Radiologiclal Investigations

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Radiodiagnosis - An overview
Dept of Radio-Diagnosis Imaging, Father Muller
Medical College , Mangalore
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Discovery of X-Rays

• Wilhelm Conrad Roentgen,a German physicist,
  discovered x rays on Nov.8,1895.
• In recognition of his outstanding contribution to
  science, he was awarded the first Nobel prize for
  physics in 1901.

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The picture that caught the scientific world by
storm was the X-ray photograph of his wifes
hand, taken on December 22, 1895. It clearly
showed the structure of the bones and the ring
she was wearing.
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Conventional Radiology

• Conventional X rays
• Barium studies of GIT
• IVU,MCU, ACU
• HSG
• Myelogram
• Sialography
• T-tube cholangiography

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Conventional x-ray units fluoroscopy
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COMPUTERISED RADIOGRAPHY
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Chest radiographs
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Abdominal radiographs
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Musculoskeletal Radiographs
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Spine
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Skull radiograph
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Pediatric radiographs
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limitations of Chest Radiography

• Some medical conditions of the chest will not
  show up on the image. Therefore, a normal chest
  x-ray does not necessarily rule out all problems
  in the chest.
• For example, patients with asthma exacerbations
  can have a normal chest x-ray. There are some
  cancers that are too small or are difficult to
  visualize and may not be identified.
• Blood clots to the lungs (pulmonary embolism)
  cannot be seen on chest x-rays and require
  additional study.
• A chest CT may be requested to further clarify a
  finding seen on the chest x-ray or to look for an
  abnormality not visible on a chest x-ray in order
  to answer the clinical problem.

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• The degree of involvement of the lung, as well as
  the distribution of disease, and anatomic
  location may be better evaluated with chest CT,
  helping aid the diagnosis.
• Some diseases, such as chronic lung disease, are
  frequently evaluated with HRCT (high-resolution
  CT).
• The chest x-ray and the physical examination
  should be correlated. The information each
  procedure provides can give the physician a
  clearer understanding of the patient's health.

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• X-rays are a type of electromagnetic radiation,
  are invisible and create no sensation when they
  pass through the body.
• The chest x-ray is one of the lowest radiation
  exposure medical examinations performed today.
• Special care is taken during chest x-ray
  examinations to ensure maximum safety for the
  patient by paying attention to correct x-ray beam
  energies.

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• Shielding the abdomen and pelvis with a lead
  apron helps reduce unnecessary radiation to the
  abdomen and pelvis.
• Women should always inform their doctor or x-ray
  technologist if there is any possibility that
  they are pregnant.
• The effective radiation dose from this procedure
  is about 0.1 mSv, which is about the same as the
  average person receives from background radiation
  in 10 days

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INTRAVENOUS UROGRAM (IVU)

• Radiographic examination of urinary tract
  including renal parenchyma, calyces and pelvis
  after iv inj. Of contrast media
• There has been decline in IVU in past 10 years
  due to
• Development of new modalities like CT, USG
• Cost containment
• Adverse effect of contrast media

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IVU
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ASCENDING CYSTO URETHROGRAM (ACU)
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MICTURATING CYSTOURETHROGRAM(MCU)

• Demonstrate the lower urinary tract and helps to
  detect the existance of any vesico-urethral
  reflux, bladder pathology and congenital and
  acquired anomalies of bladder outflow tract

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BARIUM STUDIES

• BARIUM SWALLOW
• BARIUM MEAL
• BARIUM MEAL FOLLOW THROUGH
• ENTEROCLYSIS
• BARIUM ENEMA

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BARIUM SULPHATE

• Ba has high atomic number 56
• Non absorbable /non toxic
• Insoluble in water/liquid
• Inert to tissues
• Can be used for double contrast studies

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BARIUM SWALLOW

• Contrast study from oral cavity upto the fundus
  of stomach

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Barium meal

• Radiological study of oesophagus, stomach,
  duodenum and proximal jejunum

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BARIUM MEAL FOLLOW THROUGH

• To study the suspected small bowel
  abrormalities
• Major methods
• Small bowel follow through examination
• Dedicated small bowel follow through examination
• Enteroclysis
• Peroral pneumocolon
• Retrograde small bowel examination

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BMFT
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Enteroclysis

• Radiological study of small bowel from jejunum
  to IC junction and instillation of contrast
  through the tube

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Barium enema

• Study of large bowel by administration of
  contrast through rectum

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HYSTEROSALPINGOGRAPHY(HSG)

• Contrast is injected in the uterus to study the
  uterine cavity and fallopian tubes

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Sialography

• Study to demonstrate the parotid or
  submandibular glands by injection of contrast
  medium into duct system

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T-tube cholangiography

• To study the CBD in post operative period prior
  to removial of T-tube

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MYELOGRAM

• Injection of contrast medium in spinal
  subarachnoid space to study the stuctural details
  of spinal cord, conus medullaris nerve roots
  spinal canal

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MYELOGRAM
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Mammography
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Indications for mammography

• Screening for CA in symptomatic women aged 50
  years and over
• Women above 35 years with high risk (family h/o
  breast CA)
• Symptomatic women with breast lump
• Surveillance of the breast following local
  excision of breast CA

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Ultrasonography

• Grey scale ultrasound
• Colour Doppler
• Musculoskeletal USG
• 3D/4D ultrasound
• USG guided procedures

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ULTRASONOGRAPHY

• Important technique for tomographic imaging of
  soft tissues
• Provides real time images
• Major application in heart, abdomen, pelvis,
  neck, breast, peripheries neonatal brain.
• Most imp application in obstetrics due to
  combination of safety and tomographinc imaging of
  fetus has rendered it indispensable

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• LIMITATIONS ultrasound doesn't cross tissue-gas
  or tissue-bone boundary ? poor window
• ADVANTAGE just a light pressure on the skin
  non invasive
• Preparation is minimal
• Ideally fasting and full bladder is required

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Doppler
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Comuterised Tomography (CT)
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Clinical application of spiral CT

• General survey
• Vascular studies CT angiography
• Imaging of trauma
• Pediatric studies
• Oncology- radiotherapy treatment planning
• Gastrointestinal studies- CT enteroclysis
• Newer tech- cardiac ct, VRT, MIP, virtual
  endoscopy
• Biopsy and drainage procedures

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MAGNETIC RESONANCE IMAGING (MRI)
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Clinical application of MRI

• MRI provides information that differs from other
  imaging modalities.
• Its major technological advantage is that it can
  characterize and discriminate among tissues using
  their physical and biochemical properties (water,
  iron, fat, and extravascular blood and its
  breakdown products).
• Blood flow, cerebrospinal fluid flow, and
  contraction and relaxation of organs, both
  physiologic and pathologic, can be evaluated.
• Because calcium emits no signal on spin echo
  images, tissues surrounded by bone, such as the
  contents of the posterior fossa and the spine,
  can be imaged.

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Continued

• MRI produces sectional images of equivalent
  resolution in any projection without moving the
  patient.
• The ability to obtain images in multiple planes
  adds to its versatility and diagnostic utility
  and offers special advantages for radiation
  and/or surgical treatment planning.
• Excellent delineation of anatomic structures
  results from inherent high levels of contrast
  resolution.

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• MRI acquisitions can be programmed to encode for
  various physiological phenomena including
  velocity of moving tissue or blood, diffusion of
  water (useful in detecting stroke)
• MR image acquisition does not use ionizing
  radiation.
• Because it requires little patient preparation
  and is noninvasive, patient acceptability is
  high.
• MRI contrast agents are very well tolerated and
  are much less likely than x-ray contrast agents
  to cause allergic reactions or alter kidney
  function.

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Limitations of MRI

• Because of the small bore of the magnet, some
  patients experience claustrophobia and have
  difficulty in cooperating during the study. Some
  obese patients cannot be examined.
• Some patients, particularly acutely ill patients,
  cannot cooperate and movement artifacts may
  result.
• Patient throughput is slow compared with other
  imaging modalities.

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• Patients with pacemakers and certain
  ferromagnetic appliances cannot be studied.
• MRI units require careful shielding.
• Greater technological expertise is required for
  utilization of MRI than for most other imaging
  modalities.
• MRI equipment is expensive to purchase, maintain,
  and operate

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Interventional procedures

• FLUROSCOPY GUIDED-
• USG GUIDED -
• CT GUIDED-
• ANGIOGRAPHY AND INTERVENTIONAL PROCEDURES

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Current trends in Radio Diagnosis.
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MDCT
Multi Detector CT. (MDCT) Presently 64 and 128
slice Head to toe in just 4 sec.
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SUPERCON MRI

• 1.5 3 Tesla
• MR spectroscopy
• Functional MRI

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PACS AND TELERADIOLOGY
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Digital Radiography
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Positron Emission Tomography PET CT fusion
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Thank You