Radiology
Radiology is the medical specialty that uses medical imaging to diagnose diseases and guide treatment within the bodies of humans and other animals. It began with radiography, but today it includes all imaging modalities. This includes technologies that use no ionizing electromagnetic radiation, such as ultrasonography and magnetic resonance imaging, as well as others that do use radiation, such as computed tomography, fluoroscopy, and nuclear medicine including positron emission tomography. Interventional radiology is the performance of usually minimally invasive medical procedures with the guidance of imaging technologies such as those mentioned above.
The modern practice of radiology involves a team of several different healthcare professionals. A radiologist, who is a medical doctor with specialized post-graduate training, interprets medical images, communicates these findings to other physicians through reports or verbal communication, and uses imaging to perform minimally invasive medical procedures The nurse is involved in the care of patients before and after imaging or procedures, including administration of medications, monitoring of vital signs and monitoring of sedated patients. The radiographer, also known as a radiologic technologist in countries such as the United States and Canada, is a specialized healthcare professional who performs radiographic procedures and radiation therapy for the diagnosis and treatment of diseases such as cancer. The images produced through radiographic procedures are used for interpretation by radiologists, and depending on their education, training, and the regulations of the country in which they practice, radiographers in some regions also have an extended role in image interpretation and reporting.
Diagnostic imaging modalities
Projection (plain) radiography
are produced by transmitting X-rays through a patient. The X-rays are projected through the body onto a detector; an image is formed based on which rays pass through versus those that are absorbed or scattered in the patient. Röntgen discovered X-rays on November 8, 1895, and received the first Nobel Prize in Physics in 1901 for this discovery.In film-screen radiography, an X-ray tube generates a beam of X-rays, which is aimed at the patient. The X-rays that pass through the patient are filtered through a device called a grid or X-ray filter, to reduce scatter, and strike an undeveloped film, which is held tightly to a screen of light-emitting phosphors in a light-tight cassette. The film is then developed chemically and an image appears on the film. Film-screen radiography is being replaced by phosphor plate radiography but more recently by digital radiography and the EOS imaging. In the two latest systems, the X-rays strike sensors that converts the signals generated into digital information, which is transmitted and converted into an image displayed on a computer screen. In digital radiography the sensors shape a plate, but in the EOS system, which is a slot-scanning system, a linear sensor vertically scans the patient.
Plain radiography was one of the earliest imaging modalities used in clinical medicine and remained the most widely used for several decades. Due to its broad availability, speed, and relatively low cost, it continues to be a common first-line tool in radiologic evaluation. Despite advances in CT, MRI, and other imaging techniques, there are many conditions in which traditional radiographs remain helpful in diagnosis. These include arthritis, pneumonia, bone tumors, fractures, congenital skeletal anomalies, and certain types of kidney stones.
Mammography and DXA are two applications of low energy projectional radiography, used for the evaluation of breast cancer and osteoporosis, respectively.
Fluoroscopy
Fluoroscopy and angiography are special applications of X-ray imaging, in which a fluorescent screen and image intensifier tube is connected to a closed-circuit television system. This allows real-time imaging of structures in motion or augmented with a radiocontrast agent. Radiocontrast agents are usually administered by swallowing or injecting into the body of the patient to delineate anatomy and functioning of the blood vessels, the genitourinary system, or the gastrointestinal tract. Two radiocontrast agents are presently in common use. Barium sulfate is given orally or rectally for evaluation of the GI tract. Iodine, in multiple proprietary forms, is given by oral, rectal, vaginal, intra-arterial or intravenous routes. These radiocontrast agents strongly absorb or scatter X-rays, and in conjunction with the real-time imaging, allow demonstration of dynamic processes, such as peristalsis in the digestive tract or blood flow in arteries and veins. Iodine contrast may also be concentrated in abnormal areas more or less than in normal tissues and make abnormalities more conspicuous. Additionally, in specific circumstances, air can be used as a contrast agent for the gastrointestinal system and carbon dioxide can be used as a contrast agent in the venous system; in these cases, the contrast agent attenuates the X-ray radiation less than the surrounding tissues.Computed tomography
CT imaging uses X-rays in conjunction with computing algorithms to image the body.In CT, an X-ray tube opposite an X-ray detector in a ring-shaped apparatus rotate around a patient, producing a computer-generated cross-sectional image. CT is acquired in the axial plane, with coronal and sagittal images produced by computer reconstruction. Radiocontrast agents are often used with CT for enhanced delineation of anatomy. Although radiographs provide higher spatial resolution, CT can detect more subtle variations in attenuation of X-rays. CT exposes the patient to significantly more ionizing radiation than a radiograph.
Spiral multidetector CT uses 16, 64, 254 or more detectors during continuous motion of the patient through the radiation beam to obtain fine detail images in a short exam time. With rapid administration of intravenous contrast during the CT scan, these fine detail images can be reconstructed into three-dimensional images of carotid, cerebral, coronary or other arteries.
The introduction of computed tomography in the early 1970s revolutionized diagnostic radiology by providing front-line clinicians with detailed images of anatomic structures in three dimensions. CT scanning has become the test of choice in diagnosing some urgent and emergent conditions, such as cerebral hemorrhage, pulmonary embolism, aortic dissection, appendicitis, diverticulitis, and obstructing kidney stones. Before the development of CT imaging, risky and painful exploratory surgery was often the only way to obtain a definitive diagnosis of the cause of severe abdominal pain which could not be otherwise ascertained from external observation. Continuing improvements in CT technology, including faster scanning times and improved resolution, have dramatically increased the accuracy and usefulness of CT scanning, which may partially account for increased use in medical diagnosis.
Ultrasound
Medical ultrasonography uses ultrasound to visualize soft tissue structures in the body in real time. No ionizing radiation is involved, but the quality of the images obtained using ultrasound is highly dependent on the skill of the person performing the exam and the patient's body size. Examinations of larger, overweight patients may have a decrease in image quality as their subcutaneous fat absorbs more of the sound waves. This results in fewer sound waves penetrating to organs and reflecting back to the transducer, resulting in loss of information and a poorer quality image. Ultrasound is also limited by its inability to image through air pockets or bone. Its use in medical imaging has developed mostly within the last 30 years. The first ultrasound images were static and two-dimensional, but with modern ultrasonography, 3D reconstructions can be observed in real time, effectively becoming "4D".Because ultrasound imaging techniques do not employ ionizing radiation to generate images, they are generally considered safer and are therefore more common in obstetrical imaging. The progression of pregnancies can be thoroughly evaluated with less concern about damage from the techniques employed, allowing early detection and diagnosis of many fetal anomalies. Growth can be assessed over time, important in patients with chronic disease or pregnancy-induced disease, and in multiple pregnancies. Color-flow Doppler ultrasound measures the severity of peripheral vascular disease and is used by cardiologists for dynamic evaluation of the heart, heart valves and major vessels. Stenosis, for example, of the carotid arteries may be a warning sign for an impending stroke. A clot, embedded deep in one of the inner veins of the legs, can be found via ultrasound before it dislodges and travels to the lungs, resulting in a potentially fatal pulmonary embolism. Ultrasound is useful as a guide to performing biopsies to minimize damage to surrounding tissues and in drainages such as thoracentesis. Small, portable ultrasound devices now replace peritoneal lavage in trauma wards by non-invasively assessing for the presence of internal bleeding and any internal organ damage. Extensive internal bleeding or injury to the major organs may require surgery and repair.
Magnetic resonance imaging
MRI uses strong magnetic fields to align atomic nuclei within body tissues, then uses a radio signal to disturb the axis of rotation of these nuclei and observes the radio frequency signal generated as the nuclei return to their baseline states. The radio signals are collected by small antennae, called coils, placed near the area of interest. An advantage of MRI is its ability to produce images in axial, coronal, sagittal and multiple oblique planes with equal ease. MRI scans give the best soft tissue contrast of all the imaging modalities. With advances in scanning speed and spatial resolution, and improvements in computer 3D algorithms and hardware, MRI has become an important tool in musculoskeletal radiology and neuroradiology.One disadvantage is the patient has to hold still for long periods of time in a noisy, cramped space while the imaging is performed. Claustrophobia severe enough to terminate the MRI exam is reported in up to 5% of patients. Recent improvements in magnet design including stronger magnetic fields, shortening exam times, wider, shorter magnet bores and more open magnet designs, have brought some relief for claustrophobic patients. However, for magnets with equivalent field strengths, there is often a trade-off between image quality and open design. MRI has great benefit in imaging the brain, spine, and musculoskeletal system. The use of MRI is currently contraindicated for patients with pacemakers, cochlear implants, some indwelling medication pumps, certain types of cerebral aneurysm clips, metal fragments in the eyes, some metallic hardware due to the powerful magnetic fields, and strong fluctuating radio signals to which the body is exposed. Areas of potential advancement include functional imaging, cardiovascular MRI, and MRI-guided therapy.