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Wednesday, 4 December 2024
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Contrast Enhanced Computed Tomography
(CECT) Contrast agents are used during contrast enhanced computed (or computerized) tomography examinations to highlight specific tissues and parts of the body. Bones can be clearly seen on x-ray images, the visualization of some other organs and soft tissues is more difficult. Sufficient contrast is important in perceiving a difference in the density between areas of a CT image. The identification of a disease may be challenging due to very low contrast between pathological tissues (for example tumors, metastases and abscesses), normal organ structures and surrounding tissues.
Contrast agents are used in CT angiography (CTA) to delineate vessels, in multiphasic CT studies to provide dynamic information of blood supply (e.g., liver CT) and in CECT studies of various body parts to achieve opacification of tissue of interest (e.g., kidney CT) in relation to the background tissue. Contrast enhanced multi-detector row CT (MDCT) replaces several conventional diagnostic imaging methods such as intravenous urography, cholangiography, or catheter angiography, due to advanced CT studies with fast examination times, high contrast enhancement, perfusion measurement and multiplanar reformatting capabilities.
See also Contrast Media Injector, Single-Head CT Power Injector, Multi-Head Contrast Media Injector, Syringeless CT Power Injector, CT Power Injector.
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Contrast Media Injector
Contrast media injectors are part of the medical equipment used to deliver fluids in examinations such as CT, MRI, fluoroscopy and angiography. Many of these diagnostic imaging procedures include the administration of intravenous contrast agents to enhance the blood and perfusion in tissues.

Mainly there are two types of injector technology:
Piston-based systems use a plunger/piston to move a piston in the cylinder of a reservoir, which works in two directions to first fill the reservoir and then deliver the fluid from the reservoir to the patient, similar to a hand-held syringe.
Peristaltic-pump-based systems operate as rotary pumps that use rollers to compress sections of flexible tubing, drawing fluid directly from the supply source and delivering it to the patient.

See also Single-Head Contrast Media Injector, Dual-Head CT Power Injector, Syringeless CT Power Injector.

The use of x-ray contrast agents in computed tomography (CT) began with a hand injection by the radiologist in the scan room. During its history, CT scanners have made great improvements in speed and image quality. Actual CT systems with multiple detectors allow scan times of a few seconds per body region. Some CT protocols require multiphase scans, where a body region is imaged with a single bolus of contrast in different blood flow phases. Automatic power (pressure) contrast media injectors are required to provide precise control of flow rate, volume and timing of injection. The use of a saline bolus following contrast administration reduces the volume of contrast required.

Most relevant topics for the use of a power injector in medical imaging procedures such as contrast enhanced computed tomography (CECT):
Avoidance of microbiologic contamination;
workflow efficiency in the use of the contrast media injector;
contrast cost and waste volume;
reimbursement.

Must have basic injector control options:
Flow rate with a usual range from 0.1 to 10 mL/sec in 0.1 mL/sec increments; some injectors can be set to inject in ml/min or ml/hour;
volume range from 1 mL to 200 mL for contrast and saline phases;
pressure limit typically programmable from 50 psi to 300 psi in 1 psi increments (also displayable in kPa and kg/cm²).

Examples of other injector control options:
Warmer/heater; an increase in temperature of the contrast medium results in a decrease in its viscosity; warmed contrast media are less viscous and offer lesser resistance;
pre-filled syringes; the compatibility with many selected syringes makes it easy to change and select the appropriate contrast medium for each patient;
injection reports accessible via RIS/PACS for dose management systems and records of prior injections.

Conventional Radiography
Conventional (also called analog, plain-film or projectional) radiography is a fundamental diagnostic imaging tool in the detection and diagnosis of diseases. X-rays reveal differences in tissue structures using attenuation or absorption of x-ray photons by materials with high density (like calcium-rich bones).
Basically, a projection or conventional radiograph shows differences between bones, air and sometimes fat, which makes it particularly useful to asses bone conditions and chest pathologies. Low natural contrast between adjacent structures of similar radiographic density requires the use of contrast media to enhance the contrast.
In conventional radiography, the patient is placed between an x-ray tube and a film or detector, sensitive for x-rays. The choice of film and intensifying screen (which indirectly exposes the film) influence the contrast resolution and spatial resolution. Chemicals are needed to process the film and are often the source of errors and retakes. The result is a fixed image that is difficult to manipulate after radiation exposure. The images may be also visualized on fluoroscopic screens, movies or computer monitors.
X-rays emerge as a diverging conical beam from the focal spot of the x-ray tube. For this reason, the radiographic projection produces a variable degree of distortion. This effect decreases with increased source to object distance relative to the object to film distance, and by using a collimator, which let through parallel x-rays only.
Conventional radiography has the disadvantage of a lower contrast resolution. Compared with computed tomography (CT) and magnetic resonance imaging (MRI), it has the advantage of a higher spatial resolution, is inexpensive, easy to use, and widely available. Conventional radiography can give high quality results if the technique selected is proper and adequate. X-ray systems and radioactive isotopes such as Iridium-192 and Cobalt-60 for generating penetrating radiation, are also used in non-destructive testing.

See also Computed Radiography and Digital Radiography.
Coronary CT Angiography
(CCTA) Coronary computed tomography angiography is a diagnostic imaging procedure to visualize the coronary arteries. CCTA is a non-invasive angiogram that allows the assessment of narrowed and clogged arteries that can cause heart attack and stroke.
Coronary CTA is a non-invasive alternative to traditional angiography that offers detailed images of heart function, resulting in faster, more accurate diagnosis. It helps stratify cardiac risk in patients with low to intermediate likelihood of coronary artery disease. For some patients with chest pain, coronary CTA can rule out the need for cardiac catheterization.
Coronary imaging requires a very fast CT scan, because the coronary arteries and other cardiac structures move rapidly during the cardiac cycle. The current 'state of the art' 64 slice multi-detector row CT systems rotate around the patient in less than 500 ms. The data must be acquired monitored by an electrocardiogram, which allows the computer to reconstruct retrospectively slices at different small segments of the cardiac cycle. This cardiac synchronization reduces motion artifacts in the coronary arteries and provides movies of the beating heart and valve motion.
See also Coronary Angiogram, Calcium Score, Cardiac Phase, Cine Mode and Defibrillator.
Diagnostic Imaging
Imaging refers to the visual representation of an object. Today, diagnostic imaging uses radiology and other techniques, mostly noninvasive, to create pictures of the human body. Diagnostic radiography studies the anatomy and physiology to diagnose an array of medical conditions. The history of medical diagnostic imaging is in many ways the history of radiology. Many imaging techniques also have scientific and industrial applications. Diagnostic imaging in its widest sense is part of biological science and may include medical photography, microscopy and techniques which are not primarily designed to produce images (e.g., electroencephalography and magnetoencephalography).
Brief overview about important developments:
Imaging used for medical purposes, began after the discovery of x-rays by Konrad Roentgen 1896. The first fifty years of radiological imaging, pictures have been created by focusing x-rays on the examined body part and direct depiction onto a single piece of film inside a special cassette.
In the 1950s, first nuclear medicine studies showed the up-take of very low-level radioactive chemicals in organs, using special gamma cameras. This diagnostic imaging technology allows information of biologic processes in vivo. Today, single photon emission computed tomography (SPECT) and positron emission tomography (PET) play an important role in both clinical research and diagnosis of biochemical and physiologic processes.
In the 1960s, the principals of sonar were applied to diagnostic imaging. Ultrasound has been imported into practically every area of medicine as an important diagnostic tool, and there are great opportunities for its further development. Looking into the future, the grand challenges include targeted contrast imaging, real-time 3D or 4D ultrasound, and molecular imaging. The earliest use of ultrasound contrast agents (USCA) was in 1968.
The introduction of computed tomography (CT/CAT) in the 1970s revolutionized medical imaging with cross sectional images of the human body and high contrast between different types of soft tissues. These developments were made possible by analog to digital converters and computers. First, spiral CT (also called helical), then multislice CT (or multi-detector row CT) technology expanded the clinical applications dramatically.
The first magnetic resonance imaging (MRI) devices were tested on clinical patients in 1980. With technological improvements including higher field strength, more open MRI magnets, faster gradient systems, and novel data-acquisition techniques, MRI is a real-time interactive imaging modality that provides both detailed structural and functional information of the body.

Today, imaging in medicine has been developed to a stage that was inconceivable a century ago, with growing modalities:
x-ray projection imaging, including conventional radiography and digital radiography;
scintigraphy;
single photon emission computed tomography;
positron emission tomography.

All these types of scans are an integral part of modern healthcare. Usually, a radiologist interprets the images. Most clinical studies are acquired by a radiographer or radiologic technologist. In filmless, digital radiology departments all images are acquired and stored on computers. Because of the rapid development of digital imaging modalities, the increasing need for an efficient management leads to the widening of radiology information systems (RIS) and archival of images in digital form in a picture archiving and communication system (PACS). In telemedicine, medical images of MRI scans, x-ray examinations, CT scans and ultrasound pictures are transmitted in real time.

See also Interventional Radiology, Image Quality and CT Scanner.
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