Introduction to Medical Imaging

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Introduction to Medical Imaging

• Jeff Benseler, D.O.

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Objectives

• Medical Imaging What to expect in your first 2
  years at OUHCOM
• Overview How do x-rays create an image of
  internal body structures?
• What are the advantages of CT, MRI and
  Ultrasound?

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Medical Imaging (Radiology)

• Nearly all medical disciplines utilize medical
  imaging
• As you move from block to block we will learn
• How each modality works to create an image of
  internal body structures
• Selecting the best imaging tests for a given
  clinical presentation
• Develop a stepwise repeatable pattern of
  evaluating medical images

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Method for learning medical image interpretation

• Most blocks will contain recorded presentations
• These recordings last approximately 10 to 30
  minutes each
• Most blocks will have 2 to 4 recordings to view
  before the live class
• The recordings can be viewed and reviewed as
  needed anytime 24/7
• In class, we will learn by interpreting unknown
  cases

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Questions about medical imaging

• Please feel free to contact me with questions
• My preferred contact method is email
• benseler_at_ohio.edu

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Objective 2
What are x-rays?

• No mass
• No charge
• Energy

X-rays are a type of electromagnetic energy
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How do x-rays passing through the body create an
image?

• X-rays that pass through the body render the
  image dark (black)
• X-rays that are totally blocked render the image
  light (white)
• Air low atomic x-rays get through image
  is dark (black)
• Metal high atomic x-rays blocked image is
  light (white)

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5 Basic Radiographic Densities
1.

• Air
• Fat
• Soft tissue/fluid
• Mineral
• Metal

4.
5.
2.
3.
Name these radiographic densities.
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Optimal environment for visual perception

• Dedicated source of light (5 to 9 mega pixel
  monitors)
• Darkened environment (like a movie theater)
• Limit distraction

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X-ray viewing station
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Can you recognize shapes and density?
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Find the pathology What clues do you have?
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Medical Imaging Interpretation3 basic steps

• First learn how each modality creates an image of
  internal body structures
• Next, be able to accurately label normal anatomy
  (body structures)
• Then, search for structures that dont belong and
  for body structures that are abnormal in size,
  shape, position and/or density

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History 11 year old twisting injury of the foot
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Naming the parts of a long bone
Distal
3.
2.
1.
Proximal
Word bank epiphysis, metaphysis, diaphysis,
cortex, medullary cavity
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Review What are the 5 basic radiographic
densities from black to bright white?

• Air
• Fat
• Soft tissue/fluid
• Bone/mineral
• Metal

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Summary for objective 2 How do x-rays create an
image of internal body structures?

• X-rays pass through the body to varying degrees
• Higher atomic number structures block x-rays
  better, example bone
• Lower atomic number structures allow x-rays to
  pass through, example air in the lungs

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Objective 3Advantages of CT, MRI and Ultrasound

• These modalities are cross sectional imaging
• Cross sections are like slices
• X-ray studies are a 2 dimensional representation
  of 3 dimensional structures can result in
  undesirable overlapping densities and artifacts

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CT

• Advantages
• Eliminates overlapping densities
• Excellent resolution
• Excellent for detecting intracranial bleeding
• Excellent in the neck, chest and abdomen
• Excellent for evaluating fractures

• Disadvantages
• More expensive than x-ray and ultrasound
• Much more radiation
• Dense bone (petrous ridge for example) and metal
  cause severe artifacts

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air
CT scan of the abdomen
X-rays used
skin
What density is this?
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MRI

• Advantages
• No overlapping artifact
• Excellent resolution
• Very good at detecting fluid
• Excellent for imaging the brain, spine and joints
• No radiation
• Multiple imaging tests within the same study (T1,
  T2, IR, GE)

• Disadvantages
• Very expensive
• Patients cannot have a pacemaker or ferromagnetic
  material
• Slower to acquire images
• (approximately 45 minutes)

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Ultrasound

• Advantages
• No radiation
• Portable
• Instantaneous (real time)
• Excellent for cysts and fluid
• Doppler ultrasound is excellent to assess blood
  flow
• Excellent for newborn brain, thyroid, gall
  bladder, female pelvis, scrotum, pregnancy

• Disadvantages
• Does not work well in large or obese patients
• Resolution less than CT and MRI
• Air or bowel gas prevents visualization of
  structures

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Ultrasound of the gall bladder showing a gall
stone
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X-rays, CT, MRI and ultrasound help us see into
the body

• Internal body structures are composed of varied
  material (fat, muscle, bone, gland) or contain
  air, water or minerals that show up differently
  on each type of imaging test.
• Each modality has its own advantages allowing us
  the choose the best one for each medical
  circumstance.

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What an excellent medical student at your level
can do

• Be able to describe how x-rays can create an
  image of internal body structures
• Recognize and label the 5 basic densities on an
  x-ray
• Be familiar with the advantages for CT, for MRI
  and for ultrasound

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List of Potentially HelpfulRadiology Websites

• http//www.med-ed.virginia.edu/courses/rad/
• Online tutorial series.
• http//radiopaedia.org/
• A free educational radiology resource with one of
  the web's largest collections of radiology cases
  and reference articles.
• http//www.radiologyassistant.nl/en/p42023a885587e
  /welcome-to-the-radiology-assistant.html

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Websites Continued

• http//learningradiology.com/index.htm
• Seems to have some good stuff but difficult to
  navigate the site.
• http//www.swansea-radiology.co.uk/index.html
• http//bubbasoft.org/
• Strange name but the website is useful. Breaks it
  into radiologic anatomy (identification of
  structures) and clinical radiology
  (identification of pathology).

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Websites continued

• http//eradiology.bidmc.harvard.edu/index.html
• This source seems really valuable. Includes
  sections on primary care radiology,
  representative images of classic cases,
  interactive tutorials, and living anatomy
• http//www.radiologyeducation.com/
• List of radiology resources
• http//www.med.wayne.edu/diagRadiology/TeachingFil
  e.html
• Collection of interesting cases

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Websites continued

• http//headneckbrainspine.com/
• Neuroradiology anatomy and cases.
• https//3s.acr.org/CIP/Default.aspx
• Case in point. American College of Radiologys
  case of the day.