X总论（留学生用）

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 （ 40150KV ）



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 • a transport of energy through space.

fields

•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 body tissue

High density (bone)

Attenuation after absorbtion

less

Moderate density (liver)

Middle

Low density (lung)

more

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

High density Isodensity

Bone Liver, pancreas, kidney, brain Lipid 、 gas

Low density

Presentati on

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 Examinationdirect 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 Examinationpuncture 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 examinationpuncture 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 Examinationphysiological 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

Detector X-ray

Phosphor

Object

X-ray tube

Images storaging devices

Imaging recorder

digital

screen

Diagram of CR

Digital signal

film

Laser camera

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

A/D converter

printer

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 激 光 打 印 机

HP刻 录 机

临 床 科 室 工 作 站

1000G 磁 盘 阵 列 PACS

M odem

远 程 会 诊

H IS 交 换 机

交 换 机

PACS专 用 服 务 器

H IS 服 务 器

DSA采 集 计 算 机

CR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

ECT登 记 计 算 机

CT报 告 浏 览 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