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Tuesday, 7 May 2024
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Orientation
If available, some graphic aids can be helpful to show image orientations.
1) A graphic icon of the labeled primary axes (A, L, H) with relative lengths given by direction sines and system of coordinates as if viewed from the normal to the image plane can help orient the viewer, both to identify image plane orientation and to indicate possible in plane rotation.
2) In graphic prescription of obliques from other images, a sample original image with an overlaid line or set of lines indicating the intersection of the original and oblique image planes can help orient the viewer.
The 3 basic orthogonal slice orientations are:
transverse (T), sagittal (S) and coronal (C).
The basic anatomical directions are:
right(R) to left (L), posterior (P) to anterior (A), and feet (F) to head (H).
A standard display orientation for images in the basic slice orientation is:
1) transverse: A to top of image and L to right,
2) coronal: H to top of image and L to right and
3) sagittal: H to top of image and A to left.
The location in the R/L and P/A directions can be specified relative to the axis of the scanner.
The F/H location can be specified relative to a convenient patient structure.
The orientation of single oblique slices can be specified by rotating a slice in one of the basic orientations toward one of the other two basic orthogonal planes about an axis defined by the intersection of the 2 planes.
Double oblique slices can be specified as the result of tipping a single oblique plane toward the remaining basic orientation plane, about an axis defined by the intersection of the oblique plane and the remaining basic plane. In double oblique angulations, the first rotation is chosen about the vertical image axis and the second about the (new) horizontal axis. Angles are chosen to have magnitudes less than 90° (for single oblique slices less than 45°); the sign of the angle is taken to be positive when the rotation brings positive axes closer together.
Fluoroscope
A fluoroscope projects x-ray images in a video sequence (movie) onto a screen monitor.
Early generation fluoroscopes presented particularly difficult viewing challenges for radiologists. The human retina contains two types of image receptors. Cones (central vision) operate better in bright light, while rods (peripheral vision) are more sensitive to blue-green light and low light. Therefore, the radiologists wear red goggles to filter out blue-green wavelengths to allow the rods to recover peak sensitivity before viewing fluoroscopic images.
To avoid this time consuming accommodation, the industry developed the image intensifier tube in the 1950s. Due to the high amount of individual images during a fluoroscan, a very sensitive amplifier is needed to cut down radiation exposure. Until today, image intensifiers amplify the faint light emitted by the fluorescing screen and the images can be viewed on a monitor. Recently, digital technique replaces the large and bulky image intensifier with flat-panel technology.
Various other components of a fluoroscope system include a gantry, patient table, x-ray tube, filters, collimators, images sensor, camera and computer, most similar to other radiographic systems.
A fluoroscopy system provides the view of moving anatomic structures and is valuable in performing procedures that require continuous imaging and monitoring, such as barium studies, gastrointestinal function tests, cardiac functions, studies of diaphragmatic movement, or catheter placements. A number of technologies are available to record images created during fluoroscopic (fluorographic) exams.
Contrast
Contrast is the relative difference of intensities in two adjacent regions of an image. When referring to computed tomography (CT), contrast is defined as a difference in Hounsfield units between structures. The measurement of contrast resolution in CT imaging involves determining how easy it is to differentiate tissues whose CT density is similar to that of their surroundings. An image lacks contrast when there are no sharp differences between black and white. Brightness refers to the overall lightness or darkness of an image.
The contrast between air, soft tissue, and bones in x-ray and CT images is based on their different absorption of x-rays. Differences in tissue density, thickness and changes of the x-ray spectrum have consequences for image contrast, image noise as well as patient dose.
Optimized tube current, collimation, pitch and image reconstruction improves the contrast. Higher image contrast is produced by increased slice thickness, smaller matrix, and large field of view which results in large voxel size; high mAs to reduce noise; low pass filter.

See also Contrast Enhanced Computed Tomography.
Multiphase Bone Scintigraphy
A multiphase bone scintigraphy (bone scan) is a nuclear medical examination including blood flow images, immediate images, and delayed images.
The blood flow study is a dynamic sequence of planar images of the bone region of interest obtained during the injection of the radiopharmaceutical (radioactive tracer).
The immediate phase (blood pool or soft tissue study) include one or more static images of selected regions, obtained immediately after the blood flow phase within 10 min.
Delayed images (usually whole body) are usually acquired 2-5 hours after injection. Later (6-24 hour) delayed images result in a higher target to background ratio and may permit better evaluation of the pelvis if this was obscured by bladder activity on the routine images. This late imaging may be particularly helpful in patients with renal insufficiency or peripheral circulatory disorders and those with urinary retention.
Diagnostic Imaging
Imaging refers to the visual representation of an object. Today, diagnostic imaging uses radiology and other techniques, mostly noninvasive, to create pictures of the human body. Diagnostic radiography studies the anatomy and physiology to diagnose an array of medical conditions. The history of medical diagnostic imaging is in many ways the history of radiology. Many imaging techniques also have scientific and industrial applications. Diagnostic imaging in its widest sense is part of biological science and may include medical photography, microscopy and techniques which are not primarily designed to produce images (e.g., electroencephalography and magnetoencephalography).
Brief overview about important developments:
Imaging used for medical purposes, began after the discovery of x-rays by Konrad Roentgen 1896. The first fifty years of radiological imaging, pictures have been created by focusing x-rays on the examined body part and direct depiction onto a single piece of film inside a special cassette.
In the 1950s, first nuclear medicine studies showed the up-take of very low-level radioactive chemicals in organs, using special gamma cameras. This diagnostic imaging technology allows information of biologic processes in vivo. Today, single photon emission computed tomography (SPECT) and positron emission tomography (PET) play an important role in both clinical research and diagnosis of biochemical and physiologic processes.
In the 1960s, the principals of sonar were applied to diagnostic imaging. Ultrasound has been imported into practically every area of medicine as an important diagnostic tool, and there are great opportunities for its further development. Looking into the future, the grand challenges include targeted contrast imaging, real-time 3D or 4D ultrasound, and molecular imaging. The earliest use of ultrasound contrast agents (USCA) was in 1968.
The introduction of computed tomography (CT/CAT) in the 1970s revolutionized medical imaging with cross sectional images of the human body and high contrast between different types of soft tissues. These developments were made possible by analog to digital converters and computers. First, spiral CT (also called helical), then multislice CT (or multi-detector row CT) technology expanded the clinical applications dramatically.
The first magnetic resonance imaging (MRI) devices were tested on clinical patients in 1980. With technological improvements including higher field strength, more open MRI magnets, faster gradient systems, and novel data-acquisition techniques, MRI is a real-time interactive imaging modality that provides both detailed structural and functional information of the body.

Today, imaging in medicine has been developed to a stage that was inconceivable a century ago, with growing modalities:
x-ray projection imaging, including conventional radiography and digital radiography;
scintigraphy;
single photon emission computed tomography;
positron emission tomography.

All these types of scans are an integral part of modern healthcare. Usually, a radiologist interprets the images. Most clinical studies are acquired by a radiographer or radiologic technologist. In filmless, digital radiology departments all images are acquired and stored on computers. Because of the rapid development of digital imaging modalities, the increasing need for an efficient management leads to the widening of radiology information systems (RIS) and archival of images in digital form in a picture archiving and communication system (PACS). In telemedicine, medical images of MRI scans, x-ray examinations, CT scans and ultrasound pictures are transmitted in real time.

See also Interventional Radiology, Image Quality and CT Scanner.
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