INTRODUCTION TO

RADIOLOGY

By
Dr. KIKOMEKO SHARIF
DEPT. OF RADIOLOGY.
HABIB MEDICAL SCHOOL, IUIU.
OBJECTIVES
 Define radiology
 To outline radiological imaging
modalities.
 To outline the basic physics of X-
rays.
 To understand the basic
operational applications,
indications and contraindications
of the various imaging modalities.
 OBJECTIVES
 To appreciate the rational of cost-
effective radiological imaging and
diagnosis.
 To outline the basic principles of
radiation protection
 To outline basic positioning in
radiography
 Definition of Radiology

 Radiology is a
medical specialty
using medical
imaging
technologies to
diagnose and treat
patients.
 Radiological practice in medicine is
dated back since 1900, after the
discovery of x-rays by Wilhelm
Roentgen in 1895.
 Radiology derived from term
radiation.
 Currently known as medical
imaging since some modalities do
not use radiation. 5
 IMAGING AND DIAGNOSIS
 Plain Radiography (X-ray)
 Fluoroscopy
 Tomography (obsolete) X-RAYS
 Mammography
 Computerized Tomography (CT scan)
 Ultrasound (U/S)
 Magnetic Resonance Imaging (MRI)
 Radiotherapy*
 Nuclear medicine – PET/SPECT*
 Intervention radiology*
Plain Radiography
 X-rays
 Part of the electromagnetic waves.
 Energy and frequency greater than
for visible light
 They are able to pass through a
patient
 Ionizes air
 Invisible to our eyes

7
The X-ray tube

8
X-Ray Production
 X-Ray Production


Thermionic Emission occurs at the
cathode when heated.

thermionic emission (22000 F or
>1200ͦc)

current is applied to the tube (tube
current) to create a larger potential
difference across the tube.
9
X-Ray Production

 Potential difference drives electrons

across tube to target surface (tungsten
anode)
 Electrons bombard tungsten atoms
interacting and dislodging tungsten
electrons creating heat and photons (x-
rays)
 Heat – 98% - 99.8%
 Photons - 0.2 to 2% photons
10
Resulting
X-Radiation

Primary
beam

Attenuated
radiation
Remnant
radiation (image
production)

11
 5 Radiographic densities/shades of
grey
 Air - black
 Fat – dark grey
 Soft tissue - grey
 Bone – light grey/off-white
 Metal and contrast material –
white/bright white
 Common uses include:
 chest x-ray,
 plain films of the abdomen,
 imaging of the skeletal system to
exclude fractures or arthritis.
AN X-RAY MACHINE
 FLUOROSCOPY
 Used for specialized examination;
uses ionising radiation (x-rays).
 Contrasted and non-contrasted
studies
 GIT: Ba. swallow, [Link], [Link]-
thru, [Link]
 GUS: Intravenous urography
(IVP/IVU), Cystourethrography (CUG),
Hysterosalphingography (HSG)
 Fluoroscopy c’tue
 Vascular: Arteriography, Venography,
Aortography
 Joints: Arthrography, Discography
(obsolete)
 Fistula and sinuses: Fistulography,
sinography
 Salivary Glands: Sialography
 Intervention: Bone biopsy; Tru-cut
BX
 ULTRASOUND
 Uses high frequency (about= 2-15MHZ) sound
waves.
 Ultrasound physics: transducer produces high
frequency sound waves which are transmitted into
patient’s body (e.g liver). The echoes are received
by the transducer as analog and converted into
digital image by the inbuilt computer system and
displayed on the monitor as gray scale image.
 Applications: OBGY; ABD organs; Echo; Vascular;
Small parts- thyroid, breasts, testes, brain, joints
and muscles, orbit, parotid, prostate
AN ULTRASOUND MACHINE
 MAMMOGRAPHY
 Used for breasts imaging
 Uses ionising radiation (x-rays)
 Plain mammography and contrasted
mammography
(ductography/galactography).
 Applications: Screening, suspected
breast tumour- diagnosis and follow
up.
 COMPUTED TOMOGRAPHY
(CTscan)
 Uses ionising radiation
 Demonstrates anatomy in axial,
coronal and sagittal planes.
 Applications: CNS, Chest, GIT, GUS,
MSS, CVS
 Indications: Congenital
malformations, Infections, Trauma,
Neoplasm, Metabolic and Others
Principle
 X rays are passed through the
patient in a circular path
 The attenuation data is used in a
computer to reconstruct high
definition images
 The images are seen on a
computer output device or films to
be interpreted
 3D reconstruction is also possible
CTscan Machine
History of the CT
 Sir Godfrey Hounsefield- an electrical
engineer- 1972
 Nobel Prize for Physiology or Medicine 1979

 Hounsfield units named after him

 Through the years CT’s have come from 1

rotation in 6 minutes to one in under 0.33
seconds
Slice them up!
Usually 5 to 10mm
 MAGNETIC RESONANCE
IMAGING (MRI)
 Uses non-ionising radiation (magnetic
field)
 Superior to CT scan in imaging of the
soft tissue; excellent for spine
 Generates Axial, coronal and sagittal
views
 MRI physics: Principles of
magnetism and Radiofrequencies
(RF).
 The rational of requesting
for an imaging modality.
Depends:
1. Indications
2. Availability
3. Cost of the examination
4. Effectiveness
5. Invasiveness
6. Biological effects (side effects)
7. Acceptability:-clients vs clinicians
Radiation Protection
Defn
 A term applied to concepts,
requirements, technologies and
operations related to protection of
people against the harmful effects
of ionizing radiation
Objective
 To become familiar with the basic
safety standards (BSS)
requirement for medical exposure:
justification, optimization,
diagnostic reference levels.

1 : Overview of Radiation Protection in

Diagnostic Radiology 31
Introduction
 Patients are medically exposed as part
of their diagnosis or treatment.
 According to ICRP and BSS, the two
basic principles of radiation protection
applicable to patients are justification
and optimization
 Dose limits are not applicable, but
Diagnostic Reference Levels (DRLs)
apply to patient dose levels
 Investigation of doses that exceed the DRLs
is strongly recommended
1 : Overview of Radiation Protection in
Diagnostic Radiology 32
Radiation Exposures
Three types of radiation
exposures
 Medical Exposure
principally the exposure
of persons as part of
their diagnosis or
treatment, care takers
and research participants
 Occupational Exposure
exposure incurred at
work, and practically as a
result of work
 Public Exposure including
all other exposures 1 : Overview of Radiation Protection in
Diagnostic Radiology 34
Medical exposure
 Medical Exposure
 Exposure of persons as part of their
diagnosis or treatment
 Exposures (other than occupational)
incurred knowingly and willingly by
individuals such as family and close
friends helping either in hospital or at
home in the support and comfort of
patients
 Exposures incurred by volunteers as
part of a program of biomedical
1 : Overview of Radiation Protection in
Diagnostic Radiology 35
protection for medical
exposure
 Justification
 Optimization
 Diagnostic Reference
Levels and Dose
constraints ARE
RECOMMENDED

1 : Overview of Radiation Protection in

Diagnostic Radiology 36
Justification
 The justification of a
practice

he decision to adopt or continue any

uman activity involves a review of
enefits and disadvantages as well as
ossible options, e.g., choosing between
he use of X Rays or ultrasound
Often, the radiation detriment will be
nly a small part of the total detriment
Most of the assessments needed for
he justification of a practice are made
n the basis of experience, professional
1 : Overview of Radiation Protection in
Diagnostic Radiology 38
Three levels of justification
 General level: The use of radiation
in medicine is accepted as doing
more good than harm
 Generic level: specific procedure
with a specific objective: chest
radiographs for patients showing
relevant symptoms
 Third level: the application of the
procedure to an individual patient
1 : Overview of Radiation Protection in
Diagnostic Radiology 39
Optimization
 The optimization of
protection
 Optimization is usually applied at two levels:
 The design and construction of equipment and
installations
 Day to day radiological practice (procedures)
 Optimization means that doses should be
“as low as reasonably achievable”,
compatible with achieving the required
image quality objectives

1 : Overview of Radiation Protection in

Diagnostic Radiology 41
 The optimization of
protection
 The optimization of protection in diagnostic
radiology does not necessarily mean the reduction
of doses to the patient, i.e., it may be necessary to
increase some doses to obtain clinical image quality
 Anti-scatter grids improve the contrast of the image but
increase the dose by a factor of 2-4
 Reducing the patient dose may reduce the quantity
as well as the quality of the information provided by
the examination or may require important extra
resources

1 : Overview of Radiation Protection in

Diagnostic Radiology 42
Diagnostic Reference Levels—
practical aspects
Diagnostic Reference Levels (DRLs)
for medical exposure (as defined by
the BSS)
 A value of dose, dose rate or activity
selected by professional bodies in
consultation with the Regulatory Authority
to indicate a level above which there
should be a review by medical
practitioners and medical physicists in
order to determine whether or not the
value is excessive, taking into account the
particular circumstances and applying
sound clinical judgement
1 : Overview of Radiation Protection in
Diagnostic Radiology 44
Diagnostic Reference Levels (DRLs)
for medical exposure (as defined by
the BSS)

 Corrective actions should be taken

as necessary if doses or activities
fall substantially below the
DRLs and images do not provide
adequate clinical image quality

1 : Overview of Radiation Protection in

Diagnostic Radiology 46
Dose constraints for
medical exposure
 For medical exposure, dose
constraints should only be used
in optimizing the protection of
persons exposed for medical
research purposes, or of persons,
other than workers, who assist in
the care, support or comfort of
exposed patients.
1 : Overview of Radiation Protection in
Diagnostic Radiology 47
Methods of Patient care in
radiographic environment
 Avoid errors – right pt for right exam
 Avoid repeated exposures
 Collimate exams
 Use high KVp technique
 Distance, Time and Shielding
 Keep image source distance at least 40”
source image distance
 Use fast Image receptors
 Provide shielding
Radiographic Positioning Terminology
 Projection
 Defined as the path of the CR as it exits
the x-ray tube, passes through the patient
to the IR
 Identified by the entrance and exit points
of the body
 Position
 Overall posture of the patient or general
body position
 Also refers to the specific placement of the
body or part in relation to the table or IR
 Radiographic Positioning Terminology
 View
 Used to describe the body part
as seen on the viewer while
observing anatomical positioning
 Method
 Refers to a specific radiographic
projection developed by an
individual
 Essential Projections
 AP (Anterior-Posterior)
 CR enters the anterior surface and
exits the posterior
 Essential Projections
 PA (Posterior-Anterior)
 CR enters the posterior surface
and exits the anterior
 Essential Projections
 Axial
 Longitudinal angle of the CR of 10
degrees or more
 Essential Projections
 Tangential
 CR directed along the outer margin of a
curved body surface
 Essential Projections
 Lateral
 CR enters one side of the body,
passing transversely along the coronal
plane
 Essential Projections
 Oblique
 CR enters from side at an angle to the
coronal plane
 Entrance and exit surfaces still
specified, e.g., AP oblique
 General Body Positions
 Upright – erect or vertical
 Seated – upright, but sitting on a stool
 Recumbent – lying down in any position
 Supine – lying on the back
 Prone – lying face down
 Lateral – lying on the side
 General Body Positions
Supine – lying on the back

Prone – lying face down

 Positions
 General body positions
 Trendelenburg’s position –
supine with the head lower than
the feet
 Positions
 General body positions
 Fowler’s position – supine with
the head elevated
 Positions
General body positions
 Sims’ position – recumbent
with patient lying on left anterior
side with left leg extended and
right knee and hip partially
flexed

Positions
General body positions

Lithotomy position – supine with
knees and hips flexed and thighs
abducted and rotated externally,
supported by ankle supports
 Positions
 General body positions
 Lateral position

 Named according to the side of

the patient that is placed closer
to the IR
 Positions
 Oblique position
 Body is rotated so that the coronal
plane is not parallel with the table
or IR
 Angle of rotation is specific for

anatomy of interest
 Named according to side and

surface of body closer to table or

IR
 Abbreviations: RPO, LPO, RAO, and
 Positions
 Right Anterior
Oblique (RAO)
Position
 Body is rotated so that
the right anterior side
of the patient is
closest to the table or
IR

Angle of rotation is
specific for anatomy of
interest
 Positions
 Left Anterior
Oblique (LAO)
Position
 Body is rotated so that
the left anterior side
of the patient is
closest to the table or
IR

Angle of rotation is
specific for anatomy
of interest
 Positions
 Right Posterior
Oblique (RPO)
Position
 Body is rotated so that
the right posterior side
of the patient is
closest to the table or
IR

Angle of rotation is
specific for anatomy of
interest
 Positions
 Left Posterior
Oblique (LPO)
Position
 Body is rotated so that
the left posterior side
of the patient is
closest to the table or
IR

Angle of rotation is
specific for anatomy of
interest
 Positions
 Decubitus position
 Recumbent position with a
horizontal CR
 Named according to the body

surface on which the patient is

lying and the side of the patient
closest to the IR
 Positions
 Left Lateral Decubitus position
 Left Lateral Recumbent position with a
horizontal CR (AP projection)

 A Right Lateral Decubitus position would be

with the right side down
 Positions
 Right Dorsal Decubitus
position
 Supine Recumbent position with a
horizontal CR (Lateral projection)
 Positions
 Left Ventral Decubitus
position
 Prone Recumbent position with a
horizontal CR (Lateral projection)
 Positions
 Lordotic
position
 Upright
position in
which the
patient is
leaning
backward