Introduction to radiology

Lecture 1
Basic terms and definitions

1
 Radiology

In medicine, the discipline of

medical science that uses
electromagnetic radiation and
ultrasonics for the diagnosis and
treatment of injury and disease.

Radiology originated with the

discovery of X rays by German
physicist Wilhelm Conrad
Roentgen in 1895.

W.C. Roentgen was awarded the

first Nobel Prize in physics (1901)
for his work.
Wilhelm Conrad Roentgen
2
 Diagnostic Radiology

Diagnostic radiology, or
diagnostic imaging, is the
medical evaluation of body
tissues and functions—both
normal anatomy and
physiology and abnormalities
caused by disease or injury—by
means of static (still) or
dynamic (moving) radiologic
images.

3
What you need to know about imaging:
a. Understand the
physical basis of
imaging. c
b. Recognize clinical d
images produced by
various modalities.
c. Identify the advantages
and disadvantages of a b
various imaging
modalities.
d. Understand the terms
used in different
imaging modalities.

4
 Medical imaging of internal body structures
is achieved through the use of following
types of radiation:

• The most commonly used types of radiation are X-rays used in roentgenology
and gamma rays used in different modalities of nuclear medicine, X-rays and
gamma rays are ionizing electromagnetic radiations with similar characteristics
differing only in their mechanism of production.
• The third type which is used in medical imaging, relatively new in medical
imaging, is radiofrequency radiation. It is used in magnetic resonance Imaging,
which is also of the electromagnetic type but is non-ionizing.
• Infrared light used in thermography is another non-ionizing type of radiation.
• Ultrasound is entirely different in nature being non-electromagnetic, and is
propagated through matter as mechanical vibrations.
5
 1
Imaging
modalities:
1. Diagnostic roentgenology, 2
or conventional
roentgenology or X-rays.
2. Computed axial 5
Tomography (CAT).
2
3. Diagnostic Ultrasound
(Ultrasonography, USI).
4. Magnetic Resonance
Imaging (MRI ).
3
5. Nuclear Medicine, 6
(radionuclid imaging ore
scintigraphy).
6. Thermography.
7. Interventional Radiology .
4 7
6
 1
Imaging
modalities:
1. Diagnostic roentgenology,
or conventional
roentgenology or X-rays.
2. Computed axial 5
Tomography (CAT). 2
2
3. Diagnostic Ultrasound
(Ultrasonography, USI).
4. Magnetic Resonance
Imaging (MRI ).
3
5. Nuclear Medicine, 6
(radionuclid imaging ore
scintigraphy).
6. Thermography.
7. Interventional Radiology .
4 7
7
 1
Imaging
modalities:
1. Diagnostic roentgenology, 2
or conventional
roentgenology or X-rays.
2. Computed axial 5
Tomography (CAT).
2
3. Diagnostic Ultrasound
(Ultrasonography, USI).
4. Magnetic Resonance
Imaging (MRI ).
3
5. Nuclear Medicine, 6
(radionuclid imaging ore
scintigraphy).
6. Thermography.
7. Interventional Radiology .
4 7
8
 1
Imaging
modalities:
1. Diagnostic roentgenology, 2
or conventional
roentgenology or X-rays.
2. Computed axial 5
Tomography (CAT).
2
3. Diagnostic Ultrasound
(Ultrasonography, USI).
4. Magnetic Resonance
Imaging (MRI ).
3
5. Nuclear Medicine, 6
(radionuclid imaging ore
scintigraphy).
6. Thermography.
7. Interventional Radiology .
4 7
9
 1
Imaging
modalities:
1. Diagnostic roentgenology, 2
or conventional
roentgenology or X-rays.
2. Computed axial 5
Tomography (CAT).
2
3. Diagnostic Ultrasound
(Ultrasonography, USI).
4. Magnetic Resonance
Imaging (MRI ).
3
5. Nuclear Medicine, 6
(radionuclid imaging ore
scintigraphy).
6. Thermography.
7. Interventional Radiology .
4 7
10
 1
Imaging
modalities:
1. Diagnostic roentgenology, 2
or conventional
roentgenology or X-rays.
2. Computed axial 5
Tomography (CAT).
2
3. Diagnostic Ultrasound
(Ultrasonography, USI).
4. Magnetic Resonance
Imaging (MRI ).
3
5. Nuclear Medicine, 6
(radionuclid imaging ore
scintigraphy).
6. Thermography.
7. Interventional Radiology .
4 7
11
 1
Imaging
modalities:
1. Diagnostic roentgenology, 2
or conventional
roentgenology or X-rays.
2. Computed axial 5
Tomography (CAT).
2
3. Diagnostic Ultrasound
(Ultrasonography, USI).
4. Magnetic Resonance
Imaging (MRI ).
3
5. Nuclear Medicine, 6
(radionuclid imaging ore
scintigraphy).
6. Thermography.
7. Interventional Radiology .
4 7
12
 Ionizing radiation

• Those types of radiation (X,

gamma, beta and alpha
radiation) which have the
capacity to ionize atoms
and dissociate molecules
and therefore cause
biological damage.
• Ionization – process by
which a neutral atom or
molecule gains or loses
electrons acquiring a net
charge.

13
 What is the damaging effect of
radiation?
• The ions formed then can go
on to react with other atoms
in the cell, causing damage.
• An example of this would be
if a gamma ray passes through
a cell, the water molecules
near the DNA might be
ionized and the ions might
react with the DNA causing it
to break.
• Charged atoms in the living
organism could cause
different type of damage for
example cancer induction or
genetic mutation!
14
 Effective dose
• The effective dose of an examination is
calculated as weighted sum of the doses to
different body tissues.
• The weighting factor for each tissue depends on
its sensitivity
• The effective dose thus provides a single dose
estimate related to the total radiation risk no
matter how the radiation dose is distributed
around the body.
15
 The effective doses
Procedure typical CXR Approx. equivalent period
effective equivalents of background radiation
dose mSv
X ray examinations
Limbs and joints 0.01 0.5 1.5 days
chest(pa) 0.02 1 3 days
abdomen 1 50 6 months
Lumbar spine 1.3 65 7 months
CT head 2.3 115 1 year
Barium meal 3 150 16 months
CT chest 8 400 3.6 years
CT abdomen pelvis 10 500 4.5 years
Rradionuclide studies of 0.3 15 7 weeks
lung ventilation
lung perfusion 1 50 6 months
16
bone 6 300 2.7 years
 For personel!
It is necessary to be
protected from ionizing
radiation by time,
distances and different
protector sources !!!

17
• For a patient the protection lies in
the doctor's decision!
• The decision to expose patients
to radiation must be made with
risks in mind!
• So an examination should be
requested only where clinical
benefits far outweigh the risks of
radiation sensitivity, cancer
induction, and genetic mutation!

18
 The following physical phenomena are
the basis of modern imaging:
X ray examination

• X-rays are absorbed in tissue.

• X-rays, are based upon the fact that different tissues provide
different degrees of X-rays attenuation.
• The transmitted X-rays moving out of the patient, fall on the
fluorescent screen or film make a image of body structures.
19
Roentgenologic equipment

20
Magnetic Resonance Imaging
In a magnetic (MRI)
examination a patient on
the examination table is exposed to a
•strong
Magneticand very resonance
homogeneous
magnetic field. This static magnetic
imaging or tomography,
field changes the direction of all of the
a form
spinning hydrogen ofnuclei medical
in the body,
so imaging
that they arethat
alignedmeasures
parallel to the
direction of the field. Radio frequency
the response of the
radiation is then applied to tissues
atomic
where energynuclei
quanta areofabsorbed
bodyby
tissues
some of thetoprotons,
high-frequency
these become
excited as a result and while decaying
radio waves when placed
send quanta of emradiation to the
in a strong
environment. These magnetic
photons are
field, and
detectable and that
slice produces
images are
reconstructed from the resultant
images of the internal
interference pattern.
organs.
21
MRI equipment

22
 Ultrasound examination (USI)

• Ultrasound utilises high-frequency sound waves, which are reflected in

specific ways by different tissues, normal or pathological, in the body.
• The reflected sound (echo) is processed by a computer to produce a real
time image which is displayed on a screen instantly.

23
Ultrasound equipment

24
• Scintigraphy, a technique in
which a scintillation counter or Nuclear Medicine Imaging
similar detector is used with a
radioactive tracer to obtain an image
Isotope Imaging
of a bodily organ or a record of its
functioning.
• Radioactive isotopes concentrated in
certain tissues emit gamma radiation.
• An organ can be visualised by
measuring the emission of gamma
radiation from a radioisotope with
which a physiological or metabolic
agent is labelled.
• Such an agent (a
radiopharmaceutical), is introduced
into the body by intravenous
injection or oral ingestion.
• The imaging or measurement of a
patient is performed with a gamma
25
camera or a PET -camera.
Gamma camera

26
Infrared Imaging or Thermography

27
Infrared detector

28
 General schemes and terms
Source of radiation,
Object of examination
Register (registrant) of information
Source of radiation

Register of information
X-rays Object of examination Chest Detector
Gamma rays Head Film
Ultrasound GI Fluorescent
Radio waves Hand screen
Infra red rays Legs
….
29
 Two types of systems
differ in source of radiation:
the transmission • roentgenology
• computed tomography transmission
system - radiation
• ultrasound imaging
transmits through
the object

MRI
radiopharmaceuticals
• scintigraphy E
the emission m
• computed emission
system – radiation tomography i
emits from the s
• Positron emission tomography s
object (PET) i
o
n
30
Transmission system

31
 Transmission system images
Plain film image of chest with Computer transmission tomography
pneumonic infiltration. images of chest with pneumonic
infiltration.

32
Emission system

33
 Emission system images
Conventional liver AP and PA
radionuclide planar images Dynamic radionuclide images.
(scintigrams).

34
 Two types of images differ in way of
presentation

Panoramic imaging
imaging of whole body Tomographic imaging
part, also called full-size
imaging of slice of some
imaging because the
anatomy is shown in its body part
original size

35
 Plain film

3-dimensional object is projected into a 2-dimensional image

Shadows of different organs are summated on film
36
 Tomogram

In tomographic imaging radiation is directed ore emitted only

into or from one thin disc or slice of tissues.
In final image there is no summation of tissues densities.
37
 In transmission system
Plane film of abdomen Computed transmission
tomography image of abdomen

38
 In emission systems
Plane AP emission radionuclide Axial, sagittal and coronal emission
image of abdomen radionuclide tomograms

39
 Panoramic images
plain film in x-ray imaging

in radionuclide imaging
Two dimensional
REPRESENTATION
it needs Anterior-posterior
(map or multiple (AP) ore posterior-
shadowgraph) of anterior (PA)
three dimensional views - Lateral (from the
object (whole projection: side)
body part: chest, Oblique (diagonally)
abdomen, hand,
head…)

40
Plain film of the head in direct and lateral
views

posterior anterior lateral

41
Plain film of the chest in direct and lateral
views

posterior-anterior lateral
42
Radionuclide imaging of the abdomen
in direct and lateral views

posterior anterior lateral

43
Tomography – imaging of slice of some body part

44
 Tomogram orientation

• Coronal – parallel with

the plane of front
• Transverse or axial –
perpendicular to the
main axis of the body
• Sagittal – parallel with
the main axis of the
body

45
 Tomographic methods

MRI CAT PET USI

46
 Analogue techniques
• With these techniques, the final X
ray image is created directly on a
detector medium, i.e., without any
complicating intermediate steps.
• The medium may be a radiographic
film or a fluorescent screen.
• The film and the screen are both
analogue detectors of X-rays,
which means that their response
to a steady and continuous
increase in radiation dose, is also
steady and continuous, as opposed
to stepwise.
• The radiographic film responds
with blackening, the fluorescent
screen by emitting visible light.
Digital techniques
• Digital image is composed of a
digital matrix, i.e., rows and
columns of numbers.
• The numbers may represent echo
strength in an ultrasound image, X
ray attenuation in a CT image,
tissue magnetism in an MR image
or light intensity from a fluorescent
screen in digital X-ray imaging.
• To visualise the image, the digital
matrix is transformed into a matrix
of visible picture elements, pixels,
where each pixel is given a shade
of grey according to the
corresponding number in the
digital matrix.
47
Analogue Digital

48
 Analogue techniques Digital techniques

• Analogue • Computed
radiography tomography
• Analogue • Ultrasonography
Fluoroscopy • Magnetic
• Analogue resonance imaging
Traditional • Digital radiography
Tomography • Isotope imaging

49
 Resolution
• A measure of the ability of an imaging system to
separate the images of closely adjacent objects.
• It is also the smallest area identified as a
separate unit.
• Spatial resolution may have to be represented
as points or distance between sample points.

50
Spatial resolution

51
 Contrast resolution or contrast of image

• Smallest difference in color intensity which can

be detected on image

52
 Do you remember what do these terms mean?

• Radiology • Projection
• X-rays, CAT, USI, MRI, Nuclear • Tomography
Medicine, Thermography, • Coronal
• Ionizing and non ionizing • Axial
radiation • Sagittal
• Transmission and emission • Analogue
systems
• Digital
• Planar and tomographic
images • Spatial and contrast
resolution

53
54
A diagnostic image is composed of differences in contrast
between tissues which result from differences in radiation
interaction in the tissues

55
• The thickness of the
tissue affects the
attenuation of the x-rays.

56
• The tissue type
affects the the
attenuation of the x-
ray

57
 5
The five densities can be
5 4 3
differentiated on film
2

1. Metal
2. Bone
3. Soft tissue
(water)
4. Fat
5. Gas
4 1

58
 Radiographs are summation shadows created by
differences in contrast between tissues. Tissue thickness
and tissue composition affect the attenuation and
therefore, the shade(s) of gray in the final shadow image.

59
 Two projections are necessary!
Fracture of the distal end of the radius (Colle's fractures).
lateral view –the angulation in a
AP view shortening or compression
dorsal direction
the distal end of the radius
v = volarly, d = dorsally

60
 Two projections (views)

• PA • Lateral 61
 Depending on information detector, and
the way of watching (real time ore frozen)
• Conventional • Digital
radiography radiography
Electron
Film detector, PC
screen

Electron
Fluorescent
detector, PC
screen,
screen,
dynamic
dynamic
images in real
images in real
time
time
• Fluoroscopy • Digital
fluoroscopy
62
 Fluoroscopy - view in real time
X-ray tube Fluorescent screen Positive view on
screen

63
 Fluoroscopy used in diagnose different motor
disorders of GI organs

Oesophagus movement during oesophagoscopy

at patient with achalasia 64
 FLUOROGRAPHY
- photography in which the
image is formed by
fluorescence.
- widely used in
prophylactic
examinations,
- used to prevent disease
such as tuberculosis and
lung cancer.

65
 Positive

Inversion
opposite or contrary in position, direction, order, or effect

Negative 66
67
 ROENTGENOGRAPHY
Plain film roentgenogram - negative view to fluoroscopy
screen view

Screen positive Film - negative

68
 Special terms used on x-ray reports
(we usually describe a negative film that is why)
• Radiopaque (light or white).
Synonym: High density.

• Radiolucent (dark or black).

Synonym: Low density.

• Water density (middle

density)

PA view of normal chest 69

Remember in film:
Black = air-filled
White = bone, calcium,
fluid, pus, blood, collapse
Gray = soft tissues and
solid organs

70
 How to Approach Reading any
Image
• Identify the patient
• When was the image taken
• Are these the proper images:
– Correct type of study
– Correct / complete views
– Correct limb
– Contrast
• The five densities
• Are the images technically adequate
• Why did you order the image
• What did you expect to see
• Do you see it
• Now start over fresh
POSITIONING FOR XRAYS
• For the FRONTAL plane, we
refer to the direction that
the XRay beam goes through
the patient. Thus a
POSTERIOR-ANTERIOR (PA)
chest is done with the XRays
entering the patient's back
(posterior) and passing
through to the front
(anterior) where they strike
the detector (film or charged
plate).

72
The frontal chest film

•View the film as

Aortic knob though the patient is
Ascending facing you with his
aorta
Descending left on your right
aorta

LA
• If the film is
RA unmarked,
RV remember your
LV
anatomy (heart and
aortic arch are left
of midline)
A lateral chest XRay
• Here the XRays strike
the patient's right side,
pass through her, and
strike the detector at
her left.
• The 'skirt' she is wearing
is made of lead to
protect her ovaries from
the radiation.

74
 Typically left chest is placed against
Normal lateral film detector to minimize cardiac
magnification

T
DA

LA

RV
LV
 Thoracic Imaging Strategies
• Approach to image interpretation
• What is the expected normal and variant
anatomy?
»Is something absent?
»Is there some additional structure present?
• Look at the bones and soft tissues
• Look at the heart and mediastinum
• Look at the lungs and pleura
• Look at the airways
• Look at the diaphragms and upper abdomen
Look at the bones …
Examine scapulae, humeri,
1 shoulder joints, clavicles, ribs
2 and spine for symmetry
3
4
5
Identify the 1st rib by its
6
anterior junction with the
7 manubrium then count down
8 the posterior ribs
9

10
The location of an abnormal
11 shadow can be described by
its proximity to a particular rib
12 or interspace
 Healing fracture

Note the multiple right and left sided rib fractures.

 Survey, look carefully and thoroughly at the
soft tissues


•Breast tissues (if applicable)

•Skin
•Supraclavicular areas
•Axillae
•Subcutaneous fat
•Muscles Which film is that of a woman?
What happened
to this patient?
Notice the asymmetry of the
left breast shadow relative
to the right and the surgical
clips in the left axilla

Diagnosis: Left
breast cancer
treated with
lumpectomy and
axillary node
dissection
 Look at the diaphragm and upper abdomen

~ ½ interspace
R

L
R

The diaphragm is a The plane of the right

musculotendinous sheet The left and right diaphragmatic dome is usually
separating the thoracic and hemidiaphragms are about half an interspace higher
abdominal cavities usually well seen on PA than the left
and lateral films
 Left phrenic nerve paralysis

The left hemidiaphragm is elevated and demonstrates paradoxical motion with

inspiration consistent with paralysis of the phrenic nerve.
Look at the mediastinum…
• look at right paratracheal stripe and hilar contours to evaluate for lymphadenopathy
• look at paraspinal lines, anterior clear space, and the spine to evaluate for a mediastinal
mass

A P
Look at the heart …
The plain film diagnosis of heart disease is limited to determining:

Cardiac enlargement

Pulmonary vascular abnormalities

Congestive failure

The width of the adult heart should be < half

NORMAL
the greatest thoracic diameter, measured
from inside the rib cage at its widest point
near the level of the
 Mitral valve
replacement from
rheumatic heart
disease
• a complication of a
streptococcal infection
resulting in mitral valve
dysfunction over time
•Treated with valve
replacement

Mitral valve replacement LA enlargement secondary

to long-standing MV
stenosis and regurgitation
The frontal film
• Pleura not normally
visible

Pulmonary artery
• Blood-filled pulmonary
vessels cast soft gray
shadow and typically
taper out to periphery,
while bronchi and
bronchioles are air filled
and do not cast a shadow
on the image
 The frontal film

Trachea

•bronchi and bronchioles

are air filled and do not
cast a shadow on the
L main image
R main bronchus
bronchus

Gastric air bubble

Airways bronchogram with contrast
in airways

THESE ARE NOT DONE ANY MORE

88
AIRWAYS CT CORONAL RECONSTRUCTION
which replaces contrast bronchography

89
 Pneumothorax
Tension
pneumothorax: the
left lung has
collapsed completely

Take note of the

resultant low X-ray
attenuation (black)
where the airways have
collapsed

The non-aerated lung

is significantly
diminished in size
Pneumothorax – where the air Air is seen in the pleural
space. Notice the air in the
goes depends on positioning… costophrenic sulcus when the
patient is supine for CT.
 Centrilobular emphysema

Hyperinflated lungs, paucity of upper lung vessels, crowding of lower

vasculature, and flattened diaphragms are seen in emphysema
Status post pneumonectomy with shift of
heart/mediastinum to the left

Clips at
bronchial
stump
Air may be present in
The stomach bubble
the stomach and can
be seen on PA and
lateral chest films

Air, being less dense

than fluid, will rise and
can be seen in the
fundus of the stomach
on plain film provided
the patient is upright
In the lateral chest film,
the presence of the air
bubble close under one R
diaphragmatic shadow L

determines which is the

left hemidiaphragm
Misplacedair on
plain film
Peritoneal air trapped
under the right
hemidiaphragm (not to
be confused with the
stomach bubble which
would appear on the left)
Can you determine the cause
for the free air ?

Dialysis catheter
responsible for air
into the peritoneal
space
How an upright posteroanterior chest
X-ray is taken •Images are usually is taken on
inspiration, with the patient standing
in front of film cassette (1)
chest and X-ray tube (2) about six
feet behind him.
•The PA position places the heart and
upper mediastinum closer to the film
with greater distance to the exposing
Xray tube (generally 72 inches)
1 2 making the Xrays more parallel as
L they enter the body and avoiding
R A disproportional enlargement of
A
anterior vs. posterior structures.
R
V L •The upper lung arterial vessels in
V
upright posture, being well above
cardiac chamber level, are usually
much less prominent than the lower
lobe vessels which are at or below
cardiac chamber level. 96
How supine AP chest X-ray is taken •With film cassette (1) in table
behind the patient's chest and X-
ray tube about six feet above him
•That way images are taken in
emergency.
•On a supine frontal Xray of the
chest there are significant
2 differences in the appearance of
normal pulmonary vasculature
and mediastinum.
• The closer distance of the
exposing Xray tube (often only 40
inches from the film cassette)
makes the Xrays more diverging
and disproportionally enlarges
the appearance of structures
that are farther from the film
1 (the anterior body structures
such as the ascending aorta).

97
 Normal pa and ap film

On a supine frontal Xray of the chest there are significant differences in

the appearance of normal pulmonary vasculature and mediastinum.
The closer distance of the exposing Xray tube (often only 40 inches from
the film cassette) makes the Xrays more diverging and disproportionally
enlarges the appearance of structures that are farther from the film (the
anterior body structures such as the ascending aorta). 98
Two films at right angles to one another are neededMajor
to fissure
determine the true location of any foreign body or
mass within the thorax

The nodule is in
the RML and
calcified

RML

Granuloma within the RML

 Natural roentgen contrast of the abdomen
organs is bad

The pathological tissue which

has almost the same density as
the adjacent structures cannot
be seen on plain film. 2 2
You can see:
1.Gas in rectum/sigmoid
2.Gas in ascending and
descending colon
3.Bones 3 1
Artificial contrast is needed to
3
create density difference.

100
 Please write down in
your paper the name of
structures in picture
with letters

Now correct yourself

X ray Imaging without contrast media is suitable
for the examination of bones and organs
containing gas (like the lungs), but soft tissues
cannot be separated from one another.
Liver and kidney for instance, as well as brain and
cerebrospinal fluid are equally grey in a
radiograph.
For the visualization of soft tissues contrast media
and/or digital methods with a computer must be
used.

102
X ray Imaging without contrast media
PNEUMOPERITONEUM

Upright –
Nondependent point
X ray Imaging without contrast media
PNEUMOPERITONEUM

Supine – Double Bowel Wall Sign Outlining of liver/GB

tion

• Calcified structures (‘WHITE BITS’)

• Calcification can be broadly divided into 3 types:
– (1) Calcium that is an abnormal structure - eg. gallstones
and renal calculi
– (2) Calcium that is within a normal structure, but represents
pathology - eg. nephrocalcinosis,
– (3) Calcium that is within a normal structure, but is harmless
- eg. lymph node calcification.
– Bones are normal ‘white’ structures. On the AXR they comprise
mainly those of the thoraco-lumbar spine and pelvis. Findings are
largely incidental as direct bone pathology would be investigated
with specific views.
Gallstones
X ray Imaging without contrast media
35 year old with recurrent abdominal
pain:
Extensive pancreatic
calcification = recurrent
pancreatitis
 X ray Imaging without contrast media
This patient was admitted with poor renal
function.
• Nephrocalcinosis
• Causes of
Nephrocalcinosis include:
– •Hyperparathyroidism
– •Medullary sponge
kidney
X ray Imaging without contrast media

35 year old with bloody

diarrhea
Thumb-printing transverse
colon = Colitis
X ray Imaging without contrast media
Bowel obstruction

110
 X ray Imaging without contrast media

• Intra-luminal Gas:
• Low Small Bowel
Obstruction
 SBO
• Plain abdominal radiograph.
• Multiple dilated loops of small bowel within
the central abdomen. Gas is not seen in the
large bowel. No evidence of hernia or
gallstone to suggest potential cause of the
dilated loops.
• These findings are in keep with a low small
bowel obstruction.
• I would like to know if the patient has a
history of abdominal surgery as the
commonest cause is surgical adhesions.
 Large bowel obstruction
• Haustra visible – do not
cross lumen
• Localised around outside of
film
• Small bowel may also be
dilated depending on
competence of ileocaecal
valve
 Contrast agents
Administered material used to see structures or
pathologic processes that would not be seen
otherwise.

• Positive contrast media - attenuate X-rays greater

than the soft tissues of the body:
– Barium sulfate into the GI tract;
– Iodine compounds into the vessel.
• Negative contrast media - attenuate X-rays less than
the soft tissues of the body:
– Air,
– Carbon dioxide and other gases.

114
 Contrast agents
Positive contrast media - attenuate Negative contrast media - attenuate
X-rays greater than the soft tissues X-rays less than the soft tissues of
of the body: Barium sulfate into the the body: Air, Carbon dioxide and
GI tract; Iodine compounds into other gases.
the vessel.

115
 Upper gastrointestinal tract study,
GI examination, upper GI series
Uses in following clinical
problems:
Normal AP supine view of the abdomen
following the oral administration of barium
• Diseases and injuries of
esophagus, dysphagia.
• Stomach and duodenum in
complex with Endoscopy
examination.

116
 Barium enema
Uses in following clinical
AP view of abdomen with barium
problems: instilled retrograde into the colon
under fluoroscopic control.
• Diseases and injuries of
colon in complex with
Endoscopy examination

117
 Intravenous pyelography
(intravenous urography – IVP)
• Iodine compound (contrast) Normal IVP
is injected intravenously and
filtered and excreted by the
kidneys.
• Contrast medium in bilateral
renal collecting system with
increased density.
• Contrast agent may be
instilled intravenously ore
into urethra, so called
retrograde cysto- or
urography

118
 Intravenous pyelography
• This method show an
Right sided hydronephrosis on PA
anatomy and physiology of abdomen film
urinary system by time of
filtration and excretion of
contrast media, and
visualization of all structures
of system.

Uses in complex with CAT and

nuclear medicine for evaluate
urethral calculus, hematuria,
infections, renal trauma,
hydronephrosis, renal tumor
119
Angiography Angiography uses to evaluate
different vessels anomalies,
diseases and injuries.

• Water soluble iodine contrast

agents ( Ultravist, Omnipak,
Urographin) used to fill
vessels, to make angiogram
• Contrast is injected into an
artery, vein, or lymph vessels.

120
 Angiography
Normal angiographic image of Normal angiographic image of
coronal vessels abdominal vessels

121
 Endoscopic retrograde
cholangiopancreatography (ERCP)
ERCP is used primarily to
diagnose and treat conditions
of the bile ducts, including
gallstones, inflammatory
strictures (scars), leaks (from
trauma and surgery), and
cancer.

Through the endoscope, the

physician can see the inside of
the stomach and duodenum,
and inject dyes into the ducts
in the biliary tree and pancreas.

122
 Endoscopic retrograde
cholangiopancreatography (ERCP)
ERCP, CBD multiple Stones
ERCP, CBD Stones

123
 Radiography (roentgenology) (X-rays)
Radiographic studies include all procedures
using X-rays

–plain film X-rays,

–fluoroscopy,
–photofluorography,
– angiography, urography
– conventional tomography

124
 Advantages Disadvantages
☺Cheap ☹ Ionizing radiation
☺Rapid ☹ Superimposition-
☺Panoramic view summation of
☺Good spatial shadows
resolution ☹ Bad contrast
resolution

125
General suggested readings
• Essentials of radiology by Fred A.
Mettler Jr.
Publisher: Saunders. 2004.
• Radiology by Amit Mehta, Douglas P.
Beall,
Publisher: Humana Press. 2007.
• Clinical Radiology Made Ridiculously
Simple (Paperback) by Hugue
Ouellette, Patrice Tetreault, 1999.
• Learning Radiology: Recognizing the
Basics: On Timeby William Herring
Textbook.
Publisher: Elsevier Science. 2007. 126