Edith Leonard

AHL1 2025

Chapter 6 Summary: Diagnostic Imaging

➢​ X-ray generation and tube anatomy

●​ X-rays have a shorter wavelength, higher frequency and higher energy than visible
light. The higher energy is what makes x-rays dangerous.
●​ In an X-ray machine, there's a part called the cathode (negative side) that
releases electrons, which come from a component similar to a light bulb
filament. These electrons are then pushed towards another part called the anode,
which is the positive side. When the electrons hit the anode, they interact with it
and produce the radiation that is required for X-ray images.
●​ The anode heel effect refers to the unequal distribution of x-ray beam intensity
along the cathode-anode axis.

➢​ Radiographic density

●​ This refers to the amount of blackness on a radiograph.

●​ Radiographic density can be intensified by increasing the mAs (a product of mA
and time) which is a result of increasing the mA (exposure time in seconds).
●​ A higher kVp yields more radiographic density by increasing the penetrating
power (quality) of the beam.

➢​ Radiographic contrast

●​ It is defined as the differences in radiographic density between adjacent areas on

a radiographic image. They can show a long scale contrast (few black and white
shades with many shades of grey) or short scale contrast (black-and-white
shades with only a few shades of grey). Most studies desire a long scale
contrast, which is dependent on subject density, kVp level, film contrast, and
fogging.
●​ Subject density is the ability of the different tissue densities to absorb x-rays,
which depends on the differences in atomic number and thickness. Denser
tissues, such as bone, absorb greater amounts of rays and appear white on the
image, whereas less dense tissues, such as lung tissues, absorb few rays and
appear black on the finished image.
●​ The scale of radiographic contrast can be lengthened or shortened by increasing
or decreasing the kVp. As kVp increases, the scale gets longer (more greys can
be visualized).

➢​ Radiographic detail

○​ Radiographic detail is considered to be of diagnostic quality when the interfaces

between tissues and organs are sharp. Patient motion and the penumbra effect
have the greatest influence on detail.
 ○​ Patient motion combined with long exposure time cause blurred interfaces. This
can be controlled by using the shortest possible exposure time unless the image
remains blurred, in which case the patient should be sedated.
○​ Three factors influence the amount of penumbra on a radiograph: the size of the
focal spot (decreasing the size decreases the penumbra), source image distance
(increasing this decreases penumbra), and object-image distance (penumbra is
decreased by keeping the OID as short as possible).

➢​ Distortion

○​ The object being radiographed must be parallel to the recording surface and the
OID kept as short as possible so as to prevent foreshortening and increased
penumbra.
○​ Distortion can also occur when the x-ray beam is not perpendicular to the
recording surface.
○​ A small amount of padding beneath the patient brings the vertebral column
parallel to the recording surface, but care must be taken not to use too much
padding. This can elevate the spinal column, which produces a false narrowing of
the intervertebral spaces.

➢​ Scatter radiation

○​ When an x-ray photon strikes an object, it can do one of three things: pass
through the object, be absorbed by the object or produce secondary radiation.
○​ Scatter radiation not only decreases the contrast of the image, but it's also a
serious safety hazard for both personnel and patients.
○​ Beam-limiting devices (cones, diaphragms, collimators, and filters) are commonly
used to decrease scatter radiation by confining the primary beam to the area
being examined.

➢​ Grids

○​ As the thickness of the area being imaged increases, the amount of kVp required
also increases, which means more scatter radiation. To minimize this, grids are
necessary when radiographing areas 10cm or more in thickness.
○​ The grids also absorb a portion of the usable x-rays, so to compensate for this
loss , the number of x-rays generated must be increased by increasing the mAs.
○​ Focused grids have lead strips placed at progressively increasing angles to
match the divergence of the x-ray beam. By angling the lead strips, the cut off of
the primary beam is eliminated and radiographic density is uniform.

➢​ mAs

○​ When the mA is increased, the amount of radiographic density also increases

because more x-rays are being generated.
○​ Using a longer exposure time allows the electrons to cross from the cathode to
the anode, generating more x-rays.
 ○​ Exposure time and mA are inversely related: as mA increases, the exposure time
required to maintain the desired number of x-rays generated decreases.

➢​ kVp

○​ Increasing kVp increases penetrating power.

○​ kVp setting is determined by the thickness of the part being imaged.
○​ To double radiographic density, increase kVp 20%; To halve the radiographic
density, decrease kVp 16%.

➢​ Source image distance

○​ SID is the distance from the target to the recording surface.

○​ The inverse square law states that the intensity of the x-ray beam is inversely
proportional to the square of the distance from the source of the x-ray. If the SID
is doubled, the mAs must be increased four times to maintain radiographic
density.

➢​ Object-film distance

○​ OID is the distance from the object being imaged to the recording surface.
○​ Distance should be as short as possible to reduce penumbra effect and
magnification that occurs with a long OID.

➢​ Radiographic film

○​ X-ray film consists of three layers: a thin protective layer, an emulsion containing
silver halide crystals and a polyester film base. The emulsion coats both sides,
which gives the film greater sensitivity, increasing the speed, density and
contrast. Increasing the speed also decreases the required exposure for the
patient and personnel.
○​ Film is sensitive to all types of electromagnetic radiation including gamma
radiation, particulate (alpha or beta) radiation x-rays, heat, and light.
○​ Unexposed film should be stored in a cool, dry place away from chemical fumes.
It is also pressure sensitive and should be stored on an end and not laid flat on
its side.

➢​ Intensifying screens

○​ When exposed to x-rays, they emit foci of light. Approximately 95% of

radiographic density comes from the fluorescence of the intensifying screens,
and only 5% is the result of direct x-ray exposure.
○​ Rare earth screens allow for shorter exposure time.
○​ Intensifying screens are available at three different speeds: high (regular), par
(medium), and slow (detail or fine).
➢​ X-ray equipment

○​ There are three basic types of x-ray equipment from which to choose: portable,
stationary or mobile units.
○​ Basic equipment requirements for a stationary unit include the x-ray generator
system . collamiter, grid, table, tube stand and positioning aides. These
accessories allow individuals to be positioned farther from the primary beam.

➢​ Digital x-ray imaging

○​ Three main types of digital systems: computed radiology (CR), digital radiography
(DR), and charged coupled devices (CCD) technologies.
○​ Digital radiographs can be enhanced and viewed on computer software that
enables contrast, brightness, zoom, and pan adjustments as well as
measurement of various anatomical structures.
○​ Digital x-rays may reduce the number of repeat x-rays needed and eliminate the
need for film, chemicals and screens.

➢​ Radiation safety

○​ Tissues that are most sensitive to ionizing radiation are those with rapidly
growing or reproducing cells.
○​ Blood-forming cells (especially lymphocytic blood cells) are relatively sensitive to
radiation. Damage to these cells reduces the resistance to infection and causes
clotting disorders.
○​ Radiodermatitis (reddened, dry skin) can result from excessive, chronic, low-level
radiation exposure.

➢​ Terminology

○​ REM is used to express the dose equivalent to ionizing radiation. REM takes into
account the quality of radiation, so doses of different kinds of x-rays can be
compared. (1 SV= 100 REM) (MPD= maximum personal dose.
○​ The recommended dose for occupationally exposed persons should not exceed
5 REM per year. Your badge should not exceed 0.05 REM per month.
○​ Good radiation control programs consist of safe x-ray equipment, low-exposure
techniques , use of positioning aides, proper patient measurement, proper
positioning methods, shielding, and monitoring personal radiation exposure.

➢​ Darkroom setup

○​ The room must be just large enough to provide a dry bench area away from the
wet bench area to prevent chemical splashes. Cleanliness is also important.
○​ The most important feature of a dark room is that it is light tight.
○​ The darkroom should have adequate ventilation to prevent volatile chemical
fumes from accumulating in the room, which would cause fogged film, damage
to the electrical equipment, and health problems for personnel.
➢​ Film identification

○​ Permanent labeling is required for all images. This can be done during the
exposure or afterwards, but it must be done before the film is processed
○​ The label should include the clinic name, date, owner’s name, address, patient
name and patient signalment.

➢​ Film processing chemistry

○​ Developer
■​The developer’s main function is to convert the sensitized silver halide
crystals into black metallic silver.
■​The developer contains 5 ingredients: a solvent, reducing agents,
restrainer, activator, and preservatives.
■​Chemicals are manufactured in two forms: liquid and powder. The powder
form should never be mixed inside of the darkroom.
○​ Fixer
■​It removes the unchanged silver halide crystals from the film emulsion,
leaving the black metallic silver. It also hardens the film emulsion, which
decreases the susceptibility to scratches,
■​The fixer contains five ingredients: a solvent, a fixing agent, an acidifier, a
hardener, and a preservative.
■​It comes in two forms: powder and liquid.

➢​ Film processing equipment

○​ Manually developing the x-ray film is a chemical process that depends on the
duration of the immersion in the chemicals and the temperature of the
chemicals.
○​ Automatic processors can develop film more quickly and consistently provide
high quality radiographs.
○​ The manual processing fixer solution, silver recovery systems, and old
radiographs can be sold to companies to reclaim the silver.

➢​ Radiographic artifacts

○​ Before processing (box 6-2)

■​Common causes of artifacts that occur before processing include fogged
film, black crescents or lines, black or white areas, visible gridlines, and
decreased detail.
○​ After processing (box 6-3)
■​Common causes of artifacts that occur during processing include:
increased radiographic density with poor contrast, decreased
radiographic density with poor contrast, uneven development, defined
areas of decreased radiographic density, clear areas or spots, entirely
clear film, film turned brown and areas that are entirely black or have
black spots or streaks.
➢​ Contrast studies

○​ The purpose of a contrast study is to delineate an organ or area against

surrounding tissues. They are useful in determining the size, shape, position,
location, and function of an organ.
○​ The information obtained either confirms or compliments findings on the finished
radiographs.
○​ Tissues appear either radiopaque (appear white) or radiolucent (appear black) on
the finished radiograph. Positive-contrast agents are radiopaque on a radiograph.
Negative-contrast agents produce radiolucencies on a radiograph.

➢​ Positive contrast media

○​ They contain elements with a high atomic number (absorb more x-rays) including
water-soluble organic iodides or barium sulfate.
○​ A commonly used oral form of water-soluble organic iodide is a solution of
meglumine and sodium diatrizoate. They will be absorbed into the bloodstream
and excreted by the kidneys.

➢​ Negative contrast media

○​ Negative contrast agents include air, oxygen, and carbon dioxide, which will
appear radiolucent on the finished radiograph.
○​ Care must be taken not to over-inflate the organs such as the bladder.

➢​ Diagnostic ultrasound

○​ A transducer sends low intensity, high-frequency sound waves into the soft
tissues where they interact with tissue interfaces. Some of the sound waves are
reflected back to the transducer and some transmitted into deeper tissues. The
ones reflected back to the transducer (echos) are analyzed by the computer to
produce a grey-scale image.
○​ Radiographs demonstrate the size, shape and position of the organs. Ultrasound
displays the findings found on the radiograph as well as the soft tissue textures
and the dynamics of some organs, like motility of the bowel.

○​ Transducers

■​Sector scanners are useful when imaging areas limited by ribs, gas-filled
bowels, or lungs. Linear-array scanners are useful in areas with
unrestricted window size.
■​The frequency of the transducer determines the amount of detail or
resolution of an image. As frequency increases, the wavelength gets
shorter and the shorter the wavelength is, the better the resolution of the
image will be.
 ○​ Display modes

■​There are three different display modes: A-mode (amplitude mode),

B-mode (brightness mode), and M-mode (motion mode).
■​The image generated from B-mode (uses bright dots or pixels on screen)
is a two dimensional anatomic slive that is continually updated and can
be used currently for diagnostic applications.
■​M-mode is the continuous display of a thin slice of an organ over time.
The main use is with echocardiography to assess the size of the heart
chambers and the motion of the heart valves and walls.

○​ Patient preparation

■​To produce the best quality images, the transducer head must be placed
in close contact with the skin, so the animal’s hair must be clipped or
shaved before the study.
■​Fasting of small animals before abdominal ultrasound examination is
recommended.

○​ Instrument controls

■​Ultrasound equipment has many controls for adjusting the quality of the
image. Improper adjustment of any of these can greatly decrease the
quality of the image.
■​Controls include brightness and contrast, depth, gain and power, and
Time Gain Compensation (TGC).

○​ Artifacts

■​Acoustic shadowing occurs when the sound is attenuated or reflected at

an acoustic interface, which prevents the sound from being transmitted to
the deeper tissues, resulting in few or no echoes.
■​Distance enhancement occurs when the sound beam transverses a cystic
structure. Tissues deep to the cystic structure appear brighter than the
surrounding tissues.
■​Mirror-image artifacts create the illusion of the liver of the thoracic side of
the diaphragm or the appearance of a second heart beyond the lung
interface. The computer sees the misdirected echoes as being reflected
from the other side of the diaphragm.

➢​ Endoscopy

○​ This is the best method of evaluating the digestive system because it provides
the opportunity to examine and obtain tissue samples without the invasiveness
of surgery.
○​ Responsibilities of the vet techs assistitng with endoscopy include selection,
care and maintenance of the endoscopes and the care and positioning of the
patient.
 ○​ Rigid

■​These are commonly used for rhinoscopy, female cystoscopy,

laparoscopy, arthroscopy, vaginoscopy, and thoracoscopy.
■​Rigid endoscopes are composed of a metal tube, lenses and glass rods.
They vary in size and characteristics, but all are composed of a hollow
tube containing no fiber bundles.
■​They should always be held by the eyepiece and NOT the rod.

○​ Flexible

■​These are used for gastrointestinal endoscopy, male cystoscopy, and

bronchoscopy exams. They are also used for percutaneous placement of
gastrostomy tubes in small animals.
■​There are two types of flexible endoscopes: fiberoptic ( uses glass fiber
bundles for transmission of images) and video.
■​Video endoscopes contain a microchip located at the distal end that
records then transmits the image to a computer and then onto a
monitoring screen.

➢​ Endoscopy room

○​ The room should never be so dark that proper anesthetic monitoring is inhibited.
○​ All necessary equipment should be located near the endoscopy unit so that it can
be reached quickly if needed during the endoscopy. The items should be
meticulously organized.
○​ Ensure the room is well-stocked before the procedure (checklists and procedure
cards will help this). All anesthetic equipment should be ready before the
procedure begins.

➢​ Accessory instruments

○​ THe most basic instruments include biopsy forceps, foreign body removal
forceps and a cytology brush.
○​ Before each endoscopy exam, be sure each piece of ancillary equipment is
functioning and anticipate the need for these pieces of equipment.
○​ They should be cleaned as soon as possible after use or the jaws of the forceps
may become locked in the closed position.

➢​ Cleaning a flexible endoscope

○​ Endoscopes must be handled carefully during cleaning and never placed where
they could fall or be bumped.
○​ Gather the following supplies: latex gloves, cleaning solution , two large basins
(for cleaning solution and distilled water), distilled water, Methyl alcohol, lint-free
gauze pads, cotton-tipped applicators, and channel-cleaning brush.
○​ Biopsy instruments should be immersed in soapy water, brushed carefully with a
cleaning brush, and then rinsed.
➢​ Storing an endoscope

○​ The ideal way to store a flexible endoscope is in a hanging position in a

well-ventilated cabinet so as to allow it to drain completely after cleaning and
permits better air movement through the channels.

➢​ Gastrointestinal endoscopy

○​ GI endoscopy allows visualization of the upper and lower digestive tract,

including all of its contents.
○​ Place the patient in left lateral recumbency, with a mouth speculum placed to
prevent damage to the endoscope from biting.

➢​ Colonoscopy

○​ Flexible colonoscopy allows examination of the transverse and ascending colon,

cecum, ileocolic valve and ileum.
○​ Food should be withheld from the patient for 36 hours.
○​ Ideally, all feces should be removed from the colon to obtain best possible
visualization, but that is not always possible. Several different colonic cleansing
protocols can be used, depending on how cooperative the patient is and the
amount of help available.

➢​ Bronchoscopy

○​ Airway endoscopy allows visualization of the trachea and bronchi. It is most

useful when diagnosing collapsed trachea, collapsed main stem bronchi, airway
airway parasitism, lower airway infections and inflammatory diseases, and
foreign bodies.
○​ General anesthesia is required and the patient must be closely monitored for
proper oxygenation and anesthetic depth.

➢​ Computed tomography

○​ Using x-rays and a bank of detectors, a CT scan provides a cross-sectional image

of all tissue types of the body region scanned based on the physical density of
the tissue compared to water.
○​ CT is frequently used for imaging many disease processes, such as cancer,
fractures, lung disease, and vascular abnormalities. They also provide invaluable
information for surgical and radiation treatment planning.
○​ CT scanning frequently requires the patient to be anesthetized.

➢​ Magnetic resonance imaging

○​ MRI uses a high-strength external magnetic field, a variety of radiofrequency
excitation pulses, and the natural resonance (normal circular motion of the atom)
of protons (hydrogen ions) in the body to visualize the structure and function of
organs.
○​ It is primarily used to the imaging of the brain, spinal cord and intervertebral disc
areas, tumor localization and extension within soft tissues, tendon and muscle
 injury, vascular and arterial anomalies or disease, and thoracic and abdominal
organs.

➢​ Nuclear medicine

○​ Nuclear medicine (scintigraphy) is an image modality that uses radionuclides

and a gamma camera for the detection of decay of gamma radiation that is
emitted from the radionuclide within the patient.
○​ This allows for imaging of the anatomic, physiologic, or metabolic processes that
occur within the patient.
○​ The most common nuclear medicine studies performed in vet medicine are
thyroid scans, bone scans, renal function testing with GFR calculation and
hepatobiliary scans.