A Primer on Imaging Anatomy and Physiology

  • Denise Aberle
  • Suzie El-saden
  • Pablo Abbona
  • Ana Gomez
  • Kambiz Motamedi
  • Nagesh Ragavendra
  • Lawrence Bassett
  • Leanne Seeger
  • Matthew Brown
  • Kathleen Brown
  • Alex A. T. Bui
  • Hooshang Kangarloo


An understanding of medical imaging informatics begins with knowledge of medical imaging and its application toward diagnostic and therapeutic clinical assessment. This chapter is divided into two sections: a review of current imaging modalities; and a primer on imaging anatomy and physiology. In the first half, we introduce the major imaging modalities that are in use today: projectional imaging, computed tomography, magnetic resonance, and ultrasound. The core physics concepts behind each modality; the parameters and algorithms driving image formation; and variants and newer advances in each of these areas are briefly covered to familiarize the reader with the capabilities of each technique. From this foundation, in the second half of the chapter we describe several anatomical and physiologic systems from the perspective of imaging. Three areas are covered in detail: 1) the respiratory system; 2) the brain; and 3) breast imaging. Additional coverage of musculoskeletal, cardiac, urinary, and upper gastrointestinal systems is included. Each anatomical section begins with a general description of the anatomy and physiology, discusses the use of different imaging modalities, and concludes with a description of common medical problems/conditions and their appearance on imaging. From this chapter, the utility of imaging and its complexities becomes apparent and will serve to ground discussion in future chapters.


Cerebral Spinal Fluid Blood Oxygenation Level Dependent Compute Radiography Compute Tomography Perfusion Magnetic Resonance Signal 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    (2002) American Thoracic Society/European Respiratory Society International Multi¬disciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias. This joint statement of the American Thoracic Society (ATS), and the European Respiratory Society (ERS) was adopted by the ATS board of directors, June 2001 and by the ERS Executive Committee, June 2001. Am J Respir Crit Care Med, 165(2):277-304.Google Scholar
  2. 2.
    Adler LP, Crowe JP, al-Kaisi NK, Sunshine JL (1993) Evaluation of breast masses and axillary lymph nodes with [F-18] 2-deoxy-2-fluoro-D-glucose PET. Radiology, 187(3):743-750.Google Scholar
  3. 3.
    American College of Radiology (ACR) (1994) Clinical Practice Guideline for the Performance of Diagnostic Mammography and Problem-solving Breast Evaluation.Google Scholar
  4. 4.
    American College of Radiology (ACR) (1994) Standards for the Performance of Screening Mammography.Google Scholar
  5. 5.
    American College of Radiology (ACR) (2003) Breast Imaging Reporting and Data Systems (BI-RADS), 3rd ed.Google Scholar
  6. 6.
    Aziz ZA, Wells AU, Desai SR, Ellis SM, Walker AE, MacDonald S, Hansell DM (2005) Functional impairment in emphysema: Contribution of airway abnormalities and distribution of parenchymal disease. AJR Am J Roentgenol, 185(6):1509-1515.CrossRefGoogle Scholar
  7. 7.
    Barrett JF, Keat N (2004) Artifacts in CT: Recognition and avoidance. RadioGraphics, 24(6):1679-1691.CrossRefGoogle Scholar
  8. 8.
    Bassett LW, Hendrick RE, Bassford TL (1994) Quality Determinants of Mammography: Clinical Practice Guideline No. 13 (AHCPR 95-0632). Agency for Health Care Policy and Research, US Dept Health and Human Services.Google Scholar
  9. 9.
    Berg WA, Blume JD, Cormack JB, Mendelson EB, Lehrer D, Bohm-Velez M, Pisano ED, Jong RA, Evans WP, Morton MJ, Mahoney MC, Larsen LH, Barr RG, Farria DM, Marques HS, Boparai K (2008) Combined screening with ultrasound and mammography vs. mammography alone in women at elevated risk of breast cancer. JAMA, 299(18):2151-2163.CrossRefGoogle Scholar
  10. 10.
    Berger P, Perot V, Desbarats P, Tunon-de-Lara JM, Marthan R, Laurent F (2005) Airway wall thickness in cigarette smokers: Quantitative thin-section CT assessment. Radiology, 235(3):1055-1064.CrossRefGoogle Scholar
  11. 11.
    Bitar R, Leung G, Perng R, Tadros S, Moody AR, Sarrazin J, McGregor C, Christakis M, Symons S, Nelson A, Roberts TP (2006) MR pulse sequences: What every radiologist wants to know but is afraid to ask. Radiographics, 26(2):513-537.CrossRefGoogle Scholar
  12. 12.
    Brem RF, Floerke AC, Rapelyea JA, Teal C, Kelly T, Mathur V (2008) Breast-specific gamma imaging as an adjunct imaging modality for the diagnosis of breast cancer. Radio¬logy, 247(3):651-657.Google Scholar
  13. 13.
    Brem RF, Petrovitch I, Rapelyea JA, Young H, Teal C, Kelly T (2007) Breast-specific gamma imaging with 99mTc-Sestamibi and magnetic resonance imaging in the diagnosis of breast cancer–a comparative study. Breast J, 13(5):465-469.CrossRefGoogle Scholar
  14. 14.
    Buchberer W, Niehoff A, Obrist P, et al. (2002) Clinically and mammographically occult breast lesions: Detection and classification with high resolution sonography. Semin Ultrasound CT MR, 21:325-336.CrossRefGoogle Scholar
  15. 15.
    Bushberg JT, Seibert JA, Leidholdt Jr EM, Boone JM (2002) The Essential Physics of Medical Imaging. 2nd edition. Lippincott Williams & Wilkins, Philadelphia, PA.Google Scholar
  16. 16.
    Buxton RB (2002) Introduction to Functional Magnetic Resonance Imaging: Principles and Techniques. Cambridge University Press, New York, NY.Google Scholar
  17. 17.
    Chotas HG, Dobbins JT, III, Ravin CE (1999) Principles of digital radiography with large-area, electronically readable detectors: A review of the basics. Radiology, 210(3):595-599.Google Scholar
  18. 18.
    Crystal P, Strano SD, Shcharynski S, Koretz MJ (2003) Using sonography to screen women with mammographically dense breasts. AJR Am J Roentgenol, 181(1):177-182.Google Scholar
  19. 19.
    Curry TS, Dowdey JE, Murry RC, Christensen EE (1990) Christensen's physics of diagnostic radiology. 4th edition. Lea & Febiger, Philadelphia, PA.Google Scholar
  20. 20.
    De Bazelaire C, Rofsky NM, Duhamel G, Michaelson MD, George D, Alsop DC (2005) Arterial spin labeling blood flow magnetic resonance imaging for the characterization of metastatic renal cell carcinoma. Academic Radiology, 12(3):347-357.CrossRefGoogle Scholar
  21. 21.
    de Jong PA, Muller NL, Pare PD, Coxson HO (2005) Computed tomographic imaging of the airways: Relationship to structure and function. Eur Respir J, 26(1):140-152.CrossRefGoogle Scholar
  22. 22.
    Donald I, Macvicar J, Brown TG (1958) Investigation of abdominal masses by pulsed ultrasound. Lancet, 1(7032):1188-1195.CrossRefGoogle Scholar
  23. 23.
    Eastwood JD, Lev MH, Provenzale JM (2003) Perfusion CT with iodinated contrast material. Am J Roentgenol, 180(1):3-12.Google Scholar
  24. 24.
    Fanta CH (2009) Asthma. N Engl J Med, 360(10):1002-1014.CrossRefGoogle Scholar
  25. 25.
    Flohr T, McCollough C, Bruder H, Petersilka M, Gruber K, Süß C, Grasruck M, Stierstorfer K, Krauss B, Raupach R, Primak A, Küttner A, Achenbach S, Becker C, Kopp A, Ohnesorge B (2006) First performance evaluation of a dual-source CT (DSCT) system. European Radio¬logy, 16(2):256-268.CrossRefGoogle Scholar
  26. 26.
    Fornage BD, Lorigan JG, Andry E (1989) Fibroadenoma of the breast: Sonographic appearance. Radiology, 172(3):671-675.Google Scholar
  27. 27.
    Gietema HA, Schilham AM, van Ginneken B, van Klaveren RJ, Lammers JW, Prokop M (2007) Monitoring of smoking-induced emphysema with CT in a lung cancer screening setting: Detection of real increase in extent of emphysema. Radiology, 244(3):890-897.CrossRefGoogle Scholar
  28. 28.
    Gold RH, Montgomery CK, Rambo ON (1973) Significance of margination of benign and malignant infiltrative mammary lesions: Roentgenologic-pathologic correlation. AJR Am J Roentgenol, 118:881-894.Google Scholar
  29. 29.
    Gordon PB, Goldenberg SL (1995) Malignant breast masses detected only by ultrasound. A retrospective review. Cancer, 76(4):626-630.CrossRefGoogle Scholar
  30. 30.
    Guyton AC (1987) Basic Neuroscience: Anatomy and Physiology. Saunders, Philadelphia, PA.Google Scholar
  31. 31.
    Hagmann P, Jonasson L, Maeder P, Thiran J-P, Wedeen VJ, Meuli R (2006) Understanding diffusion MR imaging techniques: From scalar diffusion-weighted imaging to diffusion tensor imaging and beyond. RadioGraphics, 26(S1):S205-223.CrossRefGoogle Scholar
  32. 32.
    Hall FM, Storella JM, Silverstone DZ, Wyshak G (1988) Nonpalpable breast lesions: Recommendations for biopsy based on suspicion of carcinoma at mammography. Radio¬logy, 167(2):353-358.Google Scholar
  33. 33.
    Hamper UM, DeJong MR, Caskey CI, Sheth S (1997) Power Doppler imaging: Clinical experience and correlation with color Doppler US and other imaging modalities. RadioGraphics, 17(2):499-513.Google Scholar
  34. 34.
    Harvey CJ, Pilcher JM, Eckersley RJ, Blomley MJ, Cosgrove DO (2002) Advances in ultrasound. Clin Radiol, 57(3):157-177.CrossRefGoogle Scholar
  35. 35.
    Hasegawa M, Nasuhara Y, Onodera Y, Makita H, Nagai K, Fuke S, Ito Y, Betsuyaku T, Nishimura M (2006) Airflow limitation and airway dimensions in chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 173(12):1309-1315.CrossRefGoogle Scholar
  36. 36.
    Hendee WR, Ritenour ER (2002) Medical Imaging Physics. 4th edition. Wiley-Liss, New York, NY.Google Scholar
  37. 37.
    Hounsfield GN (1973) Computerized transverse axial scanning (tomography): Part 1, Description of system. Br J Radiol, 46(552):1016-1022.CrossRefGoogle Scholar
  38. 38.
    Hsieh J (2003) Image artifacts: Appearances, causes, and corrections. Computed Tomography: Principles, Design, Artifacts and Recent Advances. SPIE Press.Google Scholar
  39. 39.
    Huang HK (1987) Elements of Digital Radiography: A Professional Handbook and Guide. Prentice-Hall, Inc.Google Scholar
  40. 40.
    Jackson VP, Bassett LW (1990) Stereotactic fine-needle aspiration biopsy for nonpalpable breast lesions. AJR Am J Roentgenol, 154(6):1196-1197.Google Scholar
  41. 41.
    Jerosch-Herold M, Muehling O, Wilke N (2006) MRI of myocardial perfusion. Seminars in Ultrasound, CT, and MRI, 27(1):2-10.CrossRefGoogle Scholar
  42. 42.
    Johnson TRC (2009) Dual-energy CT – Technical background. Multislice CT, pp 65-73.Google Scholar
  43. 43.
    Kak AC, Slaney M (2001) Algebraic reconstruction algorithms. Principles of Computerized Tomographic Imaging. Society for Industrial and Applied Mathematics (SIAM), Philadelphia, PA.Google Scholar
  44. 44.
    Kaplan SS (2001) Clinical utility of bilateral whole-breast US in the evaluation of women with dense breast tissue. Radiology, 221(3):641-649.CrossRefGoogle Scholar
  45. 45.
    Kato T, Inubushi T, Kato N (1998) Magnetic resonance spectroscopy in affective disorders. J Neuropsychiatry Clin Neurosci, 10(2):133-147.Google Scholar
  46. 46.
    Katz DS, Hon M (2005) Multidetector-row CT angiography: Evolution, current usage, clinical perspectives and comparison with other imaging modalities. In: Catalano C, Passariello R (eds) Multidetector-row CT Angiography. Springer.Google Scholar
  47. 47.
    Khalkhali I, Mena I, Jouanne E, Diggles L, Venegas R, Block J, Alle K, Klein S (1994) Prone scintimammography in patients with suspicion of carcinoma of the breast. J Am Coll Surg, 178(5):491-497.Google Scholar
  48. 48.
    Koenig M, Klotz E, Luka B, Venderink DJ, Spittler JF, Heuser L (1998) Perfusion CT of the brain: Diagnostic approach for early detection of ischemic stroke. Radiology, 209(1):85-93.Google Scholar
  49. 49.
    Kolb TM, Lichy J, Newhouse JH (1998) Occult cancer in women with dense breasts: Detection with screening US - Diagnostic yield and tumor characteristics. Radiology, 207(1):191-199.Google Scholar
  50. 50.
    Korner M, Weber CH, Wirth S, Pfeifer K-J, Reiser MF, Treitl M (2007) Advances in digital radiography: Physical principles and system overview. RadioGraphics, 27(3):675-686.CrossRefGoogle Scholar
  51. 51.
    Kung HC, Hoyert DL, Xu J, Murphy S (2008) Deaths: Final data for 2005. National Vital Statistics Reports, 56(10):1-121.Google Scholar
  52. 52.
    Lehman CD, Isaacs C, Schnall MD, Pisano ED, Ascher SM, Weatherall PT, Bluemke DA, Bowen DJ, Marcom PK, Armstrong DK, Domchek SM, Tomlinson G, Skates SJ, Gatsonis C (2007) Cancer yield of mammography, MR, and US in high-risk women: Prospective multi-institution breast cancer screening study. Radiology, 244(2):381-388.CrossRefGoogle Scholar
  53. 53.
    Lencioni R, Cioni D, Bartolozzi C (2002) Tissue harmonic and contrast-specific imaging: Back to gray scale in ultrasound. Eur Radiol, 12(1):151-165.CrossRefGoogle Scholar
  54. 54.
    Logothetis NK (2008) What we can do and what we cannot do with fMRI. Nature, 453(7197):869-878.CrossRefGoogle Scholar
  55. 55.
    Lufkin RF (1998) The MRI Manual. Mosby, St. Louis, MO.Google Scholar
  56. 56.
    Lynch DA, Travis WD, Muller NL, Galvin JR, Hansell DM, Grenier PA, King TE, Jr. (2005) Idiopathic interstitial pneumonias: CT features. Radiology, 236(1):10-21.CrossRefGoogle Scholar
  57. 57.
    Mayer TE, Hamann GF, Baranczyk J, Rosengarten B, Klotz E, Wiesmann M, Missler U, Schulte-Altedorneburg G, Brueckmann HJ (2000) Dynamic CT perfusion imaging of acute stroke. AJNR Am J Neuroradiol, 21(8):1441-1449.Google Scholar
  58. 58.
    McLelland R, Hendrick RE, Zinninger MD, Wilcox PA (1991) The American College of Radiology Mammography Accreditation Program. AJR Am J Roentgenol, 157(3):473-479.Google Scholar
  59. 59.
    McNitt-Gray MF (2002) AAPM/RSNA Physics tutorial for residents: Topics in CT: Radiation dose in CT. RadioGraphics, 22(6):1541-1553.CrossRefGoogle Scholar
  60. 60.
    Middleton WD, Kurtz AB, Hertzberg BS (eds) (2004) Ultrasound, The Requisites. Mosby St. Louis, MO.Google Scholar
  61. 61.
    Moskowitz M (1983) The predictive value of certain mammographic signs in screening for breast cancer. Cancer, 51(6):1007-1011.CrossRefGoogle Scholar
  62. 62.
    Mueller-Mang C, Grosse C, Schmid K, Stiebellehner L, Bankier AA (2007) What every radio¬logist should know about idiopathic interstitial pneumonias. Radiographics, 27(3):595-615.CrossRefGoogle Scholar
  63. 63.
    National Heart Lung and Blood Institute (NHLBI) (2007) What are congenital heart defects? National Institutes of Health. Accessed January 26, 2009.
  64. 64.
    Parker SH, Lovin JD, Jobe WE, Luethke JM, Hopper KD, Yakes WF, Burke BJ (1990) Stereotactic breast biopsy with a biopsy gun. Radiology, 176(3):741-747.Google Scholar
  65. 65.
    Passe TJ, Charles HC, Rajagopalan P, Krishnan KR (1995) Nuclear magnetic resonance spectroscopy: A review of neuropsychiatric applications. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 19(4):541-563.CrossRefGoogle Scholar
  66. 66.
    Ragavendra N, Ju J, Sayre JW, Hirschowitz S, Chopra I, Yeh MW (2008) In vivo analysis of fracture toughness of thyroid gland tumors. J Biol Eng, 2:12.CrossRefGoogle Scholar
  67. 67.
    Rahbar G, Sie AC, Hansen GC, Prince JS, Melany ML, Reynolds HE, Jackson VP, Sayre JW, Bassett LW (1999) Benign versus malignant solid breast masses: US differentiation. Radiology, 213(3):889-894.Google Scholar
  68. 68.
    Rubin GD, Shiau MC, Leung AN, Kee ST, Logan LJ, Sofilos MC (2000) Aorta and iliac arteries: Single versus multiple detector-row helical CT angiography. Radiology, 215(3):670-676.Google Scholar
  69. 69.
    Rumack CM, Wilson SR, Charboneau JW, Johnson JAM (2005) Diagnostic Ultrasound. 3rd edition. Elsevier Mosby, St. Louis, MO.Google Scholar
  70. 70.
    Sanders RC (ed) (1997) Clinical Sonography: A Practical Guide. Lippincott Williams & Wilkins Philadelphia, PA.Google Scholar
  71. 71.
    Saslow D, Boetes C, Burke W, Harms S, Leach MO, Lehman CD, Morris E, Pisano E, Schnall M, Sener S, Smith RA, Warner E, Yaffe M, Andrews KS, Russell CA (2007) American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin, 57(2):75-89.CrossRefGoogle Scholar
  72. 72.
    Schwartz GF, Guiliano AE, Veronesi U (2002) Proceeding of the consensus conference of the role of sentinel lymph node biopsy in carcinoma or the breast April 19-22, 2001, Philadelphia, PA, USA. Breast J, 8(3):124-138.Google Scholar
  73. 73.
    Sharafkhaneh A, Hanania NA, Kim V (2008) Pathogenesis of emphysema: From the bench to the bedside. Proc Am Thorac Soc, 5(4):475-477.CrossRefGoogle Scholar
  74. 74.
    Sibtain NA, Howe FA, Saunders DE (2007) The clinical value of proton magnetic resonance spectroscopy in adult brain tumours. Clinical Radiology, 62(2):109-119.CrossRefGoogle Scholar
  75. 75.
    Silver MD, Taguchi K, Hein IA, Chiang B, Kazama M, Mori I (2003) Windmill artifact in multislice helical CT. Medical Imaging 2003: Image Processing,vol 5032. SPIE, San Diego, CA, USA, pp 1918-1927.Google Scholar
  76. 76.
    Stavros AT, Thickman D, Rapp CL, Dennis MA, Parker SH, Sisney GA (1995) Solid breast nodules: Use of sonography to distinguish between benign and malignant lesions. Radiology, 196(1):123-134.Google Scholar
  77. 77.
    Tabar L, Fagerberg CJ, Gad A, Baldetorp L, Holmberg LH, Grontoft O, Ljungquist U, Lundstrom B, Manson JC, Eklund G, et al. (1985) Reduction in mortality from breast cancer after mass screening with mammography: Randomised trial from the Breast Cancer Screening Working Group of the Swedish National Board of Health and Welfare. Lancet, 1(8433):829-832.CrossRefGoogle Scholar
  78. 78.
    Taraseviciene-Stewart L, Voelkel NF (2008) Molecular pathogenesis of emphysema. J Clin Invest, 118(2):394-402.CrossRefGoogle Scholar
  79. 79.
    Thomas M, Lange T, Velan S, Nagarajan R, Raman S, Gomez A, Margolis D, Swart S, Raylman R, Schulte R, Boesiger P (2008) Two-dimensional MR spectroscopy of healthy and cancerous prostates in vivo. Magnetic Resonance Materials in Physics, Biology and Medicine, 21(6):443-458.CrossRefGoogle Scholar
  80. 80.
    Thomas MA, Huda A, Guze B, Curran J, Bugbee M, Fairbanks L, Ke Y, Oshiro T, Martin P, Fawzy F (1998) Cerebral 1H MR spectroscopy and neuropsychologic status of patients with hepatic encephalopathy. AJR Am J Roentgenol, 171(4):1123-1130.Google Scholar
  81. 81.
    Thomas MA, Ke Y, Levitt J, Caplan R, Curran J, Asarnow R, McCracken J (1998) Preliminary study of frontal lobe 1H MR spectroscopy in childhood-onset schizophrenia. J Magn Reson Imaging, 8(4):841-846.CrossRefGoogle Scholar
  82. 82.
    Tolmos J, Cutrone JA, Wang B, Vargas HI, Stuntz M, Mishkin FS, Diggles LE, Venegas RJ, Klein SR, Khalkhali I (1998) Scintimammographic analysis of nonpalpable breast lesions previously identified by conventional mammography. J Natl Cancer Inst, 90(11):846-849.CrossRefGoogle Scholar
  83. 83.
    Ulzheimer S, Flohr T (2009) Multislice CT: Current technology and future developments. Multislice CT, pp 3-23.Google Scholar
  84. 84.
    Weiller C, May A, Sach M, Buhmann C, Rijntjes M (2006) Role of functional imaging in neurological disorders. J Magnetic Resonance Imaging, 23(6):840-850.CrossRefGoogle Scholar
  85. 85.
    Weishaupt D, Köchli VD, Marincek B (2006) How does MRI work? An Introduction to the Physics and Function of Magnetic Resonance Imaging. 2nd edition. Springer, Berlin, Germany.Google Scholar
  86. 86.
    Wong EC, Cronin M, Wu WC, Inglis B, Frank LR, Liu TT (2006) Velocity-selective arterial spin labeling. Magnetic Resonance in Medicine, 55(6):1334-1341.CrossRefGoogle Scholar
  87. 87.
    Wouters EF, Groenewegen KH, Dentener MA, Vernooy JH (2007) Systemic inflammation in chronic obstructive pulmonary disease: The role of exacerbations. Proc Am Thorac Soc, 4(8):626-634.CrossRefGoogle Scholar
  88. 88.
    Yaffe MJ, Rowlands JA (1997) X-ray detectors for digital radiography. Phys Med Biol, 42(1):1-39.CrossRefGoogle Scholar
  89. 89.
    Zavaletta VA, Bartholmai BJ, Robb RA (2007) High resolution multidetector CT-aided tissue analysis and quantification of lung fibrosis. Acad Radiol, 14(7):772-787.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Denise Aberle
    • 1
  • Suzie El-saden
    • 2
  • Pablo Abbona
    • 3
  • Ana Gomez
    • 3
  • Kambiz Motamedi
    • 3
  • Nagesh Ragavendra
    • 3
  • Lawrence Bassett
    • 3
  • Leanne Seeger
    • 3
  • Matthew Brown
    • 4
  • Kathleen Brown
    • 3
  • Alex A. T. Bui
    • 5
  • Hooshang Kangarloo
    • 6
  1. 1.Medical Imaging Informatics & Department of Radiological SciencesUCLA David Geffen School of MedicineLos AngelesUSA
  2. 2.Department of RadiologyVeteran’s Administration WadsworthLos AngelesUSA
  3. 3.Department of Radiological SciencesUCLA David Geffen School of MedicineLos AngelesUSA
  4. 4.Thoracic Imaging Laboratory & Department of Radiological SciencesUCLA David Geffen School of MedicineLos AngelesUSA
  5. 5.Medical Imaging Informatics Group Department of Radiological SciencesDavid Geffen School of Medicine University of California, Los AngelesLos AngelesUSA
  6. 6.Medical Imaging InformaticsUCLA David Geffen School of MedicineLos AngelesUSA

Personalised recommendations