Medical Imaging Modalities

An Introduction

Stephan Scheidegger,
2016
Medical Imaging Modalities ‐ An Introduction

Contents

GRUNDLAGEN RADIOLOGIE

IK


EC HN
Imaging – purpose?
STRAHLENBIOLOGIE
STRAHLENPHYSIK

GEN T
 Xrays
ROENT
 XRF / XRA
 CT
 NUK: PET / SPECT
 MRI
 Ultrasound
 Image viewing
Medical Imaging Modalities ‐ An Introduction

Aim

GRUNDLAGEN RADIOLOGIE

IK
 You know the basic principle

EC HN
STRAHLENBIOLOGIE
STRAHLENPHYSIK

GEN T
and some clinical
ROENT applications of XR, XRF, XRA, 
CT, SPECT, PET, MRI, SONO / 
US
Imaging ‐ Purpose?

Different questions – different modalities:

 Diagnostic: Imaging of anatomy and physiology!

 Image guided therapy: Interventional radiology and
radiotherapy
 Theranostics: Tracer with isotpes for functional imaging and
therapy
Xrays – toward an insight into pationts anatomy

Steps to modern diagnostics:

 1895: Discovery of Xrays by
C.W. Röntgen
 End of 19th Century: first
medical applications
(diagnostics)
 Early 20th Century: first
therapeutic applications
 1969 / 72 first CTs 
(Hounsfield, first conercial
scanner by EMI)
Xrays – toward an insight into pationts anatomy

Anode Principles of Xray generation:

 High voltage (U) between
+ anode and cathode (40‐140 
kV for diognostics; 20‐300 
kV for therapy)
U  Accelaration of electrons
between cathode and anode
 Electron transport toward
- anode (tube current, mA)
 Collision of electrons with
annode (Bremsstrahlung, 
Kathode characteristic lines)
The Xray Source

Tube Voltage

Tube

Heating
Curcuit
 Hip Imaging …
Koenig et al. 2001, Am J Roentgenol.

after coronar
Angiography

after CT Angiography

Wagner, 2007:Biomed Imaging Interv J

100 mSv 4D-CT
Nieren-Angio
50 mSv
131I-Therapie Cerebr.-Angio
20 mSv
Nephrostomie
10 mSv CT
Abdomen-
5 mSv Thorax
CT Schädel
Skelet Szinti natürliche
2 mSv jährliche
Exposition
1 mSv
LWS a.p.
0.5 mSv Mammographie cc & mlo

0.2 mSv
DVT
Schädel a.p.
0.1 mSv
Zahnstatus
0.05 mSv Thorax p.a.

0.02 mSv Einzelzahn

Conventional Xray – Projection Radiography

What can be seen? 

(densities):

 Air
 Fat
 Muscle
 Bone
 Metal
 High contrast
produced by
Photo effect
Conventional Xray – Projection Radiography

Indications):

 Bone fractures
 Reposition (e.g. 
shoulder)
 Chest
Detectors

Task: Convert Xrays into a signal:

 Photographic system: Film 
with fluorescent screen
 CR‐system: Imaging plate
 DR‐system: Conversion of Xray
quanta into a signal (electrical
charge)
CdTe‐Detektor
 Detectors

Information width:

Optical density  Small for photographic system

Gray scale (film with fluorescent screen)
 Large for CR – and DR‐system: 
typical resolution 12 bit, 
special monitors for displaying
medical Xray images 10 bit

Radiation dose
XRF & XRA: Fluoroscopy and Angiography

Indications / Applications:

 Imaging movements (Hip 
and Knee)
 Imaging vessels by using
contrast media (cerebral or
coronar angiography)
 Interventional radiology
(stents, treatment of 
aneurysm)
 Medical disciplines: 
Neuroradiology, Cardiology, 
Urology, Gastro‐Enterology, 
Orthopedics, Surgery, etc.)
XRF: 
Flouroscopy

XRA: 
Angiography (+ Contrast media)

DSA: 
Digital Subtractions‐Angiography
(Contrast‐enhanced image – native image)
Cardangio setting
(Dose rate measured up to 2 mSv/h)
Something special?
CT: Computer Tomography

Applications / Indications:

 2D‐ (slice) or 3D‐ view

(renederd contours) 
available
 DVT: Dental Volume 
Tomography and CBCT
 Soft tissue contrast clearly
better than with
conventional (projection‐) 
radiography
 CT angiography
 Fast reconstruction
algorithm allowing 4D‐CT 
(tracking)
 RT planning
CT ‐ based Radiation Therapy Planning
EMI‐Scanner
1972
IAEA HUMAN HEALTH REPORTS No. 5: STATUS OF COMPUTED TOMOGRAPHY DOSIMETRY FOR WIDE CONE BEAM SCANNERS
Dental Volume Tomography DVT
CT: 2D or 3D?
CT: How To Get An Image (Slice)

Basic Principle:

 Projection: Absorption of 
radiation can be detected
as relief
 Reconstruct 2‐dim. Image 
from n 1‐dim projections
 n  ∞ for ideal image (n > 
36 for real image)
 Image matrix
80x80 Pixles
(1974)

Image matrix
512x512 Pixles
(2000)

imbie.meb.uni‐bonn.de/epileptologie/staff/lehnertz/CT1.pdf
CT: How To Get An Image (Slice)

Basic Principle:

 Real image is a pixelized
image
 Every pixel represents a 
grey scale corresponding to
the tissue density
(resolution 12 bit)
 Task: find the density of a 
pixel based on n
projections
CT: How To Get An Image (Slice)

Basic Principle:

 Task: find the density of a 

pixel based on n
projections
 The absorption
contribution from a specific
direction to every pixel is
defined by the sum of 
contributions of every path
element
CT: How To Get An Image (Slice)

Basic Principle:

 ds  ( x , y )
I  I 0e s
 The absorption
contribution from a specific
 I0 
 P( )  ln  direction to every pixel is
defined by the sum of 
 I  contributions of every path
element
  ds   ( x, y )  The signal strength P in a 
s projection is given by the

  ik
the detected intensity I
 For absorption, the Beer‐
i Lambert law is assumed
CT: How To Get An Image (Slice)

Algebraic approach:

 All projections are defining

a system of (linear) 
equations
 The projection values P() 
are known
 Rearrange equations to
find the contributions x
Reconstruction Algoritms

Different approaches:

 Arithmetic (slow)
 FFT: A projection in the real space
corresponds in the k‐space
(frequency domain) to a slice; FFT of 
projection, add all k‐space slices, 
reverse FFT
 Filtered back projection: 
Convolution of real space
projections with filter function (e.g. 
Shepp Logan Kerner)
 Iterative reconstruction: estimation
of the real pixel value by a statistical
/ physical model
Scanning‐Techniques
Scanning‐Techniques

Pencil-Beam-Geometry

• Parallel beams needed for

reconstruction
Scanning‐Techniques

Fan-Beam-Geometry

• Divergence in slice
Scanning‐Techniques

Fan-Beam-Geometry

• Divergence in slice
• Parallel beams (rays) in
different projections
Scanning‐Techniques

Fan-Beam-Geometry

• Divergence in slice
• Parallel beams (rays) in
different projections
• Reassembly of parallel
beams
Scanning‐Techniques: Axial / Sequential vs. Spiral Scans
 CT: Image Content and Window

Hounsfield‐Units  x  Wasser
HU  1000
Wasser
200

Knochen

Leber
100

Herz

Darm
Water 0

-100

Fett

Lunge
-200
CT: Image Content and Window

Window
+148
+1000 + 120
+ 800 + 100
+ 600 + 80 Displayed
+ 400 + 60
+ 200 Center
grey scale
+ 40
0 + 20 8‐10 bit
- 200 - 0
- 400 - 20
- 600 - 40
- 800 - 60
- 1000 - 80
- 100
HU - 108
 soft tissue and lung window

W 400 HU W 750 HU
C +45 HU C -720 HU
PET & SPECT: Tomography in Nuclear Medicine

Applications / Indications:

 Metabolic information
(tracer priciple)
 19F‐FDG for PET brain
imaging or cancer
metastasis search
 99mTcO4 for bone micro
fractions or metastasis
search
 Cardiology
 Theranostics
PET & SPECT: Tomography in Nuclear Medicine

Priciple opf tracer and imaging:

 Tracer (specific molecule defines

biokinetics)
 Tracer accumulates in certain structures
(e.g. metastasis or activ brain region)
 Isotope defines radiation energy and
characteristics: For PET, a positron emitter
has to be used
PET & SPECT: Tomography in Nuclear Medicine

Typical isotopes

SPECT (Single Photon Emission Computer Tomography)
• 99mTc: phys. HWZ 6.02 h
• 123I: phys. HWZ 13.2 h, biol. HWZ 80 d
• 125I: phys. HWZ 60.14 d, biol. HWZ 80 d
• 131I: phys. HWZ 8.04 d, biol. HWZ 80 d

PET (Positron Emission Computer Tomography)
• 11C: HWZ 20.3 min
• 13N: HWZ 10 min
• 18F: HWZ 109.7 min
 Isotopes in use (%, FOPH statistics)

45

40

35

30

25

20

15

10

0
PET & SPECT: Tomography in Nuclear Medicine

How to get an Image?:

 Radiation detection with a szintillation

detector
 Gamma (Anger‐) cam: Collimation of 
radiation (scatter = bluring; no or less
collimation needed for PET)
 For tomography: measurements at different 
angles / posistions  Projections!
SPECT: Single Photon Emission Tomography

How to get an Image?:

 For tomography: measurements at different 

angles / posistions  Projections!
SPECT‐CT
PET: Positron Emission Tomography

How to get an Image?:

 + ‐decay: Emission of 
a positron (e+)
 Anihilation: two
photons are emitted
 The angle between the
photons is (approx.) 
180°
PET: Positron Emission Tomography

How to get an Image?:

 The angle between the photons is (approx.) 
180°
 Coincidence: Two photons detected within a 
certain time window have the same origin
 Position of decay is defined!
 The two photons define a projection
 For tomography: measurements at different 
angles / posistions  Projections!
PET: Positron Emission Tomography

CT PET Detector
Image Fusion:
PET and MRI
MRI: Magnetic Resonance Imaging

Applications / Indications:

 Soft tissue (not bones due 

to lack of signal)
 Anatomic and functional / 
physiological information
 fMRI, blood flow
 Spectroscopy
 Cerebral diagnostics
 Cardiology
…
MRI: Magnetic Resonance Imaging

Principle:

 Need of a signal from the

body, which can be located
 Water is widely distributed
in the body, concentration
depends on tissue:
 Protons have a nuclear
spin, resulting in a 
magnetic dipole

Figures by Berberat J (2016), KSA
MRI: Magnetic Resonance Imaging

Principle:

 Protons have a nuclear
spin, resulting in a 
magnetic dipole
 In a thermodynamic
equilibrium without
external magnetic field, 
there is no net
magnetisation

Figures by Berberat J (2016), KSA
MRI: Magnetic Resonance Imaging

Principle:
N
 with external magnetic
field B0, protons start to
precess
 The rate of precession is 
the Larmor‐frequency (with 
the gyro‐magnetic ratio 
for 1H):
B0
   B0
S
  42.57 MHz / T
Figures by Berberat J (2016), KSA
 MRI: Magnetic Resonance Imaging

Principle:

 with external magnetic

B0 field B0, protons start to
precess
 In a thermodynamic
equilibrium, a net
magnetisation results
(temperature dependent, 
given by Boltzmann 
equation)

Figures: byBerberat J (2016), KSA
 Inside the magnetic field, net magnetization will occur

z
z
B0 B0
y
y
M

x
x

Berberat J (2016), KSA net magnetization

MRI: Magnetic Resonance Imaging

Principle:

 The nuclear spins can be

influenced by external
magnetic and electro‐
magnetic fields
 Applying a RF‐puls can turn 
the spins and subsequent 
the orientation of the net
magnetisation
 Bloch equations
 Magnetic resonance
Energy is applied as radiofrequency (RF) energy
– usually in so-called 90º and 180º pulses (SE)

RF-energy
applied
re-emitting the
M M absorbed energy
(FID)

protons begin to realign themselves to the direction of main magnetic

field Berberat J (2016), KSA
 Relaxation
• Decay ofr signal: T2 relaxation, spin-spin or transverse relaxation (xy-
plane)
– decrease of transverse coherence of protons
– energy is exchanged between spins
– sensitive to water mobility
• combination of magnetic field inhomogeneities and spin spin transverse
relaxation, with the result of rapid loss in transverse magnetization and
MRI signal: Free Induction Decay (FID)

Mxy
T2* = total relaxation time
T2= spin-spin relaxation
T2`= component of T2
T2
Relaxation time induced
T2 *
Berberat J (2016), KSA by field inhomogeneities
 Berberat J (2016), KSA

T1 relaxation T2 relaxation
increase of longitudinal decrease of transverse
magnetization magnetization

Mz Mxy
T1

T2

t
t
or:
 MRI: Magnetic Resonance Imaging

How to get an image?:

 Larmor frequency is
dependent on external
magnetic field
 A gradient field leads to a 
space dependent Larmor
frequency
 Emmitted RF‐signal can be
located by the frequency

Figures by Berberat J (2016), KSA
 Input:            Puls Sequ

Output:            (FID) Signal
 Gradients
• Three physical gradients: x, y and z gradients
– embedded inside magnet
– used to modify static magnetic field
• Gradients used in imaging
– Slice selection gradient (GSS)
– Read-out or frequency encoding gradient (GRO)
– Phase encoding gradient (GPE)

Berberat J (2016), KSA

From measured signals (frequency and phase map),
regular image can be calculated using Fourier
Transform

freq

phase

Each pixel in the image is related to the amount of

spins and the magnetic environment at the
corresponding location in the sample
In a MR image, different measures can be converted to grey scale and
displayed: Weighting in different images

PDw T1w T2w

TR/TE=5500/14ms TR/TE=500/10ms TR/TE=5500/101ms

SONO/US: Ultra Sound

Applications / Indications:

 Soft tissue (not bones due 

to high impedance)
 Endosonography
 Echocardiography
 Doppler sonography
 Vascular system by using
contrast media
 Advantage: non‐ionizing
radiation! 
 … and gives 2‐dim. slices
through patients anatomy
Endosonography
SONO/US: Ultra Sound

Priciple of image generation:

 Mechanical waves emitted

into patients body
 Frequency 1‐20 MHz
 Reflected waves are
detected
SONO/US: Ultra Sound

Priciple of image generation:

E
c Wave velocity depends on 
 material (elastical proprieties
and density)

 Fatty tissue: c = 1475 m/s
 Blood: c = 1570 m/s
 Brain:  c =1560 m/s
1
c  Liver: c = 1570 m/s

 

Muscles: c = 1580 m/s
Bone (Compacta): c = 3600 
m/s
SONO/US: Ultra Sound

Z   c Priciple of image generation:

Accoustic impedance Z defines

reflection

I ref  Difference of c large  R 

R large
I inc  R large  strong reflection

Z 2  Z1

Z 2  Z1
Material Density C ImpedanceN
g/m³ m/s s/m³

Air 1,29 331 429

Water 998 1483 1.48×106

Fatty tissue 920 1410–1479 1.33×106

Bone 1380-1810 2700-4100 4.3-6.6×106

Kramme (Ed.), Medizintechnik, Kapitel 27
SONO/US: Ultra Sound

Transducer
= source
and sensor

Reflecting object / surface

SONO/US: Ultra Sound

Components of a transducer
SONO/US: Ultra Sound
SONO/US: Ultra Sound

Different types of transducers:

 Linear field
 Sectoriel field
SONO/US: Ultra Sound

Different image modes:

 A mode: Amplitudes
 B mode: Amplitudes
converted to grey scale
 M Mode: Motion curves
 Doppler mode: Velocity
displayed by colors
Doppler US
(Images by S. Ohlerth, Tierspital
Zürich)
Echokardiography
(Images by S. Ohlerth, Tierspital
Zürich)

M Mode
Image Viewing and Medical Decision Making

• Suitable location:
Illumination / light!
• Equipment: special
monitors for radiology
(10 bit resolution,
calibrated)
• Good knowledge of
anatomy, physiology
and manifestations of
pathology
• Silence!