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"An excellent primer on medical imaging for all members of the medical profession . . . including non-radiological specialists. It is technically solid and filled with diagrams and clinical images illustrating important points, but it is also easily readable . . . So many outstanding chapters . . . The book uses little mathematics beyond simple algebra [and] presents complex ideas in very understandable terms." - Melvin E. Clouse , MD, Vice Chairman Emeritus, Department of Radiology, Beth Israel Deaconess Medical Center and Deaconess Professor of Radiology, Harvard Medical School A…mehr
"An excellent primer on medical imaging for all members of the medical profession . . . including non-radiological specialists. It is technically solid and filled with diagrams and clinical images illustrating important points, but it is also easily readable . . . So many outstanding chapters . . . The book uses little mathematics beyond simple algebra [and] presents complex ideas in very understandable terms." -Melvin E. Clouse, MD, Vice Chairman Emeritus, Department of Radiology, Beth Israel Deaconess Medical Center and Deaconess Professor of Radiology, Harvard Medical School
A well-known medical physicist and author, an interventional radiologist, and an emergency room physician with no special training in radiology have collaborated to write, in the language familiar to physicians, an introduction to the technology and clinical applications of medical imaging. It is intentionally brief and not overly detailed, intended to help clinicians with very little free time rapidly gain enough command of the critically important imaging tools of their trade to be able to discuss them confidently with medical and technical colleagues; to explain the general ideas accurately to students, nurses, and technologists; and to describe them effectively to concerned patients and loved ones. Chapter coverage includes:
Introduction: Dr. Doe's Headaches
Sketches of the Standard Imaging Modalities
Image Quality and Dose
Creating Subject Contrast in the Primary X-Ray Image
Twentieth-Century (Analog) Radiography and Fluoroscopy
Radiation Dose and Radiogenic Cancer Risk
Twenty-First-Century (Digital) Imaging
Digital Planar Imaging
Computed Tomography
Nuclear Medicine (Including SPECT and PET)
Diagnostic Ultrasound (Including Doppler)
MRI in One Dimension and with No Relaxation
Mapping T1 and T2 Proton Spin Relaxation in 3D
Evolving and Experimental Modalities
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Autorenporträt
Anthony Brinton Wolbarst, PhD, a physicist formerly at Harvard Medical School, the National Cancer Institute, and the U.S. Environmental Protection Agency, is currently an Associate Professor at the University of Kentucky College of Health Sciences, Division of Radiation Sciences and College of Medicine, Department of Diagnostic Radiology in Lexington, Kentucky, USA.
Patrizio Capasso, MD, is Professor and Division Chief of Vascular & Interventional Radiology in the Departments of Diagnostic Radiology and Surgery at the University of Kentucky Chandler Medical Center Lexington, Kentucky, USA.
Andrew R. Wyant, MD, is Assistant Professor for Physician Assistant Studies at the University of Kentucky Chandler Medical Center Lexington, Kentucky, USA. Among many other courses that he teaches is a popular clinical skills seminar in in Radiographic Interpretation.
Inhaltsangabe
Preface x Acknowledgments xiii Introduction: Dr. Doe's Headaches: An Imaging Case Study xiv Computed tomography xiv Picture archiving and communication system xv T1, T2, and FLAIR MRI xvi MR spectroscopy and a virtual biopsy xvii Functional MRI xviii Diffusion tensor MR imaging xviii MR guided biopsy xx Pathology xxi Positron emission tomography? xxi Treatment and follow-up xxii 1 Sketches of the Standard Imaging Modalities: Different Ways of Creating Visible Contrast Among Tissues 1 "Roentgen has surely gone crazy!" 2 Different imaging probes interact with different tissues in different ways and yield different kinds of medical information 4 Twentieth-century (analog) radiography and fluoroscopy: contrast from differential attenuation of X-rays by tissues 7 Twenty-first century (digital) images and digital planar imaging: computer-based images and solid-state image receptors 16 Computed tomography: three-dimensional mapping of X-ray attenuation by tissues 17 Nuclear medicine, including SPECT and PET: contrast from the differential uptake of a radiopharmaceutical by tissues 20 Diagnostic ultrasound: contrast from differences in tissue elasticity or density 26 Magnetic resonance imaging: mapping the spatial distribution of spin-relaxation times of hydrogen nuclei in tissue water and lipids 28 Appendix: selection of imaging modalities to assist in medical diagnosis 30 References 36 2 Image Quality and Dose: What Constitutes a "Good" Medical Image? 37 A brief history of magnetism 37 About those probes and their interactions with matter . . . 39 The image quality quartet: contrast, resolution, stochastic (random) noise, artifacts - and always dose 47 Quality assurance 57 Known medical benefits versus potential radiation risks 61 3 Creating Subject Contrast in the Primary X-ray Image: Projection Maps of the Body from Differential Attenuation of X-rays by Tissues 67 Creating a (nearly) uniform beam of penetrating X-rays 69 Interaction of X-ray and gamma-ray photons with tissues or an image receptor 75 What a body does to the beam: subject contrast in the pattern of X-rays emerging from the patient 83 What the beam does to a body: dose and risk 87 4 Twentieth-century (Analog) Radiography and Fluoroscopy: Capturing the X-ray Shadow with a Film Cassette or an Image Intensifier Tube plus Electronic Optical Camera Combination 91 Recording the X-ray pattern emerging from the patient with a screen-film image receptor 92 Prime determinants/measures of image quality: contrast, resolution, random noise, artifacts, . . . and, always, patient dose 98 Special requirements for mammography 114 Image intensifier-tube fluoroscopy: viewing in real time 122 Conclusion: bringing radiography and fluoroscopy into the twenty-first century with solid-state digital X-ray image receptors 125 Reference 126 5 Radiation Dose and Radiogenic Risk: Ionization-Induced Damage to DNA can cause Stochastic, Deterministic, and Teratogenic Health Effects - And How To Protect Against Them 127 Our exposure to ionizing radiation has doubled over the past few decades 127 Radiation health effects are caused by damage to DNA 129 Stochastic health effects: cancer may arise from mutations in a single cell 132 Deterministic health effects at high doses: radiation killing of a large number of tissue cells 139 The Four Quartets of radiation safety 146 References 151 6 Twenty-first Century (Digital) Imaging: Computer-Based Representation, Acquisition, Processing, Storage, Transmission, and Analysis of Images 152 Digital computers 153 Digital acquisition and representation of an image 157 Digital image processing: enhancing tissue contrast, SNR, edge sharpness, etc. 166 Computer networks: PACS, RIS, and the Internet 168 Image analysis and interpretation: computer-assisted detection 170 Computer and computer-network security 172 Liquid crystal displays and other digital displays 173 The joy of digital 174 7 Digital Planar Imaging: Replacing Film and Image Intensifiers with Solid State, Electronic Image Receptors 176 Digital planar imaging modalities 176 Indirect detection with a fluorescent screen and a CCD 178 Computed radiography 178 Digital radiography with an active matrix flat panel imager 179 Digital mammography 184 Digital fluoroscopy and digital subtraction angiography 186 Digital tomosynthesis: planar imaging in three dimensions 189 References 190 8 Computed Tomography: Superior Contrast in Three-Dimensional X-Ray Attenuation Maps 191 Computed tomography maps out X-ray attenuation in two and three dimensions 192 Image reconstruction 198 Seven generations of CT scanners 204 Technology and image quality 208 Patient- and machine-caused artifacts 219 Dose and QA 221 Appendix: mathematical basis of filtered back-projection 229 References 233 9 Nuclear Medicine: Contrast from Differential Uptake of a Radiopharmaceutical by Tissues 234 Unstable atomic nuclei: radioactivity 235 Radiopharmaceuticals: gamma- or positron-emitting radionuclei attached to organ-specific agents 245 Imaging radiopharmaceutical concentration with a gamma camera 248 Static and dynamic studies 254 Tomographic nuclear imaging: SPECT and PET 260 Quality assurance and radiation safety 270 References 273 10 Diagnostic Ultrasound: Contrast from Differences in Tissue Elasticity or Density Across Boundaries 274 Medical ultrasound 274 The US beam: MHz compressional waves in tissues 277 Production of an ultrasound beam and detection of echoes with a transducer 280 Piezoelectric transducer elements 281 Transmission and attenuation of the beam within a homogeneous material 285 Reflection of the beam at an interface between materials with different acoustic impedances 288 Imaging in 1 and 1 × 1 dimensions: A- and M-modes 291 Imaging in two, three, and four dimensions: B-mode 294 Doppler imaging of blood flow 300 Elastography 302 Safety and QA 303 11 MRI in One Dimension and with No Relaxation: A Gentle Introduction to a Challenging Subject 307 Prologue to MRI 308 "Quantum" approach to proton nuclear magnetic resonance 310 Magnetic resonance imaging in one dimension 316 "Classical" approach to NMR 321 Free induction decay imaging (but without the decay) 331 Spin-echo imaging (still without T1 or T2 relaxation) 338 MRI instrumentation 343 Reference 351 12 Mapping T1 and T2 Relaxation in Three Dimensions 352 Longitudinal spin relaxation and T1 353 Transverse spin relaxation and T2-w images 364 T2¿ and the gradient-echo (G-E) pulse sequence 372 Into two and three dimensions 374 MR imaging of fluid movement/motion 382 13 Evolving and Experimental Modalities 387 Optical and near-infrared imaging 388 Molecular imaging and nanotechnology 390 Thermography 392 Terahertz (T-ray) imaging of epithelial tissues 393 Microwave and electron spin resonance imaging 393 Electroencephalography, magnetocardiography, and impedance imaging 394 Photo-acoustic imaging 396 Computer technology: the constant revolution 397 Imaging with a crystal ball 399 References 399 Suggested Further Reading 400 Index 403
Preface x Acknowledgments xiii Introduction: Dr. Doe's Headaches: An Imaging Case Study xiv Computed tomography xiv Picture archiving and communication system xv T1, T2, and FLAIR MRI xvi MR spectroscopy and a virtual biopsy xvii Functional MRI xviii Diffusion tensor MR imaging xviii MR guided biopsy xx Pathology xxi Positron emission tomography? xxi Treatment and follow-up xxii 1 Sketches of the Standard Imaging Modalities: Different Ways of Creating Visible Contrast Among Tissues 1 "Roentgen has surely gone crazy!" 2 Different imaging probes interact with different tissues in different ways and yield different kinds of medical information 4 Twentieth-century (analog) radiography and fluoroscopy: contrast from differential attenuation of X-rays by tissues 7 Twenty-first century (digital) images and digital planar imaging: computer-based images and solid-state image receptors 16 Computed tomography: three-dimensional mapping of X-ray attenuation by tissues 17 Nuclear medicine, including SPECT and PET: contrast from the differential uptake of a radiopharmaceutical by tissues 20 Diagnostic ultrasound: contrast from differences in tissue elasticity or density 26 Magnetic resonance imaging: mapping the spatial distribution of spin-relaxation times of hydrogen nuclei in tissue water and lipids 28 Appendix: selection of imaging modalities to assist in medical diagnosis 30 References 36 2 Image Quality and Dose: What Constitutes a "Good" Medical Image? 37 A brief history of magnetism 37 About those probes and their interactions with matter . . . 39 The image quality quartet: contrast, resolution, stochastic (random) noise, artifacts - and always dose 47 Quality assurance 57 Known medical benefits versus potential radiation risks 61 3 Creating Subject Contrast in the Primary X-ray Image: Projection Maps of the Body from Differential Attenuation of X-rays by Tissues 67 Creating a (nearly) uniform beam of penetrating X-rays 69 Interaction of X-ray and gamma-ray photons with tissues or an image receptor 75 What a body does to the beam: subject contrast in the pattern of X-rays emerging from the patient 83 What the beam does to a body: dose and risk 87 4 Twentieth-century (Analog) Radiography and Fluoroscopy: Capturing the X-ray Shadow with a Film Cassette or an Image Intensifier Tube plus Electronic Optical Camera Combination 91 Recording the X-ray pattern emerging from the patient with a screen-film image receptor 92 Prime determinants/measures of image quality: contrast, resolution, random noise, artifacts, . . . and, always, patient dose 98 Special requirements for mammography 114 Image intensifier-tube fluoroscopy: viewing in real time 122 Conclusion: bringing radiography and fluoroscopy into the twenty-first century with solid-state digital X-ray image receptors 125 Reference 126 5 Radiation Dose and Radiogenic Risk: Ionization-Induced Damage to DNA can cause Stochastic, Deterministic, and Teratogenic Health Effects - And How To Protect Against Them 127 Our exposure to ionizing radiation has doubled over the past few decades 127 Radiation health effects are caused by damage to DNA 129 Stochastic health effects: cancer may arise from mutations in a single cell 132 Deterministic health effects at high doses: radiation killing of a large number of tissue cells 139 The Four Quartets of radiation safety 146 References 151 6 Twenty-first Century (Digital) Imaging: Computer-Based Representation, Acquisition, Processing, Storage, Transmission, and Analysis of Images 152 Digital computers 153 Digital acquisition and representation of an image 157 Digital image processing: enhancing tissue contrast, SNR, edge sharpness, etc. 166 Computer networks: PACS, RIS, and the Internet 168 Image analysis and interpretation: computer-assisted detection 170 Computer and computer-network security 172 Liquid crystal displays and other digital displays 173 The joy of digital 174 7 Digital Planar Imaging: Replacing Film and Image Intensifiers with Solid State, Electronic Image Receptors 176 Digital planar imaging modalities 176 Indirect detection with a fluorescent screen and a CCD 178 Computed radiography 178 Digital radiography with an active matrix flat panel imager 179 Digital mammography 184 Digital fluoroscopy and digital subtraction angiography 186 Digital tomosynthesis: planar imaging in three dimensions 189 References 190 8 Computed Tomography: Superior Contrast in Three-Dimensional X-Ray Attenuation Maps 191 Computed tomography maps out X-ray attenuation in two and three dimensions 192 Image reconstruction 198 Seven generations of CT scanners 204 Technology and image quality 208 Patient- and machine-caused artifacts 219 Dose and QA 221 Appendix: mathematical basis of filtered back-projection 229 References 233 9 Nuclear Medicine: Contrast from Differential Uptake of a Radiopharmaceutical by Tissues 234 Unstable atomic nuclei: radioactivity 235 Radiopharmaceuticals: gamma- or positron-emitting radionuclei attached to organ-specific agents 245 Imaging radiopharmaceutical concentration with a gamma camera 248 Static and dynamic studies 254 Tomographic nuclear imaging: SPECT and PET 260 Quality assurance and radiation safety 270 References 273 10 Diagnostic Ultrasound: Contrast from Differences in Tissue Elasticity or Density Across Boundaries 274 Medical ultrasound 274 The US beam: MHz compressional waves in tissues 277 Production of an ultrasound beam and detection of echoes with a transducer 280 Piezoelectric transducer elements 281 Transmission and attenuation of the beam within a homogeneous material 285 Reflection of the beam at an interface between materials with different acoustic impedances 288 Imaging in 1 and 1 × 1 dimensions: A- and M-modes 291 Imaging in two, three, and four dimensions: B-mode 294 Doppler imaging of blood flow 300 Elastography 302 Safety and QA 303 11 MRI in One Dimension and with No Relaxation: A Gentle Introduction to a Challenging Subject 307 Prologue to MRI 308 "Quantum" approach to proton nuclear magnetic resonance 310 Magnetic resonance imaging in one dimension 316 "Classical" approach to NMR 321 Free induction decay imaging (but without the decay) 331 Spin-echo imaging (still without T1 or T2 relaxation) 338 MRI instrumentation 343 Reference 351 12 Mapping T1 and T2 Relaxation in Three Dimensions 352 Longitudinal spin relaxation and T1 353 Transverse spin relaxation and T2-w images 364 T2¿ and the gradient-echo (G-E) pulse sequence 372 Into two and three dimensions 374 MR imaging of fluid movement/motion 382 13 Evolving and Experimental Modalities 387 Optical and near-infrared imaging 388 Molecular imaging and nanotechnology 390 Thermography 392 Terahertz (T-ray) imaging of epithelial tissues 393 Microwave and electron spin resonance imaging 393 Electroencephalography, magnetocardiography, and impedance imaging 394 Photo-acoustic imaging 396 Computer technology: the constant revolution 397 Imaging with a crystal ball 399 References 399 Suggested Further Reading 400 Index 403
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