ADVANCED IMAGING TECHNIQUES

The most versatile of advanced imaging techniques include: Computed tomography(CT)

Magnetic resonance imaging(MRI)

Ultrasonography

Nuclear medicine.

COMPUTED TOMOGRAPHY

In 1972 Godfrey hounfield,an engineer,announced the invention of revolutionary imaging techniques that used image reconstruction mathamatics developed by Alan cormade in 1950s & 1960s.

Computed tomography scanners

This form of imaging is called as computed tomography,abbreviated as CT,Computed tomographic scanning,axial tomography & computerised transaxial tomography.

CT scanner consists of an xray tube that emits a finely collimated,fan shaped x-ray directed through a patient to a series of scintillation detectors or ionization chambers.These detectors measure the no of photons that exit the patient.

The intensity of the x-ray beam exiting the body is determined by:

1)The energy of the x-ray tube source.

2)The distance between the source of x-ray & the detector.

3)The attenuation of beam by materials in object being scanned.

TECHNIQUE

Patient would lie on a stationary table while the x-ray source rotates one cycle around them.The table would move 1-5mm for the next scan.

CT scan that uses this type of step & shootmovement for image acquisition are called incremental scanners.

The final image set consists of series of overlapping axial images,made up of right angles to the long axis of the patients body.

These two dimensional slices are crosssections,typically 1mm thick.

Pitch=Table travel per x-ray rotations/image thickness

In 1989 CT scanners were introduced that acquire image data in helical fashion. In helical CT scanners,Pitch refers to the amount of patient movement compared with the width of the image acquired.

MULTIDETECTOR HELICAL CT-

MDCT,multislice ct,multirow CT.With this method anywhere from 4-64 adjacent detectors arrays are used in conjunction with helical CT.

The time for the x-ray tube to make a full cycle around the patients has been reduced to as little as 0.35sec.

ELECTRON BEAM CT
An electron gun generates an electron beam that is focused electrostatically on a fixed tungstan target circling halfway around the patient. Because there are no moving parts an image may be acquired in less than 100microsec.This technique is primarily used for cardiac imaging to stop heart motion.

CT TOMOGRAPHIC SCANNER COMPUTED ASSEMBLY The basic components of CT are: 1.Gantry 2.Patient supporting couch 3.Computer

GANTRY
The gantry is made up of detector array,patient supporting couch & the xray tube or source. The gantry can be tilted up to 30degree. The facility to tilt helps in excluding structure from the scan that may degrade the final image(eg metallic dental restoration). Components of gantry are:

X-ray detectors

Detector array

X-ray tube
CT scanners use x-ray tubes with rotating anodes.These tubes a high heat capicity 8 million heat units. Operate at-120-140(kvp)

Focal spot sizes ranges-0.5-2.0mm.

Xray beam is collimated before & after the patient.Prepatient collimation adjusts patient exposure.Postpatient collimation controls slice thickness. Slice thickness is typically between 1 &3mm. Thinner slices results in higher spatial resolution & contrast less partial volume effect & higher patient dose.

DETECTORS
X-ray beam exiting the patient is captured by an array of detectors.
The detectors are usually gas filled or solid state. Gas filled ion chamber detectors are usually made of high pressure xenon. Gas filled ion chamber respond quickly but only capture about 50% of photons. Solid state detectors are commonly used they are made up of cadmium tungstate

IMAGE RECONSTRUCTION

Computer algorithms use these photons counts to construct one or more often,many digital crossectional images.The ct image is recorded and displayed as a matrix of individual blocks called voxels(volume elements).Each square of the image matrix is a pixel.

Next an interpolator algorithm is used to correct for the helical motion of the scanner and to construct planer crossectional from the helical information.

PATIENT SUPPORT COUCH

The patient support couch helps in stabilising the position of the patient during ct scan.The couch must be made of low molecular weight material such as carbon filter to ensure that the path of the x ray beam is not altered before or after it transverse the patient.

COMPUTER
The rapidly of capturing the image,acquring data,and larger matrix size(512 *512) necessitates the use of high speed computers.

CONTROL CONSOLE
The control console allows the operator to select the parameters of the ct scan and view the image as they are been generated. Image is stored in the computer so that it can be manipulated in no. of ways(eg. Magnetic tapes or discs).

COMPUTED TOMOGRAPHIC IMAGE

CT number representing tissue density.

The no. is propotional to the degree to which the material with in the voxel has attenuated the xray beam.
Ct no. also called as hounsfield units range from -1000 to +1000. An image optimised for viewing bone-a bone window,may have a range of 700 units and mean of 5000units.

TYPICAL HOUNSFIELD UNITS FOR AIR AND TISSUES TISSUE BONE SOFT TISSUE WATER FAT LUNG AIR HOUNSFIELD UNITS +400-+1000 +40-+80 0 -60_-100 -400_-600 -1000

ARTIFACTS
Different types of artifacts may degrade CT images. Some are: Partial volume artifacts

Beam hardening artifacts

Metal artifacts

CONTRAST AGENTS

Are the substances used to improve visualization of structure. CT imaging frequency uses iodine,administered i/v to enhance soft tissue and vascular image details.

ADVANTAGES
Multiplaner images.
Greater geometric projections. Manipulation of acquired images. Soft tissue imaging.

DISADVANTAGES

Production of artifacts.

Expensive.

Patients exposure to radiations.

USES IN DENTISTRY Evaluation of presence & extent of clinically suspected pathology in the head & neck. Detection of extention of disease process into the paranasal sinus,base of skull& orbit.

Determination of location,extent & displacement of maxillofacial skeletal fractures,including direction of subdural & epidural haematomas.
Salivary gland imaging.

Evaluvation of potential implants sites using 3D image. Evaluation of components of TMJ.

CT guided FNAC biopsies.

Virtual surgeries.

NUCLEAR MEDICINE

Radionuclide imaging uses radioactive atoms or molecules that emit gamma rays.

Radionuclides allow measurement of tissue funtions in vivo & provide early marker of disease through measurement of biochemical changes.

After the radionuclides are administered in the body they distribute according to there chemical properties.

RADIONUCLITIDES

The ideal radionuclide has a short half life,emits gamma rays and is capable of binding to a variety of pharmaceuticals.Although many gamma emitting isotopes are used in imaging,including iodine,gallium,selenium.The most commonly used is Technetium. Technetium has a half life of 6hr and emits primarily 140 kiloelectron volt photon.As Tc is injected i/v it gets concentrated in thyroid gland and gastric mucosa.

TO IMAGE A BONE
Tc is typically bound to methylene diphosphonate and a dose of 20 to 30mlci is injected i/v.immediately after injection the tracer distributes intravascularly. Images made during this flow phase,the first 60-90sec are called as radionuclide angiography. In the second,or blood pool phase,the tracer moves quickly into the extracellular spaces. The third or bone scintigraphy phase,is made 2-3hrs after injection show most of the tracer activity in skelton,kidney,and bladder.

GAMMA SCINTILLSTION CAMERA

These camera capture photon and convert them to light and then to voltage signal.

Gamma sclintillation camera also called as anger camera are most common means of forming an image.

These signal is constructed to a planer image that shows the distribution of the radionuclide in the patient.

SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY

SPECT is the method of acquiring tromographic slices through the patient.

In this technique either a single or multiple gamma camera is rotated 360degree about the patient.

Image acquisition takes about 3045min.

Tomography enhances contrast and removes superimposed activity.

APPLICATIONS

Investigate abnormal metabolic bone activity.helps in assessing growth activity in case of condylar hyperplasia and presence of metabolic lesions.

POSITRON EMISSION TOMOGRAPHY

Radionuclide used are glucose,aminoacid

PET is most advanced imaging modality in nuclear medicine.

Relies on positron emitting radionuclide generated in cyclotron.

100 times sensitive than gamma camera.

USES

The PET/CT combination has been helpful in staging and treatment of squamous cell carcinoma in head and neck.

PRESENTED BY

ROLL NO:75

SAKEENA ASSAD