MEDICAL

RADIOLOGY
 STEPS FOR DIAGNOSIS
 1. Registration

 2.Collecting anamnesis (objective/subjective)

 3. Proper direction

 4.Examination methods:
Laboratory
Instrumental
WHAT IS MEDICAL RADIOLOGY ?

 The field of medicine, which is based on

usage of radiation for medical purposes.

 Medical radiology is including 2 main medical

branches :
 1.Diagnostic radiology and
 2. Radial therapy
1. RADIAL DIAGNOSIS
 Radial diagnostics – the science of the application
of radiation for studying the structure and
function of normal and pathological changes in
human organs and systems for the prevention and
detection of diseases.

 A very important area of radiation diagnostic -

Interventional Radiology: performing medical
procedures/interventions under the control of
beam/radial examinations.

 The role of medical radiology.

2. RADIAL THERAPY
 The science of the application of ionizing beam/radiation
for the treatment of diseases.

 Radiation therapy has a wide range sources and quantum

corpuscular radiation, providing exposure to volume of
tissue in optimal therapeutic dose.

 It became an important part of complex treatment of

malignant diseases.

 Radial therapeutists work closely with oncologists,

surgeons, chemotherapist.
WHY ITS DONE ?
 Type of cancer treatment that uses beams of intense
energy to kill cancer cells.
 Radiation therapy most often gets its power from

X-rays, but the power can also come from protons or

other types of energy.
 The high-energy beams come from a machine outside of
your body that aims the beams at a precise point on
your body.
 Damages cells by destroying the genetic material that
controls how cells grow and divide.
 The goal of radial therapy is to destroy as few normal,
healthy cells as possible.
 IT IS SUGGESTED
As an option at different times during cancer treatment and
for different reasons, including:
 As the only (primary) treatment for cancer

 Before surgery, to shrink a cancerous tumor (neoadjuvant

therapy)

 After surgery, to stop the growth of any remaining cancer

cells (adjuvant therapy)

 In combination with other treatments, such as

chemotherapy, to destroy cancer cells

 In advanced cancer to alleviate/reduce symptoms caused by

the cancer.
 RISKS ?
 Side effects are temporary, can be controlled and
generally disappear over time once treatment has
ended.
 Hair loss at treatment site (sometimes permanent),
skin irritation at treatment site, fatigue. (Any time ).
 Dry mouth, thickened saliva, difficulty swallowing,
sore throat, changes in the way food tastes, nausea,
mouth sores, tooth decay
 Difficulty swallowing, cough, shortness of breath
 Nausea, vomiting, diarrhea

 Some side effects may develop later. For example, in rare

circumstances a new cancer (second primary cancer) that's
different from the first one treated with radiation may develop
years later
HOW TO PREPARE ?

 Precise spot in the body

 Comfortable position
 Planning scans/effective dose

Result?

 Doctor may perform/ undergo periodic scans after (as

before) treatment to see how cancer has responded to
radiation therapy.
 In some cases, cancer may respond to treatment right
away.
 In other cases, it may take weeks or months for cancer
to respond. Some people aren't helped by radiation
therapy.
 RADIATION- IONIZING
Physical basis of radiation diagnosis:

Radiation, used in radiology can be divided into two groups: ionizing

and non-ionizing.

 Ionizing is exposure, which ,travelling through the space, cause

exitment and ionizing of the atoms , from which this space is
constructed. According to the physical abbilities, Ionizing exposure is
devided into : 1.Photon (quantum) and 2.Corpuscular.

 1.Photon ionizing exposure perform the beam/ flow of electro-

magnetic vibrations/ waves. Roentgen/X-ray exposure belong to this.
 2. Corpuscular ionizing exposure – the beam of positively or
negatively charged or either neutraly elementar particles. Alpha- and
beta-particles (electrons and positrons), protons, neutrons and so on
… belong to this.

 Ultrasound and MRI exams do not produce ionizing radiation.

 Abbilities of ionizing radiation

 Ionizing action – ability to cause braking down of neutral

atoms into the positively and negatively charged particles.

 It penetrate through the body and things (solid), which

doesn’t let the light though itself

 It causes lighting/luminescence of several chemical

compounds (x-ray beam is based on this).

 Its evident, that this exposure isn’t intact (harmless) for

alive organisms , whereas it determines changes in bio-
substrates.
 RADIATION SAFETY STANDARDS

Radiation effects and safety

 The biologic effects are caused by interaction between

excessive x-rays interaction with atoms in tissue DNA and other
molecules in the body .

 These high energy x-rays have enough kinetic energy to ionize

electrons , that can directly damage the DNA or produce free
radicals , and may cause cell death or mutation.

 Most diagnostic radiologic exams expose patients to relatively

low levels of ionizing radiation and are relatively safe.

 Radiology workers, however, are exposed to the cumulative

dose of all examination they perform and are therefore at a
much higher risk.
 RADIATION SAFETY STANDARDS

 Performing radiologic examinations only the

minimum amount of radiation necessary to obtain
adequate test results should be used, and the
benefits of doing the examination should
outweigh the risks of performing the exam.

 Be aware and use available protection ! (e.g.,

lead vests, thyroid and gonad shields).

 Also, be aware that many interventional

procedures are carried out utilizing ionizing
radiation (i.e., CT guided biopsies, ablations,
angiograms, etc).
 RADIATION SAFETY STANDARDS

 Correct placement of the cabinets and rooms of

hospital.
 Walls,ceiling, protective doors and windows perform
safety from direct and indirect exposure/radiation of
all the personal who placed in the building, where
the sourse of radiation is located.
 We should mention about the usage of things of
individual protection - aprons and gloves of
plumbum resine(просвинцованнойрезины). Patients
body parts , which doesn’t undergo radiation, also
must be closed by resin.
 All the employers are mandatorly use individual
protective closes, aprons, gloves and nessesary to
use remote controles .
 RADIATION SAFETY STANDARDS

Lower-dose examinations include:

 Plain films, like a basic chest radiograph(x-ray-film)
 Higher dose examinations include computed tomography
(CT) scans and scans involving the use of contrast dyes
such as barium or iodine ( especially in cases where
clinical suspicion is extremely low and a radiologic study
may not be warranted).

 Pregnancy is also an important consideration in deciding

whether to proceed with certain radiologic studies.
 Delivering radiation, the risks and benefits of CT during
pregnancy must be strongly weighed and these
examinations are done much less commonly in pregnant
women.
DOSIMETRY
 The dose of radiation a patient is exposed to -
varies from patient to patient.
 This dose will depend on the size of the body
part examined
 The type of procedure
 The type of CT or other equipment and its
operation.

 Generally, radiation /exposure is calculated as

the “effective dose.”
 Advancements in computer technology now allow
for advanced 3Dreconstruction and 3D modeling,
which can also help aid patient care.

Examination methods :
 Radiographs or plain films (X-Ray machine)
 CT
 PET and other nuclear medicine studies
 Vascular/interventional Radiology
(Angiography; Angioplasty)
 Ultrasound
 MRI
 4 BASIC DENSITIES
Arranged here from least to most dense :

 Air, which appears the blackest on a radiograph.

 Fat,which is a lighter shade of gray than air.
 Soft tissue or fluid (because both soft tissue and
fluid appear the same on conventional
radiographs, you can’t differentiate between
heart muscle and the blood inside of the heart on
a chest radiograph).
 Bone/Calcium (usually contained within bones).
 FIVE BASIC DENSITIES

 Objects of metal density are not normally present in the

body. Radiologic contrast media and prosthetic knees or
hips are examples of metal densities artificially placed in
the body .

 One of the major benefits of CT scanning is its ability to

expand the gray scale, which enables us to differentiate
many more than these five basic densities.

 Remember, the denser an object is, the more x-rays it

absorbs, and the whiter it appears on radiographic
images.
 The less dense an object is, the fewer x-rays it absorbs,
and the blacker it will appear on radiographs
X-RAY DIAGNOSTIC
 A complex technical device, consists of an X-
ray tube (electrophysical generator), metal
frame a table for placing the patient, and the
remote control and analizing/ sensing device.
 X-ray diagnostic apparatus are divided into :
universal (main purpose), which helps to
provide general examination of all body parts
by imaging or Radiographs - plain films.
 And for especial purpose (specialized) , for
performing radiographic investigations in
neurology, dentistry, urology, mammology,
angiology.
X-RAY DIAGNOSTIC
 In time of passaging of x-ray beam through the human body,
beam weakens. Human body itself isn’t homogenic ,that’s
why exposure is engulfed with the different level, inside
different widness and density organs .

 More is organ in density, more exposure it is able to engulf

(absorb). And more intensive visualization (picture/film )
shade/shadow it gives.

 And opposite, more beams pass through the organ, more

transparent will be its visualization/appearance

 2times less exposure is engulfed by soft tissues,then with

bones, but it freely pass through the gas/air located inside
lungs, stomach, intenstines.
CONVENTIONAL RADIOGRAPHY / X-RAY
(PLAIN FILMS)

 Images produced through the use of ionizing radiation, i.e., x-rays, but
without added contrast material like barium or iodine, are called
conventional radiographs or, more often, “plain films or X-ray picture.”
 These images are relatively inexpensive to produce, can be obtained
almost anywhere using portable or mobile machines, and are still the
most widely obtained imaging studies.

 They require a source to produce the x-rays (the “x-raymachine”), a
method to record the image (a film, cassette,or plate) and a way to
process the recorded image (eitherusing chemicals or a digital reader).

 Common uses for conventional radiography include theubiquitous chest
x-ray, plain films of the abdomen, andvirtually every initial image of
the skeletal system to excludef ractures or arthritis.

 Ionizing radiation in large doses, substantially higher than any medical
radiographic procedure, is known to produce cell mutations that can
lead to many forms of cancer or anomalies.
 With the X-ray image can be obtained any parts/any
organs image.
 Some organs are well distinguished in the pictures
because of the natural contrast (bones, heart and lungs).
 Other organs are sufficiently clarified only after
artificial contrasting (bronchi,vessels, bile ducts,
cavities of the heart, stomach, intestines). In anythe
case of X-ray pattern is formed from the light and dark
and shades of grey.
 Public health data on lower levels of radiation vary as
to their assessment of risk, but it is generally heldthat
only medically necessary diagnostic examinationsshould
be performed and that studies using x-rays shouldbe
avoided during potentially teratogenic times, such as
pregnancy.
 Radioscopy - Fluoroscopy (x-raying) - X-ray
inspection method, in which the object
image is obtained on luminous (fluorescent)
display. Like a film. In a dark room.

 Fluorography - X-ray inspection method,
which consists in photographing images with
X-ray fluorescence on screen.
 CONTRAST MATERIAL

 The use of pharmacevticals, to differentiate

between normal and abnormal tissues, to
define vascular anatomy, to improve
visualization of some organs. (chemically
bound molecules of iodine that cause x-ray
absorbtion. When contrast agents are
injected intravasculary to tell difference
between normal and abnormal tissues
(enhancement ).
 . They are based on contrast materials :
Barium or Iodine.
 There are 2 methods of contrasting organs :
 Direct mechanical intake of contrasting material
inside of hollow organs : esophagus, stomach, gall
bladder, uterine hollow, vessels or heart chambers .
 Its based on ability of several organs to engulf intaken
contrast material from the blood an excrete it.
 Contrast material , used in radiology are : 1. Ba SO4.
Not dilluteable in water or gastric juices, non-toxic.
 2. Iodine-contained materials. Which are used for
contrasting vessels and heart chambers.
 In some cases, X-ray examination is carried out with
double-contrast. When simultaneously is injected air
and barium sulfate.
CONTRAST MATERIAL
 Many uses for iodinated compounds in
radiographic examinations such as in :

 Angyography
 Myelography
 Arthrography
 CT
 Arthrography : injection of contrast media and/or air into a joint. Air can be used alone, or in combination
with these compounds,to improve contrast. It has been used in injuries of joints, to assess meniscus injuries in
knee. Since thew advent of MRI, the arthrography has become less important .


 Myelography : Placement of contrast media in the spinal subarachnoid space, via lumbar puncture. For
diagnosing deseases inside and around the spinal cord and canal. The use of Myelogramm has decreased
because of advent of less invasive CT and MRI modalities.


 In the past, orally ingested tablets –iodinated compounds were used to to visualize gall-blade (filling effect).
These compounds were removed from the blood by the hepatic cells, then excreted into biliary tree and
concentrated in dall-bladder. Oral cholecystogramm provided information about gall bladder function, and
presence of filling defects, calculi or tumors. Now its rearlyused since ultrasonography imaging became
widely available.


 Angiography is called X-ray examination of the blood vessels, produced with the use of contrast agents.
 On plain radiographs ,image of the arteries, veins and lymphatic vessels aren’t differentiated, since they
absorb X-rays , as well as the surrounding tissue. The exceptions are the arteries and veins of the lungs,which
emerge as a dark branching light an the background of the light lung fields (filled with air).
 For artificial contrasting ,organic compounds of iodine solution( contrast material, designed for this purpose )
is injected into the bloodstream. Depending on what part of the vascular system contrast, distinguish
arteriography, venography (phlebography).
 Angiography is performed only after the general clinical cheking and only in those cases, when with using non-
invasive methods it was unable to diagnose a disease. And it is supposed, that only based on the vessels
visualization ,or the study of blood flow can be detected lesions of the vessels themselves or their changes
caused by diseases of other organs . However, we must remember that angiography - an invasive study,
associated with complications and with a rather significant radiation exposure.
 It is used for the study of hemodynamics and vascular pathology to identify itself, diagnosing injuries and
malformations of organs, detection of inflammatory, degenerative and tumoral lesions, causing dysfunction and
vascular morphology. Angiography is a necessary step in conducting endovascular operations .
 COMPUTED TOMOGRAPHY / CT SCANS

 CT scanners, first introduced in the 1970s, brought a quantum leap to medical

imaging.
 Obtaining images is based on X-ray beam (higher).
 Imaging is used to obtain images of isolated structures located in one plane,
without overlapping.
 Using a gantry with a rotating x-ray beam and multiple detectors in various
arrays (which themselves are rotating continuously around the patient on the
moving table) along with sophisticated computer algorithms to process the data,
a large number of two-dimensional, slicelike images could be formatted in
multiple imaging planes.
 CT scans can also be “windowed” in a way that optimizes the visibility of
different types of pathology after they are obtained, a benefit called
postprocessing that digital imaging, in general, markedly advanced.
 The most widely its usage is spread in pulmonology. On tomograms
obtainedImage trachea and the large bronchi, without needness of
artificiallcontrasting. Imaging of lungs is very valuable for the detection of decay
cavities ,infiltrations, or in tumors, hyperplasia of intrathoracic lymph nodes.
 It also provides an opportunity to study the structure of the paranasal sinuses,
larynx,
 get the image idifferent parts of such a complex object asa spine.
 According to the densities of the different organs, we can
elavuate them by the smallest unit – HU .Along the way,
determine the density of the tissue in certain areas, which
 measured in units - units of Hounsfield (HU).
 For zero mark adopted the density of water.
 Bone density is +1000 HU,Air density is -1000 HU.
 All other human tissuesare intermediate body (usually
from 0 to 200-300 HU).
 Actually, doctor chooses a limited range onHounsfield
scale - a "window", the size of which usually do not
exceed several units of Hounsfield units.
 Appropriate program ( written before) for each organ
examination.

 MAGNETIC RESONANCE IMAGING (MRI)

 MRI another method of displaying anatomy in axial, sagittal and

corronar planes, slice thickness of the image varies from 1-
10mm . The main strength of MRI is ability to detect small
changes whithinsof t tissue. Magnetic field for patient is believed
to be harmless. But it isn’t established the safety of MRI for fetal
imaging. Severa; animal studies suggested that there is potential
for teratogenic effect during early fetal development, maybe
acoustic damage. Therefore, MRI should be used in cautiously ,
especially during first trimester. Howerer, maternal safety is the
same as for nonpregnant woman.
 MR scanning is a problem for the people who are prone to
develop claustrophobia, because they are surrounding by a
tunnel-shaped structure for 30-45 minutes. The patient feels
sounds like hammerthumping , while examination is in progress.
 Magnetic resonance imaging utilizes the potential energy stored in
the body’s hydrogen atoms. The atoms aremanipulated by very
strong magnetic fields and radiofrequencypulses to produce enough
localizing andtissue-specific energy to allow highly sophisticated
computer programs to generate 2- or 3-dimensional images.
  MRI scanners are not as widely available as CT scanners; they are
expensive to acquire and require careful site constructionto operate
properly. In general, they also have arelatively high, ongoing
operating cost.
  However, they utilize no ionizing radiation and produce much
higher contrast between different types of soft tissuesthan can CT.
  MRI is widely used in neurologic imaging and is particularly
sensitive in imaging soft tissues like muscles, tendons,and
ligaments.
  Safety issues are associated with the extremely strong magnetic
fields of an MRI scanner, both for objects within thebody (e.g.,
pacemakers) and for ferromagnetic projectilesin the MRI scanner
environment (e.g., metal oxygen tanks).
ULTRASOUND (US)

 Ultrasound utilizes acoustical energy above the audible frequency of human hearing to produce
images, instead of using x-rays as both conventional radiography and CTscans do.

 It employs a transducer/PROBE, which both produces the ultrasonic signal and records it. The signal
is processed for its characteristics by an onboard computer. Ultrasound imagesare recorded digitally.
 Ultrasound scanners are relatively inexpensive compared to CT and MRI scanners. They are widely
available and canbe made portable to the point of being handheld.
  Because ultrasound utilizes no ionizing radiation, it is particularly useful in imaging women of child-
bearing age,pregnant women, and children.
  Ultrasound is especially useful in imaging soft tissues and for delineating solid from cystic
structures. It is also widelyused for image-guided biopsies and is a noninvasive meansof studying blood
flow.
  Ultrasound is generally considered to be a very safe imaging modality without any known major side
effects when usedat medically diagnostic levels.

 Ultrasound – environmental waves with frequency, exseessing the waves heard and recognizing by
human sounds, more then 10mega hertz (?).
 This prolonged waves, forming narrow (пучок ) directed to the examining part, have ability to
penetrate through the body tissues, wich doesn’t let the light pass through itself. Provoke waving /
vibrations of the tissue and give response – echo , changing and digitalizing asimages.
 Ultrasound is method of distant investigating of organs and tissues shape, location, size, their
movements and pathologic areas as well.
 Frequency of the us waves is choosed in order how deeper is located examined organ.
 In order to the examination, there are different transdusers/probes, through wich waves pass through
the body.
 One kind is for scanning .examining body surfaces, , second fconnected for with endoscopic tube,
used for hollow s examination, including combination with endoscopy.

ULTRASOUND
ULTRASOUND
ANGIOGRAPHY
 Angiography is called X-ray examination of the blood vessels, produced with the use of
contrast agents.
 On plain radiographs ,image of the arteries, veins and lymphatic vessels aren’t
differentiated, since they absorb X-rays , as well as the surrounding tissue. The
exceptions are the arteries and veins of the lungs,which emerge as a dark branching
light an the background of the light lung fields (filled with air).
 For artificial contrasting ,organic compounds of iodine solution( contrast material,
designed for this purpose ) is injected into the bloodstream. Depending on what part of
the vascular system contrast, distinguish arteriography, venography (phlebography).
 Angiography is performed only after the general clinical cheking and only in those
cases, when with using non-invasive methods it was unable to diagnose a disease. And
it is supposed, that only based on the vessels visualization ,or the study of blood flow
can be detected lesions of the vessels themselves or their changes caused by diseases
of other organs . However, we must remember that angiography - an invasive study,
associated with complications and with a rather significant radiation exposure.
 It is used for the study of hemodynamics and vascular pathology to identify itself,
diagnosing injuries and malformations of organs, detection of inflammatory,
degenerative and tumoral lesions, causing dysfunction and vascular morphology.
Angiography is a necessary step in conducting endovascular operations .
 Contraindications to angiography are extremely serious condition patient, acute
infectious, inflammatory and psychiatric diseases, severe cardiac, hepatic and renal
failure, hypersensitivity to iodine preparations.