Physical Aspects of Organs and Imaging, 1st Edition

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These volumes are dedicated to my grandchildren
Hanna, Henriette, Katharina, Niklas, Raphael, and Sonja.
Now it’s your turn again.
Preface
According to the American Association of Physicists in Medicine, Medical Physics is an
applied branch of physics concerned with the application of concepts and methods of
physics to diagnostics and therapeutics of human diseases. In recent years many aca-
demic institutions have started offering Medical Physics in their Bachelor, Master, and
PhD programs in response to the expanding job market and increasing demand for
professionals in this discipline. The Volumes 1 and 2 on Medical Physics are introduc-
tory texts intended to guide bachelor students during their first semesters through the
broad range of topics relevant in this field. There are many excellent books available
that specialize on more specific topics of Medical Physics, such as imaging and radia-
tion therapy. However, there is rarely a single text covering the entire field, including
the physics of the body, imaging methods, radiology, laser methods, nanomedicine,
and prosthetics. Because of the multitude of topics to be covered and the rapid de-
velopment of the field chances are that such a script might be incomplete or partially
outdated by the time of publication. Nevertheless, these two volumes try to provide
a reasonably balanced overview as well as guidance to more specialized and more
comprehensive literature. Each chapter is rounded off with a summary, references,
hints for further reading and useful webpages, and with questions and answers to the
respective chapters. Historical remarks are kept at a minimum to keep the text at a
reasonable total length.
This textbook does not provide any medical interpretation or any medical judge-
ment. It is entirely focused on methods and procedures from a physical point of view.
Furthermore, this text is neither an introduction into elementary physics nor into med-
ical physiology. It tries to connect the principles of physics with the functionality of the
body and with physical methods used for diagnostics and therapeutics. Furthermore,
medical physics is located somewhere in between medical sciences and engineer-
ing with regard to diagnostic and therapeutic equipment. As such, medical physics
acts as a mediator between these disciplines. While the physical principles of medical
equipment and instrumentation are introduced, for more detailed engineering aspects
of hardware and software developments references are provided for further reading.
Throughout the text it is assumed that the reader has a basic understanding of physics
corresponding to about one to two years of college physics.
Physics and medicine have their own distinct terminology. Here we will mainly
use a “physics language”, but medical and physiological terms will not be avoided. In
fact it is important for students of medical physics to know at least the most important
terms in order to be able to communicate with physicians in medical practice. There-
fore in these volumes medical and physiological terms will be introduced and defined
whenever they are used. In addition, a list of acronyms and definitions is provided
in the appendix. In physiology it is still common practice to use non-MKS (SI) units,
such as mmHg for pressure. In this text we strictly adhere to the SI system with one

DOI 10.1515/9783110372830-001
viii | Preface

exception: for practical reasons we make use of the energy unit ‘electron volt’ (eV) in
the context of electromagnetic and particle radiation.
The present Volume 1 contains 15 chapters divided into two parts. The first 12 chap-
ters in Part A focus on physical and physiological aspects of body parts, organs, and
sensors. This is a selection of body systems that have a strong physical component,
such as body mechanics including bones and muscles, energy household, electro-
physical aspects, circulatory system, respiration, kidneys, and the sensory systems
for light and sound. Fundamental to all these topics is an understanding of the rest-
ing potential and the action potential and how the action potential travels along nerve
fibers for communication and motor control. Part B covers imaging modalities without
the use of ionizing radiation, which includes sonography, endoscopy, and magnetic
resonance imaging (MRI). Sometimes MRI is also listed under radiography. But this
is not justified as the typical frequencies involved are in the GHz regime, far away
from ionizing conditions. For reading and learning about imaging modalities in Part B
a basic understanding of wave propagation, interference phenomena, and resonance
conditions would be beneficial.
Volume 2 Part A complements the imaging modalities by using ionizing radia-
tion: x-ray radiography, scintigraphy with γ-rays, and positron emission tomography.
The other parts of Volume 2 treat external beam radiation therapy with x-rays, pro-
tons, and neutrons as well as brachytherapy. Volume 2 concludes with chapters on
diagnostics and therapeutics beyond radiology: laser applications, multifunctional
nanoparticles, and prosthetics.
Each chapter is concluded by a summary of the main points. A number of contex-
tual questions pertaining to each chapter are listed in the appendix. They are comple-
mented by corresponding answers as a guide and for providing an incentive for further
studies.
The more I read, the more I recognize the immense scientific activity that has taken
place in the past in the field of medical physics and that will continue to take place in
the future, and the little that I know about it. Any suggestions and hints for missing
aspects or inadequate presentations are highly welcome. Nevertheless, I would like to
express my hope that this introductory text may turn out to be a useful companion to
students enrolled in a course on Medical Physics during their first semesters.

Bochum and Mainz, January 2017

Acknowledgments
Writing this text would not have been possible without the help of many. First, I am
highly thankful to authors and publishers who make their work freely accessible in
open access journals, and to the organization Wikipedia including their contributors
who do an amazing job for the benefit of those who are eager to know. Furthermore,
I am deeply indebted to colleagues and experts who devoted their precious time
to critically reading and correcting various chapters. In particular I would like to
thank, in alphabetic order, Professor Ping Ao and Dr. Xiaomei Zhu, Shanghai Jiao
Tong University, for sharing their deep insight into the causes and development of
cancer; Dr. Andrea Denker, Helmholtz Zentrum Berlin, for pointing out intricacies of
proton therapy and eliminating misconceptions; Professor Helmut Ermert, Univer-
sity of Erlangen, for sharing his expertise of ultrasonic imaging; Professor Ulf Eysel,
Ruhr-University Bochum, for critically reading and correcting the chapter on the
mechanism of vision; Professor Werner Havers, University Clinic Essen, for improving
the chapter on x-ray radiotherapy; Dr. Margot Jonas, University Clinic Knappschaft
Bochum, for valuable suggestions concerning scintigraphy and positron annihilation
tomography, and for sharing most instructive images on the comparison of x-ray
imaging versus PET; Professor Jan Meijer, University Leipzig, for important amend-
ments to the chapter on dosimetry; Professor Werner Meyer and Dr. Gerhard Reicherz,
Ruhr-University Bochum, for their critical reading of and valuable contributions to
the chapter on magnetic resonance imaging; Professor Winfried Petry and Professor
Franz Wagner, Technical University Munich, for their modifications of the chapters on
neutron radiotherapy and on nuclei and isotopes, and for providing proper numbers
of neutron energies and dose distributions; Professor Franz Pfeiffer, Technical Uni-
versity Munich, for his improvements to the chapter on x-ray radiography and sharing
images on phase contrast imaging; Professor Lutz Pott, Ruhr-University Bochum, for
critically reading and rectifying the chapter on electrophysical aspects of the heart;
Professor Katharina Theis-Bröhl, University Bremerhaven, for valuable suggestions
towards improvement of the chapter on x-ray generators; Dr. Sebastian Tripple, CFEL
Hamburg, for his expert input and revisions of the chapter on laser applications.
Last but not least, I am grateful to my wife Rosemarie for reading and correcting all
chapters with respect to spelling and solecisms. For any remaining inaccuracies or
ambiguities I take the sole responsibility.
Furthermore, I would like to thank Professor Mathias Kläui for his hospitality and
that provided by the Mainz Graduate School of Excellence at the Johannes Gutenberg
University Mainz while this text was being written. My hearty thanks also go to Astrid
Seifert and Nadja Schedensack of de Gruyter Verlag, who patiently waited for the sub-
mission of this manuscript, and Anne Hirschelmann and her staff, who did a superb
job on layout and graphical enhancement of the figures.

DOI 10.1515/9783110372830-002
Contents
Preface | vii

Acknowledgments | ix

Part A: Physical and physiological aspects of the body

1 Brief overview of body parts and functions | 3

1.1 Introduction | 3
1.2 Overview | 3
1.2.1 Cells | 3
1.2.2 Circulation | 5
1.2.3 Heart | 6
1.2.4 Kidneys | 6
1.2.5 Respiratory system | 7
1.2.6 Digestive system | 8
1.2.7 Sensory organs | 9
1.2.8 Nervous system | 10
1.2.9 Locomotor system | 11
1.2.10 Skin | 12
1.2.11 Reproductive system | 13
1.3 Summary | 14

2 Body mechanics and muscles | 16

2.1 Introduction | 16
2.2 Static mechanical properties | 16
2.2.1 Density | 16
2.2.2 Center of mass | 17
2.3 Body mechanics | 19
2.3.1 Mechanical models | 19
2.3.2 Levers | 20
2.3.3 Femur | 22
2.3.4 Degrees of freedom | 23
2.3.5 Biomechanics of walking | 25
2.4 Skeletal muscles | 27
2.4.1 Structure of skeletal muscles | 27
2.4.2 Muscle contraction | 30
2.4.3 Muscle activation | 33
2.5 Summary | 35
xii | Contents

3 Elastomechanics: bones and fractures | 37

3.1 Introduction | 37
3.2 Elastic deformation | 38
3.3 Plastic deformation | 39
3.4 Elastic properties of beams | 41
3.5 Structure of bones | 42
3.6 Elastic and plastic properties of bones | 46
3.6.1 Macroscopic level | 47
3.6.2 Microscopic level | 49
3.7 Summary | 51

4 Energy household of the body | 53

4.1 Thermodynamics | 53
4.2 Caloric oxygen equivalent (COE) | 53
4.3 Metabolic rate | 54
4.4 Metabolic heat production of the body | 57
4.5 Heat losses of the body | 58
4.5.1 Heat conduction | 59
4.5.2 Heat radiation | 60
4.5.3 Convection or wind chill | 61
4.5.4 Sweating and shivering | 61
4.6 Temperature regulation | 62
4.7 Summary | 63

5 Resting potential and action potential | 65

5.1 Introduction | 65
5.2 Resting potential | 67
5.3 Action potential | 69
5.4 Channel conductivity | 71
5.5 ATP pump | 72
5.6 Summary | 74

6 Signal transmission in neurons | 76

6.1 Introduction | 76
6.2 Overview on signal transmission | 76
6.3 Sensory receptor potential | 79
6.4 Analog-digital conversion | 81
6.5 Saltatory polarization current | 82
6.6 Communication across axons | 84
6.7 Neuromuscular junction – triggering muscle contraction | 86
6.8 Spinal reflexes | 88
6.9 Electromyography (EMG) | 89
 Contents | xiii

6.10 Electroencephalography (EEG) | 90

6.11 Summary | 93

7 Electrophysical aspects of the heart | 95

7.1 Introduction | 95
7.2 Cardiac action potential | 96
7.3 Electric polarization of the heart | 99
7.4 Electrocardiography (ECG) | 102
7.5 Leads according to Goldberger and Wilson | 105
7.6 Methods, procedures, and new developments | 109
7.6.1 Electrocardiography | 109
7.6.2 Magnetocardiography | 111
7.6.3 Artificial pacemaker | 112
7.7 Summary | 113

8 The circulatory system | 115

8.1 Introduction and overview | 115
8.2 The heart as a pump | 117
8.3 Energy, power, and efficiency of the heart | 120
8.4 Fluid statics of the circulatory system | 123
8.5 Hemodynamics of the circulatory system | 126
8.5.1 Basic equations and assumptions | 126
8.5.2 Flow resistance | 129
8.5.3 Turbulent flow and windkessel | 130
8.5.4 Flow velocity and pulse wave velocity | 132
8.5.5 Viscosity of blood | 135
8.5.6 Osmotic pressure | 139
8.6 Binding of oxygen to heme | 140
8.6.1 Structure of hemoglobin | 140
8.6.2 High spin-low spin transition | 141
8.6.3 Saturation curve | 143
8.6.4 Ferritin | 146
8.6.5 Absorbance | 147
8.7 Summary | 148

9 The respiratory system | 150

9.1 Introduction | 150
9.2 Respiratory organs | 151
9.3 Gas exchange | 153
9.4 Tidal volume and vital capacity | 158
9.5 Pulmonary volume and pressure changes | 160
9.6 Compliance | 163
xiv | Contents

9.7 Surface tension | 166

9.8 Airway resistance | 167
9.9 Cardiopulmonary bypass | 170
9.10 Summary | 174

10 Kidneys | 175
10.1 Introduction | 175
10.2 Global characteristics of kidneys | 175
10.3 Structure of kidneys | 177
10.4 Filtration | 178
10.5 Reabsorption | 181
10.6 Renal clearance | 184
10.7 Artificial filtering: dialysis | 190
10.8 Summary | 193

11 Basic mechanism of vision | 194

11.1 Introduction | 194
11.2 Optics of the eye | 196
11.2.1 Refraction power of the eye | 196
11.2.2 Accommodation | 198
11.2.3 Resolving power | 200
11.2.4 Visual acuity | 201
11.2.5 Lens aberrations | 202
11.2.6 Cataract | 204
11.2.7 Intraocular pressure (IOP) | 206
11.3 Photoreception and transduction | 209
11.3.1 Structure of the retina | 209
11.3.2 Sensitivity and adaptation | 211
11.3.3 Phototransduction | 214
11.3.4 Retinal signal processing | 219
11.3.5 Receptive fields | 223
11.4 Summary | 227

12 Sound and sound perception | 229

12.1 Introduction | 229
12.2 Soundwaves | 230
12.3 Crossing borders | 232
12.4 Sound intensity | 234
12.5 Outer and middle ear | 236
12.6 Inner ear | 240
12.6.1 Structure of the cochlea | 240
12.6.2 Organ of Corti | 243
 Contents | xv

12.6.3 Inner and outer hair cells | 244

12.6.4 From mechanical stimulus to receptor potential | 246
12.6.5 Frequency coding | 248
12.6.6 Pathway to the auditory cortex | 250
12.6.7 Sound localization | 250
12.7 Tone, sound, and noise | 253
12.8 Hearing aids | 254
12.9 The making of sound | 257
12.10 Summary | 258

Part B: Imaging modalities without ionizing radiation

13 Sonography | 263
13.1 Introduction | 263
13.2 Basic physical conditions for ultrasound imaging | 265
13.3 Sound propagation and attenuation | 266
13.4 Ultrasound transducer | 269
13.4.1 Piezoelectric effect | 269
13.4.2 US head | 270
13.4.3 Time gain compensation | 272
13.4.4 Near field and far field | 273
13.5 Medical imaging | 275
13.5.1 A-scan | 275
13.5.2 B-scan | 276
13.5.3 C-mode | 280
13.5.4 M-mode | 281
13.6 Scan characteristics | 282
13.6.1 Focusing | 282
13.6.2 Line density | 283
13.6.3 Scan frequency | 283
13.6.4 Depth of view | 283
13.6.5 Penetration depth | 283
13.6.6 Spatial resolution | 284
13.6.7 Artefacts | 285
13.7 Doppler Method | 285
13.7.1 CW Doppler method | 285
13.7.2 Pulsed Doppler method | 290
13.8 Summary | 293
xvi | Contents

14 Endoscopy | 295
14.1 Introduction | 295
14.2 Standard uses of medical endoscopes | 295
14.3 Fiber optics | 296
14.4 Endoscope optics | 300
14.5 Resolution and magnification | 302
14.6 Specialized endoscopes | 303
14.6.1 Narrow band imaging | 303
14.6.2 Chromoendoscopy | 304
14.6.3 Endomicroscopy | 305
14.6.4 Confocal laser endoscopy | 305
14.6.5 Optical coherence tomography endoscopes | 306
14.6.6 Capsule endoscopy | 309
14.7 Future directions | 310
14.8 Summary | 311

15 Magnetic resonance imaging | 313

15.1 Introduction | 313
15.2 NMR basics | 314
15.2.1 Zeeman splitting | 314
15.2.2 Equation of motion | 316
15.2.3 Resonance absorption | 320
15.2.4 Spin-echo techniques | 323
15.2.5 Autocorrelation and spectral density | 326
15.2.6 Final notes | 329
15.3 Acquisition parameters and contrast | 330
15.3.1 Standard terms | 331
15.3.2 Contrast generation | 332
15.4 MR signal localization | 337
15.4.1 Slice encoding gradient | 337
15.4.2 Frequency encoding gradient | 338
15.4.3 Phase encoding gradient | 340
15.4.4 K-map | 340
15.4.5 Fourier transform | 342
15.4.6 Data acquisition | 342
15.5 Magnets and coils | 343
15.5.1 Main coil | 344
15.5.2 Gradient coils | 345
15.5.3 RF coils | 346
15.5.4 MRI machine specifications | 346
15.6 Applications of MRI | 348
15.6.1 Joints | 348
 Contents | xvii

15.6.2 Dynamical contrast enhancement | 349

15.6.3 Angio-MRI | 351
15.6.4 Hyperpolarization MRI | 352
15.6.5 Diffusion-weighted imaging MRI (DWI) | 355
15.6.6 Multiple parameter MRI (mpMRI) | 358
15.6.7 Functional MRI (fMRI) | 358
15.6.8 Real time MRI | 360
15.7 New trends | 362
15.8 Advantages, hazards, and disadvantages | 363
15.9 Summary | 364

16 Questions & answers | 367

List of acronyms used in this book | 393

Index | 399
|
Part A: Physical and physiological aspects
of the body