The Use of Technology in Radiology

Abstract

 Technology can be both helpful and harmful in many aspects. In this paper I have explored how technology has been helpful and harmful in the field of radiology. Technology has made radiology safer with faster processing times, AEC, and the ability to manipulated images causing less repeat exposures. Technology brought about new ways of imaging such as ultrasound, MRI, and fMRIs that allow us to see things in the body we were never able to see before. These imaging source also allow us to perform minimally invasive procedures rather than large, complex surgeries.  As with everything else technology has its downfalls as well. Some of these downfalls include technologists not knowing proper techniques, not knowing or following proper protocol, and over manipulation of images.  Another downfall to technology in the field of radiology is the lack of collimation, which allows for more radiation exposure to the patient then is necessary. While the disadvantages of technology are no doubt present, I do believe the benefit of the advantages outweigh the risk of the disadvantages.

Technology is an ever changing field. This is especially true in the field of medicine. Technological advanced in medicine have no doubt been an asset but they have their downfalls as well. In this paper I will explore if technology has helped or hurt us as a people when it comes to the field of radiology. As with everything else there are advantages and disadvantages to technology in the field of radiology. We will first look at some of the advantages.

One of the biggest advantages is that technology has made radiology safer than it was in previous years. In order to understand how technology has made radiology safer, I will briefly discuss how radiation in medicine works. In some imaging processes; such as, Computed Tomography (CT), X-ray, Fluoroscopy, and interventional radiology, small amounts of radiation are passed through the body to give us an image that can be used for diagnostic purposes. This can be dangerous because too much radiation exposure can lead to radiation poisoning. Radiation poisoning is also sometimes called radiation sickness. “Radiation sickness is damage to your body caused by a large dose of radiation often received over a short period of time.” (“Radiation Sickness”, 2018,) “Radiation is the energy released from atoms as either a wave or a tiny particle of matter. Radiation sickness is caused by exposure to a high dose of radiation…” (“Radiation Sickness”, 2018) Now that we have a better understanding of radiation and how it can affect the body I will explain how technology has made medical radiation safe with the use of Automatic Exposure Control (AEC) and the discovery of ultrasound and Magnetic Resonance Imaging (MRI), which do not use radiation for imaging.

A leap forward in technology gave us the age of digital imaging in radiology. With digital radiograph came many advantages. One of these advantages is AEC. Before AEC, a radiologic technologist would have to manually set the technique for an imaging exposure. These techniques were partly based on technique charts and partly based on experience. These techniques were many times a best guess, based on the technologist’s skill and experience. Often times, if the technique was set too high a patient was overexposed and the image was unusable causing the procedure to be repeated. This would also be the case if the technique was set too low, the image was unusable because it was too light and again the procedure would need to be repeated causing additional exposure to the patient.

“AEC is a radiographic density control device that terminates the exposure when a predetermined amount of radiation has been reached.” (Sterling, 1988). AEC allows a predetermined radiation amount to be set for each exam. While performing the exam, once the predetermined amount of radiation has been reached the machine will turn off and the exam is complete. The predetermined radiation amounts come from years of researching the lowest possible dose to achieve a diagnostically viable image. This is extremely helpful in the field of radiology because it takes a lot of the guess work out of the equation, allowing for uniformly acceptable images and less radiation dose to the patient. This also equates to less exposure due to repeat exams since the radiation amount is preset there is less of a chance of over or under exposure creating less need for repeats. Another advantage that came with the age of digital is faster exposure times.

“Large exposure times have been reduced to milliseconds…” (Sansare, Khanna, and Karjodkar, 2011). “In 1896, Walkhoff succeeded in making extra-oral pictures with an exposure time of 30 minutes.” (Sansare, Khanna, and Karjodkar, 2011). In today’s medicine we couldn’t fathom having to sit for 30 minutes of exposure for something as simple as a dental x-ray. Thanks to technology we do not have to. “DR systems use imaging devices that remain in situ and produce an image with a delay that is generally no more than about 10 s.” (Allisy-Roberts and Williams, 2008).  The time difference between then and now is astonishing.  Seconds or less for an image with today’s technology is an astronomical leap toward patient safety. Less time spent being exposed to radiation equals substantially less radiation to the patient meaning less negative effects. This is a great advantage because it allows us to use radiation for the purpose of obtaining diagnostic imaging without putting the patient at great risk. Another stride toward obtaining imaging without putting the patient at great risk was the discovery of both ultrasound and MRI, which do not use ionizing radiation to obtain an image.

“Most consider French physicist Pierre Curie’s discovery of piezoelectricity in 1877 to be the moment that ultrasound was conceived, Baker said. Thirty-five years later, sonographic imaging was developed by French professor and physicist Paul Langevin.” (Orstein, 2008). There was a long time between the discovery of ultrasound or sound waves and its use in medicine, particularly imaging. “Ultrasound imaging uses sound waves to produce pictures of the inside of the body.” (Radiological Society of North America, RSNA, & American College of Radiology, “General Ultrasound” n.d.). Ultrasound allowed us a new way to look into the human body. We previously discussed medical imaging such as x-ray and CT. These imaging sources look mostly at bone. With ultrasound we were able to look at many other internal aliments. “It is used to help diagnose the causes of pain, swelling and infection in the body’s internal organs and to examine a baby in pregnant women and the brain and hips in infants. It’s also used to help guide biopsies, diagnose heart conditions, and assess damage after a heart attack. Ultrasound is safe, noninvasive, and does not use ionizing radiation.” (Radiological Society of North America, RSNA, & American College of Radiology, “General Ultrasound” n.d.) Since ultrasound does not use ionizing radiation and can be used for a wide array of imaging, it offers a great alternative to x-ray or CT. It also allows us to see things we would not be able to see using conventional radiology. We are unable to visualize the internal organs, the brain, or assess the damage caused by a heart attack with x-ray or CT. Advances in technology continue to allow us to see and do things that would not have been possible in the past. Another imaging source that came about due to new technology is the MRI.

“MRI uses a strong magnetic field and radio waves to create detailed images of the organs and tissues within the body.” (Lam, 2018). “In 1970, Raymond Damadian, a medical doctor and research scientist, discovered the basis for using magnetic resonance imaging as a tool for medical diagnosis. He found that different kinds of animal tissue emit response signals that vary in length, and that cancerous tissue emits response signals that last much longer than non-cancerous tissue.” (Bellis, n.d.) Damdian’s discovery lead researchers to come up with the MRIs we use in today’s medicine. MRIs are important because they “…give very detailed pictures of soft tissues like the brain.” (“MRI”, n.d.) This is important because it gives us a view of the body and its functions that we would not have with other imaging sources. With the use of MRIs, we can view fluid in the body. “Bone marrow, spinal fluid, blood and soft tissue vary in intensity from black to white, depending on the amount of fat and water present…” (“MRI”, n.d.) This leads us to our next advantage, angiograms.

MR angiogram (MRA) “…can be used to view arteries and veins.” (“MRI”, n.d.) MRA is a type of MRI. Since a regular MRI cannot see moving fluid we use MRA to view how the blood flows through the body. “Contrast dye (gadolinium) injected into the bloodstream helps the computer “see” the arteries and veins.” (“MRI”, n.d.) This helps us detect any abnormalities in blood flow that could potentially be life threatening to the patient. “MRA can detect aneurysms, blockages of blood vessels, carotid artery disease, and arteriovenous malformations.” (“MRI”, n.d.) These are all diseases patients would have died from in the past. Now, thanks to technology, these things can be detected and possibly corrected saving the patient. “An estimated 6 million people in the United States have an un-ruptured brain aneurysm” (“Brain Aneurysm Statistics”, n.d.). That is an extremely high number of potential deaths. With new technology many of these patients go on to live a long, healthy lives, which many not have been possible previously. Other imaging brought about due by technology are Angiograms and PET scans.

“An angiogram detects blockages using X-rays taken during the injection of a contrast agent (iodine dye).” (Marone, n.d.) This type of test is done to determine the amount of damage or blockage to your arteries. Once an angiogram is performed the vascular surgeon can determine the best course of action. Many times an Angioplasty can be done to help remove the blockage. “Guided by X-ray, your vascular surgeon navigates through the blockage with a wire and introduces a special device equipped with an inflatable balloon.” (Marone, n.d.) This process allows doctors to remove blockages that could potentially cause congestive heart failure and heart attacks. Another type of scan technology has played a major role in developing is the PET scan.

PET stands for positron emission tomography. “PET scans show problems at the cellular level, giving your doctor the best view of complex systemic diseases.” (“Healthline”, 2018). PET scans allow doctors to see things that may be missed with other types of imaging, such as the spread of cancer. This is crucial to the survival of the patient and not putting the patient through unnecessary procedures that will not work. “In one example, the PET/CT scan of a lung cancer patient revealed not only the original tumor on the lung-which a previous CT scan had found-but an additional tumor the CT missed: a small early stage lesion in the neck. Based on the CT alone, the doctor would have recommended surgery, but the additional tumor found by PET/CT indicated that the cancer had spread and was inoperable.” (“What to Expect”, n.d.) These scans not only save patients from unnecessary procedures, such as surgeries, they are extremely fast, no longer use harmful chemicals to produce images, and are not being rushed to dry in order to read them.

Some of the problems seen in the days before current technology are obsolete in todays’ world of imaging. Issues such as dark rooms and chemicals are no longer an issue since images are produced and displayed digitally. Harsh chemicals such as developing agents and fixer agents gave off a harsh smell and were corrosive. This was dangerous not only to the tech that was handling the chemicals but anyone who came into the dark room and inhaled the chemicals. Another issue that has been removed with the age of technology is errors due to wet reads. When a doctor wanted a read on an x-ray immediately, many times they would not wait for the film to dry before looking at it, this was known as a wet read. Since the films were not given the proper time to dry and they were handled while wet, this would sometimes lead to misreading of the films. Now when a doctors needs a STAT, or immediate, image it is available within seconds which could mean the matter of life and death in certain situations.

Technology did not just make our lives easier by making the process faster and more efficient, it also gave us a better understanding of the human body and how it works; more specifically the brain. With the use of new technology, we now have functioning magnetic resonance imaging. (fMRI) “fMRI measures the small changes in blood flow that occur with brain activity.” (Radiological Society of North America, RSNA, & American College of Radiology, “fMRI”, n.d.) “… fMRI looks at blood flow in the brain to detect areas of activity. These changes in blood flow, which are captured on a computer, help doctors understand more about how the brain works.” (Watson, 2018) When studying the brain using fMRI doctors and researchers are able to identify which part of the brain control things such as memory, mood, and pain. This is a huge step forward in the field of medicine as it may one day allow us to know what people are thinking even if they are unable to communicate verbally due to brain damage or other ailments. But, as with anything there are disadvantages to technology as well.

Technology in the field of Radiology certainly does have its disadvantages. One disadvantage is that most Radiology Technologists do not know the proper technique for taking an image. I have seen first-hand many technologists do not know what the proper technique is for routine exams. Since the introduction of digital imaging technologists no longer need to remember this information. As with anything else if the knowledge is not used often it is usually not retained. This can be a huge disadvantage and concern for patient safety. If a technologist, who is supposed to know how to control patient dose by selecting the proper technique, does not know the correct technique and the machine malfunctions the patient can be exposed to substantially more radiation then is needed for the image. Also, if the machine was programmed improperly for some reason the technologist would not know. When doing a routine chest x-ray the machine should be set to “100-110 kVp and 4-8 mAs.” (Murphy, n.d.) If the machine were accidentally programmed to 200 kVp, the patient would be exposed to more radiation than necessary and they imaging would not be usable causing the patient to be exposed again. This would also be the case if the machine were accidentally programmed to 20 kVp. The image would be unusable and need to be repeated. Since most technologists do not know what the kVp for a chest x-ray should be they may feel as if the first exposure was just some fluke mistake and continue to repeat the image before realizing the machine isn’t functioning properly. If the technologist knew the correct kVp they could just manually enter it; however, if they do not a technician would need to be contacted just to change the kVp because the technologist doesn’t know what is wrong with the machine.  In most x-ray machines technologists need only press a button for the body part they want and the size of the patient, for example adult or child, and press the exposure button. Technology has also played a part in technologists not knowing proper positioning.

Proper positioning is the bulk of your instruction when in school to become radiologic technologists; however, it has become lost on many of the newer technologists as technology has made it easier to manipulate an image. Images can be manipulated on a computer screen after it has been exposed. This manipulation allows the image to be rotated in many different ways. It also allows for changes in contrast, lightening and darkening an image. Images can be cropped to exclude things such as unwanted artifacts. X-ray markers can be digitally placed on the image. All of these manipulations make it so the technologist does not have to make sure proper protocols are being followed when administering an exam to a patient. If the image is not an acceptable image when it is exposed, it is likely it can be manipulated into an acceptable image. This may be a great thing in terms of patient exposure since the exposure is not repeated in most cases; however, the proper way of treating patients and doing exams is becoming a lost commodity. Aside from positioning, many technologists do not know how to properly collimate.

“A collimator is a metallic barrier with an aperture in the middle used to reduce the size and shape of the x-ray beam, thereby also reducing the volume of irradiated tissue in the patient. (Miles, D., & Hoos, J., 2011) In radiology, technologists are to collimated in order to give the patient a dose as low as reasonably achievable while maintaining an image that is still acceptable. This process is meant to shield the patient from receiving too much radiation. For example, if you are examining a patient’s elbow you would collimate to just the elbow you would not take an image of the entire arm as it is unnecessary. With the use of technology, a technologist could take an image of the entire arm and just crop the image down to the elbow making it appear as if they followed proper protocol.

Another downfall of technology in radiology is that many technologists do not know if an image is good or not just by looking at it. Digital images are given an S number that is either in the green range (good), the yellow range (satisfactory), or the red range (needs to be repeated). Without this indication many of the technologists would not know if the image they have produced is diagnostically acceptable or not. This is true for Dexa machines as well. The machine will tell you when the patient is not centered and the image is not acceptable. This is an issue because we as technologists should know when a patient is positioned correctly, if the machine is collimated correctly, and if we are using the correct exposure factors. While technology does have its advantages it also has its disadvantages.

While the world of technology is ever changing, it is sometimes difficult to determine if the changes are helpful or harmful. In most instances the changes are both. This is the case in radiology. While we have had many strides forward that have been a huge help we have also had some setbacks. Many of the advantages of technology have such a high benefit that it outweighs the disadvantages. Advantages such as faster processing that can save lives, less exposure for patients which is safer for everyone, and the ability to see things we never would have imagined without this technology. It is amazing how far technology has brought us in regards to making procedures less invasive and making the need for exploratory surgeries almost non-existent. Technology has also allowed us to be cutting edge with the use of machines that can map how the brain works.

While these advantages are no doubt assets, we must not forget at what cost these advantages come to us. We need to be consciences of the disadvantages technology may cause in radiology such as technologists who may not be as competent in proper protocol, the ability to over manipulate images so that it appears a person knows proper positioning, and not using collimation allowing the patient to become over exposed. While this disadvantages are an issue without these advances in technology many more people would become ill and die therefore, in my opinion technology is more helpful than harmful in the field of radiology.

References 

• Allisy-Roberts, P., Williams, J. R., & Farr, R. F. (2008). Farrs physics for medical imaging. Edinburgh: Saunders.
• Bellis, M. (n.d.). How Magnets and Radio Waves Changed Medicine Forever. Retrieved from https://www.thoughtco.com/magnetic-resonance-imaging-mri-1992133
• Brain Aneurysm Statistics and Facts. (n.d.). Retrieved from https://www.bafound.org/about-brain-aneurysms/brain-aneurysm-basics/brain-aneurysm-statistics-and-facts/
• Healthline. (2018). PET Scan: Definition, Purpose, Procedure, and Results. [online] Available at: https://www.healthline.com/health/pet-scan [Accessed 6 Nov. 2018].
• Lam, P. (2018, July 24). MRI Scans: Definition, uses, and procedure. Retrieved October 01, 2018, from https://www.medicalnewstoday.com/articles/146309.php
• Marone, L., Dr. (n.d.). Angiogram. Retrieved from https://vascular.org/patient-resources/vascular-tests/angiogram
• Miles, D., & Hoos, J. (2011, April 01). ALARA, rectangular collimation, and profitable practice growth. Retrieved from https://www.dentaleconomics.com/articles/print/volume-101/issue-4/features/alara-rectangular-collimation-and-profitable-practice-growth.html
• MRI (magnetic resonance imaging). (n.d.). Retrieved from https://mayfieldclinic.com/pe-mri.htm
• Murphy, A. (n.d.). Chest (PA view) | Radiology Reference Article. Retrieved from https://radiopaedia.org/articles/chest-pa-view-1
• Orenstein, B. W. (2008). Ultrasound History. Radiology Today,9(24), 28.
• Radiation sickness. (2018, September 21). Retrieved October 01, 2018, from https://www.mayoclinic.org/diseases-conditions/radiation-sickness/symptoms-causes/syc-20377058
• Radiological Society of North America, RSNA, & American College of Radiology. (n.d.). General Ultrasound. Retrieved October 01, 2018, from https://www.radiologyinfo.org/en/info.cfm?pg=genus
• Radiological Society of North America, RSNA, & American College of Radiology. (n.d.). Magnetic Resonance, Functional (fMRI) – Brain. Retrieved from https://www.radiologyinfo.org/en/info.cfm?pg=fmribrain
• Sansare, K., Khanna, V., & Karjodkar, F. (2011, February). Early Victims of X-rays: A tribute and current perception. Retrieved October 01, 2018, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3520298/
• Sterling, S. (n.d.). Automatic exposure control: A primer. Retrieved October 01, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/3290991
• What to Expect. (n.d.). Retrieved from https://stanfordhealthcare.org/medical-tests/p/pet-ct-scan/what-to-expect.html
• Watson, S. (2018, June 28). How fMRI Works. Retrieved from https://science.howstuffworks.com/fmri.htm