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The British Institute of Radiology 48-50 St John Street London EC2M 4DG

T : +44(0)20 3668 2226 E : admin@bir.org.uk

www.bir.org.uk

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Essential physics for FRCR

Meeting organised by the North Branch of

The British Institute of Radiology

Thursday 23 January 2014

Liverpool Medical Institute

08:00 Registration, tea and coffee

Chair: Dr Klaus Irion, Consultant Chest Radiologist,

Liverpool Heart and Chest Hospital

08:30 Quiz

09:00 Basic physics review

Dr Philip Mayles, Head of Physics, The Clatterbridge Cancer

Centre NHS Foundation Trust

09:30 The physics of digital radiology

Dr John Kotre, Head of the Diagnostic Radiology Physics

and Radiation Protection Group, The Christie NHS

Foundation Trust

10:00 Fluoroscopy

Dr Mike Moores, Director, Integrated Radiological Services

Ltd

10:30 Coffee and into workshops

10:40 Workshops

11:40 IR(ME)R essentials

Mr Peter Hiles, Head of Radiation Physics, North Wales

12:10 Computed tomography

Dr Lorna Sweetman, Clinical Scientist, The Christie NHS

Foundation Trust

12:40 Lunch and quiz

13:30 Ultrasound

Mr Stephen Russell, Principal Physicist,

The Christie NHS Foundation Trust

14:00 Nuclear medicine

Dr Anthony Hughes, Medical Physicist, Royal Preston

Hospital

14:30 Tea and coffee

14:40 Workshops

15:40 MR physics

Professor Andrew Jones, Consultant Clinical Scientist,

The Christie NHS Foundation Trust

16:10 Answers to MCQ’s, problems and panel discussions

17:00 Close of meeting

CPD: 7 credits

Please complete the meeting evaluation survey online at:

https://www.surveymonkey.com/s/physics_day1

We will email your CPD certificate upon collation of your feedback.

We are most grateful to

For supporting this conference

Bayer HealthCare has provided sponsorship for the cost of the exhibition

stand only at this meeting.

Speaker profiles and abstracts (where supplied)

Biography

Professor Philip Mayles, Head of Physics, The Clatterbridge Cancer Centre NHS

Foundation Trust

Philip Mayles has been Head of Physics at Clatterbridge Cancer Centre since 1994.

During this time he has led the development of a number of advanced radiotherapy

techniques. Together with Alan Nahum and Jean-Claude Rosenwald he edited the

Handbook of Radiotherapy Physics. He teaches on the University of Liverpool MSc in

Clinical Science (Medical Physics) and has responsibility for the training of Medical

Physicists in Radiotherapy in Liverpool.

Abstract

Basic physics review

This talk will cover the basic physics of diagnostic radiology with ionising radiation.

Included will be: photoelectric and Compton interactions and image quality (contrast,

noise and spatial resolution). Dose considerations in planar and CT imaging will also

be considered. A brief introduction to the physics of PET imaging will also be given.

Biography

Dr John Kotre, Head of the Diagnostic Radiology Physics and Radiation

Protection Group, The Christie NHS Foundation Trust

John Kotre is Head of the Diagnostic Radiology Physics and Radiation Protection

Group at the Christie, Manchester. He has taught aspects of FRCR physics since 1983,

recently at Manchester and previously for many years at Newcastle. He also served

on the RCR Physics Working Group (2005-2010), helping to set the FRCR Physics

multi-choice papers, so he is in a good position to discuss some of the physics

material in the context of how it might be examined in the multi-choice format.

Abstract

The physics of digital radiology

This presentation will cover the digitisation of the image, digital subtraction

angiography, computed radiography and the most common direct digital

radiography designs, with emphasis on the performance characteristics, advantages

and disadvantages of the technology. A brief discussion of PACS and image display

and processing will also be included.

Abstract

Dr Mike Moores, Director, Integrated Radiological Services Ltd

Fluoroscopy

The definition of a fluoroscope is a device equipped with a fluorescent screen on

which the internal structures of an opaque object, such as the human body, may be

continuously viewed as images formed by the differential transmission of x-rays

through the object. The mechanism for image formation is common to radiography

and fluoroscopy but the latter provides dynamic/continuous reproduction.

In the early days radiologists would view a fluorescent screen directly during an x-ray

exposure. Because the images were of low intensity they were required to dark adapt

their eyes in order to employ scotopic vision, which was applicable to low luminance

images. Scotopic vision depends upon the rods within the retina as distinct from the

cones. Since rod vision provides relatively poor resolution but high sensitivity visual

acuity is not employed optimally by a human observer.

Following war time developments in the field of image intensification aimed at

improving night vision, image intensification was applied to fluoroscopic images in

order to increase image brightness so that rod dependent vision could be employed,

thus providing increased visual acuity for the radiologist. However, image and

associated contrast perceptibility is still dictated by statistical fluctuations within the

image, which are dictated by quantum and system noise processes. This is due to the

fact that dose rates (exposure per second) must be limited so that the overall

(integrated) dose to a patient during an examination, which might take from seconds

to minutes for completion, is acceptable. Such limitations also dictate the most

beneficial clinical applications for this imaging modality, which often involves the use

of contrast agents.

The basic elements of modern fluoroscopic systems will be described including the

basis of intensification and the relevance of patient and detector dose to image

quality. The talk will also highlight how new x-ray detector technology has now

blurred the boundaries between fluoroscopy and other x-ray imaging modalities

including both radiography and CT where time domain, multi frame imaging studies

are feasible.

Educational aims:

Reinforce the role of quantum statistics in determining X-ray image

quality

Understanding the reasons for and nature of technological developments

in fluoroscopy

The role and relevance of patient dose to risk-benefit outcomes from X-ray

examinations

Learning outcome:

An improved understanding of the physical and technological basis of X-

ray image formation.

Biography

Mr Peter Hiles, Head of Radiation Physics, North Wales

Head of Radiation Physics in North Wales and the current chair of the BIR’s Radiation

Protection Special Interest Group.

He has over 30 years experience in Medical Physics and has acted as an adviser to

the IAEA and EU on radiation protection and quality assurance.

He was the chair of the working party which produced the popular IPEM report 91

on X-ray equipment testing.

Abstract

IR(ME)R essentials

This presentation will highlight the essential elements of the Ionising Radiation

(Medical Exposure) Regulations, particularly those relevant to Radiology.

Questions on IR(ME)R are a regular occurrence in the Physics paper in Part 1 of the

FRCR examination. Therefore the material for this presentation has been selected to

answer common questions in the MCQ.

Particular emphasis will be placed on the issues involved with justifying a medical

exposure.

Education Aims:

To provide refresher training on the Ionising Radiation (Medical Exposure)

Regulations, in order to aid revision and, where necessary, highlight any

deficiencies in knowledge.

Learning Outcomes:

Understand the general requirements of the regulations

Appreciate the issues involved with justifying and authorising a medical

exposure

Biography

Dr Lorna Sweetman, Clinical Scientist, The Christie NHS Foundation Trust

Lorna Sweetman is a Clinical Scientist and Radiation Protection Adviser based in the

Diagnostic Radiology and Radiation Protection Group of Christie Medical Physics and

Engineering. She has been involved in physics teaching for the North West Deanery

School of Radiology (Manchester Radiology Training Scheme) since 2009.

Abstract

Computed tomography

This talk will consider the principles of computed tomography. We will look at the

advantages and disadvantages of CT relative to other techniques and discuss

hardware technology and image reconstruction methods. The factors governing the

appearance of the CT image and those that affect image quality, including common

artefact types, will be reviewed. Delegates will be reminded of practical approaches

to staff protection in CT and how the typical patient doses compare to other imaging

modalities. The requirements of the newer CT applications, for example gated

imaging and perfusion, will be summarised.

The talk aims to help delegates to synthesise the information they have already

studied, highlighting the relationships between different elements and the

interactions that lead to compromises between competing aspects of image quality.

At the end of the talk delegates should have consolidated their previous knowledge

of CT and:

be able to describe the function and operation of the main components in

a CT scanner

understand the influence of scanning parameters and reconstruction

algorithms on image quality and patient dose

appreciate the quantitative nature of CT images

be familiar with the main causes of image artefacts and their appearance

appreciate the magnitude of radiation dose and the risks associated with

CT scanning

Biography

Mr Stephen Russell, Principal Physicist, The Christie NHS Foundation Trust

Stephen is a Principal Clinical Scientist within Christie Medical Physics and

Engineering at The Christie, Manchester and is Section Leader for the Ultrasound

Section of the Non-ionising imaging. The groups’ ultrasound section provides both

scientific support and maintenance services to ultrasound users across the North

West. He supports a number of courses at several institutions covering the physics of

ultrasound and was editor of the latest IPEM report (102) on the quality assurance of

ultrasound systems

Abstract

Ultrasound

Learning objectives:

An over view of the current curriculum

An understanding of the generation of an ultrasound B-mode image

An understanding of the different ultrasound probe types and how they

function

An understanding of the formation of harmonic signals in tissue and how

systems image them

Contrast media and enhanced images

An overview of ultrasound system safety

Biography

Dr Anthony Hughes, Medical Physicist, Royal Preston Hospital

Tony is a state registered Medical Physicist with 20 years clinical experience in clinical

nuclear medicine, with a further 7 years experience as a certified Radiation Protection

Adviser.

Since 2004 he has been the lead tutor for FRCR Part 1 Physics at the University of

Liverpool, and for the past 6 years has been an examiner for the Institute of Physics

& Engineering in Medicine (IPEM) Part 1 training scheme. He currently sits on the

Royal College of Radiologists First FRCR Examination Committee (Physics).

Abstract

Nuclear medicine

This talk will review the basic science of nuclear medicine imaging including the

following topics:

1. The design & operation of the gamma camera

a. The collimator

b. NaI crystal

c. PM tubes & pulse processing

2. Factors affecting patient dose & image quality

a. Injected activity

b. Effective half-life

c. Spatial resolution, contrast & noise

3. Radiation protection considerations for patients

a. Conception

b. Pregnancy

c. Breastfeeding

4. Additional legislative requirements for nuclear medicine

a. EPR 2010

b. MARS 1978

5. Physics of SPECT imaging

a. Detector requirements

b. Factors affecting image quality

6. Physics of PET imaging

a. Coincidence detection

b. Block detectors & scanner design

c. FDG scanning

d. 2D & 3D acquisitions

e. Factors affecting image quality

Biography

Professor Andrew Jones, Consultant Clinical Scientist,

The Christie NHS Foundation Trust

Andrew is a Consultant Clinical Scientist within Christie Medical Physics and

Engineering at The Christie, Manchester and is Group Leader for Non-ionising

Imaging. The groups MR section provides scientific support to MRI users across the

North West region. He is a frequent lecturer covering a variety of subjects within

clinical MRI. Andrew is currently President of the BIR.

Abstract

MR physics

An appreciation of the key areas of MR physics which are considered

important for radiologists in clinical practice

A basic familiarity with the origins of the MR signal and image encoding

mechanisms

An understanding of the implications of the fundamental physics that

underpins image acquisition in terms of sequence types and artifacts

A general understanding of contrast mechanisms within generic types of MR

sequences and the influence of scan parameters on image contrast and

appearance

A basic understanding of the factors that influence spatial resolution and

signal to noise within image acquisition

An understanding of the factors that can produce artifacts within MR images

and strategies to minimise or remove them

A knowledge of the key safety aspects associated with clinical MR imaging

An awareness of the fundamental guidance available for MR and the nature of

the safety framework required by this guidance

An understanding of the main risks and hazards for patients and for staff

arising from MR

Our platinum sponsors

GE Healthcare provides transformational medical technologies and services to meet

the demand for increased access, enhanced quality and more affordable healthcare

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technologies taking on tough challenges. From medical imaging, software & IT,

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Philips is a diversified health and well-being company and a world leader in

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We develop innovative healthcare solutions across the continuum of care, in

partnership with clinicians and our customers to improve patient outcomes, provide

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As part of this mission we are committed to fuelling a revolution in imaging

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FORTHCOMING EVENTS

Radiology errors

31 January 2014

London

Scottish Branch meeting: Recent advances in diagnostic imaging

14 February 2014

Glasgow

3rd Annual SPECT/CT symposium:

Current status and future directions of SPECT/CT imaging

24 February 2014

London

Multi-parametric imaging of prostate cancer -

can it facilitate a paradigm shift in management?

28 February 2014

London

Biological optimisation of radiotherapy

13 March 2014

London

Paediatric body MRI course

1 April 2014

London

Management and radiology - a guide to current and future management issues in

radiology

2 May 2014

London

Radiotherapy - meeting the current and future workforce challenges for patient

care in a changing context

19 May 2014

London

Molecular radiotherapy dosimetry

4 June 2014

Oxford

VISIT: WWW.BIR.ORG.UK FOR MORE INFORMATION AND TO REGISTER!

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