Radiology is the branch or specialty of medicine that deals with the study and application of imaging technology like x-ray and radiation to diagnosing and treating disease. Radiologists direct an array of imaging technologies (such as ultrasound, computed tomography (CT), nuclear medicine, positron emission tomography (PET) and magnetic resonance imaging (MRI)) to diagnose or treat disease. The following imaging modalities are used in the field of diagnostic radiology:
Projection (plain) radiography
Radiographs or Roentgenographs, named after the discoverer of X-rays, Wilhelm Conrad Röntgen are produced by the transmission of X-Rays through a patient to a capture device then converted into an image for diagnosis. The original and still common imaging produces silver impregnated films. Plain radiography was the only imaging modality available during the first 50 years of radiology.
Fluoroscopy and angiography are special applications of X-ray imaging, in which a fluorescent screen and image intensifier tube is connected to a closed-circuit television system. This allows real-time imaging of structures in motion or augmented with a radiocontrast agent. Iodine contrast may also be concentrated in abnormal areas more or less than in normal tissues and make abnormalities (tumors, cysts, inflammation) more conspicuous. Additionally, in specific circumstances air can be used as a contrast agent for the gastrointestinal system and carbon dioxide can be used as a contrast agent in the venous system; in these cases, the contrast agent attenuates the X-ray radiation less than the surrounding tissues.
CT imaging uses X-rays in conjunction with computing algorithms to image the body. In CT, an X-ray generating tube opposite an X-ray detector or detectors in a ring shaped apparatus rotate around a patient producing a computer generated cross-sectional image (tomogram). CT is acquired in the axial plane, while coronal and sagittal images can be rendered by computer reconstruction. Radiocontrast agents are often used with CT for enhanced delineation of anatomy. CT scanning has become the test of choice in diagnosing some urgent and emergent conditions such as cerebral hemorrhage, pulmonary embolism (clots in the arteries of the lungs), aortic dissection (tearing of the aortic wall), appendicitis,diverticulitis, and obstructing kidney stones. Continuing improvements in CT technology including faster scanning times and improved resolution have dramatically increased the accuracy and usefulness of CT scanning and consequently increased utilization in medical diagnosis.
Ultrasonography uses ultrasound high-frequency sound waves to visualize soft tissue structures in the body in real time. No ionizing radiation is involved, but the quality of the images obtained using ultrasound is highly dependent on the skill of the person (ultrasonographer) performing the exam. Ultrasound is also limited by its inability to image through air (lungs, bowel loops) or bone. The use of ultrasound in imaging has developed mostly within the last 30 years. The first ultrasound images were static and two dimensional (2D), but with modern-day ultrasonography 3D reconstructions can be observed in real-time; effectively becoming 4D. Because ultrasound does not utilize ionizing radiation, unlike radiography Color-Flow Doppler Ultrasound measures the severity of peripheral vascular disease and is used by Cardiology for dynamic evaluation of the heart, heart valves and major vessels. Stenosis of the carotid arteries can presage cerebral infarcts strokes. Extensive hemoperitoneum (bleeding inside the body cavity) or injury to the major organs may require emergent surgical exploration and repair.
MRI (Magnetic Resonance Imaging)
MRI uses strong magnetic fields to align atomic nuclei usually hydrogen protons within body tissues, then uses a radio signal to disturb the axis of rotation of these nuclei and observes the radio frequency signal generated as the nuclei return to their baseline states plus all surrounding areas. With advances in scanning speed and spatial resolution, and improvements in computer 3D algorithms and hardware, MRI has become a tool in musculoskeletal radiology and neuroradiology. Recent improvements in magnet design including stronger magnetic fields (3 teslas), shortening exam times, wider, shorter magnet bores and more open magnet designs, have brought some relief for claustrophobic patients. However, in magnets of equal field strength there is often a trade-off between image quality and open design.
Nuclear medicine imaging involves the administration into the patient of radiopharmaceuticals consisting of substances with affinity for certain body tissues labeled with radioactive tracer. The most commonly used tracers are Technetium-99m, Iodine-123, Iodine-131, Gallium-67 and Thallium-201. The heart, lungs, thyroid, liver, gallbladder, and bones are commonly evaluated for particular conditions using these techniques. While anatomical detail is limited in these studies, nuclear medicine is useful in displaying physiological function. PET images can be combined with CT images to improve diagnostic accuracy. The applications of nuclear medicine can include bone scanning which traditionally has had a strong role in the work-up/staging of cancers. Myocardial perfusion imaging is a sensitive and specific screening exam for reversible myocardial ischemia. Molecular Imaging is the new and exciting frontier in this field.