Term Paper: Radiology Reducing Patient Exposure and Maintaining Image Quality

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Radiology, Reducing Patient Exposure and Maintaining Image Quality

Radiology as a branch of medicine was born due to the pioneering effort of German physicist Wilhelm Roentgen who accidentally discovered X-rays while researching in his lab in 1895. The amazing benefit that X-rays offered to medical science was recognized and, with the research of French scientists Marie and Pierre Curie after the discovery of Roentgen, scientific and technological developments have resulted in the vital contribution which radiology has presently come to offer in the diagnosis and treatment of various ailments. Radiology is a diagnostic as well as a therapeutic instrument. In order to recognize diseases and other conditions inside the human body, diagnostic imaging makes use of several varied modalities like plain radiography, CT scanning, Magnetic Resonance Imaging -- MRI, ultrasound, and nuclear medicine. Therapeutic imaging, usually known as interventional radiology happens to be a subspecialty which entails the application of imaging technology to undertake invasive methodologies that are least invasive with devices such as catheters, balloons, and stents to free congested blood vessels, drain fluid, and also carry out needle biopsies. Radiology imaging studies are normally done by a skilled technician in radiology while the radiologist, a specially qualified medical doctor, evaluates and reads the radiographic images and submits the results to the doctor in charge of the primary care of the patient. Presently, the science of radiology is on the threshold of new chapter. Technological advancement related to computerized data has facilitated the efficient reach of diagnosis and treatment in favor of patients across the world cutting across geographical barriers.

The use of technology for visualization of the body:

Images that are taken of the human body play a central role in the usual clinical practice at the moment, not merely in the diagnosis of a lot of diseases but also in subsequent stages and treatment of patients. Following the discovery of X-rays, physicians started it as a noninvasive procedure to see inside human bodies. It is an accepted fact that x-rays comprise of electromagnetic radiation. The radiological image is produced by the darkening of a film by the radiation transmitted across the human body. Conventional radiation delivers an image of objects in a two-dimensional or 2D plane. Even though it was the foremost method of imaging to be developed, it still continues to be the usual type of radiology. The films created by X-rays reveal various features of the body in different shades of gray. The gray becomes darkest in those regions which do not absorb X-rays, while the lighter shades are seen in dense areas.

Even though Radiology started with the application of x-rays and huge flat sheets of photographic films, the modern Radiologist is equipped with a lot of instruments for taking images of living patients. A lot of these modern instruments build an image with the help of a computer which is CT or computed tomography and some do not make use of any x-rays, nor any radiation of any type such as Magnetic Resonance Imaging --MRI and Ultrasound.

Different types of Radiography:

i) Plain radiographs: Under this procedure plain x-rays are obtained through the application of different imaging techniques, and they all need exposing the patient to X-ray radiation. The image is essentially a shadow of the parts of the patient which absorb or block the X-rays. The image can be collected on a photosensitive film, on a digital imaging plate, or on a fluoroscope. The image is a "photographic negative" of the object with the "shadows" being the white areas that have been blocked by the object. Plain radiographs or plain areas are generally taken by skilled registered radiologic technologists. The films are thereafter read by the qualified Radiologist in order to make a diagnosis. An image of Plain Radiography is shown in Exhibit I.

A ii) Fluoroscopy: This is a method for seeing "live" X-ray images for a patient. The Radiologist makes use of a switch to regulate an X-ray beam which is transmitted through the patient. The X-ray thereafter hits a florescent plate which is coupled to an "image intensifier" which in turn is coupled to a television camera. The Radiologist can subsequently watch "live" images on a TV monitor. The use of fluoroscopy is regularly made to observe the digestive tract. The Upper GI series is Barium Swallow while the Lower GI series is Barium Enema or "BE." The colon becomes visible on the BE. The white areas are barium contrast, while the black regions are air. An image of Air-contrast Barium Enema is shown in Exhibit - II. The application of Fluoroscopy is also made in a lot of diagnostic and curative methods in order to observe the action of instruments that are being used either for diagnostic or treatment of patients.

A iii) Angiography: Under this procedure X-rays are used for the generation of picture which is the angiogram. This is an invasive radiology procedure as it needs the patient to be injected with a radiopaque substance i.e. It absorbs X-rays which is generally known as a contrast agent or a dye. Normally a very tiny tube with a special shape is used to put the contrast into a specific artery or vein. As the artery or vein has this radiopaque material, it will obstruct the X-rays, and in the process will cast a shadow of the injected vessels on the X-ray film or fluoroscope. This image will display the shape of the artery and can assist in the diagnosis of an obstruction, blockage, or constriction of artery. An image of angiography of the skull is shown in Exhibit III.

A iv) Computed Tomography:- Computed Tomography is popular by the name of CT or CAT Scans. Computed Tomography is a specialized X-ray imaging technique that may be conducted "plain" or following the injection of a "contrast agent" CT constructs the image through the use of a collection of individual small X-ray sensors and a computer. Through spinning the X-ray source and sensor/detectors around the patient, the data is collected from different angles. The information is then processed through a computer to create an image on the video screen which are known as 'sections' or cuts as they show to look like the cross-sections of the body. This process does away with the problem of a conventional X-ray, in which all the shadows overlap. A CT image is shown in Exhibit IV.

A v) Ultrasound (U.S.): Medical U.S. applies high frequency sound waves to create an image of living tissue based on the identical technique of weather radar and submarine ultrasound. Through transmission of sound signals and using the reflected echoes, images are created. U.S. As against majority of the other imaging techniques are capable of creating precise real-time sequences of the beating heart, bowel contraction which is known as peristalsis. U.S. can also show the speed of blood flowing through the use of Doppler and it can be measured and illustrated through the use of color pictures. The entire procedure is non-invasive without causing any harm to the patient. Through the use of Doppler Technique, Radiologists detect the presence of blockages in blood vessels in the neck and other regions. One of the most common U.S. procedures is the examination and periodic monitoring of the living fetus growing inside the mother's womb known as Obstetric Sonography. An U.S. image is shown in Exhibit V.

Magnetic Resonance Imaging (MRI): MRI does away with the use of X-rays or any category of "ionizing" radiation. As an alternative, it is a methodology that combines a large magnetic field and some RF antennas. The image is formed as the resulting image mainly reflects the water protons in the patient as also their chemical associations with protein. A MRI image is shown in Exhibit VI. Neuropathological contribution in head trauma has stressed on the distinction between focal and diffuse injury. Focal injuries caused due to hematomas and contusions while neuropathological researches have revealed the significance of microscopic diffuse axonal injury in patients who lost their lives after injury. Injury because of secondary hypoxia and ischemia can also result in focal and diffuse patterns of lesions. The difference between focal and diffuse injury is sometimes applied in favor of survivors. It has been observed that MRI is more sensitive to traumatic brain damage compared to Computed Tomography -- CT. A lot of head injury survivors have seen to sustain multiple lesions in frontal and temporal areas. Legions inside the brain stem and corpus callosum are sometimes also seen on MRI and are most probably manifestations of acute diffuse axonal injury. The subsequent psychological results of diffuse and focal injuries are not properly intelligible and constitute a matter of debate. The neuropathological view emphasizes the vast significance of diffuse axonal injury, instead of focal injury, in finding out the consequences of head injury.

Patient Exposure and its reduction in Radiology:

Through the use of digital techniques potential exists to enhance the practice of radiology, but there is also the inherent risk of overuse radiation. The… [END OF PREVIEW]

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