Applications of Diagnostic Imaging X-Ray Gerald R. Aben, MD, FACR Department of Radiology College of Osteopathic Medicine Michigan State University In this presentation, I would like to discuss some of the applications of X-Ray. 1/1/2019 Department of Radiology

Department of Radiology X-Ray Ionizing radiation Exposure concerns Somewhat limited discrimination between structures of similar density Tumor vs. normal organs Inexpensive Readily available First line imaging tool For the remainder of this lecture I would like to review some of the issues related to the various imaging modalities and some of their applications. This will be fleshed out and discussed in more detail as we go into the various units as well as well as we go through the on-line modules. When talking about x-ray we are talking about an ionizing radiation, so one of our primary concerns must be of exposure concern. We must be concerned that we do not overexpose our patients and we have some control of the exposure our patients receive to ionizing radiation. X-ray allows for somewhat limited discrimination between structures of similar density, for example separation of neoplasm from normal organ structures. The positives of x-ray include the fact that is relatively inexpensive, it is readily available, and it has become our first line imaging tool for a variety of abnormalities and conditions. 1/1/2019 Department of Radiology

Department of Radiology X-Ray Primary applications: Chest Imaging Infiltrates Masses Cardiac silhouette Abdominal imaging Gas/ bowel distribution Free air Calcifications Organomegaly/ masses Some of the primary applications of radiology include chest imaging where x-ray can be utilized in evaluation for infiltrate mass or cardiac abnormalities in shape and size. In the abdomen x-ray can be utilized for evaluation of the distribution of bowel, the presence of gas and the distribution of gas. We can evaluate for the presence of free intraperitoneal air, look for calcifications related to the biliary or the urinary tract or gastrointestinal tract. We can evaluate for the presence of organomegaly or mass 1/1/2019 Department of Radiology

Department of Radiology X-Ray Primary Applications Bone and Joint imaging Trauma Neoplasm Soft Tissues Mass Foreign bodies Breast imaging Many of the applications of x-ray include bone and joint imaging both for the purpose of evaluation of trauma and neoplasm. Soft tissues can also be evaluated for mass or foreign bodies. Breast imaging is another important application of x-ray imaging. 1/1/2019 Department of Radiology

Department of Radiology X-Ray Secondary applications: Contrast enhanced examination Urinary tract IVU Cystography, urethrography Angiography Pulmonary/ Cardiac Pulmonary Coronary Great vessels General Neoplasm Vascular abnormalities Some secondary applications of x-ray include contrast-enhanced examinations. Examinations of the urinary tract have been performed for many years. Intravenous urography is less useful today than it has been in the past, because it is has been by and large replaced by other modalities. Cystography and urethrography however continue to be useful evaluations utilizing x-ray technology in the introduction of contrast material into the bladder through a catheter. Angiography also still plays a role at times for the evaluation of the urinary tract. In pulmonary and cardiac applications contrast-enhanced examination can evaluate for pulmonary emboli and for coronary artery disease. The great vessels can also be evaluated with angiography. In general x-ray is useful in the early evaluation of various neoplasms and vascular abnormality. 1/1/2019 Department of Radiology

Department of Radiology X-Ray Secondary applications: Dual energy Lung lesions Soft tissue calcifications Bone density evaluation Tomography – tomosynthesis Other more specialized applications include dual-energy x-ray evaluation. We are able to take two sequential exposures at different x-ray keV levels allow us for the discrimination of lung lesions more clearly and allow us to evaluate soft tissue calcification. Additionally, we can use various techniques with low intensity x-ray for determining the bone density of hips, back, wrist and so forth which could be useful in determining patients who may be aided by various treatment modalities or methods for possible osteoporosis. And finally tomography creating of thin sections whether by tube motion or by computer synthesis can be helpful in evaluating various structures of the body. 1/1/2019 Department of Radiology