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Medical Imaging Technology

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Saved by Andrew P. Miller
on December 5, 2012 at 8:55:15 pm
 

 

Medical Imaging Technology   

 

  

 

"The surgical imagination can pleasurably lose itself in devising endless applications of this wonderful process." -NY Times on the discovery of the X-Ray [1] 

 

Abstract

Medical imaging has has allowed for the advancement of medical and surgical care for patients during the past century.  William Conrad Rotgen, a German physicist, was the first individual to quantitatively produce a wavelength of radiation that is consistent with the modern day X-ray [9], and helped set in motion the rapid technological advents in medical imaging.  After the ability to harness these radioactive wavelengths was accomplished, it become possible for chemists and physicists to understand the power behind the energy in which they possessed at their fingertips.  The discovery of the X-ray provided a beginning point for future imaging possibilities in medicine which allows healthcare providers to view the internal environment of the human body in a non-invasive manner.  It was not long until it was discovered how large of an impact the possibilities of imagining technologies could have in the field of medicine.  The advent of imaging techniques that displayed a pictorial representation of the internal environment and condition of the human body eventually led to technologies that allow for numerical measures of internal human dynamics, such as electrocardigrams (ECG), blood pressure monitoring, pulse oximetry, and Bispectral Index monitoring (BIS monitor).   

 


 

Discovery of X-Rays

Wilhelm Roentgen began his educational career in a manner unbecoming of a dedicated student, but disciplined himself to obtain a degree in mechanical engineering followed by a doctorate one year later [1].  His dedication towards his work led him to the development and discovery of wavelengths of radioactive material that were similar to modern X-rays.  The discovery began with him working meticulously with cathode rays in his laboratory he filled one tube with air, added unknown quantity of gas, and passed an electrical current through it [10].  After ensuring that light could not escape, the electrical current was introduced into the gas filled tube.  To Wilhelm's surprise, he noticed a fluorescent ambiance coming from a cardboard screen when placed close to the apparatus [9].  Wilhelm decided that the results and his theories on this newly discovered wave emission need to be reproduced.  On November 8, 1895, he constructed an apparatus similar to the one he previously used.  The experiment began with him covering the gas filled tube with cardboard and turned down the lights to ensure no light would pass through.  Once the lights were down, the electrical current was applied to the tube, and Wilhelm noticed a flickering light coming from the same screen used earlier coming from across the room [11].  This original screen was painted with a substance named Barium platinocyanide, which was the target for the emission of the invisible rays which Wilhelm had stumbled upon [9].  Wilhelm named these new invisible rays "X-rays" allowing "X" to be denote the unknown nature of these waves [10]. 

 

The science behind these newly discovered rays quickly began to catch up to their seemingly accidental discovery.  Modern understanding of the X-ray explains that electrons involved in the process of producing X-rays obtain kinetic energy (KE) or "energy possessed by an object by virtue of its motion" [3]. The cathode rays which Wilhelm previously used allowed for these electrons to create a beam that may strike an object, outline it, and possibly absorb into the targeted material.  When the electrons strike the target, their velocity is changed as they pass by a positively charged nucleus, and as a result they emit radiation waves in the form of photons [5].  The scientific term for this process comes from the German word Bremsstrhlung (braking radiation) [12].  These rays of radiation, which are emitted through this process, provided the effects of the X-ray from an atomic view that is invisible to the naked eye.  The study of these processes allowed for science to quantitatively measure the energy needed for these reactions, and the energy that would be emitted from these reactions.  The importance of quantifying these energy expenditures allowed future medical use of X-rays to adapt energy needed for the different tissues of the body, because different body tissues absorb X-rays differently from one another [5].

 

 

                                                                                                                   -This captions demonstrates the function of the cathode tube, and the ability                                                                                                                         to capture an electron beam and produce an X-ray.

                                                                    

-Representation of the fluorescent glow produced by cathode tubes similar to those used by Wilhelm Roentgen.    

 

 


Development of the First Medical Imaging 

 

 

Wilhelm Conrad Roentgen had discovered rays which possessed the ability to pass through objects and capture images that no one during this time era would have ever imagined possible.  One month after his initially discovery of the fluorescent glow of the Barium plantinocyanide screen, he captured the first X-ray the world had ever seen using his wife as the first photograph [10].  Wilhelm discovered that the X-rays had the ability to capture more than he had even originally believed possible.  Using the same apparatus from his initial experiment, Wilhelm produced an image of the bones of his wife's hand, and the ring that wrapped around her ring finger [1].

                                                                                                                       

"I have seen my death." -Wilhelm's wife after viewing the first X-ray of her hand [9]                                         Early X-ray procedure for the internal imaging of an infant.

 

This milestone of medical imaging set the stage for future technologies that proceeded.  The first X-ray of Wilhelm's wife's hand attracted the interest of medical professionals during the late 19th and early 20th century.  Wilhelm presented his image to the Wurburg Physical and Medical Society in 1986 which guided the path for the introduction of the X-ray into the world of medicine.  Soon after this publication, aided by these newly developed rays, a doctor in Germany diagnosed sarcoma (malignant tumor of connective tissue [3]) of the tibia of a young boy, and the military implemented X-rays in the location of bullet fragments in soldiers [1].  The quotation from the introductory photograph of this piece denotes the importance of the X-ray  in the world of medicines, for the practice of physicians, and in the outcomes of patient conditions.  X-rays allowed surgeons and physicians to have physical evidence of the internal condition of the human body without needing to unnecessarily open the body to view the internal condition.  These implications also provided useful in the medical training programs across the world.  The first training programs for medicine relied on the ancient teachings of Hippocrates, based solely on what one man believed to be true of the human body.  This was the basis for teaching anatomy to medical students until a law was passed in 1831 that provided medical schools with cadavers for the use of teaching [14].  The birth of X-ray technology provided an even greater means of teaching anatomy in a non-invasive manner.

 

The impact that X-rays have had on medical imaging is extensive, and has allowed for better patient outcomes and quicker, safer diagnostic measures.  Early cathode rays were replaced with large machines that used the same basic principles that the early gas-filled tubes used during the discovery of the unknown, invisible rays.  Dense tissues such as bones, teeth, and tumors provided great targets for absorption from electrons, and provide the emission of radiation based on the Bremsstrhlung Principle [12].  The ability to create images of hollow organs was developed through the use of basic ideas presented by Wilhelm Roentgen.  Scientists and physicians adopted Wilhelm's theories by introducing a radiopaque substance, such as Barium sulfate, which would absorb the X-ray emission [7].  This Barium based material allows for an easy route of entry into the subject's body, and essentially acts as a magnet for the X-rays subjected to the target area.  Modern use of Barium sulfate is similar to the Barium platinocyanide used on the cardboard screen that led to the discovery of the invisible rays that Wilhelm had once described.  


Additional Imaging Technologies

 

                                                                   

-CT Scan showing a left hemisphere ischemic stroke.                                                         -The second oldest method of imaging, the Ultrasound (US), showing fetal detail in utero.

 

 

After the discovery of X-rays, and the ability to harness the potential of the kinetic energy produced by the electron beams, newer technologies continued to arise. Computerized Tomography (CT) scans took X-ray imaging to the next step in medical imaging.  The first application of the CT scan was introduced in 1971 at Atkinson Morley's Hospital in South London.  At this site, the first subject was a women with a suspected frontal lobe tumor which underwent CT scanning followed by surgical intervention.  The surgeon that operated on her cerebral pathology stated after the procedure that, "it looks exactly like the picture" [2].  After this first image there was still speculation as to whether or not there was any form of coincidence involved in the findings.  Several more CT scans were conducted, and the discovery of iodine-based contrast media showed advantageous for greater contrast of tumor visualization on CT imaging results [2].  It was not long before the CT scan made its way over seas and become introduced into American medical imaging.  The results of CT scans produce their imaging by exposing the subject to a low emission intensity X-ray located on one side of the subject, which passes through the targeted area to a detector on the opposite side [7].  The X-ray tube emits the electron beam, and produces the radiation necessary for adequate imaging.  On the opposite side of the X-ray tube the detectors provide an area of absorption for the rays, and provide the source which attracts the electrons.  As the X-ray detectors rotate around the targeted area, the subject is moved insidiously through the tube creating three-dimensional slices of the targeted area [6].  This improvement provides a sequences of images of internal tissues and structures from multiple angles as opposed to the previously superior, single-angled, stationary X-ray.  The CT scan allowed for the visualization of internal structures in greater detail, in a relatively short amount of time, and are excellent for producing images of internal hemorrhage due to the iron component of the subject's blood [4].

 

Of the older imaging technologies, the X-ray does not stand alone.  The second oldest imaging technology, the Ultrasound (US), provides its imaging capabilities through the use of high-frequency ultrasound waves that penetrate the surface of the human body, strikes the targeted area, and reflects the waves back to the detector producing an image [7].  The image above shows that the contrast and detail of the ultrasound is not as crisp and clear as the CT scan, but it does provide another option for non-invasive imaging in a relatively short amount of time.  This technology has further progressed in medical imaging through the development of echocardiograms (either transthoracic or transesophageal) which allow for a quick assessment of cardiac structure and blood flow in emergent situations [15].  Compared to The X-ray and CT scan, US imaging less expensive and has greater portability, bringing the imaging source directly to the subject instead of the opposition [4].

 

                                                                    

-MRI imaging of the right medial aspect of the knee.                                                      -PET scans of a normal brain compared to a brain displaying mild cognitive impairment and                                                                                                                                 that of a subject with Alzheimer's disease.

 

 

 

After the establishment of the X-ray, and proceeding CT scanning technology, there were two more imaging technologies which arose which instantly became medical imaging milestones: Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET Scan).  MRI imaging was introduced in the medical field in the 1980's, and was based on the theory of atoms behaving in manner similar to a magnet that is set in rotation [6].  As the subject is exposed to the magnetic field produced from the MRI machine (which is roughly 3,000-60,000 times that of the earth's gravitational pull) hydrogen atoms begin to absorb the magnetic energy causing them the become aligned in a linear fashion [7].  The introduction of radio-frequency pulses from the radiology technician will result in the disruption of the linear display of the hydrogen ions exposed to one of three different spatial axes if the ions are turned on to the specific magnetic frequency.  When the linear alignment of the hydrogen ions is disrupted, a resultant emission of energy produced from this reaction necessary for the product of imaging obtained through the precise manipulation of the MRI's magnetic field gradient [7].  This precise process of manipulating hydrogen ions in targeted aspects of the subject's body provides imaging of greater detail.  The above image taken with an MRI of a patient's knee shows great detail in bone structure, muscle condition and positioning, ligament integrity, soft tissue density, as well as precise spacing of joints and the presence of abnormally occurring pathology which may or may not be present.  There is no question that MRI's produce quality imaging which aides in the health care provider's ability to accurately determine and implement needed interventions in the safest manner, but the MRI produce two disadvantages in medical imaging of the modern era.  The first disadvantage of the MRI is the length of time needed for a quality image to be obtained, making this imaging technique unsuitable for emergent situations and patient conditions (as with the example of the internal hemorrhaging patient earlier discussed with the CT scan) [4].  Lastly, the MRI machine itself is constructed as a tube shaped-apparatus in which the patient must be submerged in for the entire length of the procedure (depending on the targeted area of imaging).  This introduces concern when imaging is required for a subject with severe claustrophobia or one which is neurologically impaired (i.e. an individual with dementia), and may require the assistance of a sedative medication for cooperation during the imaging procedure [15].

 

The PET Scan was introduced in the 1970's, and provided physiological imaging of a different aspect.  This imaging technology uses positron emitting isotopes, which is usually a radioactive glucose, to produce a chemical reaction causing the unstable isotope to decay and as a result emit two separate positrons which move in complete opposite directions, and only registers the image captured if two detectors on either side of the target 180 degrees apart react at the same time [6].  Before one can truly understand the the physics behind this technology, one must first understand the terminology.  The positrons which are emitted from the reaction previously described are essentially particles with a positive charge which are similar to electrons.  When these particles collide with electrons they emit gamma rays (usually at roughly 0.511 MeV) which are the basis of the previously described emissions detectable on the PET scanner [7][8].  The above image of an example of a PET scans shows the much different appearance in this type of imaging compared with that of the images produced from X-ray and magnetic technology respectively.  PET imaging provides information regarding cerebral blood flow (in the case of the brain) as well as which target tissues are processing the injected glucose, or essentially which of the targeted tissues are active during the scan [6][7].  The image of the PET scan representing a normal human brain compared to that of one with mild cognitive dysfunction and Alzheimer's disease respectively, provides information regarding the activity level of the cerebral tissues and their ability to metabolize and use glucose.  Darkened areas represented in the brain subjected to Alzheimer's disease show the extent and magnitude of the areas of the brain which are not functioning metabolically in a manner consistent with cerebral homeostasis or normal cognitive functioning.  It is no surprise that the PET scan was initially developed to visualize the brain, and studies may be conducted using music as a stimulus providing the PET scan with different areas of activity in which to record based solely on the type of music played, along with the response of the cerebral cortex [8].

 

 

 


Numerical Imagining Based on Internal Human Conditions 

 

 

 

 


Implications in Media Ecology

 

 

 

 

 

 

References

[1] Assmus, A. Early History of X Rays. Beamline, 1995.

[2] Beckmann, E.C. CT scanning in the early days. The British Journal of Radiology, (79), 2006.

[3] Mosby’s Dictionary of Medicine, Nursing, & Health Professions(8th ed.). (2009). St. Louis, MO: Mosby’s, Inc. (2009).

[4] Niederer, P.F. Basic elements of nuclear magnetic resonance for use in medical diagnostics: Magnetic Resonances Imaging (MRI) and Magnetic Resonance Spectroscopy (MRS). Technology and   Health Care. (19). 2011.

[5] Niederer, P. F. Diagnostic Medical Imaging: X-Ray projection technique, image subtraction method, direct digital x-ray imaging, computed tomography (CT). Technology and Health Care. (17), 2009

[6] Purves, D., Augustine, G.J., Fitzpatrick, D., Hall, W.C., LaMantia, A., McNamara, J.O., & White, L.E. Neuroscience Fourth Ed. Sunderland, Mass: Sinauer Associations, 2008

[7] Saldin, K.S. Human Anatomy Second Ed. New York, NY: McGraw-Hill, 2008

[8] Zollman, D., McBride, D., Murphy, S., Aryal, B., & Kalita, S. "Teaching About the Physics of Medical Imaging." International Conference of Physics Education, 2009.

[9] "Wilhelm Rontgen" Wikipedia, The Free Encyclopedia. 29, November 2012, 17:52 UTC. Wikimedia Foundation, Inc. 2012. <http://en.wikipedia.org/wiki/Wilhelm_R%C3%B6ntgen>

[10] NDT The Discovery of X-Rays. <http://www.ndt-ed.org/EducationResources/HighSchool/Radiography/discoveryxrays.htm>

[11] Frame, P.W. Tales from the Atomic Age. Health Physics Society Newsletter. <http://www.orau.org/ptp/articlesstories/invisiblelight.htm>

[12] Britannica Encyclopedia (2012). <http://www.britannica.com/EBchecked/topic/78784/bremsstrahlung>

[13] Filler, A.G. "The History, Development, and Impact of Computed Imaging in Neurological Diagnosis and Neurosurgery: CT, MRI, and DTI." Internet Scientific Publications. <http://www.ispub.com/journal/the-internet-journal-of-neurosurgery/volume-7-number-1/the-history-development-and-impact-of-computed-imaging-in-neurological-diagnosis-and-neurosurgery-ct-mri-and-dti.html#sthash.jAsbuSM4.pl2KL6DO.dpbs> 

[14] Perry, J.L., & Kuehn, D.P. "Using Cadavers for Teaching Anatomy of the Speech and Hearing Mechanisms."ASHA (2006)

[15] Lewis, S. L., Dirkensen, S. R., Heitkemper, M. M., Bucher, L., & Camera, I. M. Medical Surgical Nursing Eighth Ed. St. Louis, MO: Mosby's, Inc. (2011).

 

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