Basic information &

introduction to Radiology
Radiology
Team 438 Lecture 1

Objectives

❖ Introduce the various Medical Imaging

Modalities
❖ Understand the basics of image generation
❖ Relate imaging to gross anatomy
❖ Appreciate constraints and limitations
❖ Develop imaging vocabulary in the
interpretation

Color Index: ⬩ Important ⬩ Doctor’s Notes ⬩ Extra ⬩ Female slides ⬩ male slides

Team Leaders

Omar Aldosari

Leena Alnassar

Shahd Alsalamh

Editing file
 Radiology

❖ Medical specialty that supervises, perform

What is and interprets imaging studies.
❖ Reports findings to referring physicians to
Radiology? help in the patients management.
❖ Medical specialty that use medical imaging
technologies to diagnose and treat patients.

Diagnostic Modalities used in radiology

Computed Magnetic Nuclear
plain Ultrasound Angiography
Tomography Resonance Medicine
X-Ray (US) (ANG)
(CT) Imaging (MRI) (NM)

Which of these modalities use ionizing radiation? • X-Ray • CT • Nuclear medicine

Contrast Media
Natural contrast in the body Added contrast in the body

❖ Air ❖ Barium sulfate (non water soluble) safe for

GI tract, given orally because it precipitates and
❖ Fat cause blocking of the vessels if given IV
❖ Bone ❖ Iodine (water soluble) can be given as IV

X-RAY
❖ It is a form of Electromagnetic energy that travel
at the speed of light.
❖ Discovered and named by Dr. W. C. Röentgen at
University of Würzburg, 1895.
❖ X-Rays are emitted and detected in cassette
generating, either a hard copy film or a digital
image. Image key = shades (Densities)

(Q:where on this image have x-rays passed through the body to the greatest degree?lungs)
Electromagnetic energy wave spectrum

❖ Gamma Rays
❖ X-rays
❖ Visible light
❖ Infrared light
❖ Microwaves
❖ Radar
❖ Radio waves Air Fat Soft tissue Bone

The higher frequency and shorter wavelength, the higher penetration ability

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 X-RAY & Fluoroscopy
The X-RAY Beam Interaction
❖ Projections (views) are usually described by the path of the x-ray beam.
❖ Thus, the term PA (poster anterior) view designates that the beam passes from the
back to the front. (standard projection for a routine chest film).
❖ X-rays are emitted and detected in cassette which generate either a hard copy film or
a digital image
1) Pass all the way through the body: 2) Be deflected, scattered or absorbed:
● Render the film DARK (BLACK shadow) ● Render the film LIGHT (WHITE shadow)
Radio-LUCENT Radio-OPAQUE
● Low atomic number, eg; air ● high atomic number, eg; bone / Fat / Soft
● Air has a low atomic number tissue/fluid /Metal / Mineral
○ X-rays get through → image is ● Bone has a high atomic number
DARK ○ X-Rays are blocked → image is LIGHT

Advantages Disadvantages
● Widely available ● Ionizing Radiation. can be
● Inexpensive carcinogenic / to the fetus →
● Doesn’t require advanced mutagenic or even lethal
technologist knowledge ● Relatively insensitive
● Can be performed quickly ● Requires patient cooperation
● Can be portable

FLUOROSCOPY
❖ A dynamic contrast study, (dynamic) real-time imaging, utilizes image intensifier.
❖ It’s a combination of: ➢ X-Rays ➢ Contrast agents

Technique
Real-time imaging Using intensifier

❖ dynamic, detect the movement of the ❖ Using intensifier: to magnify the X-Rays
contrast fluid in certain organs without increasing the amount of
➢ e.g. (to assess esophagus leakage radiations for patient’s safety.
after swallow in the GIT) since Fluoroscopy study is continuous it has
more exposure to radiation. but, using an
intensifier leads to less energy intensity but
still have a good image.
Uses of FLUOROSCOPY
❖ GIT imaging ❖ Intraoperative (during surgery)
➢ (e.g. dysphagia, peristalsis) ❖ Genitourinary imaging
❖ Angiography ➢ commonly used for recurrent UTIs,
❖ Foreign body removal vesicoureteral refluxObstructions,
❖ Musculoskeletal dilatations, collecting system abnormalities
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 FLUOROSCOPY and CT

Advantages Disadvantages
● Widely available. ● Requires ingestion/injection of contrast
● Inexpensive medium.
● Functional and anatomic imaging. ● Patient cooperation.
● No sedation required ● Radiological hazard
● Time consuming
○ It is time consuming because we are
following contrast agent inside organs

COMPUTED TOMOGRAPHY (CT)

❖ How Does CT Works?
1. Rotating an X-Ray tube with the X-Ray detector, & the patient will go through these
rays
2. cross-sectional images (like slices) is received (Axial) from the body. Each slice is an
image itself
3. Data displayed in multiple window settings (lungs parenchyma, bone, etc.)
4. these images are reconstructed to create other images from different views (e.g.
coronal) which are 3D images
5. To show coronal (frontal) or Sagittal images, data are manipulated (reconstructed) by
a computer
❖ Relies on X-Rays transmitted through the body that differs from conventional
Radiography (plane X-Ray) in that a more sensitive X-Ray detection system is used.
❖ It has the capability to measure the density by analyzing the chemical component of
tissue, “Hounsfield Unit (HU)”
Density
❖ Density is measured by Hounsfield Unit (HU)
❖ CT has very small differences in X-Ray absorption values compared with conventional
radiography; the range of densities recorded is increased approximately 10-fold.
❖ So, gradations of density within soft tissues can be recognized, e.g. brain substance
from cerebrospinal fluid, or tumor from surrounding normal tissues.

Soft Tissue: Blood: Bone/Ca:

Air: -1000 Fat: -150 Water: 0
20-80 45-75 >100->1000

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 COMPUTED
FLUOROSCOPY
TOMOGRAPHY
Different Windows
Wide window Narrow window

to visualize more structure within a certain to visualize certain structures within

organ such as bronchi, vessels and alveoli in certain region such as major vessels and
the lung (Lung window) (Bone to visualize heart in mediastinum “Vascular structures”
cortex, medulla and trabeculae) (mediastinum window)

Uses of CT
● Neuroimaging:
○ Emergency: Acute head trauma, acute ● Acute Abdomen:
intracranial hemorrhage. ○ Decrease rate of false
○ Low sensitivity for: laparotomy
■ Early ischemic stroke. ● Trauma spine imaging:
■ Intracranial metastatic disease. ○ (Cervical, thoracic,
■ White matter degenerative disease lumbar) It can miss
● Head and neck imaging: fractures.
○ Soft tissue of neck, paranasal sinuses, temporal ● Other osseous imaging:
bone, & orbital wall imaging ○ pelvis and extremities
● Body imaging: ● Vascular imaging:
○ Chest, Abdomen, Pelvis (with enteric and IV ● CT angiography I.e. Coronary
contrast) arteries.
○ Pulmonary nodules, Renal calculi (without ● Specialized protocols:
contrast) ○ Liver masses, pancreatic
○ Acute appendicitis (with enteric and IV contrast) tissue, renal masses, and
adrenal masses

Advantages Disadvantages
● Can give: Cross sectional, ● Expensive
Sagittal and Coronal ● High Radiation
Images So, don’t request a CT scan unless
● More sensitive needed, and we can't use it for a
pregnant women unless
absolutely necessary
One brain CT scan radiation = 200
X-Ray radiation
One pelvic CT radiation = 400
X-Ray radiation

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 MRI
MRI
● T1 weighted (T1WI). (Fat →whit) ( Fluid → dark) (Subacute hemorrhage → white)
● T2 weighted (T2WI), (Fluid →whit),( Fat less white compared to T1 weighted)
● Bone appear black on all sequences.
● Air also appear black on all sequences.
● On Flair fluid appear jet black. Very good for detection of demyelination plaques and
haemorrhages
● MRI contrast agent. Gadolinium DTPA (Ethylene Triamine Penta acetic acid) is used as
contrast agent. It is used with T1W images only.

How can we produce an image by the MRI?

❖ it depends on the idea of that the body is full of tiny magnets which are the atoms (Ex:
hydrogen atoms,markedly abundant in the body organs) then follow these 5 steps:
Hydrogen Atoms (protons) in water molecules and lipids:
1. Magnetism affects all protons causes them to line up in one direction.
2. Magnets can be switched on and off to change the direction of the magnetic
field.
3. Whenever the water molecule spin around they give a light radio wave.
4. MRI machine can detect it and shows it as images.
5. Like CT, gradation of density within soft tissues can be recognized e.g. brain
substance from cerebrospinal fluid, or tumor from surrounding normal
tissues.

Advantages Disadvantages
● The best soft tissue imaging and pathology (tumors and ● Expensive.
infections), Show better tissue characteristics ● Time consuming. so we
● Better tissue construction then CT can’t use it on
● No ionization. emergency patient
● Can be done on pregnant women. ● May evoke phobias
● Images can be obtained in any plane Claustrophobia
(unlike CT which is taken in axial position) ● No metals allowed
● Useful for soft tissue pathology (Tumor, infection) MSK ● Motion.
● Multisequence play with characteristic abnormal tissues ● Patients have to keep
● MR angiogram can be perform without introducing contrast still during the producer
media
Sagittal Axial Coronal

Image key = shades (Intensities)

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 Ultrasound & Nuclear medicine
ULTRASOUND
● Echogenicity ● Shadowing ● Doppler for flow
● Ultrasound is sound waves with frequencies which are higher than those audible to
humans (>20,000 Hz).
● Ultrasonic images also known as sonograms are made by sending pulses of
ultrasound into tissue using a probe.
● The sound echoes off the tissue; with different tissues reflecting varying degrees of
sound.
● The echoes are recorded and displayed as an image to the operator.
● Needs a well-trained operator.
● A Doppler ultrasound is a noninvasive test that can be used to estimate the blood
flow through the blood vessels, (can be used to differentiate the vessels (renal
arteries) from the collecting system in the kidney.)

Advantages
1. No radiation (safest for pregnant ladies) 2. Can be portable “easily used in ICU”
3. Relatively inexpensive

White areas: Black areas: Lines:

Shows echogenic structure Shows anechoic areas. Occur at boundary of two
which transmit & reflect Fluids transmit but markedly different tissue
sound waves e.g. fat, vessels, does not reflect sound reflectors (boundary of
nodes soft tissue. waves organs)

NUCLEAR MEDICINE
❖ Uses gamma rays to produce an image (counts or activity).
❖ Radioactive nuclide given IV, per OS or per rectum, etc.
❖ Rays emitted from the patient.
❖ Physiological imaging (abnormal function, metabolic activity)
❖ Poor for anatomical information.
❖ Radioactivity stays with the patient until cleared or decayed
❖ In the nuclear medicine: the source is from patient while the
detector is outside unlike the others “source were outside”

Advantages Disadvantages
● Evaluation of the functional ● Sensitive but not that
and anatomical features of much specific
the structure
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 SUMMARY
Advantages Disadvantages information

● Widely available
● Ionizing Radiation. The X-RAY Beam
● Inexpensive
● Relatively insensitive Interaction:
● Doesn’t require
(superimposed 1-Pass all the way
X-RAY advanced technologist
structures) through the body
knowledge
● Requires patient 2-Be deflected,
● Can be performed
cooperation scattered or
quickly
absorbed
● Can be portable

Uses:
● Widely available. ● Requires
⬩GIT imaging
● Inexpensive ingestion/injection of
⬩Foreign body removal
FLUOROSCOPY ● Functional and contrast medium.
⬩Musculoskeletal
anatomic imaging. ● Patient cooperation.
⬩Intraoperative
● No sedation required ● Time consuming
⬩Genitourinary imaging

Types:
COMPUTED ● Can give: Cross ● Expensive
⬩Wide window
TOMOGRAPHY sectional, Sagittal and ● High Radiation
⬩Narrow window
Coronal Images
(CT) Uses:
● More sensitive
⬩Neuroimaging
⬩Head and neck
⬩Body imaging

● The best soft tissue ● Expensive. MRI sees tissues based

imaging and pathology ● Time consuming. so upon subatomic
(tumors and we can’t use it on characteristics
infections). emergency patient (magnetism).
MRI ● No ionization. ● May evoke phobias
● Can be done on Claustrophobia
pregnant women. ● No metals allowed
● Images can be obtained ● Motion.
in any plane

● No radiation ● Needs a well-trained Ultrasonic images also

ULTRASOUND ● Can be portable operator. known as sonograms are
● Relatively inexpensive made by sending pulses of
ultrasound into tissue
using a probe.

⬩Used for Physiological ⬩Poor for anatomical Uses gamma rays to

NUCLEAR imaging (abnormal information. produce an image (counts
function, metabolic ⬩Radioactivity stays or activity).
MEDICINE
activity) with the patient
until cleared or
decayed

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 quiz

1-Which of these modalities use ionizing radiation

a. Plain X-Ray
b. Ultrasound
c. Magnetic Resonance Imaging (MRI)
d. Nuclear Medicine (NM)

2-body imaging of 3-Skeletal appearance on x-ray

chest,abdomen,pelvis using CT image is?
scan? A)Dark grey
a. With IV contrast only B) Dark
b. With enteric and IV contrast C) Bright grey
c. Without enteric D) White
d. Without contrast

4--Which of the following axises will 5-What waves are used in

appear by direct CT scan? fluoroscopy ?
A) Axial A)X-rays
B) Sagittal B) Gamma-rays
C) Coronal C) CT
D) Oblique D) Alpha

6-One of the specialized protocols

for the uses of CT SCAN? 7-High atomic number substances
will appear ...in x-ray?
a. Pancreatic tissue
a. Light
b. Pulmonary nodule
b. Dark
c. Acute appendicitis
d. Renal calculi

Extra questions
7)A
6)A
5)A
4)A
3)D
2)B
1)a & d
Answers