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Shoulder 3 : Beyond the Rotator Cuff

Bone Disease Around the Shoulder Bony Irregularity in the Humeral Head Many bony abnormalities will be encountered whilst performing rotator cuff ultrasound. Some of these are common traumatic lesions, including fractures of the greater tuberosity and Hill–Sachs lesions, others are less well understood. The location of the lesion on the humeral head can sometimes be a clue to the underlying cause. A bone defect in the…

Shoulder 2: The SASD Bursa, Rotator Interval and Other Rotator Cuff Tendons

Subacromial Subdeltoid Bursitis Anatomy and Clinical The subacromial subdeltoid (SASD) bursa is one of the largest bursae in the body and plays an important role in patients with subacromial impingement. It is likely that much of the discomfort felt during arm abduction in patients with this clinical problem is due to inflammation within the bursa. Arm abduction, particularly between 30 and 60°, typically reproduces pain that…

Shoulder 1: Supraspinatus Tendon

Introduction Shoulder pain is one of the commonest orthopaedic presentations in the general population and subacromial impingement is a common underlying cause. The glenohumeral joint is an intrinsically unstable joint and the tendons of the rotator cuff play an important role in stabilizing it ( Fig. 2.1 ). The supraspinatus tendon (SST), the most important component of the rotator cuff, lies along the superior aspect of…

Shoulder: Anatomy and Techniques

Overview The important bony landmarks in the evaluation of the supraspinatus tendon are the humeral head, the coracoid, the clavicle and acromium, joined at the acromioclavicular joint. The glenohumeral joint is an inherently unstable joint and depends on the surrounding soft tissues for stabilization. Soft tissue stabilizers are divided into intrinsic and extrinsic. The most important extrinsic soft tissues are the supraspinatus tendon superiorly, infraspinatus posteriorly…

The Fourier Transform

Fourier transforms (FTs) play an important role in tomographic reconstruction (see Chapter 16 ) and in computer implementation of convolutions (see Appendix G ). As well, they are the basis for the modulation transfer function (MTF), one of the methods for evaluating spatial resolution of imaging systems (see Chapter 15 ) and many other methods for image analysis and image processing. This appendix is intended to…

Radiation Safety and Health Physics

Chapter 22 dealt with the radiation dose received by patients undergoing nuclear medicine procedures. This chapter deals primarily with the exposure of personnel who work in nuclear medicine clinics and research laboratories and who are exposed to radiation in their normal working environment. Stored radioactive materials, handling of calibration sources, preparation of radioactive materials for patients and phantoms, and proximity to patients or phantoms to whom…

Internal Radiation Dosimetry

Absorption of energy from ionizing radiation can cause damage to living tissues. This is used to advantage in radionuclide therapy, but it is a limitation for diagnostic applications because it is a potential hazard for the patient. In either case, it is necessary to analyze the energy distribution in body tissues quantitatively to ensure an accurate therapeutic prescription or to assess potential risks. The study of…

Tracer Kinetic Modeling

The spatial distribution of a radiotracer in the body is time varying and depends on a number of components such as tracer delivery and extraction from the vasculature, binding to cell surface receptors, diffusion or transport into cells, metabolism, washout from the tissue, and excretion from the body. Thus the temporal component often is very important in nuclear medicine studies, and the timing of the imaging…

Digital Image Processing in Nuclear Medicine

Image processing refers to a variety of techniques that are used to maximize the information yield from a picture. In nuclear medicine, computer-based image-processing techniques are especially flexible and powerful. In addition to performing basic image manipulations for edge sharpening, contrast enhancement, and so forth, computer-based techniques have a variety of other uses that are essential for modern nuclear medicine. Examples are the processing of raw…

Hybrid Imaging: SPECT/CT and PET/CT

Virtually all modern positron emission tomography (PET) scanners and an increasing number of single photon emission computed tomography (SPECT) systems are integrated with an x-ray computed tomography (CT) scanner. These hybrid imaging systems are capable of acquiring PET or SPECT images, along with spatially registered CT images, in quick succession. This chapter discusses the features of these hybrid systems and describes how the CT scans not…

Tomographic Reconstruction in Nuclear Medicine

A basic problem in conventional radionuclide imaging is that the images obtained are two-dimensional (2-D) projections of three-dimensional (3-D) source distributions. Images of structures at one depth in the patient thus are obscured by superimposed images of overlying and underlying structures. One solution is to obtain projection images from different angles around the body (e.g., posterior, anterior, lateral, and oblique views). The person interpreting the images…

Image Quality in Nuclear Medicine

Image quality refers to the faithfulness with which an image represents the imaged object. The quality of nuclear medicine images is limited by several factors. Some of these factors, relating to performance limitations of the gamma camera, already have been discussed in Chapter 14 . In this chapter, we discuss the essential elements of image quality in nuclear medicine and how it is measured and characterized.…

The Gamma Camera: Performance Characteristics

The performance of a gamma camera system is defined by the sharpness and detail of the images it produces, the efficiency with which it detects incident radiation, its ability to measure the energy of the incident γ rays (to minimize scatter), and the counting rate it can handle without significant dead time losses. A gamma camera is not capable of producing “perfect” images of the radionuclide…

The Gamma Camera: Basic Principles

Radionuclide imaging is the most important application of radioactivity in nuclear medicine. Radionuclide imaging laboratories are found in almost every hospital, performing hundreds and even thousands of imaging procedures per month in larger institutions. In this chapter, we discuss briefly some general aspects of radionuclide imaging, and we describe the basic principles of the most widely used imaging device, the gamma camera, also known as the…