Radyoloji, x ışınları ve diğer görüntüleme yöntemlerinin tıpta tanı ve tedavi amacıyla kullanılmasıdır.

Radiology is a department in which many diseases are diagnosed with the help of various medical devices. Devices used in radiology department;

1. (X- Ray),

a. It is the most commonly used device in the diagnosis of bone and lung diseases.

b. X-ray is used.

2. Mammography

a. It is often used in the diagnosis of breast diseases.

b. It is also preferred as a screening tool after the age of 40.

c. X ray is used

  • Medical devices working with X-rays (May be harmful during pregnancy)
  • Devices that work with Sound Waves
  • Devices working with radiofrequency waves

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A. X-rayed medical devices (May be harmful during pregnancy)

3. Bone Densitometry

a. It is often used in the diagnosis of osteoporosis. It measures bone density.

b. X-ray is used.

4. Computed Tomography (CT),

a. It is used to diagnose diseases of the whole body.

b. The sectional view of the body is removed.

c. X-ray is used.

5. Angiography = DSA = Digital subtraction angiography = Catheter angiography

a. It is used to diagnose vascular diseases.

b. Treatment of vascular diseases is also done with angiography device.

c. Various equipment is used to enter the vein, and the vein is made visible by giving medication in the vein.

D. Uses X-ray.

B. Devices operating with Sound Waves

1. Ultrasonography

a. The most commonly used medical device for the diagnosis of disease of the organs for the abdomen.

b. It is also used in pregnancy follow-up, has no harm.

2. Color Doppler Ultrasonography

a. It is used in the diagnosis of vascular diseases.

b. The blood supply of many organs is also evaluated.

c. It is also used in pregnancy.

C. Devices operating with radiofrequency waves

1. MRI (Magnetic Resonance Imaging)

a. It is used to diagnose diseases of all body structures, especially brain and muscle-ligament structures.

b. Apart from this, it is also widely used in abdominal organs.

c. MR angiography is a frequently used method for the demonstration of vascular diseases.

D. It may be inconvenient to use in cases where there is a foreign body in the body.

Computed Tomography (CT) and Technical Information

Computed tomography is a radiological diagnostic method to create a cross-sectional image (front-to-back coronal; top-down-axial; right-to-left-sagittal) of the examined area of ​​the body using x-ray. During the examination, the patient lies on the table of the computed tomography device without moving. The table is inserted into the device's “gantry” opening by manual or remote control. The device is connected to a computer. While the x-ray source performs a 360-degree rotation movement around the patient to be examined, the data obtained by detecting the body crossing the x-ray beam by the detectors lined up along the cavity or "gantry" are processed by a computer. As a result, cross-sectional images of the textures are created one after another. The created images can be viewed on the computer screen. In addition, images can be transferred to the film or stored on an optical disc to bring them back to the computer screen when necessary. Computed tomography has some advantages over other x-ray examinations. It shows the shape and placement of organs, soft tissues and bones especially clearly. In addition, CT examinations provide physicians with a better assessment of the diseases by assisting in the differential diagnosis of a simple cyst (encircled form with a liquid or semi-liquid substance) and solid tumor (tissue mass due to rapid proliferation of some cells). More importantly, CT helps to assess the spread of cancers by creating much more detailed images than direct radiographs. The information to be obtained about cancer spread will guide doctors about the treatment to be applied for cancer and help them decide whether to use chemotherapy, radiotherapy, surgical treatment or certain combinations of these. Thus, healthy tissues are protected from unnecessary interventions of treatment methods that can have serious side effects, although they have many benefits. CT made it possible to evaluate many parts of the body, such as the brain, which cannot be shown by direct radiographs. It also provided diagnosis of many diseases earlier and more accurately than other imaging methods. As diseases are better treated when diagnosed early, CT has helped doctors save many lives with these superior features.

Is the review uncomfortable? Are there any dangers?

The review itself is completely painless. During the examination, the patient is asked to lie on the IT device's desk without moving. Depending on the type of examination to be performed, the patient may be injected with contrast material from the arm vessels, or may also be asked to drink contrast material. This part of the examination may be a little uncomfortable for the patient. Contrast agents contain iodine, and can cause allergic reactions in some individuals. Before the examination, the patient must inform the technician or radiologist whether he has previously had an allergic reaction to such substances and, if any, his allergy to other substances. The patient may have been given contrast agent in a previously performed CT examination, kidney examination called IVP, or catheterization of the heart and vessels, also called angiography. BT devices use X-rays. It is designed in the best way for the safety of the patient and it is manufactured in such a way that the amount of radiation exposed during the examination is at the minimum required. Since X-rays can damage the developing fetus in the womb, the patient should inform the doctor or technician about the pregnancy before starting the examination preparation.

What are the things to do for preparation for review?

Day of Review

Solid food should not be eaten on the day of examination, starting 4 hours before the appointment time. However, coffee, tea, soups that are not too solid and juice can be drunk, but not too much. Limiting solid food intake is a precaution for patient safety prior to many medical procedures.

Room to be examined

He must come to the hospital at least 15 minutes before the appointment time. This will provide the time required for registration procedures at the hospital. If CT examination of the abdomen (abdomen) or pelvis area (pelvis area) is to be made, one hour and 15 minutes before the appointment time should come to the hospital. The patient is asked to drink an oral contrast agent, a liquid that will make the radiologist evaluate films better by showing the intestines more clearly. Depending on the preliminary diagnoses and examination desired, the patient may be asked to drink contrast material much earlier than the appointment time. The IT technician introduces himself to the patient and gives information about the procedure and helps the patient relax by answering possible questions. Depending on the body region to be examined, it may be desirable to remove metal objects from the body. Then, the patient is dressed in an apron.

What Happens During the Review?

The technician takes the patient to the room where the examination will be carried out, allowing the patient to lie on his back or face down on the table according to the examination. It is important that the patient is comfortable because the patient should not move during the examination. CT examinations differ according to the medical problems of the patients and the body part to be examined. The radiologist decides how the examination should be done for the diagnosis of the disease. For example, if the abdomen is to be examined, the section from the lower part of the chest to the upper part of the pelvis will be scanned. During such an examination, you will be asked to hold your breath periodically to avoid blurry images. The machine makes some noise during the process. The table on which the patient is lying will move slightly after each image is formed. In addition, the patient will be signaled by the technician or machine about breathing in and out. In some examinations, a contrast agent injection can be performed by the doctor or technician before or during the procedure. This will enable the radiologist to better evaluate the images. If the patient feels discomfort during the procedure or after injection, he should report this to the technician or doctor. All IT staff are trained to provide the best service to patients and have the necessary certificates in this regard.

How Long Does a Computed Tomography Review Take?

The examinations are planned individually for each patient, taking into account the clinical findings of their patients. Therefore, it should not be worried if the CT examination is different from an IT review you have previously done or if there is a need for additional images at the end of the examination. The shooting time from the beginning to the end is on average 15 minutes.

What are the things to do at the end of the review?

After the radiologist has obtained enough information to enable the person to be examined to reach a conclusion about his disease, the examination is terminated and the patient can go home. After the examination, he can continue his normal daily activities without any restrictions.

How are Reviews Evaluated?

The examinations are related to the part of the body, evaluated by radiologists specializing in the subject, and then turned into a written report and delivered to the patient. If you have any other questions, you can get the necessary information from the doctors and technicians who will conduct your examination. They will be delighted to assist you by providing you with the necessary information on how the review was conducted.

Areas where IT is Used Frequently

Which Conditions are Used in the ENT Area: CT is frequently used in the ENT area as in other branches. It is most often used when:

Sinus and Nasal Diseases: Computed tomography is the most useful examination method in all kinds of sinus diseases, especially chronic sinusitis, and in cases such as meat growth and tumor in the nose. Sinuses have a complex structure and some degree of information is obtained by examination. However, with CT, the anatomical structure of all sinuses, the holes opened into the nose, which is a very important part, the meat growths in the nose, and tumors are seen in great detail. Contrast agent is not required when pulled for sinusitis, but may be required if it is pulled for tumor.

Middle and Inner Ear Diseases: It gives information about how chronic inflammations in the middle ear spread, how much of the ossicles in the middle ear and the structures of the middle ear. It is useful to have a CT scan especially if an operation is considered for chronic otitis media. In some hearing loss, the tumor related to the inner ear or similar diseases come to mind. In such cases, although magnetic resonance (MR) is more appropriate, sometimes CT is withdrawn.

Neck Masses: One of the most difficult issues for ENT specialists to diagnose is understanding the masses (swellings) of the neck. CT is a method that provides very important information and sometimes makes a diagnosis in such cases.

Tumor or Other Diseases of the Adolescent, Stage and Larynx: Since CT images can be obtained in cross-sectional style, information about the spread or other diseases of the tumors of these regions is obtained and surgery is planned accordingly.

Computed Tomography (CT) and Types

Classical Computed Tomography

Bilgisayarlı tomografide x ışınları veren bir tüp ile bu ışınları tutan dedektörler bulunur. Hasta ise bu ikisinin ortasındadır. Böylece x ışınları hastanın içinden geçtikten sonra dedektörler tarafından tutulur. Vücudun dokularının atomik yoğunlukları farklı farklı olduğundan her bir dokunun tuttuğu x ışını farklı olur ve böylece doku görüntüleri oluşturulur. Tüp ve dedektörler hasta etrafında 360 derece dönerek vücudun o bölümünün kesitini görüntülerler. Klasik tomografide bir kesitin görüntüsü alındıktan sonra masa biraz ileri doğru hareket ederek bir sonraki kesit alınır. Bu yöntemle inceleme hem zaman alıcıdır hem de solunum hareketlerine aşırı duyarlıdır, bundan dolayı da kalp damar incelemeleri için uygun değildir.

Spiral Computed Tomography

In order to overcome this difficulty, spiral computed tomography (Spiral CT) has been published in recent years. Here, while the tubes and detectors are constantly rotating around the patient, the table on which the patient lies lies constantly moves at a predetermined speed (Figure 2). According to the patient, this movement is called spiral CT because it is spiral-shaped. With this, the examinations can be made in a very short time. However, this was not sufficient for imaging the heart, which is a mobile organ.

Multi-Slice Tomography

Thereupon, multi-slice spiral CTs (MSCT) were removed (Figure 3). These tomographs have a thinner and multiple rows of detectors. Tube movement has also been accelerated with the latest technological advances. Detectors, which were in 4 rows before, were turned into 16 rows, and 64 rows were made in the last ones. Thus, the resolution of the images increased and became possible by holding the breath in under 20 seconds.

Advantages of Multislice Computed Tomography

• It is a diagnostic method that provides information about vascular disease and is not an effort for the patient.

• The processing time is short, it can be done in a breath holding time.

Disadvantages of Multislice Computed Tomography

The diagnosis value is low in patients with arrhythmia (especially in atrial fibrillation).

• The patient should hold his breath for 20 seconds. However, this period was shortened in 64 rows.

• It can not be done in those who are not exposed to radiation (pregnant etc.).

• At high heart rates (over 70 per minute), the diagnostic value decreases, heart rate should be decreased.

• In cases where there are high density formations (calcium-lime-, stent, clip etc.) in the coronary vessels, the diagnostic value decreases.

• The radiation dose received by the patient is not less than classical angiography.

• The patient is given contrast agent (opaque substance) as in classical angiography. Therefore, caution should be exercised in patients who are allergic to this substance or in patients who are inconvenient to administer (such as kidney failure).

Doppler Device and Technical Information

Color Doppler Ultrasonography

With this method, which is based on the fact that the sound changes from the moving structures, the frequency in the vascular structures is examined. Color Doppler imaging is obtained if the flow information is colored according to the direction and speed of the current to the transducer and placed inside the vein image on the gray scale called B-Mod. Flow rates are measured using the Doppler spectrum in the form of graphs, current types are determined. (Austrian physicist and mathematician Christian Doppler). The moving objects targeted in Doppler examinations are red blood cells, namely red blood cells.

What examinations are done with Doppler Ultrasonography?

In the examination of arterial (arterial) and venous (vein) structures (for example, neck veins-carotid and vertebral arteries, limb-arm, leg-artery-veins, kidney arteries, liver and portal system, etc.); in varicocele research in the scrotum; It is used to examine vascularization of superficial structures such as breast, testicle, thyroid, parathyroid, lymph nodes and soft tissue and tumoral and inflammatory formations occurring in the parenchymal organs. It provides obstruction in vascular structures, venous valve insufficiency, and renal artery stenosis. Doppler examinations performed in the umbilical artery and fetal organs from the 20th week of pregnancy provide information about the developmental retardation or whether there is a fetal distress. Doppler examination performed transvaginally in gynecological tumors gives information about whether the tumor is benign or malignant. Ectopic pregnancy (ectopic pregnancy) gives information about ovarian torsion. It provides evaluation of perfusion in transplanted organs. Logic 7 is a premium premium system sonography device. With coding technology, B-flow and Color-Power Doppler sonography examinations are performed. This technology; Significantly increased sensitivity ensures removal of unwanted signal components, thus maximizing image quality. With the Coded Harmonic feature, more detailed images with higher contrast resolution are obtained by using high frequencies.

It provides the most suitable and quality image in B-Mod and Doppler studies with automatic tissue optimization. Easy access to set up and control menus with LCD color touch screen. With the virtual convex feature, a convex area is created in examinations with a linear probe. Thus, accurate measurements can be made by fitting the entire image to the same area.

With the Matrix Linear probe (M12L), the examination is done in the range of 7-10-12-14 MHz, and thus, optimum view is provided especially in breast-thyroid-testis-superficial tissue and vascular examinations. E8C and 3.5C probes are also multifrequency and have a wide application area. It has raw data image creation, archiving and post-process measurement-analysis feature. Reporting and archiving can be done with integrated DVD writer and large hard disk image archive capacity. Watching Doppler Ultrasonography Shooting

What are the Requirements?

Before coming to the examination, it is necessary to make an appointment and learn at this stage if there is a situation that requires preparation according to the type of examination. For example, in renal artery Doppler US; Degassing medication is used for 3 days before arrival and 12 hours of fasting is required. Comfortable clothes should be worn when coming for review. Bringing the request paper that your doctor has written and any tests you have done before will help the Radiology specialist in the diagnosis.

What is the Place of Ultrasonography in Pregnancy Week Triosm Screening Test?

In the first trimester screening test, the nuchal translucency of the fetus is measured by ultrasonography. Pregnancies with fetal head-butt distance (CRL measurement) between 45-82 mm and between 11-14 weeks are included in the examination. CRL and nuchal thickness measurements are made by ultrasonography. With Doppler US, fetal heart, umbilical cord and ductus venosus examinations are performed. Nasal bone (nasal bone), fetal cranium, vertebral column, stomach, abdominal wall, extremities are examined.

After ultrasonographic examination, PAPP-A and Beta HCG measurements are made in the blood by taking blood from the pregnant woman. All these measurements are evaluated in a software program specific to this test provided by the FMF (Fetal Medicine Foundation) and the risk ratio of the fetus's chromosomal anomaly is calculated.

Types of Doppler

The current inside the vessels can be shown in two ways on ultrasonography. The first is to show the veins on the normal ultrasound image (color doppler), and the second is to show the current as a graphic (spectral doppler) outside the normal image. These charts are called current curves and have different properties for each vessel. In color doppler mode, the currents towards and away from the probe are reflected on the screen in red and blue colors. After obtaining this image and determining the related vessel, by applying the focus on this vessel, simultaneous spectral doppler examination can also be done and mathematical measurements can be made regarding blood flow rates and resistance occurring in the vessel against this flow.

Doppler ultrasound devices are extremely expensive compared to traditional devices, so they are not available in every center, and therefore, doppler examinations are mostly performed by a doctor other than the doctor following the pregnancy.

Detailed ultrasound examination and doppler examination, which are described incorrectly as color ultrasound among the public, requiring special education and experience, are different procedures.

Why is Doppler Useful?

Measuring the blood flow to any tissue is important in some cases, as it carries blood oxygen and nutrients to the tissues and removes waste materials from these tissues, ensuring that the tissues are viable.

For example, in cases of ovarian torsion, where the ovaries turn around, the ovary will not get enough blood and it may go to gangrene and be lost. When such a condition is suspected, the determination of whether the ovary has been adequately bloodied by doppler examination to be performed can be critical in making a surgical decision.

On the other hand, cancer causes the formation of new vessels called neovascularization in the tissue from which it occurs. The demonstration of this increased vascularity with doppler in the presence of a mass in the ovaries can provide valuable clues that the pathology is benign or malignant.

On the other hand, dopp has an important role in determining the risks in terms of some diseases and conditions in terms of cancer follow-up called neovascularization. Normally, with pregnancy, the resistance in the vessels feeding the uterus decreases and the blood flow to the placenta and the baby increases due to the uterus. If this resistance does not decrease and the blood flow remains low, notches are observed in the doppler flow curves. The demonstration of this increased vascularity with doppler in the presence of a mass in the ovaries can provide valuable clues that the pathology is benign or malignant....

Doppler tarama testi olarak adlandırılan inceleme ile hamileliğin 20. haftası civarında uterin arter adı verilen ve rahimi besleyen ana atardamarlar ile göbek kordunu içinde bulunan atardamardaki kan akımlarının ölçülmesi ve buradaki direncin değerlendirilmesi ile ileride ortaya çıkabilecek gebelik zehirlenmesi (preeklempsi), rahim içi gelişme geriliği, plasentanın erken ayrılması (ablasyo plasenta), anne karnında bebek ölümü gibi durumlar açısından artmış risklerin öngörülebileceği iddia edilmektedir.Buna göre her iki uterin arterin doppler incelemesinde çentikleşme gözlenmesinin patolojik ya da pozitif tarama testi olarak kabul edilmesi ve yakın takip yapılması önerilmektedir. Ancak konu ile ilgili yapılmış çalışmaları bir arada değerlendiren bir araştırma sonucunda her hastada doppler tarama testinin yapılmasının gerekli olmadığı, sadece yüksek risk altındaki gebelerde uygulanması gerektiği sonucu ortaya konmuştur. Göbek kordonu içinde bulunan atardamardaki kan akım eğileri de bebeğe giden kan miktarının saptanmasına ve özellikle gelişme geriliği olan durumlarda bebeğin içinde bulunduğu sıkıntılı durumun değerlendirilmesinde önemli rol oynar.

A drastically reduced current in the late stages of pregnancy can cause infant deaths in the womb, which is critical in making a birth decision. Apart from these, color doppler examination is also used to see the baby's heartbeat and rest in the early period. In the photo next, the examination of the baby heart beats with a doppler is followed during a pregnancy of 9 weeks and 6 days. Another area of application is the observation of the main vessels coming out of the baby's heart. Observing vascular structures on both sides of the baby's urinary bladder during routine pregnancy ultrasonography is also a finding that reduces the risk of a possible anomaly.

How To

There is no need for a separate examination for Doppler ultrasonography. If the ultrasound device used during routine pregnancy follow-ups has a doppler feature, your doctor can switch to this mode at any time to monitor and measure blood flows. For example, while performing the first ultrasound in a 6-week pregnancy, the baby's heartbeat is rested in this way, and when the baby's urinary bladder is seen at a later period, the vascular structures on both sides can be monitored with colored doppler.

During detailed ultrasonography performed around the 20th week of pregnancy, your doctor can measure the blood flow in the vessels that feed the uterus if necessary. In further routine examinations, blood flows in the umbilical cord are measured and the condition of the baby is evaluated.

Is Doppler Risky?

Theoretically, doppler ultrasonography has a higher risk of regional temperature increase and bubble formation. Therefore, again, theoretically, the risk posed by this examination is slightly higher than normal ultrasound examination. However, although animal experiments have shown that there may be an increase of approximately 2.5 ° C in tissues for long periods of time, even this level is safe in humans and doppler examinations during pregnancy do not take this long. To date, no adverse effects have been reported due to doppler examinations on humans.

Bone Densitometry and Technical Information

It is a bone density measurement. In other words, it is the measurement method that determines the risk of fragility of bone. If osteoporosis is detected, drug monitoring is also performed at regular intervals for the rate of utilization of the drug taken by the person. The measurement is done within 1 minute. The problems of those who give up taking the medications given because they do not feel any pain in osteoporosis increase silently. For this reason, the osteoporosis disease is called silent disease (osteoporosis). Osteoporosis disease cannot be cured. However, it is possible to stop at the right place thanks to early diagnosis, appropriate drug use and correction of living conditions.

Should I Measure My Bone Densitometer?

If bone loss has started for any reason, they cannot express these problems because they come to older ages and feel nothing before pain and fracture problems. They also usually do not notice the collapse in their spine during their daily life. Women and men aged 20-45 must be checked once.

How Often Should I Measure Bone Densitometer?

This depends entirely on the degree of loss of density in your bones, the treatment you receive, and the continuity of special conditions that cause bone loss. Your doctor will follow you on this issue.

What is Osteoporosis?

Osteoporosis, on the other hand, is a compulsory disease that women cannot get rid of after menopause and men after 55 years of age. It is more common especially in women and after menopause. The reason for this is the decrease of the female hormone after menopause.

Osteoporosis is a skeletal disease that leads to an increased risk of bone fracture as a result of a decrease in bone mass and disruption in the microscopic structure of bone tissue. Loss of calcium in everyone causes this disease. The lost bone cannot be recovered. However, if early diagnosis is made, it can be stopped where it is. It definitely happens in women because of menopause, but it can be seen in young people and men for various reasons.

What is Bone Structure?

As it is known, the development of bone structure; genetic structure of people, diseases acquired afterwards, orthopedic prosthetic surgeries, more than two post-pregnancy and menopause periods, people sitting in work environments increasingly inmobilize, long-term use of some medications, diabetes, kidney, goiter and The hormone problem is particularly closely related to the unbalanced diet of young people with ready and hormone foods.

Like other tissues of our body, bone is a living tissue. It consists of two parts, the hard layer and the spongy layer.

How Does Bone Structure Change With Osteoporosis?

In the early stages, the bone compact (hard) layer becomes thinner, the gaps in the spongy layer grow. Later, fractures occur in bones that weaken at an older age.

What Are the Results of Osteoporosis?

When the back bones lose their form, short stature and hunchback develop. With a slight trauma, hip ankle spine fractures occur.

What are the symptoms of osteoporosis?

Generally, there are no signs and pain until fractures occur. However, in some people, rheumatism in advanced ages may cause bone pain.

When severe bone loss occurs in older ages, complaints of pain arise with complaints such as spine collapse, height reduction, hump, kyphosis, hip, hand and wrist fractures. There is nothing to do after this point. Considering that it can be detected by chance after 45% bone loss occurs even in the X-ray film, the importance of the bone densitometer, which is the only diagnosis and follow-up opportunity of osteoporosis, becomes apparent.

It is essential that osteoporosis accepts that it is not only a woman or elderly human disease, but it is the latest disease to have a period of osteopenia. There is no age and gender in this. It is known that the excessive material burdens of the fractures occurring in older ages bring both the patient and their relatives and the social security system. For this reason, it is a fact that people who are tied to the bed due to the lack of daily living standards and especially femoral fractures lose their lives early. Ideally; With the “screening method”, each person first takes a control measurement and understands the situation; If osteoporosis occurs once a year, if osteoni and there is no other disease that triggers, two years later, if it is normal, it is done by the doctor at intervals recommended by the doctor according to the age and sex. In those who undergo kidney dialysis, bone loss is very fast due to the chemicals used, their 6-month control and serious drug supplements are required.

In the bone mineral densitometer systems, the scanning form is Pencil Beam, which is selected as the gold standard. In this way, just like in scintigraphies, it performs scanning in real time without jumping all over the bone tissue. In the Fan Beam method, which produces a wide-angle fan-shaped rotary arm system and generates pulsed energy, the beam tries to adjust itself continuously by passing through a “compensation wheel”. For this reason, it continuously emits a pulsed beam. D1 is like a phantom, while D2 is a soft tissue and air is like a phantom. This wheel rotates on the incoming beam and tries to adjust itself. The computer is also activated for mathematical corrections when there is voltage or minor mechanical deviations. He makes every shot twice, to be sure. In addition, the patient and user scattering fan receives high radiation due to Fan Beam method.

Bone Mineral Densitometry Measurement Methods

Bone mineral density measurements occur with low bone density and fracture syndrome. It is the method used to support and prove the diagnosis of osteoporosis, to determine the degree of osteopenia in the context of increased fracture risk as bone density decreases, to determine whether there is a need for treatment and to determine the effectiveness of the treatment. Ideal densitometric measurement; To be applied quickly and reliably, expose the person to low irradiation, have little margin of error, be able to give an idea about the risk of fracture, trabecularly and cortically evaluate bone separately and be used safely in monitoring the effectiveness of treatment.

1. Single Photon Absorbsiometry (SPA) It is the measurement of the radiation passage of a regular mono energetic photon beam emitted from an I source with a detector that contains Na iodide and detects radioactive body glows. This system cannot distinguish cortical and trabecular bone. Radius measures distal and receives radiation. SPA cannot provide sufficient information regarding prognosis. Type II osteoporosis with both cortical and trabecular bone loss may be used in patients over 70 years of age or in cases where there is a pronounced spiral deformity and spinal measurements cannot yield reliable results.

2. Dual Photon Absorptiometry (DPA) It is based on the measurement of two photon beams with two different energy. The radiation source is Gadalinium 153. Lumbal spine, femur or whole body can be measured. During this measurement, which cannot distinguish between cortical and trabecular bone, the patient receives 10-15 mrem of radiation and the procedure takes 20-40 minutes. Its reliability rate is high. L is measured between 2-4 and the result is expressed in gr / cm.

3. Dual Energy X-Ray Absorptiometry (DEXA) is a newer technique than others, it is applied in a shorter time and gives more accurate results. X-ray is used instead of radioisotope. Lumbal region, femur or whole body can be measured. Radiation dose is 1-3 mrem. Sensitivity rate is high. The intensity of the radiating beam is higher than DPA. Thus, a faster image is obtained.

Who are in the Risk Group for Osteoporosis?

• Those who do not take enough calcium foods (milk and dairy products) in their daily nutrition.

• Those of any age group who feed irregularly.

• Diabetics.

• Kidney stones and other kidney patients.

• Those who use cortisone drugs, some anti acid stomach drugs and sedatives for a long time.

• Excessive tea, coffee, smoking, alcohol users .; People who consume foods such as milk, yogurt and cheese

Those with a genetic predisposition.

• Those who have given birth more than two.

• Ladies in menopause.

• Small and slim women

• More than three births

• Having light eyes, skin and hair

• Those who lead a sedentary life

• Men over the age of 50 are at risk of osteoporosis.

• Red meat consumers

How is Osteoporosis Diagnosed?

Today, even very low bone loss, such as 1%, is diagnosed with a BONE DENSITOMETER measurement. Osteoporosis is primarily recognized by a proper history and physical examination. This story includes questions about osteoporosis, some associated medical conditions, and whether you or your relatives have broken stories. The physician will ask you to take a measurement called “Bone Densitometry” to determine your bone mineral density and x-ray films to determine the fracture, if any, after a series of physical examinations and tests to assess your history and detect possible fractures and findings.

Bone densitometry is a painless procedure, such as X-ray. During the densitometry process, the mineral density of your bones in the area where the measurement is made using x-ray or sound waves is determined. The determined value is compared with the values of healthy young adults and a value called T score is obtained and the condition of the measured bones compared to the healthy bone measurement is determined.

Features of Bone Densitometry Device

The most advanced method used in densitometers is DPX-DEXA (Dual X-Ray Absorbtiometry) and bone density measurement. The LUNAR-DPX-NT-DEXA system has the highest accuracy and can use Turkish standards with the approval of the World Health Organization (WHO). In the final report, by reporting the T-score, the risk of fracture is shown graphically according to the World Health Organization (WHO) criteria, and the response to the treatment is followed by following the% changes in the graph in repeated measurements.

Which Measurements Can Be Made?

AP Spine Femur, Whole Body, Dual Femur, Forearm, Lateral Spine measurement is performed with LUNAR-DPX-NT bone density (BMD) measuring device.

Body composition (fat ratio, etc.) can be measured in a very short time with excellent repeatability (preparation).

Who should have Bone Densitometry?

Bone densitometry test should be performed only considering the risk factors that the person carries and if the measurement results will help in making treatment decisions. Bone densitometry may be unnecessary if you are currently taking hormone replacement therapy for menopause. However, a bone densitometry before a treatment decision can be determined by determining your personal risk status in the treatment decision. In addition, bone densitometry measurements that will be performed at intervals of 18 to 24 months during the years you are under treatment will be useful for monitoring your response to treatment.

What Can Be Done Against Osteoporosis Development?

Osteoporosis can be prevented with some simple applications that start from childhood and will continue throughout life. The main ones are; ensuring the proper intake of calcium throughout the life, regular exercise and maintaining adequate levels of estrogen in women and adequate testosterone levels in men. Having strong bones in childhood and adolescence is the biggest aid in preventing osteoporosis that will occur in later years. In these ages, ensuring adequate calcium intake and adequate general nutrition are extremely important.

Bu dönemdeki yürüyüşler, egzersizler ve düzenli egzersizler, kemik kütlesinin sağlanmasında önemlidir. Genç insanlar sigara, aşırı zayıflık ve alkol tüketimi gibi zararlı davranışlardan da uzak tutulmalıdır. Tepe kemik kütlesi yirmili yaşlarda sağlanır ve sonraki 20 yıl boyunca hafif bir azalma gözlenir. Bu dönemde kişilerin diyetinde düşük kalsiyum ve D vitamini, aşırı sigara ve alkol tüketimi, hareketsiz bir yaşam tarzı veya kemik metabolizmasına etkili ilaçların kullanımı varsa kayıp beklenenin üzerinde olacak ve ilerisi için risk yaratacaktır. Daha ileri yaşlarda kemik kaybı artar. Hızlanmış kemik kaybı kadınlarda 40’lı yaşlardan itibaren izlenirken, erkeklerde daha geç yaşlarda ortaya çıkar ve kadınlardaki kadar hızlı değildir.

Older people can benefit from getting enough calcium and vitamin D daily. In this period, regular physical activity is essential to maintain muscle tone, joint mobility and bone health.

Bone Density Measurement Indications for Pediatrics Specialists (5-20 years old)

Juvenile osteoporosis (idiopathic)

Cushing's syndrome

• Hypophosphatasia, osteogenesis imperfecta

• Cortisone treatment

• Monitoring of osteoporosis treatment

• Cystic fibrosis


• Juvenile rheumatoid arthritis

• Length shortening thoracic kyphosis

• Osteoporosis (positive findings)

• Diabetes

Growth hormone deficiency

• Chronic diseases (Congenital heart disease, Chronic liver disease, Chronic kidney failure and dialysis)

• Risk factors: Stay away from sunlight, Malnutrition (protein and calorie deficiency), Immobilization

Bone Mineral Density Measurement Indications for Obstetricians:

• Osteoporosis (positive findings)

• Menopause

• Surgical menopause

• Multiple births

• History of hip fracture in mother and grandmother

• Cortisone treatment (> 7.5 mg / day> 1 year)

• Monitoring of osteoporosis treatment

Ostrogen deficiency (* Premature menopause (<45 years old)

• Long-term secondary amendore (> 1 year)

Primary hypogonadism

• Primary hypogonadism • Length shortening thoracic kyphosis (Previous fragility fracture hip, vertebra, forearm)

• Radiographic evidence of osteopenia or vertebral deformity * Low body mass index (<19 kg / square meter)

Body mass index = body weight (kg) / height (square meter)

Risk factors: Small body structure (<160 cm,> 50 kg), long-term immunization (more than 1 month), inactivity, excessive smoking, alcohol use

Bone Density Measurement Indications for Physical Therapists:

• Rheumatoid arthritis and ankildzan spdndilitis (lasting more than 5 years) Postmenopause

• History of hip fracture in mother and grandmother

• Cortisone treatment (> 7.5 mg / day> 1 year)

• Monitoring of osteoporosis treatment

• Length shortening thoracic kyphosis

• Osteoporosis (positive findings)

• Previous fragility fracture hip, vertebra, forearm

• Radiographic evidence of osteopenia or vertebral deformity

• Low body mass index (<19 kg / square meter) Body mass index = body weight (kg) / height (square meter)

• Risk factors: Small body structure (<160 cm,> 50 kg), Long-term immobilization (more than 1 month), inactivity, excessive smoking, alcohol use

Bone Density Measurement Indications for Internal Medicine Specialists:

• Hyperthyroid, Hyperxparathyroid, diabetes

• Postmenopause

• History of hip fracture in mother and grandmother

• Cortisone treatment

Leukemia, lymphoma, chemotherapy, radiotherapy

• Cortisone treatment (> 7.5 mg / day> 1 year)

• Monitoring of osteoporosis treatment malabsorption, liver failure, kidney failure * Previous fragility fracture hip, vertebra, forearm

• Radiographic evidence of osteopenia or vertebral deformity

Low body mass index (<19 kg / square meter)

• Risk factors: Small body structure, long-term immobilization (more than 1 month) inactivity, excessive smoking, alcohol use

Bone Density Measurement Indications for Orthopedists:

• Prosthesis and implant follow-up

• Postmenopause

• History of hip fracture in mother and grandmother

• Kortizon tedavisi (>7,5 mg/gün >1 yıl )

• Monitoring of osteoporosis treatment

• Bone tumors, bone metastases

• Osteoporosis (positive findings)

• Length shortening thoracic kyphosis

• Previous fragility fracture hip, vertebra, forearm

• Radiographic evidence of osteopenia or vertebral deformity

Low mass index

Bone Density Measurement Indications for Radiologists:

• Osteoporosis (positive findings)

• Monitoring of osteoporosis treatment

• Length shortening, thoracic kyphosis

• History of hip fracture in mother and grandmother

• Previous fragility fracture, hip vertebra, forearm

• Radiographic evidence of osteopenia or vertebral deformity

Low body mass index

• Menopause, postmenopause, surgical menopause

Estrogen deficiency, multiple births

• Bone tumors, bone metastases

• Prosthesis and implant follow-up

Ankylosing spondylitis (lasting more than 5 years)

• Cortisone treatment

Juvenile osteoporosis (idiopathic)

Juvenile rheumatoid arthritis

Cushing's syndrome, leukemia, diabetes, cystic fibrosis, growth hormone deficiency)

Chronic diseases (Congenital heart disease, chronic liver disease, chronic kidney failure and dialysis, hyperthyroid, hyperparathyroid, diabetes, leukemia, lymphoma, chemotherapy, radiotherapy, hypophosphatasia, osteogenesis imperfecta, malabsorption, liver failure. Clinical findings are almost the same and as listed below;

• Back pain,

• Length shortening,

• Spinal deformite,

• Osteoporotic fractures.

Magnetic Resonance Imaging (MR = MRI)

It is a technique that does not contain harmful X-rays and is a painless and allergy-free drug that allows the examination of body parts by providing the vibration of the Hydrogen atom in the body by radio waves within a very strong magnet field. For this purpose, in the isolated rooms, the patient lies on the table in a very strong tunnel-shaped magnet and remains motionless. You should lie calmly, breathing in and out without moving during the MR examination. In some examinations, you may be asked to hold a short breath. There are two types of MR.

1) Closed Form: It has high power magnet feature.

2) Open Form: It has a low power magnet feature. Its only advantage is that it provides convenience to patients with fear of confined space.

When entering the MR room, all the removable metals (belts, hairpins, jewelry, coins, keys, dental prosthesis (iron, steel) on your body are left out. The magnetic field also disrupts magnetic cards such as credit cards, CDs and tape tapes. Due to the mixed working principle, patients carrying pacemakers, patients using ear implants, patients who have clips placed on their brain vessels with brain surgery are not taken to MR examination during the first three months of pregnancy. There is no obstacle, but if the contrast material is used in MRI, the baby should be breastfed after the excretion of the substance (24 hours) .The difference from the computed tomography is the length of the examination and the slight noise during the examination. In order to better evaluate the diseased area and normal formations and guide treatment, a small amount of medication may be required (contrast). MR is the method with the highest resolution especially in the evaluation of soft tissues. MR times are long (20-30 minutes). Sometimes, special drugs can be given from the breech and vein to MR by enema in order to distinguish the patient from healthy. MR is used to determine the spread of tumors seen by colonoscopy to the intestinal wall and surrounding tissues. It is used to determine the prevalence of the masses and to plan the treatment by taking different images in each plane with the sections that can be defined as thin slices.

The magnitude of the magnetic field created by the magnet in the MR device is expressed by Tesla. 1 Tesla is equivalent to 10,000 Gauss. In obtaining a quality image, the strength, continuity and regularity of the magnetic field are critical determinants that shape the main magnetic field.

Types of MR

T1 and T2 measurement-weighted images: Seeing the anatomy are the techniques we use to detect a pathology. MR Subgroups: Diffusion MR, Angiophary MR, cerebrospinal fluid flow MR, MR spectroscopy, Perfusion MR, functional MR

MR and Coloring

Coloring provides convenience in MR. When perfusion and functional MR are color coded, it is provided to appeal to the eyes and perception. Color coding is a long and laborious task that can be done entirely with computer software. Sometimes a coloring process takes two days.

In which diagnoses is MR used?

50%: Nervous system images such as spine, spinal cord, brain, head, neck, neuroradiology, cervical (neck), lumbar (waist), herniated disc.

30-35%: Soft tissues and bone examinations called musculoskeletal system.

15-20%: Imaging of the abdomen, abdomen, breast, soft tissue lesions

Brain MR

It is the most sensitive method to detect chronic nervous system diseases such as brain tumors, strokes, dementia and multiple sclerosis. In addition, the pituitary gland is used as the most sensitive method to evaluate diseases of the brain vessels, eyes, and inner ear organs. Since the brain structure is examined, it is also used in the examination of mental disorders.

Magnetic Resonance Spectroscopy (MRS)

It is an imaging method that can show metabolite changes at the cellular level. With this technique, besides biochemical analysis of pathological tissues, existing biochemical relationships in normal tissues can also be investigated.

Diffusion Weighted MR

With diffusion MR technique, images resulting from the molecular movements of water in the tissue are obtained. The main use of diffusion MR is to monitor the stroke, which is one of the most important causes of mortality (death) and morbidity. Its accuracy is very high in the diagnosis of acute stroke. While CT and standard MR techniques cannot show 1-2 hours of infarction, infarction can be easily visualized with diffusion MR in a very early period. In addition, diffusion MR and intracranial cystic structures can be separated from each other, they are used for differentiation of benign malignant tumor in fractures due to tumor spinal compression and ADC increase in MS plates.

Perfusion Weighted MR (PA – MR)

With this technique, information is obtained about the functional state of the brain tissue. Thanks to PA MR, hemodynamic changes caused by damage to the cerebral tissue and space-occupying lesions are observed. It is used in the clinic for stroke, intracranial (intracranial) tumors, epilepsy, dementia (dementia), cognitive disorders and non-invasive evaluation of normal physiological changes.

Functional MR (fMR)

It is used as a valuable screening method in evaluating surgical risk and planning the operation by measuring changes in the oxygenation and blood supply of the brain. The most important and up-to-date usage area enables functional mapping with sufficient quality before surgery in mass lesions close to the sensory-motor and speech centers.

MR Anjiography

It provides detailed visualization of the vessels without interfering with the catheter and without radiation. It is used for the imaging of intracranial (intracranial) vessels, as well as for the aorta, kidney, lung, arm and leg vessels.

Cardiovascular System MR

It is used to determine the structure and function of the cabin and main vessels, and the size of the heart islets, the thickness of the walls, the extent of heart damage due to heart attack or progressive heart disease. Imaging of coronary vessels, functional studies and stressful perfusion MR studies are on the way to become more promising day by day. In patients with hypertension, the evaluation of vessels such as liver, lung, arm and leg veins in the detection of narrowing and problems in the kidney vessels can be easily and in detail in MR angiography.

Body MR

Heart, major vessels, lungs, liver, kidneys, spleen, pancreas, gall bladder, biliary tract, intra-abdominal vessels can be examined in detail. With cholangiopancreaticography examination for the gallbladder, biliary tract and pancreatic duct, lumen structures can be performed more comfortably and in detail without needle or catheter intervention. In addition, since MR does not contain radiation, the male and female reproductive organs are the muscular layers that hang like a hammock between the pelvic organs (Pelvic floor: pubic bone (anterior part of the pelvis) and the lower part of the vertebral bone). It is a good imaging alternative for the bladder.

Breast MR

Breast MRI is not a method used in place of mammography or USG, but a method used with both diagnostic methods. MR and all other methods for breast imaging are performed for early diagnosis of breast tumors. It can be used for screening in areas where mammography is difficult, such as multiple focus investigation in both breasts (a significant portion of breast cancers can develop in multiple foci), silicon implants or intense breast tissue observed in young patients. However, it is recommended in evaluating whether the lesions detected in mammography and USG are benign or malignant.

Prostate MR

The most common problems of MR prostate are used in the diagnosis of inflammations (prostatitis), benign prostatic enlargement (benign prostatic hypertrophy, BPH) and prostate cancer. It is also a good method to determine the size of the tumor and whether it has spread to other organs other than the prostate, in patients who have been diagnosed with prostate cancer by biopsy.

Musculoskeletal System MR

It gives detailed information about muscles, tendons, ligaments, meniscus, other joint discs, joint capsule and surrounding soft tissues. It is widely used in the evaluation of tissues due to sports injuries, other limb injuries, new and old ailments of the joints, inflammatory conditions (arthritis), as well as the evaluation of the spread from the masses of the musculoskeletal tissue to the bones. It is also used in evaluations about spinal problems such as disc hernia (such as herniated disc or neck hernia), scoliosis (humpback) and the effects of surgery after spinal surgery.

Preparation and review process in MR examination

No extra preparation is required for MR. Unless otherwise warned, the patient can come by eating their meals and taking their medication. The patient needs to fill in a form related to his medical history for MRI. In addition, the patient will be affected by the magnetic field, watch, credit card, metal goods, etc. has to remove the materials before entering the MR room.

If the bladder is full, it is okay to urinate before shooting unless otherwise stated. The review period usually takes between 15 and 45 minutes. During this period, the patient will be asked to remain still. It should also be known by the patient that the slightest movement will cause distortion in the images. In some cases, specially designed MR contrast agents can be injected to improve image quality and increase the safety of the diagnosis. These drugs will help clarify the details of MR images.

Eğer mesane doluysa aksi söylenmedikçe çekim öncesi idrarını yapmasında bir sakınca yoktur. İnceleme süresi genellikle 15-45 dakika arasında sürmektedir. Bu süre içinde hastadan hareketsiz kalması istenecektir. En küçük bir hareketin görüntülerde bozulmaya neden olacağı da hasta tarafından bilinmelidir. Bazı durumlarda görüntü kalitesini iyileştirmek ve tanının güvenliğini artırmak için özel tasarlanmış MR kontrast ajanlar enjekte edilebilir. Bu ilaçlar MR görüntülerinin detaylarını netleştirmeye yardımcı olacaktır.

The situations where MR is superior compared to CT are as follows:

1. MR reveals normal and diseased tissues more clearly. In addition, magnetic signals are used instead of radiation (x-ray) to reveal different densities between tissues.

2. MR allows a multi-sectional search or, accordingly, a three-dimensional anatomical representation. However, the representation of CT is limited to horizontal sections.

3. In MR, there is no risk of ionizing radiation for both patients and practitioners.

4. Through signals received from circulating blood, veins can be displayed directly in MR without using contrast media. Therefore, the problems and risks caused by the need to use iodinated contrast agents as in CT are not encountered.

5. MR provides a specific textural complete placement in clinical practice based on the examination of metabolic processes on living tissue. It should be noted that MR results are more affected by the experience and knowledge of practitioners than IT. Because, from time to time, practitioners have to search the most suitable physics parameters for the examination of the case.

MR Advantages

The main advantages of MR against traditional radiology, including computed tomography, are:

• There is no risk of biological, physical and genetic damage caused by the use of x-rays.

• The need to resort to the use of contrast media disappears; their use often leads to allergic reactions that are impossible to predict and in some cases can be very severe. Because of these two advantages, MR is preferred even when the diagnostic results are the same. It is also necessary to add important features in clinical-integrity practice based on the identification of biochemical tissue changes that traditional radiological examination cannot reveal. Accordingly, MR has other advantages:

• It enables to diagnose diseases that cannot be confirmed by traditional radiology or that occur at a very late stage.

• It allows a differential diagnosis to be made for certain diseases (eg benign and malignant tumors, inflammatory processes, degenerative processes) that have different structures but may appear the same in traditional radiological examination. The fact that MRI is much more specific in terms of diagnosis makes the processes that disrupt body integrity such as biopsy and surgical examination, which are generally used compulsory in the definitive diagnosis of disease processes examined with traditional diagnostic methods, unnecessary.

Negative Aspects of MR

Although it has important advantages, MR has some negative aspects like all techniques. In order not to overestimate a new technique compared to the previous one, these should be known and underestimated. A typical disadvantage of MR is that the examination takes longer time than computed tomography. This is due to the fact that the resonance signal collected at the receiver coil level is actually extremely low. It takes a longer time to sample the signal and obtain a suitable signal-to-image ratio. But it can be said that significant progress has been made in reducing the time required for MR compared to a few years ago. Indeed, from relatively slow sequences to progressively faster sequences. Today, it is possible to obtain images within a few seconds or seconds section, although it is not clinically satisfying. A second drawback is that the MR device is expensive. Superconducting devices with higher results result in higher costs in terms of hardware, placement and use. But there is a rapid change in this regard.

New devices are being developed based on superconducting technologies or other technologies with lower usage costs. MR is regarded as a non-hazardous method in terms of not using x-ray. But there is a possibility of causing side effects. The magnetic field required for MR can lead to displacement of metal objects used for therapeutic purposes, for example metal clamps used to eliminate vascular ballooning (aneurysm). Radio frequency can disrupt the function of electronic devices such as stimulated pacemakers. Due to interactions between intensive care devices such as monitors and MR, patients who are monitored and treated with these devices are subject to MR examination. In cases where it is necessary to perform rapid examinations without disturbing the function of patient assistive devices, computerized tomography is preferred in detailed examinations related to bones or bone tissues that have accumulated calcium.

MR Clinical Use

Clinical studies using MR today are mostly for the examination of the central nervous system. In terms of MR examination of the brain, it shows the following superior features:

• Competently determining the difference between the substance and the substance.

• Enabling the detection of neural diseases leading to myelin loss at an early stage, the physiological process of myelination (formation of myelin hair around nerve fibers) and examination of maturation disorders in the nervous system.

• Competently demonstrating pathological processes, such as cerebellum diseases, in the posterior cavity of the skull. All these advantages provide diagnosis for neural, degenerative (destructive) or inflammatory diseases that have been difficult to diagnose until today.


Along with mammography, ultrasound is the most commonly used method in the diagnosis of breast diseases. Investigations such as magnetic resonance imaging (MR) and scintigraphy can be applied in the second stages, when necessary. Mammography is still the gold standard for breast cancer diagnosis.

1. Why should I have a mammogram?

Breast cancer is so frequent that about one in ten women will encounter it at any stage in their lifetime. Mammography can show some early signs of cancer, even in the early period when the patient or the doctor who examined it has not yet received a mass-swelling. In some developed Northern European countries, America and Canada, studies that have been going on since the 1960s have reduced the mortality rates from breast cancer by approximately 30% with mammography scans.

2. When and how often should I have a mammogram?

The probability of breast cancer increases, especially after age 40. Therefore, mammograms for control-screening are ideally taken every year, starting at the age of 40.

3. What is done if I notice a swelling-mass in the breast before the age of 40, or if my doctor who examines it suspects a mass?

In this case, first of all, imaging is done with ultrasound. Mammography can also be taken if necessary. In such a patient over the age of 40, both mammography and ultrasound are ideally applied.

4. How is breast cancer diagnosed with mammography and ultrasound?

What to do if there is a suspicion of cancer?

Mammography and breast ultrasound are the basic devices used for imaging the breast. Radiologists who use advanced devices benefited from digital technology in recent years and experienced in this field can distinguish between benign and malignant in the majority of the changes or masses they see in the breast. A large part of the swelling that comes to the patient or the examining doctor is benign tumors or cysts. These harmless masses (fibroadenoma and the like) and cysts occur quite frequently, especially in the 30-50 age group. Most of them can be distinguished from cancer by ultrasound and mammography. When cancer is suspected, the radiologist explains to the patient that a biopsy is required, and by contacting the doctor who sent the patient, he decides how to perform the biopsy. Some audiences with a very low probability of cancer are monitored every few months with ultrasound and / or mammography to ensure that they do not grow and change, thus eliminating the possibility of cancer.