RADIOLOGICAL
(IMAGING) METHODS
Irmak DURUR SUBAŞI, MD, PhD
Istanbul Medipol University
Faculty of Medicine Department of Radiology
Istanbul-TURKEY
Imaging and radiology
Objectives
• To review the general principles of imaging
methods
courtesy of Yorgo Iakovidis
• To be familiar with the brief technical
descriptions of each modality with special
emphasis on image production, image
description, factors that influence image
quality.
Imaging and radiology
• Radiology is a branch of medicine that uses imaging
technology to diagnose and treat diseases.
• Radiology may be divided into two different areas
• diagnostic radiology
courtesy of Petya Petrova
• interventional radiology
• Doctors who specialize in radiology are called
radiologists.
X‐ray‐based imaging modalities
• Plain radiography
• Mammography
• Fluoroscopy
• Computed tomography
• X‐ray tube :
• tube voltage (kVp)
• tube current (mA)
• total exposure time (seconds)
X‐ray tube
[Link]
In digital radiography (DR), X-ray tube
• an X-ray tube generates a beam of X-rays
• X-rays pass through the patient
• They strike sensors, converting generated signals into digital
information, which is transmitted and converted into an image
displayed on a computer screen.
Image
intensifier
Plain radiography (X‐rays)-Image
production
Plain radiography (X‐rays)-Image
descriptors
• Frontal
• Anteroposterior
• Posteroanterior
• Lateral
• Oblique
Plain radiography (X‐rays)- Image
descriptors
Image performance
• availability, speed, and lower costs
Mammography (x-ray based modality)
• Molybdenum target
(low energy x-ray)
• Smaller focal spots
• Compression
Provide better RESOLUTION
28 year-old, female patient with invasive ductal
carcinoma. On mammography spiculated
masses and suspicious calcifications.
Mammography-Image descriptors
R CC L CC R MLO L MLO
Breast Imaging
Reporting and
Data System
(BI‐RADS)
lexicon
craniocaudal (CC) and mediolateral oblique (MLO) views
Fluoroscopy
• Fluoroscopy allows real-time
imaging of structures in
motion or augmented with a
radiocontrast agent.
• Hysterosalpingography (HSG),
also known as
uterosalpingography, is a
radiologic procedure to
investigate the shape of the
uterine cavity and the shape
and patency of the fallopian
tubes.
Fluoroscopy-Image production
• Radiocontrast agents
are usually
administered by
swallowing or
injecting into the
body of the patient
to delineate anatomy
and functioning of
the blood vessels,
the genitourinary
system, or the
gastrointestinal tract.
X‐ray generator, X‐ray tube, collimator, filters, patient table,
grid, image intensifier, optical coupling, television system, and
image recording
[Link]
A barium meal (upper gastrointestinal series) Digital subtraction
angiography (DSA)
Computed tomography
• CT imaging uses X-rays in conjunction
with computing algorithms
• In CT, an X-ray tube opposite an X-ray
detector (or detectors) in a ring-
shaped apparatus rotate around a
patient (gantry), producing a
computer-generated cross-sectional
image (tomogram).
X‐ray tube voltage,
current,
field of view,
collimation,
slice thickness,
and pitch
[Link]
computed-tomography-4/
From Goldman LW. Principles
of CT: multislice CT. J Nucl
Med Technol 2008;36(2):57–
68. Modified by D. Ostler.
CT fluoroscopy
Epidural Injection Technique as demonstrated in a 38-year-old man with back pain.
CT fluoroscopy image demonstrates the needle to be appropriately angled toward the epidural
space.
American Journal of Neuroradiology November 2004, 25 (10) 1821-1823;
Dual‐energy CT
improved temporal resolution,
improved tissue characterization,
ability to generate virtual non-enhanced data se
improved subtraction of bones,
pulmonary ventilation and perfusion imaging,
and improved detection of iodine‐containing
substances on low‐energy images
Radiol Diagn Imaging 2018; 2:
DOI: 10.15761/RDI.1000125
Computed tomography
• CT is acquired in the axial plane, with coronal and sagittal images produced by
computer reconstruction.
CT numbers or Hounsfield units (HU)
hypodense or low
attenuating.
hyperdense or
high attenuating
Automated medical image segmentation techniques
April 2010 Journal of Medical Physics 35(1):3-14 Artifacts from helical CT scanning
DOI: 10.4103/0971-6203.58777 during light breathing. Note
discontinuities at the lung/diaphragm
interface, indicated by blue arrows.
[Link]
radiotherapy/
Ultrasound
• Ultrasound (US) is an imaging
technology that uses high-
frequency sound waves to
characterize tissue.
• It is a useful and flexible
modality in medical imaging.
[Link]
http://
[Link]/2017/11/[Link] MAJIDMALIK13/ultrasound-production-and-interactions
Ultrasound-Prob (transducer)
The most
commonly used US
display method is
• An ultrasound transducer sends an
the brightness (B)
ultrasound pulse into tissue and then mode, which can
receives echoes back. be seen as shades
• The echoes contain spatial and contrast of gray: Gray scale
information.
[Link]
DISPLAY MODES
Color Doppler Power Doppler
Duplex scanning
Flow existence
Flow direction with better Flow direction
With the courtesy of sensitivity pulsatility, absolute
Dr. Abdulkadir Eren,
Dr. Irmak Durur Subasi No direction flow velocity, RI, PI, AI
High‐intensity focused
ultrasound (HIFU)
•Gut and liver 2010; 4 Suppl 1(Suppl. 1):S57-6
Ultrasound-Elastography
Ultrasound-Image descriptors
Ultrasound-Image performance
The quality of the
US image is based
on resolution
[Link]
Ultrasound-Artifacts
Ultrasound- Advantages
• Ultrasound uses non-ionizing sound waves and has not been associated with
carcinogenesis. This is particularly important for the evaluation of fetal and gonadal
tissue.
• Availability, ultrasound is more readily available than more advanced cross-sectional
modalities such as CT or MRI.
• COST-Less expensive to conduct than CT or MRI.
• The real-time nature of ultrasound imaging is useful for the evaluation of physiology
as well as anatomy (e.g. fetal heart rate).
• Doppler evaluation of organs and vessels adds a dimension of physiologic data, not
available on other modalities (with the exception of some MRI sequences).
• Ultrasound images may not be as adversely affected by metallic objects, as opposed to
CT or MRI.
• COMPARISON-Ultrasound exam can easily be extended to cover another organ system
or evaluate the contralateral extremity.
Magnetic resonance imaging
Hydrogen nuclei have the
largest nuclear
magnetization, and these
occur abundantly in
humans in the form of
water, which contains two
hydrogen molecules
(protons), and fat, which
contains multiple protons.
[Link]
Magnetic resonance imaging
[Link]
rare-cases-kill-5051494/
[Link]
DOI: 10.1007/978-3-642-31208-3_6
Mol Imaging Biol 21, 1003–1019
(2019).
[Link]
019-01345-2
MRI-Image production-Pulse
sequences
These pulse sequences are computer commands that control all
hardware aspects of the MRI measurement process.
• Time to repeat (TR): The time required between each pulse.
• Echo time (TE): The time between the start of a pulse sequence and
maximum signal.
• Inversion time (TI): The time between a 180° inversion pulse and 90°
excitation pulse
• TR and TE are always employed in MR sequences (and TI, if utilized),
are used to describe basic MR pulse sequences, and are all measured
in milliseconds.
T1
Short TR
Short TE
T2
Long TR
Long TE
[Link]
[Link]
[Link]
Automated medical image segmentation techniques
April 2010 Journal of Medical Physics 35(1):3-14
DOI: 10.4103/0971-6203.58777