4. Radiology Radiology is a medical specialty that uses imaging to diagnose and treat diseases seen within the body. https://en.wikipedia.org/wiki/Radiology

5. Radiographic modalityRadiographic modality  Plain radiographs  Ultrasonography  Computer tomography (CT)  Magnetic resonance imaging (MRI)  Fluoroscopy

6. Plain radiography

7. X-ray production

8. Image production

10. Density of the plain radiographs  Air  air in the bowel loops and stomach  Fat  subcutaneous layer of the abdominal wall  Water  same density as other soft tissue and internal organ  Bone  all of the bony structures and calcification  Metallic  medical instrument and foreign bodies

13. Contrast agents  Barium sulfate  Water-soluble contrast  Negative contrast

14. Barium sulfate  White crystalline powder  High specific gravity  Inert, not support bacterial growth  Radiodensity  Coat GI mucosa

15. Adverse effect of barium sulfate  Inflammation of the abdominal cavity or mediastinum - Mediastinitis - Peritonitis Do not use in case of suspected leakage within thorax or abdomen

16. Water-soluble contrast agents  Iodine compound  Do not coat the GI mucosa  Use in case of suspected leakage or post operative evaluation  High cost  Adverse effect  cause pneumonia or pulmonary edema if aspirate into lung

17. Negative contrast agent  Air  use for double-contrast study  Carbon dioxide  Drug  Simeticone

19. Esophagography  Contrast-enhanced fluoroscopy of the esophagus  Ingestion of the contrast while performing radiographic study  Can detect intraluminal/transmural esophageal lesion  Interesting in anatomy and function  Indication: Evaluation of the esophageal obstruction and function

20. Double-contrast esophagography Contrast Air

22. Area of interest  GI follow through -Esophagus -Hypopharynx/larynx -Stomach -Duodenal bulb and duodenal loop -Small bowel loops -Ceacum  Upper GI study -Esophagus -Hypopharynx/larynx -Stomach -Duodenal bulb and duodenal loop

24. Anatomy on upper GI study

25. GI follow through

27. Barium enemaBarium enema  Area of interest: Colon, sigmoid colon and rectum  Introduce barium into rectum via rectal tube, through colon to ceacum  Push air into colon  Double contrast study

28. BE machineBE machine

32. Intravenous pyelography (IVP)  Good modality to evaluate urinary system  Can evaluate  Anatomical and functional abnormality  Indication  Urinary tract obstruction, Urinary leak from trauma or post operation, urothelial tumor

33. Procedure of IVP  “ Plain radiographs along phases of the renal function and excretion”  Plain radiographs on 1. Pre-contrast (Scout film)  to detect stone, renal shadow, psoas shadow 2. 1 minute after contrast administration  evaluate nephrogram 3. 3 minutes after contrast administration  evaluate excretory function

34. Procedure of IVP 4. 10 minutes after contrast administration  evaluate pelvocaliceal system and ureter 5. 25-30 minutes after contrast administration  evaluate lower part of ureter and urinary bladder 6. Full bladder  evaluate urinary bladder 7. Post voiding  residual urine

35. IVP device

36. Principle of IVP

37. Scout film

38. 1 minute

39. 3-5 minutes

40. 10 minutes

41. 25-30 minutes

42. Both oblique views

43. Full bladder

45. Retrograde pyelography  Retrograde injection of the contrast material into ureters  extending to pelvocaliceal system  Use to evaluate collecting system of the patient who has poor renal function  Quality of the imaging can be controlled by concentration of the contrast material and rate of injection

47. Left retrograde pyelography

48. Intraluminal filling defect within right upper pole calyx

50. Cystography/voiding cystourethrography (VCUG)  Input contrast material into urinary bladder  Imaging of the urinary bladder on AP, lateral and both oblique views  Evaluate urothelial tumor, diverticulum or leakage from trauma or surgery

51. Cystography/voiding cystourethrography (VCUG)  Voiding cystourethrography  take pictures while voiding  Indication for VCUG  to rule out vesicoureteral reflux (VUR) ; use in urinary tract infection of the children, evaluation of the urethra

54. Contrast leakage

55. Normal anatomy on VCUG

56. Imaging of VCUG

57. Abnormal VCUG

59. Hyterosalpingography  Examination of the lumen of uterus and fallopian tubes  Injection of the contrast material into uterine cavity, via cervix  Use in infertility (primaryy, secondary), spontaneous abortion, preoperative evaluation to tubal anastomosis

60. Hysterosalpingography  Contraindication - Pregnancy - Active menstrution - Acute pelvic inflammatory disease - Recent undergo uterine or tubal surgery

61. Hysterosalpingography  Take pictures on AP, both oblque views after contrast injection  Complication  pain, fever, sepsis (if has intravastion of the contrast material)

63. Normal anatomy on hysterosalpingography

65. US Device

66. US probe

67. Ultrasonography  Real time imaging  Use ultrashort sound wave  Transmit and receive sound wave by transducer  Piezoelectric crystal  emit sound wave when a voltage is applied  Then convert received sound wave to digital  No radiation !!!!

70. Ultrasonography  Adjust frequency of the sound wave  adjust depth  Interaction between sound wave and tissue - Reflection - Absorbtion - Scatter

71. Differentiation of the tissue

72. Ultrasonography  Due to transmission of the sound wave between soft tissue and air is as described  Limit study for the gastric and bowel lesion  Operator dependent

74. Computer tomography  Tomos = slices  Use X-ray beam to scan the body and collect data digitally  Image production and reconstruction from the data

77. CT Reconstruction Matrix

78. Image reconstruction

81. MR study  Imaging modality that uses non-ionizing radiation to create diagnostic useful images  Advantage -The ability to image without the use of ionizing radiation (x-ray) unlike CT scanning  can be use in pregnant women -Superior soft tissue contrast than CT scans and plain films making it the ideal examination of the brain, spine, joints and other soft tissue body parts

82. MR study  Advantage (cont.) -Some angiographic images can be obtained without the use of contrast material, unlike CT or conventional angiography -Advanced techniques such as diffusion, spectroscopy and perfusion allow for specific tissue characterisation rather than merely 'macroscopic' imaging

83. MR study  Disadvantage - More expensive than CT scans - Longer study time - MRI scanning is not safe for patients with some metal implants and foreign bodies

84. MR technique  Every tissue have proton (due to large component of H2O in body  respresenting proton of H2O)  Hydrogen in H2O molecule of different tissue has different magnetic field  Put the RF pulse to hydrogen atom to push atom into same dirrection  Then stop the RF pulse  recoil vector of the hydrogen atom  Different time of recoil  analyze into digital data  form the images

86. MR sequences

87. Thank you for your attention