Related Readings/ Videos

Kindly visit the site indicated below for a video on x-ray production:
https://www.youtube.com/watch?v=IsaTx5-KLT8

Learning Activities

INSTRUCTION: Please encode your answers and the format will be A4, font
size 14, Calibri font style, 2.54 cm (1 inch) margin in all sides, to include the
questions and answers, complete name, subject title, and date of
submission. Submit it in our Google Classroom platform on or before our
next meeting. Answer the following questions in Microsoft word and send
your answers to my email, deadline is the day before our next meeting.
Activity 1. Make a step-by-step process by which an x-ray is produced and
make list containing the definition of terms used in the process that you have
made.
Activity 2. Examination on LMS

UNIT 6: OTHER IMAGING MODALITIES

Intended Learning Outcomes
At the end of the unit, you are expected to:
1. Differentiate the various special imaging modalities from the point of
view of its physical principles and applications; and
2. Describe the operational techniques and the patient on different
imaging modalities.

Introduction
Medical imaging modalities in a clinical setting is a vital contribution to the
overall diagnosis of the patient and help in the decision of an overall
treatment plan. The utilization of imaging techniques in medical radiation is
increasing with new technological advances in medical sciences. Therefore,
in the spectrum of a broad range of imaging modalities are the specialties of
nuclear medicine, positron emission tomography (PET), magnetic resonance
imaging (MRI) and ultrasound. Overall, imaging for medical radiation
purposes involves a team of radiologists, radiographers and medical
physicists.

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Unlocking of Difficulties
Intravenous pyelogram - is an x-ray exam that uses an injection of contrast
material to evaluate your kidneys, ureters and bladder and help diagnose
blood in the urine or pain in your side or lower back.
Amniotic fluid - is a clear liquid that surrounds an unborn baby during
pregnancy. It protects the baby from outside injury and cold. It also helps
promote lung development and bone growth.
Biopsy - is a procedure that removes a small sample of tissue for testing.
Cholelithiasis – there is a formation of stone in the gallbladder
Barium X-rays: Fluoroscopy is used in barium x-rays to allow the doctor to
see the movement as the intestines move the barium through them.
Fluorescent screen - a transparent screen coated with fluorescent material
to show images from X-rays.

Lecture Notes

In this lesson, we are going to talk about the different imaging modalities in
a clinical setting which will give you a general picture of what machines do
we use in our field of study.
ULTRASONOGRAPHY
Diagnostic sonography (ultrasound)
 Is an ultrasound-based diagnostic imaging technique used for
visualizing applied under the skin or body structures including
tendons, muscles, joints, vessels and internal organs for possible
pathology or a tissue that has suffered damage through injury or
disease.
The term “ultrasound” applies to all sound waves with a frequency above the
audible range of human hearing, about 20kHz.
As shown in the picture below Human Audible range is considered as from
20Hz to 20KHz.

Source: teachengineering.org

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  Ultrasound are no different from normal sound waves in their physical
properties except that human ear cannot hear these.
 Infants and children can hear some frequencies above 20KHz as the
ability to hear higher pitched sound above the said limit decreases
with age.
 Silent whistle for dogs emit ultrasound in the range 18 to 22 kHz.
 Bats, whales and some other species of animals can detect frequencies
beyond 100 kHz, maybe up to 200 kHz.
 Frequencies of 1 MHz and higher, to 20 MHz are used for Ultrasonic
imaging in medical applications. With higher frequency or shorter
wavelength, it is easy to resolve smaller organs inside the body.
Ultrasound around 1 MHz are used for biomedical, destructive
applications and around 2 to 10 MHz for diagnostic and Non-
destructive applications.
 Rough guide for the frequency of ultrasound and their applications is
shown in the picture below.

 It is possible to perform both diagnosis and therapeutic procedures,

using ultrasound to guide interventional procedures (for instance
biopsies or drainage of fluid collections.)
DIAGNOSTIC ULTRASOUND
 also called sonography or diagnostic medical sonography,
 is an imaging method that uses high-frequency sound waves to
produce images of structures of your body. The images can provide
valuable information for diagnosing and treating a variety of diseases
and conditions.
 an ultrasound transducer sends an ultrasound pulse into tissue and
then receives echoes back. The echoes contain spatial and contrast
information. The concept is analogous to sonar used in nautical
applications, but the technique in medical ultrasound is more
sophisticated, gathering enough data to form a rapidly moving two-
dimensional grayscale image.

69
  is a typically non-invasive and safe form of medical imaging that has a
wide range of applications
 It is also effective for imaging soft tissues of the body with a higher
frequency (7-18 MHz)
1. muscles
2. tendons,
3. testes,
4. breast and the
5. neonatal brain

It can be also in Deeper structures lower frequency (1-6Mhz)

1. liver and
2. kidney
Lower frequencies produce less resolution but image deeper into body.
While higher frequency sound waves have smaller wavelength and thus are
capable of reflecting or scattering from smaller structures.
They required also an excellent understanding in
1. ultrasound physics
2. cross sectional anatomy, physiology
3. pathology and
4. communication skills

There are two main categories of ultrasounds: pregnancy ultrasound and

diagnostic ultrasound.
1. Pregnancy ultrasound is used to look at an unborn baby. The test can
provide information about a baby’s growth, development, and overall
health.

70
 Source: parents.com

Pregnancy ultrasound is done to get information about the health of an

unborn baby. It may be used to:
A. to confirm pregnancy
B. to check the size and position of the unborn baby.
C. to check if pregnancy is with more than one baby.
D. to estimate gestational age.
E. to check for signs of Down syndrome, which include thickening in
the back of the baby's neck.
F. to check for birth defects in the brain, spinal cord, heart, or other
parts of the body.
H. to check the amount of amniotic fluid.

2. Diagnostic ultrasound is used to view and provide information about

other internal parts of the body. These include the heart, blood vessels,
liver, bladder, kidneys, and female reproductive organs.

Ultrasound of the liver Ultrasound of the Kidney

Source: startradiology.com Source: https://www.wjgnet.com/

Diagnostic ultrasound may be used to:

A. check out if blood is flowing at a normal rate and level.
B. see if there is a problem with the structure of the heart.
C. rule out cholelithiasis
D. check the thyroid gland for cancer or non-cancerous growths.
E. check for abnormalities in the abdomen and kidneys.
F. help guide a biopsy procedure.
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In women, diagnostic ultrasound may be used to:
A. Look at a breast lump to see if it might be cancer. (The test may also
be used to check for breast cancer in men, though this type of
cancer is far more common in women.)
B. Help find the cause of pelvic pain.
C. Help find the cause of abnormal menstrual bleeding.
D. Help diagnose infertility or monitor infertility treatments.

In men, diagnostic ultrasound may be used to help diagnose disorders of the

prostate gland.

RISKS
Diagnostic ultrasound is a safe procedure that uses low-power sound waves.
There are no known risks.
Ultrasound is a valuable tool, but it has limitations. Sound doesn't travel well
through air or bone, so ultrasound isn't effective at imaging body parts that
have gas in them or are hidden by bone, such as the lungs or head. To view
these areas, the doctor may order other imaging tests, such as CT or MRI
scans or X-rays.

PREPARATION
Most ultrasound exams require no However, there are a few exceptions:

Gallbladder ultrasound
 NPO for 8 hours before the exam.
Pelvic ultrasound
 May require a full bladder.
 The patient is instructed not to urinate until the exam is done.
Young children may need additional preparation.

Preparation for the Exam

 The technologist will verify the identification and exam requested.
 The preparation for this test will depend on the type of ultrasound
procedure the doctor has ordered. Some preparations include
drinking a quart of water before the test to obtain better images.
 For biopsy, the patient will be asked to not eat or drink anything past
midnight the night before the exam.

72
During the Exam
 The duration of the exam will vary, but the average is about 30-60
minutes.
 The technologist will position the patient on the exam table, and
give will give instructions.
 A small amount of water-soluble gel is applied to the skin over the
area to be examined.
 The transducer is placed against the gel on the patient’s body. The
transducer will be moved across the area being examined until the
desired images is achieve.
After the Exam
 The patient can go home, and may resume normal activities.

FLUOROSCOPY
The fluoroscopy procedure
 It is an imaging technique that gathers real-time moving images using
a fluoroscope of internal structures of patients.
 A fluoroscope consists of a fluorescent screen and an x-ray beam
passing through your body.
 It mimics an x-ray movie, where continuous images display on a
monitor.
 Fluoroscopy is extremely helpful to surgeons while they’re
performing surgical procedures.
 It enables doctors to see moving structures of the body and helps with
diagnosing diseases.
 Fluoroscopy offers enormous benefits over invasive surgical
procedures since it requires a tiny incision, significantly reducing your
risk of infection and recovery time.

A doctor can use fluoroscopy for any of the following reasons:

Orthopedic surgery: Surgery concerned with musculoskeletal system
conditions.
Catheter insertion: Inserting a tube into the body.
Blood flow studies: Visualizing the flow of blood to the organs.
Enemas: Inserting a rubber tip into the rectum.
Angiography: x-rays of lymph or blood vessels, including heart, leg and
cerebral vessels.

73
Urological surgery: Surgery of the urinary tract and sex organs.
Pacemaker implantation: Implanting a small electronic device in the chest.
FLUOROSCOPY RISKS
There are some minor risks associated with fluoroscopy. Because it uses x-
ray technology, will have some radiation exposure.
The amount you absorb varies depending on the procedure length and size.
Some individuals could experience radiation-induced injury to their skin
that results in “burns” of their skin tissue.

Also, no matter what amount of radiation exposure you receive, there’s

always the small risk of developing radiation-induced cancer down the road.
When you require a fluoroscopic procedure, the advantages often far
outweigh the risks.

Fluoroscopy procedure isn’t painful in itself, some aspects of preparing for

the test, such as accessing a vein or artery for angiography or injection into
a joint, may be painful. In these situations,

Conscious sedation:
Local anesthesia: These are numbing medications.
General anesthesia: Medications that put you to sleep, so you don’t feel
pain.

May have other risks depending on the health status of the patient. Further,
the Food and Drug Administration (FDA) regulates all fluoroscopy
machines, and they must meet specific criteria to be considered effective
and safe.

Specific Fluoroscopy Preparation

Many fluoroscopy and x-ray procedures like chest and bone x-rays require
no preparation. The exceptions are fluoroscopy exams of the digestive
system or kidneys, such as an upper GI series, upper GI with small bowel
exam, barium enema, a kidney exam called an intravenous pyelogram or
esophagram.

Commonly Nothing Per Orem (NPO) after midnight the night before the
procedure. No routine morning medicines.

74
Other specific fluoroscopy preparation instructions according to type
include:
1. UPPER GI SERIES
> NPO after midnight
> Upper GI tract and stomach must be empty for a
satisfactory exam.
> Should not smoke, eat or drink anything, including
mints or gum after midnight the night before the
exam.
> To assess frequent stomach pain or heartburn or
gastric reflux, which is when acid or food comes back
up to the esophagus, or an ulcer.

2. UPPER GI WITH SMALL BOWEL EXAM

> Empty the intestine and stomach for a satisfactory exam.
> Should not smoke, eat or drink
anything, including mints or gum
after midnight the night before the
exam.
> This procedure requires images on
a timed basis to assess the small
bowel. > The doctor is requesting
images of your intestine and
stomach with this exam to assess
any issues not explained by a barium
enema or upper GI test
Source: radiologykey.com .
3. BARIUM ENEMA
> fibrous foods is not allowed, such
as fiber supplements or whole grain
cereals, or raw vegetables or fruits for
three days before the procedure. Can
consume cooked and canned
vegetables or fruits.
Source: healthjade.net

75
> Can drink only clear liquids the day before the procedure. Acceptable
liquids include:
Water
Tea
Clear broth or bouillon
Clear juice like white grape, white cranberry or apple
Sodas like club soda, seltzer water or ginger ale
Also on the day before your exam:
 Laxative will be given and or suppository.
 NPO past midnight until the day of the exam.
 To assess abdominal pain, a change in bowel habits, rectal bleeding,
or if they suspect you could have colon polyps, which are abnormal
tissue growths on your colon, or diverticulitis, which are small inflamed
areas inside your colon.
 The barium could make the stools a gray or white color for 48 to 72
hours after the procedure. In some cases, the barium can cause
constipation. This could be temporary and can often be treated with
increased fluids or an over the counter laxative.
4. INTRAVENOUS PYELOGRAM (IVP)
> Patient must not drink or
eat anything for four hours
before this procedure.
> Instruct the patient to
inform the doctor if she/he
has allergies in general and
an allergy to contrast dye or
iodine.
> This injection does require
contrast material containing
iodine.
Source:medicineplus.com The exam is requested to visualize
the urinary tract, including the
kidney, bladder and the tubes
that connect them to show
function and any pathologies.

76
5. ESOPHAGRAM EXAM
> NPO four hours before the exam for a satisfactory test.
> Must not use mints, gum or cigarettes after midnight the night before the
exam.
> The exam is requested to assess
frequent heartburn, fluid or food in
your windpipe, gastric reflux or
difficulty drinking, eating or
swallowing.
> After your fluoroscopy, you can
resume your regular diet and take
your oral medications, unless the
doctor instructs you not to.
Source: semanticscholar.org

The exam may require fluoroscopy for any one of many various procedures
or examinations, including:

Barium X-rays: Fluoroscopy is used in barium x-rays to allow the doctor to

see the movement as the intestines move the barium through them.
Electro physiologic procedures: With an electro physiologic procedure, the
doctor uses fluoroscopy to treat patients with irregular heartbeats.
Cardiac catheterization: In this procedure, the doctor uses fluoroscopy to
help them see the blood flow through the coronary arteries, checking for
arterial blockages.
Arthrography: This is an x-ray to view one or more joints. Today, catheter
arthrography is one of the major uses of chest fluoroscopy.
Hysterosalpingogram: This procedure is an x-ray of the fallopian tubes and
uterus.
Placement of IV catheters: Catheters are hollow, thin tubes the doctor puts
into your arteries or veins. When inserting the IV catheter, the doctor will
use fluoroscopy to guide the catheter inside your body into a specific
location.
Percutaneous kyphoplasty/vertebroplasty: A doctor uses this procedure to
treat spinal vertebrae fractures.
Needle or Trans bronchial biopsies: A doctor uses this procedure to obtain
a biopsy of tissue from a lung.

77
As in many areas of medicine, there are risks associated with the use of
fluoroscopy, which uses ionizing radiation to generate images of the body.
Risks from exposure to ionizing radiation include:

 A small increase in the likelihood that a person exposed to radiation

will develop cancer later in life.
 Health effects that could occur after a large exposure to ionizing
radiation such as acute skin reddening, and hair loss.
 Possible allergic reactions associated with a contrast dye injected
intravenously into the veins to better see body structures being
examined.

While fluoroscopy itself is not painful, the particular procedure being

performed may be painful, such as the injection into a joint or accessing of
an artery or vein for angiography. In these cases, the radiologist will take all
comfort measures possible, which could include local anesthesia, conscious
sedation, or general anesthesia, depending on the particular procedure.

Source. Chop.edu.com

COMPUTED AND DIGITAL RADIOGRAPHY

Computed Radiography — or CR for short —
 Is the use of a Phosphor Imaging Plate to create a digital image.
 CR uses a cassette based system like analog film and is more
commonly considered to be a bridge between classical radiography and
the increasingly popular fully digital methods.
 Often considered the most initially cost friendly choice,
 CR is used almost exactly like conventional film, and so requires few
changes the workflow, and requires a smaller initial investment
compared to DR devices of similar quality.
 CR systems also do not speed up the workflow in the same way as a DR
panel and can require more maintenance.

78
 CR cassettes may additionally run the risk of getting damaged if
improperly stored or handled, but are much cheaper to replace if dropped
than a wireless DR panel.
Pros
 Low initial investment
 Compatible with a wide range of traditional systems
 Effective for smaller or low volume clinics
 Multiple sizes allow for greater flexibility
Cons
 Long time to view image
 Risk of overexposure
 High Maintenance
Computed radiography is performed by a system consisting of the following
functional components:
• A digital image receptor (The Imaging Plate)
• A digital image processing unit
• An image management system
• Image and data storage devices
• Interface to a patient information system
• A communications network
• A display device with viewer operated controls

DIGITAL RADIOGRAPHY (DR)

 It is the latest advancement to the radiography field, using a digital x-ray

detector to automatically acquire images and transfer them to a
computer for viewing. This system is additionally capable of fixed or
mobile use.
 It is the more expensive option,
 It comes to the table with much higher efficiency and quality that more
than justifies the price for many users.
 Given its high volume capabilities it is often the choice for larger or busier
clinics.
Pros
 Faster image acquisition
 Better quality images
 High volume capacity
 Greater dose efficiency [for Cesium Iodide (CsI) panels]

79
Cons
 More expensive initial costs
 Requires protection from dropping or mishandling
 Protection cover is recommended if panel will be removed from the
bucky tray or table

source: sprawls.org
Digital radiography is performed by a system consisting of the following
functional components:
 A digital image receptor
 A digital image processing unit
 An image management system
 Image and data storage devices
 Interface to a patient information system
 A communications network
 A display device with viewer operated controls

COMPUTED TOMOGRAPHY
 It is a diagnostic imaging test used to create detailed images of internal
organs, bones, soft tissue and blood vessels.
 The cross-sectional images generated during a CT scan can be
reformatted in multiple planes, and can even generate three-dimensional
images which can be viewed on a computer monitor, printed on film or
transferred to electronic media.
 CT scanning is often the best method for detecting many different cancers
since the images allow your doctor to confirm the presence of a tumor
and determine its size and location.
 CT is fast, painless, noninvasive and accurate.

80
  In emergency cases, it can reveal internal injuries and bleeding quickly
enough to help save lives.

Source: researchgate.com
Why is CT Scan being done?
1. Diagnose muscle and bone disorders, such as bone tumors and fractures
2. Pinpoint the location of a tumor, infection or blood clot
3. Guide procedures such as surgery, biopsy and radiation therapy
4. Detect and monitor diseases and conditions such as cancer, heart
disease, lung nodules and liver masses
5. Monitor the effectiveness of certain treatments, such as cancer
treatment
6. Detect internal injuries and internal bleeding
Risks
Radiation exposure
 The patient will be exposed to ionizing radiation.
 The amount of radiation is greater than during a plain X-ray because
the CT scan gathers more-detailed information.
 The low doses of radiation used in CT scans have not been shown to cause
long-term harm, although at much higher doses, there may be a small
increase in your potential risk of cancer.
 CT scans have many benefits that outweigh any small potential risk.
 Doctors use the lowest dose of radiation possible to obtain the needed
medical information.
 Also, newer, faster machines and techniques require less radiation than was
previously used.

81
 Harm to unborn babies
 Tell your doctor if you're pregnant. Although the radiation from a CT scan is
unlikely to injure your baby, your doctor may recommend another type of
exam, such as ultrasound or MRI, to avoid exposing your baby to radiation.
At the low doses of radiation used in CT imaging, no negative effects have
been observed in humans.
Reactions to contrast material
 As with all x-rays, dense structures within the body—such as bone—are
easily imaged, whereas soft tissues vary in their ability to stop x-rays and,
thus, may be faint or difficult to see.
 For this reason, intravenous (IV) contrast agents have been developed
that are highly visible in an x-ray or CT scan and are safe to use in patients.
 Contrast agents contain substances that are better at stopping x-rays and,
thus, are more visible on an x-ray image.
 For example, to examine the circulatory system, a contrast agent based
on iodine is injected into the bloodstream to help illuminate blood
vessels. This type of test is used to look for possible obstructions in blood
vessels, including those in the heart. Oral contrast agents, such as
barium-based compounds, are used for imaging the digestive system,
including the esophagus, stomach, and GI tract.

PATIENT PREPARATION
Depending on which part of the body is being scanned,
1. Instruct the patient to take off some or all of the clothing and wear the
hospital gown
2. remove metal objects, such as a belt, jewelry, dentures and eyeglasses,
which might interfere with image results
3. nothing per orem for a few hours before the scan

Contrast material
A special dye called contrast material is needed for some CT scans to help
highlight the areas of the body being examined. The contrast material
blocks X-rays and appears white on images, which can help emphasize
blood vessels, intestines or other structures.
Contrast material might be given:
 By mouth. If esophagus or stomach is being scanned, it may need to
swallow a liquid that contains contrast material. This drink may taste
unpleasant.

82
  By injection. Contrast agents can be injected through a vein in the arm
to help the gallbladder, urinary tract, liver or blood vessels stand out
on the images. The patient may experience a feeling of warmth during
the injection or a metallic taste in the mouth.
 By enema. A contrast material may be inserted in the rectum to help
visualize the intestines. This procedure can make the patient feel
bloated and uncomfortable.
Although rare, the contrast material can cause medical problems or allergic
reactions.
Most reactions are mild and result in a rash or itchiness. In rare instances, an
allergic reaction can be serious, even life-threatening.

During the procedure

CT scanners are shaped like a large doughnut standing on its side.
1. Instruct the patient to lie on a narrow, motorized table that slides through
the opening into a tunnel.
2. Straps and pillows may be used to help the patient stay in position.
3. During a head scan, the table may be fitted with a special cradle that holds
the head still.
4. While the table moves the patient into the scanner, detectors and the X-
ray tube rotate around him.
5. Each rotation yields several images of thin slices of the body.
6. He may hear buzzing and whirring noises.
7. instruct him to hold his breath at certain points to avoid blurring the
images.

After the procedure

1. After the exam he can return to his normal routine.
2. If he was given contrast material, he may receive special instructions.
3. In some cases, he may be asked to wait for a short time before leaving
ensure that he feels well after the exam.
4. After the scan, the patient must be instructed to drink lots of fluids to
help his kidneys remove the contrast material from his body.
Results
CT images are stored as electronic data files and are usually reviewed on a
computer screen. A radiologist interprets these images and sends a report to
the patients attending physician.

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 MAGNETIC RESONANCE IMAGING
 is a non-invasive imaging technology that produces three dimensional
detailed anatomical images.
 It is often used for disease detection, diagnosis, and treatment
monitoring.
 It is based on sophisticated technology that excites and detects the
change in the direction of the rotational axis of protons found in the water
that makes up living tissues.
 The scanner itself typically resembles a large tube with a table in the
middle, allowing the patient to slide in.
 An MRI scan differs from CT scans and X-rays, as it does not
use potentially harmful ionizing radiation.

Why is MRI being done?

The following are examples in which an MRI scanner would be used:
1. anomalies of the brain and spinal cord
2. tumors, cysts, and other anomalies in various parts of the body
3. breast cancer screening for women who face a high risk of breast cancer
injuries or abnormalities of the joints, such as the back and knee
4. certain types of heart problems
5. diseases of the liver and other abdominal organs
6. the evaluation of pelvic pain in women, with causes including fibroids and
endometriosis
7. suspected uterine anomalies in women undergoing evaluation for
infertility.
PATIENT PREPARATION
There is very little preparation required, if any, before an MRI scan.
1. On arrival at the hospital, doctors may ask the patient to change into a
gown.
2. As magnets are used, it is critical that no metal objects are present in the
scanner.
3. The radtech will ask the patient to remove any metal jewelry or accessories
that might interfere with the machine.
4. A person will probably be unable to have an MRI if they have any metal
inside their body, such as bullets, shrapnel, or other metallic foreign
bodies. 5. This can also include medical devices, such as cochlear
implants, aneurysm clips, and pacemakers.

84
6. Individuals who are anxious or nervous about enclosed spaces should tell
their doctor. Often they can be given medication prior to the MRI to help
make the procedure more comfortable.
7. Patients will sometimes receive an injection of intravenous (IV) contrast
liquid to improve the visibility of a particular tissue that is relevant to the
scan.
8. The radiologist, a doctor who specializes in medical images, will then talk
the individual through the MRI scanning process and answer any
questions they may have about the procedure.
9. Once the patient has entered the scanning room, the rad tech will help
them onto the scanner table to lie down. He will ensure that the patient
is as comfortable as possible by providing blankets or cushions.
10. Earplugs or headphones will be provided to block out the loud noises of
the scanner. The latter is popular with children, as they can listen to
music to calm any anxiety during the procedure.
During an MRI scan
1. Once in the scanner, the MRI technologist will communicate with the
patient via the intercom to make sure that they are comfortable. They
will not start the scan until the patient is ready.
2. During the scan, it is vital to instruct the patient to stay still. Any
movement will disrupt the images, much like a camera trying to take a
picture of a moving object.
3. Loud clanging noises will come from the scanner. This is perfectly normal.
Depending on the images, at times it may be necessary for the person to
hold their breath.
4. If the patient feels uncomfortable during the procedure, they can speak
to the MRI technologist via the intercom and request that the scan be
stopped.
After an MRI scan
1. After the scan, the radiologist will examine the images to check whether
any more are required. If the radiologist is satisfied, the patient can go
home.
2. The radiologist will prepare a report for the requesting doctor. Patients
are usually asked to make an appointment with their doctor to discuss the
results.

85
Side effects
1. It is extremely rare that a patient will experience side effects from an MRI
scan.
2. However, the contrast dye can cause nausea, headaches, and pain or
burning at the point of injection in some people.
3. Allergy to the contrast material is also seldom seen but possible, and can
cause hives or itchy eyes. Instruct the technician if any adverse reactions
occur.
4. People who experience claustrophobia or feel uncomfortable in enclosed
spaces sometimes express difficulties with undergoing an MRI scan.

Functional MRI can also be used to determine the effects of tumors, stroke,
head and brain injuries, or neurodegenerative diseases, such as Alzheimer’s.

Source: nationalmaglab.org Source: Sprawl.com

NUCLEAR MEDICINE
 is a medical specialty that uses radioactive tracers (radiopharmaceuticals)
to assess bodily functions and to diagnose and treat disease. Specially
designed cameras allow doctors to track the path of these radioactive
tracers.
Two most common imaging modalities in nuclear medicine.
1. Single Photon Emission Computed Tomography or SPECT and
2. Positron Emission Tomography or PET scans

Radioactive Tracers
 are made up of carrier molecules that are bonded tightly to a
radioactive atom.

86
 These carrier molecules vary greatly depending on the purpose of the
scan.
 Some tracers employ molecules that interact with a specific protein or
sugar in the body and can even employ the patient’s own cells. For
example, in cases where doctors need to know the exact source of
intestinal bleeding, they may radiolabel (add radioactive atoms) to a
sample of red blood cells taken from the patient. They then reinject the
blood and use a SPECT scan to follow the path of the blood in the patient.
Any accumulation of radioactivity in the intestines informs doctors of
where the problem lies.
 Approved tracers are called radiopharmaceuticals since they must meet
FDA’s exacting standards for safety and appropriate performance for the
approved clinical use.
 The nuclear medicine physician will select the tracer that will provide
the most specific and reliable information for a patient’s particular
problem. The tracer that is used determines whether the patient
receives a SPECT or PET scan.

SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY (SPECT)

 SPECT imaging instruments provide three-dimensional (tomographic)
images of the distribution of radioactive tracer molecules that have been
introduced into the patient’s body.
 The 3D images are computer generated from a large number of projection
images of the body recorded at different angles.
 SPECT imagers have gamma camera detectors that can detect the gamma
ray emissions from the tracers that have been injected into the patient.
 Gamma rays are a form of light that moves at a different wavelength than
visible light.
 The cameras are mounted on a rotating gantry that allows the detectors
to be moved in a tight circle around a patient who is lying motionless on
a pallet.

POSITRON EMISSION TOMOGRAPHY (PET)

 PET scans also use radiopharmaceuticals to create three-dimensional
images.
 The main difference between SPECT and PET scans is the type of
radiotracers used.
 While SPECT scans measure gamma rays,
 the decay of the radiotracers used with PET scans produce small particles
called positrons.

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A positron is a particle with roughly the same mass as an electron but
oppositely charged. These react with electrons in the body and when these
two particles combine they annihilate each other.
This annihilation produces a small amount of energy in the form of
two photons that shoot off in opposite directions. The detectors in the PET
scanner measure these photons and use this information to create images of
internal organ

Administration of the radioactive tracer

1. intravenous injection
2. inhalation
3. oral ingestion
4. direct injection into an organ

Common uses of the procedure

Heart
 visualize heart blood flow and function (such as a myocardial
perfusion scan)
 detect coronary artery disease and the extent of coronary stenosis
 assess damage to the heart following a heart attack
 evaluate treatment options such as bypass heart surgery
and angioplasty
 evaluate the results of revascularization (blood flow restoration)
procedures
 detect heart transplant rejection
 evaluate heart function before and after chemotherapy (MUGA)

Lungs
 scan lungs for respiratory and blood flow problems
 assess differential lung function for lung reduction or transplant
surgery
 detect lung transplant rejection
Bones
 evaluate bones for fractures, infection and arthritis
 evaluate for metastatic bone disease
 evaluate painful prosthetic joints
 evaluate bone tumors
 identify sites for biopsy

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Brain
 investigate abnormalities in the brain in patients with certain
symptoms or disorders, such as seizures, memory loss and suspected
abnormalities in blood flow
 detect the early onset of neurological disorders such as Alzheimer's
disease
 assist in surgical planning and identify the areas of the brain that may
be causing seizures
 evaluate for abnormalities in a chemical in the brain involved in
controlling movement in patients with suspected Parkinson's disease
or related movement disorders
 evaluation for suspected brain tumor recurrence, surgical or radiation
planning or localization for biopsy

Other Systems
 identify inflammation or abnormal function of the gallbladder
 identify bleeding into the bowel
 assess post-operative complications of gallbladder surgery
 evaluate lymphedema
 evaluate fever of unknown origin
 locate the presence of infection
 measure thyroid function to detect an overactive or underactive
thyroid
 help diagnose hyperthyroidism and blood cell disorders
 evaluate for hyperparathyroidism (overactive parathyroid gland)
 evaluate stomach emptying
 evaluate spinal fluid flow and potential spinal fluid leaks

Nuclear medicine therapies include:

 Radioactive iodine (I-131) therapy used to treat some causes of
hyperthyroidism (overactive thyroid gland, for example, Graves'
disease) and thyroid cancer
 Radioactive antibodies used to treat certain forms of lymphoma
(cancer of the lymphatic system)
 Radioactive phosphorus (P-32) used to treat certain blood disorders
 Radioactive materials used to treat painful tumor metastases to the
bones

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  I-131 MIBG (radioactive iodine labeled with
metaiodobenzylguanidine) used to treat adrenal gland tumors in
adults and adrenal gland/nerve tissue tumors in children

PREPARATION

 No special preparation is required for imaging involving the bones,

inflammatory, lymphatics, renal and pulmonary systems.
 Imaging involving the gastrointestinal and cardiac system requires
fasting of at least 4 hours.
 Some scans require premedication.
 Thyroid scan may require cessation of certain medication prior to the
scan (with the discretion of the attending physician).

The technologist’s responsibilities include:

1. Putting the patient at ease, obtaining pertinent history, describing the

procedure and answering the patient’s questions

2. Administering radiopharmaceuticals and medications for patient

imaging and therapeutic procedures.

3. Monitoring the patient’s physical condition during the course of the

procedure

4. Processing data and enhancing digital images using advanced computer

technology

5. Providing images, data analysis and patient information for diagnostic

interpretation or therapeutic procedures

6. Evaluating images to determine the technical quality and calibration of

instrumentation

7. Evaluating new protocols

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 RADIOTHERAPY

Radiation therapy (also called radiotherapy) uses targeted energy,

including X-rays and radioactive substances, to destroy cancer cells, shrink
tumors and/or alleviate certain cancer-related symptoms.
It may be used:
 As a primary treatment to destroy cancer cells
 In combination with other treatments to stop the growth of cancer
cells
 Before another treatment to shrink a tumor
 After another treatment to stop the growth of any remaining cancer
cells
 To relieve symptoms of advanced cancer
Types of radiation
Some radiation therapy delivery methods include:
1. External beam radiation therapy: Radiation is directed from a machine
outside the body onto cancerous cells within the body.
Examples include 3D conformal radiation therapy, intensity-modulated
radiation therapy (IMRT), image-guided radiation therapy (IGRT), Tomo
Therapy, proton therapy, stereotactic radiosurgery.
2. Internal radiation therapy: Radioactive material is placed (via a catheter
or other carrier) directly into or near a tumor.
Examples include high-dose rate brachytherapy.
3. Systemic radiation therapy: A radioactive substance (that is swallowed or
injected) travels through the blood to locate and destroy cancerous cells.
Examples include radioactive iodine therapy.

Risks
Radiation therapy side effects depend on which part of the body is being
exposed to radiation and how much radiation is used.
The patient may experience no side effects, or may experience several. Most
side effects are temporary, can be controlled and generally disappear over
time once treatment has ended.

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 Part of body being Common side effects
treated

Any part Hair loss at treatment site (sometimes permanent), skin

irritation at treatment site, fatigue

Head and neck Dry mouth, thickened saliva, difficulty swallowing, sore
throat, changes in the way food tastes, nausea, mouth
sores, tooth decay

Chest Difficulty swallowing, cough, shortness of breath

Abdomen Nausea, vomiting, diarrhea

Pelvis Diarrhea, bladder irritation, frequent urination, sexual

dysfunction

Radiation simulation

1. The patient will lie on the same type of table that will be used for his
treatment.
2. Lying still at the proper angle is very important for treatment success, so
that the healthcare team may use cushions and restraints to position
him at the best angle for treatment.
3. The patient will then undergo CT scans or X-rays to determine the full
extent of the cancer and where the radiation should be focused.
4. After determining the best location for radiation treatment, the
treatment team will then mark the area with a very small tattoo. This
tattoo is usually the size of a freckle. In certain cases, a permanent tattoo
is not needed.
5. Then the treatment will begin.

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 Source: tekdeeps.com

Focus Questions

INSTRUCTION: Please encode your answers in essay form, with at least 3

sentences. The format will be A4, font size 14, Calibri font style, 2.54 cm (1
inch) margin in all sides, to include the questions and answers, complete
name, subject title, and date of submission. Submit it in our Google
Classroom platform on or before the next meeting
1. Differentiate the various special imaging modalities from the
point of view of its physical principles and applications;
2. Describe the operational techniques of the different imaging
modalities.
3. Explain the different types of radiation involved in radiation
therapy.
4. Explain the importance of the following imaging modalities:
A. Ultrasound
B. Fluoroscopy
C. Computed and Digital Radiography
D. Computed Tomography
E. Magnetic Resonance
F. Nuclear Medicine
G. Bone Densitometry
H. PET Scan
I. SPECT Scan
J. Radiation Therapy

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Related Readings/ Videos

For further readings that can supplement your knowledge in this area, you
may read the article below:
Diagnostic Value of Imaging Modalities for COVID-19: Scoping Review
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7468642/
After reading the article, please write a two-page reflection paper on your
understanding on diagnostic value of imaging modalities for COVID 19

INSTRUCTION: Please encode your answers in essay form. The format will be
A4, font size 14, Calibri font style, 2.54 cm (1 inch) margin in all sides, to
include the questions and answers, complete name, subject title, and date
of submission. Submit it in my email on or before the next meeting.
Learning Activities

INSTRUCTION: Please encode your answers in essay form. The format will be
A4, font size 14, Calibri font style, 2.54 cm (1 inch) margin in all sides, to
include the questions and answers, complete name, subject title, and date
of submission. Submit it in my email on or before the next meeting.
Activity 1. Do an online research and list some latest trends and
developments of the different imaging modalities.
Activity 2. Examination on LMS

References

(2016), Vision and Mission Statements -- a Roadmap of Where You Want to

Go and How to Get There. Retrieved August 7, 2020, from
https://www.extension.iastate.edu/agdm/wholefarm/html/c5-
09.html
ASRT House of Delegates (2018) the ASRT Practice Standards for Medical
Imaging and Radiation Therapy, Retrieved September 13, 2020, from,
Bushong S.C. (2017), Radiologic Science for Technologist 11th edition.
Callaway W. J. (2020), Introduction to radiologic technology 8th edition.
https://www.asrt.org/main/standards-and-regulations/professional-
practice/practice-standards-online
Jones and Barlett Publishers (n.d), Introduction to health Care Delivery
Systems. Retrieved July 12, 2020, from
https://samples.jblearning.com/0763746878/46878_CH01_pass1.pdf
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https://www.healthimages.com/services-flurorscopy.html
https://www.envrad.com/services-flurorscopy.html
http://www.montclairradiology.com/preparing-for-your-fluoroscopy
https://healthcare.utah.edu/radiology/preparing-
appointment/fluoroscopy.php
https://www.medicalcenter.virginia.edu/imaging-outpatient/patient-
information/fluoroscopy-pain-management-injections/fluoroscopy-
prep.html
https://www.sciencedirect.com/topics/medicine-and-dentistry/fluoroscopy
https://www.hopkinsmedicine.org/healthlibrary/test_procedures/orthopae
dic/fluoroscopy_procedure_92,p07662
https://stanfordhealthcare.org/medical-
tests/f/fluoroscopy/procedures.html
https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypei
d=92&contentid=P07662
http://radiology.ucla.edu/x-ray-fluoro-radiography
https://www.hopkinsmedicine.org/healthlibrary/test_procedures/orthopae
dic/fluoroscopy_procedure_92,p07662
https://www.fda.gov/radiation-
emittingproducts/radiationemittingproductsandprocedures/medicali
maging/medicalx-rays/ucm115354.htm
https://www.cedars-sinai.edu/Patients/Programs-and-Services/Imaging-
Center/For-Patients/Preparing-for-Your-Exam/X-ray-and-
Fluoroscopy.aspx
http://www.augustahealth.org/health-
encyclopedia/media/file/health%20encyclopedia/patient%20educati
on/Patient_Education_Fluoro.pdf
http://www.montclairradiology.com/preparing-for-your-fluoroscopy
Radiologyinfo.com
Sprawls.com

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