Modern imaging techniques in the medical curriculum

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Amberly Nash
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1 Modern imaging techniques in the medical curriculum Prof. András s Palkó University of Szeged, Hungary 1

2 Radiology = diagnostic imaging + therapeutic intervention guided by imaging procedures OR the art of interpreting visual information by the use of very complex equipment creating very complex images 2

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4 DIAGNOSTIC IMAGING Purpose: create visible image of morphology and function of the human body Image: visual information (visualization in 2 or 3 D, vector, curve, spectrum, etc.) To bring about an image: Energy has to be conducted to the body Interaction of the energy and the components of the body Detection of the modified energy Visualization of the detected pattern 4

5 DIAGNOSTIC IMAGING consultation clinical problem indication examination consultation therapy 5

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8 DIAGNOSTIC IMAGING Roentgen: Cannon: x-ray 1895 contrast material (bismuth) 1896 Krause: (barium) 1904 Graham: brachial arteriography 1923 : cholecystography 1923 Swick: Donald: Seldinger: Hounsfield: Lauterbur: i.v. pyelography 1928 ultrasound (sonar) 1950 catheter-technique technique 1953 CT 1967 MR

9 The avalanche teranostics PACS, RIS teleradiology US MR fmr intervention CT MD-CT double contrast Ba iodine non-ionic Gd US fluorosc.. image intensifier DSA DF X-ray radiogr.. tomography CR, DDR Magic mountain

10 Trends of development full digital imaging intelligent equipments 3D, virtual reality, functional imaging genetically modified, molecular markers biologically specific contrast materials PACS, neural network, automatic image reading and interpretation - fast, personalized, easily generated and interpretable information - shorter way to diagnosis 10

11 Trends of development Star Trek - trikorder 11

12 Stagnation or progress? Time to duplication of biological/medical knowledge 1975: 30 years 2000: 10 years 2025:?? 12

13 Stagnation or progress? Time to duplication of biological/medical knowledge 1975: 30 years 2000: 10 years 2025:?? 13

14 Stagnation or progress? Time to duplication of biological/medical knowledge 1975: 30 years 2000: 10 years 2025:?? Thomas W. Lawson,, 1902 Clermont,,

15 Where we are today? 15

16 Cardio-CT CT 16

17 Cardio-MR 17

18 Cardio-MR 18

19 MR-phlebograph phlebography 19

20 CT-arteriograph arteriography 20

21 CT-arteriograph arteriography 21

22 CT-arteriograph arteriography 22

23 DSA 23

24 CT-arteriograph arteriography 24

25 MR-tractograph tractography 25

26 Functional MRI 26

27 MR-spe spectroscopy 27

28 CT-endoscop endoscopy 28

29 Computer-assist assisted detection 29

30 Automatic segmentation 30

31 Hybrid imaging (UH - CT/MR) 31

32 Hybrid imaging (PET/SPECT CT/MR /MR) 32

33 Dilemmas of development: is the application financeable? high-tech = high cost? expensive = unnecessary? are the results applicable in practice? marketing or real need? does it make sense? does better sensitivity automatically bring better specificity? does better imaging provide functional/cellular/molecular/genetical additional information? does it result in better therapy/survival /survival? will the development fragmentize radiology? 33

34 Dilemmas of development: lower back pain MRI vs. acute abdomen CT 34

35 How can we separate the tailings from the wheat? 35

36 How can we separate the tailings from the wheat? Prospective, randomized ed, multicentre study Evidence-based medicine Health technology assessment 36

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44 But if somebody does not like sweating, may try to sneak the climbing... 44

45 Somatoinfra Publication?!? 45

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49 Why is it a problem if we don t t make our homework? 49

50 Why is it a problem if we don t t make our homework? Moral considerations 50

51 Why is it a problem if we don t t make our homework? Moral considerations 51

52 Why is it a problem if we don t t make our homework? Moral considerations Unethical money-making making 52

53 Why is it a problem if we don t t make our homework? Moral considerations Unethical money-making making 53

54 Why is it a problem if we don t t make our homework? Moral considerations Unethical money-making making We make the impression that the patient had undergone a relevant, well-established established test, consequently he/she will either undergo further, unnecessary, expensive, risky examinations (downstream effect), or even worse will give rise to false sense of being disease- free 54

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56 but there are situations in which it is more righteous to eat some dust 56

57 Radiology lecture take it easy 57

58 Computed tomography 58

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62 voxel pixel

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69 Helical CT Continuous table feed & tube rotation Continuous data acquisition Volumetric data-set 69

70 Multislice CT multislice (2-360 detector-row rows) subsecond scan-time ultrasound paradigm cardiologic applications whole body imaging virtual endoscopy 3D applications EURATOM directive: ALARA principle 70

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72 Magnetic resonance imaging Lauterbur,, Mansfield (1973) Nobel-pri prize 72

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78 T2 (msec) T2 (msec) Summer School Szeged, hemangioma cyst 150 hemorrhage abscess 100 fat 50 0 liver muscle fibrosis 0 0,5 1,0 1,5 2,0 2,5 T1 (sec) 78

79 Radiology seminar case-based based, problem-solving 79

80 History Clinical Data Plain X-ray examination CT Sonography MR Contrast media enhanced X-ray examination Other methods Diagnosis and discussion Liver 01 80

81 Summary Don t t teach radiology teach what radiology is good for Teach for the future listen to research results Lecture you are the added value Practical/seminar clinically oriented 81

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Progress in X-Ray & MR

Progress in X-Ray & MR Michiel Manuel Analyst Meeting June 15 th, 2005 X-Ray & MR: Agenda Introduction General X-Ray Cardio/Vascular X-Ray Magnetic Resonance China growth opportunity Conclusion 2 X-Ray