DIAGNOSTIC IMAGING

INTRODUCTION
CONVENTIONAL RADIOLOGY
Dr. M. Yusri

Departemen Radiologi RSMH

PALEMBANG

What is Radiology?

The use of X-rays and radioactive substances in the diagnosis and

treatment of disease

What is Radiology?
Radiology is the study of images of the human - body.
Although Radiology began with the use of X-Rays and
photographic films, the modern Radiologist now has a
variety of tools for "taking pictures" of patients.
Many of these newer tools create an image with a computer (CTcomputed tomography) and some do not use any
X-Rays, such as MR and Ultrasound.

Discovery of X-RAYS

Wilhelm Conrad Rontgen, Professor of Physics at University of Wurzgburg, first made the discovery of
X ray on 8th November,1895.

He was investigating the phenomenon caused by the passage of an electric-current, through a partially evacuated glass tube.
The strange light appeared from a paper screen covered with barium platinocyanide,
a fluorescent substance, whenever electrical charges were passed through the glass tube.

Discovery of X-RAYS

He was investigating the phenomenon caused by the

passage of an electric-current, through a partially evacuated
glass tube.
The strange light appeared from a paper screen (a fluorescent
substance), whenever electrical charges were passed through
the glass tube.

Discovery of X-RAYS
Rontgen discovered that these rays could pass through all sort of objects
Moreover he could see the shadow of bones and soft tissues of his own
hand on the fluorescent screen, when his hand was placed between the
glass tube and the screen.
To document these rays, he replaced the fluorescent screen with
photographic plate, to make a photographic record.

The photograph of his wife hand, was widely

believed to be first ever radiograph (X-ray picture)
of a human.

[Courtesy: Deutsche Rontgen Museum , Lennep]

Tabung Sinar-X
Tabung luar
Tabung (gelas) sinar-x berada didalam tabung
luar (pembungkus)

Tabung (gelas) sinar-x

Dua dioda
Katoda
Anoda

Sinar-X
Hasil benturan elektron dengan katoda
Produksi radiograf (gambar)
Kilovoltase
Miliamper
Waktu
Ukuran focal spot

SIFAT SINAR X

Daya penetrasi
Memancar secara garis lurus.
Dapat diserap, dipantulkan dan dibias
Dapat menghitamkan emulsi film.
Fluorosensi.
Ionisasi.

 Bayangan pada foto terjadi akibat

perbedaan densitas tubuh yang dilalui
sinar X.
Densitas tubuh manusia terdiri dari:
- Tulang
- Jaringan lunak
- Udara/gas

BAYANGAN PADA FOTO

Tulang : bayangan putih/radio-opak
Jaringan lunak: bayangan putih ringan
Udara/gas: bayangan hitam/radio-lusen

X RAY PRODUCTION

When electrons traveling at very high speeds are made to

penetrate the atom target, transfer of energy from electron
to the atom target causes internal derangement and release
of X rays.

X-RAYS

1. A Form of radiant electromagnetic energy

2. Invisible to human eye
3. Passes through all of objects
4. Causes fluorescence
5. Exposes film etc..

FORMATION OF THE X RAY IMAGE

The formation of a X ray image depends on ;
1. Intensity (strength) of the X ray beam
2. Physical properties of the structure through
which it passes.
thickness, density and atomic number of structures.

FORMATION OF THE X RAY IMAGE

If two adjacent structures are of similar density and
X-rays passing difficulty indistinguishing these two
structures.
Structures with greatly differing densities and atomic
number are seen clearly.

Diagnostic Radiology
The discovery of X rays was not only an important
scientific event (Nobel Prize), but more significantly
heralded a new era in medical practice.

The concept of diagnostic imaging:

To visualize internal body structures and organs and
hence detect diseases.

RADIOLOGIC TECHNIQUES

Plain Radiographs
Fluoroscopy
Contrast Radiography
Angiography
Computed Tomography
Magnetic Resonance Imaging
Nuclear Medicine
Ultra Sound

PLAIN RADIOGRAPHS
The images created by X-rays. Often called "plain Xrays"
The image or picture is basically a shadow of the parts of
the patient that absorb or block the X-rays.
The image can be collected on photosensitive film, on a
digital imaging plate, or on a fluoroscopic screen.

DIAGNOSTIC RADIOLOGY
In the early years, the main indication for the X ray
examinations were to diagnose fractures and dislocation,
locate foreign bodies, to visualize congenital deformities,
and to examines specific diseases affecting bone.
These clinical indications still remain valid in todaypractice.

2 y/o fell on outstretched hand

Lateral plain radiograph of skull.

Nasal Cavity & Paranasal Sinuses

The paranasal sinuses are air filled cavities and include the
frontal, ethmoid, sphenoid and maxillary sinuses.

Cervical Spine AP-Lat.

PA. Chest

Plain Abdomen

FLUOROSCOPY
Fluoroscopy is a technique for obtaining "live X-ray
images of a living patient
The Radiologist can watch the images "live" (moving)
structures on a TV monitor.
Fluoroscopy is often used to observe the digestive tract
(Upper GI series - Barium Swallow, Lower GI series Barium Enema ).

CONTRAST IMAGING
Many structures within human body are invisible to X rays
due to similarity in density to the surrounding tissues
To outline the otherwise invisible organs within the
abdomen/brain, contras agents, administered by various
means, are required.
Most of the contras agents in conjunction with X rays are
densely opaque, in order to enable maximum differentiation
from the surrounding soft tissue structures.

CONTRAST RADIOGRAPHY

1. Barium studies (BAS/UGI, LGI/BE)

2. Cholecystography (Gall Bladder)
3. Urography (Kidney function) (IV)
4. Angiography/Venography
5. Arthrography
6. Hysterosalpingography
7. Lymphangiography (Rare)

Barium Meal
Radiographic examination of the stomach and duodenum
using contras medium ( Barium Sulphate)
May be done as single contrast (barium only as contrast )
or double contrast ( barium and gas ) examination.
The study aims to show the mucosal pattern in all part of
stomach and duodenum.

Barium Enema
Radiographic examination of the colon using
contras medium, to define the anatomy of the
large intestine and rectum
The two examination techniques are single
contras and double contras.
DC technique : Barium is combined with insufflation of air, much better than the SC.

Cholecystography
Radiographic examination of the gall bladder and
common bile duct using oral contras medium.
Has been largely replaced by modern imaging
techniques s.a ULTRASONOGRAPHY and CT.

Urography /Intravenous Pyelography (IVP)

Radiographic examination of the urinary tract with
intravenous injections of contras medium.
Serial radiographs should be obtained to demonstrate
the kidney, ureters and bladder.

Urography /Intravenous Pyelography (IVP)

Hysterosalpingography (HSG)
A radiographic procedure that uses contrast material
injected into the uterus and fallopian tubes.
May be used to diagnose infertility problems and
anomalies of the female genital tract.

What is a Radiologist ?
Use of imaging techniques, such as X ray, US or CT
Scan, in the diagnosis and treatment of disease

Role of Radiologist:
1. Identify abnormality (Nl or Abnl)
2. Characterize abnormality
3. Extent of disease (Staging)
4. Differential diagnosis
5. Suggest further work up

Subcapsuler Renal hematoma

 RADIOLOGIST:
An in Vivo Gross Macroscopist
PATHOLOGIST:
An in Vitro Microscopist

What is a Radiologist ?
Use of imaging techniques, such as X ray, US or CT
Scan, in the diagnosis and treatment of disease

The

1. Identify abnormality (Nl or Abnl)

2. Characterize abnormality
3. Extent of disease (Staging)
4. Differential diagnosis
5. Suggest further wor

ROLE OF RADIOLOGIST

1. Identify abnormality (Nl or Abnl)

2. Characterize abnormality
3. Extent of disease (Staging)
4. Differential diagnosis
5. Suggest further work up

TERMINOLOGY
1. Direction of beam (e.g. PA chest).
X-Rays pass from P to A
2. Body Part Closest to Film (e.g. Left Lateral Chest)

Joint

Discovery of X-RAYS
Rontgen discovered that these rays could pass through all sort
of objects
Moreover he could see the shadow of bones and soft tissues of
his own hand on the fluorescent screen, when his hand was
placed between the glass tube and the screen
To document these rays, he replaced the
fluorescent screen with photographic plate,
to make a photographic record.
The photograph of his wife hand, was widely believed
to be first ever radiograph (or X-ray picture) of a human.

Lennep]

[Courtesy: Deutsche Rontgen Museum ,

TERIMA KASIH