4. Wilhelm Conrad Röntgen
German] mechanical engineer and physicist
who, on 8 November 1895, produced and
detected electromagnetic radiation in
a wavelength range known as X-rays or
Röntgen rays.
About six weeks after his discovery, he took
a picture—a radiograph—using X-rays of
his wife Anna Bertha's hand
By 1896 doctors around the world were using x-rays to take pictures of patients
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10.
11. Radiology : use of radiation (X-rays and
high energy radiation) for diagnosis, and
now called Medical Imaging
Ultrasound – using focused high-frequency sound waves
X-rays – chest, mammograms, bone films
CT Scan (computed tomography) – slices of x-ray images combined by computer
MRI (magnetic resonance imaging) – strong magnetic field that aligns the protons of hydrogen atoms and
spins the protons to produce a faint signal that is detected
Nuclear Medicine – injecting an isotope into the patient and getting images to show where the radiation
concentrates
Bone Scan – use an isotope that concentrates in the bone
PET Scan (positron emission tomography) – use a positron releasing isotope attached to a specific agent
that will concentrate in the target (glucose for cancer or infection or high blood flow 18F-FDG or for bone
NaF-F18)
No radiation exposure using ultrasound or MRI
US Food and Drug Administration (FDA) estimates that
exposure to 10 mSv from an imaging test would be expected
to increase the risk of death from cancer by about
1 chance in 2000
15. Risk of radiation induced cancer is related to the patient age
and the type of procedure (dose of radiation they are exposed
to)
16. Only include mammograms for breast cancer screening, Low dose CT scans
for lung cancer screening, and option of CT for colon/rectal cancer screening
NCCN.Org
Which stages or cancers need CT, MRI or PET
scans and the frequency
20. Imaging for Advanced Breast
Cancer
Young woman with large, triple negative cancer in the
left breast
mammogram
ultrasound
PET scan
MRI scan
21. Ducts and glands are dense and look
white or grey on an X-ray and fat is
lower density and looks black on an X-
ray
So mammograms may miss cancer on
younger women or women with very
dense breasts, and they may do better
with an MRI or ultrasound.
25. Probability of Breast Cancer
by BIRADS
BI-RADS 3 1.0%
BI-RADS 4 18.6%
4A 6%
4B 15%
4C 53%
Am J Prev Med. 2013 Jan; 44(1): 15–22.
26. Mammography
sensitivity: overall 80%
age: < 40y 54 – 58%
> 65y 81 – 94%
High breast density is associated with 10 – 29% lower
sensitivity
Sensitivity of only 50% in women with dense breasts and 33%
in BRACA study
Breast cancer is accurately diagnosed through mammography in about 78 percent of all women tested, while
diagnostic accuracy rises to about 83 percent for women over 50. false positives, about 6-8%, estimated 17% of
breast cancers missed by mammography. The number may rise as high as 30% for women with dense breasts
27. How often will a mammogram miss finding a cancer in a
young woman?
42 – 46%
Never!
28. Biopsy = 9mm invasive ductal cancer
Mammogram in a woman with fatty,
low density breasts
29. Breast Density can make imaging very difficult, this woman had a palpable mass that was
very difficult to see because her diffuse breast density
mammogram CT Scan
MRI
31. Mammograms may often show areas of
calcification, these may be malignant. In
ductal carcinoma in situ (DCIS), there is
normally no mass but just an area of
calcification
35. Mammogram report = 7mm
spiculated lesion in the
upper, outer part of the breast
Pathology = 1cm, grade 1,
invasive ductal cancer with
all nodes clear
Mammogram of Early
Breast Cancer
36. Regular Mammogram with Compression Views to Better Show the
Lesion, biopsy showed 9mm Grade 1 invasive ductal cancer
41. Breast MRI
Path = 2.2 cm
cancer in right
breast, left breast
was benign
(False positive?)
benign
42. Breast MRI
Will show the breast tumor as well
as the lymph nodes
Mastectomy = 6cm lobular
cancer with 41 out of 42 lymph
nodes positive for cancer spread
47. Breast MRI Scan
In a woman with dense breasts, the mammogram was
normal but the MRI showed the cancer
48. mammogram
Breast MRI
MRI may show deep tumors that can be missed on the edge of
the mammogram images and can be better seen and the depth
on the MRI
62. 3D Mammography More Likely to Find Small Invasive
Breast Cancers, Especially in Women Younger Than 50
Three-dimensional mammography (also called digital breast tomosynthesis, digital tomosynthesis, or just
tomosynthesis) creates a three-dimensional picture of the breast using X-rays.
the study found that screening with 3D mammography increased breast cancer detection rates by about
40%.
•73.7% of breast cancers found with 3D mammography were 1 centimeter (cm) or smaller and node-
negative
•65.4% of breast cancers found with digital mammography were 1 cm or smaller and node-negative
•This difference in detecting small breast cancers was especially notable in women age 40 to 49. For these
women, 3D mammography found 4.41 invasive cancers per 1,000 exams in women with nondense breasts
compared to 2.71 invasive cancers per 1,000 exams found by conventional 2D digital mammography.
70. PET Showing Lymph Nodes Spread with Lung
Cancer
SupraClavicular Mediastinal Hilar
N3 N2 N1
Lung
Lung
Heart
71. On a CT scan, the cancer,
the fluid and the
collapsed lung may all
look the same (grey)
The PET will show the
difference since is shows
metabolism (how much
glucose is being
consumed in the area,
cancers consume a very
high quantity and appear
bright yellow)
72. SBRT with Tomotherapy
PET Scan before and 2 Months after Tomotherapy
PET Scan helps
to find the
cancer and also
helps to prove
whether the
radiation has
killed the cancer
(the grey scar
should no
longer be hot
on the PET)
Hot
Cold
74. Standard test is an MRI (not a
CT scan) given with
intravenous contrast
(gadolinium).
Since a brain biopsy may not
always be an option it is
critical that the radiologist
can accurately identify the
correct diagnosis
76. CT Scan MRI Scan
Better definition from an MRI than a CT
77. The tumor may
be almost
invisible on the
MRI unless IV
contrast is given
78. PET scans are not very
helpful for brain
tumors. Since the brain
uses large amounts of
glucose it looks so
bright on the PET a
tumor would be hard
to see.