Methods and techniques for radiology diagnostic.pptx

Radiology

1. Methods of radiation diagnosis

2. Methods of radiation diagnosis 1 . X-ray methods Radionuclide diagnostic methods 3. Ultrasound diagnostic method Ultrasound machine «Voluson». GEN. R-apparatus "Amiko" Genus Spiral computer tomograph (CT) DRB number 1 Gamma Skylight camera Genus

3. Methods of radiation diagnosis 4.Magnetic resonance tomography (MRI) 5. Positron-emitting tomography (PET) 6. Thermography (thermal imaging); radiothermometry 7. Photodynamic diagnostics (PD) 8. Other beam diagnostic methods Installation of DTK-3M in the Department of Oncology.

4. METHODS used in radiology are divided into: BASIC: 1. R-graphics 2. R- Scopy 3. Fluorography 4 . Linear tomography Basic and special methods in roentgenology The usual film fluorogram of the chest 7x7 cm. Digital fluorogram of the chest 10x10 cm. Chest X-ray in the straight and left lateral projections Linear tomogram of chest organs

5. SPECIAL: methods that require the use of special X-ray substances (R- scopies of the esophagus and stomach, R-copy of the colon, irrigoscopy , urography, bronchography , galactography , choleography , etc.). They are many dozens of species. X-ray examination esophagus and stomach Basic and special methods in roentgenology Bronchogram of the right lung Contrast study of the large intestine - irrigogram

6. High-atomic radiocontrast media with high optical density: -Water-insoluble (Barium sulfate suspension BaSO 4) - Iodine-based water solutions in vials and bottles. The concentration is 30-76%. There are ionic (monomers and dimers ) - Cardiotrastum , Urografin , Triombrastum , Myodil , Telebrix and others and non-ionic (monomers and dimers ) Ultravist ( Iopromide ), Optyray , Omnipaque , Visipaque and others. Oil-soluble ( Iodolipol 30% vials 5, 10, 20 ml. ( Lipiodol 48% 10 ml) Low-atomic radiocontrast media with low optical density - gases: Oxygen, carbon dioxide, helium, nitrogen oxide (laughing gas), air. The Radiocontrast agents classification.

7. Non-ionic contrast OPTIRAY 64% 100 ml. (USA). Barium sulphate in suspension . Ionic contrast CONRAY 43 250 ml. (USA). Non-ionic contrast ISOVUE-370 50 ml. (USA).

8. Administration of the radiocontrast media in the body 1. Through natural ostium ( mouth, anus, cervical canal etc.)is the most commonly used method of administration. For example, gastro-intestinal radiography, bladder radiography etc. 2. Intravascular injection ( arteriography , phlebography , lymphography , cholegraphy etc.) 3. Through natural closed cavities (peritoneal cavity - pneumoperitoneum , pleural cavity - pneumothorax , ventricular system of the brain - pneumoventriculography etc) 4. Through abnormal passages and perforations ( fistulography - radiographic opacification of fistula passage)

9. Cranial radiographic contrasting: (Ventriculography) pneumoventriculography . The ventricular system of the brain was accidentally visualized in 1913, when Luckett made the X-ray picture of the head injury. The method of the pneumoventriculography was introducedby American neurosurgeon W.Dandy in 1918. A craniotomy was performed, the needle with the syringe was introduced into this aperture in the direction of the cerebral cavity. When the cerebrospinal fluid appeared in the syringe it was removed and the radiocontrast media was injected ( Myodil and analogs). Then the X-ray picture in anteroposterior and lateral views was performed. If the gas was administrated, the technology was called pneumoventriculography . The localization and dimension of the neoplasm was detected by the displacement of the ventricles. At the present moment this technology is replaced by CT and MRI. The necessity for changes of the difficult ventriculography gave birth to CT scan method.

10. Contrasting the central nervous system: Ventriculography ( Pneumoventriculography ). Pneumoventriculogram in a direct projection. Pneumoventriculograms in the left lateral projection. Positron emission tomography (PET) of the brain of a healthy 20-year-old human. MRI of the brain in norm and pathology.

11. CNS Contrasting: Myelography ( pneumomyelography ) A puncture of the spinal cord is performed under the control of R- scopy . When a cerebrospinal fluid appears, it is evacuated, introducing in its place an equal amount of high-atomic or low-atomic contrast. The procedure is similar to the previous one. Detects tumors of the spinal cord, compression from the outside, blockade of the spinal canal, etc. Myelography is performed if it is impossible to perform an MRI. Myelography with compression fracture L4. (Negative picture). Myelography in a straight and lateral projection. The restriction between L3 and L4. (Positive snapshot).

12. Genital tract radiographic contrasting (men) Vesiculography ( genitography , epididymography ). It was introduced by W. Belfield in 1913. Clinical indications: male infertility, seminal vesicle stones and neoplasms ,   Tuberculosis  of the  prostate, prostate cancer etc. This is kind of exploratory surgery. The seminal duct is exposed with small incision on the scrotum. The superficial transection of the seminal duct is performed, after that the needle with grind down point is introduced into the lumen and is fixed with  the surgical catgut. About 5-6 ml of every urological radiocontrast can be used , the radiography is performed immediately.It is better to use 4-5 ml Iodolipol 30% dilutedin 1 ml ether. In this case man can make the X-ray picture after an hour and later and even on the next day.

13. Genital tract radiographic contrasting (women) Hysterosalpingography ( metrosalpingography ), pneumopelviography . The clinical indications for hysterosalpingography (X-ray picture and ultrasound) : the female infertility, uterine anomalies, uterine neoplasms , cicatrical changes. Technique: the catheterisation of the cervix is performedand the oil-soluble radiocontrast media is introduced into the uterine cavity, filling the lumen of uterus and fallopian tubes. The X-ray pictures are performed in different periods of time. GHA in dynamics .

14. Contrasting the organs of the reproductive system Hysterosalpingography ( metrosalpingography ) Both pipes are impassable in the interstitial departments. The right tube is impassable in the isthmic department, the left one in the ampullar . The right tube is absent, the left is impassable - the saktosalpinks (tube in the form of a bag). GHA in the norm. Hysterosal- pingogram (GHA) is normal. GHA. Cancer of the uterus body in the form of a filling defect on the side wall (arrow).

15. Genital tract radiographic contrasting. Pneumopelviography . In the surgery room about 1,5 -3 l of low-atomic radiocontrast media (gas) is introduced into the abdominal cavity of the patient. Than the pelvis of the patient is raised and the gas raises up, separating the pelvic organs from each other. In such position the X-ray picture is made. This method lets see the outlines of the pelvic organs, on the other hand the hysterosalpingography shows the internal lines. Over recent years this method fell into disuse, because laparoscopy, ultrasound, CT and MRI give similar result with higher quality.

16. Pneumopyelvigraphy A clear shadow of the bladder (symphysis), uterus with appendages, rectum. Sometimes it is also performed in boys with suspicion of abdominal cryptorchidism, anarchism. Norm Myoma of the body of the uterus Tumor of the left ovary Tr Tr Vesica urinaria Uterus Rectum

17. Radiation methods of urinary tract research й 1. Obligatory R-gram of the urinary tract 2. Excretory urography (intravenous urography) 3. Retrograde urography 4.Cystography 5. Pneumocleaning Overview R-gram of urinary tract (the left kidney is marked with arrows). On the eve and on the day of the study, a cleansing enema is performed.

18. The X-ray study of the urinary tract Intravenous urogram ( pyelogram ) is the most valuable urological technology at present. Clinical indications: urolithiasis , renal inflammatory disease, renal neoplasms , anomalies etc. Preparation as for plain radiography of urinary tract: enemas or taking Fortrans (2 sachets). A slow (3-4 minutes) injection of 30-60 water-soluble radiocontrast media ( Urografin , Ultravist , Urotrust etc) is given to a patient intravenous. The antishock medications are ready to use because the radiocontrast medias can cause anaphylactic shock. Man makes series of pictures on 5th, 15th, 30th and 45th minute (the urologist can assign another periods of time). Every X-ray picture shows the certain working phase of the kidney: perfusion of the radiocontrast agent in the parenchyma, excretion, agent travelling into the renal pelvis,theureter and the bladder.

19. Radiation methods of urinary tract research Excretory urogram . The right kidney is not visible - the "mute kidney" (the kidney does not function or is absent). Left - pyelonephritis, hydroureter . Excretory urogram. Congenital anomaly of the right kidney - doubling. The ureters merge in the form of the letter "U".

20. Radiation methods of urinary tract research Usual excretory intravenous urogram in the mode of usual (linear) tomography. In recent years, it is increasingly being replaced by MRT-KT-UZ-urography. Three-dimensional CT urogram, performed on a computer tomograph of the latest generation.

21. The X-ray study of the urinary tract Retrograde urography ( pyeloureterography ) Retrograde urogram ( pyelogram ). It was introduced by Völcker and Lichtenberg in 1906. Clinical indications: complete kidney failure, urolithiasis , renal inflammatory disease, renal neoplasms etc. Over recent years this method is used only if other methods don`t take effect, such as the excretional urogram doesn`t give the clear picture of the pelvicalyceal system and the ureter because of loss of kidney function. Preparation: the thorough preparation as for intravenous urogram isn`t needed because of the high opacity. The urologist makes the cystoscopy and the catheterisation of the ureteral orifice. The catheter travels to the renal pelvis and up to 5 ml of the water-soluble radiocontrast is injected. This method works in most cases just for one kidney, because it has a major flaw: the infection of low urinary tract can be brought to the renal cavity and the kidney. However the possible causes of the complete kidney failure can be closely shown by this method.

22. Radiation methods of urinary tract research Right-sided retrograde urogram (pyeloureterogram). In the enlarged pelvis there is a shadow of the concrement. The arrow marks the shadow of the catheter. Retrograde urogram. (Image in the positive).

23. The X-ray study of the urinary tract. С ystoradigraphy This is the taking of the X-Ray picture of the bladder by filling it with radiocontrast agent, that is introduced descending way (from the kidneys when the excretory cytography is performing) or ascending way (through the catheter). Different radiocontrast media ( Urotrust , Urografin etc) or gas (oxygen or carbon dioxide in the case of pneumocystography ) and their combinations like gas and the liquid agent are used.Visualising the malformations of bladder outlines and filling defects (if there are areas with lack of the radiocontrast agent) on the picture let detect the stones, the tuberculosis, the neoplasms and prostate disorders.

24. Radiation methods of urinary tract research Cystography Cystogram in different phases of filling the bladder. Double contrast of the bladder-soluble contrast (traces) + gas. Cancer in the form of cauliflower fills almost the entire bladder. Contrast cystogram is normal.

25. Radiation methods of urinary tract research Cystography Cystogram, micturition (ie at the time of urination) urethrogram. Pneumocystogram of a patient with a diverticulum of the bladder (ascending cystography): arrows indicate diverticula. Gas is used as a contrast.

26. Radiation methods of urinary tract research Pneumorenography ( pneumoren ) а) urinary tract urograph б) airborne disease а б Technique: in the paranephric fiber (through a puncture in the coccyx region), inject up to 1.2 -2 liters of gas, which envelops the kidney and visually separates it from the surrounding structures. Before the era of ultrasound, CT and MRI, this was the only way to visualize the adrenal gland.

27. Radiation methods for the study of the respiratory system Fluorography of the lungs Radiography of the lungs Radiography of the lungs Simple (linear) tomography of the lungs Computed tomography (CT) of the lungs Bronchography Magnetic resonance imaging (MRI) Ultrasound of the pleural cavity Scintigraphy of the lungs

28. The X-ray study of the respiratory system. Bronchoradiography . The first bronchography of the patient was performed by American doctor Ch.Jackson in 1918. The first bronchography in the USSR was performed by S.A.Reinberg in 1923. It can be selective or non-selective. In the first case the catheter is introduced after the anaesthesia of the upper respiratory tract into the lobar or segmental bronchus and the oil-soluble radiocontrast agent is injected. Then the X-ray picture is taken. In the second case the catheter is introduced only into the main bronchus and the radiocontrast travels into the expected area by changing the body posture (dorsal, edgeweis , upright etc.). Clinical indications: the bronchiectatis , the chronic bronchitis, the neoplasms .

29. The X-ray study of the respiratory system. The perfusion scintigraphy of the lungs The radioactive agent is injected intravenous (in the hand). The radioactive technetium micro aggregated human serum albumin (labeled Tc99m-MAA) or Albumin Micro  sphere are used for this aim. The medication goes to the lungs and spreads into pulmonary arteries. This technology is based on the arterial and capillary embolization by the injection of light particles labeled with radioisoptopes . A gamma camera acquires the images of the lungs.  

30. Radiation methods for the study of the respiratory system Comparison of fluorograms (7x7 cm) and chest X-ray . Digital (digital) fluorogram of the lungs. Dimensions 10x10 cm. The radiation load on the patient is much lower.

31. Radiation methods for the study of the respiratory system. Linear (simple tomography) Simple (linear) tomography. Allows you to see the trachea, bronchi, the thickness of their lumen (indicated by arrows).

32. Radiation methods for the study of the respiratory system Bronchography Bronchography was performed in 1918 by the American physician S. Jackson. In the USSR the first BA was executed in 1923 by SA Rheinberg. Bronchography is divided into selective and nonselective. In the first variant, the catheter is injected after anesthesia of the upper respiratory tract into the lobar or segmental bronchus and a small amount of fat-soluble contrast is fed through it. Then the R-gram is produced. In the second variant, the catheter is carried out only in the main bronchus, and the contrast falls into the desired zone due to the fact that the patient is given one or another position (lying on his back, on his side, standing, etc.). Indication: bronchiectasis (chronic bronchitis, tumors) . Sachet bronchiectasis. norm

33. Radiation methods for the study of the respiratory system. Computer tomography - CT. CT of thoracic organs. On the left in S6 is a dense, round shadow with a diameter of 7 mm. On the pleura, dense local thickenings. Pleural cavities are free on both sides. Conclusion: The calcified focus in S6 of the left lung (previously it was regarded as Mts). CT scan in dynamics after 6 months. Education has decreased in size. CT of the chest. In the projection of the lower lobar bronchus, a tumor of 5x7 cm is defined on the left, the lower part is in the state of hypoventilation. At the root of the left lung conglomerate of lymph nodes. Central cancer of the left lung with Mts at the root of the left lung.

34. Radiation methods for the study of the respiratory system. Magnetic resonance imaging - MRI. MRI of the chest. The tumor node sprouts the body of the upper thoracic vertebra. The method is based on the measurement of the electromagnetic response of hydrogen atoms to the excitation of a certain combination of electromagnetic waves in a constant magnetic field of high tension. For the invention of the MRI method in 2003, Peter Mansfield and Paul Lauterbur won the Nobel Prize. The pulmonary system is studied mainly not by MRI, CT, since there is little fluid in the pulmonary tissue and, correspondingly, of hydrogen. An open type of MRI A closed type of MRI

35. Radiation methods for the study of the respiratory system. Perfusion scintigraphy of the lungs. Scintigram of the lungs (scheme) with 99Tc-microspheres of albumin in thromboembolism of small branches of the pulmonary artery (PE). Perfusion scintigraphy. A radioactive substance is injected into the vein of the hand. For this purpose, microaggregates of human serum albumin or albumin microspheres labeled with Tc-99m or I-113 are used. The drug enters the lungs and diverges along the pulmonary arteries. The method is based on the principle of embolization of the arterial-capillary bed of the lungs with radionuclide-labeled particles after their intravenous administration. Then the gamma camera takes pictures of the lungs. Two-sided embolism of the pulmonary artery (PE)

36. Radiation methods for the study of the respiratory system. Ventilation scintigraphy of the lungs. Ventilating scintigraphy of lungs with xenon Radiobulmonography (pulmonary radiography, radiopneumography , radio- spirography , spiradiography ) is a common name for radiographic methods for the study of pulmonary ventilation and vital capacity of lungs, based on the use of an air-xenon mixture containing radioactive xenon for respiration. Krypton, aerosol 99Tc is also used. Scintigram of lungs with 99Tc-microspheres of albumin in thromboembolism of small

37. Radiation methods for the study of the respiratory system. Ultrasonic tomography - ultrasound. Pneumothorax (in the right half of the screen) and hydrothorax (left). A bubble of air in the liquid contents of the pleural cavity. Empyema of the pleura. A small amount of air in the pleural cavity. Bronchoectasis in the airless area of ​​the lung in a patient with cystic fibrosis.

38. Radiation diagnosis of the gastrointestinal tract 1. R-esophagus copy 2. R-copy of the stomach 3. R-copy of the small intestine 4. R-copy of large intestine (per os after 24 hours) 5. Irrigoscopy 6. Contrasting the bile excretory system 7. Liver scintigraphy 8. Radiohepatography 9. Ultrasound of the liver, abdomen, stomach, etc. 10. MRI 11. Other diagnostic methods

39. Radiation diagnosis of the gastrointestinal tract. X-ray examination of the esophagus. R-gram of esophagus. The narrowing zone in its middle third (cancer or chemical burn). R-gram of esophagus. 6 months back burn acid. Chemical burn. Stricture. Esophagus from the bowel X-ray examination of the esophagus does not require preparation of the patient. Performed in a standing position. If you can not make a high-quality picture, then the table is moved to a horizontal position.

40. Radiation diagnosis of the gastrointestinal tract. Parietography of the esophagus. Parietography (from the word paries - the wall), a method in which the thickness of the wall of the hollow organ becomes visible due to the introduction of gas both into the cavity of the organ and out of it. Before the era of CT, MRI, ultrasound, this was the only non-invasive method for visualizing the wall thickness of a hollow organ. Esophageal cancer on the R-gram and parietogram of the esophagus The parietogram of the esophagus is normal

41. Radiation diagnosis of the gastrointestinal tract. CT of the esophagus. Reconstructive CT in the sagittal projection. Esophageal cancer (marked by arrows). Axial CT of esophageal cancer (yellow arrow). To the right is a conglomerate of metastases (blue arrow). Axial CT of esophageal cancer. The tumor affects the trachea, but does not affect the aorta.

42. Radiation diagnosis of the gastrointestinal tract. X-ray of the stomach. The radiographic examination of the stomach is the most commonly used X-ray study. Clinical indications: peptic ulcer, chronic gastritis, the stomach neoplasms (polyps, non-epithelial tumors, cancer, sarcoma etc.). Preparations: overnight light supper such as tea and bread. 5 "no" in the morning: no meal, no drink, no smoking, no medications, no tooth brushing. The technology: at first a chest and abdominal radiography during few seconds is performed. Then the esophagography is performed with 1-2 barium swallows. So the radiographic examination of the stomach includes the esophagography. At first the internal view of the gastric mucosa is performed (barium coats the stomach lining). The R-gram of the stomach in the relief phase is normal.

43. Radiation diagnosis of the gastrointestinal tract. X-ray of the stomach. Then the patient takes the rest of the contrast (200 ml). There is an R-logical picture of tight filling of the stomach. A series of pictures is performed (up to 11 R-grams). An obligatory stage is the study of the "critical" zones - cardia, bottom, antrum, bulb 12 n. R-gram of stomach in the phase of tight filling. Endophytic (infiltrative) stomach cancer. Negative. R-Gram of the stomach. Ulcer of small curvature.

44. The X-ray study of the gastro-intestinal tract. Enterography is the examination by means of radiocontrast meal or by introducing the radiocontrast through the duodenal tube. Clinical indiction: intractable constirpation, intractable diarrhea, intestinal bleeding, chronic bowl obstruction etc. Contraindictions: major lower gastrointestinal bleeding, bowel perforation, severe febrile state. 1. While the peroral radiocontrast enhancement (continuing the radiographic examination of the stomach) the repeated X-ray visualization of the small intestine every 15-30 minutes. The location, dimension, configuration, outlines, displaceability and intestinal loop motility are studied. The examination is performed in plantigrade and recumbent positions. While studying the displaceability of the intestinal loop and synechiae testing it is recommended to make images with lateroscope in recumbent, right lateral and left lateral positions.

45. The X-ray study of the gastro-intestinal tract. The disadvantage of this method is its duration, 2-4 hours, it`s a big radiation dose. The introducing of radiocontrast media through the duodenal tube into the small intestine cuts the time of examination. 2. The double contrast entherography. The radiocontrast gas (air or nitrogen oxide) is introduced into the small intestine through the duodenal tube. The X-ray image lets examine the configuration, dimension and location of the small intestine segments, study the view of the intestinal mucosa, malformation of bowel and bowel lumen, signs of functional or mechanical intestinal congestion, congenital malformations etc. Snapshot in positive .

46. The examination with chilled radiocontrast suspension (L.S.Rosenstrauch method): the patient get 200 ml of chilled radiocontrast suspension (+4) in three points with time interval 30 minutes. The low temperature intensifies the motility and the contrast media travels faster, all segments of the small intestine are filling faster, and the duration of the study became shorter - 1-1,5 hours. Then the X-ray pictures are performed. 4. The retrograde administration of barium through the anus. The colon is thoroughly cleaned as for the lower gastrointestinal series. The patient is injected the medications (Atropine, Promedol) for relaxing the ileocaecal valve. The radiocontrast media travels from the colon to the small intestine. The X-ray pictures are performed. When peroral introducing of the suspension, the radiocontrast goes to the cecum in 2,5 hours. Снимки в позитиве.

47. After 3-6 hours the ascending colon is filled, after 12 hours the transverse colon is filled. After 24 hours the large intestine can be fully visualized. Such X-ray study lets detect the motility function disorders, give the image of the length, configuration and tonus of the large intestine, but doesn`t detect the organic diseases (neoplasms, narrowing of the colon lumen etc.). This technology doesn`t need any preparations and is well tolerated by the patients.

48. A lower gastrointestinal series ( irrigoscopy ) Preparations: 3 days without meal causing flatulence (rye bread, crude vegetable fiber, milk), recommended cereal, jelly, omelette , boiled meat and fish.A day before the examination the aged patients get 30 g of castor oil and in evening they get the cleaning enema (to clear water). Light supper. In the morning the patient gets the light breakfast and two cleaning enemas. Another method is taking the laxatives like Fleet phospho -soda and Fortrans (polyethylene glycol, 1 sachet is soluted in 1 l of water, drink a glass every 15 minutes during the hour. Use 3-4 sachets). This method is more effective than enemas preparation.

49. Irrigoscopy The Fortrans is intended for preparation the gastrointestinal tract to the diagnostic examinations (such as colonoscopy and irrigoscopy ) and to the intestinal surgical treatment. The necessary efficiency of the large intestine cleaning can be reached: -without cleaning enemas -without extra laxatives -without longstanding low-roughage diets - withoutexteriorhelp -without abdominal pain and excessive gas

50. Irrigoscopy

51. Irrigoscopy Irrigogram before and after filling with contrast medium

52. Irrigoscopy

53. Cholecystography

54. Peroral radioscopy of the large intestine (the technology of radiocontrast meal) The technology f oral contrast doesn`t guarantee the even filling of all large intestine segments and it is used mainly for studying the functional characteristics of the colon. Up to a point this method can give information about localisation , configuration, dimensions of all large intestine segments, about the haustration spesific nature. Clinical indiction : intractable constirpation , intractable diarrhea, chronic appendicitis, adhesive process in the abdominal cavity etc. Thetechnology . Preparation is not needed. In 3-4 hours after the common gastroduodenal radiography the radiogram of the ileoceacal segment is performed in the real-time. The next visualization and pictures depend on the aim of the examination and on the intestinal motor-evacuation function. Most of all the rough estimate of intestinal functions needs the image after 24 hours. Usually the large intestine is filled by the contrast agent after 24 hours. For the faster examination the method of the chilled barium suspension (by L.S.Rosenstrauch ) is recimmended : taking 50 ml of suspension every 15 minutes during the hour. The large intestine is fully contrasted after 2-3 hours. The travelling of the barium suspension in the large intestine can be faster when 20 g of sorbitol or xylitol is added.    

55. Thank you for attention !