Sianny Suryawati, dr., Sp.

Rad

IMAGING
MODALITIES IN
RADIOLOGY
 Radiology represents a branch of medicine that deals with
radiant energy in the diagnosis and treatment of
diseases.
This field can be divided into two broad areas
diagnostic radiology and interventional radiology.
A physician who specializes in radiology is called
radiologist.
The outcome of an imaging study does not rely merely on
the indication or the quality of its technical execution.
Diagnostic radiology specialist represents the last link in
the diagnostic chain, as they search for relevant image
information to evaluate and finally support a sound
diagnosis.
DIAGNOSTIC
RADIOLOGY
Radiology techniques
Conventional Radiography
Mammography
Computed tomography (CT)
Ultrasonography
Magnetic Resonance Imaging (MRI)
Fluoroscopy
Nuclear Medicine
PET/CT & PET/MRI
Conventional
Radiography
Produced by a combination of ionizing
radiation (without added contrast
materials such as barium or iodine) and
light striking a photosensitive surface,
Produces a latent image that is
subsequently processed.
Common clinical applications
Chest: to assess lung pathology
Skeletal: to examine bone structure and
diagnose fractures, dislocation or other
bone pathology
Abdomen: can assess abdominal
obstruction, free air or free fluid within the
abdominal cavity
Dental: to assess common dental
pathologies such as cavities or abscesses
Mammography
Low energy x-rays specifically for
imaging of breast tissue.
Standardized views of the breasts to for
the assessment of breast lesions.
Each breast is examined separately and
compressed against the film to obtain
maximum visualization of masses or
calcifications.
Common clinical
applications
Screening mammography: To detect early cancer
in asymptomatic women.
Diagnostic mammography: To image the breast for
diagnosis of a previously-identified suspicious
breast lesion.
Surveillance mammography: To assess recurrence
of malignancy in women with known breast cancer.
Needle localization and tumour marking: To obtain
tissue samples from breast masses that appears
suspicious on screening or diagnostic
mammography and tumour marking for surgery.
Computed tomography
(CT)
Currently represents the workhorse of
radiology.
Recent developments permit extremely fast
volume scans that can generate two-
dimensional slices in all possible
orientations, as well as sophisticated three-
dimensional reconstructions.
Nevertheless, the radiation dose remains
high, thus a very strict indication for every
intended CT is needed.
Common clinical
applications
Brain (with or without contrast and perfusion
study)/Cranial/Head/Neck CT
CT myelography
Chest/mediastinum/high resolution CT
Abdominal CT
Pelvic CT
CT urography
CT Colonography
Cardiac CT
CT angiography
Extremities
Ultrasonography
The cheapest and most harmless
technology in radiology
Ultrasound probes utilize acoustic
energy above the audible frequency of
humans in order to produce images.
No ionizing radiation with this modality
Particularly useful in imaging of children
and pregnant women.
Common clinical
applications
Abdominal ultrasound: To visualize the anatomy and pathology of the
liver and gallbladder, spleen, kidneys, retroperitonium, abdominal
vascular structures, lymph nodes.
Pelvic ultrasound: To assess the prostate, urinary bladder, reproductive
organs, adnexial masses, vascular structures, lymph nodes.
Cardiovascular ultrasound including echocardiography: To assess the
heart and peripheral vascular structures.
Intraluminal Ultrasound: To assess gastrointestinal tract and the blood
vessels.
Obstetric ultrasound: To assess the fetus and related structures in
pregnant women.
Small parts ultrasound: Thyroid, scrotum, breast ultrasound
Transfontanelle ultrasound: To visualize the intracranial structures
before the closure of the fontanelles in paediatric patients or through
boreholes.
Magnetic resonance imaging
(MRI)
Makes use of the potential energy stored in
the bodys hydrogen atoms.
Those atoms are manipulated by very
strong magnetic fields and radiofrequency
pulses to produce adequate amount of
localizing and tissue-specific energy that will
be used by highly sophisticated computer
programs in order to generate two-
dimensional and three-dimensional images.
No ionizing radiation.
Common clinical
applications
Brain MRI with diffusion/perfusion studies
Spinal MRI
Abdominal MRI to assess liver, spleen,
kidneys, MR cholangiography, etc
Neck MRI
Magnetic resonance angiography
Cardiac MRI
Extremities for joints, muscles, bone disorders
Fluoroscopy
X-rays are used in performing real-time
visualization of the body
Allowing for evaluation of body parts,
administered contrast flow and positioning
changes of bones and joints.
Radiation doses in fluoroscopy are
substantially higher when compared to
conventional radiography, as many images
are acquired for every minute of the
procedure
Common clinical applications
Barium studies: Barium swallow, barium meal
and follow-through, barium enema for
evaluation of the gastro-intestinal tract.
Hysterosalphingography (HSG): for evaluation
of the uterine cavity and the fallopian tubes.
Retrograde urethrogram, micturating cysto-
urethrogram: for the evaluation of the
abnormalities of the urinary system.
Fistulography: for the evaluation of fistulae.
Reduction of fractures under image guidance
Nuclear medicine
Images are made by giving the patient a
short-lived radioactive material
Using gamma camera or positron
emission scanner that records radiation
emanating from the patient.
Most common nuclear medicine modalities
used in clinical practice are single-photon
emission computed tomography (SPECT)
and positron emission tomography (PET).
Common clinical
applications
Bone scan; to assess metabolic activity of the bones.
Commonly used for oncology staging, arthritis, fractures.
Myocardial Perfusion scan; to compare the blood flow to
the myocardium at exercise and rest allowing for
differentiation of ischaemia and infarction.
Renal scan; to determine the perfusion and drainage of
the kidneys and allow for calculation of differential
function.
Lung scan (VQ); to allow for comparison of ventilation
and perfusion of the lungs to diagnose pulmonary
embolism.
Thyroid scan; to assess the appearance and function of
the thyroid gland.
PET/CT and PET/MRI
Finally, advances in equipment and
increases in computer power have
allowed combining data imaging sets
from various modalities in radiology.
The most popular use of this has been
integration of PET functional nuclear
medicine data with CT anatomic data
(PET/CT), which currently has
widespread use in the imaging of cancer.
INTERVENTIONAL
RADIOLOGY
Interventional Radiology
Subspecialty of radiology in which minimally invasive
procedures are performed using image guidance.
Some of these procedures are done for purely
diagnostic purposes (e.g., angiogram), while others
are done for treatment purposes (e.g., angioplasty).
These procedures are often performed with the
patient fully awake, with little or no sedation required.
Images are used for guidance, and the primary
instruments used during the procedure are needles
and catheters.]
Common clinical
applications
Diagnosis of obstructive vascular diseases
Diagnosis of aneurisms particularly
intracranial aneurism
Diagnosis of arterio-venous malformations
Diagnosis of bleeding vessels
Assessment of the vascularity of malignant
tumours
Image guided interventional procedures