The WCC Note

Your Weekly Guide to Harmonizing Clinical Trial Imaging

Posts Tagged ‘X-Ray’

Radiology: The Basic Modalities
Radiation Exposure – Vol. 1, Number 2

Tuesday, October 2nd, 2007

What it is, what it does. It’s widely known today that radiation can be harmful to humans.  The effects of large amounts of radiation, as seen in radiation therapy for cancer or among the fallout victims of Chernobyl or Hiroshima, are almost immediate and quite apparent.  However, it can be difficult to quantify the amount of damage from the smaller amounts of radiation used in diagnostic radiology, as these are the cumulative effects that are only seen many years after exposure and thus cannot be linked to the radiographic study.
The documented efforts of radiation have to do with the “ionization” of a cell.  That is, when an x-ray hits a cell, it causes the electrons to displace, damaging the cell’s function.  Although the cell may repair itself, it may not do so completely, and thus loses its ability to function normally.  The DNA within the cell also may be damaged, leading to cell death or other mutation.

HOW IS RADIATION MEASURED?

Many units are used to measure radiation dosage.  The unite used in the measurements below is called the “sievert,” a measure of the amount of radiation absorbed by the human body.

Effective Radiation Dosage (in MilliSieverts):
Average background dose in the U.S. . . . . . . . . . 3.6 mSv/year
Three-hour commercial airline flight. . . . . . . . . . 0.015 mSv
Chest X-ray (two views). . . . . . . . . . . . . . . . . . . . . 0.05 mSv
Head CT scan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2 mSv
Chest CT scan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-7 mSv
Abdomen and pelvis CT scan. . . . . . . . . . . . . . . . . 6-8 mSv
Selective diagnostic coronary angiography. . . . 3-6 mSv
Coronary CT angiography. . . . . . . . . . . . . . . . . . . 8-13 mSv

SOME RADIATION RISK FACTORS

Although exact risk levels from radiation in diagnostic imaging are difficult to quantify, we now know that the impact of radiation on a live subject or patient depends on many factors, including:

  • Patient age
    - The younger the subject, the greater the risk to an exposed cell
  • The organ affected
    - The ovaries and eyes, for example, are very radiation-sensitive, while the heart and brain are very radiation-resistant
  • The body region imaged
    - A CT scan of the pelvis causes more damaging radiation than a CT scan of the head, because the pelvis contains many radiation-sensitive organs
  • Cumulative dose
    - A certain amount of radiation delivered all at once (an acute dose) is more damaging than spreading that radiation out over a longer time
    - Even if small doses of radiation are delivered at different times (such as two abdominal x-rays done a week apart), the dose accumulates to cause an increased risk of adverse effects
    - Less radiation is ALWAYS better
  • A patient’s genetically inherent resistance to radiation

Radiology: The Basic Modalities
X-Ray Radiography – Vol. 1, Number 1

Monday, September 24th, 2007

TO EDUCATE, INFORM, AND SUPPORT

WorldCare Clinical (WCC) is launching this new electronic publication with one key goal in mind: to educate, inform, and support our colleagues in the clinical research and pharmaceutical/medical device fields about advanced medical imaging.  The WCC Note is intended for anyone interested in medical research, research procurement, or clinical trial management.  Each week, we’ll bring you relevant, useful information distilled down to its basic concepts.  In doing so, we hope to:

  • Help raise the bar for patient care and clinical research;
  • Offer advice on how to harmonize your approach to using imaging technology;
  • Present new ways to navigate the drug or device development pathway more efficiently; and
  • Educate non-medical professionals about diagnostic imaging equipment, capabilities, and new developments.

For the next several issues, we’ll present a series on the basics of each modality used in clinical trial imaging, including conventional x-ray radiography, computed tomography (CT), ultrasound, magnetic resonance imaging (MRI), and nuclear medicine.  We’ll also examine the scientific basis for each modality, as well as its clinical applications, strengths, and weaknesses.  We hope you enjoy this first post and we look forward to your comments, questions, and suggestions.
- Stephen J. Pomeranz, M.D., and Resham R. Mendi, M.D.

RADIOLOGY: THE BASIC MODALITIES

Part One: X-Ray Radiography
How it works.
X-rays are high-energy photons, which are created by an electric current within a cathode ray tube.  The x-ray is aimed at a patient’s body of interest, with a film plate positioned behind the body part (see diagram at left).  Body parts that are dense, like bone, do not allow the photos to pass through.  Less dense tissues, such as muscle fat, and air, allows the x-rays to pass through and hit the radiographic plate.

The x-rays then produce a chemical reaction in the film, causing it to be exposed.  When the film is developed, the exposed areas turn black (fat) and the non-exposed areas turn white (bone).  The entire image then becomes a reflection of tissue density: high-density tissues are white, intermediate tissue densities are gray, and low-density tissues show up as black.

Common Clinical Indications for X-rays

  • Evaluation of bones for fracture, dislocation, arthritis, etc.
  • Evaluation for foreign bodies
  • Gross evaluation of lungs for pneumonia, large mass, pneumothorax, or pulmonary edema
  • Evaluation of heart size
  • Evaluation of bowel gas pattern for free air, ileus, or bowel obstruction

SOME PROS AND CONS OF X-RAYS

Advantages

  • Fast
  • Cheap
  • Quick
  • Easy to Perform
  • Sensitive to detecting calcium, cortical bone, air, gas, and metal
  • Produces few artifacts: flaws in the image that may lead to misinterpretation

Disadvantages

  • Exposes subjects to radiation, which can cause cumulative damage
  • Insensitive to soft-tissue abnormalities involving muscles, masses, blood, water, solid tumors, etc.
  • Changes in patient positioning by the technologist can lead to moderate image-quality variability
  • Analog technology makes digital image transfer more challenging