General Radiology

Digital Radiology (DR)

Digital Substraction Angiography (DSA)
 Section 1

Conventional Radiology
X-ray
1. Production and properties of X-ray
 Free electrons ： produced with cathode
tungsten filament by low-voltage
 high-voltage transformer ： make the
acceleration of electrons
 tungsten target ： hold up the running
electrons
(1). Production of X-ray
 Free electrons ： produced with cathode
tungsten filament by low-voltage
 high-voltage transformer ： make the
acceleration of electrons
 tungsten target ： hold up the running
electrons
 Structure
 X-ray tube
 Transformer ： low-voltage (6-12V ） ,
high-voltage （ 40-
150KV ）
 Controller ： voltage （ KV ） and
electricity （ mA ） regulation, screen, and
so on
 Rotating anode
X-ray tube
 Characteristic of X-ray(1)
Electromagnetic (EM) Spectrum
wave length within 0.08 to 0.31Å (40-150KV)
will be useful to the study of human
body tissues.
What EM radiation is and how it is produced
•X-rays belong to a group of radiations called electromagnetic radiations
(or EM waves).

•EM radiation is
• a combination of electric and magnetic fields
• a transport of energy through space.

•EM radiation is produced by a charge particle being accelerated.

•Electron Energy Consume 99.8 ％ heat energy and 0.2 ％ X-ray

EM Family
 Characteristic of X-ray (2)
 Penetration is related to wave-length, density
and thickness of object
 Fluorescent effect it can cause fluorescence
with barium platinocyanide , zine sulfide, and
calcium tungstate
 Photographic effect ： AgBr→Ag+↓
 Ionization effect ＆ biological effect
Argentum bromine
2.The Principles of Radiology
The properties of X-rays
 Penetration
 Fluorescent effect
 Photographic (sensitization) effect
The differences in density and thickness
between human tissues
 第一篇 总论 第一章 X 线成像 第一节 普通 X 线成像

Screen
Film

Relation between different thickness (same density) and X-ray imaging

 第一篇 总论 第一章 X 线成像 第一节 普通 X 线成像

Density of High density Moderate Low density

body tissue density
(bone) (lung)
(liver)
Attenuation
after less Middle more
absorbtion
Film White Gray Black

Screen Black Gray White

Relation between different (tissue) density and X-ray imaging

Imaging presentation of different organs
Density Org ans Presentati
on
High density Bone
Isodensity Liver, pancreas,
kidney, brain
Low density Lipid 、 gas
X 线图像 的特点
grayscale
X-rays Examination Techniques
1. Normal X-ray Examination
 Fluoroscopy ： to exam the functional
disease of organs, easy use and cheap
 Radiography ： with low X-ray dose and
images can be kept permanently
 Special X-ray Examination
 Tomography the X-ray tube and the film or the
patient move simultaneously in opposite
directions during the exposure
 Mammography used in the examination of
breast
 else ： kymography 、 fluorography ,etc.
tomography
Mammography
Molybdenum target radiography
 3. Contrast Examination
 Direct introduction ： dispensing directly
 Puncture introduction : introduction of a catheter
into the blood vessels by puncturing the skin
followed by advanced to the desired organ
 Physiological excretion
 Contrast Examination-
direct introduction

 Gastrointestinal tract ： barium meal, barium

enema
 Air way ： bronchography
 Genitourinary tract : retrograde pyelography,
cystography and hysterosalpingography
 Fistulography, T-tube cholangiography
Barium meal, direct introduction
Bronchography, direct introduction
molybdenum target
radiography,

direct introduction
Cystography, direct introduction
Hysterosalpingography, direct introduction
 Contrast Examination-
puncture introduction(1)
 Circulation system ：
cardiovascular 、 angiography
 bile duct and portal vein system:
PTC 、 PTP 、 ERCP
PTC Percutaneous transhepatic cholangiography
PTP Percutaneous transhepatic portography
ERCP Endoscopic retrograde cholangiopancreatography
 Contrast examination-
puncture introduction(2)
 Central neural system: cisternography,
cisternography with gas, cerebral
angiography.
 Urinary and reproductive system:
retroperitoneal gas filling
Thoracic aorta angiography ： puncture introduction
Abdominal aorta angiography ： puncture introduction
PTP ： puncture introduction
ERCP ： puncture introduction
 Contrast Examination-
physiological excretion
 Injection
 oral
e.g.intravenous urography (IVU),
intravenous cholangiography,
oral cholecystography
IVU
oral cholecystography
 
Me asures b efo re c ontrast e xamination
 Hypersusceptibility test will be consided.
 Strickly controlling the contraindication of contrast media.
In cases of the patients with hypersusceptibility histroy,
hyperthyroidism, cardiac insufficiency and anuria, contrast
media is prohibited.
 The preparation of all kinds of emergency medicines
necessary for dealing with by-production reaction and
complications.
 Diagnosis Steps
 Technical conditions ： cast position, contrast
and resolution
 Observation: be integral and systemic
 Analysis ： including location,distribution, size,
shape, border, density and changes nearby
 Reference with clinical history, lab findings and
other examinations
Radiation Protection
 Time protection
 Distance protection
 Shield protection
E.G. Eyes, Thyroid glands, scrotum, etc.
 Section 2
New advances in diagnostic radiology
 Computed Radiography (CR)
 Digital Radiography (DR)
 Picture Archieve Communicating System (PACS)
 Information Radiology (infoRAD)
I. Computed Radiography (CR)
 1. Basic structures and principles of CR
Controlling computer

Imaging recorder
Detector X-ray digital
Digital signal
Phosphor

Images
X-ray tube

Object

screen film Laser camera

storaging
devices

Diagram of CR
 2. Images characteristics of CR

 High sensitiveity
 High resolution
 High linearity
 Digitalized export and storage
 Powerful post-processing function in CR system
 3. Clinical application of CR

 Head and osteoarticular system

 The application of CR system in thoracic
plate films
 Gastrointestinal system and urinary
system
II. Digital Radiology (DR)
 The Advantages of DR
1. DR permits very broad exposure latitude and
has wide dynamic range,allows technical error
happened in the process of taking a film.It can also
get a very good image in some position where the
exposing parameters is difficult to control.
2. DR can also perform all kinds of images
postprocessing as CR.
3. Compared with traditional X-rays films,
DR can reduce exposing time and the film
number, thereby reduce the exposing dose
greatly.
4. DR can reduce film deposing, retaking,
developing and fixation, thereby improve
working efficiency.
 Digital Radiography （ DR ）
 CT 、 DSA 、 MRI images: digital
 Conventional X-ray images: analog
1. conservation and lending inconvenient
2. postprocess unavailable
3. comparison and analysis with other techniques
discommodius
 Digital X-ray Imaging （ DR)
 Conventional X-ray images digital images

(DR ）

 DR : benefit for the development of the

teleradiology and informatics in radiology

(infoRAD ） .
 Theory and sets
 CR: recording X-ray image information on
Image plate (IP ）
 course: loading, processing and display
 Digital X-ray imaging (DR)

 age 80 : named computed radiography

(CR ）
 age 90 : named direct radiography or direct
digital radiography (DDR ）
 Theory and Sets
 Image information recording
 Loading of image information
 Processing of image information
 Display and save of image information
 Processing
 Gray scale
 Window level
 Digital substruction
 X-ray absorption rate
Clinical Use of DR
 High quality images
 Easy analysis and study
 Well display for bone and soft tissues
 Advancing technology
Digital Subtraction Angiography
(DSA)
I. The main components of DSA

 X-rays generator and tube

 Image intensifier
 TV fluoroscopy
 High video camera
 A/D conversion
 Computer and image storage
DSA
DSA
II. The basic principles of DSA

 Obtaining Video Image

 Logarithmic amplitude
 Analog/Digital conversion
 Theory
Step 1: changing image data into digital signals
before the injection of contrast media
Step 2: changing image data into digital signals after
the injection of contrast media
Step 3: image display is produced by computer
postprocess
 Primary x-ray image

Divided into pixels

(Pixalization)

Pixels into digital

(digitalization)

Pixalization and digitalization

X-ray angiography printer

A/D converter
 Contrast image

Mask image

Subtract image
Abdominal
aorta
angiography
Technology:selective angiography

Filling the target vessels with contrast media and

getting the exact images of target vessels by
percutaneous angiography. Lesions can be found
by the shape, density and location of its filling
vessels and treatment can be done.
 Advantages
 Little pain and easy handle
 Low invasive
 Little dose of contrast media (decrease about
40-60% in dose)
 Course recording and postprocess functions
Main stem stenosis with associated calcification
Left coronary with steep left anterior oblique and cranial tilt.
Fibular arteriography
Left coronary artery
angiography
right coronary artery
angiography
 Interventional Radiology
Techniques to get the biochemical, biological,
pathological, bacteriological data of tissues and to
produce direct treatment under the guide of medical
imaging. Including catheter embolization,
percutaneous aspiration and biopsy, percutaneous
angiography, percutaneous cannula drainage and
infusion therapy,etc.
DSA
 Technique
 Vascular Intervention

Intra-arterial DSA ， IADSA

Intravenous DSA ， IVDSA

 nonvascular Intervention
nonvascular ： ERCP
Pulmonary lesion biopsy
nonvascular ： CT guided needle biopsy
Sven-Ivar Seldinger
Seldinger Technique
Pulmonary carcinoma: bronchial arteriography
embolisation
embolisation
Interventional radiology
 PACS
(picture archiving and communicating system)
 影 像 管 理 中 心 临 床 科 室 工 作 站

激 光 打 印 机 HP刻 录 机 1000G 磁 盘 阵 列
H IS 交 换 机
PACS 交 换 机

M odem
远 程 会 诊 PACS专 用 服 务 器 H IS 服 务 器

CR采 集 计 算 机 DSA采 集 计 算 机

DSA报 告 浏 览 计 算 机
CR报 告 浏 览 计 算 机

DSA登 记 计 算 机
CR登 记 计 算 机

M R采 集 计 算 机 超 声 采 集 计 算 机

M R报 告 浏 览 计 算 机 超 声 报 告 浏 览 计 算 机

M R登 记 计 算 机 超 声 登 记 计 算 机

视 频 接 口

ECT采 集 计 算 机 CT采 集 计 算 机

ECT报 告 浏 览 计 算 机 CT报 告 浏 览 计 算 机

ECT登 记 计 算 机
影 像 各 科 室 CT登 记 计 算 机
PACS and the digital imaging
PACS
 PACS
 PACS: system of image archiving and
communicating
 Safe deposit and high efficiency
 Theory
 Image loading

 Image transmission

 Image deposit and compression

 Image process
 Clinical Use
 Mini PACS ： department

 Minor PACS ： hospital

 Middle PACS ： among

hospitals

 Major PACS ： more widely

 Clinical Use
 Teleradiology
 Avoiding missing and confusion of image films
 Easy management
 economy
 Easy analysis among different parts in all times
 Easy for postprocessing
 Info-Radiology
Quality control (QC), quality assurance (QA), PACS
and teleradiology
Based on radiology information system (RIS), PACS
and internet
Transmission with digital imaging and
communication in medicine (DICOM ） 3.0
Thanks
 vacuum tube
filament tungsten target

electron beam

X-ray
cathode anode
X-ray imaging X-ray introduce
High voltage converter

Low voltage converter

Rotating anode
 Hepatic
carcinoma:
TACE
PTRA
PTRA+STENT