lecture 1 Advanced Biomedical Imaging.pptx

Advanced Biomedical Imaging Dr/ Ahmed ElDrieny Lecture of radiological science & medical imaging Hello! I Am Radiology What you expect from Radiology Why should we study patient safety  Lecture : Saturday Week Practical 10:30 AM to2:30 PM...

Advanced Biomedical Imaging Dr/ Ahmed ElDrieny Lecture of radiological science & medical imaging Hello! I Am Radiology What you expect from Radiology Why should we study patient safety  Lecture : Saturday Week Practical 10:30 AM to2:30 PM : NO Hours Offi ce hour : Saturday 8:30 AM to 9:30 AM  Our Don’t enter lecture after 15 min. dela Lecture No side talks in lecture rules  Theory and practice of biomedical imaging from the sub-cellular to whole body level with specific emphasis on recent developments. Principles of Course digital image-processing and image analysis (including Description quantitative morphology), computed tomography and volume rendering and analysis. Imaging modalities including x- ray, CT, ultrasound Positron emission Tomography, Single  The aim of this course is to teach COURSE basic of IMPORTANCE radiology and the protection of the human body from radiation and the basic of X- ray equipment's and ultrasound Positron emission Tomography, Single photo emission computer tomography and magnetic resonance imaging.. DISTRIBUTION Interactive learning 14 marks Assignment 6 marks OF Mid-term 20 mark MARKS Final exam 60 mark  Week 1-2 lectures Our Week 3 lecture & quiz 1 Week 4 midterm calendar Week 5-7lectures& quiz 2  To understand meaning of ILOs Advanced Biomedical Imaging EDUCATIONAL BOOK Advanced Biomedical Imaging “ ⚫It is substance used to enhance the contrast of structure or fluids within the body in medical imaging Medical Imaging “ Radiological examinations are portion from medical imaging. So medial imaging term is more “ broad spectrum term than radiological imaging. “ At the beginning medical imaging depending on ionizing radiation so it was named radiological imaging. When other modalities introduced “ to the field of imaging medial and they were not depending on ionizing radiation, like ultrasound wave and magnetic waves, so medical imaging became more broad spectrum term. Aim of Medical Imaging Diagnosis of the diseases by imaging of the patient. Used as guide for aspiration of fluid collection and guide for biopsy taken. Used in treatment of some disease by interventional radiology.  Medial Diagnostic medial imaging imaging classified into Interventional radiology  Types of medical imaging modalities Ultrasound (US) X-Ray Magnetic resonance imaging (MRI) Isotope scanning Computed (Gama camera- Tomography PET-CT) (CT)  X - Types of medical imaging R modalities a y C o m p u t e How to obtain onizing radiation How to obtain Ionizing radiation Ionizing radiations are produced by X-Ray tube, which contains anode and cathode. X-Ray and CT are depending on production and detection of the ionizing radiations. How to obtain Ionizing radiation Simply X-Ray is depending on production of ionizing radiation by tube which passing through the body to be detected on the film. When all produced ionizing radiations passing through the examined part of the body reaching to the film, this part appear black on the film. This occur when ionizing passing through air containing organs like lungs. How to obtain Ionizing radiation When the body tissue prevents penetration of the ionizing radiation through it, the examined part appears white (dense). This is occur when bones prevents ionizing radiation to pass through it. How to obtain Ionizing radiation The plain X-Ray has relative limited role in medical imaging due to the resulting two dimensional images. So computed tomography was entered to the field of medical imaging. It produces two and three dimensional images. A Picture Is Worth A Thousand Words Plan X-Ray Plan X-Ray How to obtain Ionizing radiation Also in CT ionizing radiations produced by tube, but detection of the radiations which penetrating body occur be detectors which translate the radiations to electronic signals which reconstructed by computer. Multi slice computed tomography  Ultrasound It is depend on sound wave. The average diagnostic range is 3.5 to 10MHz. It is produced by piezo-electric crystals within the probe of the ultrasound. When the sound waves passing without resistance, the resulting image became black (anechoic). Like passing of the wave through water. When the organ (like bone) prevents passing of ultrasound wave the resulting image became white (hyper-echoic). Ultrasounds  I t MRI i s d e p e n  W h e MRI n m a g n e t i c  T h e MRI p r o d u c e d e n  H i Types of MRI apparatus g h f i e l d T e s MRI  advanced imaging in X-RAY Dr/ Ahmed ElDrieny Lecture of radiological science & medical imaging  X-ray Idea X-rays represent a form of electromagnetic radiation. They are produced by the x-ray tube, using the high voltage to accelerate the electrons produced by the cathode. The produced electrons interact with the anode, thus producing x-rays. An x-ray (radiograph) is a noninvasive medical test that helps physicians diagnose and treat medical conditions. A machine focuses a small amount of radiation on the area of the body to be examined. What causes the blacks, whites and grays of an x-ray image? Black Air (Lungs / Trachea / Outside the body)  Fat (Perirenal Fat / Fascial plane)  Water (Muscle / Organs)  Bone (Bone / Atherosclerotic plaquing) WhiteMetal (Fillings / Markers / Ortho devices)  Components of X-Ray Machine X-ray has three main components: Operating Console High Voltage Generator X-ray Tube Other parts include: Collimator and Grid Bucky X-ray Film.  X-ray tube An x-ray tube functions as a specific energy converter, receiving the electrical energy and converting it into two other forms of energy: x-ray radiation and heat. The x-ray tube contains two principal elements: cathode: provides a source of electrons anode: acts as the target for electrons and releases x-rays  Additional components include: 1. tube envelope (evacuated) 2. tube housing 3. cooling oil 4. rotor 5. induction stator 6. tube window  The Cathode The cathode is the negative side of the tube and c ontains two primary parts:  The filaments -made of tungsten  The focusing c up -It has a negative charge so that it can condense the electron beam to a small area of the anode.  The Anode The anode is the positive side of the tube. X-ray tubes are classified by the type of anode: Stationary Rotating  Grids Grids are used to reduce the scattered radiation and improve image contrast. They are made of parallel strips of lead Uses Grids are c ommonly used in radiography, with grid ratio available in even numbers, such as 4:1, 6:1, 8:1, 10:1 or 12:1. Generally used where the anatomy is >10 cm:  abdomen  skull  contrast studies  breast (mammography): uses 4:1 grid ratio  X-Ray Production X-rays are produced due to sudden deceleration of fast-moving electrons when they collide and interact with the target anode. In this process more than 99% of the electron energy is converted into heat and less than 1% of energy is converted into x-rays.  Conditions We Diagnose With X-Ray Various types of diagnostic X-ray procedures are ordered for different reasons. Common procedures include: Angiography: Uses an injection of contrast medium to image blood vessels in a specific part of the body. Cardiac plan X-Ray  Planning for investigations Electrocardiogram Chest X Ray Trans-thoracic Echocardiography Trans- esophageal Echocardiography Color Doppler Imaging Magnetic Resonance Imaging Hemo- 5 0 Heart Anatomy & Physiology Heart anatomy & Physiology NORMA L VC SV C PV RA LA LUN IV R L G C V V P A A O  Patient position patient is erect facing the upright image receptor, the superior aspect of the receptor is 5 cm above the shoulder joints the chin is raised as to be out of the image field shoulders are rotated anteriorly to allow the scapulae to move laterally off the lung fields, and this can be achieved by either: hands placed on the posterior aspect of the hips, elbows partially flexed rolling anterior or hands are placed around the image receptor in a hugging motion with a focus on the lateral movement of the scapulae shoulders are depressed to move the clavicles below the lung apices  Technical factors posteroanterior projection suspended inspiration centering point the level of the 7th thoracic vertebra, approximately the inferior angle of the scapulae collimation superiorly 5 cm above the shoulder joint to allow proper visualization of the upper airways inferior to the inferior border of the 12th rib lateral to the level of the acromioclavicular joints  Technical factors orientation portrait or landscape detector size 35 cm x 43 cm or 43 cm x 35 cm exposure 100-110 kVp 4-8 mAs SID 180 cm grid yes Cardiac Margin Normal CXR in PA view Normal CXR in Lateral view  Cardiac Catheterization ◾ Cardiac Catheterization -is one of the invasive procedures used to visualize the heart’s chambers, valves and great vessels in order to diagnose and treat disease related to abnormalities of the coronary arteries. ◾ The procedure involves inserting a long, flexible, radiopaque catheter into a peripheral vein peripheral artery and guiding it under fluoroscopy (x-ray observation) or angiography. Coronary Artery  Indication ◾ some of cardiac catheterization are to: ◾ Confirm suspected heart disease, including coronary artery disease, myocardial disease, valvular disease and valvular dysfunction ◾ To determine the location and extent of the disease process. ◾ To assess the following: ◾ Stable, severe angina unresponsive to medical management ◾ Uncontrolled heart failure, acute myocardial infarction, ventricular aneurysm contraindication ◾ Allergy to the contrast medium used in the study ◾ Pregnancy, unless the benefits of performing the study greatly outweigh the risk to the fetus. It is a relative but not absolutely contraindicated. ◾ Renal Failure ◾ Medical conditions such as severe infection, irreversible brain damage, or congestive heart failure (CHF), which are considered relative to their extent emergency status, and potential benefit as opposed to the risk. ◾ Inability for patient cooperation ◾ GI Hemorrhage  Procedure placed in a supine position on the x-ray table, and securely strapped into the table ECG leads are positioned and attached to the client as well as a cardiac monitor Blood pressure, pulse and respiration equipment is used for continuous monitoring of the heart activity and vital signs. The catheterization site is shaved if necessary, cleansed and draped to establish a sterile field. A needle is put into the femoral artery/vein [near groin] or brachial artery/vein[above elbow]. A guide wire is put through the needle into the blood vessel and the needle is removed.  Procedure The thin flexible catheter is placed over the guide wire and moved into the blood vessel. The catheter is then guided through the blood vessels until it reaches the area to be studied [aorta, coronary arteries, left ventricle and atrium and inferior vena cava , right atrium and ventricles, pulmonary artery etc]---- Cardiac Catheterization  Procedure The fluoroscope is used to watch the movement of the catheter in the blood vessels. When the catheter is in place, Iodine dye is injected through it. Several X-ray pictures are taken one after another which may either be still images, displayed on a image intensifier or film, or motion images stored digitally on computer. Duration: 1-3 hrs The catheter is taken out after the angiogram, and pressure is put on the needle site for 10 to 15 minutes to stop any bleeding. patient is returned to a recovery area for further observation  Angiographic view  Anatomic landmarks formed by the spine, catheter and diaphragm provide information to discern which tomographic view from which the image is obtained.  In the LAO view the catheter and spine are seen on the right side of the image, while in the RAO they are found on the right.  PA imaging places these landmarks in the center.  Cranial can usually be distinguished from caudal angulation by the presence of the diaphragm. For cranial imaging, the patient should be asked to inspire to remove the diaphragmatic shadow from the image. Cranial and Caudal Angulation RAO and LAO Angulation Angiographic Projections Cranial Caudal Image detector Image detector X-ray tube X-ray tube Coronary Anatomy Circulation Vol 63 Supp I, June 1981, I-1 to I-81 Coronary Angiographic Anatomy  Left Coronary System Standard Views – 4 (4▪ corners) LAO 40/Cranial.1 ▪ LAD, Dx 20 prox LAD, prox LCx, LAO 40/Caudal.2 ▪ distal LM 20 LM, prox/mid/disal LCx RAO 20/Caudal.3 ▪ prox/mid LAD 20 RAO 10/Cranial.4 ▪ LAD 40 LM, LCx Supplemental▪ Right Coronary System Standard Views -▪ 2 prox, mid LAO 40/Cranial.1▪ RCA prox, 20 mid RCA RAO 30/Cranial.2▪ distal 20 RCA Supplemental▪ distal Views RCA AP/Cranial 30-40▪ LAO 50/Cranial 30▪ RAO with caudal angulation  RAO/Caudal LM LA LCX – high D in cranial LC views LCx LCx D – low in caudal x x views O M  RAO/Cranial L LC Note: LCx is M x high – out of way of LAD LA D D x sept al LAO with cranial angulation LAO/ Cranial L LC M x D x LA D Steep LAO (> 60 degrees) Lateral or True Lateral (90 degrees) Very good LAD insertion view Arms up LAO with Cranial (40/2 0 degrees) Makes a ’‘C  LAO/ Cranial RC LC x A LC x RAO (30 degrees) What is this View?  What is this View? RAO Caudal What is this View?  What is this View? LAO Cranial What is this View? What is this vessel?  What is the View? What is the vessel? LAO Caudal Famous Ramos  Generally, for circumflex and proximal epicardial visualization the caudal views are most useful.  For LAD and LAD/diagonalbifurcation visualizatio the cranial views are n useful. most  Left Main AP, LAO cranial, LAO caudal  Proximal LAD LAO cranial, RAO caudal  Mid LAO cranial, RAO LAD cranial, Lateral  Distal AP, RAO cranial, Lateral LAD LAO cranial, RAO  Diagonal cranial Proximal circumflex RAO cranial, LAO caudal Intermediate RAO caudal,LAO Obtuse caudal marginal RAO caudal, LAO caudal, cranial RAO Proximal RCA LAO, Lateral Mid RCA LAO, Lateral, RAO Distal RCA LAO cranial, PDA Posterolateral Lateral LAO cranial LAO cranial, RAO cranial  The severity or degree of stenosis is measured by comparing the area toan narrowin of adjacent norma g and as a percentag l segment, and calculated e in projection which the reduction demonstrates most severe the narrowing. Finding rdiac catheterization involve adiation exposure for staff embers as well as the patie Good Bye