Introduction to Radiology

What you need to know about imaging to get through the next four years

Mark Chambers D.V.M., Ph.D., M.D.

Topics of Discussion
How to approach reading any image  What are the different imaging modalities  What imaging modality is this  Tips and tricks for image interpretation  Practice! Practice! Practice!


How to Approach Reading any Image



Identify the patient  When was the image taken  Are these the proper images  The five densities  Are the images technically adequate

Identify the Patient



Always look for the patient name and/or number  Even if the film came out of the right folder  If something seems wrong, double check

When was the Image Taken

Observe dates and times closely, especially with serial images  Date stickers (color keyed)


Are these the Proper Images

Correct type of study  Correct / complete views  Correct limb  Contrast


The Five Densities



Metal  Bone  Soft tissue (water)  Fat  Gas

Are the Images Technically Adequate



Exposure  Development / display  Positioning  Proper contrast  Artifacts

Movement Interference

What are the Different Imaging Modalities



Radiography plain films  Computed axial tomography CT  Magnetic resonance imaging MRI  Ultrasound US  Interventional radiology angio

Radiography
 

Also called plain films or standard films Image formed using broad beam ionizing radiation The image formed is related to the subjects density May involve the use of contrast agents
Iodinated Barium Air

Computed Axial Tomography



Also called CAT scanning or CT  Image formed using a rotating thin beam(s) of ionizing radiation  Image slices reconstructed by computation  The image formed is related to the subjects density  Image display on computer or multiple films  New technology is multislice helical scanner

Magnetic Resonance Imaging

 

Also called MRI (used to be NMRI) Image formed by transmitting and receiving radio waves inside a high magnetic field Image slices reconstructed by computation The image formed is related to:
Scanner settings Patient hydrogen density Patient hydrogen chemical/physical environment

Image display on computer or multiple films

Ultrasound


Also called sono or echo or US  Image formed by transmitting and receiving high frequency sound waves  Image slices reconstructed by computation  The image formed is related to interfaces between tissue areas of differing sound transmission characteristics  Image display on computer or multiple films

Interventional Radiology
 

Also called angiography or angio or IR Image formed using broad beam ionizing radiation (fluoroscopy) Images acquired using digital detector and processed by computer The image formed is related to the subjects density Usually involves the use of iodinated contrast agents and long catheters Many varied techniques including the use of CT or MRI Image display on computer or multiple films

What Imaging Modality is this



Is it plain film or interventional  Is it CT or MRI

Plain Film or Interventional

May look very similar  Angio studies usually printed on large sheet film like CT or MRI  Will usually see catheter or needle, often with contrast in IR studies


CT or MRI


CT images are tissue density related

Brightness and contrast may vary Bone is brighter than fat

MRI is not density related

Brightness and contrast may vary Bone is darker than other tissues

Tips and Tricks for Image Interpretation



The quick read technique  Scrolling through axial images

The quick read Technique



Why did you order the image  What did you expect to see  Do you see it  Now start over fresh

Scrolling Through Axial Images



Rapid paging through sequential images  On computer display of CT and MRI images  Allows you to follow long/large structures  Helps rapidly identify small higher contrast areas

Practice! Practice! Practice!

Radiology, News, Education, Service  Teenage male with severe left arm pain after hit while playing football.  Man with leg swelling and mass in popliteal fossa. History of trauma 8 months ago.  Fifty-year-old woman originally Fifty-yearpresenting with headaches and claudication.