CONTENTS

Preface Acknowledgments 1. X-Ray Imaging and Computed Tomography 1.1. 1.2. General Principles of Imaging with X-Ray s / 1 X-Ray Production / 2 1.2.1. The X-Ray Source / 3 1.2.2. X-Ray Tube Current, Tube Output, and Beam Intensity / 5 1.2.3. The X-Ray Energy Spectrum / 7 Interactions of X-Rays with Tissue / 9 1.3.1. Coherent Scattering / 9 1.3.2. Compton Scattering / 9 1.3.3. The Photoelectric Effect / 11 Linear and Mass Attenuation Coefficients of X-Rays in Tissue / 12 Instrumentation for Planar X-Ray Imaging / 15 1.5.1. Collimators / 15 1.5.2. Antiscatter Grids / 15 1.5.3. Intensifying Screens / 17 1.5.4. X-Ray Film / 19 1.5.5. Instrumentation for Computed and Digital Radiography / 20 X-Ray Image Characteristics / 22 1.6.1. Signal-to-Noise Ratio / 22 1.6.2. Spatial Resolution / 23 1.6.3. Contrast-to-Noise Ratio / 25 X-Ray Contrast Agents / 26 X-Ray Imaging Methods / 28 1.8.1. X-Ray Angiography / 28
V

xi xiii 1

1.3.

1.4. 1.5.

1.6.

1.7. 1.8.

VI

CONTENTS

1.9.

1.10.

1.11.

1.12. 1.13. 1.14. 1.15.

1.8.2. X-Ray Fluoroscopy / 29 1.8.3. Dual-Energy Imaging / 31 Clinical Applications of X-Ray Imaging / 32 1.9.1. Mammography / 32 1.9.2. Abdominal X-Ray Scans / 33 Computed Tomography / 34 1.10.1. Scanner Instrumentation / 35 1.10.2. Detectors for Computed Tomography / 37 Image Processing for Computed Tomography / 38 1.11.1. Preprocessing Data Corrections / 39 1.11.2. The Radon Transform and Backprojection Techniques / 39 1.11.3. Fan-Beam Reconstructions / 40 1.11.4. Iterative Algorithms / 41 Spiral/Helical Computed Tomography / 43 Multislice Spiral Computed Tomography / 45 Radiation Dose / 47 Clinical Applications of Computed Tomography / 48 1.15.1. Cerebral Scans / 48 1.15.2. Pulmonary Disease / 49 1.15.3. Abdominal Imaging / 49 Exercises / 50 Further Reading / 56 57

2.

Nuclear Medicine 2.1. 2.2. 2.3. 2.4. 2.5. 2.6. 2.7. General Principles of Nuclear Medicine / 57 Radioactivity / 59 The Production of Radionuclides / 60 Types of Radioactive Decay / 61 The Technetium Generator / 63 The Biodistribution of Technetium-Based Agents within the Body / 65 Instrumentation: The Gamma Camera / 66 2.7.1. Collimators / 66 2.7.2. The Scintillation Crystal and Coupled Photomultiplier Tubes / 69 2.7.3. The Anger Position Network and the Pulse Height Analyzer / 71 Image Characteristics / 73 2.8.1. Signal-to-Noise Ratio / 73 2.8.2. Spatial Resolution / 74 2.8.3. Contrast-to-Noise Ratio / 74 Single Photon Emission Computed Tomography / 75 2.9.1. Instrumentation for SPECT / 76

2.8.

2.9.

CONTENTS

Vii

2.9.2. Scatter and Attenuation Correction / 77 2.9.3. Image Reconstruction / 79 2.10. Clinical Applications of Nuclear Medicine / 80 2.10.1. Brain Imaging / 80 2.10.2. Bone Scanning and Tumor Detection / 82 2.10.3. Cardiac Imaging / 84 2.10.4. The Respiratory System / 86 2.10.5. The Liver and Reticuloendothelial System / 87 2.10.6. Renal Imaging / 88 2.11. Positron Emission Tomography / 89 2.11.1. General Principles / 89 2.11.2. Radionuclides Used for PET / 90 2.11.3. Instrumentation for PET / 91 2.11.4. Image Reconstruction / 94 2.11.5. Image Characteristics / 97 2.11.6. Multislice and Three-Dimensional PET Imaging / 98 2.11.7. Clinical Applications of PET / 99 Exercises / 102 Further Reading / 104 3. Ultrasonic Imaging General Principles of Ultrasonic Imaging / 107 Wave Propagation and Characteristic Acoustic Impedance / 108 3.3. Wave Reflection and Refraction / 111 3.4. Energy Loss Mechanisms in Tissue / 113 3.4.1. Absorption / 113 3.4.2. Scattering / 115 3.4.3. Attenuation / 115 3.5. Instrumentation / 116 3.5.1. Single-Crystal Transducers / 117 3.5.2. Transducer Arrays / 125 3.5.3. Beam Forming and Time-Gain Compensation / 128 3.6. Diagnostic Scanning Modes / 131 3.6.1. A-Mode, M-Mode, and B-Mode Scans / 131 3.6.2. Three-Dimensional Imaging / 132 3.7. Artifacts in Ultrasonic Imaging / 133 3.8. Image Characteristics / 134 3.8.1. Signal-to-Noise Ratio / 134 3.8.2. Spatial Resolution / 135 3.8.3. Contrast-to-Noise Ratio / 135 3.9. Compound Imaging / 135 3.10. Blood Velocity Measurements Using Ultrasound / 136 3.10.1. The Doppler Effect / 136 3.1. 3.2. 107

Vili

CONTENTS

Continuous Wave Doppler Measurements / 138 Pulsed-Mode Doppler Measurements / 140 Color Doppler/B-Mode Duplex Imaging / 142 Time-Domain Correlation/Color Velocity Imaging / 143 3.11. Ultrasound Contrast Agents, Harmonic Imaging, and Pulse Inversion Techniques / 145 3.12. Safety and Bioeffects in Ultrasonic Imaging / 147 3.13. Clinical Applications of Ultrasound / 148 3.13.1. Obstetrics and Gynecology / 148 3.13.2. Breast Imaging / 148 3.13.3. Musculoskeletal Structure / 150 3.13.4. Cardiac Disease / 150 Exercises / 151 Further Reading / 153 4. Magnetic Resonance Imaging 4.1. 4.2. General Principles of Magnetic Resonance Imaging / 157 Nuclear Magnetism / 158 4.2.1. Quantum Mechanical Description / 158 4.2.2. Classical Description / 162 4.2.3. Radiofrequency Pulses and the Rotating Reference Frame / 163 4.2.4. Spin-Lattice and Spin-Spin Relaxation / 167 4.2.5. Measurement of T\ and T^'. Inversion Recovery and Spin-Echo Sequences / 170 4.2.6. Signal Demodulation, Digitization, and Fourier Transformation / 172 Magnetic Resonance Imaging / 174 4.3.1. Slice Selection / 176 4.3.2. Phase-Encoding / 178 4.3.3. Frequency-Encoding / 178 4.3.4. The ^-Space Formalism / 179 Instrumentation / 182 4.4.1. Magnet Design / 183 4.4.2. Magnetic Field Gradient Coils / 184 4.4.3. Radiofrequency Coils / 186 Imaging Sequences / 189 4.5.1. Spin-Echo Imaging Sequences / 189 4.5.2. T\- and ^-Weighted Imaging Sequences / 190 4.5.3. Multislice Imaging / 193 4.5.4. Rapid Gradient-Echo Sequences and Three-Dimensional Imaging / 193 157

3.10.2. 3.10.3. 3.10.4. 3.10.5.

4.3.

4.4.

4.5.

CONTENTS

IX

4.5.5. Echo-Planar Imaging / 196 4.5.6. Spiral Imaging / 197 4.6. Image Characteristics / 198 4.6.1. Signal-to-Noise Ratio / 198 4.6.2. Spatial Resolution / 199 4.6.3. Contrast-to-Noise Ratio / 199 4.7. MRI Contrast Agents / 199 4.7.1. Paramagnetic Agents / 200 4.7.2. Superparamagnetic Agents / 201 4.8. Magnetic Resonance Angiography / 202 4.8.1. Time-of-Flight Methods / 202 4.8.2. Phase-Contrast Methods / 203 4.9. Diffusion-Weighted Imaging / 205 4.10. In Vivo Localized Spectroscopy / 206 4.11. Functional MRI / 208 4.12. Clinical Applications of MRI / 210 4.12.1. Brain / 211 4.12.2. Liver and the Reticuloendothelial System / 212 4.12.3. Musculoskeletal System / 212 4.12.4. Cardiac System / 213 Exercises / 214 Further Reading / 216 5. General Image Characteristics 5.1. 5.2. Introduction / 220 Spatial Resolution / 220 5.2.1. The Point Spread Function / 220 5.2.2. Resolution Criteria / 222 5.2.3. The Line Spread Function and Edge Spread Function / 223 5.2.4. The Modulation Transfer Function / 224 Signal-to-Noise Ratio / 225 5.3.1. The Poisson Distribution / 225 5.3.2. Signal Averaging / 227 Contrast-to-Noise Ratio / 228 Image Filtering / 229 The Receiver Operating Curve / 231 233 220

5.3.

5.4. 5.5. 5.6.

Appendix A. The Fourier Transform A.I. A.2. Introduction / 233 Fourier Transformation of Time-Domain / 233 A.2.1. Useful Properties of the Fourier Transform / 235

CONTENTS

Appendix B. B.I. B.2. B.3.

Backprojection and Filtered Backprojection

237

Introduction / 237 Backprojection / 238 Filtered Backprojection / 239 245 247

Abbreviations Index