ＩＮＴＲＯＤＵＣＴＩＯＮ　ＴＯ　ＲＡＤＩＯＬＯＧＹ

RADIOLOGY Radiology Dept. The 2 nd Affiliated Hospital SYS U. Prof. BL Liang, MD.

General introduction The concept of Radiology The basic principles of X-ray The clinic application of Radiology The principle for image interpretation MRI – basic knowledge CT- basic principles & application

Imaging Technology Diagnostic radiology X-ray Introduction CT Radiography 1895 Ultrasound Radionuclide imaging MRI 1950’ 1972 1973 1977 1950’ DSA

X-RAY 的发现人类第一张 X 线照片发现 X 线时的伦琴 Wilhelm Conrad Roentgen discovered X-rays in 1895 The discovery of X-rays Wilhelm Conrad Roentgen The 1st X-ray film of human

总论 ---- 学科构成 ( 时间发展 ) Diagnostic radiology Radiography Ultrasound Radionuclide imaging Computed Tomography Magnetic Resonance Imaging Digital Subtraction Angiography Radiology Introduction The development of radiology 计算机体层成像 X 线成像 1895 年超声诊断核素扫描磁共振成像 1950’ 1972 年 1973 年 1977 年 1950’ 数字减影血管造影 Diagnostic imaging/ Medical Imaginology

The modality of radiology Introduction Radiology diagnosis Radiography CT Radionuclide imaging Interventional radiology MRI Ultrasound X-ray X-ray nucleus X-ray Radionuclide echo treatment

CT MRI Ultrasound ECT 医学影像学科构成 DSA 普通 X 线 CT MRI ECT Technology of Radiology DSA Radiography

SUN YAT SEN Memorial Hospital / Guangzhou, China Inspace 4D 心脏运动情况 SOMATOM Sensation 64 with z-sharp 10 sec for 30mm 64 x 0.6mm Resolution < 0.4 mm Rotation 0.33 sec 120 kV 770 effective mAs

MRI 前颅窝底嗅沟嗅母细胞瘤 MRI tumor in anterior cranial fossa

MRI 3D 重建－模拟手术－－前颅窝底嗅沟嗅母细胞瘤 Surgical simulation

影像导航外科手术 Image-guided Surgery

影像导航外科手术 MRI/Glioblastoma Image-guided Surgery

PACS P icture A chieve & C ommunication S ystem storage storage

PACS diagnosis Patient ward teaching administraton scaning

Image Distribution Scenarios PACS All examinations from 8 pm to 6 am to Dr. Smith’s home (on call) All CT examinations always to reading room 1 All chest examinations from Dr. Miller to his office from 9 am to 3 pm

The basic principles of X-ray The application of Radiology The Pearl of This Morning

The basic principles of X-ray A 、 X-ray production B 、 The nature of X-ray C 、 principles of radiography ---- concept of X-ray density

A 、 X-ray production （ cathode- ） electrons high voltage （ anode+ ） tungsten target heat X-ray （ 99.8% ）（ 0.2% ） Electrons stream The voltage difference between The electrons accelerated - ->+ 3 factors X-ray tube X-ray generator X-ray tube

X 线球管 X-ray tube 热阴极阳极电子群 X-ray 0.2% Cathode - Anode + heat electrons The capability of penetration related to tube voltage Higher voltage, shorter wavelength, stronger penetrating ability

B 、 The nature of X-ray Fluoroscopy Radiotherapy radiation injury Filming Penetrating effect Fluorescent effect Photosensitive effect Ionization effect Imaging&Therapy

辐射防护 Radiation protection Technology 技术学 Shield protection - plumbum Distance protection – max. the distance from the radiation source Patient 病人 Choose appropriate image methods Min. the time near the radiation source Radiologist & technician 医务人员 Shield the radiation source Shield the patient & personnel

C 、 the principles of radiography 3 aspects ： X-ray penetration The differences between tissues Natural contrast ： The X-ray absorption is diff. among the tissues density ： atoms – number & density thickness ： Artificial contrast ： contrast media X-ray detector ： fluorescent effect photosensitive effect ★

三、 X 线成像基本原理 detector 组织间密度差异荧光屏 screen 片盒、胶片 film 检测器 detector difference penetration C 、 the principles of radiography 穿透性

3 factors ： X-ray penetration The differences between tissues Natural contrast ： The X-ray absorption is diff. among the tissues density ： atoms – heavy & amount thickness ： Artificial contrast ： contrast media X-ray detector ： fluorescent effect photosensitive effect ★ C 、 the principles of radiography

三、 X 线成像基本原理 ---- 密度的概念  与组织的密度有关  与组织的厚度有关厚度 thickness 密度 density X-ray Tissue density Tissue thickness Barium sulfate iodide water air C 、 the principles of radiography characteristics 硫酸钡碘酊水空气

三、 X 线成像原理 ---- 密度的概念收音机钢笔钳子 X -ray C 、 the principles of radiography characteristics

三、 X 线成像基本原理 ---- 影像密度密度的概念自然对比 C 、 the principles of radiography Natural contrast

X 线成像基本原理 ---- 影像密度自然对比 Chest plain film ： best X-ray contrast 密度的概念 C 、 the principles of radiography Natural contrast tissue Density / thickness X-ray rib calcium high lung air low fat loose Medium-L muscle dense Medium heart thick Medium-H m. pectoral major thin Medium

正常腹部平片膀胱结石肾结石密度的概念影像密度自然对比 Normal KUB urinary bladder calculus renal calculus Abdomen plain film Natural contrast of radiography

密度的概念影像密度自然对比左输尿管结石 ureteral calculus 左肾结石 Renal calculus 节育环 Natural contrast of radiography

Some organ / tissues lack of natural contrast, then CM are used to highlight special parts of the body and make them easier to observe during the exam Indication: vessels, hollow organ The CM must be safe, nonpoisonous Type ： High density CM ： Ba 、 iodide Low density CM ： air 密度的概念 C 、 the principles of radiography Artificial contrast contrast media application

影像密度人工对比－ contrast media application type ： Low density ： gas ： double-contrast GI tract, arthrography High density 密度的概念 Artificial contrast of radiography

影像密度人工对比 -- contrast media application High density ： Ba ： non-absorbable GI tract exam （ esophagus 、 GI 、 colon ） Iodide ： Water-soluble （ absorbable ）， excreted by urinary /biliary tract urography （ urinary system ） T-tube cholangiography ， angiography Oily ： non-absorbable fistulography 密度的概念 Artificial contrast of radiography

造影剂种类－高密度碘水溶液 contrast media – high density Barium sulfate Iodide

-- X-ray density artificial contrast contrast media application Induce methods ： direct ： oral ： esophageal & GI. Tract exam perfusion ： Ba-enema 、 retro-urography 、 uterography 、 fistulography penetration ： trans- catheter indirect ： excrete by uritary / biliary oral ： biliography Iv. injection ： excretory biliography 、 excretory urography 密度的概念 C 、 the principles of radiography

造影剂的使用直接引入 Direct induce 口服法 oral 胃肠钡餐检查密度的概念双对比造影 Low 低密度－气 air High 高密度－钡 Ba contrast media application Double contrast GI.

造影剂的使用直接引入 Direct induce 灌注法 perfusion 双对比钡剂灌肠密度的概念 contrast media application Double contrast enema

造影剂的使用直接引入 Direct induce 灌注法 perfusion Retrograde urography 密度的概念 contrast media application

造影剂的使用直接引入－膀胱尿道造影密度的概念高密度造影－碘低密度造影－气 contrast media application High CM radiography Low CM radiography Direct induce -- cystourethrography

造影剂的使用直接引入 direct induce uterosalpingography 密度的概念 contrast media application

造影剂的使用直接引入 direct induce 穿刺引入法 iv. injection 心、脑血管造影密度的概念 contrast media application Cardio & cerebral Angiography

造影剂的使用间接引入 indirect induce 分泌性胆囊造影 excretory biliography 密度的概念 contrast media application

造影剂的使用间接引入 indirect induce 排泄性尿路造影静脉性肾盂造影 Descending excretory urography 密度的概念 contrast media application

造影剂的使用间接引入 indirect induce 排泄性尿路造影静脉性肾盂造影密度的概念 contrast media application

三、 X 线成像基本原理荧光屏 screen 片盒、胶片 film 检测器 detector C 、 the principles of radiography

--- X-ray detector diff. modality with diff. detector C 、 the principles of radiography X-ray detector analog digital screen film Image Intensifier Digital detector fluoroscopy fluorography Plain film tomography recorder CT DSA DR / CR / DSI

数字影像透视 - 今天 Electron Image Intensifier (I.I.) TV PickupTube ( 摄像管或 CCD) X-Ray Light Tube 乳腺片 & 普通拍片 - 今天 Phosphor Film Light X-Ray 模拟影像 Tube X-Ray X-Ray 模拟影像 Digital Medical Image Mammo & plain film - today Fluoroscopy - today All medical image – digital detector – today & tomorrow Analog image Analog image Digital image Detector ( 数字平板 ,Flat panel) Tube X-Ray X-Ray 所有的应用－数字式探测器－今天 & 明天数字影像

X 线检查方法（模拟 or 数字） X 线普通检查 X 线透视 X 线平片 X 线特殊检查体层摄影软线摄影荧光摄影 X 线特殊造影胃肠道气钡双对比造影排泄性造影： IVP 、 IVC 血管造影（介入放射学） CT X-ray routine exam fluoroscopy Plain film X-ray special exam tomography mammography fluorography X-ray special exam GI. Tract Double-contrast Excrete radiography ： IVP 、 IVC angiography CT Technology of exam by X-ray （ analog/digital ）

四、影像学检查方法及应用检查方法从简 simple 严格掌握适应症和禁忌症 indication 应用的合理性原则 reasonable 尽量减少病人痛苦和经济负担 comfortable & economic The modality of choice

X 线普通检查 ---- 透视、平片 The routine X-ray exam – fluoroscopy , plain film

X 线透视－荧光屏 Fluoroscopy - screen

X 线普通检查 -- 透视、平片 plain film

 X 线检测器为数字平板－ DR 影像信息板－ CR DR Detector - digital Flat Panel - DR Imaging Panel - CR 1

 操作简单方便 , 病人流通快 DR 2

数字影像 Digital radiography

动态范围调节 -- 想看什么 , 就看什么 ! Dynamic manipulation 数字影像 Digital radiography Dynamic Range Management Can Mimic Look of Film... … or many different looks such as a soft-tissue look … or a Bone Look Image Brightness X-ray Detected Spine, Diaphragm Lung, Skin Line Soft Tissue Spine, Diaphragm Lung, Skin Line Soft Tissue Dense Breast Skin Line Typical Breast Mass Spine, Diaphragm Lung, Skin Line Soft Tissue Dense Breast Skin Line Typical Breast Mass Spine, Diaphragm Lung, Skin Line Soft Tissue

数字影像 ---- 强大的后处理功能边缘增强 Edge enhancement 局部放大 Regional magnify 图像反转 Imaging conversion 放大 & 漫游 Magnification & Digital radiography -- Powerful post-processing

舟骨骨折 Digital radiography magnification

卧位立位 Dynamic window judgment

X 线特殊检查 ---- 体层摄影－ X 线球管与胶片同步反向运动 special radiography - tomography

X 线特殊检查 ---- 体层摄影 special radiography - tomography

X 线特殊检查 ---- 软线摄影（钼靶） special radiography - mammography

X 线特殊造影 ---- 胃肠道气钡双对比造影 special exam – GI tract double contrast

X 线特殊造影 ---- 排泄性造影： IVP special radiography - IVP

X 线特殊造影 ---- 血管造影（介入放射学） special radiography - angiography Interventional Radiology

X 线特殊检查 ---- 体层摄影（ CT ）计算机体层扫描（ Computed tomography, 简称 CT ）是由英国科学家 Hounsfield 于 1969 年首先设计成功，于 1972 年在英国放射学会学术会议上宣布，并于 1979 年获得了诺贝尔医学生物学奖。 special radiography -- CT CT was invented in 1972 by British engineer Godfrey Hounsfield of EMI Lab. In England, and was awarded the Nobel Price in 1979

CT 成像基本原理 The basic principles of CT CT 是用准直后的 X 线束对人体的某一层面从不同的角度进行照射，用探测器接受到各种原始数据，经计算机重建后产生显示数据矩阵，并在显示器或胶片上成象的 X 线诊断设备。 CT uses a beam of highly collimated X-ray to scan a desired section of the object. CT X-ray computer The X-ray beam go through the object in 360 º, detector placed on the opposite direction to detect the surplus X-ray , the signal -> electronic and coded as signal number ->computer ->monitor Cross section imaging The CT imaging consisted with many uniform cuboids, which is called “voxel”.

CT 成像基本原理 The basic principles of CT 体素与像素 voxel & pixel Voxel -> pixel (displayed as gray-scaled cuboids), is arrayed as digital matrix

像素（ pixel ）的大小与数目像素是体素（ voxel ）在成像时的表现，像素 =Fov/ 矩阵 i.e.. Fov 350mm matrix pixel size 128×128 7.467mm 256×256 1.867 mm 320×320 1.196mm 512×512 0.47 mm 1024×1024 0.117mm Pixel is represented the voxel in imaging, Pixel (displayed as gray-scaled cuboids) size and number determined the imaging quality and display details. The pixel size, the smaller the better imaging quality

CT 成像基本原理－像素的大小与图像清晰度 128×128 256×256 The basic principle of CT － the pixel size & imaging quality

CT 设备 ---- 普通 CT 的发展 The CT development 1st 2nd 3rd 4th

X 线特殊检查 ---- 体层摄影（ CT ） X-ray special exam --- CT CT 的成象过程是用 X 线束围绕人体某一选定部位作 360 度的匀速旋转扫描，穿过人体的 X 线经检测器接收，转变为数字信号经计算机存储、运算并重建为断层图象。 The X-ray beam go through the object in 360 º, detector placed on the opposite direction to detect the surplus X-ray Cross section imaging

CT 值标度 CT density scale CT 值：说明某一组织密度高低的程度，反应了器官或组织对 X 线的吸收程度，以 Hu （ Hounsfield Unit ）表示定义对空气和水的衰减的 CT 值 Hounsfield 标度中空气为 -1000 水为 0 致密骨为 1000 CT value ： represented the mean attenuation of the tissue contained within the voxel. HU （ Hounsfield Unit ） By means of internal calibration of the scanner, the density value of the body tissues are expressed in relation of this scale. Hounsfield scale: air -1000 HU water 0 HU dense bone 1000 HU bone Soft tissue water fat air

The classification of CT scan Conventional CT Ordinary scan High resolution scan Spiral CT Single slice spiral Multi-detector spiral , MDCT/ MSCT

普通 CT 扫描 conventional CT 高分辨率 CT 扫描 High resolution CT

CT 设备 ---- 螺旋 CT Spiral CT Conventional CT spiral CT

CT 设备 ---- 螺旋 CT 单层 Single slice 单层螺旋 single spiral 多层螺旋 multi-slice spiral

多层螺旋 CT— 多排探测器 1998 年研制成功多排探测器 2 、 4 、 8 、 16 、 32 、 64 …… 320 平板探测器 ·

X 线特殊检查 ---- 体层摄影（ CT ）

64 层螺旋 CT 在我院目前的应用情况头颅五官

CT:linda 右下肺前基底段亚段肺梗塞胸部 chest Right lobe infarction

右下肺前基底段亚段肺梗塞胸部 chest Right lobe infarction

正常冠脉 VRT 重建胸部 chest Normal coronary artery CT reconstruction

心脏冠脉 MIP Normal coronary artery CT reconstruction

评价投照条件分析病变五、影像学诊断步骤肯定性诊断否定性诊断可能性诊断结合临床资料综合分析核对病人的姓名、年龄、号码、日期 Image quality Image analysis Image diagnosis The procedure of radiology diagnosis Check patient’s Name , gender , age Exam time

评价投照技术 image quality 摄影位置 position 摄影条件 X-ray power 照片质量 image Q 有无异物 artifact

影像学诊断原则 diagnosis steps 明辨正常 normal 分析异常 abnormal 结合临床 clinical 综合诊断 diagnosis

影像学诊断步骤 ---- 明辨正常 normal

影像学诊断步骤 ---- 分析病变 abnormal 病变部位分布 position 大小、数目 size & number 形态 appearance 边缘 margin 密度 X-ray density 邻近器官、组织变化器官功能改变 func. 动态变化 dynemic

影像学诊断步骤 ---- 结合临床，综合诊断发热，寒战，胸痛伴咳嗽咳痰，痰液放置后有分层改变 Clinical information Fever, cough with rusty & yellowish sputum 急性肺脓肿 acute lung abscess

MRI Magnetic Resonance Imaging Sun Yat-sen Memorial Hospital of SYSU Biling Liang MD

MRI – uses magnetic field and radio frequency waves to detect Hydrogen atoms, can detect body chemical composition and tissue structure, it is computer generated imaging.

The history of MRI 1946 discovered the nuclear magnetic resonance phenomenon Bloch,Purcell 1972 created the MR image Lauterbur 1980 MRI equipment marketing 1986 1st set MRI installed in China

Basic principle Magnetic Resonance Imaging MR imaging （ MRI ） MR MR Exam phenomenon MR spectroscopy （ MRS ）

The MR image is the H + atom image

Nuclear & Resonance behavior

Relaxation Decay Excitation N S

MR imaging processing Coil RF Shutdown RF Positioning The patient Coil receiver Computer MR diagnosis

The relaxation process can described as T 1 & T 2 T 1 is the time taken for approximately 63% of the longitudinal magnetization to be restored following a 90°pulse T 2 is the time taken for 37% of the transverse magnetization decay

The common MRI sequences T 1 weighted , T 1 W Short TR , short TE T 2 weighted , T 2 W Long TR , long TE Proton Density weighted , PD Long TR , short TE

MR signal intensity SE sequence ： --T 1 W fat SI strong ， best display the anatomic structure T 2 W water SI strong ， easy to detect lesion PD display proton density GRE sequence ： flip angle ， scan speed faster than SE ， signal intensity mimic SE IR sequence ： fat 、 water suppression

Fat suppression Water suppression

normal MRCP chronic pancreatitis MRI water imaging technique

The tissue T 1 、 T 2 value tissue T 1 T 2 muscle 600 40 liver 270 50 spleen 480 80 fat 180 90 white matter 350 90 gray matter 520 100 blood 800 180 CSF 2000 300 water 2500 2500

MR signal intensity Tissue relaxation time （ T 1 & T 2 ） H + density --- imaging Blood / liquid flow --- MR-angio （ MRA ）

MRS (spectroscopy) Non invasive detect the tissue chemical composition in vivo NAA 、 Creatine 、 Lactate 、 Lat 、 Choline Evaluated the treatment effect, tissue ischemia,et al.

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