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Intro to Radiology

Organisation of the Body

QuestionAnswer
Anatomical imaging types X-rays Ultrasound CT MRI
Functional imaging types Planar e.g. bone scan PET
Interventions in radiology For diagnosis - biopsies and angiogram For therapeutic - Drains, stents, embolization, injections
Issues with X-rays No functional/soft tissue info 2D representation of 3D anatomy (so multiple angles needed) X-rays themselves are highly damaging
X-ray fluoroscopy Performing lots of x-rays whilst the patient moves to get functional info
Oral contrast Can be swallowed normally and followed through the digestive track e.g. to see if it is swallowed normally or to look for tears in the stomach
Intravenous contrast A lateral x-ray is taken through the skull Contrast is injected into an artery in the arm or leg Once the contrast reaches the brain another X-ray is taken Two images are combined to isolate the blood vessels in the brain
4 basic densities of X-rays Air - black Fat - grey Soft tissue - light grey Bone/contrast - white
What are x-rays used for Good for lungs and bones Used to identify - foreign bodies, fractures, dislocations, lung mass, pneumonia, pleural effusion, pulmonary edema
CT scans 2 x-ray sources project lots of beams at different angles onto the body 200 detectors pick these up and create an image with a high spatial resolution X-ray source spins around the body so this is very rapid Taken at 3 angles-axial, coronal, sagittal
Density of tissues on CT Air < Fat < Fluid < Soft tissue < bone < metal Fat floats on water so is less dense than fluid Soft tissue is mostly intracellular fluid with some connective tissue
What can CT images look like 2D planar 3D volumetric CT reconstructions
Radiation - tissue effect When skin burns due to radiation exposure
Radiation - stochastic effect The risk of causing harm due to radiation exposure Particularly a risk in developing fatal cancers E.g. a CT has a 1/200 chance of causing a fatal cancer
Average radiation from different scans Chest X-ray - 0.02 mSv (2-3 days worth) CT head - 2mSv (1 year worth) CT abdomen - 10mSv (5 years worth)
Relationship between radiation and cancer risk Linear, no-threshold dose response relationship between exposure to X-rays and risk of cancer The imaging itself is viewed as safe, but the risk is not zero and it adds up
High risk groups Women of child-bearing age Pregnant patients Children and teenagers
MRI scan Uses strong magnetic fields generated close to the body to create images This doesn't use ionising radiation Better for soft tissue - good contrast Low spatial resolution
Issues with MRI Metal fragments in eyes Pacemakers Ferromagnetic intracranial aneurysm clips Coils/stents Cannot move Noisy/cramped Essentially anything magnetic (can move and creates artifacts)
Nuclear medicine Includes PET CT and Single photon emission CT PET - gives coloured areas to show metabolic activity SPECT - gives shing areas of high bone turnover These have the spatial info of CT but the functional info of injection contrast
Ultrasound High frequency sound reflected off body structures Gaps or gas will look bright Allows you to look at blood flow and functional structures Portable ultrasound probes can be used e.g. for inserting a cannula
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