Radiology

Radiology imaging methods started with the discovery of X-rays in 1895 as a science that provides the diagnosis and treatment of diseases.

Today, working with X-ray devices and radio waves that acquire images using X-rays, computed tomography (CT), mammography, fluoroscopy, sonography (US) working with sound waves and magnetic resonance imaging (MRI) and angiography devices, which is a large magnet. is common in diagnosing diseases.

Radiology Department Imaging Devices

  • Digital X-ray
  • Digital Mammography
  • Digital Fluoroscopy
  • Ultrasonography and Doppler
  • Digital Angiography (DSA)
  • Bone Mineral Densitometer
  • 16-Section Computed Tomography
  • 256-Slice Computed Tomography
  • 3 Tesla Magnetic Resonance Imaging
  • 1.5 and 3 Tesla Magnetic Resonance Imaging
  • PACS (Image archiving and communication system)

Magnetic Resonance Imaging (MRI)

The magnetic resonance imaging device uses a strong magnetic field and radio waves to create images of organs, soft tissues, bones and all other internal structures. It does not contain radiation and does not cause any harm to the patient.

The duration of the MRI examination varies according to the area examined, the number of regions, and the pre-diagnosis made, and it takes between 5 minutes to 45 min, ranges. In addition, the contrast material can be administered through the vein during the examination in order to improve the image quality and increase the reliability of the diagnosis in some cases where it is deemed necessary.

Since MRI is the imaging method with the highest soft-tissue resolution, it is used especially for imaging soft tissues. It is frequently used in athlete injuries, in the detection of disorders such as the musculoskeletal system, especially meniscus, and herniated disc, and in the evaluation of all kinds of neurological diseases. In addition to MRI uniqueness such as brain, neck, spine, thorax, abdomen, musculoskeletal, which are frequently used in routine, advanced MRI examinations such as cardiac MRI, prostate MRI, diffusion MRI, perfusion MRI, MRI defecography, and MRI spectroscopy can be performed. With MR angiography, it is possible to visualize body vessels with or without using contrast. Cardiac MR is an imaging method that demonstrates the structure of the pericardium, heart chambers, valves, heart muscle, major arteries emerging from the heart, and some coronary artery diseases (only the main branches for now), extremely easily and without the need for any medication or procedure. The processing time is around 45 minutes and does not require any preparation.

Computed Tomography (CT)

Computed tomography is a radiological diagnostic method to create a cross-sectional image of the area of the body being examined using X-rays. The basis of CT is based on the x-ray machine. A large number of two-dimensional X-ray images of a body area are taken from different angles, and two and three-dimensional images of the internal structure of that area are obtained. During the CT examination, the patient lies on the table of the CT device without moving. While the X-ray source performs a 360-degree rotation around the patient to be examined, the part of the X-ray beam passing through the body is detected by detectors, and the data obtained are processed with the help of a computer, and images are created. The digital images created can be viewed on the computer screen. In addition, images can be transferred to a film or CD, or permanently stored in PACS to be brought back to the computer screen when necessary. Depending on the type of examination to be performed, the patient may be injected with a contrast agent through the arm vessels or it may be requested to drink contrast material. Contrast agents can cause allergic reactions in some people

because they contain iodine. Before the examination, the patient should inform the technician or radiologist whether he has had an allergic reaction to such substances and, if any, allergies to other substances. Since X-ray is used as a method, there is a risk of radiation. However, for patient safety, the radiation dose is minimized as much as possible in multi-slice technology and the image is obtained. Since X-rays may harm the unborn baby, patients with suspected pregnancy should inform the doctor or technician before starting the examination.

With the multi-slice CT devices offered by the developing technology, the speed of the examination has increased and the section thicknesses of the images created by the device have been thinned. In a single breath holding time of 15-20 seconds, the whole-body area is displayed in 0.5 mm slices; Different plan sections, 3-dimensional anatomy, and details can be revealed by processing the sections taken continuously on the computer. Thanks to the increase in the examination speed, the duration of breath-holding is shortened in examinations that require breath-holding such as the abdomen and lungs. It is one of the most used diagnostic methods in radiology due to its easy accessibility and short examination period.

CT Usage Areas

Emergency Situations

It is preferred for fractures and organ injuries, especially in trauma patients, as it can view the entire region of the body in multi-sectional views in a short time. Before starting treatment in patients with stroke, whether there is a brain hemorrhage or not is revealed by CT. It provides very valuable information in showing pulmonary vascular occlusion in rapidly developing respiratory problems, revealing suddenly developing circulatory system problems, showing the cause of abdominal pain such as appendicitis, and in the diagnosis of complications that develop after surgery.

Coronary CT Angiography

With the 256-slice CT device, the heart vessels can be imaged without any pre-preparation, catheter-free, and only in one breath-hold period. Coronary CT angiography is a groundbreaking new diagnostic method in the field of imaging because it can be performed easier and faster than classical angiography and can be performed without blood and pain. It eliminates the obligation to stay in the hospital. The patient continues his normal daily life after the procedure. Thanks to this system, coronary angiography of people with risk factors can be performed easily. Thanks to coronary CT angiography, many patients are diagnosed with coronary artery disease at an early stage and treated.

Interventional Transactions

CT-guided interventional radiological procedures can be performed in body areas where ultrasonography is not suitable. Many procedures such as abscess evacuation, a biopsy from diseased tissue, and treatment of tumor tissue can be easily performed with CT.

Direct X-ray

These are the examinations performed using X-rays. Our hospital has two digital x-ray machines and four portable x-rays. The images taken are digital and can be viewed instantly in DICOM format over the PACS system in our hospital.

  • Chest X-ray and Telecardiography: Lung, heart and other chest structures are evaluated.
  • Vertebra Graphs: It is taken to evaluate the spine bone structures. Scoliosis radiography can be taken in our hospital.
  • Bone and Joint Graphs: These are the examinations performed to evaluate bones and joints in cases such as bone fractures, mass or rheumatic diseases.
  • Extremity Graphs: Requested to evaluate arm and leg bones. Leg length radiography can be taken in our hospital.
  • Skull Graphs: They are often taken on trauma patients to evaluate skull and facial bones.
  • Paranasal Sinus Graphs: It is an examination applied for the evaluation of sinus structures and the diagnosis of sinusitis.
  • Direct Urinary System Radiography: Used to evaluate urinary system stones.
  • Standing Direct Abdominal X-ray: It is the first examination used to diagnose intestinal obstruction and perforation.

Fluoroscopy

Fluoroscopy is a medical imaging technique used to obtain real-time images of the patient with the help of a device called a fluoroscope. X-ray is used. Siemens Luminos fluoroscopy device is used in our department.

  • Esophagography: Visualization of the esophagus by giving contrast (barium) material
  • Voiding Cystourethrography: It is an imaging method used for the evaluation of the bladder and lower urinary system, and it is the imaging of the urinary tract during voiding using a contrast agent injected into the bladder with a catheter. It is used to investigate urine leakage from the bladder to the ureters, especially in children with urinary tract infections.
  • Retrograde Urethrography: It is an examination performed to determine the location and size of the possible stricture in the urethra by administering contrast material to the urethra.
  • Dacryocystography: It is the radiological examination of the lacrimal sac and duct by giving contrast material.
  • Fistulography: It is the image taking by giving contrast material into a connection (fistula) that should not normally exist between the skin and body cavities.
  • Double Contrast Colonial X-ray: It is the examination of the large intestines by giving barium contrast material and air from the anus.
  • Double Contrast Gastric Veduodenum Graph: It is called esophagus-stomach-duodenum (esophagus-stomach-duodenum) graphy. It is performed by giving the patient a gas-forming tablet and barium contrast agent to visualize the internal surfaces of these organs.
  • Small Intestine X-ray: It is the examination of small intestine passage graphy and sometimes by giving air and contrast (enteroclysis) through a tube that is swallowed to the patient.
  • Sialography: It is the graph obtained after injection of radiopaque contrast material into the salivary gland canal system.

Ultrasound (US) and Doppler

Since sound waves do not contain X-rays, there is no radiation effect. Since it has no harmful effects on humans, it can be repeated safely and as often as desired. Since the application is easy and harmless, it is frequently used in imaging the internal organs and diagnosing diseases. Since the ultrasound device does not transmit sound waves well, it cannot visualize organs and bone structures containing air or gas. Ultrasound is most commonly used to examine the abdominal liver, spleen, gall bladder, bile ducts, pancreas, kidney, bladder, uterus, ovaries, and prostate. It is used as the first imaging method in the evaluation of gall bladder and bile ducts and genitourinary diseases, especially due to abdominal pain. The second most common use is pregnancy and gynecological diseases. Ultrasound is the best method used to determine whether the baby’s development is normal during pregnancy. No proven side effect of ultrasound on the baby has been reported so far. Therefore, ultrasonography can be used safely during pregnancy. The most important disadvantage of ultrasound during pregnancy is that the baby cannot show all the abnormalities. Apart from this, it is a reliable diagnostic method in the evaluation of the neck, thyroid gland, salivary glands, breast, muscles and joints, penis and testicles, and superficial soft tissues.

Color Doppler ultrasound is an ultrasound device that includes classical ultrasound and Doppler systems. Color Doppler US is a new US technique that shows the presence of blood flow in the vessels, the direction and velocity of the flow by color-coding the flow. It is used in the diagnosis of arterial and venous diseases and in the evaluation of vascularization of masses detected in the body. It is a reliable diagnostic method, especially when it is easy to use and well done in the diagnosis of vascular diseases such as vascular occlusion and varicose veins.

Mammography

Mammography is a type of x-ray film and is the most effective imaging method used in breast cancer screening. Breast cancer is the most common type of cancer in women and early diagnosis is very important. Early diagnosis of breast cancer is possible with mammography examination to detect cancers that are too small to be detected by examination. American Cancer Institute, World Health Organization, and Turkish Radiology Association recommend women over the age of 40 have mammography every year. Routine mammography is not recommended before the age of 40, except for high-risk patients.

Nozzles should be clamped between the two plates on the device during shooting. In this way, overlapping of the breast tissue is prevented and the emergence of masses is ensured. This compression improves image quality and reduces radiation exposure during the examination. For this reason, the period in the 7-14th day of menstruation, which is the period when swelling and sensitivity in the breasts are the least. It is recommended to have a mammography between days. Sweat, perfume, deodorant, powder, etc. Since residues may give misleading results, it is recommended to take a shower and not to use such substances before having a mammogram.

Bone Mineral Density Test (Bone Densitometry  DXA)

Minerals such as calcium and phosphorus make up an important part of the bone structure. A Bone densitometry scan is a test used to measure bone mineral density and evaluate bone mineral density loss. The purpose of bone density measurement methods is to determine the quantitative ratio of this mineral part of the bone. The greater the mineral loss in the bone, the lower the density is measured, and in this case, it is interpreted that the bone mineral density decreases, that is, osteoporosis occurs. This test is used to diagnose osteoporosis that develops as a result of calcium loss in the bones. A very small amount of radiation is used during this process. The amount of radiation used is extremely small, like one-tenth of the lung film.

INTERVENTIONAL RADIOLOGY

Interventional radiology is a sub-branch that has progressed rapidly in recent years and is the therapeutic part of radiology. Nowadays, new treatment methods that cause minimal damage to the patient and the treated tissue, shorten the duration of hospital stay, are easy to care for, can be applied without the need for general anesthesia, and have low complications (undesirable side effects, undesirable effects), the rate and cost of new treatment methods are rapidly applied. Interventional radiology is a new sub-branch developed in line with these principles, with a history dating back to the ’60s and allowing non-surgical treatment in many different diseases, applied by interventional radiologists within the Department of Radiology. Purpose of Interventional Radiology; Under the guidance of ultrasonography, computed tomography, angiography, fluoroscopy, and magnetic resonance imaging, which are imaging methods, penetrate through the skin and reach the disease through millimetric, thin materials through veins or other extravascular means, and perform the non-surgical treatment. The variety of interventional radiological treatments has been increasing rapidly recently and new techniques emerging in parallel with the development of technology make it possible to treat many diseases with interventional methods.

Interventional radiological procedures are divided into two large groups as vascular (related to vascular) and nonvascular (related to extravascular organs). Vascular interventions are divided into two as neurovascular interventions (related to the brain vessels) and peripheral vascular interventions (related to the vessels of organs outside the brain).

Vascular Interventional Procedures

The most well-known vascular interventional radiological procedure is classical diagnostic angiography. However, the fact that the diagnostic ability of tomography and MRI angiography has become very high has significantly reduced this need. Angiography is mainly used in therapeutic procedures such as opening occluded or narrowed vessels or closing diseased vessels. Clogged or narrowed arteries or veins are opened with the help of balloon catheters (balloon angioplasty) or metallic cages (stents) that are passed through and inflated in the diseased vein. Diseases of internal organ vessels such as liver and kidney other than heart vessels, vessels leading to arm and leg, and brain vessels are treated by interventional radiology physicians.

Apart from opening veins, occluding some veins (embolization) when necessary can be life-saving. With embolization procedures, bubble formation in the vessel (aneurysm), abnormal vascular ball (arteriovenous malformation), and the focus that causes bleeding can be found and treated. Among these, the most important interventional procedures are those performed in the brain vessels. In this way, such vascular diseases, which were previously treated surgically, are now treated by interventional radiology physicians with micro materials produced intravenously by the closed method. Another important embolization process is “chemoembolization” and it refers to the injection of microspheres loaded with cancer drug by reaching the organ where the cancer is located via the vascular access and the administration of cancer drug directly to the tumor by occluding

the vessel feeding cancer. Chemoembolization is most commonly used in liver tumors.

An aortic aneurysm is the ballooning and widening of the aortic vessel, which is the largest artery in our body. These diseases, which can be fatal if untreated, were previously treated with surgeries performed by opening the whole abdomen, but today they are performed with the help of specially coated stents by entering the groin vein thanks to interventional radiological techniques. (EVAR)

Some of the procedures in interventional radiology are related to the veins, and the placement of temporary and permanent dialysis catheters, opening of clotted leg veins, inserting protective filters into the vein, and ultrasound imaging and laser burning of leg varicose veins without the need for surgery (endovascular varicose treatment) are some of them.

Non-vascular Interventional Procedures

The second main group of interventional radiological procedures is non-vascular (related to extravascular organs) procedures. The most common method is a needle biopsy. A biopsy is required for many diseases and tumor suspicions to reach a definitive diagnosis, and today most of the biopsies can be taken without surgery but with fine needles. Imaging-guided needle biopsies allow a thin needle to be inserted through the skin without any incision and visually advanced into the tissue to be biopsied, from which a cell, tissue, or fluid sample is taken for pathological examination

Ultrasound and tomography devices are often used for imaging guidance. A blind biopsy is not performed in interventional radiology.

Drainage procedures constitute an important part of interventional radiological applications related to therapeutic extravascular organs. Drainage procedures are diverse and include the evacuation of fluid collection areas such as abscesses, cysts, or hematoma (blood collection), evacuation of fluids accumulated in the lung or abdomen, and opening of the obstructed urinary tract or bile ducts with catheter interventions. Such procedures are carried out by inserting special thin needles through the skin into the areas where the diseased fluid is collected, accompanied by imaging, and placing thin plastic pipes called catheters.

It is now possible to burn and treat tumors (ablation therapy) with the help of heat or laser techniques. With imaging, a needle is sent into the tumor and the tumor is treated by creating high temperature in the environment with radiofrequency or microwave energies. This method is currently used frequently in the treatment of liver, kidney, bone, and lung tumors and has the potential to be used in many other tumors.

As a result, interventional radiology, which performs therapeutic procedures on many organ systems under the guidance of imaging, ensures that previous surgeries are performed without the need for narcosis. The most important advantages are less pain, no need for an incision, short recovery time, and being able to send the patient home on the same day or at most one day after hospitalization in most of the procedures.