A CT X-ray machine is shown on the right.
Just for general interest

Medical Physics
Shaded surface rendering (left) only uses the

firstdefinedvoxel*asthesurfaceofthebone
(adjacent images left) producing an image
[belowleft]that
showsexternal3Drelationshipswell
fails to show features hidden beneath the
bonesurface
Shaded volume rendering (adjacent images

right)usestheentiredataset.
Theimageconveysmoreinformation
Thecontributionsofeachdatasetvoxelare
summed
May be viewed in any plane or projection
andinarangeofopacityfromtransparentto
opaque
* a voxel is a volume element i.e. a 3D

analogueofapixel

Medical Physics
Describe circumstances where a CAT scan would be a superior diagnostic tool

compared to either X-rays or ultrasound
SinceCTcanproduceimagesofsofttissue,itsuseisaclearadvantagewhendoctorsneedtomake
anassessmentofsofttissueinthebody.ConventionalXraysdonotproduceusefulimagesofsoft
tissue.
AsecondadvantageofCToveraconventionalXrayisthetrue2DnatureoftheCTimage.The
CTimageshowsathinslicethroughthebody.Incontrast,conventionalXraysalwaysshow2D
imageofeverythingthattheXrayspassthrough.Structuresoverlyingothersareseenasbeing
superimposedontheunderlyingstructuresinthefinalimage.Thiscanbeclearlyseeninpreceding
Xrayimages.ThefollowingchestXraysshowsthisfeature.Aclearunderstandingofanatomyis
requiredtocorrectly interpretthis picture,sinceribsatthefrontofthebodyandthebackare
superimposedonthephotograph,alongwiththeheart,whichliesbetweenthesetwoextremes.
CTandUltrasoundcanbothproducetrue2Dimagesrepresentingslicesthroughthebody.The
benefitsofCToverultrasoundarethat
CTcanbeusedtoimagebone,whichultrasoundcannotdobecausetherelativelyhighacoustic
impedanceofboneresultsintheultrasoundbeingalmosttotallyreflectedfromthebone,sothat
nointernalfeaturesofthebonearediscernible
CTcanbeusedtoimagetissueunderlyingbone,whereasultrasoundisreflectedfromthebone
surfaceandnothingbeyonditisvisible
CThasbetterresolutionthatultrasound,sofinerdetailisvisibleusingCTthanUS

Medical Physics
Explain how an endoscope works in relation to total internal reflection

Total Internal Reflection
ReviewfromPreliminaryModule:TheWorldCommunicates
Recallthepathoflighttravellingfromonemediumtoanother.Iftheangleofincidenceisother
thanzero(perpendiculartotheboundarysurface),thelightsvelocitychanges,causingrefractionto
occur.NotethateachofthepathsinfiguresIIIIarereversibleasindicatedbelow.
fig(I) fig(II) fig(III)
fig(IV) fig(V) fig(VI)
Inthefollowingdiagram,thelightintheprismmeetstheinterfaceatthecriticalangleic,theangle
atwhichtherefractedraytravelsparalleltotheinterfaceafterrefraction.
Iftheangleofincidence,i,exceedsthecriticalangle,allofthelightwillbereflectedbackintothe
medium,withnonepassingthroughtheinterface.
Forlighttravellingfromamediumintoavacuum(orairasacloseapproximation),thecritical
angleiscalculatedfromtherelationship:
1
Sin(ic)=
n
Note that a critical angle only exists when a ray of light is travelling in a medium of higher
refractiveindexwhenitmeetsaboundarywithamediumoflowerrefractiveindex.
Thissituationcommonlyappliestolighttravellinginatransparentliquidorsolidmediumwhenit
meetsaninterfaceofthatmediumwithair.
Thecriticalangleisalsodefinedforlightpassingfromonetransparentmediumtoanotheroflower
refractiveindex(n1),inwhichcase,thecriticalangleisdefinedas:

Medical Physics
n1
sin(ic)=
n2
[notethatthesineratiomustbdelessthan1andhencecriticalangleonlyhasmeaningiflightis
travellingfromamediumofhighertoamediumoflowerrefractiveindex.
Thisisillustratedinthefollowingdiagram.
Fibre Optics
Thephenomenonoftotalinternalreflectionisthebasisofendoscopy.Thisistheprocessbywhich
medicalpractitionersareabletousevisiblelighttoconductaninternalexaminationofapatients
body.Abundleofopticalfibresisusedtobothtransmitlighttothesiteoftheexamination,aswell
astransferringtheimagebackfrominsidethepatient.
Thefollowingimage(belowleft)isatypicalexampleofanimageproducedusingthistechnique.It
isapictureofagastriculcer.[WatchQuantumvideoUlcer]
Basics of Fibre Optics

Thestructureofatypicalopticalfibreisshowninthediagramabove(right).Theconcentriclayers
ofanopticalfibreincludethelightcarryingcore,thecladdingandtheprotectivebuffer.
Core theinnerlightcarryingmember.
Cladding themiddlelayer,whichservestoconfinethelighttothecore.Itmusthavealower
refractiveindexthanthecore.
Buffer theouterlayerservingtoprotectthecoreandcladdingfromdamage.
Lightenteringoneendoftheopticalfibreistransmittedalongtheopticalfibrebytotalinternal
reflection.
Lightraystravelstraightlinesbetweenopticalelements,whichcanreflectorbend(refract)them.

Medical Physics
Mostopticalfibresusedforcommunicationspurposestransmitlightinthenearinfraredlightat
wavelengths of 8001600nm. The silica glass used for most fibres is transparent at these
wavelengths.
Fibres used in medical endoscopy must be able to transmit light in the visible region of the
spectrum.Becauseoftheshortdistancesinvolved(usuallylessthanabouttwometres),thefibresdo
nothavetohavethesametransparencyasfibresusedforcommunicationtechnology,nevertheless
endoscopicfibresaremadefromhighquality,homogeneous,hightransparencyglass.Homogeneity
isanimportantpropertyofthefibrebecauseanyirregularitieswoulddistortanddegradetheimage.
Refractive Index and Total Internal Reflection in Optical Fibres
Themostimportantopticalmeasurementforanytransparentmaterialisitsrefractiveindex(n).The
refractiveindexistheratioofthespeedoflightinvacuumtothespeedoflightinthemedium:
c
n
vm
wherecisthespeedoflightinvacuumandvmisthespeedoflightinthemedium.
Thespeedoflightinamaterialisalwaysslowerthaninvacuum,sotherefractiveindexhasavalue
greaterthan1.0.Althoughlighttravelsinstraightlinesthroughhomogeneousopticalmaterials,
lightisbentatthesurface.Thishappensbecauseoftherefractiveindexchangeattheinterface
betweenthemedia.Whentheangleofincidenceexceedsacriticalvalue,wherethesineofthe
angleequals1.0,thelightwillundergototalinternalreflectionandbebouncedbackintotheglass,
asshowninthefigurebelow.
The light will thus propagate along the fibre, bouncing from side to side as it does so, being
internallyreflectedeachtime.
Itisthisphenomenonoftotalinternalreflectionthatkeepslightconfinedinopticalfibresandisthe
basicprincipleunderlyingtheoperationofanopticalfibre.
Optical fibre technology is used extensively as a means of communication for cable TV,
telecommunications,andcomputerdata.
Opticalfibresarealsousedinavarietyofmedicalinstrumentsusedforvisualexaminationinside
thebodythroughabundleofopticalfibresinsertedthroughasmallopening.Medicalinstruments
usingopticalfibresincludeendoscopes,arthroscopesandlaproscopes.
Minimallyinvasivesurgeryisconductedusingopticalfibreinstrumentstoseeinsidethebody.A
commonexampleisthereplacementoftheanteriorcruciateligamentintheknee.

Medical Physics

Images showing a normal anterior cruciate ligament (ACL) and a repaired ACL
Thispartoftheanatomyisfrequentlytorninsportssuchasnetballandfootball,whichinvolve
vigoroustwistingforcesontheknees.
Discuss differences between the role of coherent and incoherent bundles of fibres
in an endoscope
If,inanopticalfibrebundle,allofthefibresareparallelalongthefulllengthofthebundle,sothat
thereisaonetoonecorrespondencebetweenthepositionsofthefibresatoneendofthebundle
andthepositionsoftheoppositeendsofeachfibreattheotherendofthebundle,thenthefibre
bundleissaidtobecoherent.
Thelightfromanobjectprojectedontotheendsofthefibrebundlebyasimplelenswilltravel
alongthefibres,emergingasacorrespondingimageoftheobject,visibleattheotherendofthe
bundle.Thisistheprincipleofthemedicalendoscope.
Inanoncoherentfibrebundle,oneormoreofthefibresswappositionsrelativetoeachotherat
oppositeendsofthefibre.Typically,thearrangementoffibresalongthebundleisrandom,so
althoughthelighttravelsalongeachfibre,aswithacoherentbundle,noimageisproducedatthe
exitend.

Medical Physics
Thearrangementoffibresinacoherentbundle The arrangement of fibres in a noncoherent

is represented schematically in the diagram bundle is represented schematically in the
below. diagrambelow.
Anoncoherentfibrebundleisusedtotransmitlighttothepointwhereobservationsarebeingmade
withtheendoscope.
Whitelightisusedsothatthedoctorcanobservethetissuesinrealcolour.
Explain why different types of optical fibres will affect the image produced by an
endoscope
Acoherentbundleoffibresisessentialinthetransmissionoftheimage.Alensatthedistalend(the
endoppositetotheeyepiece,orcamera)focusesanimageoftheareabeingobservedontotheend
ofthefibre.Thecoherentbundlesendsthisimagetotheotherendofthefibrethroughtheprocess
oftotalinternalreflection.Thecoherentbundleisnecessarytoensurethattheintegrityoftheimage
ismaintainedfromoneendtotheother.Eachfibreinthebundleeffectivelytransmitsapixelfrom
oneendtotheother.
Explain how an endoscope is used in observing internal organs:

Theendoscopictubethatisinsertedintothepatienttypicallyhasthefollowingcomponents.
Fibrestotransmitlighttothepointofobservation.Thismaybeanoncoherentbundlesincethe
lightisbeingusedonlytoilluminatetheobservationsite.
Fibrestocarrytheimagebacktotheobserverfromthetissuebeingobserved
Asystemoflensesthepartthatisinsertedintothepatienthasalenssystemtofocusanimage
ofthetissuesunderexaminationontotheopticalfibrebundle.Attheotherendoftheoptical
fibrebundle,morelensesallowdirectviewingoftheimagewiththeeye,orconnectiontoa
video/computermonitor.
Suctiontubetoremovebloodandotherloosetissuematerialfromtheareaunderinspectionso
thatthedesiredtissuecanbeclearlyseen.
Asaltwaterinletandoutletpermittingtheareaunderobservationtobeflushedwithclearsaline
solutiontoincreasevisibility

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Controllinestomanipulatethetubeinsideofthepatient.Thesevaryincomplexitydepending
on the task undertaken. A simple gastroscopy may not require complex controls however
endoscopesusedforsurgicalproceduresmayrequirefinecontroloverthepositionofthelensat
thetissueend.
Miniatureremotecontrolledsurgicalinstrumentsmaybepresent,rangingfromsimplesuction
tools(below)tomoreelaboratesurgicaltoolsusedinoperativeprocedures.
AdvantagesofEndoscopy
Thetissuesareseeninrealcolours
Theprocesstakesplaceinrealtime,enablingthedoctortointerveneintheprocessatany
time
Theprocessisminimallyinvasivecomparedwithopensurgery
Theprocessusesnonionisingradiation,namelylight,anadvantageoverXrays
Used in conjunction with remotely operated miniature surgical instruments, minimally
invasivesurgicalprocedurescanbeperformedandthisissaferforthepatientandallows
themtoleavehospitalinashortertimethanwithconventionalsurgery
DisdvantagesofEndoscopy
Theprocessmustbedoneinrealtimeandistimeconsumingcomparedwithultrasound,X
rays
Theprocesspresentsminorriskstothepatient,especiallyifsurgicalendoscopyisusedand
ananaestheticisrequired
Onlythesurfaceoftissuesisvisible
Explain how an endoscope is used in obtaining tissue samples of internal organs
for further testing
A common use for endoscopes is the removal of tissue samples for testing, for example to
determinewhetheragrowthismalignantornot.Thisiscalledabiopsy.Typicalexamplesinclude
theremovalofpolypsorothergrowthsfromtheintestine.Theendoscopeisusedparticularlyfor
theremovaloftissuesamplesfromtheabdomen.Surgeryinthispartofthebodyhasasignificant
riskassociatedwithitbecauseofthechanceofintestinalbacteriainfectingtheabdomenifthe

Medical Physics
intestineisperforated.Endoscopyreducesthisriskbecausetheincisionsandamountofcuttingis
minimised.
Thefollowingimageshowsacuttingdeviceinsertedintotheabdomentoobtainabiopsy.The
suctiontubetocleartheareaisvisibleontheleftoftheimage.Thepicturewastakenwithacamera
attachedtoanendoscope.
Onecommonlyusedtoolconsistsofahollowtubewithadiagonalcuttingbladeattheend.The
tissuesampleispushedorsuckedintothehollowtubeandthebladecutsitandslidesacrossthe
tubeentranceensuringthatthespecimenisnotlostastheendoscopetubeiswithdrawn.
ThefollowinginformationaboutendoscopyisquotedfromtheGrolierEncyclopediaCDROM
Fibre optics is the channelled transmission of light through hair-thin glass fibres. The light is
prevented from escaping the fibre by total internal reflection a process that takes place
when a light ray travels through a medium with an index of refraction higher than that of the
medium surrounding it. In this case the fibre core has a higher refractive index than the
material around the core, and light hitting that material is reflected back into the core, where it
continues to travel down the fibre.
Fibre-optic technology has been applied in many areas, although its greatest impact has come
in the field of telecommunications, where optical fibre offers the ability to transmit audio, video,
and data information as coded light pulses. Other applications include the simple transmission
of light for illumination in awkward places, image guiding for remote viewing, and sensing the
measurement of various properties of materials, structures or living things.
Other Applications of Fibre Optics
Non-communication advances in fibre optics have fallen into two main areas, flexible and rigid
fibres. Sensors are a major flexible fibre application, and uses include the measurement of
pressure, temperature, rotation, fluid flow, and electric current. Other flexible fibre applications
concern high-intensity illumination in general, instrument illumination for automotive and
avionic systems, power transmission for use with robotics, surgical and dental procedures, and
image guiding which involves fibre bundles that are aligned from end to end. The technique is
used for direct viewing of otherwise inaccessible areas, as in medical endoscopes. In rigid
fibre optics, thousands of fibres are fused into a solid block. These optic plates are used for
image transfer from a cathode-ray tube to a permanent photographic recording.
Endoscope
An endoscope is a tubular instrument equipped with optical viewing and lighting systems. It is
used for examining the inside of certain cavities or hollow organs of the body, or to
perform surgery. An endoscope often uses a fibre optic telescope that provides excellent
visibility of minute internal structures. Either suction or pumping methods are used to clear the

Medical Physics
visual pathway to the target organ. An endoscope can also be equipped with a laser that can
vaporise, coagulate, or cut structures, often with more ease and flexibility than a more rigid
cutting knife. Endoscopy is visual examination of the interior of the body by inserting an
endoscope through a natural body opening, such as the throat, or through a small incision into
the body cavity. It is a less invasive method that causes less scarring and a quicker recovery
time than other surgical techniques. Several million endoscopy procedures are performed in
the United States each year at a total cost of several billion dollars. Common types of
endoscopes are the cytoscope to view the bladder, the bronchoscope to view the lungs, the
otoscope to view the ear, the arthroscope to view the knee and other joints, and the
laparoscope to view the female reproductive structures. The most common surgery
performed through endoscopy is biopsy, the removal of tissue for microscopic study to detect a
malignancy.
3. Radioactivity can be used as a diagnostic tool
References
http://perso.clubinternet.fr/molaire1/e_plan.html
Outline properties of radioactive isotopes and their half lives

Isotopes
Isotopesareatomsofthesameelementhavingthesamenumberofprotonsbutdifferentnumbersof
neutronsinthenuclei.
Different isotopesofthesameelement havethesamechemical properties.This factis ofkey
importanceinusingradioisotopesinmedicalapplications.
Hydrogenistheonlyelementhavingspecialnamesforitsthreeisotopes;hydrogen,deuteriumand
tritium.Allotherelementshavemoreisotopesthanhydrogen.Manyisotopesoccurnaturallyand
somearemadeartificially.Thenucleusisrepresentedbythesymbolfortheelement,withthemass
number(totalnumberofprotonsandneutrons)asasuperscriptandtheatomicnumber(numberof
protons) as a subscript. In the case of isotopes other than those of hydrogen, the nuclide i is
representedinthesamesymbolicmannerbutnamedasfollows:carbon12,carbon14,iodine131,
phosphorus31,fluorine18,technetium99etcthenumberbeingthemassnumberofthenuclide.

Medical Physics
Protonsandneutronsarecollectivelycallednucleons.
Whatareradioisotopes?
Reference:Materialunderthisheadingisquotedsubstantiallyfromthefollowingwebsite.
http://www.uic.com.au/nip26.htm
Thereare82stableelementsandabout275isotopesoftheseelements.Whenacombination
ofneutronsandprotons,whichdoesnotalreadyexistinnature,isproducedartificially,the
atomwillbeunstableandiscalledaradioactiveisotopeorradioisotope.
Radioisotopes can be manufactured in several ways. The most common is by neutron
activationinanuclearreactor.Thisinvolvesthecaptureofaneutronbythenucleusofan
atomresultinginanexcessofneutrons(neutronrich).
Someradioisotopesaremanufacturedinacyclotroninwhichprotonsareintroducedtothe
nucleusresultinginadeficiencyofneutrons(protonrich).
Thenucleusofaradioisotopeusuallybecomesstablebyemittinganalphaand/orbetaparticle
(orpositron).Theseparticlesmaybeaccompaniedbytheemissionofenergyintheformof
electromagneticradiationknownasgammarays.Thisprocessisknownasradioactivedecay.
Radioactiveproductsusedinmedicinearereferredtoasradiopharmaceuticals.
AdistinctadvantageofnuclearimagingoverXraytechniquesisthatbothboneandsoft
tissuecanbeimagedverysuccessfully.

Medical Physics
Isotopes and radioactivity

Thestabilityofanatomicnucleusdependsontheratioofprotonstoneutrons.Forthefirst30orso
elements,thenumberofprotonsisroughlythesameasthenumberofneutronsinthenatural
isotopes.Nucleihavingtoofewortoomanyneutronsareunstableandundergoradioactivedecay,
whichproducesfourtypesofradiation,dependingonthenatureofthedecay.
Principal Radiation Types Emitted by Radionuclides

Alpha Radiation
Someunstablenucleidecaybyemittingtwoprotonsandtwoneutronsemittedfromthenucleus.
Thisparticleiscalledanalphaparticleitisinfactaheliumnucleus.Theremainingnucleusthus
hasamassnumberreducedby4andanatomicnumberreducedby2.
e.g. Forexample,radioactive Uranium238 emitsanalpharayandthusloses4nucleons(2
protons+2neutrons):U238therebytransformsitselfintoThorium234(because2protons
lessthatchangestheatomtothatofadifferentelement).Inanuclearreaction,bothmass
numberandchargeareconserved,andthedecayprocesscanbewrittenasanequation.
238
92U 234 4
90Th 2 He
ThisreactionisthesourceofmostoftheheliumonEarth.LiquidheliumisusedinMRI
imaging machines for the operation of the superconducting electromagnets essential in
creatingtheverystrongmagneticfieldneededforthisimagingprocess.

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Misconception:Itisincorrecttocallanalphaparticlearadioactiveparticleonlyunstablenuclei
can be called radioactive. An alpha particle is a perfectly stable helium nucleus. It is not
radioactive!
Therangeofa5MeValphaparticleinairisabout3.5cmandintissueitsrangeisabout3mmin
tissue.
Beta Radiation
Anelectronemittedfromthenucleus.Hangonaminutenucleidonthaveelectrons!Hereswhat
happens.Inradioactivenucleithatundergobetadecay,aneutronchangesintoaproton,(cool!)and
ahighenergyelectronisformedintheprocess.Itisejectedfromthenucleuswithsuchahigh
velocitythatittotallyescapestheatomfromwhichitcame.Asaresultofbetadecay,theatomic
numberofthedecayingnucleusincreasesbyonebutthemassnumberdoesnotchangethereis
onelessneutronbutonemoreprotonthetotalnumberofnucleonsdoesnotchange.
Theaveragerangeofa1MeVbetaparticleisabout3minairbutonlyabout3mmintissue.
Carbon14decaysbybetadecay.Thereactionisasfollows
14 0
6 C174N 10 e where 1 e representsabetaparticle
Beta Radiation Positron Production
Apositronistheantiparticleoftheelectron.Ithasthesamemagnitudechargeastheelectron,but
itispositive.Ithasthesamemassasanelectron.
When a radioactive nucleus decays to produce a positron, the atomic number of the decaying
nucleusincreasesbyoneandthemassnumberremainsthesame.Aprotonchangesintoaneutron
andapositroninthisprocess.

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PositronsareusedinPETscanning(PositronEmissionTomography)
Gamma and X rays

Theseareformsofelectromagneticradiation,emittedasenergypacketscalledphotons,similarto
lightandradiowavesbuthavingmuchgreaterenergy.Xraysoriginateintheelectronssurrounding
thenucleus.Gammaraysareemittedfromthenucleus. Noparticlesareemittedduringgamma
radiation, howevergradiationisoftenemitted during,andsimultaneous to, or radioactive
decay.
Toabsorb95%ofthegammaenergyfroma 60Cosource,6cmoflead,10cmofiron,or33cmof
concretewouldbeneeded.
Forenvironmentaldosimetry,importantbothforinternalandexternalexposure.Gammaemitters
depositedinoneorganofthebodycansignificantlyirradiateotherorgans.

Medical Physics
Source:NationalGeographic(January1987)

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Penetrating Capacity of Radiation
Half-Life
Thetimeittakesforhalfthemass(oratoms)oftheparentisotopetoturnintoitsdaughter
isotopeiscalledthehalflife.
Thefollowinggraphshowshowtheactivityofradioactiveamericiumdecreasesovertime,adirect
resultofthedecreasingnumberofamericiumatomsremaininginthesample.Americium242hasa
halflifeof16.02hours.
Factorsgoverningthechoiceofradioisotopesusedinmedicineinclude
Havingahalflifelongenoughtoexaminemetabolicprocesses,yetshortenoughtominimise
theradiationdosetothepatient.
Rapiduptakeintothedesiredtissuethisisachievedbyincorporatingtheradioisotopeintoan
appropriatecompoundwhichismetabolisedbythetargettissueinthebody.
Rapid excretion from the body this is again a chemical choice, appropriately chosen
compoundsarebrokendownandexcretedasapartofthenormalbodychemistry.

Medical Physics
Radioisotopes used in Nuclear Medicine

Reference:
ThefollowingmaterialissubstantiallyquotedfromtheaboveURL.
NuclearMedicineisabranchofmedicinethatusesradiationtoprovideinformationaboutthe
functioningofapersonsspecificorgans.
Thethyroid,bones,heart,liverandmanyotherorganscanbeeasilyimaged,anddisordersin
their function revealed. In some cases radiation can be used to treat diseased organs or
tumours.
We describe nuclear medicine studies as functional studies because they demonstrate
physiological function. Xray procedures are generally nonfunctional; they demonstrate
anatomy.
Diagnosis
Diagnostictechniquesinnuclearmedicineuseradioactivetracers,whichemitgammarays
fromwithinthebody.Thesetracers aregenerally shortlivedisotopes linked tochemical
compoundspermittingspecificphysiologicalprocesses(functional)tobeexamined.
Theycanbegivenbyinjection,inhalationororally.
Thefirsttypearewheresinglephotonsaredetectedbyagammacamerawhichcanview
organsfrommanydifferentangles.Thecamerabuildsupanimagefromthepointsfrom
whichradiationisemitted;thisimageisenhancedbyacomputerandviewedbyaphysician
onamonitorforindicationsofabnormalconditions.Thisistypicallyusedtocarryoutabone
scan.
A more recent development is Positron Emission Tomography (PET) which is a more
precise and sophisticated technique using isotopes produced in a cyclotron. A positron
emittingradionuclideisintroduced,usuallybyinjection,andaccumulatesinthetargettissue.
Asitdecaysitemitsapositron,whichpromptlycombineswithanearbyelectronresultingin
thesimultaneousemissionoftwoidentifiablegammaraysinoppositedirections.Theseare
detectedbyaPETcameraandgiveverypreciseindicationoftheirorigin.
Positioningoftheradiationsourcewithinthebodymakesthefundamentaldifferencebetween
nuclearmedicineimagingandotherimagingtechniquessuchasXrays.Gammaimagingby
eithermethoddescribedprovidesaviewofthepositionandconcentrationoftheradioisotope
withinthebody.Organmalfunctioncanbeindicatediftheisotopeiseitherpartiallytakenup
intheorgan(coldspot),ortakenupinexcess(hotspot).Ifaseriesofimagesistakenovera
periodoftime,anunusualpatternorrateofisotopemovementcouldindicatemalfunctionin
theorgan.
AdistinctadvantageofnuclearimagingoverXraytechniquesisthatbothboneandsoft
tissuecanbeimagedverysuccessfully.ThishasledtoitscommonuseinAustraliawherethe
probabilityofanyonehavingsuchatestisaboutoneinthreeandrising.


Medical Physics
ISOTOPES FOR MEDICINE AND SCIENCE PROGRAMS

Isotopes Save Lives and Reduce Health Care Costs
One of every three persons admitted to U.S. hospitals undergoes a nuclear medical procedure for
diagnosis or therapy. Many of these procedures employ radioactive isotopes (radioisotopes). As a
result, nuclear medicine is a $7-$10 billion per year industry. Isotope sales to support these
procedures are more than $100 million per year, of which the U.S. Department of Energy (DOE)
currently provides 5 percent of the market. Some of the more frequent uses of medical radioisotopes
include diagnosis and treatment of several major diseases, sterilization of medical products, tissue
grafts, nutrition research, and biomedical research into cellular processes.
A technician prepares a young girl for Positron Emission
Tomography scanning, a medical diagnostic tool that uses
isotopes produced by the U.S. Department of Energys Isotope
Program.
The diagnostic uses of radioisotopes are many. Molybdenum-
99 is a radioactive isotope that decays to form technetium-
99m, an isotope used in about 36,000 medical procedures each
day in the United States. Technetium-99m allows physicians
to diagnose many conditions in the brain, lungs, heart, and
other organs without the use of dangerous and expensive
exploratory surgery. For example, technetium-99m imaging
is used to diagnose poor blood flow in the lungs and heart.
Alternative diagnostic methods include an arteriogram, a
procedure in which an imaging device is inserted into a large
vein, and cardiac catheterisation, that requires inserting a tube
into the heart. These alternative methods cause the patient some
discomfort and require a recovery period. Because technetium-99m imaging is not a surgical
procedure, costs for surgical facilities and personnel, as well as medication to ease pain and
promote healing, can be avoided. Technetium-99m also is used in bone scans to identify the
spread of cancer to the skeletal system or to spot stress fractures that cannot be seen in x-rays.
Radioisotopes such as thallium-201 and rubidium-82 are used for cardiac imaging to diagnose heart
disease. Other radioisotopes are used for brain scans, bone scans, and diagnosis of diseases such as
AIDS, Alzheimers, and many others. For example, a patient can be given a specific radioisotope in
a chemical vehicle called a radiopharmaceutical. A gamma camera can then trace the
radiopharmaceutical through the body, providing pictures of alterations caused by disease in
a body part, such as the spread of bone cancer.
During brain scans, a radioisotope traces activity to give doctors a clear picture of whether the brain
is functioning normally. In nuclear cardiology, a radioactive tracer relays changes in blood volume
as the heart contracts.
Radioisotopes also play an important role in effectively treating diseases such as heart disease,
arthritis, and cancer. Several of the isotopes produced by the DOE, such as palladium-103 and
iridium-192, are used for various types of cancer therapy. One technique is called labeling in
which a chemical is bonded to an isotope and injected into the body. The chemical-isotope
reagent is called a radiopharmaceutical. Since some chemical elements concentrate naturally in
certain parts of the bodyas iodine does in the thyroid the chemical takes the isotope
directly to a specific site. By detecting the location of the isotope, medical technicians can
detect and photograph an otherwise unseen tumor. The same process can be used to send
radioisotopes to destroy cancer cells in a certain location or to send antibodies or other chemical
compounds to a tumor site.

Medical Physics
Scanning technique using radioisotopes (This is a PET scanner)

The use of medical isotopes also reduces health care costs. Radioisotopes help medical specialists
diagnose and treat diseases earlywhen they are most treatable. The earlier a disease can be
diagnosed and treated, the lower the cost. Also, hospital stays are usually shorter, and patients often
recover quicker than when a disease or condition is diagnosed in its later stages.
Thousands of lives and millions of dollars are saved every year because of medical isotope
procedures, treatments, and technologies. Other isotopes are being used for medical research that
may lead to new breakthroughs in the diagnosis and treatment of disease. By producing isotopes
needed by the U.S. health care industry and medical researchers, DOE supports and promotes the
continued health and well being of the American people.
Reference: http://www.ne.doe.gov/isotope/lives.html
In Australia, radioisotopes are prepared for medical purposes at Lucus Heights reactor in Sydney
and through the use of two medical cyclotrons one of these is at Prince Alfred hospital in Sydney
and there is one in Melbourne.

Medical Physics
Identify radioisotopes that are used to obtain scans of organs

Radioisotopes Produced in a Reactor

Isotope Half-life Emission Uses
cobalt-60 5.3 y Used for external beam radiotherapy
iodine-131 8d Used in functional imaging and therapeutic applications for
the thyroid problems and carcinoma diagnosis
phosphorus-32 14.3 d Used in the treatment of excess red blood cells
molybdenum-99 Used as the 'parent' in a generator to produce technetium-
99m, the most widely used isotope in nuclear medicine
technetium-99m 6h Used to image the skeleton and heart muscle in particular,
but also for brain, thyroid, lungs (perfusion and ventilation),
liver, spleen, kidney (structure and filtration rate), gall
bladder, bone marrow, salivary and lacrimal glands, heart
blood pool, infection and numerous specialised medical
studies
Radioisotopes Produced in a Cyclotron

Isotope Half-life Emission Uses
carbon-11 20.3 m These are used in PET for studying brain physiology and
nitrogen-13 pathology, for investigating epilepsy. They also have a useful
role in cardiology. F-18 in FDG has become very important in
oxygen-15 2.03 m detection of cancers and the monitoring of progress in their
fluorine-18 109.8 m treatment, using PET.
Iodine-124 4.5 d Used to investigate cancer
Everyorganinourbodiesactsdifferentlyfromachemicalpointofview.Doctorsandchemists
haveidentifiedanumberofchemicalsabsorbedbyspecificorgans.Thethyroid,forexample,takes
upiodine,thebrainconsumesquantitiesofglucose,andsoon.
With this knowledge, radiopharmacists are able to attach various radioisotopes to biologically
active substances. Once a radioactive form of one of these substances enters the body, it is
incorporatedintothenormalbiologicalprocessesandexcretedintheusualways.
Theamountoftheradiopharmaceuticalgiventoapatientisjustsufficienttoobtaintherequired
informationbeforeitsdecay.Theradiationdosereceivedismedicallyinsignificant.Thepatient
experiencesnodiscomfortduringthetestandafterashorttimethereisnotracethatthetestwas
everdone.Thenoninvasivenatureofthistechnology,togetherwiththeabilitytoobserveanorgan
functioningfromoutsidethebody,makesthistechniqueapowerfuldiagnostictool.
Aradioisotopeusedfordiagnosismustemitgammaraysofsufficientenergytoescapefromthe
body anditmust haveahalflifeshortenoughforittodecayawaysoonafterimagingis
completed.
Technetium-99m
Theradioisotopemostwidelyusedinmedicineistechnetium99m,usedinoverhalfofallnuclear
medicineprocedures.Itisanisotopeoftheartificiallyproducedelementtechnetiumandithas
almostidealcharacteristicsforanuclearmedicinescan.Theseare:

Medical Physics
ThemostcommonradioisotopeusedinnuclearmedicineisTechnetium99.Thisisotope
hasahalflifeof6hoursandwhenitdecaysitemitsasinglegammaraywithenergyof140
keV.Itdoesnotemitanyalphaorbetaparticlesanadvantagesincethesecausebiological
damage.AfurtheradvantageofTc99isthatithasseveralvalencestates;henceitcanbe
usedforlabellingavarietyofpharmaceuticals.Tc99isproducedinthenuclearreactorat
LucasheightsnearSydney.
A technetium generator consisting of a lead pot enclosing a glass tube containing the
radioisotope molybdenum99 is supplied to hospitals from the nuclear reactor where the
isotopesaremade.Thegeneratorcontainsmolybdenum99,withahalflifeof66hours,which
progressivelydecaystotechnetium99mbynormalbetadecay.TheTc99miswashedoutof
theleadpotbysalinesolution,aprocesscalled elution,whenitisrequired.Afterabouttwo
weeks the generator is returned for recharging. Lucas Heights Reactor supplies these in
AustraliaandforexporttoAsia.
The low energygamma rays it emits easily escape thehuman bodyandareaccurately

detectedbyagammacamera.Onceagaintheradiationdosetothepatientisminimised.
Agammacameraisaninstrumentthatproducesacomputerisedpictureofthedistributionof
radioactivematerialinapatient.Itcontainsascintillatingcrystal,whichisthesizeofthe
image. This produces light when irradiated with Xrays and the light is detected and
convertedtoanimage.Gammaraycamerasareusedtoproduceabonescan.
Describe how radioactive isotopes may be metabolised by the body to bind or

accumulate in the target organ
Thechemistryoftechnetiumissoversatileitcanformtracersbybeingincorporatedintoarangeof
biologicallyactivesubstancestoensurethatitconcentratesinthetissueororganofinterest.
Pharmaceuticalsarechosensothatwhentheyareinjectedintoaveintheywillcirculatearoundthe
bodyandbeabsorbedbytheorganofinterest.
Technetium99hasahalflifeofsixhours,whichislongenoughtoexaminemetabolicprocesses,
yetshortenoughtominimisetheradiationdosetothepatient.Itisusuallydeliveredasaninjection.
Otherradioisotopesareadministeredwhichhavethecapacitytotargetspecificorgansbecausethey
aremetabolisedspecificallybythetargetedorgan.Examplesareshowninthefollowingtablefrom
abrochureproducedbyANSTO.

Medical Physics
Theradioisotopeslistedintheabovetableareproducedinanuclearreactor.
Theradioisotopeslistedintheabovetableareproducedinamedicalcyclotron.
Radiopharmaceuticals are used in very small
Diagnosticradiopharmaceuticalscanbeusedtoexaminebloodflowtothebrain,to
assessfunctioningoftheliver,lungs,heartorkidneys,toassessbonedamage,andto
confirm other diagnostic procedures. They are increasingly being used in sports
medicine to diagnose stress fractures, which are not generally visible in Xrays.
Anotherimportantuseistopredicttheeffectsofsurgeryandtoassesschangesafter
treatment.
Radiopharmaceuticals are used in very small quantities for diagnostic work just
enough is administered to obtain the required information before the

Medical Physics
radiopharmaceutical decays. The radiation dose received is similar to that from
diagnosticXrays.1
Wheneverpossibleradioisotopesthatarerapidlymetabolisedandexcretedarechosentominimise
exposure to radiation. Medical isotopes have short halflives, again to minimise exposure to
radiation.

Medical Physics
Identify that during decay of specific radioactive nuclei positrons are given off
11
6C115 B 10 e 15
8 O15 0
7 N 1 e
18
9 F18 0
8 O 1 e
Discuss the interaction of electrons and positrons resulting in the production of

gamma rays
PET radioactive tracers, which emit positrons (rather than photons produced by conventional
nuclearmedicinetracers),areadministeredjustpriortothePETimagingprocedure.
Apositroncreated inthebodybythedecayoftheradioactive positrontracerinteracts almost
immediatelywithanelectrontoproduceapairofgammarayphotonsasshowninthefollowing
graphic.Positronstravelashortdistance(1to2mm)inthetissuebeforecollidingwithanelectron.
Thepositronandtheelectronannihilateeachotherandintheprocesstheirmassisconvertedto
energywhichisemittedastwogammarayshavinganenergyof511keVandtravellinginopposite
directionstoeachother.[1eV=1.6x1019J]

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InaPETscannertheseannihilationphotonsaredetectedbyarraysofdetectorssurroundingthe
patient.Avalideventoccurswhentwodetectorsrecordphotonswithinafewnanosecondsof
each other. To compute the 3D distribution of the radionuclide requires a large number of
measurementsfrommanydifferentangles(hencetheringdesignofmanyPETscanners).
Positronemittingisotopesexistforcarbon,oxygen,nitrogenandfluorine,andothers,whichallows
manynaturallyoccurringsubstancesusedbythebody(suchasglucose,ammoniaandwater)tobe
labelledwithradioactivetracersandbyimagingthedistributionofthesetracers,regionalblood
flowandglucosemetabolismcanbeimaged.PETisthusafunctionalimagingtechnology.
Describe how positron emission tomography (PET) technique is used for diagnosis
[patient in a PET scanner - http://ccins.camosun.bc.ca/~tonks/courses/psyc110/PET.gif ]

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[reference]
http://neurocog.psy.tufts.edu/images/positron_emission_tomography.htm
What is a PET scan?

PET is one of the newest, most advanced methods for studying organs in the body such as the
brain. Like an X-ray, or MRI scan PET is painless and relatively non-invasive (i.e., no surgery or
opening of the body is required). Unlike X-rays and traditional MRI, PET does not produce a
picture of the structure or anatomy of the brain, but rather it gives an image of brain function or
physiology. In other words, it can be used to image what the brain is doing. The following shows
PET images of which reveal the different parts of the brain that are active when a person is
reading (seeing) written words or hearing the same words spoken by person.
How does it work? Steps in the PET process:

production of positron emitting isotope in a cyclotron
substance of interest is labelled with the positron emitter
transport of labelled substance to PET camera area
administration (injection) of tracer compound & data acquisition with PET camera
processing of data from PET camera to extract information related to the tracers activity in the
body
interpretation of results
In PET a chemical substance the investigator would like to follow through the brain is labelled
with radioactive atoms. The labelled substance (called a radiotracer) is introduced into the body,

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usually by injection, where it migrates to the structures of interest. PET radiotracers emit
positrons. Positrons travel a short distance in the brain before colliding with an electron. The
positron and the electron annihilate each other and in the process emit two photons at 180
degrees to each other. The photons are detected as pairs in coincidence by a series of
specialized detectors arranged in a ring around the subject. A computer is then used to assemble
an image from all of the pairs of coincidental photons detected by the scanner. Areas of the brain
which emitted the most photons will produce a more intense PET signal and areas which emitted
few photons will produce a weak signal.
Labelling is a process whereby a tag is attached to a substance that the investigator wants to
follow. With PET labelling is accomplished by using a (very expensive) device called a cyclotron.
The radioactive atoms created by the cyclotron decay by emitting particles called positrons
which can be monitored with a special array of detectors called a PET camera. The substances
that can be labelled for PET scanning are limited only by the imagination of the investigators and
the physical half-life of the positron-emitting label (half-life is the amount of time it takes for half of
the label to decaythe faster the decay, the less time between injection and scanning). The real
power of PET is that atoms which naturally comprise the organic molecules utilized in the body
can be labelled (turned into positron emitters). These atoms include oxygen, carbon and nitrogen.
Since these atoms occur naturally in organic compounds, replacing the naturally occurring atoms
with labelled versions leaves a compound that will behave in a manner identical to its unlabeled
sibling, but which will be traceable in the body.
In most cognitive studies using PET the labelled compound is oxygen (O 15) and it is injected into
the body in the form of radioactive water. The basic idea is that areas of the brain that are working
relatively harder tend to get increased blood flow relative to areas that are not working as hard.
This results in more labelled oxygen migrating to these areas -- that is, these harder working
regions have a higher oxygen concentration and hence a more intense PET signal than areas
which are not working as hard.
PET stands for positron emission tomography. It is a functional imaging technique, allowing
physiciansorresearcherstoassesschemicalorphysiologicalchangesrelatedtometabolism.PET
imagingutilisesavarietyofradiopharmaceuticals,calledtracers,toobtainimages.PETtracers
aresimilartothenaturalsugars,water,proteins,andoxygenfoundinourbodies,butcarryaweak,
radioactivetag.Thesetracersareinjectedintoapatientandcollectinvarioustissuesandorgans.
Gammaraysassociatedwithpositronemissionfromtheseareascanbedetectedandanalysedto
provideafunctionalmapofbrainactivation.ThePETsystemdetectsthegammaradiationemitted
fromtheradioactivetracerinsidethebody,andusesthedatatocalculateanimageofcellular
biologicalactivities.
Whenthebodyschemistryconcentratesapositronemitterinaparticularlocation,Vbelow,more
gammaradiationisemittedfromthatregionthanregionswheretheemitterisnotasconcentrated.

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Gammaraydetectorsarearrangedinpairsoppositeeachotheraroundthepatient.Signalsreaching
oppositedetectorsareanalysedbyacomputercalculatesthepositionoftheannihilationeventfrom
thedifferencesintheattenuationofthegammaraystravellingthroughdifferentdistances,d1andd2
inthepatientsbody.Inthediagramabove,detector1willreceivemoregammaradiationfromthe
voxel,V,thandetector2.
PET and the Images it Produces

PETimagingcananalysesugarmetabolism,bloodflow,oxygenutilisationandalonglistofother
vitalphysiologicalactivities.Ifglucoselabelledwithfluorine18,apositronemitter,isgiventothe

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patient,andthentheyareaskedtodosomething,theregionsinthebraininwhichtheradioactivity
iscollectingistheregionthatisactivelyinvolvedinthatbehaviour.
WhatisFDG?
18FFDG(fluorodeoxyglucose)isasugarlabelledwiththeisotopefluorine18,andinjectedinto
thepatientintravenously.Glucoseiswellmetabolisedbygrowingcancercells,brainandheart
muscle.18FFDGoffersthelongesthalflifetime(110m)amongallthePETradioisotopesandcan
thereforebedistributedinallnearbyhospitals.Thisexplainswhy18FFDGissosuccessfulin
nuclearmedicine.Thestructureofthemoleculeisshownbelow.
[http://www.triumf.ca/welcome/petscan.html]
Asaresult,PETscanningcanrevealinformationaboutthefunctioninparticularregionsofthe
brain. PET is commonly used to determine what parts of the brain are involved in different
neurologicalillnessesincludingseizures,schizophrenia,andParkinsonsdisease,aswellaswhich
partsareactiveduringspecificactivities,suchassolvingmathsorworkpuzzles.Brainactivity
showninthecolouredPETimagesbelowcomparedwiththecorrespondinganatomicalMRimages.
InPETtheprocessesareverydifferentfromotherimagingmethodssofardiscussed.Incontrastto
CTforexample,radiationthatisusedtoexaminetheobjectdoesntcomefromanexteriorsource,
butisratheremittedbyaradionuclide,injectedintothepatientsbody.
Twoexamplesofsucharadionuclidesisfluorine18andoxygen11.

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Becausetheradionuclidesareabsorbeddifferentlyinthevarioustissuesdependingonphysiological
processes,wecanvisualisethoseprocessesbymonitoringthedistributionoftheradionuclidesin
thebody.
PET is thus a functional imaging technology, as opposed to structural, i.e. PET is used to
investigatephysiologicalbehaviourofthebodyasopposedtoanatomicalfeatures.
ThefollowingimageshowsacomparisonbetweenPETandCTscansindiagnosingatumour.
TheuseoffalsecolourenhancementincreasesthediagnosticcapabilitiesofPET.

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AwholebodycolourPETscanofawoman40yearsoldtwoyearsaftermastectomy.PETfound
multiplemetastasesextendingthroughoutthebody,includingmultiplelivermetastases.
Perform an investigation to compare a bone scan with an X-ray

Abonescanisperformedtoobtainafunctionalimageofthebones.Abonescancanbeusedto
detect abnormal metabolism in the bones, which may be an indication of cancer or other
abnormality.Becausecancerinvolvedahigherthannormalrateofdivisionofcells(thusproducing
arapidlygrowingtumour),chemicalsinvolvedinmetabolicprocessesinbonetendtoaccumulate
inhigherconcentrationsincanceroustissue.
What are Bone Scans?
Reference:
http://medicine.wustl.edu/~ippolitj/anatomy/cases/cow1.htm
AradioactiveagentcalledTechnetium99MMethylenediphosphonate(Tc99mMDP)isinjected
intothepatient.Theradioactivephosphatetravelsthroughthebloodandisincorporatedintothe
bone(Rememberthatboneismadeoutofcalciumandphosphate).
Thepatientliesunderagammaraycamera.Thegammarayscomingfromtheradioactivetracerin
thebodytraveloutofthebodyinalldirections.Onlythosetravellingparalleltothesmallholes
passingfromthebottomtothetopoftheleadcollimatorreachthedetector,acrystalofsodium
iodide.
SodiumiodidedetectorsconsistofasinglecrystalofNaIwithtraceamountsofthallium.The
thalliumimpuritycausesthecrystaltoscintillate(i.e.emitasmallflashoflight)whenanXrayor
gammarayinteractswiththecrystal.Thelightisthendetectedelectronically.Theyareusedin
wholebodygammacounters,gammacamerasand(withsomevariations)insomeCTmachines.

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Whenagammaraystrikesthedetector,aflashoflightisproduced.Theflashisveryfaint,andso
sensitive devices called photomultipliers are used to detect the flash and amplify its effects,
convertingtheresultintoanelectricalsignal.
Thesignalsareprocessedbyacomputerandanimageisproduced.Itmaybevieweddirectlyona
screen,printedorstoredelectronically,sincetheinformationisalldigitallyencoded.
Ifyouhaveareaswithhighboneactivity(fromcancerspreadingtobone,fracture,arthritis,etc),
therewillbemoreofthisradioactivephosphatetakenupintothebone,appearingdarkeronthe
bonescan.
Typicalimagesofhealthyboneandcancerousboneareshowninthefollowingimage.

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Question: Inthenormalscan,whydoyouthinkthepatientsleftelbowhasanintensefocusof
radioactivity?(Hint:HowdidtheygivethepatienttheMDP?)
Question:Inthenormalscan,thelowerpelvishasaregionofhighintensity.Whyisthis?(Hint:It
maybesofttissue,notbone...lookingatthePETmighthelpyouwiththisquestion.)
Discussion of Bone Scan
Althoughourpatientsimageisalittleoverexposed,notethattherearenumerousintensespots
(althoughsmall)alongthespinethatindicatethatthebreastcancerhasmetastasised,orspreadto
thebone.Onecanalsopickoutmultiplespotsontheleftpelvis,leftandrightshoulders,aswellas
thefirstfourribs.Thisisanextremelybadfindingandtheonlytreatmentispainrelief.Notethat
breast cancer does metastasise to bone. The bone metastases in breast cancer can either be
osteoblastic(increasedbonedeposition)orosteolytic(increasedboneresorption).Itistoughtosay
determinethenatureofthemetsinthiscase.XRayswouldbegoodforfiguringthisout.

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4. The magnetic field produced by particles can be used as a diagnostic tool

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Nobel prize for medicine awarded to British scanner pioneer

by Ian Sample, science correspondent
Tuesday October 7, 2003
The Guardian
A British scientist was awarded the Nobel prize for medicine yesterday for his pioneering work on medical
scanners.
Sir Peter Mansfield played a vital role in developing magnetic resonance imaging, a technique which gives
doctors an unprecedented view of the insides of the human body.
He shares the award, and the prize money of nearly 800,000, with an American scientist, Paul Lauterbur.
The prize came as an early birthday present for Professor Mansfield, who turns 70 on Thursday.
I wasnt planning to do anything special for my 70th, but I suppose I may have to change my mind now, he
said.
When I got the call from Sweden, I didnt believe it at first, but then I began to realise it was for real. I just
feel greatly honoured.
Magnetic resonance imaging scanners are now commonplace in hospitals around the world. Some 22,000
are in operation, taking about 60 million pictures a day. They can take detailed three-dimensional images
of organs and bones and reveal if they are diseased or damaged.
The scanners have become popular because they are so versatile.
MRI scanners can be used to look at just about any part of the body, whether its the brain, the spine, the
joints or the heart, said Sir George Radda, a physiologist at Oxford University. This award is long
overdue.
Prof Mansfield, a physicist at the University of Nottingham, was one of the first scientists to produce
images of human organs using the technique, but it was his fundamental work in the 1970s that really
made MRI a valuable medical tool.
He was first to work out how to turn signals from the scanners into meaningful images. Later, he
developed a way of making the scanners much faster, so much so that he could take snapshots of a heart
in a fraction of a heartbeat.
Peter did such a huge amount of work on this, it would have been a crime if his work had not been
recognised, said Peter Jezzard, an MRI expert.
MRI scanners work because two-thirds of the human body is made up of water. When a patient lies down
in an MRI scanner, an intense but harmless magnetic field makes charged ions in the water line up like so
many microscopic compass needles. The scanner then uses pulses to give the ions a gentle flick.
MRI scanners measure how the ions respond and use that to piece together a picture of the organs and
tissues.
Diseases often change the water content of different organs so the technique can reveal illnesses as well
as damage caused by accidents. Because it does not use X-rays, it is believed to be less risky than other
imaging techniques such as Cat scans.
The award puts the total number of Nobel laureates working in British science at 14.
Sir Paul Nurse, who won the Nobel prize for medicine last year, is due to leave the country next month to
take up a position as president of the Rockefeller University in New York.

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Introduction to Magnetic Resonance Imaging (MRI)

Thepotentialapplicationofmagneticresonance(MR)tomedicalimagingwassuggestedin1973,
althoughitwas15yearsbeforeclinicallyusefulimageswereobtainedusingmagneticresonance.
MRhadbeenusedasatoolforstudyingatomicstructuresince1946.Magneticresonanceimaging
(MRI),like CT can beused to produce tomographic images (slices). MRIhas the capacity to
producehighresolutionimagesofbothboneandsofttissueascanbeseeninthefollowingMRI
images.Digitisingtheimageandapplyingfalsecolourcanbeusedtohighlightspecificareasof
interest.
MRI scans of the neck and head

MRIusestheinteractionbetweenthemagneticpropertiesofhydrogennucleiandexternalmagnetic
fieldsandelectromagneticradiation.
To produce the strong magnetic field required for MRI, the scanners have a superconducting
magnet that requires liquid helium cooling. Entry to the MRI area is restricted to ensure that
ferromagneticmaterialsarekeptatasafedistancefromthemagnet.(0.2to2.0tesla,comparedwith
50microteslas for Earth's field and 40T for the strongest sustained manmade field). Some
extraordinaryaccidentshaveoccurredthroughafailuretoappreciatethestrengthofthemagnetsin
anMRImachine!

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The phantom is a device placed in the

MRI machine when it is not in use. A metal
oxygen cylinder pulled into the machine
did this damage!
AllmajorhospitalsandmanyprivateimagingbusinessesinAustralianowhavemagneticresonance
imagingmachine.Theycostmorethan2milliondollarstopurchaseandaboutonemilliondollars
peryeartooperateandstaffthem.
AsofOctober2003,therewereabout150MRImachinesinAustralia.Thecombinedeffectof
doctors fears of legal claims against them, and the patients desire to always use the best
technologyavailabletodiagnosediseasehascausedawellpublicisedblowoutinmedicalinsurance
costs.
OneoftheinitialsuccessesofMRIisthatimageswereobtainedoftheplaquethatischaracteristic
ofmultiplesclerosis(MS),givingamuchearlierdiagnosisofMS.PriortoMRI,patientswerekept
insuspensesometimesformanyyearsawaitingapositivediagnosis.AnothercharacteristicofMRI
isthatimagescanbeobtainedofsofttissueveryclosetobone.CThasmanyartefactsinsofttissue
close to bone. Hence MRI gives excellent images of deformed disks in the spine and of
abnormalitiesatthebaseofthebasebothofwhichcannotbeimagedsatisfactorilywithCT.
Identify that protons and neutrons in the nucleus have properties of spin and
describe how net spin is obtained
Bothprotonsandneutronsinthenucleiofatomshaveapropertycalledspin.Thisspinpropertycan
haveoneoftwopossibledirectionsforanygivennucleon.Ifthereareevennumbersofprotonsor
neutrons,thentheirspinsaligninoppositedirectionssothatthenetspinofthepairiszero.

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[Image source: National Geographic January 1987]
Ifthereisanoddnumberofprotonsorneutrons,thenthenucleusmustpossessanetspinsince
pairing cannot occur with one of the nucleons. Nuclei having a net spin include hydrogen,
phosphorus31,fluorine19,nitrogen15andcarbon13.
Explanation:Phosphorus31hasamassnumberof31andanatomicnumberof15,itthereforehas
16neutrons.Theneutronnumberbeingevenresultsinpairingoftheirspinsproducinganetspinof
zero.Becausethereisanoddnumberofprotons,onemustbeunpairedandthisunpairedproton
producesthenetspinforthisnuclide.Phosphorus31isarelativelycommonnuclideinthehuman
body.
ThenetspinofhydrogenisusedinMRimagingbecauseitisfoundinthebodyinrelativelylarge
amounts,giventhehighproportionofwatermakingupthebody.
Identify that the nuclei of certain atoms behave as small magnets
Nucleiwithanetspinduetounpairedprotonshaveapropertycalledmagneticmoment.Thiscan
bethoughtofasamagneticeffectcausedbytherotationoftheproton,whichactslikeacirculating
electriccurrentloop,resultingintheformationofamagneticdipoleshown(belowleft).
Thehydrogennucleusisonesuchnucleuswithanetspin.Themagneticpropertiesofhydrogenare
not normally evident because in the gaseous state, the magnetic properties of the nuclei are
randomlyaligned(aboveright),resultinginazeronetmagneticeffect.

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Explain that the behaviour of nuclei with a net spin, particularly hydrogen, is related
to the magnetic field they produce
Becauseofthemagneticfieldthehydrogennucleusproducesduetoitsspin,externalmagnetic
fieldsandelectromagneticradiationaffectthenucleusofhydrogen.Thisisnotablysoiftheexternal
field is very strong, and if the nucleus is exposed to electromagnetic radiation at specific
frequencies(seebelow).
Describe the changes that occur in the orientation of the magnetic axis of nuclei
before and after the application of a strong magnetic field
When placed in a very strong magnetic field, of about 0.5 to 2 teslas, hydrogen atoms align
themselveswiththeappliedfieldbecauseoftheinteractionbetweenthenuclearmagneticdipole
andtheexternalfield.Theangularmomentumoftheproton,aconsequenceofitsrotationonits
ownaxis,howeverhindersitfromdoingso.Asaresult,theaxisofrotationoftheprotonisnot
exactlyparalleltotheexternalfieldandtheprotonwillprecess.(seebelow)
Thealignmentisanalogoustothebehaviourofacompassneedleinamagneticfield,however
unlikecompassneedles,themagneticmomentsmayassumeoneoftwopossiblealignments,inthe
oppositedirectionstoeachother.About0.0004%moreprotonsfavourtheparallelalignmentover
theantiparallelalignment.(Notethatthetermparallelinthiscontextisnotexactlyliteral)
Protonsthatarealignedparalleltotheappliedfieldhaveaslightlylowerenergythantheoneswith
anantiparallelalignment.

Whentheappliedexternalfieldisremoved,theatomsresumearandomorientation.Thisoccurs
duetotherandommotionofatomsassociatedwiththermalvibrationsatanytemperatureabove
0K.

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Define precession and relate the frequency of the precession, ie Larmor frequency,
to the composition of the nuclei and the strength of the applied external
magnetic field

Thedirectionoftheaxisofthemagneticmomentrotatesaboutanaxisparalleltotheexternal
magneticfieldasshowninthediagram(abovecentreandright).Thismotioniscalledprecession.
Thismotionissimilartoaspinningtopwithitsaxisofrotationtiltedatanangletothevertical.
Precessionisthemotionthatresultsintheaxisofrotationofabodysweepingoutaconicalmotion
whenatorqueactstoaffectachangeintheaxisofrotationofthatbody.
Precessionisaconsequenceofthelawofconservationofangularmomentum.
ThefrequencyofprecessioniscalledtheLarmorfrequency.TheLarmorfrequencyisdependent
onthecompositionofthenucleusandthemagnitudeoftheexternalfield.
Foraprotonina2Tmagneticfield,theLarmorfrequencyis85.2MHz.Thiscorrespondstoaradio
frequencyelectromagneticwave.
Discuss the effect of subjecting precessing nuclei to pulses of radio waves
Whenprotonsinastrongmagneticfieldradioareexposedtoradiowaveswithafrequencyequal
totheLarmorfrequency,theirenergyisabsorbedbytheprotonsinaprocesscalledresonance.
Thiscausestheprotonsmagneticalignmenttoflipfromtheparalleltotheantiparallelstate,a
phenomenonsometimesreferredtoasspinflip.
Resonanceoccursbetweentwooscillatingsystemsiftheyhavethesamenaturalvibrational
frequencyandifthereissomemeansbywhichenergycanbetransferredfromonesystemto
theother.Thiscanbeobservedusingaguitarpressingdownonthefifthfretofthefirststring
andpluckingtheadjacentstring.Iftheguitaristunedcorrectly,thefirststringwillalsovibrate.
Thisoccursbecausethetwostringsundertheseconditionshavethesamenaturalfrequencyand
theenergycanbetransferredfromonestringtotheotherviathebodyoftheguitar.
Thehydrogennucleiprefertoreturntotheiroriginalstateinthemagneticfieldandastheydoso,
theyreemittheenergyabsorbedfromtheradiowaveoveraperiodvaryingfrom0.01to0.1ofa
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second.TheemittedenergyisaradiowavethatisdetectedwiththesamecoilthatemittedtheRF
wavestofliptheprotons.ThesesignalsemittedbytheprotonareusedtocreatetheMRimage.
RF signal flips the hydrogen nucleus The nucleus emits a radio signal as it flips
back
ThereturnoftheprotontothelessexcitedstateafterabsorbingtheRFenergyiscalledrelaxation.
The emission of the energy from the hydrogen nuclei returning to the lower energy state is
describedbytwotimeconstants,T1andT2associatedwithtwodifferentelectromagneticprocesses
(notnecessarytodiscussthesehere!).T1relatestoaninteractionbetweenprecessingprotonsand
the other atoms in the material. T2 relates to an interaction between the precessing nuclei
themselves.
Unlikemanyothermedicalimagingtechniques,thecontrastinanMRimageisstronglydependent
uponthewaytheimageisacquired.ByaddingRForgradientpulses,andbycarefulchoiceof
timings,itispossibletohighlightdifferentcomponentsintheobjectbeingimaged.Inthesequence
descriptionsthatfollowitisassumedthattheimagingmethodusedisEPI,howeveridenticalor
similarmethodscanbeusedwiththeotherMRimagingtechniquesoutlinedabove.
Thebasisofcontrastisthespindensitythroughouttheobject.Iftherearenospinspresentina
regionitisnotpossibletogetanNMRsignalatall.Protonspindensitiesdependonwatercontent.
ThelowprotonspindensityofbonemakesMRIalesssuitablechoiceforskeletalimagingthanX
ray shadowgraphs or Xray CT. Since there is such a small difference in proton spin density
betweenmostothertissuesinthebody,othersuitablecontrastmechanisms mustbeemployed.
ThesearegenerallybasedonthevariationinthevaluesofT1andT2fordifferenttissues.
[referenceforabove2paragraphs:MRIPrinciples.pdf.
SeeNuclearMagneticResonance
http://www.rzuser.uniheidelberg.de/~slange_expired/imaging/chap3.htm
ifyoureallywanttoknow.
Explain that the amplitude of the signal given out when precessing nuclei relax is
related to the number of nuclei present
With magnetic resonance imaging it is possible to produce a map of the hydrogen density
throughoutavolumeofthepatientbecauseincreasesinthedensityofhydrogennucleiproducesa
signalassociatedwiththeirrelaxationhavingagreateramplitude.
Alternatively,imagescanalsobeobtainedusingthevaluesofT 1andT2.Images,whosecontrastis
dominatedbydifferencesintheT1valuesarecalledT1weighted,thosedominatedbyT2differences

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thereforeT2weighted.Furthermoreeachtissueortissuegrouphasitsownspecificsetofvaluesfor
T1,andT2.
Allthreetypesofimagesareusedclinically.
Theseprocessesareusedtodistinguishthevarioustissues.Anotherverypowerfultoolwhichcan
enhancetheimagescontrastistovarythevaluesofthetimebetweentworepetitionsofasequence
ofappliedRFsignals,asthischangestheweightingoftherelaxationtimeswhichcanthenbeused
toimproveselectivecontrastbetweendifferenttissues.
Explain that large differences would occur in the relaxation time between tissue
containing hydrogen bound water molecules and tissues containing other
molecules
Thedifferenceinrelaxationparameters,T1 andT2 issignificantlygreaterfortissuescontaining
relativelylargeamountsofwater,asopposedtosomeothermolecule.MRIisverysensitiveto
variationsinwatercontentoftissuesandthisisasignificantfactorin
itsbeingabletoproducehighresolutionhighcontrastimages.
Becausetumoursarecharacterisedbyrapidcelldivisionandhigh
growthrates,theytypicallyhaveahigherpercentageofwaterand
similarnoncanceroustissue,andcanthusbeclearlyimagedusing
MR.
Haemoglobinmoleculesinredbloodcellsalsoprovideaclearlyidentifiableresonancesignaland
soMRIcanbeusedtocomparethebloodcontentofdifferenttissues.Thisisoftengreaterin
canceroustissue,becauseofthehighgrowthrates,andsoMRIisaneffectivediagnostictoolfor
canceroustissue.
MRIscansofthebrainshowmorecontrastanddetailthanconventionalXrayorCTscansbecause
ofthedifferencesinwatercontentofthegreymatterandwhitematterofthebrain.Atypicalbrain
MRIisshownbelow(left).ExcellentsofttissueresolutioncanalsobeseenintheMRIofthechest
(right).

Contrast media in MRI
Magneticresonance(MR)contrastagentsareuniqueinradiologybecauseitisnotthechemicalthat
isdetected,butrathertheeffectthatthechemicalhasonsurroundingmoleculesthatisdetected.
MRimagingreliesonsignaloriginatingfromhydrogennucleiinwaterandfat.Theseprotonshave
properties known as T1 and T2 relaxation times, which vary depending on the immediate
surroundings,andaffectsignalmagnitudefromthegivenregion.MRimagingusesmagneticfield
changestoaccentuatethedifferenceinsignalmagnitudesfromdifferentregions.Thereasonthat
differentanatomicstructurescanbeseenonanMRIislargelyduetodifferencesinT1andT2
relaxationtimesbetweendifferenttissues.

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Gadolinium(chelatedtoacarriermolecule)isanintravenouslyinjectedMRcontrastagentwhich
shortenstheT1ofprotonsnearit,makingthetissuesappearbrighter.Becausegadoliniumnormally
staysinbloodvessels,ithastheeffectofmakingvessels,highlyvasculartissues,andareasofblood
leakageappearbrighter.
Gadoliniumisexcretedthroughthekidneys,withahalflifeof1.251.6hours.
[2005HSC]

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Magnetic Resonance Imaging Spin and Relaxation

Reference: NationalGeographicArticle,January1987

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Magnetic Resonance Imaging Putting it all Together

References: HealthPhysics,McCormick,A.K.andElliot,A.T.
NationalGeographicArticle,January1987
The patient is placed in the strong magnetic field inside the MR scanner tunnel. The field is
producedbyliquidheliumcooled(4K)superconductingelectromagnets.
Thegradientcoilsproducesmallvariationsinthemagneticfieldacrossthepatientsbodysothat
themagneticfieldintensityhasauniquevalueateverypointinthepatientsbody.Thismeansthat
thehydrogenatomsateachpointhaveaknown,anduniqueLarmorfrequency.Boththeexact
positionandthecorrespondingLarmorfrequencyareaccuratelyknown.
ThepulseofradiowavesistransmittedthroughthepatientsbodyfromtheRFcoils.Thisflipsthe
magneticaxesofthehydrogennuclei.Astheyflipback(relaxation)theatomswithineachvolume
element(voxel)emitradiowaveswithaintensityproportionaltothenumberofhydrogenatomsin
thevoxel.
ThefrequencyoftheRFisvariedandthehydrogennucleiwithineachvoxelresonateattheir
characteristicLarmorfrequency.Dataisthusgatheredconnectingthelocationofthevoxeltothe
hydrogenatomconcentration.FromthisdataonetypeofMRimageiscomputed.
The relaxation data from each voxel are what really provides the key information for the
computationoftheimage.
Insomecases,chemicalagentsthatconcentrateinspecificorgansandwhichresponduniquelyto
MRareintroducedintothebodytoprovideanenhancedimage,similartotheuseofcontrastagents
inxradiography.

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Advantages of Using MRI
MRdoesnotinvolvetheuseofionisingradiationwithwhichthereareassociatedrisksforthe
patientandthemedicalstaff.
Itisnoninvasive
MRIprovidesexcellentsofttissueimagingprovidingbettercontrastthanCTorconventionalx
raysandmuchbetterresolutionthanultrasound.
MRIdatacanbeprocessedtoproduceatomographicimageora3Dimage
ExceptinthecaseofafewpatientswhoexperienceanxietyintheMRtubebecauseofthe
confinedspace,thereisnodiscomforttothepatient.SomeMRmachinesuseanopendesign
thatmakessomepatientslessanxiousabouttheprocedure
Disadvantages of Using MRI

CostMRIisaveryexpensiveimagingprocess.Thecapitalcostofthemachinesishigh,as
wellastherunningcosts.Theliquidheliumtypicallyhastobetoppedupweekly.
ThereiscurrentlyashortageofskilledpeopleinthemedicalimagingindustryinAustralia
(2001),afactorcontributingtohighercostssincehighersalariesareneededtoattractmore
peopleintotheindustry,andtokeeptheminAustralia,ratherthanworkoverseaswheretheir
skillsattracthighersalaries.
TheMRImachinesareverysensitiveandmustbescreenedfromoutsideradioandmagnetic
interferenceaddingtothecapitalcostsofinstallingsuchmachines
Patientswithheartpacemakersormetalpartsintheirbodiescannotbeimaged
GreatcaremustbetakentoavoidintroducingferromagneticmaterialsintotheMRimaging
room,asthesemaybeattractedintothemachineathighspeed,injuringthepatientordamaging
themachine
Thestrongmagneticfieldproducedcaninterferewithnearbyelectronicequipment

Medical Physics
Social Implications of Using MRI

Medical imaging technologies increase peoples chance of surviving medical problems. MRI
especially, is a diagnostic tool that often outperforms other procedures. Technology improves
qualityoflifeinmanycases.Butitcomesatacost,botheconomicandsocial.
MRIisoneofthemoreexpensiveimagingtechnologies.Becauseithasbetterresolvingcapabilities
thanultrasoundandCT,itisoftenusedasalastresortwhenthoseothertechnologiesfail.
Increasingly however, patients are demanding from the outset, access to the best available
technology. Doctors are also coming under increasing pressure from litigants who pursue
compensationwhenadoctorfailstopursueeverypossibleavenuethattechnologyhastooffer.
TheresultisthatsomedoctorsnowroutinelyorderanMRIifthereistheslightestreasonfor
suspectingthatitmayrevealwhatothertechnologieswillnot.Theeconomiccostisveryhigh
because our system of medical insurance means that few patients pay the full cost of such
procedures.
Thecosthowevermustbemet,sincethehospitalsandprivatepracticesusingimagingtechnologies
must factor in capital and ongoing costs. As a result of the growing use of MRI especially,
insurancecostshaveincreasedsubstantially.
Qualityoflifehasimproved.Costshaveincreased.Asasociety,wehavemadeachoice.

Medical Physics
Comparing MRI and CT

Medical Physics
Questions
1. Examinetheimagesbelow.

Image1 Image2

Image3 Image4
Identifytheimagingtechnologyusedtoproduceeachoftheimages.
2. Nucleihavinganetspinincludehydrogen,phosphorus31andcarbon13.Explaincarefully
whythesenuclidesmusthaveanetspin.
3. Explainwhyfluorine19hasanuclearmagneticmoment,butnitrogen14doesnot.
4.
5.
6.
7.

i
Definition:Anuclideistheparticularnucleuswithagivennumberofprotonsandneutronsinagivenenergystate

Medical Physics Course Notes (Greg Pitt)

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Medical Physics

1. The properties of ultrasound waves can be used as diagnostic tools

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Why is Ultrasound Done?

What A Person Experiences, What to Expect During an Ultrasound Study

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How Does Ultrasound Work?

Color ultrasound image of the kidney

What is Ultrasound Good at Imaging?

Because high-frequency sound waves cannot

Updated: November 10, 2000

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Introduction and Principles of Ultrasound

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Define acoustic impedance:

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Identify that different materials have different acoustic impedances

Substance density (kg m 3) Ultrasound velocity Impedance (rayl)

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Identify that the ratio of reflected to initial intensity is 2 :

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When is A Mode used?

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Real Time or Compound B Mode

Cross-sectional image of the heart (real time B mode)

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Renal cyst - (real time B mode)

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Base of the tongue (B-Scan)

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Bone Density Measurements

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Assessing the value of ultrasound bone density measurement.

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The physical properties of electromagnetic radiation can be used as diagnostic tools

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Explain how a computed axial tomography (CAT) scan is produced

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A sequence of images can be digitally processed to produce a threedimensional image, or

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Just for general interest

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