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Anatomy by Diagnostic
Radiologic
g g
Imaging WE ARE HERE
Anatomy
Patricia Moser, MD
Assistant Professor, Diagnostic Radiology
University
y of Florida College
g of Medicine
Radiology
gy Diagnostic
g Imaging
g g
• Diagnostic Imaging • Electromagnetic Radiation
• Angiography and Interventional – X-ray & Computed Tomography (CT)
Radiology – Magnetic Resonance Imaging (MRI)
– Nuclear Scintigraphy
(Nuclear Medicine)
• Not to be confused with
Radiation Oncology • Sound Waves (not radiation)
((Radiation
ad at o Therapy)
e apy) – Ultrasound
Different specialty
ELECTRONS
Tissue Thickness
Inherent Contrast
• Tissue • Appearance on XRAY BONE
– Air – Bl k
Black
– Fat – Dark Gray SOFT
– Soft Tissues – Gray TISSUE
– Bone, Calcium – White
– Metal – Reallyy White
FAT
AIR
BONE
SOFT
TISSUE
FAT
AIR
METAL
‘Digital’
g Radiography
g p y Computed Radiography CR
• Two types
– Computed radiography, called CR
• Uses existing equipment to make exposures
• Film cassette is replaced with a charged metal plate
• After exposure, plate is ‘read’ in a special device HERE ARE
THE PLATES
– Digital
Di it l radiography,
di h called
ll d DR
• Requires conversion of the entire xray room
• Film cassette is replaced by a CCD sensor (like in a
digital camera or video camera)
20TH CENTURY
•Bad haircuts
•Films
•View box
•What’s
Wh ’ with i h the
h
t-shirts dudes?
PLAIN
Contrast Agent
g BARIUM
RADIOGRAPH
SWALLOW
OF THE CHEST
• Anything that enhances the differences
between tissues of similar densities
• For XRAY there are TWO commonly used
contrast agents:
– Barium
– Iodine
• Various ways they are introduced
– Swallowed: barium swallow, upper GI
– By enema: barium enema
– In vein: Intravenous urogram
– In artery:
y Arteriogram
g
PLAIN RADIOGRAPH
BARIUM ENEMA
Barium: upper GI
OF THE ABDOMEN
STOMACH
Iodine: Iodine:
Intravenous urogram Arteriogram through
Intravenous pyelogram
py g a catheter (tube)
( )
(IVU or IVP) in the leg
URETERS AORTA
Xray
• Plain Radiography
– X ray production
– inherent contrast
– film
– digital / PACS
• Contrast Radiography
– barium
Diagram of Photograph of a
– iodine
i di
fluoroscopic unit fluoroscopic unit • Fluoroscopy
• CT (COMPUTED TOMOGRAPHY)
Computed
p Tomography
g p y ((CT)) Computed Tomography (CT)
• Still uses XRAYS like radiography
$$$$
EMI • Tube spins around patient
• Detector spins around patient
opposite the tube
• Detector output and angular position fed
into a computer
p
• Computer performs calculations to
estimate density of tissues in each square
of a ‘slice’
Computed Tomography (CT) Contrast for CT
• Iodine injected into an arm vein during the
scan
• Iodine or Barium diluted in water given orally
for abdomen scans
• There are some risks
– Allergic reaction
– Kidney damage
• Enhances the blood vessels and organs and
makes them much easier to see
• Enhances cancerous tissue in many cases
CONTRAST
IODINE
Bone Lung
CT Colonography CT Bronchoscopy
3D CT of the heart 3D CT of the knee and leg
Ultrasound
• Uses high frequency sound to make
g
images
• The sound is produced and detected
Ultrasound with the same device: TRANSDUCER
• Transducer
– Speaker: sound into patient
– Microphone: sound coming back from
patient
• Analogous to SONAR used in undersea
warfare
TRANSDUCER
Ultrasound Machines
Getting Much Smaller
TRANSDUCER
Obstetric
Ultrasound
Ultrasound Of Breast Benign Ultrasound Of Breast Cancer
Magnetic
g Resonance Imaging
g g
• Starts with a really strong magnet
– Supercooled with Liquid Helium / Nitrogen
• Transmit radio wave pulses into patient
Magnetic Resonance Imaging
• Listen for return radio waves caused by
(MRI) interaction with protons (water) in the
patient’s
patient s body
• Process the frequency and phase of the
e u ed ssignals
returned g a s by co
computer
pu e
• Different tissues give different
intensities of returned radio waves >
image
MRI Contrast
• Gadolinium solution injected into vein
• Same idea as the Iodine contrast used
for CT
• Gadolinium alters the interaction of
radio waves with the p
protons in water so
that it gives MORE signal
• Shows up as white on images
Magnetic Resonance
Angiography
Nuclear Scintigraphy
• Often called NUCLEAR MEDICINE
• Uses radioactive tracers that emit
Nuclear Scintigraphy radiation
Nuclear Medicine – Electromagnetic OR particulate
• Often these are injected
j into the vein
• Different tracers go to different organs
or parts of the body
• Images are made by detecting the
radiation coming out of the patient
Angiography And
Interventional Radiology
Interventional Radiology Drawing of normal kidney
• Radiologists do invasive procedures guided
by images for either diagnosis or treatment
• Basically anything that breaks the skin
– Needles for biopsy or fluid removal
– Catheters to make angiograms Frank
Netter, MD
– Catheters with balloons to open
p blood vessels you will love
– Stents to hold blood vessels open this guy by
the time you
– Coils and material to block blood vessels are
a e finished
s ed
– Catheters to drain abscesses
– Tubes for feeding
– etc
t etc
t
SPINE
11TH RIB
THIS IS THE
CANCER MASS
THIS IS THE
CATHETER
COMING
UP FROM
THE LEG
ARTERY
NO BLOOD
FLOW TO
THE MASS
NOW IT CAN
BE REMOVED
WITHOUT
EXCESSIVE
BLEEDING
Non Surgical Shunting For Angioplasty Balloon
Cirrhosis of Liver TIPS Vascular Stent
AFTER
• X-ray
– radiography,
di h contrast
t t studies,
t di CT
• Ultrasound
• Magnetic Resonance Imaging
– MRA
• Nuclear Scintigraphy
Angiography And
Interventional Radiology
ANATOMY Knee - MRI Sagittal
PATHOLOGY
ANTERIOR POSTERIOR
CRUCIATE CRUCIATE
LIGAMENT LIGAMENT
IMAGING IS
GROWTH OF IMAGING
ESSENTIAL TO
MODERN HEALTH
CARE DELIVERY
Rothenberg, Korn. The Opportunities and Challenges Posed by the Rapid Growth of Diagnostic Imaging.
J Am Coll Radiol 2005;2:407-410.
Percentage
g of internists saying
y g that the loss of an innovation
would have the most adverse effect on their patients.
Fuchs VR, Sox HC Jr. Physicians’ views of the relative importance of thirty medical innovations.
Health Aff 2001;20:30-42.