Topic : The Principle of Conventional Tomography for chest, abdomen, kidney, liver and biliary system

Medical Imaging HS112

Name Student ID Lecturers Name

: Nur Farhain Bt. Ghazali : 2010449142 : Alice Demi Anak Numpang

Date of Submission : 22.02.2012

Contents
y y y Introduction Principle of Conventional Tomography Application of Conventional Tomography (i) Kidney (ii) Liver (iii) Chest (iv) Abdomen (v) Biliary system y y y Basic Principles of Positioning Reference Index

Introduction (def name,who create when what fx Tomography is a special type of imaging that is used to obtain diagnostic image of a specific layer of tissue or an object that is superimposed by other tissues or object(s) (Kenneth and John 2010, p. 773). Conventional tomography is called as axial tomography as the long axis of the body is parallel to the plane of the image. It is usually produce coronal images, although sagittal sections of most body parts and transverse sections of the head may be accomplished through positioning. Tomography also has been called as planigraphy, stratigraphy, laminography and also body section radiography.

Image 1. A tomographic unit. The patient sat while the film and x-ray tube move.

According to Carlton, R. R. & Adler, A. M.(2006), in the development of tomography, there were only nine investigators who had taken part in developing it, and they were Andr Edmund Bocage (French dermatologist 1892-1953) and including the American radiographer named Jean Kieffer. This conventional tomography was first developed in the year of 1921.

Principle of Conventional Tomography In conventional tomography, there are three basic requirements which are source of an x-ray, an object and an image receptor (IR). The principle of tomography is based on the synchronous movements of two out of the three elements in a tomographic system at the same time, which are: the x-ray tube and the image receptor. These two elements move at the opposite direction while the object (patient) remains stationary. The basic tomographic blurring principle :

In conventional tomography, there are five possible tube trajectories which are Linear(i), Elliptical(ii), Circular(iii), Spiral(iv) and Hypocycloidal(v).

Application of Conventional Tomography

Biliary system Tomographic examination for biliary system is performed if an oral cholecystogram does not provide adequate information for diagnosis or a cholecystectomized patient is suspected having a biliary ductal disease. Therefore, intravenous cholangiogram (IVC) may be performed. In order to perform intravenous cholangiograms, the contrast material solution which is Cholegrafin is infused into the bloodstream slowly over approximately 20 to 30 minutes. The contrast is infused slowly in order to reduce the possibility of the patient having anaphylactic shock. The examination is done when the full length of bile duct is visualized which is usually between 30 minutes and one hour after injection. The rationale of performing tomographic examination on biliary system is to give better visualization of the opacified bile ducts and to get extra information which is not available with conventional radiography. Zonography is usually used during IVC, but hypocycloidal or trispiral motion is preferred when blurring or a thinner tomographic section is desired. If using a linear motion, an exposure angle of 15 to 20 should be used. Positioning for posterior oblique projection : The patient lies supine on the table then the left side is raised rotating the median sagittal plane through 20 to 30. Maintaining this degree of rotation the patient is moved so that a vertical central ray would pass to a point along the midline of the anterior abdominal wall at the level of lower costal margin. Pivot height used is between 11 cm and 13 cm.
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Positioning for anterior oblique projection : The patient may alternatively be positioned with the right side is raised 10 to 20 and positioned on the table so that a vertical central ray would pass to a point 7.5 cm to the right of the midline at the level of lower costal margin. Pivot height used is between 8 cm and 10 cm. Tomographic movement used is 20 transverse linear or circular.

Liver Chest Abdomen When performing tomographic examination on abdominal organs, zonography is usually preferred as it produces focal plane images of greater contrast. Other than that, tomographic imaging is effectively performed with the used of contrast media because of the relatively homogeneous densities of abdominal structures. A circular motion with an exposure angle of 8 or 10 degrees is recommended for use in the abdomen. If the smaller angle does not does not provide enough blurring, an angle of 15 degrees may be necessary to eliminate bowel gas shadows.

Kidney The common tomographic examinations of the kidneys are normally performed with the use of contrast media because of the relatively homogeneous density. Tomography is used during intravenous urography either at about 20 minutes after injection, to diffuse the shadows of gas which overlie the calyces preventing their clear visualization, or immediately on completion of the injection to show the nephrogram stage. This latter method, nephrotomography, can be used to differentiate between kidney cysts and tumor and between intra- and extra-renal masses Procedure for anteroposterior (AP) projection : The patient is supine on the table with the median sagittal plane of the body at right angle angles to and in the midline of the table. The position is adjusted so that a vertical central ray would be incident in the midline midway between the suprasternal notch and the symphysis pubis. Pivot height used is 8 cm to 11 cm and the tomographic movement used is circular or linear 10 degrees.

Basic Principles of Positioning

In conventional tomography, usually two or more tomographic image planes are required as one series of tomograms in a single plane may not provide adequate details for diagnosis. On the other hand, in the case of bilateral structures, such as the auditory canals, only one radiograph is used for each side in order to make comparison between both structures. Basically, AP and Lateral projections are performed to most tomographic examinations. A special oblique projection may be necessarily to optimally visualize the part under investigation. In tomography, part of the structure being examined is usually positioned either parallel or perpendicular to the tomographic plane and if the patient is slightly oblique,