MAHSA University

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Faculty of Medicine

Introduction to Medical
Imaging
Part (1)
DR MUNA MOHAMMED HUSSEIN MOFREH
 Learning Outcomes
By the end of this lecture the student will be able to:
 Explain Historical Notes About Radiology.
 Recognize the different modalities which are used for diagnostic and therapeutic indications in daily
medical practice.
 Discuss the principles of each modality mode of action, and introduction to its physics.
 Define the Advantages , Disadvantages and Limitations of each modality through clinical cases.
 Explain the concept of radiological studies with contrast, types of contrast that are commonly used
during medical imaging, and its possible hazards .
 Recognize the concepts of Radiobiology , patient protection and safety measures which should be
applied for each study.
 Practice the process of justification and optimization for radiological studies, and concept and
sources for medicolegal responsibilities.
 Explain and use the terms which are used for interpretation of each type of radiological image, and
reporting of radiological findings.
Diagnostic Radiology (Imaging)
 Diagnostic Radiology

 Old radiology when “conventional” X-ray images were the only means of
visualizing the interior of the human body.
 “Imaging” was then called radiography and the study of the normal or
diseased body was radiology.
 Rapid innovative creative science : started by Computerized Tomography
(CT) then (Ultrasound, MRI…), and non stop development.
 Imaging Modalities

 Conventional radiographs (“x-rays”)

 Fluoroscopy
 Mammography

 Computed Tomography (CT)

 Nuclear Medicine (NM)
 Bone scan, PET scan , SPECT scan , then hybrid imaging.

 Ultrasound (US)
 Magnetic resonance imaging (MRI)

 Angiography and interventional radiology

 Imaging Modalities
The field of medical imaging rapid progress:

 X-Ray Photography discovered by Wilhelm Roentgen, 1895

 Catheter Angiography (1950s)
 Nuclear Medicine (1960s)
 Ultrasound and CT (1970s),
 Magnetic Resonance Imaging (MR imaging), Positron Emission Tomography
(PET), and Interventional Radiology (1980s)
 Multi-detector CT and Ultrafast MR Techniques (early to mid-1990s)
 Functional and Molecular Imaging (late 1990s to the present)
The Beginnings Of Radiology
November 1895
Roentgen Discovered X-rays
The beginnings of Radiology

X-Ray Photography discovered by Wilhelm Roentgen, 1895

• when experimenting with cathode ray tubes in a darkened room, he

noticed a faint fluorescent glow emanating from a plate he had left on the
bench
• when he moved to pick it up, he was amazed to see the image of the
bones from his hand cast onto the plates
• the prospects for x-ray diagnosis were immediately recognised but
Roentgen refused to patent his discovery

• He won first Nobel Prize in Physics for his discovery - 1901

Imaging Employs Electromagnetic Radiation

 An x-ray is a discrete bundle of electromagnetic

energy called a photon.
 It is similar to other forms of electromagnetic energy
such as light, infrared, ultraviolet, radio waves, or
gamma rays.
 Imaging Employs Electromagnetic Radiation

 The various forms of electromagnetic energy differ

only in frequency (or wavelength).
 However, because the energy carried by each
photon is proportional to the frequency, higher
energy will give higher frequency x-ray or gamma
ray photons.
X-ray Imaging
 X Ray Imaging

Early X-ray apparatus ~ 1920’s Modern direct capture Radiography

X Ray Imaging
 Conventional X-ray images

Called x-ray film.

 Digital X-ray images

 X-ray image stored in

a digital form on a
computer.
Fluoroscopy

 X-ray images can also be viewed with a fluorescent screen like that
of a monitor. In such an image exposed areas are bright, unexposed
areas dark.
 Such images are temporary.
 This method is called fluoroscopy. It exposes the patient to much
higher doses of X-radiation and is far more hazardous.
Black grey and white

 Attenuation.
 Transparent or “translucent”
 Radioopaque.
 Image Densities
 On the x-ray film or image:

 Bone or calcium  greater attenuation  white shadows

 Soft tissues  less attenuation  gray shadows
 Air  least attenuation  black or dark shadows

However … tissue thickness will affect the density of the shadow color.
 5 Basic Radiographic Densities
1.

 Air
 Fat 4.
 Soft tissue/fluid
 Bones or calcifications
 Metal

2. 5.

3.

Name these radiographic densities.

 Chest X-ray - Bones
Chest X-ray PA view:
A
A
B
Oval A (lateral part of the clavicle);
Oval B, the medial end of the E
clavicle. C
D
 The appearance of the rib at C. F
The arrowheads D where greater
lengths of the ribs are across the X-ray
beam, as the ribs curve around the
thorax.
E : Scapula
F: vertebral column
Chest X-ray – air & soft tissues

A
Define The Animated Structures
 Chest X-ray & TISSUE Thickness

 Identify the following structures on

the provided image:
-Heart
-The right breast
-Musculature at both axillary
regions.
-Liver
 Cartilage

 Elbow x ray.
 Soft Tissues

In this image of a part of the lumbar vertebral column, can you see the bands by the
sides of the vertebrae? What do you think they are?
ABDOMINAL XRAY TISSUE Contrast
Chest X-ray Tissue Contrast
 Contrast Media
 Radiopaque material to X-ray can be introduced in hollow organs.
 Will create ‘contrast’ between the contents of the cavity and walls.
The cavity shows up as white in an X-ray image.
 In some organs we can also introduce air or a gas so that it shows up
as black.
 These two modes are sometimes
described as positive or negative contrast.
 Materials thus introduced for
this purpose are called contrast media.
Barium Swallow

Oblique view of a barium swallow.

 Barium Meal - Stomach

 the air bubble in the fundus (F).

F

 The white arrow shows the pylorus.

The pyloric sphincter is a small mass
of muscle and therefore not visible,
just a thin line of barium is seen in the
narrow channel in the sphincter
 The small intestine – in some parts
you can see the breaks in the
continuity of barium due to the plicae
circulares.
 Urography

 intravenous urography (IVU).

 In intravenous urography, the
medium is injected through a vein.
 In about an hour’s time all the
iodine compound will be in the
urinary bladder.
 This imaging method also indicates
that the kidney is functional.
 Contrast Media

 A contrast media :
 Must be inert (non-reactive) non-toxic.
 Must be easily excreted.
 It must not be absorbed or retained by the body.
 Limitations of X-ray Imaging

 Ionizing Radiation.
 A two dimensional images for a 3-D object.
 Limited resolution of the images.
 Tomography with conventional methods has even more
limitations.

 Modern methods of imaging have sought to overcome some of

these limitations.
 CT, MRI and Ultrasound
 (CT) : X-ray source rotates around a plane of the body-taking serial pictures
with a detector (instead of a film) which are synthesized by a computer.

 (MRI) uses the property of protons aligning themselves in a magnetic field and
their reaction to radio frequency waves. The protons ‘resonate’ to the radio
frequency and revert to normal (‘decay’) when the decay is stopped. Effectively
it is the imaging the proton of hydrogen nucleus. No Ionizing Radiation.

 (US) Ultrasound uses mechanical waves of frequencies beyond the audible range.
These waves are reflected to various degrees from junctions of tissues of
different nature. No Ionizing Radiation.
Computed Tomography
(CT scan)
 The CT Setup

1
2

D
Computed Tomography (CT Scan)

Terms used:
 Attenuation
 Density
 Enhancement
Hounsfield Scale or CT Numbers

 Hounsfield scale or CT numbers is a quantitative scale

for describing radiodensity.

 Hounsfield Units
 -1000 air ***
 -100 fat
 0 water ***
 20-80 soft tissues
 1000 bone / Ca/ contrast
 >1000’s metal
 The CT Image
 A CT image can be taken as a plain image or with the introduction of a contrast
medium.

 Like conventional X-ray images, bone appears white, air black and soft tissues have
intermediate densities depending on their composition and thickness.
A

R Liver L

P
Computed Tomography (CT scan)

Large radiation dose

End of Part 1