Introduction to radiology

Lecture 1
Basic terms and definitions

1
 Radiology
In medicine, the discipline of
medical science that uses
electromagnetic radiation and
ultrasonics for the diagnosis and
treatment of injury and disease.

Radiology originated with the

discovery of X rays by German
physicist Wilhelm Conrad
Roentgen in 1895.

W.C. Roentgen was awarded the

first Nobel Prize in physics (1901)
for his work.

Wilhelm Conrad Roentgen

2
 Diagnostic Radiology

Diagnostic radiology,
or diagnostic imaging,
is the medical evaluation
of body tissues and
functions—both normal
anatomy and physiology
and abnormalities caused
by disease or injury—by
means of static (still) or
dynamic (moving)
radiologic images.

3
 What you need to know about
imaging:
a. Understand the
physical basis of
imaging.
b. Recognize clinical c
images produced by d
various modalities.
c. Identify the
advantages and
disadvantages of a
various imaging b
modalities.
d. Understand the terms
used in different
imaging modalities.

4
 Medical imaging of internal body
structures is achieved through the
use of following types of radiation:

• The most commonly used types of radiation are X-rays used in roentgenology
and gamma rays used in different modalities of nuclear medicine, X-rays and
gamma rays are ionizing electromagnetic radiations with similar characteristics
differing only in their mechanism of production.
• The third type which is used in medical imaging, relatively new in medical
imaging, is radiofrequency radiation. It is used in magnetic resonance Imaging,
which is also of the electromagnetic type but is non-ionizing.
• Infrared light used in thermography is another non-ionizing type of radiation.
• Ultrasound is entirely different in nature being non-electromagnetic, and is
propagated through matter as mechanical vibrations.

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 1

Imaging
modalities:
1. Diagnostic roentgenology, 2
or conventional
roentgenology or X-rays.
2. Computed axial
Tomography (CAT).
5
3. Diagnostic Ultrasound
(Ultrasonography, USI). 2
4. Magnetic Resonance
Imaging (MRI ).
5. Nuclear Medicine,
(radionuclid imaging ore
scintigraphy). 3
6. Thermography. 6
7. Interventional Radiology .

4 7
6
 1

Imaging
modalities:
1. Diagnostic roentgenology,
or conventional
roentgenology or X-rays.
2. Computed axial
Tomography (CAT).
5
3. Diagnostic Ultrasound
2
(Ultrasonography, USI). 2
4. Magnetic Resonance
Imaging (MRI ).
5. Nuclear Medicine,
(radionuclid imaging ore
scintigraphy). 3
6. Thermography. 6
7. Interventional Radiology .

4 7
7
 1

Imaging
modalities:
1. Diagnostic roentgenology, 2
or conventional
roentgenology or X-rays.
2. Computed axial
Tomography (CAT).
5
3. Diagnostic Ultrasound
(Ultrasonography, USI). 2
4. Magnetic Resonance
Imaging (MRI ).
5. Nuclear Medicine,
(radionuclid imaging ore
scintigraphy). 3
6. Thermography. 6
7. Interventional Radiology .

4 7
8
 1

Imaging
modalities:
1. Diagnostic roentgenology, 2
or conventional
roentgenology or X-rays.
2. Computed axial
Tomography (CAT).
5
3. Diagnostic Ultrasound
(Ultrasonography, USI). 2
4. Magnetic Resonance
Imaging (MRI ).
5. Nuclear Medicine,
(radionuclid imaging ore
scintigraphy). 3
6. Thermography. 6
7. Interventional Radiology .

4 7
9
 1

Imaging
modalities:
1. Diagnostic roentgenology, 2
or conventional
roentgenology or X-rays.
2. Computed axial
Tomography (CAT).
5
3. Diagnostic Ultrasound
(Ultrasonography, USI). 2
4. Magnetic Resonance
Imaging (MRI ).
5. Nuclear Medicine,
(radionuclid imaging ore
scintigraphy). 3
6. Thermography. 6
7. Interventional Radiology .

4 7
10
 1

Imaging
modalities:
1. Diagnostic roentgenology, 2
or conventional
roentgenology or X-rays.
2. Computed axial
Tomography (CAT).
5
3. Diagnostic Ultrasound
(Ultrasonography, USI). 2
4. Magnetic Resonance
Imaging (MRI ).
5. Nuclear Medicine,
(radionuclid imaging ore
scintigraphy). 3
6. Thermography. 6
7. Interventional Radiology .

4 7
11
 1

Imaging
modalities:
1. Diagnostic roentgenology, 2
or conventional
roentgenology or X-rays.
2. Computed axial
Tomography (CAT).
5
3. Diagnostic Ultrasound
(Ultrasonography, USI). 2
4. Magnetic Resonance
Imaging (MRI ).
5. Nuclear Medicine,
(radionuclid imaging ore
scintigraphy). 3
6. Thermography. 6
7. Interventional Radiology .

4 7
12
 Ionizing radiation

• Those types of radiation

(X, gamma, beta and
alpha radiation) which
have the capacity to ionize
atoms and dissociate
molecules and therefore
cause biological damage.
• Ionization – process by
which a neutral atom or
molecule gains or loses
electrons acquiring a net
charge.

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What is the damaging effect of
radiation?
• T
he ions formed then can go on
to react with other atoms in the
cell, causing damage.
• A
n example of this would be if a
gamma ray passes through a
cell, the water molecules near
the DNA might be ionized and
the ions might react with the
DNA causing it to break.
• C
harged atoms in the living
organism could cause different
type of damage for example
cancer induction or genetic
mutation!

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 Effective dose
• The effective dose of an examination is
calculated as weighted sum of the doses to
different body tissues.
• The weighting factor for each tissue
depends on its sensitivity
• The effective dose thus provides a
single dose estimate related to the
total radiation risk no matter how the
radiation dose is distributed around
the body.
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 The effective doses
Procedure typical CXR Approx. equivalent
effective equivalenperiod of
dose mSv ts background
radiation
X ray examinations

Limbs and joints 0.01 0.5 1.5 days

chest(pa) 0.02 1 3 days
abdomen 1 50 6 months
Lumbar spine 1.3 65 7 months
CT head 2.3 115 1 year
Barium meal 3 150 16 months
CT chest 8 400 3.6 years
CT abdomen pelvis 10 500 4.5 years

Rradionuclide 0.3 15 7 weeks 16

studies of
 For personel!
It is necessary to
be protected
from ionizing
radiation by time,
distances and
different
protector sources
!!!

17
• For a patient the protection
lies in the doctor's decision!
• The decision to expose
patients to radiation must be
made with risks in mind!
• So an examination should be
requested only where clinical
benefits far outweigh the
risks of radiation sensitivity,
cancer induction, and genetic
mutation!

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 The following physical
phenomena are the basis of
modern imaging:
X ray examination

• X-rays are absorbed in tissue.

• X-rays, are based upon the fact that different tissues provide
different degrees of X-rays attenuation.
• The transmitted X-rays moving out of the patient, fall on the
fluorescent screen or film make a image of body structures.

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Roentgenologic equipment

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Magnetic Resonance Imaging
In a magnetic examination a patient on
(MRI)•
the examination
Magnetic table is exposed
resonance imaging
a strong and very homogeneous
to
or tomography, a form of
magnetic field. This static magnetic
medical imaging that
field changes the direction of all of
measures
the spinning the response
hydrogen of in
nuclei thethe
atomic
body, so nuclei
that of body
they aretissues
aligned
to
parallel high-frequency radio
to the direction of the field.
waves
Radio when radiation
frequency placed in a
is then
strong tomagnetic
applied field, energy
tissues where and
that produces
quanta are absorbedimages
by someof ofthethe
protons,
internalthese become excited as a
organs.
result and while decaying send
quanta of emradiation to the
environment. These photons are
detectable and slice images are
reconstructed from the resultant
interference pattern.

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MRI equipment

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 Ultrasound examination (USI)

• Ultrasound utilises high-frequency sound waves, which are

reflected in specific ways by different tissues, normal or
pathological, in the body.
• The reflected sound (echo) is processed by a computer to
produce a real time image which is displayed on a screen
instantly.
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Ultrasound equipment

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• Scintigraphy, a technique in which a
scintillation counter or similar detector is Nuclear Medicine
used with a radioactive tracer to obtain an
image of a bodily organ or a record of its Imaging
functioning.
• Radioactive isotopes concentrated in Isotope Imaging
certain tissues emit gamma radiation.
• An organ can be visualised by measuring
the emission of gamma radiation from a
radioisotope with which a physiological or
metabolic agent is labelled.
• Such an agent (a radiopharmaceutical), is
introduced into the body by intravenous
injection or oral ingestion.
• The imaging or measurement of a patient
is performed with a gamma camera or a
PET -camera.

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Gamma camera

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Infrared Imaging or
Thermography

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Infrared detector

28
General schemes and terms
Source of radiation,
Object of examination
Register (registrant) of information

29
 Two types of systems
differ in source of radiation:

MRI
radiopharmaceuti
cals E
m
i
s
s
i
o
n
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Transmission system

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 Transmission system
images
Plain film image of chest with Computer transmission
pneumonic infiltration. tomography images of chest
with pneumonic infiltration.

32
Emission system

33
 Emission system images
Conventional liver AP and PA
radionuclide planar images Dynamic radionuclide images.
(scintigrams).

34
35
Plain film

36
Tomogram

37
In transmission system

38
 In emission systems
Plane AP emission radionuclide Axial, sagittal and coronal emission
image of abdomen radionuclide tomograms

39
 Panoramic images
plain film in x-ray imaging

in radionuclide imaging

40
Plain film of the head in direct and
lateral views

posterior anterior
lateral 41
Plain film of the chest in direct and
lateral views

posterior-anterior
lateral 42
 Radionuclide imaging of the
abdomen in direct and lateral
views

posterior anterior
lateral 43
Tomography – imaging of slice of some
body part

44
 Tomogram orientation

• Coronal – parallel
with the plane of
front
• Transverse or axial
– perpendicular to
the main axis of the
body
• Sagittal – parallel
with the main axis
of the body
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Tomographic methods

MRI CAT PET

USI 46
 Analogue techniques
• With these techniques, the final X
ray image is created directly on a
detector medium, i.e., without any
complicating intermediate steps.
• The medium may be a radiographic
film or a fluorescent screen.
• The film and the screen are both
analogue detectors of X-rays, which
means that their response to a
steady and continuous increase in
radiation dose, is also steady and
continuous, as opposed to
stepwise.
• The radiographic film responds with
blackening, the fluorescent screen
by emitting visible light.
Digital techniques
• Digital image is composed of a
digital matrix, i.e., rows and
columns of numbers.
• The numbers may represent echo
strength in an ultrasound image,
X ray attenuation in a CT image,
tissue magnetism in an MR image
or light intensity from a
fluorescent screen in digital X-ray
imaging.
• To visualise the image, the digital
matrix is transformed into a
matrix of visible picture
elements, pixels, where each
pixel is given a shade of grey
according to the corresponding
number in the digital matrix.
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Analogue Digital

48
 Analogue techniques Digital techniques

• Analogue • Computed
radiography tomography
• Analogue • Ultrasonography
Fluoroscopy • Magnetic
• Analogue resonance
Traditional imaging
Tomography • Digital
radiography
• Isotope imaging
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 Resolution
• A measure of the ability of an imaging
system to separate the images of
closely adjacent objects.
• It is also the smallest area identified
as a separate unit.
• Spatial resolution may have to be
represented as points or distance
between sample points.

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Spatial resolution

51
 Contrast resolution or contrast of
image
• Smallest difference in color intensity
which can be detected on image

52
 Do you remember what do these terms
mean?
• Radiology • Projection
• X-rays, CAT, USI, MRI, • Tomography
Nuclear Medicine, • Coronal
Thermography, • Axial
• Ionizing and non • Sagittal
ionizing radiation
• Analogue
• Transmission and
• Digital
emission systems
• Planar and tomographic • Spatial and contrast
images resolution

53
54
A diagnostic image is composed of differences
in contrast between tissues which result from
differences in radiation interaction in the
tissues

55
• The thickness of the
tissue affects the
attenuation of the x-
rays.

56
• The tissue type
affects the the
attenuation of
the x-ray

57
 5
The five densities
5 4 3
can be differentiated
on film 2

1. Metal
2. Bone
3. Soft
tissue
(water)
4. Fat
1
5. Gas 4

58
Radiographs are summation shadows created
by differences in contrast between tissues.
Tissue thickness and tissue composition affect
the attenuation and therefore, the shade(s) of
gray in the final shadow image.

59
 Two projections are necessary!
Fracture of the distal end of the radius (Colle's
fractures).
lateral view –the angulation in a
AP view shortening or compression
dorsal direction
the distal end of the radius
v = volarly, d = dorsally

60
 Two projections (views)

• PA • Lateral 61
Depending on information detector,
and the way of watching (real time
ore frozen)

62
Fluoroscopy - view in real time
X-ray Fluorescent screen Positive view on
tube screen

63
 Fluoroscopy used in diagnose different
motor disorders of GI organs

Oesophagus movement during oesophagoscopy

at patient with achalasia 64
 FLUOROGRAPHY
- photography in which
the image is formed by
fluorescence.
- widely used in
prophylactic
examinations,
- used to prevent disease
such as tuberculosis
and lung cancer.

65
 Positive

Inversion
opposite or contrary in position, direction, order, or effect

Negative 66
67
 ROENTGENOGRAPHY
Plain film roentgenogram - negative view to
fluoroscopy screen view

Screen positive Film

- negative

68
 Special terms used on x-ray reports
(we usually describe a negative film that
is why)
• Radiopaque (light or
white). Synonym: High
density.

• Radiolucent (dark or
black). Synonym: Low
density.

• Water density (middle

density)

PA view of normal chest 69

Remember in film:
Black = air-filled
White = bone, calcium,
fluid, pus, blood, collapse
Gray = soft tissues and
solid organs

70
 How to Approach Reading
any Image
• Identify the patient
• When was the image taken
• Are these the proper images:
– Correct type of study
– Correct / complete views
– Correct limb
– Contrast
• The five densities
• Are the images technically adequate
• Why did you order the image
• What did you expect to see
• Do you see it
• Now start over fresh
POSITIONING FOR XRAYS
• For the FRONTAL plane,
we refer to the direction
that the XRay beam goes
through the patient. Thus
a POSTERIOR-ANTERIOR
(PA) chest is done with
the XRays entering the
patient's back (posterior)
and passing through to
the front (anterior) where
they strike the detector
(film or charged plate).

72
 The frontal chest film

•View the film as

Aortic knob though the patient is
Ascending facing you with his
aorta
Descendin left on your right
g

LA
aorta • If the film is
RA unmarked,
RV remember your
LV
anatomy (heart and
aortic arch are left
of midline)
A lateral chest XRay
• Here the XRays
strike the patient's
right side, pass
through her, and
strike the detector at
her left.
• The 'skirt' she is
wearing is made of
lead to protect her
ovaries from the
radiation.
74
 Typically left chest is placed against
Normal lateral film detector to minimize cardiac
magnification
es
ss u
f t i
s o
n es
i ck
h
ee pt E
d
Asc T
A DA

LA

RV
LV
 Thoracic Imaging Strategies
• Approach to image interpretation
• What is the expected normal and variant
anatomy?
» Is something absent?
» Is there some additional structure present?
• Look at the bones and soft tissues
• Look at the heart and mediastinum
• Look at the lungs and pleura
• Look at the airways
• Look at the diaphragms and upper abdomen
Look at the bones …
Examine scapulae, humeri,
1 shoulder joints, clavicles, ribs
2 and spine for symmetry
3
4
5
Identify the 1st rib by its
6
anterior junction with the
7 manubrium then count down
8 the posterior ribs
9

10
The location of an abnormal
11 shadow can be described by
its proximity to a particular rib
12 or interspace
 Healing fracture

Note the multiple right and left sided rib fractures.

 Survey, look carefully and thoroughly at th
soft tissues


•Breast tissues (if applicable)

•Skin
•Supraclavicular areas
•Axillae
•Subcutaneous fat
•Muscles Which film is that of a woman?
What happened
to this patient?
Notice the asymmetry of the
left breast shadow relative
to the right and the surgical
clips in the left axilla

Diagnosis: Left
breast cancer
treated with
lumpectomy and
axillary node
dissection
 Look at the diaphragm and upper abdomen

~ ½ interspace
R

L
R

The diaphragm is a The plane of the right

musculotendinous sheet The left and right diaphragmatic dome is usually
separating the thoracic and hemidiaphragms are about half an interspace higher
abdominal cavities usually well seen on PA than the left
and lateral films
 Left phrenic nerve paralysis

The left hemidiaphragm is elevated and demonstrates paradoxical motion with

inspiration consistent with paralysis of the phrenic nerve.
Look at the mediastinum…
• look at right paratracheal stripe and hilar contours to evaluate for lymphadenopathy
• look at paraspinal lines, anterior clear space, and the spine to evaluate for a mediastinal
mass

A P
Look at the heart …
The plain film diagnosis of heart disease is limited to determining:

Cardiac enlargement

Pulmonary vascular abnormalities

Congestive failure

NORMAL
 Mitral valve
replacement from
rheumatic heart
disease
• a complication of a
streptococcal infection
resulting in mitral valve
dysfunction over time
•Treated with valve
replacement

Mitral valve replacement LA enlargement secondary

to long-standing MV
stenosis and regurgitation
The frontal film
• Pleura not normally
visible

Pulmonary artery
• Blood-filled pulmonary
vessels cast soft gray
shadow and typically
taper out to periphery,
while bronchi and
bronchioles are air filled
and do not cast a shadow
on the image
 The frontal film

Trachea

•bronchi and bronchioles

are air filled and do not
cast a shadow on the
L main image
R main bronchus
bronchus

Gastric air bubble

Airways bronchogram with contrast
in airways

THESE ARE NOT DONE ANY MORE

88
AIRWAYS CT CORONAL
RECONSTRUCTION
which replaces contrast
bronchography

89
 Pneumothorax
Tension
pneumothorax: the
left lung has
collapsed completely

Take note of the

resultant low X-ray
attenuation (black)
where the airways have
collapsed

The non-aerated lung

is significantly
diminished in size
Pneumothorax – where the air Air is seen in the pleural
space. Notice the air in the
goes depends on positioning… costophrenic sulcus when the
patient is supine for CT.
 Centrilobular emphysema

Hyperinflated lungs, paucity of upper lung vessels, crowding of lower

vasculature, and flattened diaphragms are seen in emphysema
Status post pneumonectomy with shift of
heart/mediastinum to the left

Clips at
bronchial
stump
Air may be present in
The stomach bubble
the stomach and can
be seen on PA and
lateral chest films

Air, being less dense

than fluid, will rise and
can be seen in the
fundus of the stomach
on plain film provided
the patient is upright
In the lateral chest film,
the presence of the air
bubble close under one R
diaphragmatic shadow L

determines which is the

left hemidiaphragm
Misplacedair on
plain film
Peritoneal air trapped
under the right
hemidiaphragm (not to
be confused with the
stomach bubble which
would appear on the left)
Can you determine the cause
for the free air ?

Dialysis catheter
responsible for air
into the peritoneal
space
How an upright posteroanterior
chest X-ray is taken •Images are usually is taken on
inspiration, with the patient standing
in front of film cassette (1)
chest and X-ray tube (2) about six
feet behind him.
•The PA position places the heart and
upper mediastinum closer to the film
with greater distance to the exposing
Xray tube (generally 72 inches)
making the Xrays more parallel as
they enter the body and avoiding
1 2 disproportional enlargement of
anterior vs. posterior structures.
L •The upper lung arterial vessels in
R A upright posture, being well above
A cardiac chamber level, are usually
R much less prominent than the lower
V L lobe vessels which are at or below
V
cardiac chamber level.

96
How supine AP chest X-ray is
taken
2 the chest there are
1 the appearance of
•With film cassette (1) in
table behind the patient's
chest and X-ray tube about
six feet above him
•That way images are taken
in emergency.
•On a supine frontal Xray of
significant differences in
the appearance of normal
pulmonary vasculature and
mediastinum.
• The closer distance of the
exposing Xray tube (often
only 40 inches from the
film cassette) makes the
Xrays more diverging and
disproportionally enlarges
structures that are farther
from the film (the anterior
body structures such as the
ascending aorta).
97
 Normal pa and ap film

On a supine frontal Xray of the chest there are significant differences in

the appearance of normal pulmonary vasculature and mediastinum.
The closer distance of the exposing Xray tube (often only 40 inches from
the film cassette) makes the Xrays more diverging and disproportionally
enlarges the appearance of structures that are farther from the film (the
anterior body structures such as the ascending aorta). 98
Two films at right angles to one another are neededMajor
to fissure
determine the true location of any foreign body or
mass within the thorax

The nodule is in
the RML and
calcified

RML

Granuloma within the RML

 Natural roentgen contrast of the
abdomen organs is bad

The pathological tissue which

has almost the same density
as the adjacent structures 2 2
cannot be seen on plain film.
You can see:
1.Gas in rectum/sigmoid
2.Gas in ascending and
descending colon
3.Bones 3 1
Artificial contrast is needed to
create density difference.
3

100
Please write down
in your paper the
name of structures
in picture with
letters

Now correct yourself

X ray Imaging without contrast media is
suitable for the examination of bones and
organs containing gas (like the lungs), but soft
tissues cannot be separated from one another.
Liver and kidney for instance, as well as brain
and cerebrospinal fluid are equally grey in a
radiograph.
For the visualization of soft tissues contrast
media and/or digital methods with a computer
must be used.

102
X ray Imaging without contrast
media
PNEUMOPERITONEUM

Upright –
Nondependent point
X ray Imaging without contrast
media
PNEUMOPERITONEUM

Supine – Double Bowel Wall Sign Outlining of liver/GB

 ‘WHITE BITS’ = Calcification

• Calcified structures (‘WHITE BITS’)

• Calcification can be broadly divided into 3
types:
– (1) Calcium that is an abnormal structure - eg.
gallstones and renal calculi
– (2) Calcium that is within a normal structure, but
represents pathology - eg. nephrocalcinosis,
– (3) Calcium that is within a normal structure, but
is harmless - eg. lymph node calcification.
– Bones are normal ‘white’ structures. On the AXR
they comprise mainly those of the thoraco-lumbar
spine and pelvis. Findings are largely incidental as
direct bone pathology would be investigated with
specific views.
Gallstones
X ray Imaging without contrast
media
35 year old with recurrent
abdominal pain:
Extensive pancreatic
calcification = recurrent
pancreatitis
 X ray Imaging without contrast media
This patient was admitted with poor renal
function.
• Nephrocalcinosis
• Causes of
Nephrocalcinosis
include:
– •Hyperparathyroidi
sm
– •Medullary sponge
kidney
X ray Imaging without contrast
media

35 year old with bloody

diarrhea
Thumb-printing transverse
colon = Colitis
X ray Imaging without contrast
media Bowel obstruction

110
 X ray Imaging without contrast media

• Intra-luminal
Gas:
• Low Small Bowel
Obstruction
 SBO
• Plain abdominal radiograph.
• Multiple dilated loops of small bowel
within the central abdomen. Gas is
not seen in the large bowel. No
evidence of hernia or gallstone to
suggest potential cause of the
dilated loops.
• These findings are in keep with a
low small bowel obstruction.
• I would like to know if the patient
has a history of abdominal surgery
as the commonest cause is surgical
adhesions.
 Large bowel obstruction
• Haustra visible – do
not cross lumen
• Localised around
outside of film
• Small bowel may also
be dilated depending
on competence of
ileocaecal valve
 Contrast agents
Administered material used to see structures or pathologic
processes that would not be seen otherwise.

• Positive contrast media - attenuate X-rays

greater than the soft tissues of the body:
– Barium sulfate into the GI tract;
– Iodine compounds into the vessel.
• Negative contrast media - attenuate X-
rays less than the soft tissues of the body:
– Air,
– Carbon dioxide and other gases.

114
 Contrast agents
Positive contrast media - attenuate X-
rays greater than the soft tissues of the
body: Barium sulfate into the GI tract;
Iodine compounds into the vessel.
Negative contrast media - attenuate X-rays
less than the soft tissues of the body: Air,
Carbon dioxide and other gases.
115
 Upper gastrointestinal tract study,
GI examination, upper GI series
Uses in following clinical problems:
Normal AP supine view of the abdomen
following the oral administration of barium
• Diseases and injuries of
esophagus, dysphagia.
• Stomach and duodenum in
complex with Endoscopy
examination.

116
 Barium enema
Uses in following clinical
AP view of abdomen with barium
problems:
instilled retrograde into the colon
under fluoroscopic control.

• Diseases and injuries of

colon in complex with
Endoscopy
examination

117
 Intravenous pyelography
(intravenous urography – IVP)
• Iodine compound Normal IVP
(contrast) is injected
intravenously and filtered
and excreted by the
kidneys.
• Contrast medium in
bilateral renal collecting
system with increased
density.
• Contrast agent may be
instilled intravenously ore
into urethra, so called
retrograde cysto- or
urography

118
 Intravenous pyelography
• This method show an
Right sided hydronephrosis on PA
anatomy and abdomen film
physiology of urinary
system by time of
filtration and excretion
of contrast media, and
visualization of all
structures of system.
Uses in complex with
CAT and nuclear
medicine for evaluate
urethral calculus,
hematuria, infections,
renal trauma,
hydronephrosis, renal 119
Angiography
Angiography uses to evaluate
different vessels anomalies,
diseases and injuries.

• Water soluble iodine

contrast agents
( Ultravist, Omnipak,
Urographin) used to fill
vessels, to make
angiogram
• Contrast is injected into
an artery, vein, or lymph
vessels.

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 Angiography
Normal angiographic image Normal angiographic image of abdominal
vessels
of coronal vessels

121
 Endoscopic retrograde
cholangiopancreatography (ERCP)
ERCP is used primarily to diagnose
and treat conditions of the bile
ducts, including gallstones,
inflammatory strictures (scars),
leaks (from trauma and surgery),
and cancer.

Through the endoscope, the

physician can see the inside
of the stomach and
duodenum, and inject dyes
into the ducts in the biliary
tree and pancreas.
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 Endoscopic retrograde
cholangiopancreatography
(ERCP) ERCP, CBD multiple Stones
ERCP, CBD Stones

123
 Radiography (roentgenology)
(X-rays )
Radiographic studies include all procedures
using X-rays

–plain film X-rays,

–fluoroscopy,
–photofluorography,
– angiography, urography
– conventional tomography

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 Advantages Disadvantages
☺Cheap ☹Ionizing radiation
☺Rapid ☹Superimposition-
☺Panoramic view summation of
☺Good spatial shadows
resolution ☹Bad contrast
resolution

125
General suggested
readings
• Essentials of radiology by Fred A. Mettler Jr.
Publisher: Saunders. 2004.
• Radiology by Amit Mehta, Douglas P. Beall,
Publisher: Humana Press. 2007.
• Clinical Radiology Made Ridiculously Simple
(Paperback) by Hugue Ouellette, Patrice
Tetreault, 1999.
• Learning Radiology: Recognizing the Basics: On
Timeby William Herring Textbook.
Publisher: Elsevier Science. 2007.

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