IMAGING MODALITIES

ULTRASOUN
D
ULTRASOUND
• It is an imaging technology that uses high-frequency
sound waves to characterize tissue.
• It is a useful and flexible modality in medical imaging
and often provides an additional or unique
characterization of tissues when compared to other
modalities such as conventional radiography or CT.
ULTRASOUND
• It is based on the use of high-frequency sound to aid in
the diagnosis and treatment of patients.
• Ultrasound frequencies range from 2 to approximately
15 MHz, although even higher frequencies may be used
in some situations.
• The ultrasound beam originates from mechanical
oscillations of numerous crystals in a transducer, which
is excited by electrical pulses (piezoelectric effect).
• The transducer converts one type of energy into
another (electrical to mechanical/sound).
TRANSDUCER
• An ultrasound transducer, also known as a probe,
operates based on the physical principles of ultrasound.
It 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.
HOW IMAGES ARE FORMED IN
ULTRASOUND
• The ultrasound waves (pulses of sound) are sent from
the transducer, propagate through different tissues, and
then return to the transducer as reflected echoes. The
returned echoes are converted back into electrical
impulses by the transducer crystals and are further
processed to form the ultrasound image presented on
the screen.
ULTRASOUND FREQUENCIES
• 2.5 MHz: deep abdomen, obstetric and gynecological
imaging
• 3.5 MHz: general abdomen, obstetric and
gynecological imaging
• 5.0 MHz: vascular, breast, pelvic imaging
• 7.5 MHz: breast, thyroid
• 10.0 MHz: breast, thyroid, superficial veins, superficial
masses, musculoskeletal imaging
• 15.0 MHz: superficial structures, musculoskeletal
imaging
ECHOGENICITY
• It refers to the ability to reflect or transmit US waves in
the context of surrounding tissues.
• Whenever there is an interface of structures with
different echogenicities, a visible difference in contrast
will be apparent on the screen.
• Based on echogenicity, a structure can be characterized
as anechoic, hypoechoic and hyperechoic.
• Anechoic: Structures appear black, meaning no internal echoes.
Examples include cysts, vessels, gallbladder ascites and water.
• Hypoechoic: Gives off fewer echoes; they are darker than
surrounding structures. Examples include lymph nodes and
tumors.
• Hyperechoic: Increased density of sound waves compared to
surrounding structures. Examples include bone and fat
calcifications.
• Isoechoic: structure exhibits the same brightness as its surround
structure, same echogenicity. Echogenicity terms are relative. Ex.
The normal liver parenchyma appears isoechoic to kidney's
echotexture.
DIFFERENT TYPES OF
PROBE
TYPES OF PROBE
• LINEAR PROBE
• CURVED LINEAR / CONVEX PROBE
• ENDOCAVITARY PROBE
• PHASED ARRAY / CARDIAC PROBE
LINEAR PROBE
(5-13 MHz)
• Linear probes have a flat array and
appearance.
• A linear probe’s piezoelectric crystals
are arranged in a linear formation to
create a straight sound wave.
• Linear probes can be applied to a wide
variety of uses, such
as vascular and breast ultrasound, or
thyroid and tendon examinations.
• These probes typically have a
rectangular beam with high near-field
resolution and run at a high frequency
to produce a better image resolution.
CURVED LINEAR/
CONVEX (2-6
MHz)
• Convex probes (also called curved linear probes)
have a curved array that allows for a wider field
of view.
• The makeup of the piezoelectric crystals in the
convex array probe are arranged in a curvilinear
fashion.
• These types of ultrasound probes are complex
and can have over 500 elements in their crystal
makeup. Typically, these are great for more in-
depth examinations.
• These transducers serve a variety of purposes
and are great for vascular, abdominal, OB/GYN,
nerve and musculoskeletal examinations.
• Because of its shape, convex probes are primarily
used for abdominal scans due to their wider and
deeper view.
ENDOCAVITAR
Y (3.5-11.5
MHz)
• Endocavitary probes have a
much longer probe handle and a
“U” shaped lens and array.
• These probes are used for
scanning the inside of the body.
• Because of the shape,
endocavitary probes do not
have a great range of depth, but
they allow for a wider field than
even the convex probes.
PHASED ARRAY / CARDIAC (2-10
MHz)
• Phased array or cardiac probes have a
smaller handle with a square-shaped lens
and array. Usually, they scan images of the
heart.
• Phased array probes will have greater depth
in order to reach the heart and produce an
image. The phased array crystal
arrangement is what gives this transducer
its name.
• Phased Array transducers have fewer
crystals in them, which means that the
crystals fire in phases to create the image
seen on the screen.
 ADVANTAGES AND
DISADVANTAGES OF
ULTRASOUND
ADVANTAGES
• ultrasound uses non-ionizing sound waves and has not been associated with carcinogenesis
- this is particularly important for the evaluation of the fetal and gonads
• in most centers, ultrasound is more readily available than more advanced
cross-sectional modalities such as CT or MRI
• ultrasound examination is less expensive to perform than CT or MRI
• ultrasound is straightforward to perform portably, unlike CT/MRI
• there are few (if any) contraindications to the use of ultrasound, compared with MRI or
contrast-enhanced CT
• the real-time nature of ultrasound imaging is useful for the evaluation of physiology as well
as anatomy (e.g. fetal heart rate)
• Doppler evaluation of organs and vessels adds a dimension of physiologic data, not
available on other modalities (except some MRI sequences)
• ultrasound images may not be as adversely affected by metallic objects, as opposed to CT
or MRI
• an ultrasound exam can easily be extended to cover another organ system or evaluate the
contralateral extremity
DISADVANTAGES
• training is required to accurately and efficiently conduct an ultrasound
exam and there is non-uniformity in the quality of examinations
("operator dependence")
• ultrasound is not capable of evaluating the internal structure of tissue
types with high acoustical impedance (e.g. bone, air). It is also limited in
evaluating structures encased in bone (e.g. cerebral parenchyma inside
the calvaria)
• the high frequencies of ultrasound result in a potential risk of
thermal heating or mechanical injury to tissue at a microscopic level, this
is of most concern in fetal imaging
• ultrasound has its own set of unique artifacts (US artifacts), which can
potentially degrade image quality or lead to misinterpretation
• some ultrasound exams may be limited by abnormally large body habitus
FLUOROSCOPY
FLUOROSCOPY
• It is an imaging modality that allows real-time x-
ray viewing of a patient with high temporal resolution.
• It is based on an x-ray image intensifier coupled to a
still/video camera. In years, flat panel detectors (like
those used in direct digital radiography) have been
replacing image intensifiers.
 Overview of a fluoroscopy system

• x-ray generator
• x-ray tube, including filters and collimation
• patient table (which may be horizontal or erect)
• image intensifier: converts x-rays emerging from the patient into an optical image
• optical distributor: used to couple the output image from the image intensifier to
receiving devices:
• video camera: converts the image into an electronic signal, which can be fed into the image
display/record device
• spot-film camera recording static images onto film, which may incorporate a film changer (
radiography and fluoroscopy (R&F) system)
• cine camera: to record a sequence of images onto a roll of film/digital medium
• image displaying/recording device
• video monitor: for immediate display of image (videofluoroscopy)
• videotape recorder: for storage and subsequent replay
• computer: for digital image processing, analysis and storage (digital fluorography), e.g.
digital subtraction angiography (DSA)
 Design of the x-ray tube and image intensifier
assembly

• ceiling-suspended image intensifier and under-table

tube (most common)
• ceiling-suspended tube and under-table image
intensifier
• C-arm assembly: either ceiling-suspended or floor-
mounted (for DSA and interventional procedures)
• mobile C-arm system (for operating theater)