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Slide 1-

Medical exposure in radiology: Scope and responsibilities Module VIII.1 - Part 1 : General principles
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Module VIII.1 Scope & responsibilities: general principles 2 Introduction We will introduce briefly in this lecture the main modalities using ionizing radiation in a Medical Imaging Department And who are the “actors” using these imaging modalities ?
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Module VIII.1 Scope & responsibilities: general principles 3 Topics What IS radiology ? And the different modalities. The team of professionals
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Module VIII.1 Scope & responsibilities: general principles 4 Overview In this presentation we will present the scope of medical imaging, the terminology used, the variety of modalities (from plain radiography to CT), and the complementarity with other imaging techniques The medical physicist as expert plays an important roel in radiation protection
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Topic 1: what is radiology? An Introduction to Radiology: purpose, sub-modalities and basic terminology
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Module VIII.1 Scope & responsibilities: general principles 6 Topic 1: content What is radiology and who performs it Some basic terminology and equipment Different modalities overview Plain radiography Fluoroscopy Angiography Digital subtraction angiography (DSA) Computed tomography (CT) Complementarity of methods: CT and MRI Isotopes: Nuclear Medicine
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Module VIII.1 Scope & responsibilities: general principles 7 What IS Radiology ? (from EUR16260)
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Module VIII.1 Scope & responsibilities: general principles 8 Radiology is… Study of images of the human body Start: use of X Rays and photographic film Additional: use of X Rays in therapy Now: separate specialty and department Today variety of tools for imaging Creating images computer assisted: CT Some using no ionizing radiation: US, MRI
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Module VIII.1 Scope & responsibilities: general principles 9 “Radiology” in this course series… Restricted to the use of X Rays (Ionizing radiation) Plain radiography: static Fluoroscopy: dynamic Angiography: use of contrast material Computed tomography Specific applications: Mammography: breast cancer detection Pediatric radiology: from newborn to grown-up Aid to other specialties: Interventional radiology
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Module VIII.1 Scope & responsibilities: general principles 10 Plain radiography
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Module VIII.1 Scope & responsibilities: general principles 11 Plain Radiography Obtained by exposing patient to X Rays Image is basically a shadow of parts of patient absorbing or blocking X Rays Image is collected on Photosensitive film A digital imaging plate A fluoroscopic system with cassette holder Image is a “photographic negative” Darker regions have less absorbed X Rays
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Module VIII.1 Scope & responsibilities: general principles 12 Plain radiography: example of equipment High voltage generator Tube housing And diaphragm Movable patient “couch” Film cassette holder
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Module VIII.1 Scope & responsibilities: general principles 13 Fluoroscopy
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Module VIII.1 Scope & responsibilities: general principles 14 Fluoroscopy One image of a “life” sequence Colon White areas: Barium, contrast medium Black areas: air
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Module VIII.1 Scope & responsibilities: general principles 15 Fluoroscopy X Ray transmitted trough patient Out-beam strikes fluorescent screen Part of an Image Intensifier system Coupled to a television camera Radiologist can watch the images “live” on TV-monitor; images can be recorded Fluoroscopy often used to observe digestive tract Upper GI series, Barium Swallow Lower GI series Barium Enema
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Module VIII.1 Scope & responsibilities: general principles 16 The Image Intensifier: basic element of the fluoroscopy equipment Input fluorescent screen In vacuum electronic amplification system Output window
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Module VIII.1 Scope & responsibilities: general principles 17 Fluoroscopy room equipment Typical Fluoroscopy equipment, with “over-coach” tube, viewed from above (Philips) I I and TV camera under patient’s table
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Module VIII.1 Scope & responsibilities: general principles 18 C-arm equipment Ability to maneuver c-arm around patient without moving him Often used as “mobile” unit Critical care units In room examination Modern units allow fluo + radiography
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Module VIII.1 Scope & responsibilities: general principles 19 Mobile unit Parking conditions
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Module VIII.1 Scope & responsibilities: general principles 20 Angiography
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Module VIII.1 Scope & responsibilities: general principles 21 Angiography images
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Module VIII.1 Scope & responsibilities: general principles 22 What is angiography Invasive procedure Injection into patient of radio-opaque substance (“Dye” or “Contrast Agent”) Injection by small tube into vein or artery The radio-opaque material Blocks X Rays Gives shadow of injected vessels Reveals shape of artery/vein Diagnosis of obstruction, narrowing (Stenosis)
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Module VIII.1 Scope & responsibilities: general principles 23 Digital Subtraction Angiography or DSA Digital: allows subtraction, image manipulation Two images with different calculation algorithms
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Module VIII.1 Scope & responsibilities: general principles 24 What is DSA? Subtraction: removes non-essential structures in the image Combining mathematically pre- and post-contrast images Noisier, but improves visibility of important structures DSA was first full digital based fluoroscopic imaging procedure: high spatial resolution not necessary
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Module VIII.1 Scope & responsibilities: general principles 25 Computed Tomography
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Module VIII.1 Scope & responsibilities: general principles 26 Computed Tomography CT- Scan: Computer tomography CAT-scan: Computer axial tomography Gives sectional, in depth or 3-D information CT supersedes “linear tomography” or
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Module VIII.1 Scope & responsibilities: general principles 27 What is CT ? Spinning X Ray source and detectors around patient Attenuation data collected from multiple angles Computer processes these data A reconstructed image is presented on screen These images: “cuts”, “slices”, “sections” Newer generation: helical/spiral scan, 3-D data Problem of overlap of shadows is solved CT can be performed “plain” or after injection of “contrast agent”
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Module VIII.1 Scope & responsibilities: general principles 28 Complementarity with other modalities Magnetic Resonance Imaging (MR or MRI)
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Module VIII.1 Scope & responsibilities: general principles 29 Magnetic Resonance Imaging Two images obtained with (different) MRI techniques, compared to CT-slice (DYSEMBRYOPLASTIC NEUROEPITHELIAL TUMOR)
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Module VIII.1 Scope & responsibilities: general principles 30 Magnetic Resonance Imaging No use of X Rays or other type of Ion. Radiation Magnetic field “lines-up” protons Coils with high frequency pulse knocks the out of alignment Radiofrequency antennas “listen” to the emitted resonance signals Resonance signals are treated by computer, creates 3-d information “Cuts” or “slices” presented similar to CT, but information collected different/complementary
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Module VIII.1 Scope & responsibilities: general principles 31 Historical pictures An X Ray examination room (Mayo Clinic circa 1925) Original EMI CT head scanner an 80 x 80-matrix head CT image obtained with it (1973)
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Module VIII.1 Scope & responsibilities: general principles 32 Historical Pictures: radiology and… risks Radiograph of the hand of Mrs. Roentgen 1903: first radiation risk reports [From R F Mould, A Century of X-Rays…]
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Module VIII.1 Scope & responsibilities: general principles 33 Summary of Topic 1 Radiology serve the diagnosis of patients Uses different modalities, mainly involving ionizing radiation: X Rays Plain radiography gives static projection image Fluoroscopy gives dynamic images Contrast agents improve visibility, used e.g. in angiography
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Module VIII.1 Scope & responsibilities: general principles 34 Summary of Topic 1 (cont.) Digital systems allow subtraction of images, enhancing visibility (DSA) CT techniques allow 3-d reconstruction Nuclear medicine and MRI images are complementary to X Ray images From early beginnings radiology included radiation risks
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Topic 2: the professionals
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Module VIII.1 Scope & responsibilities: general principles 36 The team… Medical practitioner: the Radiologist M.D. with training interpretation of medical images Interprets the images to establish diagnosis Radiographer (radiological technologist) Staff member trained in positioning patient and optimal use of equipment for image quality and radiation protection Radiodiagnostic Physicist as qualified expert Dose optimization Optimizing of imaging protocols Link with “outside” of department The referring M. D.
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Module VIII.1 Scope & responsibilities: general principles 37 BSS Requirement As per BSS II.2, registrants and licensees should ensure that for diagnostic uses of radiation, the imaging and quality assurance requirements of the Standards be fulfilled with the advise of a qualified expert in radiodiagnostic physics
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Module VIII.1 Scope & responsibilities: general principles 38 Clinical responsibility Responsibility regarding individual medical exposures attributed to a practitioner This includes: justification; optimization; clinical evaluation of the outcome; cooperation with other specialists and the staff, as appropriate
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Module VIII.1 Scope & responsibilities: general principles 39 Clinical responsibility (2) Practical aspects: obtaining information of previous examinations; providing existing radiological information and/or records to other practitioners and/or prescribers; giving information on the risk of ionizing radiation to patients and other individuals involved
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Module VIII.1 Scope & responsibilities: general principles 40 The Roles, Responsibilities and Status of the Radiodiagnostic Physicist Two categories One category : of physicists working as teachers and scientists in universities, as researchers in industrial laboratories, in governmental research institutions The second category: physicists working in a clinical environment, in the hospital Names: "medical physicist", "clinical physicist", "hospital physicist“ are used in different countries
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Module VIII.1 Scope & responsibilities: general principles 41 Radiodiagnostic Physicist: definition Has or might have an influence on the diagnosis and/or treatment and safety of patients, or their decisions might have consequences for the performance of diagnostic, treatment and safety procedures in hospital care.
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Module VIII.1 Scope & responsibilities: general principles 42 Radiodiagnostic physicist: responsibilities The main responsibility of the Radiodiagnostic physicist is to provide a high standard of service in the hospital.… He is a member of a team of personnel responsible for diagnosis and treatment of patients. The physicist wil have an influence on the diagnosis, treatment and safety procedures for the patient and thus his decisions will have consequences for the patient. As his decisions are based on his competence, a competence not found elsewhere he should be fully responsible for his work [ from EFOMP]
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Module VIII.1 Scope & responsibilities: general principles 43 More Responsibilities of the Radiodiagnostic Physicist High standard of service Standardisation and calibration of medical physical equipment Safety of physical methods used in routine clinical applications (with medical staff) Research and in the development Providing education and training in applied physics for doctors, nurses, medical technical assistants Recognised by the national health authorities
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Module VIII.1 Scope & responsibilities: general principles 44 Ionizing radiation: Radiodiagnostic Physicist as the qualified expert Man-made contribution to the radiation exposure of human beings primarily due to the use of Ionizing Radiation and radioactive substances in medicine. Radiodiagnostic Physicist will act as the “Qualified Expert in Radiation physics” Responsible for radiation protection of the patient and the staff in radiological department
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Module VIII.1 Scope & responsibilities: general principles 45 The Role of the Qualified Expert in Radiodiagnostic Physics Dosimetry of the equipment beams Lay down and supervise the Quality Assurance programme Surveillance with respect to radioprotection Public, staff, … Reduce dose to patients, keeping in mind the required image quality Choose equipment for radiation protection Give advice on purchase of diagnostic equipment with respect to image quality and radiation protection
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Module VIII.1 Scope & responsibilities: general principles 46 What we learned To become familiar with the multiple imaging modalities in a radiological department Each modality requires specific equipment In radiation protection (patient or staff) the medical physicist as a qualified expert plays a central role
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Module VIII.1 Scope & responsibilities: general principles 47 Where to get more information? The Physics of Diagnostic Imaging, David J. Dowsett, Patrick A. Kenny and R. Eugene Johnston, Chapman & Hall Medical, ISBN 0-412-40170-1 International Basic Safety Standards for Protection Against Ionizing Radiation and for the Safety of Radiation Sources. 115, Safety Standards. IAEA, February 1996. ICRP 73. Radiological Protection and Safety in Medicine. Annals of the ICRP, 26(2), 1996. Qualified Expert in Radiophysics,The European Federation of Organisations for Medical Physics, Policy Statement 3 Role and Responsibilities of Medical Physicists in Radiological Protection of Patients, Azam Niroomand-Rad, Ph D; See: IOMP Website