Modern imaging techniques in the medical curriculum

Summer School Szeged, 2011.Summer School Szeged, 2011.

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Modern imaging techniques Modern imaging techniques in the medical curriculumin the medical curriculum

Prof. AndrProf. Andráás Palks PalkóóUniversity of Szeged, HungaryUniversity of Szeged, Hungary


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RadiologyRadiology

= =

diagnostic imaging + therapeutic intervention diagnostic imaging + therapeutic intervention guided by imaging proceduresguided by imaging procedures

OROR

the art of interpreting visual information by the the art of interpreting visual information by the use of very complex equipment creating very use of very complex equipment creating very

complex imagescomplex images


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•• Purpose: create visible image of morphology Purpose: create visible image of morphology and function of the human bodyand function of the human body

•• Image: visual information (visualization in 2 Image: visual information (visualization in 2 or 3 D, vector, curve, spectrum, etc.)or 3 D, vector, curve, spectrum, etc.)

•• To bring about an image: To bring about an image: –– Energy has to be conducted to the bodyEnergy has to be conducted to the body–– Interaction of the energy and the components of Interaction of the energy and the components of

the bodythe body–– Detection of the modified energyDetection of the modified energy–– Visualization of the detected patternVisualization of the detected pattern

DIAGNOSTIC IMAGINGDIAGNOSTIC IMAGING


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indicationindication

examinationexamination

clinicalclinical problemproblem

therapytherapy

consultationconsultation

consultationconsultation



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18951895


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•• Roentgen:Roentgen: xx--ray ray 18951895•• Cannon:Cannon: contrast material (bismuth) contrast material (bismuth) 18961896•• Krause: Krause: ““ (barium) (barium) 19041904•• Graham: Graham: brachial brachial arteriographyarteriography 19231923•• ““ :: cholecystographycholecystography 19231923•• SwickSwick: : i.v.i.v. pyelographypyelography 1928 1928 •• Donald:Donald: ultrasound (sonar) ultrasound (sonar) 19501950•• SeldingerSeldinger:: cathetercatheter--technique technique 19531953•• Hounsfield: Hounsfield: CT CT 19671967•• LauterburLauterbur:: MR MR 1973 1973



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1900 1925 1900 1925 1950 11950 1975 2000 2010975 2000 2010

XX--rayray radiogrradiogr. tomography. tomography CR, DDRCR, DDR

fluoroscfluorosc. image . image intensifierintensifier DSA DFDSA DF

interventionintervention CT MDCT MD--CT CT

US MR US MR fMRfMR

BaBa iodineiodine nonnon--ionicionic Gd USGd US

double double contrastcontrast

The The „„avalancheavalanche””

PACS, RISPACS, RISteleradiologyteleradiology

MagicMagic mountainmountain

teranosticsteranostics


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–– full digital imagingfull digital imaging–– „„intelligentintelligent”” equipmentsequipments–– 3D, virtual reality, functional imaging3D, virtual reality, functional imaging–– genetically modified, molecular markersgenetically modified, molecular markers–– biologically specific contrast materialsbiologically specific contrast materials–– PACS, neural network, automatic image reading PACS, neural network, automatic image reading

and interpretationand interpretation

-- fast, personalized, easily generated and fast, personalized, easily generated and interpretable informationinterpretable information

-- shorter way to diagnosis shorter way to diagnosis

Trends of developmentTrends of development


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Trends of developmentTrends of development

Star Star TrekTrek -- trikordertrikorder


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Stagnation or progress?Stagnation or progress?

•• Time to duplication of biological/medical knowledgeTime to duplication of biological/medical knowledge

–– 1975: 30 years1975: 30 years–– 2000: 10 years2000: 10 years–– 2025: ??2025: ??


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Thomas W. Thomas W. LawsonLawson, 1902 , 1902 ClermontClermont, 1807, 1807





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Where we are today?Where we are today?


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CardioCardio--CTCT


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CardioCardio--MRMR


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CardioCardio--MRMR


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MRMR--phlebographphlebographyy


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CTCT--arteriographarteriographyy


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DSADSA


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MRMR--tractographtractographyy


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FunctionalFunctional MRMRII


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MRMR--spespecctrostroscocoppyy


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CTCT--endoscopendoscopyy


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ComputerComputer--assistassisteded detedeteccttionion


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AutomatiAutomaticc segmentsegmentationation


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HHyybridbrid imagingimaging (UH(UH -- CT/MR)CT/MR)


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HHyybridbrid imagingimaging (PET(PET/SPECT /SPECT –– CTCT/MR/MR))


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Dilemmas of development:Dilemmas of development:

–– is the application financeableis the application financeable??•• highhigh--tech = high cost ?tech = high cost ?•• expensive = unnecessary ?expensive = unnecessary ?

–– are the results applicable in practice?are the results applicable in practice?•• marketing or real need ?marketing or real need ?

–– does it make sense?does it make sense?•• does better sensitivity automatically bring better does better sensitivity automatically bring better

specificity?specificity?•• does better imaging providedoes better imaging provide

functional/cellular/molecular/genetical additional functional/cellular/molecular/genetical additional information?information?

•• does does it result in better it result in better therapytherapy/survival/survival??

–– willwill the the development fragmentize radiology?development fragmentize radiology?


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Dilemmas of development:Dilemmas of development:

lowerlower back back painpain –– MRI vs. MRI vs. acuteacute abdomenabdomen –– CT CT


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


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•• Prospective, randomizProspective, randomizeded, , multicentre studymulticentre study•• EvidenceEvidence--based medicinebased medicine•• Health technology assessmentHealth technology assessment

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


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

climbing...climbing...


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PubliPublicationcation ?!??!?

SomatoinfraSomatoinfra


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Why is it a problem if we donWhy is it a problem if we don’’t make our t make our homework?homework?


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•• MorMoral considerationsal considerations



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•• MorMoral considerationsal considerations



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•• MorMoral considerations al considerations •• Unethical moneyUnethical money--makingmaking



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•• MorMoral considerations al considerations •• Unethical moneyUnethical money--makingmaking



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•• MorMoral considerations al considerations •• Unethical moneyUnethical money--makingmaking•• We make the impression that the patient had undergone a We make the impression that the patient had undergone a

relevant, wellrelevant, well--established test, consequently he/she will established test, consequently he/she will –– either undergo further, unnecessary, expensive, risky either undergo further, unnecessary, expensive, risky

examinationsexaminations ((downstreamdownstream effecteffect)),,–– or or –– even worse even worse –– will give rise to false sense of being diseasewill give rise to false sense of being disease--

freefree



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…… but there are situations in which it is more but there are situations in which it is more righteousrighteous to eat some dustto eat some dust……


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Radiology lectureRadiology lecture

take it easytake it easy


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Computed tomographyComputed tomography


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voxe

lvo

xel

pixelpixel

+1+1

+1+1

+1+1

+1+1+2+2

+2+2

--22

--22

+5+5

+5+5

--44

+3+3

--44

--66

00

00


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ContinuousContinuous tabletable feedfeed & & tubetube rotationrotation

ContinuousContinuous datadata acquisitionacquisition

VolumetricVolumetric datadata--setset

HelicalHelical CTCT


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•• multislice (2multislice (2 -- 360360 detectordetector--rowrowss) ) •• subsecond scansubsecond scan--timetime•• „„ultrasound paradigmultrasound paradigm”” 3D applications3D applications•• cardiologic applications cardiologic applications •• „„whole bodywhole body”” imagingimaging•• virtual endoscopyvirtual endoscopy

EURATOM EURATOM directivedirective::ALARA ALARA principleprinciple

Multislice CTMultislice CT


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Magnetic resonance imagingMagnetic resonance imaging

LauterburLauterbur, Mansfield (1973) , Mansfield (1973) –– NobelNobel--priprizzee


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fatfat

liverliver

musclemuscle

fibrosisfibrosis

hemorrhagehemorrhage

hemangiomahemangioma

abscessabscess

cystcyst

0 0,5 1,0 1,5 0 0,5 1,0 1,5 2,0 2,52,0 2,500

5050

100100

200200

T1 (sec)T1 (sec)

T2 (m

sec)

T2 (m

sec)

150150


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Radiology seminarRadiology seminar

casecase--basedbased, , problemproblem--solvingsolving


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CT

History Clinical Data

Plain X-ray examination

Contrast media enhan-ced X-ray examination

MRSonography

Diagnosis and discussion

Other methods

Liver 01


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SummarySummary

•• DonDon’’t teach radiology t teach radiology –– teach what teach what

radiology is good for radiology is good for

•• Teach for the future Teach for the future –– listen to listen to

research resultsresearch results

•• Lecture Lecture –– you are the you are the ””added valueadded value””

•• Practical/seminar Practical/seminar –– clinically orientedclinically oriented


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Modern imaging techniques in the medical curriculum

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