Medical Imaging
The study of medical imaging is concerned with the
interaction of all forms of radiation with tissue
and
the development of appropriate technology to extract
clinically useful information (usually displayed in an
image format) from observation of this technology
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Understanding Visual Information: Technical, Cognitive and Social Factors
Anatomy to Physiology
• Anatomy: Body regions, organs, blood
vessels, etc.
•Can we see smaller anatomy? How small is
small?
•Static vs. Dynamics: how fast can we detect
and record?
• Physiology: Functions, metabolism, oxygen
concentration, blood flow, etc.
How fast can we detect and record?
• Can we combine anatomy and physiology?
Can we see the dynamic?
X-ray Imaging
Projection vs Tomographic
Chest
Mass
Cross-sectional Image
Projection Image
On the left reconstructed sagittal CT-images in a patient
with bilateral parasagittal hemorrhage due to thrombosis
of the superior sagittal sinus.
The red arrow on the contrast enhanced image indicates
the filling defect caused by the thrombus.
MRI
cardiac cancer
stroke
neuro function joint lung
• Radiography
• Fluoroscopy X-RAY
• Mammography
• Computed Tomography (CT)
• Nuclear Medicine Imaging
• Single Photon Emission Computed Tomography (SPECT)
• Positron Emission Tomography (PET)
• Magnetic Resonance Imaging (MRI)
• Ultrasound Imaging
• Doppler Ultrasound Imaging
•X-ray Imaging
• Computed Tomography (CT)
• Magnetic Resonance Imaging (MRI)
• Nuclear Imaging – Positron Emission
Tomography (PET)
• Ultrasound Imaging
• Endoscopy means looking inside and typically refers to looking
inside the body for medical reasons using an endoscope, an
instrument used to examine the interior of a hollow organ or cavity
of the body. Unlike most other medical imaging techniques,
endoscopes are inserted directly into the organ.
• Endoscopic ultrasound (EUS) or echo-endoscopy is a medical
procedure in which endoscopy (insertion of a probe into a hollow
organ) is combined with ultrasound to obtain images of the internal
organs in the chest , abdomen and colon. It can be used to visualize
the walls of these organs, or to look at adjacent structures.
Combined with Doppler imaging, nearby blood vessels can also be
evaluated.
• MRI-guided endoscopy offers the potential for an improvement in Seeing Both Sides: A CT
clinical outcomes by combining the strengths of both procedures. scanner’s X-rays [left side]
provide good structural
detail; MRI images [right]
• Combined MRI and CT Scanner- interior tomography- In standard are good for seeing
CT, X‑rays pass through two-dimensional slices of the body. If the functional flaws. Omni-
tomography could combine
scanner is trying to image the aorta, for instance, it will X-ray a the two technologies in the
whole section of the chest. But interior tomography focuses only on same machine.
structures inside the body, which reduces the patient’s radiation
exposure. MRI gives high contrast and allows doctors to measure
functional and even molecular changes; CT provides greater
structural detail.
Image properties
• Contrast
• Spatial resolution
Contrast
Contrast
• X-ray contrast is produced by differences in
tissue composition, which affect the local x-ray
absorption coefficient.
• Contrast in MRI is related primarily to the
proton density and to relaxation phenomena
(i.e., how fast a group of protons gives up its
absorbed energy).
• Contrast in ultrasound imaging is largely
determined by the acoustic properties of the
tissues being imaged.
Spatial resolution
• resolve fine detail in the patient.
• RESOVE= separate into constituent parts
• the ability to see small detail, and an imaging system has higher
spatial resolution if it can demonstrate the presence of smaller
objects in the image.
• The limiting spatial resolution is the size of the smallest object that an
imaging system can resolve.
• In ultrasound imaging, the wavelength of sound is the fundamental
limit of spatial resolution.
Definitions
• Spatial resolution – the amount of geometric detail
• How close can two points be before you can’t distinguish them
Spatial resolution
Classical medical imaging: utilizes images that are direct manifestation
of the interaction of radiation with tissue (conventional: X-ray, nuclear
medicine, medical ultrasound)
Contemporary medical imaging: two-part process:
(1) the collection of data concerning the interaction
of some form of radiation with tissue
(2) The transformation of these data into an image (or a set of images)
using specific computational tools (X-ray CT, SPECT, MR, NMR…)
Understanding Visual Information: Technical, Cognitive and Social Factors
Classical medical imaging:
direct and intuitive
Contemporary Medical imaging:
indirect and often counterintuitive
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Understanding Visual Information: Technical, Cognitive and Social Factors
Sources of Images
• Structural/anatomical information (CT, MRI, US) - within each
elemental volume, tissue-differentiating properties are measured.
• Information about function (PET, SPECT, fMRI).
_____________________________________________________________
Understanding Visual Information: Technical, Cognitive and Social Factors
List of diagnostic imaging
studies
• Plain x-rays
• CT scan
• MRI
• Nuclear imaging/PET
• Ultrasound
• Mammography
• Angiography
• Fluoroscopy
MEDICAL IMAGING: FROM
PHYSIOLOGY TO INFORMATION
• 1. Understanding Image medium:
tissue density is a static property that causes
attenuation of an external radiation beam in X-ray
imaging modality. Blood flow, perfusion and cardiac
motion are examples of dynamic physiological
properties that may alter the image of a biological
entity.
MEDICAL IMAGING: FROM
PHYSIOLOGY TO INFORMATION
2 Physics of Imaging: The next important
consideration is the principle of imaging to be used
for obtaining the data. For example, X-ray imaging
modality uses transmission of X-rays through the body
as the basis of imaging. On the other hand, in the
nuclear medicine modality, Single Photon Emission
Computed Tomography (SPECT) uses emission of
gamma rays resulting from the interaction of
radiopharmaceutical substance with the target tissue.
MEDICAL IMAGING: FROM
PHYSIOLOGY TO INFORMATION
• 3. Imaging instrumentation: The instrumentation used in collecting
the data is one of the most important factors defining the image
quality in terms of signal-to noise ratio, resolution and ability to show
diagnostic information.
• Source specifications of the instrumentation directly affect imaging
capabilities. In addition, detector responses such as non-linearity, low
efficiency and long decay time may cause artifacts in the image.
MEDICAL IMAGING: FROM
PHYSIOLOGY TO INFORMATION
• 4. Data Acquisition Methods for Image formation:
The data acquisition methods used in imaging play an
important role in image formation. Optimized with
the imaging instrumentation, the data collection
methods become a decisive factor in determining the
best temporal and spatial resolution.
MEDICAL IMAGING: FROM
PHYSIOLOGY TO INFORMATION
• 5. Image Processing and
Analysis: Image processing
and analysis methods are
aimed at the enhancement
of diagnostic information to
improve manual or
computer-assisted
interpretation of medical
images.
Medical Imaging began with radiography after the discovery of x-rays in 1895 by
Wilhelm Röntgen. Upon travelling through the tissues, the radiation from X-rays
is absorbed differentially depending on the density of the tissue being
penetrated. The limiting factor in this method of diagnosis is the similarity
between the densities of adjacent soft tissues within the body.
The application of pharmaceutical contrast agents between 1906 and 1912 to
help visualize organs and blood vessels was a major development in radiography.
By the 1960's, this made possible a new radiological application: angiography.
•Nuclear Medicine became possible in the 1950s. Once these
radiopharmaceuticals have been administered to the patient, they converge
in specific organs or in cellular clusters that are more 'active' than others.
•In the 1960's the principals of sonar were applied to diagnostic imaging. The
ultrasound scanner transmits high-frequency sound waves into a body by use
of a probe or transducer.
•The pulses or waves penetrate into the body and bounce off the organs. The
return wave vibrates the transducer; the transducer turns the vibrations into
electrical pulses that are sent to the ultrasonic scanner where they are
transformed into an image.
•In the 1970's G.N. Hounsfield and A.M. Cormack were awarded the Nobel Prize
in medicine for the invention of Computed Tomography. This technique uses
computer-processed X-rays to produce tomographic slices of specific areas of the
body.
•In 1971 Raymond Damadian showed that nuclear magnetic relaxation times of
tissues and tumors differed, motivating scientists to use MRI to study disease.
With MRI radio waves 10,000 to 30,000 times stronger than the magnetic field of
the earth are sent through the body. This strong magnetic field causes the
alignment of particles, called protons. As these protons move back into their
original positions, they send out radio waves of their own. The scanner picks up
these signals and a computer turns them into a picture. These pictures are based
on the location and strength of the incoming signals. Different protons send out
different signals, depending on which tissue the proton can be found in.
•The most exciting test in nuclear medicine today is positron emission tomography
or "PET" scanning. Instead of emitting gamma rays, these isotopes emit positrons
when they decay. Positrons are positively charged electrons. Following emission, a
positron combines with a local electron and annihilates, emitting two 511 kev
photons in opposite directions. By noting the arrival time of the two photons at
the detectors around the patient ("coincidence detection"), the source of
emission can be localized in spac
How does the referring doctor decide to request an
MRI rather than an X-ray, CT or ultrasound image?
• In general, the investigation chosen is the simplest, cheapest and
safest able to answer the specific question posed.
X-ray
• Because of the high contrast between bone and soft tissue, the X-ray
is particularly useful in the investigation of the skeletal system.
• An X-ray image of the chest, for example, reveals a remarkable
amount of information about the state of health of the lungs, heart
and the soft tissues in the mediastinum (the area behind the breast
bone).
X-ray
• In contrast, soft tissue organs such as the spinal cord, kidneys,
bladder, gut and blood vessels are very poorly resolved by X-ray.
Imaging of these areas necessitates the administration of an artificial
contrast medium to help delineate the organ in question.
CT
• In general, CT images are only obtained after a problem has been
identified with a single projection X-ray or ultrasound image; however,
there are clinical situations (a head injury, for example) in which the
clinician will request a CT image as the first investigation.
• CT is particularly useful when imaging soft tissue organs such as the
brain, lungs, mediastinum, abdomen and, with newer ultra-fast
acquisitions, the heart.
Gamma imaging: SPECT
Single Photon Emission Computed Tomography
• Like X-ray images, gamma investigations are limited by the dose-
related effects of ionising radiation and their spatial resolution, even
with tomographic enhancement, means that they are poorly suited
for the imaging of anatomical structure. However, the technique has
found an important niche in the imaging of function- how well a
particular organ is working.
Gamma imaging
• The radionuclide is usually injected into a vein and activity measured
after a variable delay depending on the investigation being
performed. A quantitative difference in ‘function’ provides the
contrast between neighbouring tissues, allowing a crude image to be
obtained.
PET
Positron Emission Tomography
• In contrast, PET, first proposed in the 1950’s, has taken much longer to
be accepted as a clinical tool. The problem is related in part to the
cost of the scanner and its ancillary services the cyclotron and
radiopharmacy — and in part to the absence of a defined clinical
niche.
• Thus, while PET has a number of theoretical advantages over SPECT
such as its higher spatial resolution and its use of a number of
biologically interesting radionuclides, in practice, it remains a research
tool, found in a handful of national specialist centres, used in the
investigation of tumours or heart and brain function.
MRI
• it has already found a particular place in the imaging of the brain and
spinal cord.
• One reason is its ability to detect subtle changes in cerebral and spinal
cord anatomy that were not resolvable with CT (a slipped disc
pressing on a spinal nerve or a small brain tumour, for example).
MRI
• This advantage of MRI over CT is due in part to the superior spatial
resolution of the technique and in part to the fact that MR images are
insensitive to bone — in CT, the proximity of bony vertebrae to the
spinal cord make this region difficult to image as a result of partial
volume effects.
• Furthermore, patients with pacemakers, artificial joints or surgical
clips cannot be scanned and there are technical problems in scanning
unconscious patients that require monitoring or artificial ventilation.
Ultrasound
• Ultrasound is an effective and safe investigative tool. It offers only
limited spatial resolution but can answer a number of clinical
questions without the use of ionising radiation and, unlike MRI, the
equipment required is portable, compact and relatively inexpensive.
• It has found a particular place in the imaging of pregnancy, but it is
also used to image the liver, spleen, kidneys, pancreas, thyroid and
prostate glands, and is also used as a screening tool in interventional
radiology .
• Ultrasound plays an important role in the investigation of the heart
and blood vessels
Ultrasound
• However, there are a number of specific clinical situations in which
ultrasound cannot be used. Structures surrounded by bone, such as
the brain and spinal cord, do not give clinically useful images, and the
attenuation of the ultrasound signal at air/tissue boundaries means
that the technique is not suitable for imaging structures in the lung or
abdominal organs obscured by gas in the overlying bowel.
Waves and Particles: What do we mean by them ?
Common types of waves:
Ripples, surf, ocean waves, sound waves, radio waves.
Need to see crests and troughs to define them.
Waves are oscillations in space and time.
Direction of travel, velocity
Up-down
oscillations
Wavelength ,frequency, velocity and oscillation size defines waves
Yodh 47
Waves… a review
• Most waves are either longitudinal or transverse.
• Sound waves are longitudinal.
• But all electromagnetic waves are transverse…
Wave-particle Duality
• Light can behave like a wave or like a particle
• A “particle” of light is called a photon
Radio waves
• Longest wavelength EM waves
• Uses:
• TV broadcasting
• AM and FM broadcast radio
• Avalanche beacons
• Heart rate monitors
• Cell phone communication
Microwaves
• Wavelengths from 1 mm- 1 m
• Uses:
• Microwave ovens
• Bluetooth headsets
• Broadband Wireless Internet
• Radar
• GPS
Microwave Heat Therapy
Hyperthermia therapy is a type of
medical treatment in which body
tissue is exposed to slightly higher
temperatures to damage and kill
cancer cells or to make cancer cells
more sensitive to the effects of
radiation and certain anti-cancer
drugs.
Cancer cells being targeted
by microwaves
Infrared Radiation
• Wavelengths in between microwaves and visible
light
• Uses:
• Night vision goggles
• Remote controls
• Heat-seeking missiles
Visible light
• Only type of EM wave able to be detected by the human eye
• Violet is the highest frequency light
• Red light is the lowest frequency light
Wavelengths of Light -
Visible
What we see as white light is
actually made up of a continuum
of components
Traditionally, we break white light
into red, orange, yellow, green,
blue, indigo, and violet (ROY G
BIV)
There is actually a continuous
transition of color, each with its
own wavelength and frequency
Ultraviolet
• Shorter wavelengths than visible light
• Uses:
• Black lights
• Sterilizing medical equipment
• Water disinfection
• Security images
X-rays
• Tiny wavelength, high
energy waves
• Uses:
• Medical imaging
• Airport security
• Inspecting industrial welds
Gamma Rays
• Smallest wavelengths, highest energy EM
waves
• Uses
• Food irradiation
• Cancer treatment
• Treating wood flooring
The Sun at Different
Wavelengths
Visible Ultraviolet
X-ray X-ray