Introduction to Medical

Imaging

Jeff Benseler, D.O.

 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?
 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
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
Questions about medical imaging
 Please feel free to contact me with questions
 My preferred contact method is email
 benseler@ohio.edu
Objective 2

What are x-rays?

 No mass
 No charge
 Energy

X-rays are a type

of electromagnetic
energy
 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)
 5 Basic Radiographic Densities
1.

 Air
 Fat 4.
 Soft tissue/fluid
 Mineral
 Metal 2. 5.

3.

Name these radiographic densities.

 Optimal environment for visual
perception

 Dedicated source of light (5 to 9 mega pixel

monitors)

 Darkened environment (like a movie theater)

 Limit distraction
X-ray viewing station
Can you recognize
shapes and density?
Find the pathology
What clues do you have?
 Medical Imaging Interpretation
3 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 don’t belong

and for body structures that are abnormal in
size, shape, position and/or density
History: 11 year old twisting
injury of the foot
 Naming the parts of a long bone

Distal

3.

2.

1.

Proximal

Word bank: epiphysis, metaphysis, diaphysis, cortex, medullary cavity

 Review: What are the 5 basic
radiographic densities from black to
bright white?
 Air
 Fat
 Soft tissue/fluid
 Bone/mineral
 Metal
 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
 Objective 3
Advantages 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
 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
 air

CT scan of the abdomen

X-rays used skin
What density is this?
 MRI
 Advantages  Disadvantages
 No overlapping artifact  Very expensive
 Excellent resolution  Patients cannot have a
 Very good at detecting pacemaker or
fluid ferromagnetic material
 Excellent for imaging the  Slower to acquire images
brain, spine and joints (approximately 45 minutes)
 No radiation
 Multiple imaging tests
within the same study
(T1, T2, IR, GE)
 Ultrasound
 Advantages  Disadvantages
 No radiation  Does not work well in large
 Portable or obese patients
 Instantaneous (real time)  Resolution less than CT and
 Excellent for cysts and fluid MRI
 Doppler ultrasound is
 Air or bowel gas prevents
excellent to assess blood flow visualization of structures
 Excellent for newborn brain,
thyroid, gall bladder, female
pelvis, scrotum, pregnancy
Ultrasound of the
gall bladder showing
a gall stone
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.
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
 List of Potentially Helpful
Radiology 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
 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).
 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/Teaching
File.html
 Collection of interesting cases
 Websites continued
 http://headneckbrainspine.com/
 Neuroradiology anatomy and cases.

 https://3s.acr.org/CIP/Default.aspx
 Case in point. American College of
Radiology’s case of the day.