Physics of Radiology Lior Copel, M.D. Assaf Harofeh Medical Center, Zerifin Sackler School of Medicine, Tel-Aviv University Clinical Case Jaundice and Fever • Subjective: – 42 year old female – Malaise and jaundice for 2 months – Fever for 1 week • Objective: – Fever – 38.5 – Leukocytes – 16700 ; PMN – 78% – Skin and corneal jaundice: Total bilirubin – 11.3 mg/dL Direct bilirubin – 6.7 mg/dL Diagnosis • Pancreatic adenocarcinoma (head) • Obstructive jaundice • Ascending cholangitis due to obstructive jaundice Conventional Radiology The Electromagnetic Spectrum Photons • Electromagnetic radiation is quantized in discrete quantities called photons • Photons behave as waves or particles but have no mass • Photons energy (E) – Frequency Wavelength • C = velocity of light = 300,000 km/sec E = h x f = h x (C / λ) Photons • Photons X-Rays • Photons – high energy - 20 – 200 keV short wavelength - 10-10 m X-Ray Tube X-Ray Interaction in Material • Pass through (penetrate) • Absorbed (transfer energy to the absorbed medium) • Scattered (change direction and possibly lose energy) The Cassette Radiology Examination Room X-Ray Advantages • • • • • • Excellent imaging of the chest and skeleton Good evaluation of GIT and GUT Good spatial resolution Can be performed dynamically Availability Relative low radiation dose to patient X-Ray Disadvantages • Poor 3D geometry • Poor soft tissue resolution • Insensitive to small lesions (esp. lung fields) • No evaluation of CNS and PNS Ultrasound (US) Natural Ultrasound Sound Wave Sound Waves • Infrasound - < 20 Hz • Audible sound – 15 – 20,000 Hz • Diagnostic ultrasound – 1 – 20 MHz (1 MHz = 106 Hz) • Diagnostic US uses transducers for the production of the waves Velocity of the US Wave in Different Tissues Doppler Physics • Doppler effect – the change in frequency that results from a moving sample • Object Movement: – Toward the detector higher frequency, lower wavelength – Away from the detector lower frequency, higher wavelength Doppler Shift US - Advantages • Excellent soft tissue contrast resolution • Dynamic • No radiation • Safe in pregnancy • Available, cheap US - Disadvantages • Operator dependent not imagined-not seen ! • Relatively no anatomic landmarks • Cannot penetrate air and bone • No imaging of lungs, CNS, PNS and GIT Computed Tomography (CT) Computed Tomography • Tomography – Greek: – tomos slice or section – graphein to write or record • CT scan – a diagnostic test that combines X-rays with computer technology • A series of X-rays from many different angles are used to create a cross-sectional image of the patient’s body Computed Tomography • Reconstruction “builds” the CT image from the data collected and represents a cross section of the patient Computed Tomography • Four hardware components: – Radiation source – Radiation detector system – Mechanical manipulator – Computer with display Contrast-Enhanced CT • Abnormal tissues (e.g. tumor, inflammation) enhance differently than normal tissues with IV contrast. This enables the abnormal tissue to be identified and characterized • Contrast media opacify specific structures (blood vessels, liver, spleen and the urinary tract) enabling abnormal findings to be detected in those structures Hounsfield Units The Gantry PROPOSALS FOR THE IONISING RADIATION (MEDICAL EXPOSURE) REGULATIONS 1999 REPIACING The Ionising Radiation (Protection of Persons Undergoing Medical Examination or Treatment) Regulations 1988 CONSULTATIVE DOCUMENT Comments to be sent to: Ms P M Brown Room 525 Wellington House 133-155 Waterloo Road London SEI 8UG No later than 31 May 1999 DEPARTMENT OF HEALTH MARCH 1999 T y p ic a l e ffe c tiv e d o se s fro m d ia g n o stic M e d ic a l e x p o su re s in th e 1 9 9 0 s D ia g n o s t ic p ro c e d u re X - r a y e x a m in a tio n s : L im b s a n d j o in t s ( e x c e p t h ip ) C h e s t ( s in g le P A f ilm ) S k u ll T h o r a c ic s p in e L u m b a r s p in e H ip P e lv is A bdom en IV U B a r iu m s w a llo w B a r iu m m e a l B a r iu m f o llo w t h r o u g h B a r iu m e n c m a C T head C T chest C T a b d o m e n o r p e lv is T y p ic a l E f f e c t iv e D ose (m S v ) E q u iv . No. of chest xra y s A p p ro x . e q u iv . P e r io d o f n a tu ra l b a c k g ro u nd r a d ia t io n < 0 .0 1 < 0 .5 < 1 .5 d a y s 0 .0 2 0 .0 7 0 .7 1 .3 0 .3 0 .7 1 .0 2 .5 1 .5 3 3 7 2 .3 8 10 1 3 .5 35 65 15 35 50 125 75 150 150 350 115 400 500 3 days 11 days 4 m o nths 7 m o nths 7 weeks 4 m o nths 6 m o nths 1 4 m o nths 8 m o nths 1 6 m o nths 1 6 m o nths 3 .2 y e a r s 1 year 3 .6 y e a r s 4 .5 y e a r s CT - Advantages • Excellent anatomical data • Excellent spatial resolution • Good contrast resolution (fair in CNS and MSK imaging) • Reconstructions (MPR, MIP, VR, navigation) • Fast exam (20sec.- 1min.) • Available CT - Disadvantages • • • • • Radiation dose Reactions to contrast material Static exam Availability Cost Magnetic Resonance Imaging (MRI) Magnetic Resonance Imaging • Concept – 1970 • Present – 60 million examinations per year Hydrogen Nuclei The Hydrogen Nuclei • • • • Have the largest magnetic moment Abundant in the body 1023 H protons in each 1 cm3 of tissue These protons are normally randomly oriented and have no net magnetic moment (magnetization vector) The Hydrogen Nuclei Hydrogen Nuclei in Nature The Magnet 1 Tesla = 10,000 gauss (G) Earth’s magnetic field 50 µT (0.5 gauss) MRI magnet is 20,000 more powerful than earth’s magnetic field Protons in a Magnetic Field Protons in a Magnetic Field 90 Degree RF Pulse 90 Degree RF Pulse Time Constants Measurements • T1 – Time to recover longitudinal magnetization – Realigning to B0 – Range 200 – 2000 msec • T2 – Time to dephase loose horizontal magnetization – Range 30 – 500 msec • Differences in T1 and T2 provide basis for variations in signal intensities and tissue contrast T1 Relaxation Time The time it takes to each tissue to return to its steady state position is the base for MR imaging T2 Relaxation Time Relaxation Time • Different tissues return to equilibrium in different time • Those difference in relaxation time enables different contrast resolution to different tissues and make it possible to differentiate normal tissue from abnormal one Contrast Agents – Gadolinium-DTPA • Abnormal tissues (e.g. tumor, inflammation) enhance differently than normal tissues with iv contrast. This enables the abnormal tissue to be identified and characterized • Contrast media opacify specific structures (blood vessels, liver, spleen and the urinary tract) enabling abnormal findings to be detected in those structures Planes of Imaging • Coronal • Sagittal • Axial (Horizontal) MRI Advantages • Excellent contrast resolution (esp. CNS, MSK, mediastinum, pelvis and heart) • Each tissue / pathology can be evaluated with different sequences • No radiation MRI Advantages • Multiplanar imaging • Can be performed in pregnancy (not in first trimester) • No risk with contrast materials • Can be performed dynamically MRI Disadvantages • • • • • • • Problem with cortical bone and calcifications Hazard to patients with metallic objects Problems in trauma and ventilated patients Claustrophobia Long examination Availability Expensive Be Careful !!!