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Cross Sectional Imaging Nuclear Medicine

Cross Sectional Imaging Nuclear Medicine. Dr. LeeAnn Pack Dipl. ACVR. Computed Tomography (CT). Cross Sectional Imaging. No superimposition of structures Excellent contrast resolution – can see the difference between 2 similar tissues

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Cross Sectional Imaging Nuclear Medicine

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  1. Cross Sectional ImagingNuclear Medicine Dr. LeeAnn Pack Dipl. ACVR

  2. Computed Tomography (CT)

  3. Cross Sectional Imaging • No superimposition of structures • Excellent contrast resolution – can see the difference between 2 similar tissues • For CT – scan can be performed in one plane (usually transverse) and reformatted in the others (sag, dorsal) • CT – good for bone and soft tissue • MRI – better for soft tissue

  4. Computed Tomography • Uses X-rays, X-ray tube, detectors, collimators – very similar to radiography in how it works. • Patient placed in gantry • Multiple samples are taken from around the patient and then reconstruction can occur to make a slice

  5. Generation configuration detectors beam min scan time First translate-rotate 1~2 pencil thin 2.5 min Second translate-rotate 3~52 narrow fan 10 sec Third Rotate-rotate 256~1000 wide fan 0.5 sec Fourth Rotate-fixed 600~4800 wide fan 1 sec Fifth electron beam 1284 detectors wide fan electron beam 33 ms CT Generations Helical and Multislice CT’s are used now

  6. How It Works • Scout image is made first to pick the area to scan • Parameters set on the computer • Scan begins • Linear attenuation coefficient of tissues • Houndsfield units calculated • Shade of grey assigned to a CT number

  7. CT Principles • The image is divided into small areas called pixels • Each pixel has a location • Each pixel has an attenuation value • Using this information and very complex math formulas, the computer constructs the image

  8. CT numbers • High CT number = white because of increased attenuation • Low CT number = black because of decreased attenuation • Houndsfield scale • Water is zero, air is –1,000 and bone is 1,000 • 256 shades of grey

  9. Windowing • Level • Center portion of the Houndsfield scale that is being used • Should be near the tissue of interest • Width • How much of the Houndsfield scale is used • Values within the window will be various shades of grey - rest black or white

  10. Level and Width

  11. Windowing - Use • Narrow window – enhance contrast of the tissues • Brain • Wide window – area with high inherent contrast • Lungs • Soft tissue window • Bone window • Reformatting – can not be better than original slice – decreased spatial resolution

  12. CT Terminology • Density • Hypodense • Isodense • Hyperdense • IV Contrast can also be administered – then contrast enhancing, ring enhancement etc can be used

  13. Soft Tissue Bone

  14. Choroid Plexus Tumor

  15. Fibrosarcoma Cat Back

  16. Multilobular Osteochondrosarcoma

  17. CT images

  18. Bone Lysis Nasal Tumor

  19. Nasal Adenocarcinoma

  20. Retrobulbar Mass

  21. Pituitary Tumor

  22. Magnetic Resonance Imaging (MRI)

  23. Magnetic Resonance Imaging • Does not involve ionizing radiation • Uses magnetic field and radiofrequency pulses • Hydrogen proton on tissues (water) • Water = like tiny magnets • When placed into magnetic field H protons line up along field

  24. MRI • Radiofrequency pulse passed through patient • Protons flip and spin • Pulse turned off and H protons return to normal state = relaxation • T1 • T2

  25. Meningioma Hydrocephalus

  26. MRI • Tissues that have little H protons have little signal and are black • Air, bone, moving blood • Good for soft tissue imaging though • Paramagnetic contrast agent – Gad • No reformat – must scan all planes • Thus much longer scan than CT • Transverse, sagittal, dorsal

  27. T1 vs. T2

  28. MRI Machines • Can vary from .3 Tesla to 3 Tesla for routine working machines • Many are superconducting – use helium • Magnet is always on and must be contained in a Faraday cage (blocks stray radiofrequency signals) • Open and closed magnets

  29. MRI Terminology • Intensity • Hyperintense • Isointense • Hypointense • Contrast enhancing with Gadolinium

  30. MRI Safety • Augment T waves on EKG • Light flashes – Mild skin tingling • Involuntary muscle twitching • Increased body temperature • Projectile effects • Effects on surgical implants – ferrous • Magnetic foreign bodies • Life support devices

  31. MRI Contraindications • Pacemaker • Intra-cranial implants, clips • Metallic foreign bodies • Implanted electrical pumps, mechanical devices

  32. Nuclear Scintigraphy (Nuc Med)

  33. The Basics • Radionuclides (radioisotopes) are used • Injected, oral, per rectal etc. administration • They undergo decay over time • Linked to a radiopharmaceutical • Determines the area of distribution • Gamma rays come from the patient • Radioactive – ionizing radiation is involved • Gamma camera detects the radiation • Good for physiologic function stuff • Does not provide a good anatomical info

  34. The Ideal Radionuclide • Technetium 99m • Short half life = 6 hours • Binds to radiopharmaceuticals • Cheap to purchase

  35. The Gamma Camera • The gamma rays produce scintillations • They are converted to electrical signals and multiplied by photomultiplier tubes • The computer records the strength and location of the scintillation events

  36. Types of Scanning • Static • Images are acquired os structures at a single point in time • Dynamic • Images are acquired of a structure over a period of time • Provides functional activity • Time activity curves • Activity in a region is followed over time and a graph made

  37. Bone Scans • One of the most common scans we do • Equine • 3 phases: • Vascular phase • Soft tissue phase • Bone phase

  38. Items to Consider • Age of the animal • Young animals – physis • Older animal – longer time to distribution of radiopharmaceutical • Must scan both limbs etc even if only one is suspected of being abnormal • Symmetry is your friend • Animals are radioactive for a time after the scan

  39. Normal Equine Bone Scan

  40. Bone Scans

  41. Equine Head

  42. Thyroid Scintigraphy • Technetium99m Pertechnetate • Uptake in thyroid glands is compared to uptake in salivary glands – should be equal • Hyperthyroid – Benign adenoma • Thyroid glands exceed salivary glands • Functional thyroid tumors • Patchy irregular inconsistent pattern

  43. Thyroid Scintigraphy Scans

  44. Portosystemic Shunts • Technetium 99m is placed in the rectum and dynamic images every 4 seconds are acquired over 2-3 minutes • Non invasive, quick, accurate, quantitative • Liver then heart = normal • Heart then liver = abnormal (shunt) • Time Activity Curves - important

  45. Time Activity Curve – Portosystemic Shunt

  46. Shunt vs. No Shunt

  47. Other Scan Types • Renal Scans • To determine GFR and ERPF • Cardiac Scans • Hepatobiliary Scans • Hepatocyte function, function of the reticuloendothelial system, biliary function • Gastrointestinal scans • Lung Scans • Infection and tumor imaging

  48. Nuc Med Safety • Higher energy radiation • Especially before injection • Urine from horses • Bedding • Isolation • Lead for workers – not work • Wear plastic gloves to keep off hands • Wear monitoring badges, rings

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