Diagnostic Radiology: Recent Advances and Applied Physics in Imaging PDF
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DIAGNOSTIC RADIOLOGY Recent Advances and Applied Physics in Imaging AIIMS-MAMC-PGI Imaging Series DIAGNOSTIC RADIOLOGY Recent Advances and Applied Physics in Imaging Second Edition Editors Arun Kumar Gupta MD MNAMS FAMS Veena Chowdhury MD Niranjan Khandelwal MD Dip NBE FICR Professor and Head Director Professor and Head Professor and Head Department of Radio-diagnosis Department of Radio-diagnosis Department of Radio-diagnosis All India Institute of Medical Sciences Maulana Azad Medical College Postgraduate Institute of Medical Education (AIIMS), New Delhi, India (MAMC), New Delhi, India and Research (PGIMER), Chandigarh, India Associate Editors Sanjay Sharma MD DNB FRCR Ashu Seith Bhalla MD MNAMS Smriti Hari MD Additional Professor Additional Professor Associate Professor Department of Radio-diagnosis Department of Radio-diagnosis Department of Radio-diagnosis All India Institute of Medical Sciences All India Institute of Medical Sciences All India Institute of Medical Sciences (AIIMS), New Delhi, India (AIIMS), New Delhi, India (AIIMS), New Delhi, India ® JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD New Delhi • London • Philadelphia • Panama ® Jaypee Brothers Medical Publishers (P) Ltd. 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If not specifically stated, all figures and tables are courtesy of the editors. Where appropriate, the readers should consult with a specialist or contact the manufacturer of the drug or device. Diagnostic Radiology: Recent Advances and Applied Physics in Imaging First Edition: 2000 Second Edition: 2013 ISBN: 978-93-5090-497-8 Printed at Contributors Ajay Gulati MD Arun Deep Arora MD Jyoti Kumar MD DNB MNAMS Assistant Professor Senior Research Associate Associate Professor Department of Radio-diagnosis Department of Radio-diagnosis Department of Radio-diagnosis PGIMER, Chandigarh, India AIIMS, New Delhi, India MAMC, New Delhi, India Ajay Kumar MD Arun Kumar Gupta MD MNAMS FAMS Kushaljit Singh Sodhi MD MNAMS FICR Assistant Professor Professor and Head Associate Professor Department of Radio-diagnosis Department of Radio-diagnosis Department of Radio-diagnosis PGIMER, Chandigarh, India AIIMS, New Delhi, India PGIMER, Chandigarh, India Akshay Kumar Saxena MD Dip NBE Ashu Seith Bhalla MD MNAMS Madhusudhan KS MD FRCR Additional Professor Additional Professor Assistant Professor Department of Radio-diagnosis Department of Radio-diagnosis Department of Radio-diagnosis PGIMER, Chandigarh, India AIIMS, New Delhi, India AIIMS, New Delhi, India Alpana Manchanda MD Atin Kumar MD DNB MNAMS Mandeep Kang MD Professor Associate Professor Additional Professor Department of Radio-diagnosis Department of Radio-diagnosis Department of Radio-diagnosis MAMC, New Delhi, India PGIMER, Chandigarh, India (Trauma Centre Division) AIIMS, New Delhi, India Anil Chauhan MBBS Board Certified in Manisha Jana MD DNB FRCR Radiology, USA BR Mittal MD DRM DNB FICNM FAMS Assistant Professor Fellow, Body imaging, Department of Radiology Department of Radio-diagnosis Professor and Head University of Texas MD Anderson Cancer (BRAIRCH Division) Department of Nuclear Medicine center, Houston, USA AIIMS, New Delhi, India PGIMER, Chandigarh, India Anil K Pandey PhD Manphool Singhal MD DNB MNAMS Chandan Jyoti Das MD DNB MNAMS Assistant Professor (Medical Physics) Assistant Professor Assistant Professor Department of Nuclear Medicine Department of Radio-diagnosis Department of Radio-diagnosis AIIMS, New Delhi, India PGIMER, Chandigarh, India AIIMS, New Delhi, India Anindita Sinha MD Manavjit Singh Sandhu MD FICR Chandrashekhara SH MD DNB MNAMS Assistant Professor Professor Assistant Professor Department of Radio-diagnosis Department of Radio-diagnosis Department of Radio-diagnosis PGIMER, Chandigarh, India PGIMER, Chandigarh, India (BRAIRCH Division) Anish Bhattacharya DNB DRM MNAMS AIIMS, New Delhi, India Mukesh Kumar Yadav MD Additional Professor Assistant Professor Deep Narayan Srivastava MD MNAMS Department of Nuclear medicine Department of Radio-diagnosis FAMS PGIMER, Chandigarh, India PGIMER, Chandigarh, India Professor Anjali Prakash DMRD DNB MNAMS Department of Radio-diagnosis Naveen Kalra MD Professor AIIMS, New Delhi, India Additional Professor Department of Radio-diagnosis Department of Radio-diagnosis Devasenathipathy Kandasamy MD DNB MAMC, New Delhi, India PGIMER, Chandigarh, India FRCR Anju Garg MD Assistant Professor Niranjan Khandelwal MD Dip NBE FICR Director Professor Department of Radio-diagnosis Professor and Head Department of Radio-diagnosis (BRAIRCH Division) Department of Radio-diagnosis MAMC, New Delhi, India AIIMS, New Delhi, India PGIMER, Chandigarh, India Anupam Lal MD Gaurav Pradhan DMRD DNB Pratik Kumar PhD Dip RP Associate Professor Professor Additional Professor Department of Radio-diagnosis Department of Radio-diagnosis Medical Physics Unit (BRAIRCH) PGIMER, Chandigarh, India MAMC, New Delhi, India AIIMS, New Delhi, India vi Diagnostic Radiology: Recent Advances and Applied Physics in Imaging Rajat Jain MD Sanjay Sharma MD DNB FRCR Surabhi Vyas MD Senior Resident Additional Professor Assistant Professor Department of Radio-diagnosis Department of Radio-diagnosis (RPC Division) Department of Radio-diagnosis MAMC AIIMS, New Delhi, India AIIMS, New Delhi, India New Delhi, India Sapna Singh MD DNB MNAMS Thulkar S MD Raju Sharma MD Associate Professor Additional Professor Professor Department of Radio-diagnosis Department of Radio-diagnosis (BRAIRCH) Department of Radio-diagnosis MAMC, New Delhi, India AIIMS, New Delhi, India AIIMS SC Bansal MA MSc (Med Tech) PhD Tulika Singh MD New Delhi, India Lecturer Assistant Professor Rakesh Kumar MD PhD Department of Radio-diagnosis Department of Radio-diagnosis PGIMER, Chandigarh, India PGIMER Additional Professor Chandigarh, India Department of Nuclear Medicine Shashi Bala Paul AIIMS Senior Scientist Veena Chowdhury MD New Delhi, India Department of Radio-diagnosis Director Professor and Head AIIMS, New Delhi, India Department of Radio-diagnosis Rashmi Dixit MD MAMC, New Delhi, India Professor Shivanand Gamanagatti MD MNAMS Department of Radio-diagnosis Associate Professor Veenu Singla MD MAMC Department of Radio-diagnosis Assistant Professor New Delhi, India (Trauma Centre Division) Department of Radio-diagnosis AIIMS, New Delhi, India PGIMER, Chandigarh, India Sameer Vyas MD Assistant Professor Smriti Hari MD Vivek Gupta MD DM (Neuroradiology) Department of Radio-diagnosis Associate Professor Associate Professor PGIMER Department of Radio-diagnosis Department of Radio-diagnosis Chandigarh, India AIIMS, New Delhi, India PGIMER, Chandigarh, India Preface to the Second Edition The First Edition of diagnostic radiology volume on Advances in Imaging Technology was published in the year 2000. During the second series, technical advances were dealt with under different organ systems, and no separate volume was compiled. The explosion of imaging technology in the last decade and the imperative need for the radiologist to stay abreast with these, motivate us to release a new volume on topic. The ever-evolving field of radiology makes continuing education in technical advances almost a compulsion rather than an option for those in the field. As a commitment to our readers and as part of our constant endeavor to improve as students ourselves, we publish the new edition titled Recent Advances and Applied Physics in Imaging. Recent years have witnessed an astounding revolution in the field of imaging technology. At the heart of this revolution are major strides taken by the industry in all modalities including radiography, ultrasonography, digital subtraction angiography, computed tomography and magnetic resonance imaging. The imaging has moved from anatomic to functional, from static to real-time and from 2 dimensional to 3 or even 4 dimensional. All these major advancements in the information provided are expected at a faster rate and with lesser radiation dose. It is truly a tribute to science that several of these goals have actually been achieved. As radiologists, we have been privileged to be the chosen few to deliver these stunning images to the medical community. With this, however, comes greater responsibility. Our ability to create and interpret these amazing pictures requires us to comprehend the physics that goes into creating them. Also, the onus of minimizing the cost of imaging, selection of the optimal modality and minimizing radiation exposure finally rests on us. This book has hence been planned as a volume attempting to summarize and deliver the advances in imaging technology relevant to the radiologist in a manageable capsule. We hope that it will serve as your friend and companion in understanding and negotiating the labyrinth of Imaging Physics. Compared to the First Edition published in 2000, the book has understandably been majorly restructured. We have attempted to cover all major aspects of technological advances relevant to a practicing radiologist, while keeping the book compact. It is our earnest hope that our readers will find this text informative and that it will aid in their learning process and daily practice. We wish to thank all the contributors from the institutions, i.e. All India Institute of Medical Sciences, New Delhi, Maulana Azad Medical College, New Delhi and Postgraduate Institute of Medical Education and Research, Chandigarh, India, for their efforts in compiling this edition. We would also like to express our sincere appreciation to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Mr Tarun Duneja (Director-Publishing), Mrs Samina Khan (PA to Director- Publishing), Mr KK Raman (Production Manager), Mr Sunil Kumar Dogra (Production Executive), Mr Neelambar Pant (Production Coordinator), Mr Subrata Adhikary (Commissioning Editor), Dr Mohd Naved (Senior Proofreader), Mr Girish Pandey (Typesetter), Mr Dinesh Joshi (Graphic Designer) and other staff of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for their professionalism and dedication towards publication of this edition. Arun Kumar Gupta Veena Chowdhury Niranjan Khandelwal Preface to the First Edition Diagnostic imaging has undergone an astonishingly rapid transformation over the last two decades. The constant expansion of imaging techniques and their potential is based on scientific and technical advances including improvement in computer hardware and software technology. The fusion of computer technology to diagnostics imaging was indeed a turning point in the history of diagnostics imaging. This, in fact, has brought medical imaging to the forefront of various clinical disciplines. The amazing speed at which the field of radiology is mushrooming today would have surely astounded Roentgen, the “Father” of radiology. While physicians, a century ago, struggled with the nation of looking inside the living body without the cutting it open. At present, the physicians find it almost impossible to practice medicine without the help of sophisticated diagnostics imaging. Cross-sectional imaging modalities have revolutionized the concept of imaging. Ultrasonography has advanced into wider areas of applications with increasing contrast use of color Doppler and Power Doppler techniques. The introduction of ultrasound contrast media and tissue harmonic imaging has further opened up new vistas in clinical applications of ultrasonography. Since its introduction in 1971, computed tomography (CT) technology has come a long way. Modern scanners, capable of subsecond scanning, are ideal for the scanning chest and abdomen in a single breath-hold. Additional improvement includes more detectors to increase resolution and finer collimation allowing a reduction in slice thickness to minimize partial volume averaging. Introduction of spiral scanners has widened the scope of imaging by making 3D CT and 3D CT angiography possible. Magnetic resonance imaging (MRI) was introduced into clinical medicine in 1981 and within a short time, it has assumed a role of unparalleled importance in diagnostic medicine. It is probably the most important imaging advancement since the introduction of X-rays in 1895. The resolution of 3D MR and 3D MR angiography has also advanced to the stage, where the replacement of conventional invasive angiography is now in sight. However, MR spectroscopy has failed to fill its early promise and still await routine clinical acceptance. The role of the radiology is fast changing from that of a diagnostician usually supporting clinical diagnosis to that of a more active colleague tackling various clinical problems and performing a wide gamut of interventional procedures. The interventional radiologist of today is indeed going to be surgeon of the new millennium. Functional neuroimaging with PET and SPET is emerging from the research stages and when more freely available, may have a major influence on clinical practice. Teleradiology, which allows long distance transmission of images by extensive networking, has expanded the scope of diagnostic imaging well beyond our expectation. The student of radiology needs constant guidance through this bewildering plethora of new information on imaging technology. A comprehensive understanding of technological advances in imaging and their clinical applications are necessary for practicing radiologists to be able to make an optimal choice of investigation in helping the referring physician to reach at a diagnosis. Keeping this in mind, the faculty of radio-diagnosis at the All India Institute of Medical Sciences, Maulana Azad Medical College, New Delhi and Postgraduate Institute of Medical Education and Research, Chandigarh, India, present this seventh book in the series of Diagnostic Radiology, devoted to Advances in Imaging Technology, thus concluding the series of AIIMS, MAMC, PGI Imaging Courses.
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