CHAPTER 3
Radiology And Nuclear Medicine
放射学和核医学
1、Introduction
Radiology is the medical specialty concerned with the study and application of x-rays and other technologies (such as ultrasound and magnetic resonance) to produce and interpret images of the human body for the diagnosis of disease. X-rays are invisible waves of energy that are produced by an energy source (such as an x-ray machine or cathode ray tube) and are useful in the diagnosis and treatment of disease. Nuclear medicine is the medical specialty that uses radioactive substances in the diagnosis and treatment of disease. These radioactive substances (radionuclides) are materials that emit high-speed particles and energy-containing rays from the interior of their matter. The emitted particles and rays are called radioactivity and can be of three types: alpha particles, beta particles, and gamma rays. Gamma rays are used effectively as a diagnostic label to trace the path and uptake of chemical substances in the body.
放射学是研究和应用x射线和其他技术(如超声波和磁共振)来做出和解释人体图像,来诊断疾病的医学专业。x射线是由能量源(如x光机或阴极射线管)产生的不可见的能量波,对疾病的诊断和治疗有很大作用。核医学是利用放射性物质进行疾病诊断和治疗的医学专业。这些放射性物质(放射性核素)是从物质内部发射高速粒子和含能射线。发射出粒子和射线的能力称为放射性,放射性物质有三种类型:α粒子,β粒子和γ射线。γ射线被有效地用作一种诊断工具,以追踪化学物质在体内的路径和吸收。
Several characteristics of x-rays are useful to physicians in the diagnosis and treatment of disease.
Some of these characteristics are the following:
x射线的一些特征对医生诊断和治疗疾病是有用的。
其中一些特征如下:
①Ability to cause exposure of a photographic plate. If a photographic plate is placed in front of a beam of x-rays, the x-rays, traveling unimpeded through the air, will expose the silver coating of the plate and cause it to blacken.
使感光平面曝光的能力。如果把感光平面放在一束x射线前,x射线在空气中无阻地传播,就会使感光板的镀银层暴露出来,使其变黑。
②Ability to penetrate different substances to varying degrees. X-rays pass through the different types of substances in the human body (air in the lungs, water in blood vessels and lymph, fat around muscles, and metal such as calcium in bones) with varying ease. Air is the least dense substance and allows the greatest transmission. Fat is denser, water is next, followed by hard materials, such as calcium in bone, which is the densest and transmits least. If the x-rays are absorbed (stopped) by the denser body substance (e.g., calcium in bones), they do not reach the photographic plate held behind the patient, and white areas are left in the x-ray detector (plate).
能在不同程度上穿透不同物质。x光穿透人体不同类型的物质(肺部的空气,血管和淋巴液中的水,肌肉周围的脂肪,骨骼中的钙等金属)的能力各不相同。空气是密度最小的物质,传播力最大。脂肪密度较大,其次是水,其次是硬物质,如骨中的钙,它是密度最大,传递最少的。如果x光被较密集的身体物质(如骨骼中的钙)吸收(停止穿透),它们就不能到达病人身后的感光板,在x光检测器(感光板)上呈现空白区域。
③Invisibility. X-rays cannot be detected by sight, hearing, or touch. Workers exposed to x-rays must wear a film badge to detect and record the amount of radiation to which they have been exposed.
不可见。视觉、听觉和触觉都无法感觉到x射线。暴露在x光下的工作人员必须佩戴一个胶片标记,以检测和记录他们所受到的辐射量。
④Travel in straight lines. This property allows the formation of precise shadow images on the x-ray plate and also permits x-ray beams to be directed accurately at a tissue site during radiotherapy.
走直线。这种特性允许x线形成精确的图像,也允许其在放射治疗期间精确地定向并到达组织部位。
⑤Scattering of x-rays. Scattering occurs when x-rays come into contact with any material. Greater scatter occurs with dense objects and less scatter with those substances that are radiolucent. In digital imaging, an image receptor replaces film.
x射线的散射作用。当x射线与任何物质接触时就会发生散射。密度大的物体会产生较大的散射,而那些有辐射的物质会产生较小的散射。在数字成像技术中,图像接收器代替胶片。
⑥Ionization. X-rays have the ability to ionize substances through which they pass. Ionization is a chemical process in which the energy of an x-ray beam causes rearrangement and disruption within a substance, so that previously neutral particles are changed to charged particles called ions. This strongly ionizing ability of x-rays is a double-edged sword. In x-ray or radiation therapy, the ionizing effect of high energy x-ray beams can help kill cancerous cells and stop tumor growth; however, ionizing x-rays in even small doses can affect normal body cells, leading to tissue damage and malignant changes. Thus, persons exposed to high doses of x-rays are at risk for the development of leukemia, thyroid tumors, breast cancer, or other malignancies.
电离。x射线有使其通过的物质发生电离的能力。电离是一种化学过程,在这个过程中,x射线束的能量会导致物质内部的重排和破坏,使之前的中性粒子变成带电粒子,即离子。x射线的强电离能力是一把双刃剑。在x射线或放射治疗中,高能x射线束的电离效应可以帮助杀死癌细胞和阻止肿瘤生长;然而,即使是小剂量的电离x射线也会影响正常的身体细胞,导致组织损伤和恶性变化。因此,暴露于高剂量x射线下的人有发展为白血病、甲状腺肿瘤、乳腺癌或其他恶性肿瘤的风险。
①X-Ray Studies
X-ray imaging is used in a variety of ways to detect pathologic conditions. Digital radiography is a form of x-ray imaging in which digital x-ray sensors are used instead of traditional photographic film. Thus images can be enhanced and transferred easily, and less radiation can be used than in conventional radiography. The chest x-ray is the most commonly performed diagnostic x-ray examination. Mammography uses low-dose x-rays to visualize breast tissue.
①x射线
x射线成像用于多种方式来检测疾病。数字射线照相是x射线成像的一种形式,用数字x射线传感器代替传统的照相胶片。因此,图像可以容易地被加强或转换,并可以比传统的射线照相使用更少的辐射。胸部x光检查是最常见的诊断性x光检查。乳房x线照相术使用低剂量x射线来可视化乳房组织。
②Computed Tomography (CT)
The CT scan, sometimes called “CAT scan” (because the technique originally was known as “computerized axial tomography”), is made by beaming x-rays at multiple angles through a section of the patient's body. The absorption of all of these x-rays, after they pass through the body, is recorded and used by a computer to create multiple cross-sectional images. The ability of a CT scanner to detect abnormalities is increased with the use of iodine-containing contrast agents, which outline blood vessels and confer additional density to soft tissues.
②计算机断层扫描(CT)
CT扫描,有时也被称为“CAT扫描”(因为这项技术最初被称为“计算机轴向断层扫描”),是将x射线从多个角度射向病人身体的一个部位。所有这些x射线经过人体吸收后的情况会被记录下来,并由计算机生成多个横截面图像。含碘造影剂的使用,增强了CT扫描仪检测异常的能力,这种造影剂能勾勒出血管轮廓,增加软组织的密度。
③Contrast Studies
A contrast material used in diagnostic radiologic studies: Barium Sulfate. Barium sulfate is a radiopaque substance that is mixed in water and used for examination of the upper and lower GI (gastrointestinal) tract. An upper GI series (UGI) involves oral ingestion of barium sulfate so that the esophagus, stomach, and duodenum can be visualized. A barium enema (BE) study is a lower GI series that opacifies the lumen (passageway) of the large intestine using an enema containing barium sulfate. This test has largely been replaced by endoscopy, which allows visualization of the inside of the bowel. A double-contrast study uses both a radiopaque and a radiolucent contrast medium.
用于诊断放射学研究的造影剂——硫酸钡,是一种不溶于水的不透明物质,用于检查上、下消化道。上消化道系列(UGI)包括口服硫酸钡,可以看到食道、胃和十二指肠。钡剂灌肠(BE)是利用含有硫酸钡的灌肠液观察不透明的下消化道——大肠腔。这种检查在很大程度上已经被内窥镜所取代,内窥镜可以让你看到肠道内部。双重对比研究使用了不透明和透明的对比介质。
2、Ultrasound Imaging
Ultrasound imaging, or ultrasonography, uses high-frequency inaudible sound waves that bounce off body tissues and are then recorded to give information about the anatomy of an internal organ. An instrument called a transducer or probe is placed near or on the skin, which is covered with a thin coating of gel to ensure good transmission of sound waves. The transducer emits sound waves in short, repetitive pulses. The ultrasound waves move through body tissues and detect interfaces between tissues of different densities.
超声波成像,或超声检查,使用一种高频的,我们无法听到的声波,声波通过身体组织时被反弹,然后记录,以提供有关内部器官的解剖信息。将换能器或探头放置在皮肤附近或皮肤上,皮肤覆盖一层薄的凝胶,以确保声波能良好地传播。换能器以短而重复的脉冲发出声波。超声波通过人体组织,检测不同密度组织之间的平面。
Ultrasound imaging has several advantages in that the sound waves are not ionizing and do not injure tissues at the energy ranges used for diagnostic purposes. Because water is an excellent conductor of the ultrasound beams, patients are requested to drink large quantities of water before examination so that the urinary bladder will be distended, allowing better viewing of pelvic and abdominal organs. Two ultrasound techniques, Doppler ultrasound and color flow imaging, make it possible to record blood flow velocity (speed).
超声波成像有几个优点,在用于诊断目的的能量范围内,声波不会电离,不会损伤组织。因为水是超声光束的优秀导体,所以在检查前要求患者饮用大量的水,膀胱就会膨胀,以便更好地观察盆腔和腹部器官。两种超声技术——多普勒超声和彩色血流成像,使记录血流速度(速度)成为可能。
3、Magnetic Resonance Imaging
Magnetic resonance imaging (MRI) uses magnetic fields and radio waves rather than x-rays. Because bone is virtually devoid of water, it is not well visualized on MRI. This technique produces sagittal (lateral), frontal (coronal), and axial (cross-sectional) images, as well as images in oblique (slanted) planes.
磁共振成像(MRI)使用磁场和无线电波而不是x射线。通过将人体置于强磁场中,并将其暴露在无线电波中。因为骨骼几乎没有水分,所以在MRI上不能很好地显示。该技术可生成矢状面(侧面)、额面(冠状面)和轴面(水平面)图像,以及斜面(倾斜)图像。
MRI provides excellent soft tissue images, detecting edema in the brain, providing direct imaging of the spinal cord, detecting tumors in the chest and abdomen, and visualizing the cardiovascular system. MRI is contraindicated for patients with pacemakers or metallic implants because the powerful magnet can alter position and functioning of such devices.
MRI提供了优秀的软组织图像、检测脑水肿、提供脊髓的直接成像、检测胸部和腹部的肿瘤,并显示心血管系统。心脏起搏器或有金属植入物患者禁用核磁共振成像,因为强大的磁场可以改变这些设备的位置和功能。
4、Nuclear Medicine Radioactivity And Radionuclides
The spontaneous emission of energy in the form of particles or rays coming from the interior of a substance is called radioactivity. A radionuclide (or radioisotope) is a substance that gives off high-energy particles or rays as it disintegrates. Half-life is the time required for a radioactive substance (radionuclide) to lose half of its radioactivity by disintegration. The half-life must be long enough to allow for diagnostic imaging but as short as possible to minimize patient exposure to radiation.
能量以粒子或射线的形式自发地从物质内部发射出来,这叫做放射性。放射性核素(或放射性同位素)是一种物质,它在分解时会释放出高能粒子或射线。半衰期是指放射性物质(放射性核素)在衰变过程中失去一半放射性所需要的时间。半衰期必须足够长,以允许诊断成像,但尽可能短,以减少病人的辐射暴露。
Radionuclides emit three types of radioactivity: alpha particles, beta particles, and gamma rays. Gamma rays, which have greater penetrating ability than alpha and beta particles, and more ionizing power, are especially useful to physicians in both the diagnosis and the treatment of disease. Technetium-99m (99mTc) is essentially a pure gamma emitter with a half-life of 6 hours. Its properties make it the most frequently used radionuclide in diagnostic imaging. Nuclear medicine studies depict the physiologic behavior (how the organ works) rather than the specific anatomy of an organ.
放射性核素释放出三种放射性:α粒子,β粒子和射线。γ射线比粒子和粒子具有更强的穿透能力和更强的电离能力,在诊断和治疗疾病方面对医生特别有用。锝-99m (99mTc)本质上是一个纯γ发射器,半衰期为6小时。它的特性使其成为诊断成像中最常用的放射性核素。核医学研究描述的是生理行为(器官如何工作),而不是器官的具体解剖结构。
Some diagnostic procedures that use radionuclides include the following:
使用放射性核素的其他诊断程序包括:
①Bone scan. Technetium-99m (Tc-99m) is used to label a phosphate-containing substance, which then is injected intravenously. The scan detects infection, inflammation, or tumors involving the skeleton, which appear as areas of high uptake (“hot spots”) on the scan.
骨扫描。锝-99m (Tc-99m)用于标记含有磷酸盐的物质,然后将其静脉注射。扫描检测到骨骼感染、炎症或肿瘤,这些在扫描中表现为高摄取区域(“热点”)。
②Positron emission tomography (PET or PET scan). This radionuclide technique produces images of the distribution of radioactivity in the body through emission of positrons. It is similar to the CT scan, but radioisotopes are used instead of contrast and x-rays. After intravenous injection, the radionuclides are incorporated into the tissues and an image is made showing where the radionuclide is or is not being metabolized. The most common radionuclide is radiolabeled fluorodeoxyglucose (18F-FDG), but others are in use. Areas of metabolic deficiency can be pinpointed by PET, making it helpful in diagnosing and treating other neurologic disorders such as stroke, epilepsy, and Alzheimer disease. Areas of infection, inflammation, and tumor demonstrate increased metabolic activity, highlighted as hot spots on the PET scan.
正电子发射断层扫描(PET或PET扫描)。这种放射性核素技术通过发射正电子产生人体中放射性分布的图像。它类似于CT扫描,但使用放射性同位素代替造影剂和x射线。在静脉注射后,放射性核素被植入组织中,并形成一幅图像,显示放射性核素在什么地方被代谢或没有被代谢。最常见的放射性核素是放射性标记的氟脱氧葡萄糖(18F-FDG),但也在使用其他放射性核素。PET可以精确定位代谢不足的区域,从而有助于诊断和治疗其他神经系统疾病,如中风、癫痫和阿尔茨海默病。感染、炎症和肿瘤区域显示代谢活动增加,在PET扫描上突出显示为热点。
③PET-CT scan. This scan combines PET and CT techniques to produce a more accurate image than PET or CT alone. It is often used to detect cancer and metastases, especially to determine if the cancer is responding to treatment.
PET-CT扫描。这种扫描结合了PET和CT技术,比单独使用PET或CT产生更准确的图像。它经常被用来检测癌症和转移,特别是确定癌症是否对治疗有反应。
④Single photon emission computed tomography (SPECT). This technique involves an intravenous injection of radioactive tracer (such as Tc-99m) and the computer reconstruction of a 3D image based on a composite of many views. Clinical applications include detecting liver tumors, detecting cardiac ischemia, and evaluating bone disease of the spine.
单光子发射计算机断层扫描(SPECT)。这项技术包括静脉注射放射性示踪剂(如Tc-99m)和基于多种视图合成的计算机重建的三维图像。临床应用包括检测肝肿瘤、心肌缺血、评估脊柱骨病。
⑤Thyroid scan. In a thyroid scan, an iodine radionuclide, usually iodine-123 (I123), is administered orally, and the scan reveals the size, shape, and position of the thyroid gland. Hyperfunctioning thyroid nodules (adenomas) accumulate higher amounts of radioactivity and are termed “hot.” Thyroid carcinoma does not concentrate radioiodine well and is seen as a “cold” spot on the scan. Figure 20-15 shows thyroid scans.
甲状腺扫描。在甲状腺扫描中,口服碘放射性核素,通常为碘-123 (I123),扫描显示甲状腺的大小、形状和位置。功能亢进的甲状腺结节(腺瘤)积累了较高的放射性,被称为“热”。甲状腺癌不能很好地浓缩放射性碘,在扫描上呈现为“冷”。
1、生词
computed tomography (CT) |
计算机断层扫描 |
gamma rays |
γ射线 |
half-life |
半衰期 |
interventional radiology |
介入放射学 |
in vitro |
体外 |
in vivo |
体内 |
ionization |
电离 |
magnetic resonance imaging (MRI) |
磁共振成像 |
nuclear medicine |
核医学 |
positron emission tomography (PET) |
正电子发射断层扫描 |
radioisotope |
放射性同位素 |
radiolabeled compound |
放射性标记的化合物 |
radiology |
放射学 |
radionuclide |
放射性核素 |
radiopaque |
不可透过射线的 |
radiopharmaceutical |
放射性药物的 |
scan |
扫描 |
single photon emission computed tomography (SPECT) |
单电子发射计算机断层扫描 |
tracer studies |
示踪剂研究 |
ultrasonography (US, U/S) |
超声 |
ultrasound transducer |
超声波传感器 |
uptake |
吸收 |
ventilation-perfusion study (V/Q scan) |
气流灌注扫描 |
2、结构和词根词缀
is/o |
same |
pharmaceut/o |
drug |
radio/o |
x-rays |
son/o |
sound |
therapeut/o |
treatment |
vitro/o |
glass |
viv/o |
life |
-gram |
record |
-graphy |
process of recording |
-lucent |
to shine |
-opaque |
obscure |
echo- |
a repeated sound |
ultra- |
beyond |
3、缩写
Angio |
angiography |
AP |
anteroposterior |
BE |
barium enema |
CT |
computed tomography |
CXR |
chest x-ray |
Decub |
decubitus-lying down |
DICOM |
digital image communication in medicine——standard protocol for storage and transmission of images between imaging and devices |
DI |
diagnostic imaging |
DSA |
digital subtraction angiography |
ECHO |
echocardiography |
EUD |
endoscopic ultrasonography |
IVP |
intravenous pyelogram |
KUB |
kidneys-ureters-bladder (series) |
LAT |
lateral |
LS film |
lumbosacral films |
MDCT |
multidetector CT scanner |
MR, MRI |
magnetic resonance, magnetic resonance imaging |
MRA |
magnetic resonance angiography |
MRV |
magnetic resonance venography |
PA |
posteroanterior |
PET |
positron emission tomography |
PET-CT |
positron emission tomography-computed tomography |
SPECT |
single photon emission computed tomography |
往期回顾:
【医学英语】Digestive System 消化系统
【医学英语】Urinary System 泌尿系统
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