Medical Physics

1. The properties of ultrasound waves can be used as diagnostic tools

Identify the differences between ultrasound and sound in normal hearing range

Humans can hear sound waves with a frequency between 20 - 20 000 Hz.

Sound waves with a higher frequency are called ultrasound, and are too high
pitched for the human ear to hear.

Describe the piezoelectric effect and the effect of using an alternating potential
difference with a piezoelectric crystal

piezoelectric effect: Where mechanical vibrations of a substance are converted

into electric signals and vice versa

Piezoelectric materials (quartz or barium titanate for example) are made up of

dipole molecules in a lattice formation.

When a voltage is applied to the crystal, the dipoles realign and change the
dimensions of the crystal.

If alternating voltage is applied, then the crystal will rapidly expand and contract,
producing a sound wave the same frequency as the input current.

The same principle applies in reverse, with sound waves resonating in the crystal
to produce an AC voltage.
Define acoustic impedance: Z = ρυ, and identify that different materials have
different acoustic impedances

Acoustic Impedance: Refers to the ease with which a sound wave can pass
through a material. It is dependent on the density of the material and the velocity
of the sound wave in the material:

Thus, different parts of the body will have different acoustic impedances:

Define the ratio of reflected to initial intensity

Describe how the principles of acoustic impedance and reflection and refraction are
applied to ultrasound

Ultrasound is produced by a transducer and directed into the body.

As defined above, when the ultrasound reaches a boundary between tissues, some
is reflected and some is refracted through the material. This is dependent on
difference in acoustic impedance.

The reflected waves are detected by a piezoelectric detector.

Identify that the greater the difference in acoustic impedance between two
materials, the greater is the reflected proportion of the incident pulse

The larger the difference in acoustic impedance, the greater the amount of reflected
waves. Thus, ultrasound is most effective at barriers between unlike materials.
Describe situations in which A scans, B scans and sector scans would be used and
the reasons for the use of each

Amplitude (A) Scans:

• The reflected ultrasound waves are displayed on a voltage/time graph
(Cathode Ray Oscilloscope) as wave peaks.
• The amplitude of the peaks determines the nature of the boundary, while their
position in time provides information regarding the size and position of a body part
• The image produced is a two dimensional representation, the transducer is kept
stationary

• A scans are rarely used clinically, but are useful for accurate depth
measurements
• They can be used to measure the internal dimensions of eyes, the depth of
tumors, or the dimensions of a fetus
Brightness (B) Scans:
• Where the intensity of the reflected ultrasound waves correspond to a dot of
varying brightness of a grey scale
• Produces a one dimensional image of a cross sectional slice of tissue
• The brightness of the dots corresponds to the amplitude

• Useful for soft tissue examinations: Abdominal structures and fetal structures,
for example
• Forms the basis of other useful scan
types...

Linear Scans:

• Essentially a brightness scan

conducted across a two
dimensional frame
• Achieved by either moving a single
transducer, or using an array of
many transducers
• Also useful for soft tissue
examination
Sector Scans:
• Similar to a linear scan, except the array of transducers is arranged in a curved
line to produce a sector shaped image field
• The most common form of scan, creates the clearest image
• Used for a variety of examinations, including examination of the fetus, detecting
gallstones and kidney stones, or detecting cysts

Gather secondary information to observe at least two ultrasound images of body

organs
Ultrasound images can be distinguished by:
• Grey scale colouration
• Sector shaped image
• Soft tissue subject area

A Foetal Sector Scan showing a baby in the

womb



A gallstone visible in the Gall

Bladder
Describe the Doppler effect in sound waves and how it is used in ultrasonics to
obtain flow characteristics of blood moving through the heart

Doppler Effect: The apparent change in frequency of sound waves when the
source is moving relative to the observer

The Doppler Effect has recently been integrated into ultrasonics, with computers
able to use changes in the wavelength of an echo source to determine it’s speed
relative to the transducer.

Doppler shift due to moving red blood cell boundaries causes a change in
frequency of approximately 3 KHz in waves in the range of 5 - 15 MHz.

Computer programs assign a colour to this movement, with the shade based on
direction, and brightness based on speed.

Outline some cardiac problems that can be detected through the use of the Doppler
effect

Doppler ultrasound can detect cardiac issues where blood flow is altered:
• Blockages and leakages
• Malfunctioning valves, as a result of stenosis or regurgitation
• Uneven/inadequate blood flow
Identify data sources, gather, process and analyse information to describe how
ultrasound is used to measure bone density

For the last decade, ultrasound has been used to assess bone density to screen for
osteoporosis.

Ultrasound measurements of bone density are taken with the heel bone, as it is flat
and a weight bearing site.

The speed of sound in the bone is measured by measuring the time taken for an
ultrasound pulse to pass through the bone.

The broadband ultrasound attenuation within the bone measures the amount of
ultrasound at specific frequencies absorbed in the bone.

These two figures are combined to approximate bone density.

Describe the compromise between resolution and penetration in ultrasound scans.

Resolution is a measure of the smallest detail that can be detected.

Higher frequency ultrasound (smaller wavelength) yield higher resolution

images.

Attenuation of a wave is a decrease in intensity as it travels through a medium.

It is caused by:

• Spreading out of sound waves from the initial linear path

• Scattering
• Absorption

All of which contribute to the acoustic impedance of the medium.

Attenuation becomes more prominent with higher frequencies

Therefore, the choice of frequency of ultrasound is a compromise between

penetration and resolution.
2. The physical properties of electromagnetic radiation can be used as
diagnostic tools

Describe how X rays are currently produced

X ray tubes generate two types of X ray radiation:

Bremsstrahlung (Braking) Radiation: Kinetic energy from electrons is converted

into X rays due to collisions with atoms in the anode

Characteristic Radiation: Vacancies formed in the inner shells of atoms in the

anode are filled by outer shell electrons, which emit energy in the form of X rays
Compare the differences between ‘soft’ and ‘hard’ X-rays

Soft X rays have lower frequencies than hard X rays. Only Hard X rays are useful
for medical imaging, as they have enough energy to penetrate the body.

Gather information to observe at least one image of a fracture on an X-ray film and
X-ray images of other body parts

This image shows a

fracture in the finger.

The images below show a

healthy chest (left) and
one with damaged lung
tissue.

X rays pass easily through

air, so the chest should
appear black (negative
image)
Explain how a computed axial tomography (CAT) scan is produced

A CAT scanner consists of a

motorized bed which passes
through a ring shaped X ray
scanner and detector.

The ring shaped scanner rotates

360 degrees around the patient,
with collimators focusing data so
as to image a single slice of the
body.

The bed then moves through the

scanner to repeat the process, and
a computer constructs the image.
Describe circumstances where a CAT scan would be a superior diagnostic tool
compared to either X-rays or ultrasound

Brain:
• Unlike X rays, CAT scans can visualize the brain, not just the skull
• Higher resolution assists in distinguishing between different types of brain tissue

Lungs:
• Gives better idea of size of abnormal collections of fluid or diseased tissue
• More subtle conditions may only be detectable by CAT


Abdominal Organs:
• Higher detail effectively distinguishes between types of tissue
• Contrast medium can further improve results


Soft Tissue:
• Small differences in attenuation of X rays are detectable in CAT scans

Gather secondary information to observe a CAT scan image and compare the
information provided by CAT scans to that provided by an X-ray image for the same
body part

The key differences between X ray and CAT images:

• CAT’s are more detailed and may be in 3D

• X rays are almost exclusively of the skeletal system
• CAT’s are in slices, X rays may be from angle
Explain how an endoscope works in relation to total internal reflection and discuss
differences between the role of coherent and incoherent bundles of fibres in an
endoscope

Total internal reflection occurs when light strikes a boundary at an angle of

incidence greater than a critical angle, causing it to reflect from the boundary.

Optical fibers are constructed with a very dense core, so the critical angle is low.
Total internal reflection allows the light to travel through fiber as shown.

This is the basis of how light travels in an endoscope, through bundles of these
fibers.

Coherent bundles retain the transmitted light patterns, and are used to return the
image to the eyepiece/monitor.

Incoherent bundles are used to transmit light into the organ.

Perform a first-hand investigation to demonstrate the transfer of light by optical

fibres and gather secondary information to observe internal organs from images
produced by an endoscope

Our class examined an incoherent bundle of optical fibres.

When a light was shone through the fibres, the light shone through the other end,
even around corners and bends.

Shining multiple colours through the bundle, we observed the colours to be mixed
at the other end.
Explain how an endoscope is used in:
–  observing internal organs

Different types of endoscopes are used for observing different parts of the body.

Colonoscopes are used for examining the large bowel

Arthroscopes are used for examining joints

Bronchoscopes are used for examining the lungs

The endoscope is inserted into the patient via a natural opening or surgical incision.
The examiner then controls the endoscope, maneuvering it to the desired position
to view the required organ or foreign body.

–  obtaining tissue samples of 


internal organs for further testing

Laparascopes are utilised for key hole surgeries, procedures which greatly reduce
recovery times and burdens on the healthcare system.

Endoscopes may be equipped with instrument channels to conduct biopsies. If a

doctor believes further testing on a particular tissue is needed, instruments are fed
through the channel to carefully remove a piece of tissue and remove it from the
body.
3. Radioactivity can be used as a diagnostic tool

Outline properties of radioactive isotopes and their half lives that are used to obtain
scans of organs AND Identify that during decay of specific radioactive nuclei
positrons are given off

Radioactivity is the release of energy or particles by unstable nuclei.

Isotopes are atoms of the same element with different numbers of neutrons.
Radioisotopes are radioactive.

Transmutation involves one element becoming another due to decay or a

chemical reaction.

Atomic Number: Number of protons in an elements nucleus

Mass Number: Total number of nucleons

Alpha Decay

Alpha particles are helium nuclei, two protons and two neutrons, and thus are
positively charged.

Alpha decay causes the element to transmute into an element with a lower atomic
number. It usually occurs for unstable nuclei (atomic number greater than 83)

Alpha particles are highly ionizing, but have a short range and are easily stopped.

Beta Minus Decay

Beta minus decay involves the emission of fast moving electrons. Neutrons are
converted into protons and electrons; the electrons are ejected.

This normally occurs when an element has too many neutrons (the ideal ratio is
approximately 1:1)
Beta Plus Decay

Beta plus decay involves the emission of fast moving positrons. Protons are
converted into neutrons, ejecting a positron.

This normally occurs for elements with too few neutrons.

Beta particles (plus and minus) are not as ionizing as alpha particles, but are harder
to stop and have a longer range.

Gamma Radiation/Decay

Gamma decay involves the emission of pure energy from the nucleus, in the form
of gamma ray photons. The nucleus structure is unchanged.

Gamma decay usually occurs as a result of a prior energy transfer to the atom.

Medical imaging relies on the use of gamma radiation. Thus, gamma emitters are
favoured, followed by Beta emitters. Alpha emitters are too dangerous for medical
use. The most common medical radioisotope is Technetium 99-m.

Half Life

Half life is the time taken for an element to decay to half of it’s original mass, or for
the intensity of it’s radioactivity to halve.

Elements with short half lives are preferred to minimise exposure to the body.
Describe how radioactive isotopes may be metabolised by the body to bind or
accumulate in the target organ

Nuclear medicine encompasses the medical imaging procedures which rely on

radiation.

Radiopharmaceuticals: Radioisotopes which are attached to biological molecules

utilised in bodily processes. This is done to prevent the body recognising the
substance as foreign, and to allow the isotope to accumulate in the target organ.

These substances are usually injected into the body through a vein. They then
accumulate in the desired organ (according to the pharmaceutical). The amount of
accumulation depends on the metabolic activity of the organ.

The isotopes emit gamma radiation which is detected by a gamma camera, a

device which converts the radiation into light flashes and then electrical signals
using the photoelectric effect.

Discuss the interaction of electrons and positrons

resulting in the production of gamma rays

When an electron and positron meet, they annihilate

each other. Their mass is converted into energy in the
form of a gamma ray pair.
Perform an investigation to compare an image of bone scan with an X-ray image

Examining the images above, we can see that an X ray yields greater structural
detail. However, it fails to detect the fracture, which is visible on the nuclear image
due to metabolic activity in the bone.

Gather and process secondary information to compare a scanned image of at least

one healthy body part or organ with a scanned image of its diseased counterpart

In this image, we can see the normal areas of metabolic activity. A dark spot on the
right hip is indicative of cancerous tissue.
Describe how the positron emission tomography (PET) technique is used for
diagnosis

The most positron emitter used in PET is Fluorine 18, and it is usually attached to
glucose to form FDG molecules.

The FDG molecules are injected and accumulate in the target organ, and the
patient is positioned in a gantry surrounded by gamma cameras.

As the radiopharmaceuticals decay, gamma ray pairs are formed due to the
annihilation of positrons and electrons. These are detected, and the time difference
calculated to determine their source. This is combined with intensity data to form
the image.
4. The magnetic field produced by nuclear particles can be used as a
diagnostic tool

Identify that the nuclei of certain atoms and molecules behave as small magnets
AND Identify that protons and neutrons in the nucleus have properties of spin and
describe how net spin is obtained

Sub atomic particles all possess spin; it is a

fundamental quantum property.

The nuclei of certain atoms (odd atomic number or

odd atomic weight) possess net spin, where the
individual spin of protons and neutrons does not
cancel each other out.

Explain that the behaviour of nuclei with a net spin, particularly hydrogen, is related
to the magnetic field they produce

As the nucleus spins, an electric charge is moving, and a tiny magnetic field is
formed. The atom behaves as a small magnet.

Hydrogen nuclei have net spin, and as such, behave as extremely small bar
magnets.
Describe the changes that occur in the orientation of the magnetic axis of nuclei
before and after the application of a strong magnetic field

Normally, the magnetic vectors of nuclei in the body are randomly aligned. They
cancel each other out and produce a net magnetic field of zero.

However, if an external magnetic field is applied, the nuclei align their magnetic
fields. This produces a net magnetic flux.

The nuclei, unlike regular magnets, can align themselves in one of two ways. The
net magnetic field can be in the same direction as the applied field, or the opposite.
This is called parallel and anti parallel alignment.

Anti parallel alignments require a higher energy state than parallel

alignments. Thus, parallel nuclei can be excited into anti parallel states by
absorbing energy, and then return by emitting energy. This is the basis of MRI.
Define precessing and relate the frequency of the precessing to the composition of
the nuclei and the strength of the applied external magnetic field

Precession is the movement where the

rotational axis of a spinning object
revolves around another central axis

The rate of precession depends on the

strength of the magnetic field applied,
and the type of nuclei.

The rate at which the nuclei precess in a

magnetic is called the Larmor
frequency.

Discuss the effect of subjecting precessing nuclei to pulses of radio waves

If an external stimulus with frequency equal to the Larmor frequency is applied to a

precessing nuclei, it resonates, absorbing energy and moving to a higher energy
state. This stimulus is provided in the form of pulses of radio waves.

When the stimulus is removed, the nuclei relax and emit radio waves of the
Larmor frequency.

In MRI, the Larmor frequency of hydrogen specifically is targeted. No other

elements interact with the field.

Explain that the amplitude of the signal given out when precessing nuclei relax is
related to the number of nuclei present

The amplitude of an emitted Larmor frequency signal is related to the

concentration of hydrogen nuclei in the area. More nuclei obviously generate a
stronger signal, as the individual emitted signals constructively superimpose to form
a larger wave output.

Images in an MRI are formed by measuring intensity of incoming radio signals.

To differentiate the location of the signal source, gradient magnetic fields are
used.

Three coils (X, Y and Z) generate gradient fields which interact with the main
solenoid, so that every position in the body is subjected to a slightly different
magnetic field. This means every position in the body will emit a slightly different
radio frequency.

The Z coil dictates slice selection

The Y coil dictates phase encoding.

The X coil dictates frequency encoding.

Each slice consists of 256 x 256 voxels, with each voxel representing a specific
phase and frequency value.
Explain that differences would occur in the relaxation time between tissue
containing hydrogen bound water molecules and those containing other molecules

Differences in relaxation time allow an MRI to differentiate between tissues, based

on hydrogen content.

As nuclei are subjected to external stimuli and resonate, their net magnetization
vector (M) shifts from parallel to the field, to perpendicular, as parallel alignments
are converted to anti parallel alignments.

This is called transverse magnetization. Relaxation is based on changes to

this M vector.

T1 Relaxation

T1 relaxation is related to the return of the M vector to it’s original position.

Specifically, T1 relaxation time is the time taken for the M vector to return to 63
percent of it’s original value.

This is called spin lattice relaxation, as nuclei dissipate their energy to the lattice.

Large molecules and bound water molecules have a shorter T1 relaxation time than
freely bound water molecules.
T2 Relaxation

T2 relaxation is related to the coherency and phase of the precession of the nuclei.

As the M vector returns to it’s original position, the coherency is lost and the
induced MR signals begin to decay. T2 relaxation time is the time taken for the
nuclei to decay to 37 percent of their initial precession coherence.

This is called spin spin relaxation, as nuclei transfer their energy to other
precessing nuclei.

Large molecules have a shorter T2 relaxation time than free water.

These two relaxations occur simultaneously

T1 and T2 Weighted Images

Repetition Time (TR): Elapsed time between pulses of radio waves

Echo Delay Time (TE): Time delay between the sending of radio waves and
measurement of emitted signals

T1 weighted images enhance tissues with a short T1 by shortening repetition time,

maximizing their opportunity to absorb energy.

T2 weighted images enhance tissues with a long T2, by lengthening the echo
delay time so only tissues with long T2 remain in phase.
Gather and process secondary information to identify the function of the
electromagnet, radio frequency oscillator, radio receiver and computer in the MRI
equipment

Electromagnets
• Electromagnets in MRI’s use superconductive materials, limiting heat loss and
improving efficiency
• A primary solenoid produces a strong magnetic field between 1 and 2 teslas.
• Less powerful coils produce gradient fields

Radio Frequency Oscillator

• Produces radio waves of the required Larmor frequency to interact with
precessing nuclei

Radio Receiver
• A set of coils which use the emitted radio signals to create electrical currents,
digitised for analysis by a computer

Computer
• Controls the function of all other aspects of the MRI scanner
• Analyses the gathered data to produce the desired image with the desired
weighting

Identify data sources, gather, process and present information using available
evidence to explain why MRI scans can be used to:
–  detect cancerous tissues

Cancerous tissues contain hydrogen atoms with different relaxation times than the
surrounding tissue. Thus, they can be visualised on an MRI. They may also have a
larger hydrogen content and can be enhanced with contrast mediums.

–  identify areas of high blood flow

Magnetic resonance angiograms (MRA’s) can be achieved by two methods.

Time of flight MRA involves pre saturating tissue and blood with radio waves, and
then reconstructing blood vessels.

Phase contrast MRA detects phase shifts due to the movement of blood through
high activity areas.

–  distinguish between grey and white matter in the brain

Grey and white matter in the brain, while structurally identical, have different
hydrogen concentrations. Thus, they can be differentiated on an MRI.
Perform an investigation to observe images from magnetic resonance image (MRI)
scans, including a comparison of healthy and damaged tissue

MRI images can be distinguished by their extreme detail.

In the images below, the right image shows a loss of differentiation between white
and grey matter. This could indicate a stroke.
Gather, analyse information and use available evidence to assess the impact of
medical applications of physics on society

Economic
• Shorter recovery times allow patients • Expensive treatments (EG: MRI)
to return to work sooner (EG- accentuate class divisions, some
keyhole surgeries) health services are restricted to the
• New avenues of research create wealthy
employment opportunities (EG- PET • Facilities are expensive (EG: MRI’s
and nuclear development facilities) cost millions of dollars to install
• Cost of treatment is minimised and maintain) and drain medical
• More effective diagnosis reduces budgets. Also expensive to maintain
strain on healthcare system

Health and Wellbeing

• More effective treatments (EG- X • Treatments run risks (EG- endoscopy
rays combatting tuberculosis) can risk damage to internal organs)
improve wellbeing of general society • Ionising radiation increases risk of
• This in turn increases reproductive developing cancer, particularly CAT
capacity and population growth and PET
• Patient comfort normally improved • Contributes to “aging population” crisis
• Increased medical knowledge from • Some treatments not suitable for
PET and MRI has improved our certain individuals (EG- MRI is
response to emerging crises claustrophobic)

Also ethical implications involving abortion and euthanasia, and X ray

crystallography linked to genetic engineering.

Identify data sources, gather and process information to compare the advantages
and disadvantages of X-rays, CAT scans, PET scans and MRI scans

X Rays:
• Cheap, fast, accessible and painless, but exposes to ionising radiation
• High resolution, but only useful for high density objects such as bones
CAT:
• Detailed and versatile, but highly ionizing and more expensive than X rays
• However, still cheaper than MRI and can construct 3D images
PET:
• Non invasive, painless, and allows view of bodily function not just structure
• However, highly ionising and very expensive
MRI:
• Extremely detailed, versatile, and highly advanced with no ionising radiation
• However, extremely expensive and can induce claustrophobia