Clinical Skill

General Approach to Diagnostic Imaging

ELYSANTI DWI MARTADIANI
RADIOLOGY DEPARTMENT , UDAYANA SCHOOL OF MEDICINE/ SANGLAH GENERAL HOSPITAL DENPASAR

Diagnostic Imaging
Technique to make body imaging for diagnostic purpose

IMAGING MODALITY
Using ionizing radiation

1.Radiography : a. plain radiograph b. with contrast agent 2.Computerized X-ray tomography (CT Scan ) 3. Radioisotop scanning = nuclear medicine = radionuclide scanning = scintiscanning

IMAGING MODALITY
Without ionizing

1.
2.

Ultrasound (US)
Magnetic Resonance Imaging (MRI)

radiation

X-Ray
X-ray : part of electromagnetic wave Discovered by Conrad Roentgen (1895) Short wavelenght can penetrate materials without transmit visible light

High voltage electric current passing across the vacuum tube induced a stream of electrons from cathode to strike a metal target (anode ) produced X-ray (1%) and heat (99%)

How does x-ray produced ?

High voltage electric current

passing across the vacuum tube induced a stream of electrons from cathode to strike a metal target(anode ) produced X-ray (1%) and heat (99%)

Radiation Hazard
Very large dose damage to human tissue. Local tissue necrosis Damage to the sensitive reproductive cell fetal deformity / sterility Cancerous growth / leukaemia Be carefull : pregnancy !

Simple / Plain Radiography

X-ray beam is passed through the patient on to a photographic plate Depend on the region that needs to examine Head , chest, abdomen, spine,limb etc

RADIOGRAPHY

Head Radiograph

Chest radiograph

Abdominal Radiograph/ BOF

Limb / extremity Radiograph

Spine Radiograph

Contrast Radiography
Contrast agent introduced into various organ cavities, vein and arteries. Upper Gastrointestinal (UGI) : gaster , duodenum Barium follow through : yeyunum, ileum (small bowel) Barium enema/ colon in loop : large bowel Invasive : Intravenous Urography /IVU Arteriography

Contrast study

BOF

Arteriography

Radiography
ADVANTAGE General overview Low cost Widely available DISADVANTAGE Minimal ability to differentiate soft tissue density Cross-sectional imaging ability (-) Ionizing radiation (+)

Computed Tomography / CT Scan

Computed Tomography /CT scan

Developed & introduced by Godfrey Hounsfield (1972) X-ray fall not on the film x-ray but on to detectors Detectors convert x-ray photon into scintillations quantified & recorded digitally into computer produced different readings data as the x-ray beam traverse round the patient.

CT Scan
Giving information about tissue density that is equal with amount of x-ray absorbed by the tissue More x-ray photons are absorbed by denser tissue) HU ( Hounsfield Unit) Demonstrate human body in the cross sectional image (slices)

Head CT

Chest CT

Abdominal CT

CT SCAN
Advantage High quality image Anatomic overlapp (-) Can differentate various tissue density Widely available High cost

Disadvantage Ionizing radiation (+), higher than simple xray Not portable If using contrast : potensial nephrotoxic

Radioisotope Scanning
Radioisotope : radioactive that disintegrates spontaneusly, emitting radiation which includes gamma radiation Half life : time taken for radioactive activity to fall by one-half ( i.e 6 hr for 99Tc) Example : 123I , 125I, 131I,99Tc

Radioisotope scanning
Particular isotopes selectively taken up by particular organs using radiofarmaka Radioisotop + radiofarmaka injected / inhaled isotope release gamma ray gamma ray is catched by gamma camera picture that shows hot-spot or cold area, depend on the uptake by the organs.

Radionuclide Scanning
Giving information about physiological / metabolic state. Patient : source of radiation patient isolation is important Low resolution anatomical picture Price : medium high cost

Bone Scintigraphy / Bone scan

ULTRASONOGRAPHY( US /USG)
Using sound waves ( high frequency )

Ultrasonic waves are produced from a transducer travel through human tissue reaches an object / surface with different texture a wave is reflected back.

ULTRASONOGRAPHY
Can differentiate : solid from cytic structure Can not use for evaluate bone and air-filled structure

US MACHINE

US of the solid structure ( liver)

US OF THE CYSTIC STRUCTURE : GALL BLADDER

ULTRASOUND
ADVANTAGE
DISADVANTAGE

Real-time tomographic imaging Inexpensive Portable No ionizing radiation

Operator dependent Can not evaluate bowel / bones Soft tissue resolution < CT/MRI

Magnetic Resonance Imaging/ MRI

MAGNETIC RESONANCE IMAGING / MRI

Cross sectional imaging technique

Strong magnetic field & multiple radiofrequency generate image

Can evaluate almost every part of the body, especially soft tissue ( brain, muscle, spinal cord , etc)

MRI

MRI
ADVANTAGE

Very good resolution & soft tissue contrast Multiplanar No ionizing radiation

DISADVANTAGE Expensive Not good enough for evaluating bone Not portable Not widely available Contraindication for patient with pacemaker/ vascular stent/ vascular clip

Summary
There are many imaging modalities that have their own advantage and disadvantage Conventional radiography, CT scan and radioisotope scan give ionizing radiation, but US and MRI do not give ionizing radiation Sometimes one imaging modality is not adequate, so that needs additional examination with other modality.

THANK YOU