Certified Imaging

Informatics Professional

Part 4:
Clinical Engineering
 Imaging Modalities
• Computed Radiography (CR)
• Digital Radiography (DR)
• Mammography (MM)
• Fluoroscopy (RF)
• Ultrasound (US)
• Computed Tomography (CT)
• Magnetic Resonance Imaging (MRI)
• Nuclear Medicine (NM)
• Positron Emission Tomography (PET)
 Radiography
• Computed Radiography
• Digital Radiography
• Fluoroscopy
• Mammography
 Radiography
• Ionizing radiation penetrates a body part
• Radiation beam is attenuated
• Degree of attenuation based on density
• Resultant part of beam is captured
• Shades of gray correspond to attenuation
• Parameters include
• Milliampere-seconds: quantity (mAs)
• Kilovoltage-peak: quality (kVp)
• Pro: inexpensive and quick
• Con: anatomy is superimposed
 Computed Radiography
• Photostimulable phosphor storage (PSP)
• Can use existing radiographic equipment
• Imaging plate inside cassette
• Requires image processing device
• Not as fast as DR
• Not as expensive as DR
• More flexible than DR
• Requires user to process and display images
• Image size: 8-16 MB
 Digital Radiography
• Integrated detector
• Doesn’t require user to process and display
image
• Faster than CR
• More expensive than CR
• Detector technologies include charge coupled
device (CCD) and thin-film transistor (TFT)
• Image size: 8-32 MB
 Digital Mammography
• Governed by Mammography Quality Standards
Act (MQSA)
• Requires 5 MP monitors (2500 x 2000 matrix)
• Used in conjunction with computer-aided
detection (CAD) systems
• Raw image data is necessary
• Image size: 8-50 MB
 Digital Fluoroscopy
• X-ray video images from 30 to 60 frames/sec
• Storage includes several hundred images or
video sequences but not entire run
• Image size: 512 x 512 x 8 bits all the way to
1024 x 1024 x 12 bits
• When not digital, a “DICOM box” is required to
convert the video to DICOM format for PACS
storage
 Computed Tomography
• Cross-sectional imaging
• Uses a rotating x-ray tube and detectors
inside a gantry to generate images
• Multi-detector scanners have rows that
acquire multiple slices per rotation
• Number of slices: 30 - 2,500+
• Additional parameters include slice
thickness
• Image sizes: 512 x 512 x 12 bits
 Computed Tomography
• Hounsfield Units (HU) measure the x-ray
attenuation characteristics and relative
densities
• Air: -1,000 HU
• Fatty tissues: -10 to -1,000 HU
• Water: 0 HU
• Blood: 40 HU
• Window Width (WW) determines the range of
shades of gray
• Window Level (WL) is the average brightness
setting
 Computed Tomography
• Average WW and WL settings
– Abdominal: 400/40
– Bone: 2000/300
– Brain: 80/35
– Liver: 200/50
– Lung: 1500/70

• Studies such as chest,abdomen and pelvis

are scanned together but must be split
sometimes.
 Magnetic Resonance Imaging
• Strong magnetic fields and radio waves are
used to generate images in all 3 planes
– Patient placed in a magnetic field
– Hydrogen atoms align with the field
– Radio waves excite the atoms
– When they relax, they give off a signal
– All the signals are measured, mapped and
converted into an image
 Magnetic Resonance Imaging
• Takes advantage of tissue characteristics
• T1: longitudinal relaxation
• T2: transverse relaxation
• Proton density: amount of protons (hydrogen atoms)
• Blood flow
• Parameters include:
• TR: repetition time
• TE: echo time
• TI: inversion time
• Flip angle
• Slice thickness
 Magnetic Resonance Imaging
• Pathology is accompanied by fluid
accumulation
• Typical MR study divided into parts called pulse
sequences
• T1-weighted
– Anatomical (normal) scan
– Anatomy looks good
– Fluid appears gray or dark
– Fat is bright
• T2-weighted
– Pathological (abnormal) scan
– Pathology stands out
– Fluid appears bright
Magnetic Resonance Imaging
 Magnetic Resonance Imaging
• Pulse sequences specific methods of applying
the magnetic fields and radio waves
• Common sequences include:
• Spin echo (SE)
• Fast spin echo (FSE)
• Inversion recovery
– STIR
– FLAIR
• Gradient echo
• Contrast for MRI is called gadolinium
• Safety training is required due to magnetic field,
tissue heating, etc.
Magnetic Resonance Imaging
• Scanning planes
– Axial: transverse view
– Sagittal: side view
– Coronal: frontal view

• Image size: depends

on matrix; usually 12
bit images
 Ultrasound
• Non-ionizing sound waves use echoes to
produce grayscale anatomic images
• Transducers used to apply sound waves to
tissue
• Doppler techniques used for blood-flow
evaluation
• Measurements used a lot for US reports
• Image size: 512 x 512 x 8 bits or 24 bits for
color images
Ultrasound
 Nuclear Medicine
• Radioactive materials are injected into the body
and then traced and imaged with a scintillation
camera
• Type of substance is specific to the body part
and pathology
• Variations include:
• Single Photon Emission Tomography (SPECT)
• Positron Emission Tomography (PET)
• PET/CT
• Image size: depends on matrix (64,128,256)
Nuclear Medicine
 DICOM configuration
• Source AE title
• Destination AE title
• IP address/port of PACS server
• IP address/port of MWL server
• PACS server promiscuity status