Medical imaging

Modalities: Basic
Principles and
operations

Akochi, Sunday Joshua

Department of medical Imaging
Sciences
University of Rwanda
 Objectives

 How do x-rays create an image of

internal body structures?

 What are the 5 basic radiographic

densities?

 Review of different imaging modalities

 Guide to making Imaging Request

Akochi, S. Joshua 2
 Definition
 Non-invasive visualization of internal
organs, tissue, etc.

 Primary purpose is to identify pathologic

conditions.

 Requires recognition of normal anatomy.

Akochi, S. Joshua 3
 List of diagnostic imaging
Modalities
 Plain x-rays
 CT scan
 MRI
 Nuclear imaging/PET
Which of these modalities use
ionizing radiation?
 Ultrasound
 Mammography
 Fluoroscopy

Akochi, S. Joshua 4
 Plain
Radiography/X-
Ray Transmission
Imaging
X- ray machine( floor
mounted)

Akochi, S. Joshua 6
What are x-rays?
 No mass
 No charge
 Energy

What is your
diagnosis?

Akochi, S. Joshua 7
 Basic x-ray physics
 X-rays: a form of electromagnetic
energy
 Travel at the speed of light
 Electromagnetic spectrum
 Gamma Rays X-rays
 Visible light Infrared light
 Microwaves Radar
 Radio waves

Akochi, S. Joshua 8
Three things can happen
 X-rays can:
 Pass all the way through the
body(transmitted)
 Be deflected or scattered

 Be absorbed

Akochi, S. Joshua 9
 X-rays Passing Through
Tissue
 Depends on the energy of the x-ray
and the atomic number of the tissue
 Higher energy x-ray - more likely to
pass through
 Higher atomic number - more likely
to absorb the x-ray
Where on this image
have x-rays passed
through the body
to the greatest
degree?
10
 5 Basic Radiographic
Densities
1.

 Air
 Fat 4.
 Soft tissue/fluid
 Bone/Mineral
 Metal 2. 5.

3.

Name these radiographic densities.

Akochi, S. Joshua 11
 Optimal Viewing
 Dedicated light source
 Darkened environment (like a movie
theater)
 Limit distraction

Akochi, S. Joshua 12
X-ray viewing station
Akochi, S. Joshua 13
 Find the pathology
What clues do you have?
Akochi, S. Joshua 14
History: 11 y/o twisting
injury of the foot

15
Akochi, S. Joshua 16
 Naming the parts of a long bone

Distal

3.
2.

1.

Proximal

Word bank: epiphysis, metaphysis, diaphysis, cortex, medullary cavity

17
 What density
are the
lungs?

Why?

The list: air, fat, soft tissue, mineral and metal 18

 D
Diagnosis?
i

Akochi, S. Joshua 19
 Radiographic Analysis
 Any structure, normal or pathologic,
should be analyzed for:
1. Size
2. Shape and contour
3. Position
4. Density (You must know the 5 basic
densities)
5. Fractures: site, type, alignment

Akochi, S. Joshua 20
Medullary bone

Soft tissue

Metal
Note:
Right-left marker
21
Technologist’s initials
 3
Name these
densities

4
1

2
22
Computed Tomography

Akochi, S. Joshua 23
 Computed Tomography
 An x-ray tube is rotated around the
patient and a detector measures the
intensity of the transmitted rays from
different angles
 Uses an electronic receiver/detector

instead of film.
 X-ray photons are converted to gray

scale image through a mathematical

algorithm
 Images appear as slice and can be

reconstructed
 Gives more bony detail than MRI
Akochi, S. Joshua 24
 air

CT scan of the abdomen

X-rays used skin
What density is this?
Akochi, S. Joshua 25
Akochi, S. Joshua 26
Magnetic Resonance
Imaging(MRI)

Akochi, S. Joshua 27
Akochi, S. Joshua 28
 Body coil

Akochi, S. Joshua 29
 Magnetic Resonance
Imaging
 Uses magnetic field and radiofrequency
waves to obtain images of the body in
slices.

 It utilizes the nuclei magnetic properties

of the body.
 Hydrogen proton is the choice element
because of its abundance and sensitivity.
 More soft tissue detail than CT.
 Contraindicated in patients with
pacemakers and ferromagnetic implants.
Akochi, S. Joshua 30
Akochi, S. Joshua 31
 Ultrasonography
Principle of operation similar to those used in physiotherapy except
for energy levels

Akochi, S. Joshua 32
 Ultrasonography
 Utilizes sounds beyond hearing
range(>20khz)
 Uses Transducer/probe to transmit sound
and receive echoes.
 Piezoelectric material in the probe
transmits electrical signals to sound
waves and vice versa
 Sound can be transmitted, absorbed,
deflected/refracted/scattered or reflected.
 Output depends on acoustic impedance of
each tissue Akochi, S. Joshua 33
Ultrasound images

Akochi, S. Joshua 34
Nuclear Medicine

Akochi, S. Joshua 35
Akochi, S. Joshua 36
 Nuclear Medicine
Imaging
 Introduction of a radiopharmaceutical
by injection, ingestion or inhalation.
 The drug decay according to the half
life of the radionuclide
 Gamma rays are produced
 Detected by
Gamma/Anger/Scintillation camera
 Image analysis by the computer

Akochi, S. Joshua 37
 Other imaging
Modalities
 Mammography: X-ray Imaging of the
breast

 Fluoroscopy: x-ray Dynamic studies.

Often used for most contrast studies

Akochi, S. Joshua 38
Mammography Machine

Akochi, S. Joshua 39
Fluoroscopy Machine

Akochi, S. Joshua 40
 Guide to Making an
Imaging/Radiographic
Request
 Start from the basis
 Consider availability of equipment and cost
 Requesting the correct study: know the
patient’s clinical history and what you want
to evaluate.
 Justification of procedure: Adequacy of
clinical information.
 Proper filling of request form
 Comparism study where applicable

Akochi, S. Joshua 41
 Guide to Requesting
Radiographic examinations
 Prior to requesting an X-ray, ask if the result
would change your diagnosis and
management.

 Comparison studies (if any) and Contact

details in addition to the Correct study.

 Skull X-rays are rarely of use in head injury.

Any significant head injury should be referred
to the emergency department and proceed
directly for CT imaging.
Akochi, S. Joshua 42
DISCUSSIONS

Akochi, S. Joshua 43