RADIO 250 [5]: ICC in Radiology and Nuclear Medicine Lec 1: Introduction to Radiology/ Radio rotection !o"anna Ca#al$ MD 1 %e&ruary '$ 2015 TOPIC OUTLINE PART ONE: INTRO TO RADIO I. Background II. Imaging Modal ities A. X-Ray B. Angiography C. Ultrasound D. CT-can !. MRI ". #uclear Medicine III$ Radiotherapy I. BAC%&R'U#D A. HISTORY 1. 1895: Wilhemlm Konrad Roentgen Discovered Xra!s • ("e )ery *r+t ,-ray .a+ a *lot"e "and oRoentgen+ .ie .it" "er ring on it3 • 4Did ore to c"ange t"e ace oedicine t"an any ot"er +ingle itein "i+tory6787 6rogdon %oren+ic Radiologi+t3 • ("e di+co)ery o9-ray+ .a+ al+o naed t"e toac"ie)eent &y a 6riti+" u+eu• 9-ray oAdol;itler+ oral ca)ity +"o.ed dental carie+< t"i+ .a+ a te+taent to "o. dental care .a+ )ery oor during t"o+e tie+ ". 189#: $arie %rie Discovered Radioactivit! • ="e died oleu>eia due to e,o+u re to radioacti)e aterial+ B. USES OF RADIOLOGY • May &e u+ed or diagnosticor thera'eticuro+e+ (a)le 1. *ses o+ Radiolog! D,A-/0(, % (2RA32*(,%,(2R2(, / AL -eneral radiogra'hs Angiogra"y *ltrasond Contra+t rocedure+ %( scan $R, 8uided a+iration clear medicine 6RA,7 )one scan8uided &io+y Radiation oncology Note: ??Nucl ear Medicine i+ under t"e Deart ent oMedicine in 8; &ecau+e o"i+t or ical rea+on+7 @ndocrinologi+t+ ounded t"e *eld or uro+e+ oradio- a&lation in t"yroid di+ea+e7 ;o.e)er$ &y rincile and or uro+e+ ocerti*cation$ it i+ under radiology7 C. OBJECTIVES • =elect o+t aroriate iaging odality or a gi)en clinical +ituation • 8i)e a diagno+i+ or a gi)en c"e+t ,-ray • 8i)e dierential diagno+e+ • @,lain "o. ,-ray$ ultra+ound$ C( +can$ MRI and nuclear edicine +can+ are done • Bno. +oe &a+ic+ a&out radiot"eray I. IMA&I#& M'DA(ITI!A. XRAYS 1. %onventional Radiogra'hs XRa!s • tilie+ radiation • 6lac>/E"ite/8ray o 6lac> radiolucent3: air lung+$ +inu+e+$ &o.el3 o E"ite radio-oaFue3: Guid+$ +olid+ • Contra+t i+ ea+ily areciated • Al.ay+ correlate *nding+ .it" "i+tory and @ *nding+ ,$A-2 R2%ALL 6"1#• 9-ray *lloo>ing li>e neuonia7 6ut radiologi+t .ill &e a&le to tel l o&+ tructi)e neuonia ros;amos cell lng carcinoma< t"e carcinoa "a+ 13 a central location$ 23 lo&ar di+t ri&ut ion due to &ron c"i ole o&+tru ction H3 eta+tatic- loo>ing nodule+ • 9-ray *l+"o.ing di+tended dia"ragdue to air &eneat" t"e dia"ragor 'nemo'eritonem7 Ee need to loo> at atient "i+tory or t"i+7 Iatient i+ o+t-+urgery$ air in t"e a&doen i+ not nece++arily a&noral< t"e air ay re+or& in H day +7 6ut iit .a+ an OD con+ul t$ +oet"ing u+t "a)e rutured and "ence u+t need e,loratory laarotoy7 ". $ammogra'h! • =creening tool or &rea+t cancer • Dicult to interret • /( the gold standardor &rea+t e)aluation/+creening o 6rea+t MRI or @(3 reain+ to &e t"e &e+t iaging odality o 6( t"i+ cannot &e u+ed or +creening ro&le.it" cost and accessi)ilit! R,-( A-2 (/ -2( <,R0( $A$$/-RA$= o /LD -*,D2L,20: Initial +creening at J0 year+ old unle++ .it" aily "i+tory o&rea+t cancer lo.ering it to age H53 @)ery ot"er year ater initial +creening until age 50 @)ery year &eyond 50 year+ old o 2W -*,D2L,20 6Decem)er "9 > ?anar ! "1: %ir+t +creening at age 50$ t"en e)ery ot"er year until K5 Eere de)eloed or co+t-eciency uro+e+ ro&le+ .it" ne. guideline+: • =oe eole +till get &rea+t cancer &eore 507 ("ere+ a &ig art ot"e oulation t"at get+ &rea+t cancer in t"eir J0+7 • =oe eole can al+o get &rea+t cancer ater K57 o Old guideline+ are +till &eing u+ed in clinical ractice e+ecially in t"e = &ecau+e incidence i+ "ig" o 6e.are ori+> act or+: o&e+ ity $ "i g" e+tr ogen +torage o Con+ider t"e aternal ai ly "i+tory o&rea+t cancer and o)arian cancer7 Age on ."ic" to +tart +creening i+ &a+ed on RI=B7 ,$A-2 R2%ALL • Maogra+"o.ing *&rocy+ti c c"ange+7 In ale+ t"i+ i+ not real ly a ro& le7 ;o.e )er$ in eal e+ it norally cau+e+ +oe degree oain &eore an ei+ode oen+e+7 • Maogra+"o.ing an 4angry loo>in gductal &rea+ t carcinoa7 Note lot+ ocalci*cation+ and line+7 @. %ontrast XRa!s • ti li e + I contra+t: iodine or &ariu -& a+ed recon+tituted o.der$ c"al>-li>e3 • +ed e+ecially or )i+ualiing t"e 8I +y+te&ecau+e it .ill &e e,creted • Dierent >ind+: o @+o"agograo er 8I +erie+ o 6ariuenea o Di+tal colonograo C"olangiograo =inugrao Intra)enou+yelograDi+tended &ladder i+ noral7 I o+t )oid$ a&noral7 o %i+tulograo ;y+tero+alingogra0(2R/0AL3,-/-RA$
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Radio 250 E1 Lec 01 Intro to Radiology and Radioprotection
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7/21/2019 Radio 250 E1 Lec 01 Intro to Radiology and Radioprotection
• 0tandard angiogra'h!: )e++el+ aear ."ite.it" +tructure+ in t"e &ac>ground
• Digitall! s)tracted angiogra'h!: all non-contra+t iage+ are reo)ed< )e++el+ aear&lac>
• -el+oam or alcohol em)oliCation: or &rainaneury++< t"eraeutic
• 3igtail catheter:
o In renal angiogra"y< indicated or "ig"-)olue contra+t rocedure+
o Mo+t oten u+ed in >idney tran+lant +urgeryre-oerati)e a++e++ent or donor+3
o +e+ large )olue o contra+t to +ee i t"euta>e o &ot" >idney+ are t"e +ae
,$A-2 R2%ALL
• Angiogra+ +"o.ing cere&ral di+tri&ution o &lood )e++el+ int"e early arterial and caillary "a+e+7 An outouc"ing can&e o&+er)ed in t"e region o t"e arietal lo&e< t"i+ i+ ananer!sm7
• Bidney angiogra u+ed to a++e++ ."ic" >idney i+ ea+ier to"ar)e+t7 A ig-tail cat"eter can &e +een7 ("e rig"t >idney "a+only one artery connecting to t"e aorta$ a+ oo+ed to t"eone at t"e let ."ic" "a+ 2-H )e++el+ connected to t"e aorta7
("ereore$ t"e let >idney i+ "arder to e,tract &ecau+e t"ereare ore )e++el+ t"at .ill need to &e ligated7
C. ULTRASOUND
istor!
• 6egan a+ =ONAR u+ed &y t"e ilitary
• Medically &ecae oular in t"e 1'K0+
• Inno)ation+ no.aday+ include 2D$ HD$ JD$Doler and color
o JD: u+ually or etu+$ c/o O6$ t"e ourt"dien+ion i+ time +o t"i+ i+ a )ideo
-eneral <eatres
• ;ig"-reFuency +oundo %reFuency o +ound a&o)e t"e range o
"earing 20 ; to 20 B;3o Medical ultra+ound u+e+ )alue+ .it"in t"e
t"e C( can roduce in one +econd7 8; "a+ 2-+lice."ile =t7 Lu>e+ "a+ TJ-+lice7
*ses o+ %( 0can
• %or urt"er e)aluation o an ,-ray le+ion
• +ed or +creening or +inu+ di+ea+e &ecau+et"ere i+ no .ay t"at you can +ee t"e +inu+ro t"e out+ide3 and certain lung di+ea+e+
• 6e+t or +tudying &one+< al+o u+ed oraneury++$ &rain a++e+ and eta+ta+i+$+tro>e+$ "eorr"age+$ +taging o neola++$a+iration o cy+t+$ or &io+y o a++e+ C(-
guided &io+y3• A++e++ent o alignancy or eta+ta+i+ +ee
roce++ i+ a+ter$ and edea i+ a Fuic> reaction to a+udden in+ult
o ara+itic inection DO@= NO( re+ult in edea &ecau+e t"i+i+ a +lo. roce++ and t"e &rain i+ a&le to adat
• C( iage o a laterally-laced .ell-de*ned enca+ulatedcy+tic a++ in t"e nec> area7 ("i+ i+ o+t li>ely &enign$ a&ranc"ial clet cy+t7 Reo)e entire ca+ule7o Midline cy+t+ on t"e nec> t"yroglo++alduct cy+to Lateral cy+t+ &ranc"ial clet cy+t congenital3
• HD C( iage +"o.ing a )ery large a&doinal aorticaneury+$ an-renal in nature$ already aecting t"e cooniliac+7 E"at can you doS Not"ing7 ("ere i+ no ot"er )e++elt"at can +er)e to &y-a++ t"e aneury+7 Al+o$ lacing a +tent.ill not .or>< t"e e+" around it .ill Qu+t old on it+el +o t"atit *t+ on t"e +tent$ t"u+ o&+tructing Go.7
• 6one .indo. o C( to +"o. ro+t"e+i+7 ro&le: ortion+ are
+tic>ing out o t"e &one$ need ro+t"e+i+ adQu+tent7 atiei+ o&liFuely o+itioned and cant lie +traig"t7
• F scan: gold +tandard or ulonaryt"ro&oe&oli+ &eore$ &ut no. C( +can i+u+ed
(hallim scan
Renal +nction scan 6D$0A7 D(3A
Liver scan
,$A-2 R2%ALL
• Noral t"yroid +can7 Not really t"at clear in ter+ o )i+ualiation7 ;o.e)er$ t"e concern "ere i+ t"at o iodineuta>e: it u+t &e di+tri&uted "oogenou+ly7
• 6one +can: loo> or 4"ot area+ "yereta&olic area+ +uc"a+ lu&ar and cer)ical +ine3
• @(-C(7 ("i+ i+ u+ed to +ee t"e unctioning a++ relati)e to."ere it i+ anatoically located7 Do not do or an untreatedle+ion7 8et a C($ t"en &io+y$ t"en treat7 +e @(-C( to c"ec>or any re+idual cancer cell+7
III. RADI'T)!RA*+
• +ed in radiation oncologyo 2Gternal )eam radiation thera'! 62ER(:
con)entional$ HD conoral$ inten+ity-radiatedo 0tereotactic radiosrger! - +ource i+
u+ually done or ca+e+ o cer)ical$ t"yroidand ro+tate cancer+
HD conoral i+ &etter t"an &rac"yt"erayor na+o"aryngeal CA
• %or treatent o alignancie+ and &enigncondition+ .art+$ "yertro"ic +car+3 &utu+ually t"e la+t re+ort
• +e+ "ig"-energy gaa ray+
• @6R( or &rac"yt"erayo Co&alt
+e+ gaa ray+
Le++ rotecti)e &ecau+e e)en i you turnedo t"e ac"ine$ t"e rod .ill +till eitradiation
;ead "a+ to &e lined .it" T-V inc" lead +la&a+ counter .eig"t
o Linear accelerator +e+ electricity$ +o it i+ +aer t"an co&alt
No need or counter .eig"t
/L RAD,/L/-,% 2$2R-2%,20 ? - entioned
&y Maa3
• =C +yndroe?
• 6rain "erniation
• =inal cord core++ion?
• ery &ad non-+toa&le3 )aginal and intrana+al&leeding?
3AR( (W/: RAD,/3R/(2%(,//*(L,2 *n
included in the exam
I7 8eneral InorationII7 Ri+>+ o Radiation @,o+ureIII7 Radiation alue+I7 Radiation in Medicine7 %inal Eord+
I. &!#!RA( I#"'RMATI'#
A. USES OF RADIATION
(a)le 1. *ses o+ Radiation
•
MILI(AR /
ARAMILI(A
R =@
• Radiation a+ .eaon i7e7 atoic&o&3
• Eeaon+ o a++ de+truction EMD3
• 4Dirty &o&+ &o&+ .it" radioactiaterial3
- en)ironent &ecoe+ radioacti)e
- al+o aect t"e *r+t re+onder+
doctor+$ olice$ olitician+$ etc73IND=(RIAL
=@•Ci)il engineering c"ec> integrity o
inra+tructure+3
•=teriliation canned good+ to rolong+"el lie: radiation +lo.+ do.n t"eaging roce++ o ruit+3
M@DICAL
=@
Diagno+tic and t"eraeutic
B. IS RADIATION SAFE
• It can &e +ae
• ("ere i+ no +uc" t"ing a+ 4+ae do+e o radiation
• ("ere i+ no t"re+"old do+e ."erein )alue+&elo. ."ic" radiation i+ +aid to &e 4+ae
• 6( it ay &e )ery &ene*cial to atient+
C. RADIATION-CANCER LINK
• Only ro)en cancer+ are:o Melanoa due to and not ioniing
radiation3o ("yroid cancer gaa ray+3o Leu>eia
D. RADIATION POISONING
• Radiation .ill aect acti)ely di)iding cell+
• Recall B86 e&er ."o deected to 8reat6ritain and &ecae )icti o oloniuoi+oning in 2002o oloniu in tea ended u in "i+ 8I(
• 6ecau+e o i+ an Hemitter ."ic" are .ea>ert"an W-eitter+ t"at can ea+ily ierce t"e &ody3$t"e radiation "it t"e .all o t"e e+o"agu+$&ounce+ o t"e 8I tract$ and >ee going until
7/21/2019 Radio 250 E1 Lec 01 Intro to Radiology and Radioprotection