1. INTRODUCTION TO RADIOLOGY IMAGING MODALITIES Asilah Al-Obeidani

2. A widely varied discipline  General Radiography  Pediatric & Geriatric radiography  A/E Radiography  Theater Radiography  Mobile Radiography  Mammography  Contrast & Fluoroscopic examination  Specialize imaging Modalities  CT  MRI  IR  US  RNI

3. The diagnostic tools?  X-rays  CT  MRI  Ultrasound  Nuc Medicine  Fluoroscopy  Mammography

4. Conventional Radiography “X-Ray”  Lingo: Density Opacity  Observable Densities:  Metal  Bone  Soft Tissue  Gas

5. Computed Tomography (CT)  Lingo: Attenuation Density Enhancement  Hounsfield Units -1000 air *** -100 fat 0 water *** 20-80 soft tissues 100’s bone/Ca/contrast >1000’s metal  Large radiation dose

6. Nuclear Medicine (NM)  Lingo: Counts or Activity  Physiologic imaging  Radionuclides (Technetium)  Radiopharmaceuticals (Choletec)  Radioactivity stays with the patient until cleared or decayed

7. Ultrasound  Lingo Echogenicity Shadowing Doppler for flow  No radiation  Can be portable  Relatively inexpensive

8. Magnetic Resonance Imaging (MRI)  Lingo: Signal intensity T1 T2 Enhancement  No radiation  Strong magnetic field No pacemakers No electronic implants  Small, loud tube  Patients must hold still  Relatively expensive

9. Fluoroscopy  Lingo  Filling defect  Density  Opacity  Real time information  Radiation dose dependent on length of exam http://www.med-ed.virginia.edu/courses/rad/gi/index.html

10. Mammography  Lingo  Microcalcifications  Mass  Asymmetric density  Screening exam consisting of 2 views recommended yearly for women over 50  We still recommend it! http://www.mdgrant.com/images/NormalMammogram.jpg

11. How can you help us help you?  Read & interprets: Indication, indication, indication  How will this “information” impact your clinical decision making (radiographic examination)? perhaps its useful to rethink the need for further projection or examination.  Become adept at how to recognize/read basic studies (on plain film of upper & lower extremities to identify fractures or common pathology, chest and abdominal films for line and tube placement in particular)

12. Why is indication so important?  It provides a paradigm for the picture we are reading.  More information will help to produce diagnostic image quality for a better patient management.  Depending on the indication, the hospital may not be reimbursed for the study

13. GOODBAD dyspnea in cancer patientR/O PE abdominal pain in Crohn’s patient SB resection R/O pain Pain over dorsal aspect of hand trauma

14. Contrast  Oral contrast is frequently used in CT of the abdomen and pelvis and is very safe  There are 2 types of intravenous contrast.  Iodinated contrast for CT  Gadolinium based contrast for MRI  Radiologists like contrast !! BUT Contrast is not without risks

15. Basics: Looking at Imaging Studies:  Adequate Study? Diagnostic film produced by professional radiographer  Correctly labeled with patient’s name, XR#, and the date of the study?  Technically adequate?  Systematic review of the film produced:  As the radiographer you produced the image, you should also look at your patient’s study (at least plain films), as well as follow up on the previous report. Pleural effusions, SBO, free air, old fracture; any internal or external fixation Evaluate exposure factor (especially the ones you placed!)

16. Useful web pages for radiographer  http://radiopaedia.org/ http://radiopaedia.org/  http://radiologymasterclass.co.uk/tutorials/tutorials.html - http://radiologymasterclass.co.uk/tutorials/tutorials.html  http://radiologymasterclass.co.uk/gallery/galleries.html http://radiologymasterclass.co.uk/gallery/galleries.html http://www.mypacs.net/mpv4/hss/casemanager  http://www.mypacs.net/mpv4/hss/casemanagerhttp://www.mypacs.net/mpv4/hss/casemanager  http://www.imageinterpretation.co.uk/ http://www.imageinterpretation.co.uk/  http://www.orthopaedicsone.com/display/Main/Radiographic+Ana tomy+of+the+Skeleton http://www.orthopaedicsone.com/display/Main/Radiographic+Ana tomy+of+the+Skeleton

17. RECAP o Review patient history and indications o Produce diagnostic film o Review the film you produced this will improve your competency level o Radiography is a cool specialty. Think whether it’s a good fit as you go through the year.

18. Thanks for listening! Questions? Hx: Please Evaluate New Line. “?!@#!%!”