introduction to imaging physics capabilities and limitations
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INTRODUCTION TO IMAGING PHYSICS CAPABILITIES AND LIMITATIONS. DAVID B. CHALPIN, MD. ASSISTANT PROFESSOR OF CLINICAL RADIOLOGY LSU HEALTH SCIENCES CENTER NEW ORLEANS, LA. GOALS. TO BECOME FAMILIAR WITH THE BASICS OF IMAGE GENERATION USING X-rays, CT, AND MRI

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david b chalpin md
DAVID B. CHALPIN, MD

ASSISTANT PROFESSOR OF

CLINICAL RADIOLOGY

LSU HEALTH SCIENCES CENTER

NEW ORLEANS, LA

goals
GOALS
  • TO BECOME FAMILIAR WITH THE BASICS OF IMAGE GENERATION USING X-rays, CT, AND MRI
  • TO BECOME FAMILIAR WITH THE LIMITATIONS OF IMAGING AS PRACTICALLY APPLIED
test taker topics
TEST-TAKER TOPICS
  • KNOW THE WISHFULTHINKING PITFALLS!
  • REVIEW THE “TAKE-HOME” MESSAGES FOR EACH IMAGING MODALITY!

(denoted by a RED asterisk - *)

overview
OVERVIEW
  • RADIOGRAPHY, FLUOROSCOPY, & DSA
  • COMPUTED TOMOGRAPHY
  • MAGNETIC RESONANCE IMAGING
generation of x rays
GENERATION OF X-Rays

VACUUM TUBE

Electric current is passed through a filament, leading to e-emission, then striking target (W or Mb), leading to X-ray emission.

mas and kvp
mAs*and kVp*
  • e-current through filament (expressed in mAsfor milliAmperes) at Cathode generates a proportionate amount of X-Ray photons
  • kVp= kiloVoltage peak relates to the Voltage potential between the Anode & Cathode and reflects a SPECTRUM of emitted X-ray photon energies
x rays 3 fates
X-Rays – 3 Fates*
  • Photons can beABSORBED
  • Photonscan beSCATTERED with some exposing the film degrading the image, akaFOGGING, OR
  • Photonscan proceed directly through subject to EXPOSE film.
how reduce x ray scattering
How reduce X-ray SCATTERING?

ASK YOUR PATIENTS TO

LOSE WEIGHT?

to scattering
TO  SCATTERING
  • COLLIMATION* of X-ray Beam
  • Use of GRIDS* in cassettes
x ray grid
X-ray GRID

Tradeoff

Grids require 

mAs compared with XR studies done w/o grids

slide16

Center the Area

of Interest!

ap versus pa
AP versus PA

Direction of emitted beam from the X-ray tube PatientCassette

  • AP = Anterior to Posterior
  • PA = Posterior to Anterior
portable x rays
PORTABLE X-RAYS
  • HOWCONVENIENT!!
  • DECREASED QUALITY (sometimes) due to: limited kVp & mAs,  tube to subject distance, & positioning ROI
  • Is it FEASIBLE that the patient could have had the X-ray study done in the Radiology Department? If so, ………..
first aphorism
FIRST APHORISM

DON’T MAKE GOOD CALLS FROM “BAD” FILMS !!

don t make good calls from bad films
DON’T MAKE GOOD CALLS FROM “BAD” FILMS !!!*

“Bad”

can mean Suboptimal QualityOR the study as ordered was NOT dedicated for evaluation of Region or Organ of Interest.

second aphorism
SECOND APHORISM

YOU CANNOT CALL WHAT YOU DON’T SEE!*

HOWEVER, IF YOU

SUSPECT SOMETHING,

GET ANOTHER VIEW!!*

digital computed radiography
DIGITAL/COMPUTED RADIOGRAPHY

IMAGES CAN BE MANIPULATED POST-ACQUISITION TO OPTIMIZE VIEWING OF ONE PART OF H&D Curve.

wishful thinking in radiography
WISHFUL THINKING IN RADIOGRAPHY
  • QUALITY OF PORTABLE STUDIES*
  • PATIENT THICKNESS & SIZE*
  • Table Weight limits*
  • COOPERATIVENESS OF PATIENT*
wishful thinking in radiography24
WISHFUL THINKING IN RADIOGRAPHY
  • QUALITY OF PORTABLE STUDIES*
  • PATIENT THICKNESS & SIZE*
  • Table Weight limits*
  • COOPERATIVENESS OF PATIENT*
x ray computed axial tomography
X-ray COMPUTED AXIAL TOMOGRAPHY
  • aka CAT scan (archaic,) now CT
  • “STEP AND SHOOT” mode
  • 1st Gen CT Scanner – 45 min/slice
transmission special case
%TransmissionSpecial Case

For monochromatic Photon energy –

log %T α 1/linear attenuation

what data generates an image as a slice
What data generates an image as a slice?

The %Transmission of Photon energy received by detectors is recorded at multiple projections around the subject& the data is then reconstructed to create a cross-sectional image

x ray attenuation revisited
X-ray AttenuationRevisited

*%Transmission of photon energyreceived by detectors is recorded at multiple projections around the subject

& the data is reconstructed to create

a cross-sectional image

x ray attenuation
X-ray ATTENUATION

µ - the intrinsic X-ray coefficient

a function of:

  • kVp*
  • Atomic Mass*
  • electron density*
attenuation value ct
ATTENUATION VALUE – CT*

Hounsfield Units (H.U.)*

of sample S =

(μS - μH2O) x 1000

μH2O

ct advantages i
CT – ADVANTAGES I

COMPARED WITH X-rays, U/S, & MRI

  • Better Soft Tissue ContrastResolutionthan XR & usually Ultrasound (except reproductive organs, in general)*
  • Along with Fluoroscopy using Barium, CT best for Intestinal Tract Evaluation* (though not so “dynamic” as fluoro.)
ct advantages ii
CT – ADVANTAGES II
  • Easier & Quicker than MRI* but not always better tissue contrast resolution
  • ~BEST for detection & characterization of CALCIFICATION*
ct best for calcification
CT BEST FOR Calcification

e.g. a Bony Sequestrum & Involucrum

of Osteomyelitis

ct disadvantages
CT - DISADVANTAGES
  • IONIZING RADIATION!!*
  • EACH SERIES OF IMAGES TOGETHER IS ONLYONE SNAPSHOT IN TIME*
  • ARTIFACTS: Partial Volume*

Scattering (Obesity)*

Beam Hardening*

Metal Streaking*

helical ct
HELICAL CT
  • 3rd GENERATION CT SCANNER +
  • ADVENT OF

SLIP RING TECHNOLOGY TO CREATE HELICAL ACQ’N!

origin of multidetector ct
ORIGIN OF MultiDetector CT
  • TWIN DETECTORconcept done with conventional “STEP & SHOOT” technique
  • MARRIAGE OF MULTIDETECTOR DESIGN WITH HELICAL DESIGN

→ MDCT !

iv contrast timing of image acquisition
IV Contrast - TIMING of Image Acquisition
  • X-ray, U/S, but ESPECIALLY CT & MRI!
  • CONTRAST ENHANCEMENT PHASES:

Arterial; Hepatic Arterial;

Portal Venous; Renal Capillary;

Renal Excretion, etc.

resolution in imaging
RESOLUTION IN IMAGING
  • THERE ARE 3 COMPETING FORMS OF RESOLUTION: SPATIAL, CONTRAST, AND TEMPORAL!*
  • SUCH “COMPETITION” IS GREATEST IN MRI, WHILE IN CT IT CAN BE TRADED OFF THROUGH CHOICE OF A RECONSTRUCTION KERNEL BUT ESCALATED BY HIGHER RAD’N DOSE & USE OF IV CONTRAST.
spatial resolution
SPATIAL RESOLUTION
  • Improves with THINNER SLICES

But need  mAs to compensate

  • Improves with choice of reconstruction KERNEL* emphasizing spatial resolution when facilitated by great inherent differences in attenuation within region or organ of interest
contrast resolution
CONTRAST RESOLUTION
  • MAY IMPROVE WITH INHERENT DIFFERENCES IN TISSUE ATTENUATION, e.g. IV contrast
  • IMPROVES WITH MORE mAs
  • IMPROVES WITH USE OF SOFT TISSUE KERNEL
temporal resolution
TEMPORAL RESOLUTION
  • IMPROVES BY SCANNING FASTER
  • Useful for “Freezing” or Evaluating RAPIDLY-MOVING STRUCTURES, e.g. the HEART OR

MULTIPHASIC Imaging for assessing Contrast Enhancement over time within Organ(s) or Lesion(s) → Pt.Increased Radiation Dose if using CT

wishful thinking in ct
WISHFUL THINKING IN CT*
  • PATIENT SIZE– WEIGHT LIMIT OF SCANNER TABLE
  • PATIENT BODY HABITUS OBESITY → SCATTER; “PRETZEL” CONFIGURATION
  • RESIDUAL DENSE GI Contrast
wishful thinking in ct52
WISHFUL THINKING IN CT*

(rhetorical negatives)

  • NO INCREASED BEAM HARDENING ARTIFACT AT SHOULDERS & HIPS
  • NO EFFECT 2° to UE position
  • PT. COOPERATION – NO PROB!
mri 1
MRI 1
  • CURRENTLY, CLINICAL MRI INVOLVES PRIMARILY HYDROGEN NUCLEI
  • 1 TESLA = 10,000 gauss
  • Earth Magnetic Field Strength = 0.5g
mri 2
MRI 2
  • TWO SPIN STATES FOR PROTONS EXIST - PARALLEL TO APPLIED MAIN MAGNETIC FIELD AND ANTIPARALLEL
  • THE ANTIPARALLEL STATE HAS A HIGHER ENERGY LEVEL (Q.M.)
  • AT EQUILIBRIUM, 100,000 NUCLEI ARE ANTI-// AND 100,001 ARE //.
mri 4
MRI 4
  • RF (radiofrequency) Energy added to system, “flipping” protons from parallel to higher energy antiparallel state.
  • The excitation frequency required, ω, to “flip” the protons is governed by the LARMOR EQUATION: ω = γBo
magnetic field gradients
MAGNETIC FIELD GRADIENTS
  • MANIPULATION (OF THE RF ENERGY DEPOSITED) BY MAGNETIC FIELD GRADIENTS IS DONE TO ENCODE SPATIAL INFORMATION
  • ADDITIONAL GRADIENTS MAY BE USED TO CREATE IMAGES BASED ON DIFFUSION, DIFFERENCES IN FLOW VELOCITY, etc.
mr signal reception
MR Signal Reception
  • When RF turned off, the excess # of protons in antiparallel state returns to the ground state and emit either heat or RF, i.e. the patient is essentially turned into a “little radio station”!!
principle concepts of coil usage in mri 1
PRINCIPLE CONCEPTS OF COIL USAGE IN MRI - 1*
  • An RF coil*is used to receive the emitted signal, like an antenna.
principle concepts of coil usage in mri 2
PRINCIPLE CONCEPTS OF COIL USAGE IN MRI - 2*
  • The larger the coil used, the greater the volume of coverage.*
  • BUT, the Larger the Coil, the Lower the Signal-to-Noise (aka S/N)*
principle concepts of coil usage in mri 3
PRINCIPLE CONCEPTS OF COIL USAGE IN MRI - 3*
  • AND, the Further the Region of Interest is from the coil,

the Lowerthe S/N !!*

what is the significance
WHAT IS THE SIGNIFICANCE?
  • USE THE SMALLEST POSSIBLE COILNECESSARY TO SCAN THE REGION & ANSWER THE CLINICAL QUESTION!*
  • THUS, STATING THE CLINICAL QUESTION(S) CLEARLY MAYAIDNOT ONLY IMAGE INTERPRETATION,BUTMAY DETERMINE HOW THE STUDY IS CONDUCTED!! *
image contrast possibilities
IMAGE CONTRAST POSSIBILITIES

Processing of emitted RF signal yields SpatialInformationas

well as various forms of

Image Contrast

forms of mri contrast
Forms of MRI contrast
  • T1
  • T2
  • T2*
  • Balanced (“Proton Density”)
  • Contrast administration effects
forms of mri contrast66
Forms of MRI contrast
  • Selective 1H excitation or presaturation in lipid, free H2O, bound H2O, or Si-hyd
  • Flow velocity or rate
  • Differential [O2] (aka BOLD)
  • Diffusion
  • Diffusion Tensor
  • Multi-nuclear Spectroscopy, e.g. 1H, 13C, 19F, 31P
mri 7 wishful thinking
MRI 7*WISHFUL THINKING

PATIENTS MUST -

  • LIE FLAT!
  • BE STILL!
  • FIT INSIDE MAGNET!
  • Have SAFETY SCREENING Done!
  • FOLLOW INSTRUCTIONS (prn) !
acknowledgements
ACKNOWLEDGEMENTS

ILLUSTRATIONS COURTESY OF:

MRI in Practice, 3rd ed. Westbrook…

Clinical MRI Atlas, 2nd ed. Runge…

Radiologic Physics, 4th ed. Christenson…

Fundamentals of Radiology, LF Squire

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