AHM 244 AHM 244 Introduction to Introduction to

ImagingImaging

Principles of RadiologyPrinciples of Radiology

X-rays (discovered late 19X-rays (discovered late 19thth century) century) Computed Tomography (CT scan)Computed Tomography (CT scan) Sonography (ultrasound)Sonography (ultrasound) FluoroscopyFluoroscopy Nuclear Medicine – used for diagnostic Nuclear Medicine – used for diagnostic

and therapeutic proceduresand therapeutic procedures Magnetic Resonance Imaging (MRI)Magnetic Resonance Imaging (MRI) Positron Emission Tomography (PET)Positron Emission Tomography (PET)

X-raysX-raysRadiographyRadiography High energy waves that High energy waves that

cannot be seen or feltcannot be seen or felt

Similar to photographsSimilar to photographs

Radiopaque – do not Radiopaque – do not permit passage of x-rays permit passage of x-rays i.e. bones; show up on x-i.e. bones; show up on x-rayray

Radiolucent – permit the Radiolucent – permit the passage of x-rays i.e. soft passage of x-rays i.e. soft tissue; do not show up on tissue; do not show up on x-rayx-ray

X-raysX-raysPatient PositioningPatient Positioning

2-dimensional2-dimensional

Requires 2 exposures 90 degrees Requires 2 exposures 90 degrees to each otherto each other

May require multiple positions May require multiple positions and viewsand views

Review standard positions in Review standard positions in handouts and in texthandouts and in text

Review exam sequencing in textReview exam sequencing in text

http://www.rtstudents.com/radiolhttp://www.rtstudents.com/radiology-positions.htmogy-positions.htm

Radiation SafetyRadiation Safety Can cause cellular or genetic Can cause cellular or genetic

damagedamage

Minimize exposureMinimize exposure

Avoid unnecessary examsAvoid unnecessary exams

Limit area of body exposedLimit area of body exposed

Shield sensitive body partsShield sensitive body parts

Pregnancy statusPregnancy status

Workers:Workers:

Use shieldingUse shielding Wear dosimeterWear dosimeter

Diagnostic ProceduresDiagnostic Procedures

Mammography – Mammography –

x-ray examination of x-ray examination of the breastthe breast

Vital adjunct to Vital adjunct to biopsybiopsy

Performed yearly Performed yearly after age 40 or after age 40 or sooner with history sooner with history or suspicion or suspicion

Diagnostics cont…Diagnostics cont…Contrast StudiesContrast Studies

Used to differentiate Used to differentiate structuresstructures

Introduced via IV, catheter, Introduced via IV, catheter, orallyorally

Iodine – blood vessels; if Iodine – blood vessels; if allergic to shellfish, do not allergic to shellfish, do not use iodine!use iodine!

Barium – intestines and Barium – intestines and stomachstomach

Air - JointsAir - Joints

FluoroscopyFluoroscopy Use of x-rays to observe Use of x-rays to observe

movement within bodymovement within body

Contrast mediums used Contrast mediums used such as barium or such as barium or iodineiodine

Blood flow, beating Blood flow, beating heart, digestive tract heart, digestive tract

Also used to aid in Also used to aid in reducing fractures or reducing fractures or implanting devices such implanting devices such as pacemakers, stents, as pacemakers, stents, etc..etc..

Computed TomographyComputed Tomography Cross-sectional group of Cross-sectional group of

x-rays that target a x-rays that target a specific sitespecific site

Tube circles the patient, Tube circles the patient, computer analyzes to computer analyzes to create the cross-create the cross-sectional viewssectional views

Done with and without Done with and without contrast contrast

Organs can be viewed Organs can be viewed from all anglesfrom all angles

CT Cont….CT Cont….

SonographySonographyUltrasoundUltrasound Non-invasiveNon-invasive

Uses high-frequency Uses high-frequency sound wavessound waves

Creates cross-sectional Creates cross-sectional still views or views in real still views or views in real time movement with help time movement with help of a computerof a computer

Used for heart function, Used for heart function, abdominal and pelvic abdominal and pelvic structure views and fetal structure views and fetal visualizationvisualization

Sonography cont…Sonography cont…

MRIMRIMagnetic Resonance ImagingMagnetic Resonance Imaging

Uses high-intensity magnetic Uses high-intensity magnetic fields (magnets), radio waves and fields (magnets), radio waves and computer analysis to create computer analysis to create cross-sectional imagescross-sectional images

Used for central nervous system Used for central nervous system studies, joint structure, etc.studies, joint structure, etc.

Done with or without contrastDone with or without contrast

Claustrophobia is an issueClaustrophobia is an issue

Metal implants from surgeries is Metal implants from surgeries is a contraindicationa contraindication

Patient must remove any jewelry Patient must remove any jewelry and other metal objectsand other metal objects

MRI cont…MRI cont…

Nuclear MedicineNuclear Medicine Small amounts of radionuclides Small amounts of radionuclides

(radioactive materials) are injected(radioactive materials) are injected

These concentrate in specific areas These concentrate in specific areas of bodyof body

Computer cameras detect particles Computer cameras detect particles and create an imageand create an image

Used to study thyroid, brain, lungs, Used to study thyroid, brain, lungs, liver, spleen, kidney, bone and liver, spleen, kidney, bone and breastbreast

Positron Emission Tomography Positron Emission Tomography (PET)(PET)

Single Photon Emission Computed Single Photon Emission Computed Tomography (SPECT)Tomography (SPECT)

Assists with diagnosis of cellular Assists with diagnosis of cellular abnormalities esp. cancerabnormalities esp. cancer

Nuclear Medicine cont…Nuclear Medicine cont…

Interventional Radiologic Interventional Radiologic ProceduresProcedures

Designed to treat specific disease conditions – helps patients Designed to treat specific disease conditions – helps patients avoid surgeries, life-savingavoid surgeries, life-saving

Percutaneous Transluminal Coronary Angioplasty Percutaneous Transluminal Coronary Angioplasty (PTCA)(PTCA) – balloon angioplasty; used to enlarge lumen of – balloon angioplasty; used to enlarge lumen of blocked arteryblocked artery

Laser AngioplastiesLaser Angioplasties – use lasers to remove deposits in – use lasers to remove deposits in vesselsvessels

Vascular StentsVascular Stents – plastic or wire tubes inserted into a – plastic or wire tubes inserted into a constricted vessel to open it; this procedure is guided by constricted vessel to open it; this procedure is guided by fluoroscopyfluoroscopy

EmbolizationsEmbolizations – artificially stop bleeding from a blood – artificially stop bleeding from a blood vessel or reduce blood flow to a diseased area of an organ vessel or reduce blood flow to a diseased area of an organ

PTCAPTCA

Laser AngioplastyLaser Angioplasty

Vascular StentVascular Stent

EmbolizationEmbolization

Radiation TherapyRadiation Therapy Major force in fight against Major force in fight against

cancercancer

Uses high-energy radiation to kill Uses high-energy radiation to kill cancer cellscancer cells

Used in conjunction with surgery Used in conjunction with surgery and chemotherapy (drug therapy)and chemotherapy (drug therapy)

Precise and carefully planned by Precise and carefully planned by radiation oncologist (MD radiation oncologist (MD specializing in radiology)specializing in radiology)

Each treatment must be identical Each treatment must be identical to a specifically defined area of to a specifically defined area of the bodythe body

Side effects: weight loss, hair Side effects: weight loss, hair loss, loss of appetite, skin loss, loss of appetite, skin changes, digestive system changes, digestive system disturbancesdisturbances

Patient Education & Patient Education & PreparationPreparation

Help alleviate anxietyHelp alleviate anxiety Calm fearsCalm fears Explain proceduresExplain procedures Explain preparation – different for Explain preparation – different for

each test from no prep to liquid diet each test from no prep to liquid diet and laxativesand laxatives

Assist as needed Assist as needed Post procedure educationPost procedure education

Handling and Storage of Handling and Storage of Radiographic FilmsRadiographic Films

Protect unexposed films from extremes of temperature and lightProtect unexposed films from extremes of temperature and light Exposed films kept in protective sleevesExposed films kept in protective sleeves Maintain patient confidentiality per HIPAAMaintain patient confidentiality per HIPAA Correct labeling of patient filmsCorrect labeling of patient films Films obtained on site remain part of patient record – films Films obtained on site remain part of patient record – films

belong to the site that performed the procedure; can be signed belong to the site that performed the procedure; can be signed out by patient or sent by courier to specialist or PCPout by patient or sent by courier to specialist or PCP

Digital films can be kept in the EMRDigital films can be kept in the EMR Written summary sent to providers of patient care Written summary sent to providers of patient care

Teleradiology – computed imaging and information systems; many Teleradiology – computed imaging and information systems; many places use (PACS) Picture Archiving and Communication System places use (PACS) Picture Archiving and Communication System to store films on computersto store films on computers

Can outsource films this way to other countries even for a Can outsource films this way to other countries even for a radiologist to read films; consults with specialists from around radiologist to read films; consults with specialists from around the world is possible with this system and in rural areasthe world is possible with this system and in rural areas