Medical Flashcards

1
Q

How were X-rays discovered?

A

via the acceleration of electrons across evacuated glass tubes. It was observed that as the electrons were rapidly decelerated on hitting a metal plate, x-ray radiation was produced.|These x-rays could be detected using photographic plates

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2
Q

What does the attenuation of x-rays depend on?|reduction in amplitude of a signal

A
  1. the thickness of the material |
  2. the x-ray photon energy, given by E=hf |
  3. the atomic number (z) of the material ||a materials attenuation effect can be described using the equation on the right
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3
Q

Describe the dB scale often used to describe attenuation?

A

a decibel scale is a logarithmic scale often used to describe attenuation |10log₁₀(I/I(o)) dB

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4
Q

What is the primary attenuator in the body?

A

bone as has a lot of calcium which has z=20

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5
Q

What types of damage can you get from radiation?|what is the units of the measure of the biological effect of radiation?

A

rule: there is no such thing as a safe dose.|1. somatic damage: something that happens to the individual e.g. ionising radiation damages DNA in somatic cells, the mutation caused causes cancerous cell|2. genetic damage: happens to sex cells and can be passed on||unit is the sieverts (Sv)

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6
Q

How can we protect ourselves from radiation?

A
  1. use radiation does as low as reasonably achievable.|2. use shielding to protect workers from radiation |3. alternative work for pregnant workers |4. only exposure if justified e.g. old person cancer isn’t much of a threat as takes time to develop|5.ionising radiation sources stored carefully
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7
Q

Explain what x-ray computed tomography , CT, does

A

(CT) produces cross-sectional (transverse) slice images by rotating an x-ray source and detectors around the patient.|can be used to detect damage to bones, injuries to internal organs, problems with blood flow, strokes and cancer.

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8
Q

How does a CT scan work?

A
  1. the principle behind it is the idea that a cross section can be generated from multiple views of an object recorded at different angles (known as “projections”)||2.each projection obtained by shining a narrow beam of x-rays through the body onto a linear detector. Different views obtained by rotating x-ray source and detector around patient||3. we obtain attenuation values recorded by the detectors at different angles and by mathematically combining the series of projections in a method of filtered back projection we produce a 2-d cross sectional image.
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9
Q

What is the method of filtered back projection

A

Back-projection involves assigning the|measured attenuation values representing each projection (a one-dimensional image) to a series of|columns in two-dimensional (2D) array.|These 2D arrays are then added together after rotating each array so that they correspond to the angle used to record the projection. The resulting image is contaminated by the so-called “star artefact” (since the image of a single point produces a star pattern).|The artefact may be removed by mathematically “filtering” each projection before the back-projection|is performed

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10
Q

Explain how diagnostic ultrasounds creates images….

A
  1. diagnostic ultrasound employs sound waves with frequencies between 1-20 MHz |The frequency f is related to the acoustic wavelength λ via the expression: c = f λ|2. it exploits the pulse echo principle: measure time for an echo after a short pulse of ultrasound is emitted. We use phased arrays to “steer” the beam by pulsing the small elements in the array sequentially. The depth of the reflecting boundary can be given by d=c∆t/2|3. the echo is a reflection which occurs when the pulse meets a boundary between tissues with different Acoustic impedances.|we measure the reflection coefficient R: equation given on the right.|4. echos are displayed as dots (dot position and brightness= echo depth and intensity). An ultrasound beam is swept over a slice of tissues to display a 2-d image
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11
Q

Why do we use such high frequency soundwaves for ultrasound?

A

since c=fλ, a high frequency sound wave has a much smaller wavelength. |The smaller wavelength enables smaller detail to be observed, higher frequency waves provide better spacial resolution.||(higher f are attenuated more in tissue than lower frequencies)

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12
Q

Why must we use a coupling gel when carrying out diagnostic ultrasound

A

air has a much lower acoustic impedance than soft tissue so R is nearly 1 at a air-tissue boundary so virtually all the ultrasound energy is reflected

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13
Q

How does the transducer in diagnostic ultrasound work?

A

the ultrasound is generated and detected by a transducer ||inside the transducer is a substance known as a piezoelectric crystal- a crystal in which the molecules have a positive and negative end. ||An alternating voltage causes the crystal to vibrate emitting high frequency vibration- ultrasound||Meanwhile, if a piezoelectric crystal is subjected to a mechanical stress (e.g. by an ultrasound echo),|rotation of the crystal produce a voltage across the crystal (producing a measurable electrical signal).

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14
Q

What is doppler effect?

A

the perceived change in frequency of a wave e.g. a sound wave due to the relative motion of the source with the observer.

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15
Q

How can we use the doppler effect with ultrasound to examine blood velocity?

A

doppler effect occurs when ultrasound waves are reflected back off moving blood cells. |-the frequency is higher if the blood cells are moving towards us but lower if moving away||we measure this frequency shift to get a value for blood velocity

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16
Q

What is one of the medical imaging techniques using doppler ultrasounds?

A

The Pulsed Doppler instrument uses a single transducer which emits pulses.|Successive pulses are shifted in phase with respect to a reference signal as reflector moves–>phase shift oscillates at Doppler frequency.|We combine a convectional ultrasound image with blood flow information. Blood flow information is normally displayed in colour on top of the conventional greyscale ultrasound image.

17
Q

What is one of the medical imaging techniques using doppler ultrasounds?

A

continuous wave doppler ultrasound, |a transducer emits a wave continuously while another transducer detects the returning wave continuously. |The doppler frequency can be calculated and provides a direct measurement of blood flow. |Continuous wave Doppler ultrasound is sensitive to all flow in region of overlap. For depth information we need pulses

18
Q

Upon which phenomenon is MRI based?|Explain the details of the phenomenon…

A
  1. protons and neutrons inside atomic nuclei can have a property known as angular momentum or spin|- this spin can be interpreted as a positive charge orbiting the spin axis. The orbiting charge can be seen as a current I in a small wire.||2. the current loop will generate a tiny magnetic field, like that of a bar magnet ||3. a bar magnet will usually try to align with an external magnetic field|-But quantum mechanics permits only two possible alignments for a proton, and neither are parallel to the external field. Spin up or Spin down (spin up lower energy)||4. a bar magnet unable to align with external field will precess around the main field direction at an angular frequency known as the larmor frequency. Direction of precession depends on right hand corkscrew rule.||5. A sample of tissue in an external field contains billions of precessing protons (H nuclei).|Normally, slightly more protons will occupy the lower-energy spin up state.||6.If another magnetic field B1 is applied to the sample, perpendicular to B0 and rotating around the B0 axis at the Larmor frequency, a nucleus can switch spin states. We use radiowaves to provide the varying magnetic field.||7.This switching of the many tiny magnetic fields can induce a current in a coil. This is the NMR signal
19
Q

How can we create images using this NMR signal?

A
  • to make images using the signal, the magnetic field B0 (or rotational phase of the net magnetic moment) must be different at different locations within the patient to allow for spatial encoding of the signals.|This is achieved by external magnetic field gradients which distort the field in a predictable pattern.||- Since w=γB0, the frequency, w, will depend on spatial location within the patient.|A small field B1 is rotated at a range of frequencies, causing|the NMR signal to be observed.||- The signal obtained at each frequency tells us about the|density of protons (and their local magnetic environment) at|different spatial locations|-we can then map signals and their intensity to produce an image.
20
Q

What is fMRI?|What are the principles behind it?

A

functional magnetic resonance imaging ||1. the magnetic properties of haemoglobin, the oxygen carrying molecule in the blood are dependant on amount of oxygen it carries|2. a small change to the oxygenation of haemoglobin causes a small change to the magnetic field in its immediate vicinity- e.g. field experienced by nearby water molecules ||3. MRI signal of blood is therefore slightly different depending on the level of oxygenation.||4. The change in signal can be detected during MRI scanning enabling images to display BOLD (blood-oxygen-level-dependant) contrast.

21
Q

How do we use fMRI?

A

We use it to image brain activation to get an insight into how the brain works.||we need two sets of data…|1. brain at rest|2. brain performing a given task ||difference between the signals used to display regions where blood flow/oxygenation changes have occurred due to the task

22
Q

What is an EEG?

A

electroencephalography||EEG measures electrical activity in the brain resulting from spontaneous or stimulated activation of thousands of nerve cells, called neurons.| |flow of electrons within these cells produces an electrical voltage on the surface which can be detected using an array of electrode placed in contrast with the scalp.

23
Q

How do we interpret EEG signals?

A

the variation of the observed signals with time (wave patterns) are characteristic of certain types of brain activity. ||EEG is often used to diagnose epilepsy

24
Q

What are some of the specific wave patterns called?

A

note deep sleep/sleep wave patterns can appear similar to brain damage

25
Q

What is SPECT

A

single photon emission computed tomography ||its a technique which involves determining the distribution of radioactive drugs in the body. ||A radioactive drug is administered, and emitted radiation (gamma ray photons) are detected using one or more “gamma cameras” rotated around the body.||Multiple views and filtered back projection allow a 3D image of the distribution of the tracer.

26
Q

How do gamma cameras work?

A

gamma camera uses collimators which only collect radiation parallel to collimator. Multiple views enable cross section images of the drug distribution to be reconstructed.||gamma photon hit crystal and give off photons

27
Q

What tracers do we use for SPECT and how do they allow us to analyse our biological acivity?

A

99-Tc-HMPAO is a common tracer or Xenon-133 gas ||concentration in tissue proportional to blood flow and thus allow brain metabolism to be assessed

28
Q

What is PET?|What does PET detect to create an image and how?

A

positron emission tomography||1. uses a radioactive tracer which decays to produce a positron, the antimatter counter part of an electron.||2.after travelling up to a few mm the positron meets an electron and annihilates producing a pair of identical gamma ray photons emitted in opposite directions||3.relies on the simultaneous detection of photons (within a few seconds of each other) by detectors in a ring around the patient.

29
Q

How is the PET image formed from detection?

A

as photons have travelled in exactly opposite directions the reconstruction algorithm uses info that annihilation occurred somewhere along the lie of the two photons- high spatial resolution.

30
Q

What type of isotopes do we use for PET?|what does PET require as a result of these isotopes?

A

short halve lived isotopes: |C-13|N-12|O-15|needs nearby cyclotron.||often incorporated into glucose or specific drugs which bind to certain sites in the body.

31
Q

What is X-ray Angiography?

A

x-ray linear attenuation coefficients of blood and surrounding soft tissue are almost identical, and thus dont show up conventional x-ray images with significant contrast ||visibility of blood enhanced by injecting a high attenuating liquid into the blood, common contrast agents are based on iodine (z=53)

32
Q

How is the image produced?

A

images taken before and during injection|access to the blood vessel is gained commonly through the fermoral artery to look at the left side of the heart or jugular vein. ||for most tissues x-ray image taken 2-3 per second and use a subtraction technique (image recorded before subtracted from subsequent images to show only vessel filled with contrast agent) ||for the heart 15-30 per second and don’t use a subtraction technique

33
Q

What are the X-ray Angiography images used for?

A

shows blocked veins/artery in the heart.

34
Q

What are the different types of medical images

A
  1. two dimensional slice |2. tomographic slide- combining lots of projections to produce a slice (revolving detectors) |3. three dimensional image- computer generated surface e.g. 3D ultrasound, 3D CT, 3D MRI
35
Q

What are the criteria to select an appropriate medical imaging technique?

A
  1. contrast mechanism (must have contrast for thing we want to observe): must display subtle changes in tissue properties|2. ability to display fine detail (spatial resolution)|3. ability to obtain images quickly |4. condition of the patient (e.g. don’t PET scan someone witha broken arm)|5. safety (MRI if they have pacemaker) |6. cost
36
Q

What is temporal resolution?

A

ability to reveal rapid changes over time- can tell events occurred at different times ||(important in moving tissues)

37
Q

What is spatial resolution?

A

ability to show fine detail|-resolved if you can tell they are seperate||Spatial resolution is measured by recording the “Point Spread Function” (PSF) = image of a single point

38
Q

What is contrast?

A

ability to display subtle changes in tissue property

39
Q

What is signal to noise ratio

A

SNR=S/N, a measurement will contain wanted data (signal) and unwanted data (noise) which may be random (e.g. due to a limited number of photons) or structured (interference)