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© Endeavour College of Natural Health endeavour.edu.au 1
HMCL223Clinical Diagnostic Techniques
Session 9:
Electro Diagnostic
Testing, Imaging
© Endeavour College of Natural Health endeavour.edu.au 2
Session ObjectivesElectro Diagnostic Tests
o Electrocardiograph
o Holter monitor
o Electroencephalograph
o Electromyograph
Imaging
o X-ray studies: X-ray, CT Scans, DEXA
o Ultrasound studies: Ultrasound
o Magnetic Resonance Imaging (MRI)
o Nuclear Scanning: Radionucleotide testing - PET scan
o Clinical Digital Thermography
© Endeavour College of Natural Health endeavour.edu.au 3
Electro Diagnostic Tests
o The use of electrical activity with in the body can be used
to evaluate disease or injury.
o This electrical activity can be endogenous
(electrocardiograph mapping the electrical activity of the
heart) or exogenous (electromyography a shock is
applied to the body and the body’s electrical impulses
are mapped).
(Pagana & Pagana, 2014, p. 536)
© Endeavour College of Natural Health endeavour.edu.au 4
Peripheral Nervous System
(Nucleus medical media, 2015, Peripheral nervous system, viewed 08/09/2015
<http://ebsco.smartimagebase.com.ezproxy.endeavour.edu.au/peripheral-nervous-
system/download?ItemID=73695>)
© Endeavour College of Natural Health endeavour.edu.au 5
Electrocardiograph (ECG)
© Endeavour College of Natural Health endeavour.edu.au 6
Atrial Fibrillation
(Nucleus medical media, 2015, Atrial fibrillation – medical animation ANH11047, viewed
7/09/2015 http://ebsco.smartimagebase.com.ezproxy.endeavour.edu.au/atrial-
fibrillation/view-item?ItemID=72535)
© Endeavour College of Natural Health endeavour.edu.au 7
Electrocardiograph (ECG)
Electrocardiograph (ECG)
o Electrodes attached to the skin measure electrical
impulses from the conduction system of the heart.
o Generates a graphical representation of cardiac
contraction (depolarization), recovery (repolarization)
and rest period (asystole).
o Used to determine electrical and structural changes to
the heart.
(Labtestsonline, 2012; Pagana & Pagana, 2014, p. 544)
© Endeavour College of Natural Health endeavour.edu.au 8
ECG
Electrodes are attached
at two main points:
o Limbs: electrode
attached to each arm
& leg
o Chest: 6 electrodes
extending form the
fourth intercostal
space (RHS sternum)
to the LHS mid-
axillary line.
Source: www.medlineplus.gov
© Endeavour College of Natural Health endeavour.edu.au 9
Electrocardiograph (ECG)
ECG tracing denotes a complete cardiac cycle:
P wave depolarisation of the atria
QRS
complex
depolarization of the
ventricles
T wave repolarization of the
ventricles
U wave refractory period
following ventricular
repolarization
(Nuclear medical media, 2015, ECG / EKG strip components – medical illustration, viewed 7/09/2015
http://ebsco.smartimagebase.com.ezproxy.endeavour.edu.au/ekg-ecg-strip-components-qrs-complex/view-
item?ItemID=8281)
© Endeavour College of Natural Health endeavour.edu.au 10
Electrocardiograph (ECG)
o The P to R interval: time
it takes for the electrical
impulse to travel from the
SA node to the ventricles.
o The Q to T interval: time
it takes for the ventricles
to depolarize (contract)
and then repolarize (relax)
o The QRS duration: total
time of ventricle
contraction
(Pagana & Pagana, 2014, p. 546)
Source: http://www.merckmanuals.com/home/sec03/ch021/ch021c.html
© Endeavour College of Natural Health endeavour.edu.au 11
ECG
ECG information aids the
assessment of:
o Functional capability of
heart muscle
o Damage to the heart
muscle
o Major arrhythmia’s
o Presence of valve
dysfunction
Requires specialist
interpretation by a cardiologist
Source: http://www.merckmanuals.com/home/sec03/ch021/ch021c.html
© Endeavour College of Natural Health endeavour.edu.au 12
Electrocardiograph (ECG)
o Normal ECG:
o Cardiac Ischaemia:
(Nucleus medical media, 2014, EKG revealing cardiac ischaemia, viewed 7/09/2015
<http://ebsco.smartimagebase.com.ezproxy.endeavour.edu.au/ekgs-revealing-cardiac-
ischemia/view-item?ItemID=863>)
© Endeavour College of Natural Health endeavour.edu.au 13
Electrocardiograph (ECG)
Normal ECG:
Atrial Fibrillation:
(Nucleus medical media, 2014, Atrial fibrillation, viewed 7/09/2015
<http://ebsco.smartimagebase.com.ezproxy.endeavour.edu.au/external-cardioversion/view-
item?ItemID=10364>)
© Endeavour College of Natural Health endeavour.edu.au 14
ECG: Interpreting the Results
Common causes of changes are:
o CNS disease (i.e. subarachnoid haemorrhage, stroke,
trauma), Coronary heart disease (some post MI
patients), Myocardial ischemia (infarct or angina)
o Hereditary Long QT Syndrome
o Ectopic beats or accessory pathways causing arrhythmia
o Subacute or chronic pericarditis
o Myocarditis and myocardial contusion
o Cardiomyopathy or ventricular hypertrophy
o Valve prolapse
© Endeavour College of Natural Health endeavour.edu.au 15
ECG: Interfering FactorsInterfering Factors:
o Electrode placement or attachment issues
o Movement or muscle tremors through the test
o Drugs: anti-arrhythmics, tricyclics, phenothiazine, digoxin
effect (cardiac glycoside from foxglove)
Electrolyte Abnormalities ECG Abnormalities
Increased calcium Prolonged PR interval
Shortened QT interval
Decreased calcium Prolonged QT interval
Increased potassium Narrowed, elevated T waves
AV conduction changes
Widened QRS complex
Decreased potassium Prolonged U wave
Prolonged QT interval
(Pagana & Pagana, 2014, Table 3.2, p. 549)
© Endeavour College of Natural Health endeavour.edu.au 16
ECG: Referral
Symptoms that may warrant
referral for ECG:
o Chest paino Shortness of breath (on
exertion or at rest)o Fatigue (particularly on
exertion)o Tiredness (even at rest)o Palpitationso Peripheral oedema (i.e.
ankle swelling) or pulmonary oedema
o Dizzinesso Postural hypertension
(nuclear medical media, 2015, Heart attack symptoms, viewed 7/09/2015
http://ebsco.smartimagebase.com.ezproxy.endeavour.edu.au/heart-attack-symptoms/view-
item?ItemID=3770)
© Endeavour College of Natural Health endeavour.edu.au 17
Exercise Stress Test
© Endeavour College of Natural Health endeavour.edu.au 18
Stress Test
Assessment of cardiac function
o Measuring ECG and blood pressure while the heart is under stress can identify the risk of cardiac ischaemia.
Exercise Stress Test
o The patient exercises (treadmill or stationary bike) and the ECG & blood pressure are recorded.
Chemical Stress Test
o Administration of a drug (e.g. dobutamine) that increases heart function or that dilates the heart vessels (e.g. dipyridamole) while the ECG & blood pressure are recorded. Considered safer and more accurate than the exercise stress test.
(Pagana & Pagana, p. 540-1)
© Endeavour College of Natural Health endeavour.edu.au 19
Exercise Stress Test
(Medical expo, 2015, Cardiac stress test equipment viewed 7/09/2015
<http://www.medicalexpo.com/prod/neurosoft/product-69506-454324.html>)
© Endeavour College of Natural Health endeavour.edu.au 20
Electroencephalograph (EEG)
© Endeavour College of Natural Health endeavour.edu.au 21
Electroencephalograph (EEG)
o Electrodes (applied to the scalp) detect & record
electrical impulses. Results are graphed & classified
according to frequency, amplitude, shape & position.
(Nucleus medical material, 2014, EEG – medical illustration, viewed 7/09/2015
http://ebsco.smartimagebase.com.ezproxy.endeavour.edu.au/eeg/view-item?ItemID=20180)
© Endeavour College of Natural Health endeavour.edu.au 22
Brain Anatomy & Functional Areas
Language,
comprehension
Vision
Speech
Voluntary motor function
HearingCo-ordination
Association
(Jkwchui, 2013, Cerebrum lobes, viewed 8/09/2015
<https://upload.wikimedia.org/wikipedia/commons/thumb/d/d8/Cerebrum_lobes.svg/640px-
Cerebrum_lobes.svg.png>)
Adapted from Nucleus medical media, 2014, Brain anatomy & functional areas, viewed 08/09/2015
http://ebsco.smartimagebase.com.ezproxy.endeavour.edu.au/brain-anatomy-and-functional-areas/view-
item?ItemID=14614)
© Endeavour College of Natural Health endeavour.edu.au 23
Electroencephalograph (EEG)
Waveform Description Wave Pattern
Delta (∆) (up to 4 Hz)
Highest amplitude &
slowest wave.
Adults: indicates slow
wave sleep. Babies:
common
Theta (ᶱ)
(4-7 Hz)
Slow: drowsiness &
meditation. Common:
young children.
Increasing age:
abnormal with
increased presence
Mu (μ)
(8-13 Hz )
Partly overlaps with
other frequencies.
Synchronous firing of
motor neurons in rest
state.
© Endeavour College of Natural Health endeavour.edu.au 24
Electroencephalograph (EEG)Waveform Description Wave Pattern
Alpha
(8-12Hz)
Posterior &
non-
dominant
side
Occurs: relaxation,
eyes closed.
Disappears: opening
the eyes, stress &
mental exertion.
Beta (β)
(12–30Hz)
Anterior /
frontal &
both sides
Occurs: motor
behaviour.
Disappears: active
movements.
Drugs: generate
benzodiazapines &
barbituarates
Gamma (γ) (30-100 Hz)
Binding of different
populations of neurons
together into a network
(neuroplasticity) for
certain cognitive or
motor function.
© Endeavour College of Natural Health endeavour.edu.au 25
Electroencephalograph (EEG)
Clinically used to assess:
o Clients presenting with seizures
o Pathological conditions involving the brain cortex (such
as tumours, infarction)
o Extent of trauma & drug intoxication
o Monitor cervical blood flow in surgery
o Identification of brain death
o Adjunctive measure in the exploration of sleep pathology
(Pagana & Pagana, 2014, p. 549-60)
© Endeavour College of Natural Health endeavour.edu.au 26
EEG: Interfering Factors
Abstain prior to test:
o No fasting prior to test, hypoglycaemia affects brain activity
o Avoiding stimulants (caffeine, energy drinks) or sedative
medication
During the test:
o Bright or flashing lights can alter the test
o Body or eye movements during the test can alter the brain
wave patterns (not required in sleep studies)
o Sleep study: the patient may need to adjust their sleep time
in preparation for the study
(Pagana & Pagana, 2014, p. 550-1)
© Endeavour College of Natural Health endeavour.edu.au 27
Electromyograph (EMG)
© Endeavour College of Natural Health endeavour.edu.au 28
Electromyograph (EMG)
Electromyograph:
o Assesses muscle & motor neuron health.
o Indicates: nerve dysfunction, muscle dysfunction or
transmission issues.
o Indicates: primary muscular disorders or abnormalities
caused by other system diseases ( e.g. nerve
dysfunction, sarcoidosis, paraneoplastic syndrome).
o Spontaneous muscle movement (eg. fibrillation &
fasciculation) may indicate injury or disease of the nerve
innervating that muscle or spastic myotonic muscle
disease. (Pagana & Pagana, 2014, p. 554;
Mayo Foundation, 2015)
© Endeavour College of Natural Health endeavour.edu.au 29
Electromyograph (EMG)
Test:
o Recording electrodes are inserted
into skeletal muscle to monitor
the electrical activity of the
muscle.
o This can be graphed & sound
added (audio electrical amplifier)
so that electrical potential can be
compared & analyses
simultaneously.
(Pagana & Pagana, 2014, p. 554)
(Source: www.medlineplus.gov)
© Endeavour College of Natural Health endeavour.edu.au 30
(Nucleus medical media, 2012, Nerve conduction studies with abnormal findings, viewed 8/09/2015
<http://ebsco.smartimagebase.com.ezproxy.endeavour.edu.au/nerve-conduction-studies-with-
abnormal-findings/view-item?ItemID=63102>)
© Endeavour College of Natural Health endeavour.edu.au 31
EMG: Interfering Factors
Interfering factors that alter the transmission of electrical
waves to the electrodes include:
o Oedema
o Haemorrhage
o Thick subcutaneous fat
o Patients with excessive pain
(Pagana & Pagana, 2014, p. 555)
© Endeavour College of Natural Health endeavour.edu.au 32
Holter Monitor
© Endeavour College of Natural Health endeavour.edu.au 33
Holter Monitor
Holter Monitor:
o Portable machine that continuously records the heart's
rhythms (a portable ECG). The monitor is usually worn
for 24 - 48 hours during normal activity (including sleep).
o The monitor constantly measures the heart's electrical
activity and records a single continuous lead as a
reference. A change to the heart rhythm it will
automatically record a more detailed tracing.
(Pagana & Pagana, 2014, p. 571; U.S National Library of
Medicine, 2015)
© Endeavour College of Natural Health endeavour.edu.au 34
Holter Monitor
o Electrodes (2 to 4) are attached to the chest.
o The battery operated Holter monitor is then worn in a
pocket or small pouch worn around the neck or waist.
Source: www.medlineplus.gov
© Endeavour College of Natural Health endeavour.edu.au 35
Holter Monitor
o The heart rate varies during various activities, however,
the heart should remain in sinus rhythm and not develop
any arrhythmia. Holter monitoring is used to determine
how the heart responds to normal activity.
o Holter monitoring is requested when:
o Post heart attack or other heart event
o To diagnose heart rhythm problems
o When starting a new heart medication
(Pagana & Pagana, 2014, p. 571)
© Endeavour College of Natural Health endeavour.edu.au 36
Holter Monitor
Results may be useful in identifying:
o Atrial fibrillation/flutter
o Multifocal atrial tachycardia
o Palpitations
o Paroxysmal supraventricular tachycardia
o Reasons for dizzyness or fainting
o Slow heart rate (bradycardia)
o Ventricular tachycardia
(Pagana & Pagana, 2014, p. 573)
© Endeavour College of Natural Health endeavour.edu.au 37
Imaging
© Endeavour College of Natural Health endeavour.edu.au 38
Imaging
Used to investigate the internal structures that are
suspected of being involved in a disease process.
Aim:
o Creating images of what is inside the body
o Derive clinically useful information from living organisms
by an imaging modality
o Confirmation of a diagnosis to direct clinical interventions
o Monitoring the effect of clinical interventions and
treatments
o Newer techniques facilitate our understanding of normal
and abnormal physiology (e.g. Functional MRI)
© Endeavour College of Natural Health endeavour.edu.au 39
X-Ray
© Endeavour College of Natural Health endeavour.edu.au 40
X-Ray
X-Ray:
o Single burst of x-rays which
penetrate the tissues to
varying degrees, depending
on density, to produce a 2D
film, known as a radiograph (x-
ray). May also use contrast.
o Lighter areas are dense (e.g.
bone) & dark areas are soft
tissue, fluids or gases.
(O’Sullivan & Goergen, 2009; Pagana &
Pagana, 2014, p. 982)(Upfal J & O’Callaghan, 2001)
© Endeavour College of Natural Health endeavour.edu.au 41
X-Ray
o Useful in the detection of pathology of the skeletal system. Also detecting some disease processes in soft tissue including:
• Chest: identify lung diseases eg. pneumonia, lung cancer or pulmonary oedema
• Abdomen: detect ileus (blockage of the intestine), free air (from visceral perforations) and free fluid (in ascites).
o In some cases, the use of X-rays is debatable, such as:
• Gallstones (rarely radiopaque)
• Kidney stones (often visible, but not always)
(Pagana & Pagana, 2014, p. 982)
© Endeavour College of Natural Health endeavour.edu.au 42
X-Ray: Limitations
Limitations:
o Skewed 2D image of a 3D structure
o Requires specialist interpretation
o Structures can be masked by other structures
o Cannot view soft tissue damage unless a large mass is
present with little use in the imaging of soft tissues such
as the brain or muscle.
o Radiation hazards (not used in pregnancy) and potential
overuse
(Pagana & Pagana, 2014, p. 985-7)
© Endeavour College of Natural Health endeavour.edu.au 43
X-Ray Images
Bone tumour (enchondroma) in distal femur (Upfal & O’Callaghan, 2001)
Image A: normal chest Image B: pneumonia
(Upfal & O’Callaghan, 2001)
© Endeavour College of Natural Health endeavour.edu.au 44
X-Ray Images
Congestive Heart Failure (Upfal & O’Callaghan, 2001)Eosinophilic oesophagitis (Upfal & O’Callaghan, 2001)
© Endeavour College of Natural Health endeavour.edu.au 45
X-Ray Images
Star Shaped Bladder Urolith (Upfal & O’Callaghan, 2001)
Small bowel obstruction with multiple pockets of air
(Upfal & O’Callaghan, 2001)
© Endeavour College of Natural Health endeavour.edu.au 46
X-Ray Images
(Nucleus medical media, 2015, Progression of breast mass, viewed 17/09/2015
http://ebsco.smartimagebase.com.ezproxy.endeavour.edu.au/progression-of-breast-
mass/download?ItemID=830)
© Endeavour College of Natural Health endeavour.edu.au 47
X-Ray Images
Nucleus medical media, 2015, Mammograpy, viewed 20/09/2015
<http://ebsco.smartimagebase.com.ezproxy.endeavour.edu.au/mammography/view-
item?ItemID=65448>)
© Endeavour College of Natural Health endeavour.edu.au 48
Computed Tomography (CT)
© Endeavour College of Natural Health endeavour.edu.au 49
Computed Tomography (CT)
(Nucleus medical media, 2015, CT scan, viewed 17/09/2015
http://ebsco.smartimagebase.com.ezproxy.endeavour.edu.au/ct-scan/view-
item?ItemID=74923)
© Endeavour College of Natural Health endeavour.edu.au 50
Computed Tomography (CT)
Computed Tomography (CT)
o Creates a 3D cross-sectional view of body structures
from many x-rays taken at multiple angles around 360o
o Different densities of tissues are computed as various
shades of grey and displayed as a composite image.
o Unlike conventional x-ray films which can only produce a
limited 2D aspect, CTs are able to give greater detail at a
higher resolution, including better imaging of soft tissues
o The image can be further enhanced by using radiopaque
contrast, although often this may not be necessary
(McKenzie & Goergen, 2009; Pagana & Pagana, 2014, p. 1020)
© Endeavour College of Natural Health endeavour.edu.au 51
CT: Limitations
Computed Tomography (CT) Limitations:
o Cost and availability (~$200-500 per process)
o Still potential to miss areas
o Accuracy varies when viewing small structures
o Radiation hazards
o Cannot use in pregnancy
(Pagana & Pagana, 2014, p. 1022)
© Endeavour College of Natural Health endeavour.edu.au 52
CT:
Images
(Nucleus medical media, 2015, Progression of lung cancer, viewed 17/09/2015
http://ebsco.smartimagebase.com.ezproxy.endeavour.edu.au/progression-of-lung-cancer/view-
item?ItemID=3544)
Image:
Progression of
Metastatic Lung Cancer
(axial cross section).
© Endeavour College of Natural Health endeavour.edu.au 53
CT:
Images
(Nucleaus medical media, 2015, CT guided percutaneous drainage of
pelvic abscess, viewed
20/09/2015<http://ebsco.smartimagebase.com.ezproxy.endeavour.edu.
au/ct-guided-percutaneous-drainage-of-pelvic-abscess/view-
item?ItemID=18144>)
© Endeavour College of Natural Health endeavour.edu.au 54
Dual-Energy X-ray
Absorptiometry (DEXA)
© Endeavour College of Natural Health endeavour.edu.au 55
Dual-Energy X-ray Absorptiometry
(DEXA)
Dual-Energy X-ray Absorptiometry
o Determines bone mineral content & density to diagnose
osteoporosis or assess treatment.
o Bone mineral assessment at early stages in osteoporotic
disease have far better clinical outcomes if treatment
begins early.
o Test has double the x-ray energies to provide greater
soft tissue penetration and subsequent image clarity
(spine, hip including femoral neck).
(Hendrich, 2013; Pagana & Pagana, 2014, p. 1003)
© Endeavour College of Natural Health endeavour.edu.au 56
Dual-Energy X-ray Absorptiometry
(DEXA)
Dual-Energy X-ray Absorptiometry (DEXA) Interfering
Factors:
o Barium (contrast agent used in other imaging studies) &
radionuclide (radioactive positively charged ions used in
PET scans) may falsely increase the density of the
lumbar spine. Separate by 10 days.
o Surgically implanted screws, metal clips or overlying
jewellery will alter the images produced.
(Pagana & Pagana, 2014, p. 1004)
© Endeavour College of Natural Health endeavour.edu.au 57
DEXA: Images
(Smith, N, 2011, DEXA scanner in use ALSPAC.jpg, viewed 20/09/2015
<https://en.wikipedia.org/wiki/Dual-energy_X-
ray_absorptiometry#/media/File:DEXA_scanner_in_use_ALSPAC.jpg>)
© Endeavour College of Natural Health endeavour.edu.au 58
DEXA:
Images
(Maher K, 2006, Dual Energy Image Demo.jpg
viewd 20/09/2015
<https://commons.wikimedia.org/wiki/File:DualE
nergyImageDemo.jpg)
© Endeavour College of Natural Health endeavour.edu.au 59
DEXA: Images
(Lebreton, C, 2010, Morbus Fabry DXA 01.jpg, viewed 20/09/2015
<https://commons.wikimedia.org/wiki/File:Morbus_Fabry_DXA_01.jpg.
© Endeavour College of Natural Health endeavour.edu.au 60
Ultrasound
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Ultrasound
Ultrasound:
o Uses ultrasonic (high-frequency) sound waves to
determine the density of the underlying structures based
on the degree with which the sound is reflected back.
o This echo is then detected by the ultrasound machine
and converted into a real-time moving image, from which
still images can be captured.
o The image produced on the screen is similar to the
image of an x-ray.
(Coombs & Goergen, 2009; Pagana & Pagana, 2014, p.
861)
© Endeavour College of Natural Health endeavour.edu.au 62
Ultrasound
o Doppler ultrasound is generally used to image blood flow
through blood vessels or the heart. It is similar to the
standard ultrasound, except that the image is formed by
analysing the change in the sound wave frequency,
which is caused by the moving red blood cells.
o The faster the blood is moving, the more distortion there
is to the frequency wave, the slower the blood flow, the
less distortion. The difference in frequency is displayed
in the image as different colours, or can be converted
into sound (e.g. fetal heart rate, echocardiography)
(Pagana & Pagana, 2014, p. 863)
© Endeavour College of Natural Health endeavour.edu.au 63
Ultrasound
Uses:
o Assess size, structure & position of body organs, blood
flow in arteries & veins
o Assess functional movements in real time
o Foetal visualisation for early health checks & position
o Detection (cysts, tumours, calculi)
o Treatment assessment
o Support medical procedures
(Pagana & Pagana, 2014, p. 861-2)
© Endeavour College of Natural Health endeavour.edu.au 64
Ultrasound
Advantages Disadvantages
Non invasive (except trans-vaginal,
per rectal, trans-oesophageal and per
rectal) and painless
Resolution difficult to maintain
Requires no Ionizing radiation or use
of contrast
Specialist interpretation
Repeated studies may be performed
and multiple images obtained with no
risk
May miss entire structures as they can
be masked by another structure
Less expensive that CT or MRI Suggested there may be side effects
in using ultrasound, however there is
insufficient evidence to support this
Can be performed at an office/lab/at
the bedside
(Pagana & Pagana, 2014, p. 865-6)
© Endeavour College of Natural Health endeavour.edu.au 65
Ultrasound
(Nucleus medical media, 2015, Fetal ultrasound – medical animation, viewed 16/09/2015
<http://ebsco.smartimagebase.com.ezproxy.endeavour.edu.au/fetal-
ultrasound/download?ItemID=68388>)
© Endeavour College of Natural Health endeavour.edu.au 66
Ultrasound: Images
Sonogram of 14 week old foetus (Upfal & O’Callaghan, 2001)
Ovary: PCOS (Upfal & O’Callaghan, 2001)
© Endeavour College of Natural Health endeavour.edu.au 67
Ultrasound: Images
© Endeavour College of Natural Health endeavour.edu.au 68
Magnetic Resonance Imaging
(MRI)
© Endeavour College of Natural Health endeavour.edu.au 69
Magnetic Resonance Imaging
(MRI)
Magnetic Resonance Imaging (MRI)
o Body is placed in high-level electro-magnetic field. All body
tissue has H atoms & these H protons align parallel to this
field.
o At the point of required imaging, a pulse of radio waves is
sent through the body generating excitation in the hydrogen
protons.
o This is then converted into a calculation of pre, post to pre
excited state. This time is measured, analysed &
constructed into detailed images.
(McIntyre & Goergen, 2013; Pagana & Pagana, 2014, p.
1107)
© Endeavour College of Natural Health endeavour.edu.au 70
Magnetic Resonance Imaging
(MRI)
Magnetic Resonance Imaging (MRI) Uses:
o H atoms in all tissue: very fine detail of solid structures and
& soft tissues
o More imaging power than a CT scan with 10-20 times
better resolution for detail & hence more reliable (high
resolution)
o Detects tumors (even small), nerve pathways (including
MS), blood flow (including aneurysm and tissue changes
due to hypoxia)
o In cancer treatment, ongoing imaging can be performed
without the use of contrast dyes or x-rays
(Pagana & Pagana, 2014, p. 1107)
© Endeavour College of Natural Health endeavour.edu.au 71
MRI: Limitations
Magnetic Resonance Imaging (MRI) Limitations:
o No metal objects (powerful magnetic field): no
pacemakers, prostheses, plates, screw etc.
o Obese clients (130kg+) may exceed the safe working
capacity of the machine
o Very expensive (~$2000-5000 per exam)
o Movement during MRI causes significant distortion of
images: clients in pain, confused, agitated,
claustrophobic
(Pagana & Pagana, 2014, p. 1110-1111)
© Endeavour College of Natural Health endeavour.edu.au 72
MRI: Images
(Nucleus medical media, 2014, Cervical spine MRI, viewed 17/09/2015
http://ebsco.smartimagebase.com.ezproxy.endeavour.edu.au/cervical-spine-mri/download-
one?id=4230&mt=tmp&decIDs=31870#content)
© Endeavour College of Natural Health endeavour.edu.au 73
MRI: Images
(Nucleus medical media, 2015, Brain injuries, viewed 17/09/2015
http://ebsco.smartimagebase.com.ezproxy.endeavour.edu.au/brain-injuries/view-
item?ItemID=16730)
© Endeavour College of Natural Health endeavour.edu.au 74
MRI: Images
(Nucleus medical media, 2015, Brain injuries, viewed 17/09/2015
http://ebsco.smartimagebase.com.ezproxy.endeavour.edu.au/brain-injuries/view-
item?ItemID=16730)
© Endeavour College of Natural Health endeavour.edu.au 75
CT Scans & MRI
(Nucleus medical media, 2014, Muscular inflammation & infection, viewed 17/09/2015
http://ebsco.smartimagebase.com.ezproxy.endeavour.edu.au/muscular-inflammation-and-
infection/view-item?ItemID=79283)
© Endeavour College of Natural Health endeavour.edu.au 76
Nuclear Scanning:
Radionucleotide Testing
© Endeavour College of Natural Health endeavour.edu.au 77
Nuclear Scanning: Radionucleotide
Testing
Positron Emission Tomography (PET Scan)
o A radio active substance that emits positively charged
particles called positrons, is injected into the body
o The collision of these with negatively charged electrons in
body tissues releases gamma radiation, similar to
x-rays
o Sensors positioned around the patient detects this gamma
radiation for a computer generated image on a colour
monitor
o Used widely in Neurology, Cardiology and Oncology
(Gunn, 2008, p. 304; Hofman & Nandurkur, 2009; Pagana &
Pagana, 2014, p. 821)
© Endeavour College of Natural Health endeavour.edu.au 78
Nuclear Scanning: Radionucleotide
Testing
Positron Emission Tomography (PET Scan) Uses:
o Provide information on function & structure.
o Detect metabolic changes in healthy & diseased organs
(i.e. heart, brain). This indicates blood flow & glucose
metabolism.
o Combined with CT or MRI imaging to produce an
anatomically accurate image of physiology / metabolism
of the organ or area being explored.
(Pagana & Pagana, 2014, p. 822, 827)
© Endeavour College of Natural Health endeavour.edu.au 79
Nuclear Scanning: Radionucleotide
Testing
Positron Emission Tomography (PET Scan) Interfering
Factors:
o Caffeine, alcohol &/ or tobacco intake in the previous 24
hours can affect results.
o Recent anxiety, exercise and food can alter the delivery
to target sites of the radionucleotide.
(Pagana & Pagana, 2014, p. 825)
© Endeavour College of Natural Health endeavour.edu.au 80
PET Scan:
Images
(Nucleus medical media, 2015 , Positron emission
tomography (PET) scan, viewed 20/09/2015
<http://ebsco.smartimagebase.com.ezproxy.endeavour.ed
u.au/positron-emission-tomography-pet-scans/view-
item?ItemID=11811>)
© Endeavour College of Natural Health endeavour.edu.au 81
PET Scan:
Images
(Nucleus medical media, 2015 , Positron emission
tomography (PET) scan, viewed 20/09/2015
<http://ebsco.smartimagebase.com.ezproxy.endeavour.ed
u.au/positron-emission-tomography-pet-scans/view-
item?ItemID=11811>)
© Endeavour College of Natural Health endeavour.edu.au 82
PET Scan:
Images
(Klunkwe, 2008, PiB PET Images AD.jpg,
viewed 20/09/2015
<https://upload.wikimedia.org/wikipedia/common
s/thumb/b/b9/PiB_PET_Images_AD.jpg/622px-
PiB_PET_Images_AD.jpg>)
© Endeavour College of Natural Health endeavour.edu.au 83
PET Scan: Images
(Kouchiyama A, 2009, PET-CT scanning of lymph node metastases in cancer 2.jpg, viewed 20/09/2015,
https://commons.wikimedia.org/wiki/File:PET-CT_scanning_of_lymph_node_metastases_in_cancer_2.jpg)
© Endeavour College of Natural Health endeavour.edu.au 84
Clinical Digital Thermography
© Endeavour College of Natural Health endeavour.edu.au 85
Clinical Digital Thermography
Digital Infrared Thermal Imaging (DITI)
o Investigation that detects minute temperature differences
in body’s radiant heat. (Gunn, 2008, p. 372)
o Due to this can detect disease in the vascular, muscular,
neural and skeletal systems
o Can identify physiological or functional changes and
metabolic processes via heat signatures & or asymmetry
(Damnjanovic, Petrovic, Pantovic & Smiljanic, 2010, p. 426)
© Endeavour College of Natural Health endeavour.edu.au 86
Clinical Digital Thermography
Digital Infrared Thermal Imaging (DITI) Advantages:
o Infrared: no exposure to radiation
o May identify early illness & a number of different
illnesses
o Images body function & body systems: overall image &
awareness to asymmetry
o Doesn’t require client pre-preparation
(Damnjanovic, et al, 2010, p. 426-7)
© Endeavour College of Natural Health endeavour.edu.au 87
Clinical Digital Thermography
Digital Infrared Thermal Imaging (DITI) Common uses:
o Early detection of some cancers, i.e. breast, prostate
o Monitoring changes in overall health: metabolic change,
degeneration
o Monitoring healing processes: healing and repair
o Disease and Virus Monitoring: temperature heat
signatures including fever Screening (i.e. H1N1)
(Damnjanovic, et al, 2010, p. 426-7)
© Endeavour College of Natural Health endeavour.edu.au 88
DITI:
Images
Source: www.medlineplus.gov
© Endeavour College of Natural Health endeavour.edu.au 89
DITI:
Images
Source: www.medlineplus.gov
© Endeavour College of Natural Health endeavour.edu.au 90
References
o Damnjanovic Z, Petrovic D, Pantovic R & Smiljanic Z 2010, Infrared imaging in
medicine, International journal of collaborative research on internal medicine
and public health, Vol. 2, Iss 12, p. 425-434 Viewed 20/09/2015
<http://ezproxy.qa.proquest.com.ezproxy.endeavour.edu.au/docview/847198517
?accountid=45102>
o Gunn C 2008, Pocket radiography and medical imaging dictionary, Churchill
Livingstone Elsevier, Nottinghamshire, UK
o Coombs P & Goergen S 2009, Ultrasound, The Royal Australian and New Zealand
College of Radiologists, viewed 20/09/2015
http://www.insideradiology.com.au/pages/view.php?T_id=5#.VgDWWH0b0eE
o Hofman M & Nandurkur D, 2009, PET Scan, The Royal Australian and New Zealand
College of Radiologists, viewed 20/09/2015
http://www.insideradiology.com.au/pages/view.php?T_id=16#.VgDXJn0b0eE
o Hendrich E 2013, Bone Mineral Density Scan (Bone Densitometry or DXA scan) The
Royal Australian and New Zealand College of Radiologists, viewed 20/09/2015
http://www.insideradiology.com.au/pages/view.php?T_id=51#.VgDVj30b0eE
© Endeavour College of Natural Health endeavour.edu.au 91
References
o McIntyre R & Goergen S, 2013, Magnetic Resonance Imaging (MRI) The Royal
Australian and New Zealand College of Radiologists, viewed 20/09/2015
http://www.insideradiology.com.au/pages/view.php?T_id=53#.VgDTD30b0eE
o McKenzie J & Goergen S, 2009, Computed Tomography (CT), The Royal
Australian and New Zealand College of Radiologists, viewed 20/09/2015
http://www.insideradiology.com.au/pages/view.php?T_id=61#.VgDUyH0b0eE
o O’Sullivan B & Goergen S, 2009, Plain Radiography/X-rays, The Royal
Australian and New Zealand College of Radiologists, viewed 20/09/2015
http://www.insideradiology.com.au/pages/view.php?T_id=24#.VgDT4n0b0eE
o Pagana KD & Pagana, TJ (eds) 2014, Mosby’s manual of Diagnostic and
Laboratory tests, 5th Edition, Elsevier, Missouri, USA
o Upfal J & O’Callaghan, 2001, Your Medical Tests. What do they really mean?
Black Inc. Melbourne, Australia.
© Endeavour College of Natural Health endeavour.edu.au 92
Recommended Reading
o Pagana KD & Pagana, TJ (eds) 2014, Mosby’s manual
of Diagnostic and Laboratory tests, 5th Edition, Elsevier,
Missouri, USA
o Chapter 8: Nuclear scanning: bone scanning (p. 782-4)
PET scan (p. 821)
o Chapter 10: Ultrasound studies (p. 861-866)
o Chapter 12: X-ray studies (p. 982-7), bone densitometry
(p. 1002-5), computed tomography (p. 1020-1032),
mammography (p. 1043-47)
o Chapter 13: magnetic resonance imaging (p. 1106-1113)
© Endeavour College of Natural Health endeavour.edu.au 93
COMMONWEALTH OF AUSTRALIA
Copyright Regulations 1969
COMMONWEALTH OF AUSTRALIA
Copyright Regulations 1969
WARNING
This material has been reproduced and communicated to you by or on
behalf of the Australian College of Natural Medicine Pty Ltd (ACNM)
trading as Endeavour College of Natural Health, FIAFitnation, College
of Natural Beauty, Wellnation - Pursuant Part VB of the Copyright Act
1968 (the Act).
The material in this communication may be subject to copyright under
the Act. Any further reproduction or communication of this material by
you may be the subject of copyright protection under the Act.
Do not remove this notice.
© Endeavour College of Natural Health endeavour.edu.au 94
References
o Labtestsonline, 2015, Viewed 20/08/2015 http://www.labtestsonline.org.au/
o Lord, RS & Bralley, JA (eds) Laboratory evaluations for integrative and
functional medicine. 2nd edn, Metametrix institute, Duluth, Georgia
o Pagana KD & Pagana, TJ (eds) 2014, Mosby’s manual of Diagnostic and
Laboratory tests, 5th Edition, Elsevier, Missouri, USA
o WebMd, 2015, EEG overview, viewed 7/09/2015
http://emedicine.medscape.com/article/1139332-overview
o Mayo Foundation for Medical Education and Research, 2015, Tests &
procedures: Electromyography (EMG), viewed 12/09/2015
http://www.mayoclinic.org/tests-procedures/electroconvulsive-
therapy/basics/definition/prc-20014183
o www.medlineplus.gov viewed 09/01/2011
© Endeavour College of Natural Health endeavour.edu.au 95
Recommended Reading
Video: What is a stress test?
https://www.youtube.com/watch?v=PXay0q1kJVw
Video: 24-Hour Holter Monitor Test_Rutland Heart
Center_Rutland Regional Medical Center
https://www.youtube.com/watch?v=mMzeuJyKz1E
© Endeavour College of Natural Health endeavour.edu.au 96
COMMONWEALTH OF AUSTRALIA
Copyright Regulations 1969
COMMONWEALTH OF AUSTRALIA
Copyright Regulations 1969
WARNING
This material has been reproduced and communicated to you by or on
behalf of the Australian College of Natural Medicine Pty Ltd (ACNM)
trading as Endeavour College of Natural Health, FIAFitnation, College
of Natural Beauty, Wellnation - Pursuant Part VB of the Copyright Act
1968 (the Act).
The material in this communication may be subject to copyright under
the Act. Any further reproduction or communication of this material by
you may be the subject of copyright protection under the Act.
Do not remove this notice.