UNIT-4 Thermal imaging& other techniques

B.Tech (ECE, ME, CSE, IT) 3rd Year

Open Elective Subject –MIT Notes

Defination of Fluoroscopy: Fluoroscopy is a technique for obtaining "live" X-ray images of a

living patient - it is like an X-ray TV camera. The Radiologist uses a switch to control an X-Ray
beam that is transmitted through the patient. The X-rays then strike a fluorescent plate that is
coupled to an "image intensifier" that is (in turn) coupled to a television camera. The Radiologist
can then watch the images "live" on a TV monitor. Fluoroscopy is also used during many
diagnostic and therapeutic Radiologic procedures, to observe the action of instruments being
used either to diagnose or to treat the patient.

Components or Block Diagram of Fluoroscopy:

Figure 1: Schematic Diagram of a fluoroscopic system using an X-ray image intensifier (XRII)
and video camera

The key components include an X-ray tube, spectral shaping filters, a field restriction device (aka
collimator), an anti-scatter grid, an image receptor, an image processing computer and a display
device. Ancillary but necessary components include a high-voltage generator, a patient-support
device (table or couch) and hardware to allow positioning of the X-ray source assembly and the
image receptor assembly relative to the patient.

a) X-Ray Source: The high-voltage generator and X-ray tube used in most fluoroscopy
systems is similar in design and construction to tubes used for general radiographic
applications. For special purpose rooms such as those used for cardiovascular imaging,
 extra heat capacity is needed to allow angiographic “runs,” sequences of higher-dose
radiographic images acquired in rapid succession to visualize opacified vessels. These
runs are often interspersed with fluoroscopic imaging in a diagnostic or interventional
procedure and the combination can result in a high demand on the X-ray tube. Special X-
ray tubes are generally found in such systems. Focal spot sizes in fluoroscopic tubes can
be as small as 0.3 mm (when high spatial resolution is required but low radiation output
can be tolerated) and as large as 1.0 or 1.2 mm when higher power is needed. The
radiation output can be either continuous or pulsed, with pulsed being more common in
modern systems. Automatic exposure rate control maintains the radiation dose per frame
at a predetermined level, adapting to the attenuation characteristics of the patients’
anatomy and maintaining a consistent level of image quality throughout the examination

b) Beam Filtration: It is common for fluoroscopic imaging systems to be equipped with

beam hardening filters between the X-ray tube exit port and the collimator. Added
aluminum and/or copper filtration can reduce skin dose at the patient’s entrance surface,
while a low kVp produces a spectral shape that is well-matched to the barium or iodine k-
edge for high contrast in the anatomy of interest. Insertion of this added filtration in the
beam path may be user-selectable, providing the operator with the flexibility to switch
between low dose and higher dose modes as conditions dictate during a fluoroscopic
procedure. In other systems the added filtration is automatic, based on beam attenuation
conditions, to achieve a desired level of image quality and dose savings. In addition to
beam shaping filters, many fluoroscopy systems have “wedge” filters that are partially
transparent to the X-ray beam. These moveable filters attenuate the beam in regions
selected by the operator to reduce entrance dose and excessive image brightness.

c) Collimation: Shutters that limit the geometric extent of the X-ray field are present in all
X-ray equipment. In fluoroscopy, the collimation may be circular or rectangular in shape,
matching the shape of the image receptor. When the operator selects a field of view, the
collimator blade positions automatically move under motor control to be just a bit larger
than the visible field. When the source-to-image distance (SID) changes, the collimator
blades adjust to maintain the field of view and minimize “spillover” radiation outside of
the visible area. This automatic collimation exists in both circular and rectangular field of
view systems.

d) Patient Table and Pad: Patient tables must provide strength to support patients and are
rated by the manufacturer for a particular weight limit. It is important that the table not
absorb much radiation to avoid shadows, loss of signal and loss of contrast in the image.
Carbon fiber technology offers a good combination of high strength and minimal radiation
absorption, making it an ideal table material. Foam pads are often placed between the
patient and the table for added comfort, yet with minimal radiation absorption.

e) Anti-Scatter Grid: Anti-scatter grids are standard components in fluoroscopic systems,

since a large percentage of fluoroscopic examinations are performed in high-scatter
conditions, such as in the abdominal region. Typical grid ratios range from 6:1 to 10:1.
Grids may be circular (XRII systems) or rectangular (FPD systems) and are often
removable by the operator.
 f) Image Receptor(X-Ray Image Intensifier i.e. (XRII): The X-ray image intensifier
(Figure 2) is an electronic device that converts the X-ray beam intensity pattern (aka, the
“remnant beam”) into a visible image suitable for capture by a video camera and displayed
on a video display monitor. The key components of an XRII are an input phosphor layer, a
photocathode, electron optics and an output phosphor. The cesium iodide (CsI) input
phosphor coverts the X-ray image into a visible light image, much like the original
fluoroscope. The photocathode is placed in close proximity to the input phosphor, and it
releases electrons in direct proportion to the visible light from the input phosphor that is
incident on its surface. The electrons are steered, accelerated and multiplied in number by
the electron optic components, and finally impinge upon a surface coated with a phosphor
material that glows visibly when struck by high-energy electrons. This is the output
phosphor of the XRII.

In principle, one could directly observe the intensified image on the small (1” diameter)
output phosphor, but in practice a video camera is optically coupled to this phosphor
screen through an adjustable aperture and lens. The video signal is then displayed directly
(or digitized), post-processed in a computer and rendered for display.

Figure 2: Components of an X-ray image intensifier

The XRII achieves orders of magnitude more light per X-ray photon than a simple fluorescent
screen. This occurs through electronic gain (amplification by the electron optics) and
minification gain (concentrating the information from a large input surface area to a small output
phosphor area) as shown in Figure 2. This allows relatively high image quality (signal-to-noise
ratio) at modest dose levels compared with non-intensified fluoroscopy. The use of video
technology added an important convenience factor it allows several people to observe the image
simultaneously and offers the ability to record and post-process fluoroscopic image sequences.
Image intensifiers are available in a variety of input diameters, ranging from about 10–15 cm up
to 40 cm. The input surface is always circular and curved, a design characteristic of the vacuum
tube technology from which it is constructed. The video cameras used in XRII systems were
originally vidicon or plumbicon analog devices borrowed from the broadcast television industry.
In later systems, digital cameras based on charge-coupled device (CCD) image sensors or
complementary metal oxide semiconductor (CMOS) technology came into common use.
g) Image Receptor (Flat Panel Detector): In recent years we have seen the introduction of
fluoroscopic systems in which the XRII and video camera components are replaced by a
“flat panel detector” (FPD) assembly. When flat panel X-ray detectors first appeared in
radiography, they offered the advantages of a “digital camera” compared with existing
technologies. In fluoroscopic applications, the challenge for FPDs has been the
requirement of low dose per image frame, meaning that the inherent electronic noise of the
detector must be extremely low, and the required dynamic range is high. It has proven to
be quite difficult to manufacture FPDs with electronic noise characteristics low enough to
achieve good signal-to-noise ratio (SNR) under low exposure conditions, yet such devices
do now exist. Flat panel detectors are more physically compact than XRII/video systems,
allowing more flexibility in movement and patient positioning. However, the most
important benefit of the FPD is that it does not suffer from the many inherent limitations
of the XRII, including geometric “pin-cushion” distortion, “S” distortion, veiling glare
(glare extending from very bright areas) and igniting (loss of brightness at periphery).
These phenomena simply do not occur in FPDs. FPDs often have wider dynamic range
than some XRII/video systems. Another advantage of FPDs is that the image receptor’s
spatial resolution is defined primarily by the detector element size, and unlike the
XRII/video, is independent of the field of view. In XRII systems, the minification gain
requires the entrance dose to vary inversely with field-of-view to maintain a constant
brightness at the output phosphor. No such constraint exists for FPDs; the entrance
detector dose is independent of the field of view. Flat panel detectors consist of an array
of individual detector elements. The elements are square, 140–200 microns per side and
are fabricated using amorphous silicon thin-film technology onto glass substrates.
Detector arrays used for fluoroscopy range from about 20 x 20 cm up to 40 x 30 cm. A
single detector may contain as many as 5 million individual detector elements. A cesium
iodide (CsI) scintillation layer is coated onto the amorphous silicon, with thin-film
photodiodes and transistors capturing the visible light signal from the scintillator to form
the digital image, which is then transferred to a computer at a frame rate selected by the
user (Figure 3). Frame rates can be as high as 30 frames per second.

Figure 3: Cross-section of flat panel detector for fluoroscopic imaging

h) Image Display: Fluoroscopy requires high-quality video displays that allow users to
appreciate fine details and subtle contrast differences in the anatomy of interest. Medical
image display technology has been fortunate to “ride on the coattails” of the television
industry over the last several years. Modern systems feature high resolution flat-panel
LCDs with high maximum luminance and high-contrast ratios. These displays should be
calibrated to a standard luminance response function (such as the DICOM part 14
Grayscale Standard Display Function) to ensure that the widest range of gray levels are
visible. The newest interventional/angiographic systems feature 60” diagonal high-
 definition displays supporting up to 24 different video input sources that can be arranged
in various ways on the single large display monitor. Display layouts can be uniquely
customized and saved for individual physician preference.
Advantages of Fluoroscopy:

 Allows a physician to see a live image of the body's internal organs in order to observe their size,
shape and movement.
 Provide dynamic and functional information.
 Readily available.
 Inexpensive.
 Allow real time interaction.
 Good for visualized bony structure.

Disadvantages of Fluoroscopy:

 Although radiation is minimal, there is the chance of skin injury due to radiation exposure, as
well as the usual risks associated with radiation.
 May display overlapping anatomy.
 May be limited by patient mobility and ability to comply.
 Poor soft tissue resolution.
 Use ionizing radiation.

Applications of Fluoroscopy: To produce an instantaneous (‘real time’) and visible image by a

phosphor screen which converts the pattern of x-rays leaving the patient into a pattern of light.
By through the process of:

 Provide a stream of high velocity of electron.

 Focus these electrons on a metal target.
 Direct resulting x-rays through the tissue.
 Capture x-rays after tissue.
 Process the resultant image for viewing.

Endoscopy: Endoscopy is the insertion of a long, thin tube directly into the body to observe an
internal organ or tissue in detail. It can also be used to carry out other tasks including imaging
and minor surgery.

Parts of Endoscopes:
  Shaft: The shaft is only 10mm in diameter and can be up to 2 meters long. It is flexible
and coated in steel and plastic in order to make it waterproof, prevent chemical damage
and to make it easy to manoeuvre through the body. It has contains:
 Fibre optic bundles: Light is guided to the area under investigation by non-coherent
fibre optic bundles (bundles where the optical fibres are not lined up at both ends).
However, the image must be transmitted back by a coherent fibre optic bundle (a bundle
where the optical fibres are lined up at both ends of the fibre so that an image can be
transmitted). In order to produce a clear image, the shaft contains up to 10 000 fibres.
 Water Pipes: Carry water to wash the lens and keep the view clear.
 Operations channel: Carries accessories to the distil end for surgery.
 Control cables: Controls which way the distil end is bent.
 Additional optional channel: Carries air or carbon dioxide to and from the distil end
 Distil End: The distil end is inserted into the patient's body. There are controls on the
viewing end to make it bend in the desired direction. The image is focused by a lens on
the end.

Classification of Endoscopes:

 Rigid Endoscopes: Rigid endoscopes vary from simple metal tubes with a light source at
the distal end to operating telescopes that can enlarge, reduce or bend the image and are
used to perform complex surgical procedures in enclosed areas of the body. The anatomy
and position of the internal organ or bodily orifice that is to be examined will determine
the design of the simple endoscope. Examples include the oesophagoscope,
sigmoidoscope and laryngoscope. These instruments are used for examination under
direct vision and the field of vision is limited to the area immediately in front of the end
of the endoscope. They have changed very little over the years except for the way that the
light, originating from an electric lamp, is delivered to the subject. Until relatively
recently, a “light carrier” consisted of a metal tube with an internal wire connected to a
bulb at the distal end of the carrier. The carrier would be inserted down the endoscope,
illuminating the area immediately around the light source, which became hot with use.
The power source was either a battery or transformed mains current. Today, almost
universally, light carriers consist of optical fibres through which light is transported and
which deliver a cold, more powerful, reliable and even illumination Fibreoptic
transmission of light is dependent on the phenomenon of total internal reflection. Light
reaching a glass–air or similar interface will either be refracted or internally reflected. If
the light strikes the glass–air junction at an angle greater than 42° it will be totally
reflected. Optical fibres are long strands of glass bundled together to produce a fibreoptic
cable. All the strands transmit light because as the light travels along the glass fibre the
 rays strike the surface at an angle greater than the critical angle of 42°. The rays are
therefore reflected totally, cannot escape through refraction and remain within the glass
fibre. Thus the light travelling along these cables not only illuminates the object but can
be used to transmit all kinds of images as information.

 Flexible Endoscopes: Flexible endoscopes, as the name suggests, can bend and flex
within the orifices, lumina and tracts of the body. The main difference is that the flexible
endoscope has the ability to transmit an image as well as light along optical fibres, thus
enabling the tube to bend considerably without compromising the performance of the
instrument. (This also permits a much more thorough examination with less chance of
missing pathology.) Flexible endoscopes may be linked to television and recording
equipment, enabling review and of course opportunities for teaching. They can be much
longer than rigid endoscopes and are fitted with channels for suction, blowing, irrigation
and biopsy depending on the type of endoscope. The advent of flexible endoscopes has
enabled the use of some types of laser, transmitted down the optical fibres, especially in
the field of gastrointestinal treatment when bleeding can be accurately and safely
coagulated within the alimentary tract.

 Basic principle of endoscopes: Some of the optical fibres take light down to the end of
the endoscope which shines inside the body. Other optical fibres in
the bundle collect the reflected light using lenses. The reflected light is sent along
the fibres to a computer which displays the information as a picture on a monitor. It is
sometimes possible to perform medical operations inside people by using an endoscope,
rather than making a large cut in the skin.

Working Principle of Endoscopes:

1. One of the two main endoscope cables carries light from a bright lamp in the operating
room into the body, illuminating the cavity where the endoscope has been inserted.
2. The light bounces along the walls of the cable into the patient's body cavity.
3. The diseased or injured part of the patient's body is illuminated by the light shining in.
4. Light reflected off the body part travels back up a separate fiber-optic cable, bouncing off
the glass walls as it goes.
5. The light shines into the physician's eyepiece so he or she can see what's happening
inside the patient's body. Sometimes the fiber-optic cable is directed into a video
camera (which displays what's happening on a television monitor) or a CCD (which can
capture images like a digital camera or feed them into a computer for various kinds of
image enhancement).

Structure or Construction & Working of Endoscopes: Below Figure shows the

structure of endoscope.
  Outer Fibre: The outer fiber consists of many fibers bundled together without any
particular order of arrangement and is called incoherent bundle. These fiber bundles
as a whole are enclosed in a thin sleeve for protection. The outer fiber is used to
illuminate or focus the light onto the inner parts of the body.

 Inner Fibre: The inner fiber also consists of a bundle of fibers, but in perfect order.
Therefore this arrangement is called coherent bundle. This fiber is used to collect the
reflected light from the object. A tiny lens is fixed to one end of the bundle in order to
effectively focus the light, reflected from the object.
 For a wider field of view and better image quality, a telescope system is added in the
internal part of the telescope.

Working of Endoscopes: Light from the source is passed through the outer fiber (f0). The light
is illuminated on the internal part of the body. The reflected light from the object is brought to
focus using the telescope to the inner fiber (fi). Here each fiber picks up a part of the picture
from the body. Hence the picture will be collected bit by bit and is transmitted in an order by the
array of fibers. As a result, the whole picture is reproduced at the other end of the receiving fiber
as shown in the figure. The output is properly amplified and can be viewed through the eye piece
at the receiving end. The cross sectional view is as shown in the figure. In figure, we can see
that along with input and output fibers, we have two more channels namely, (i) Instrumental
Channel (C1) and (ii) Irrigation channel (C2) used for the following purposes.

(i)Instrumentation Channel: It is used to insert or take the surgical instruments needed for
operation.
(ii)Irrigation Channel: It is used to blow air or this is used to clear the blood in the operation
region, so that the affected parts of the body can be clearly viewed.

Types of Endoscopes:

 Arthroscopy: Arthroscopy is a procedure in which a tiny incision is made in the skin and
a scope is inserted into a joint. Arthroscopy can be used to diagnose and treat joint
 conditions, ranging from diagnosing different types of arthritis to repairing rotator cuff
tears. The procedure cannot be used on all joints, and we don't as yet have a way to
perform all surgeries, such as joint replacement surgery, by this method.
 Bronchoscopy: In a Bronchoscopy, a tube is inserted through the mouth and passed
down through the trachea into the bronchial tubes (the large airways of the
lungs). Bronchoscopy can be used to visualize tumors and do biopsies. By adding
ultrasound, it can also be used to biopsy lung tumors that are near but not within the
airways (endobronchial ultrasound). It may be used for treatment as well, to stop bleeding
from a tumor, or to dilate the airway if a tumor is causing narrowing.
 Colonoscopy: You may be familiar with colonoscopy from colon cancer screening. In a
colonoscopy, a tube is inserted through the rectum and threaded up through the colon. It
can be used in this way to diagnose colon cancers or to remove polyps which may have
the ability to turn into cancer. As such, colonoscopies have reduced the risk of death from
colon cancer both by early detection, finding cancers when they are small and have not
spread, and through primary prevention, removing polyps that could become cancerous.
 Colposcopy: A colposcopy is inserted through the vaginal opening in order to better
visualize the cervix. It is most often done due to an abnormal Pap smear to look for
evidence of cervical dysplasia or cervical cancer.
 Cystoscopy: A cystoscopy allows a doctor to visualize the inside of your bladder to
diagnose conditions ranging from interstitial cystitis to bladder cancer. In this procedure,
a narrow tube is inserted through the urethra (the tube going from the bladder to the
outside of the body) and into the bladder. The instrument has a special tool at the end
which allows doctors to take a biopsy of any suspicious appearing areas.
 ERCP (endoscopic retrograde cholangiopancreatography): In an ERCP, a tube is
inserted down through the mouth and stomach and into the bile and pancreatic ducts
which lead into the small intestine from the liver and pancreas. This method can be used
to retrieve gallstones that have lodged in these ducts, as well as to visualize the ducts
(such as with the rare bile duct cancers).
 EGD (esophogealgastroduodenoscopy): In an EGD, a doctor inserts a narrow tube in
through the mouth and down sequentially through the esophagus, the stomach, and into
the duodenum (the first part of the small intestine). EGD has been very effective in
diagnosing conditions which were once hard to diagnose, including problems with the
esophagus such as Barrett's esophagus, ulcers in the stomach and duodenum,
inflammation, cancers, gastroesophageal reflux disease, and even celiac disease.
 Laparoscopy: In a laparoscopy, small incisions are made in the belly button and over the
abdomen allowing a scope to be introduced into the peritoneal cavity (the area housing
the abdominal organs). It can be done both for diagnosis and as a method of treating
everything from infertility to removing an appendix.
 Laryngoscope: A laryngoscopy is a procedure in which a tube is inserted through the
mouth in order to visualize the larynx (the voice box). This method can detect
abnormalities in the voice box ranging from polyps to laryngeal cancer.
 Mediastinoscopy: A mediastinoscopy is a procedure in which a scope is inserted through
the chest wall into the space between the lungs (the mediastinum). It may be used to
diagnose conditions such as lymphomas and sarcoidosis, but is most often done as a part
of staging lung cancer, to look for lymph nodes in the mediastinum to which cancer may
have spread.
  Proctoscopy: A proctoscopy is a scope that can be inserted through the anus to evaluate
the rectum (the last 6 to 8 inches of the colon or large intestine). It is done most often to
evaluate rectal bleeding.
 Thoracoscopy: A thoracoscopy is a procedure in which small incisions are made in the
chest wall to gain access to the lungs. In addition to being used to do lung biopsies, this
procedure is now often used to remove lung cancers. This procedure is referred to as
VATS or video-assisted thoracoscopic surgery. A VATS procedure can be done in much
less time with a significantly fewer short term and long term side effects of surgery. Not
all surgeons, however, are trained in this procedure, and not all lung cancers can be
reached by this technique.

Risks of Endoscopes: Endoscopy is a relatively safe procedure, but there are certain risks
involved. Risks depend on the area that is being examined. Risks of endoscopy may include:

 Over-sedation, although sedation is not always necessary

 Feeling bloated for a short time after the procedure

 Mild cramping

 A numb throat for a few hours due to the use of local anesthetic

 Infection of the area of investigation: This most commonly occurs when additional procedures
are carried out at the same time. The infections are normally minor and treatable with a course
of antibiotics

 Persistent pain in the area of the endoscopy

 Perforation or tear of the lining of the stomach or esophagus occurs in 1 in every 2,500-11,000
cases

 Internal bleeding, usually minor and sometimes treatable by endoscopic cauterization

 Complications related to preexisting conditions

Uses of endoscopes: Five medical procedures carried out using an endoscope are given below.

 Arthroscopy: The endoscope is inserted through an incision in the skin near a joint under
investigation. This can be used to look at the joint and perform operations such as
removing torn tissues.
 Bronchoscopy: The endoscope is inserted through bronchial tubes within the lungs in
order to look at the airway and to remove any objects blocking the airway.
  Endoscope Biopsy: The endoscope is inserted through an incision or opening in the body
that leads to the area under investigation. Biopsy forceps are then used to take a sample
of tissue that can then be analysed by a pathologist.
 Gastroscopy (Also called Oesophagogastroduodenoscopy): The endoscope is inserted
down the throat to look for problems with the oesophagus, stomach and duodenum such
as bleeding or ulcers.
 Laparoscopy: The endoscope is inserted through an incision in the abdominal in order to
look at abdominal organs and perform minor surgery.

Advantages of using endoscopes: The use of endoscopes is much less invasive than open
surgery because only a small incision in the body is required where as open surgery requires
deep incisions. This also means that recovery is quicker and there is less swelling, scarring and
risk of infection. Endoscopes can be used by an outpatients department and does not need to be
done by a hospital. This reduces costs.

Types of endoscopy in details:

Colonoscopy, Ureteroscopy or Cystoscopy, Bronchoscope is given below:

Defination of Ureteroscope: It is a procedure in which a small scope (like a flexible telescope)

is inserted into the bladder and Ureter and it is used to diagnose and treat a variety of problems in
the urinary tract. For ureteral stones, it allows the urologist to actually look into the ureter, find
the stone and remove it. The surgeon passes a tiny wire basket into the lower ureter via the
bladder, grabs the stone and pulls the stone free. This is an outpatient procedure with or without
a stent inserted (a tube that is placed in the ureter to hold it open).

Defination of Cystoscopes: A cystoscopy is an examination of the inside of the bladder and

urethra, the tube that carries urine from the bladder to the outside of the body. In men, the urethra
is the tube that runs through the penis. The doctor performing the examination uses a cystoscopy
a long, thin instrument with an eyepiece on the external end and a tiny lens and a light on the end
that is inserted into the bladder. The doctor inserts the Cystoscopes into the patient's urethra, and
the small lens magnifies the inner lining of the urethra and bladder, allowing the doctor to see
inside the hollow bladder. Many Cystoscopes have extra channels within the sheath to insert
other small instruments that can be used to treat or diagnose urinary problems.
Reasons for a cystoscopy: A doctor may perform a cystoscopy to find the cause of many
urinary conditions, including

 frequent urinary tract infections

 blood in the urine, which is called hematuria
 a frequent and urgent need to urinate
 unusual cells found in a urine sample
 painful urination, chronic pelvic pain, or interstitial cystitis/painful bladder syndrome
  urinary blockage caused by prostate enlargement or some other abnormal narrowing of
the urinary tract
 a stone in the urinary tract, such as a kidney stone
 an unusual growth, polyp, tumor, or cancer in the urinary tract

Reasons for a Ureteroscope: The reasons for a Ureteroscope include the following conditions:

 frequent urinary tract infections

 hematuria
 unusual cells found in a urine sample
 urinary blockage caused by an abnormal narrowing of the ureter
 a kidney stone in the ureter
 an unusual growth, polyp, tumor, or cancer in the ureter

Preparations for a Cystoscopy or Ureteroscope: People scheduled for a cystoscopy or

ureteroscopy should ask their doctor about any special instructions. In most cases, for
cystoscopy, people will be able to eat normally in the hours before the test. For ureteroscopy,
people may be told not to eat before the test. Because any medical procedure has a small risk of
injury, patients must sign a consent form before the test. They should not hesitate to ask their
doctor about any concerns they might have. Patients may be asked to give a urine sample before
the test to check for infection. They should avoid urinating for an hour before this part of the test.
Usually, patients lie on their back with knees raised and apart. A nurse or technician cleans the
area around the urethral opening and applies a local anesthetic so the patient will not experience
any discomfort during the test. People having a ureteroscopy may receive a spinal or general
anesthetic. They should arrange for a ride home after the test.

Cystoscope or Ureteroscope performed:

During Procedure of a Ureteroscope:

 After a local anesthetic is used to take away sensation in the ureter, the doctor gently
inserts the tip of the Cystoscopes or Ureteroscope into the urethra and slowly glides it up
into the bladder. A sterile liquid i.e. water or salt water, called saline flows through the
 scope to slowly fill the bladder and stretch it so the doctor has a better view of the bladder
wall.
 As the bladder is filled with liquid, patients feel some discomfort and the urge to urinate.
The doctor may then release some of the fluid, or the patient may empty the bladder as
soon as the examination is over.
 The time from insertion of the scope to removal may be only a few minutes, or it may be
longer if the doctor finds a stone and decides to treat it. Taking a biopsy a small tissue
sample for examination with a microscope will also make the procedure last longer. In
most cases, the entire examination, including preparation, takes 15 to 30 minutes.

After Procedure of a Cystoscope or Ureteroscope:

 Patients may have a mild burning feeling when they urinate, and they may see small
amounts of blood in their urine.
 These problems should not last more than 24 hours.
 Patients should tell their doctor if bleeding or pain is severe or if problems last more than
a day.
 To relieve discomfort, patients should drink two 8-ounce glasses of water each hour for 2
hours after the procedure.
 They may ask their doctor if they can take a warm bath to relieve the burning feeling.
If not, they may be able to hold a warm, damp washcloth over the urethral opening.
 The doctor may prescribe an antibiotic to take for 1 or 2 days to prevent an infection.
 Any signs of infection including severe pain, chills, or fever should be reported to a
doctor.

Advantages of Ureteroscope: Listed below are some of the advantages of ureteroscopy:

 Direct Approach: The stone can be viewed directly which makes it easy to locate it and
break it with lasers or special instruments.
 No Incision: The entire procedure from detection to rectification can be carried out in the
absence of any incisions.
 Entry into the kidney: If flexible ureteroscopy is done, the advantage is that access is
available into each part of the kidney, enabling a complete elimination of the stones.
 Stones Undetected by X-rays: Due to the awkward location of some stones, they sometimes
do not show up in an x-ray. Through ureteroscopy, the advantage is to detect such stones
easily.
 Substitute for Drug Therapy: Some patients like pregnant women or highly obese people
respond well to ureteroscopy, where they cannot take drugs for dissolving the stones.

Disadvantages of Ureteroscope: Although considered safe and effective, there are a few
limitations which are mentioned below:

 Regional Restrictions: A disadvantage of this procedure is that access is restricted to only

certain regions of the body.
 Stone Size: A major disadvantage of ureteroscopy is that treatment of larger stones meets
with limited success.
 More Invasive: Ureteroscopy is said to be more invasive than shock wave lithotripsy.
 Damage Risk: If the procedure is not done properly, there is a chance of some damage being
caused by puncturing or tearing the walls of the urethra or urinary bladder.

Side-effects of Ureteroscope:

 Urinating Sensation: There is a feeling of the need to urinate frequently.

 Blood in the Urine: Blood may be found in the urine for a few days after the surgery.
 Stent Discomfort: A stent may be used in the case of a swollen ureter. If this is the case, it is
likely to have a string attached to it to remove it later which may extend outside. Special care
will have to taken not to disturb this.
 Pain: It is common for pain to develop in the region of the kidneys, bladder and urethra as a
side-effect of ureteroscopy. Fortunately, this can be combated through
painkillers administered promptly.

COLONSCOPE NOTES
Defination of colonoscopy: Colonoscopy is a procedure that uses a long, flexible, narrow tube
with a light and tiny camera on one end, called a colonoscope or scope, to look inside the rectum
and entire colon. Colonoscopy can show irritated and swollen tissue, ulcers, and polyps extra
pieces of tissue that grow on the lining of the intestine.

Defination of rectum and colon: The rectum and colon are part of the gastrointestinal (GI)
tract, a series of hollow organs joined in a long, twisting tube from the mouth to the anus a 1-
inch-long opening through which stool leaves the body. The body digests food using the
movement of muscles in the GI tract, along with the release of hormones and enzymes. Organs
that make up the GI tract are the mouth, esophagus, stomach, small intestine, large intestine
which includes the appendix, cecum, colon, and rectum and anus. The intestines are sometimes
called the bowel. The last part of the GI tract called the lower GI tract consists of the large
intestine and anus.

Colonoscopy performed: A colonoscopy is performed to help diagnose

• changes in bowel habits
• abdominal pain
• bleeding from the anus
• weight loss

A gastroenterologist also performs a colonoscopy as a screening test for colon cancer. Screening
is testing for diseases when people have no symptoms. Screening may find diseases at an early
stage, when a health care provider has a better chance of curing the disease.

Preparation for a colonoscopy: Preparation for a colonoscopy includes the following steps:

Talk with a gastroenterologist: When people schedule a colonoscopy, they should talk with
their gastroenterologist about medical conditions they have and all prescribed and over-the-
counter medications, vitamins, and supplements they take, including aspirin or medications that
contain aspirin, nonsteroidal anti-inflammatory drugs such as ibuprofen or naproxen, arthritis
medications , blood thinners, diabetes medications and vitamins that contain iron or iron
supplements

Arrange for a ride home after the procedure: Driving is not allowed for 24 hours after the
procedure to allow time for the anesthesia to wear off.

Cleanse the bowel: The gastroenterologist will give written bowel prep instructions to follow at
home. A gastroenterologist orders a bowel prep so that little to no stool is present inside the
person’s intestine. A complete bowel prep lets the person pass stool that is clear. Stool inside the
colon can prevent the gastroenterologist from clearly seeing the lining of the intestine.

Instructions may include following a clear liquid die and avoiding drinks that contain red or
purple dye. The instructions will provide specific direction about when to start and stop the clear
liquid diet. People may drink or eat the following:
  fat-free bouillon or broth
 strained fruit juice, such as apple or white grape—orange juice is not
recommended
 water
 plain coffee or tea, without cream or milk
 sports drinks in flavors such as lemon, lime, or orange
 gelatin in flavors such as lemon, lime, or orange

The person needs to take laxatives and enemas the night before a colonoscopy. A laxative is
medication that loosens stool and increases bowel movements. An enema involves flushing
water or laxative into the rectum using a special wash bottle. Laxatives and enemas can cause
diarrhea, so the person should stay close to a bathroom during the bowel prep. Laxatives are
usually swallowed in pill form or as a powder dissolved in water. Some people will need to drink
a large amount, usually a gallon, of liquid laxative at scheduled times.
People may find this part of the bowel prep difficult; however, it is very important to complete
the prep. The gastroenterologist will not be able to see the colon clearly if the prep is incomplete.
People should call the gastroenterologist if they are having side effects that are preventing them
from finishing the prep.

Colonoscopy performed:
 A gastroenterologist performs a colonoscopy at a hospital or an outpatient
center. In most cases, light anesthesia and pain medication help people relax
for the test. The medical staff will monitor people’s vital signs and try to make
people as comfortable as possible. A nurse or technician places an intravenous
(IV) needle in a vein in the arm to give anesthesia.

 For the test, the person will lie on a table while the gastroenterologist inserts a
colonoscope into the anus and slowly guides it through the rectum and into the colon. The
scope inflates the large intestine with air to give the gastroenterologist a better view. The
camera sends a video image of the intestinal lining to a computer screen, allowing the
gastroenterologist to carefully examine the intestinal tissues. The gastroenterologist may
move the person several times so the scope can be adjusted for better viewing. Once the
scope has reached the opening to the small intestine, the gastroenterologist slowly
withdraws it and examines the lining of the large intestine again. The gastroenterologist
can remove polyps during colonoscopy and send them to a lab for testing. Polyps are
common in adults and are usually harmless. However, most colon cancer begins as a
polyp, so removing polyps early is an effective way to prevent cancer.
 The gastroenterologist may also perform a biopsy, a procedure that involves taking a
small piece of intestinal lining for examination with a microscope. The person will not
feel the biopsy. A pathologist a doctor who specializes in diagnosing diseases will
examine the tissue.
  The gastroenterologist may pass tiny tools through the scope to remove polyps and take a
sample for biopsy. If bleeding occurs, the gastroenterologist can usually stop it with an
electrical probe or special medications passed through the scope. Colonoscopy usually
takes 30 to 60 minutes.
After a colonoscopy: After the colonoscopy, a person can expect the following:

 People may need to stay at the hospital or outpatient center for 1 to 2 hours after the
procedure.
 Cramping or bloating may occur during the first hour after the test.
 The anesthesia takes time to completely wear off.
 Full recovery is expected by the next day, and people should be able to go back to their
normal diet.
 A member of the health care team will review the discharge instructions with the person
or with an accompanying friend or family member if the person is still groggy and
provide a written copy. The person should follow all instructions given.
 A friend or family member will need to drive the person home after the procedure.
 If the gastroenterologist removed polyps or performed a biopsy, light bleeding from the
anus is normal.
 Some results from a colonoscopy are available immediately after the procedure.
 After the anesthesia has worn off, the gastroenterologist will share results with the
person or a designee.
 Biopsy results take a few days to come back.

Risks of colonoscopy: The risks of colonoscopy include which are given below:

 Bleeding.
 Perforation (A hole or tear in the lining of the colon is called perforation.)
 Diverticulitis (A condition that occurs when small pouches in the colon, called
diverticulitis) becomes irritated, swollen, and infected.
 Cardiovascular events, such as a heart attack, low blood pressure, or the heart skipping
beats or beating too fast or too slow.
 Severe abdominal pain.
 Death, although this risk is rare.

Advantages of a colonoscopy: The advantages of a colonoscopy are:

 The most complete screening method available

 This test allows the doctor to view the rectum and the entire colon.
 The doctor can also perform a biopsy and remove polyps or other abnormal tissue during
the test, if necessary.
 Sedation is given to the patient to minimize discomfort
 Test is one of the most sensitive tests currently available.
Disadvantages to a colonoscopy: The disadvantages of a colonoscopy include:

 The test may not detect all small polyps, nonpolypoid lesions, and cancers.
 The accuracy of the test is dependent on the skill of the doctor doing the colonoscopy,
amount of time incision and amount of time to withdraw the scope.
 Thorough cleansing of the colon is necessary before this test. Cleansing typically requires
one day of clear liquids and laxative preparation. Laxatives are medications that increase
the action of the intestines or stimulate the addition of water to the stool to increase its
bulk and ease passage.
 Some form of sedation is used in most cases.
 A day is needed for the procedure and recovery from sedation.
 A ride home from the medical facility is required if sedation is used.
 Although uncommon, complications can occur such as bleeding and/or tearing of the
lining of the colon.

BRONCHOSCOPE NOTES

Defination of Bronchoscope: Bronchoscope is a procedure during in which an examiner uses a

viewing tube to evaluate a patient's lung and airways including the voice box and vocal cord,
trachea, and many branches of bronchi. Bronchoscope is usually performed by a pulmonologist
or a thoracic surgeon. Although a bronchoscope does not allow for direct viewing and inspection
of the lung tissue itself, samples of the lung tissue can be biopsied through the bronchoscope for
examination in the laboratory.

Types of Bronchoscope:

 Rigid bronchoscope: A rigid bronchoscope is a straight, hollow, metal tube. Doctors

perform rigid bronchoscope less often today, but it remains the procedure of choice for
removing foreign material and for several other treatments. Rigid bronchoscope also
becomes useful when bleeding interferes with seeing the area.
 Flexible bronchoscope: A flexible bronchoscope is a long thin tube that contains small
clear fibers that transmit light images as the tube bends. Its flexibility allows this
instrument to reach further points in an airway than rigid bronchoscope. The procedure
can be performed easily and safely under local anesthesia.

Indications of bronchoscope: Bronchoscope can be used for diagnosis or treatment.

Bronchoscope is used to make a diagnosis most commonly for these conditions:
  Persistent or unexplained cough;
 Blood in the sputum (coughed up mucus material from the lungs);
 Abnormal chest x-ray such as a mass, nodule, or inflammation in the lung; or
 Evaluation of a possible lung infection.

Preparation for bronchoscope: Usually, patients undergoing bronchoscope should take nothing
by mouth after midnight prior to the procedure. Routine medications should be taken with sips of
water except for those drugs that can enhance the risk of bleeding. These medications
are aspirin products, blood thinners such as warfarin(Coumadin), and non-steroidal anti-
inflammatory products such as ibuprofen. (These drugs must be discontinued at varying numbers
of days before the procedure, depending on the medication. Patients must consult their doctors
for the appropriate schedule in their particular situation.) The doctor will also want to know of
any drug allergies or major drug reactions that the patient may have experienced.

During the procedure of bronchoscope:

1) As the patient arrives in the bronchoscope suite (or if the patient is already in the
hospital), an intravenous catheter (IV) will be started for administration of medication
and fluid. The patient is then connected to a monitor for continuous monitoring of the
heart rate, blood pressure, and oxygen level in the blood. If needed, supplemental oxygen
will be supplied either through a 1/4-inch tube inserted into the nostrils (cannula) or a
facemask. Medication is then given through the IV to make the patient feel relaxed and
sleepy for the flexible fiber optic bronchoscope. If rigid bronchoscope is to be performed,
an anesthesiologist will be present to induce and monitor the general anesthesia.
2) Patients will be lying on their back with oxygen supplemented through the mouth or the
nose. Prior to the insertion of the flexible bronchoscope, a local anesthesia with
topical lidocaine is given in the nose and to the back of the throat. The flexible
bronchoscope can be introduced either through the mouth or the nose. Some patients may
require a special tube called an endotracheal tube to be inserted through the mouth,
passing the vocal cord, and into the trachea to protect and secure the airway. Once the
bronchoscope is in the airway, an additional topical anesthetic will be sprayed into the
airway for local anesthesia to minimize discomfort and coughing spells. The rigid
 bronchoscope is inserted by mouth only. This is usually done after the patient is under
general anesthesia.
3) Flexible bronchoscope rarely causes any discomfort or pain. Patients may feel the urge
to cough because of the sensation of a foreign object in the "windpipe." Again, this
feeling can be minimized by pre-procedural medication given for relaxation and local
anesthesia with lidocaine. The procedure usually takes between 15 to 60 minutes. If a
specific area needs to be more thoroughly evaluated or an abnormality is detected during
the procedure, samples can be collected by several methods listed below:
 Washing: Squirts of salt water (saline) are injected through the bronchoscope into the
area of interest and the fluid is then suctioned back. This process is repeated several times
to obtain adequate samples, which are then submitted to the laboratory for analysis.
Brushing - A soft brush is inserted through the bronchoscope to the area of interest. Cells
around the airway are collected by brushing up and down the airway. The samples are
also sent to the laboratory for analysis.
 Needle aspiration: A small needle is inserted into the airway and through the wall of the
airway to obtain samples outside of the airway for analysis under a microscope.
 Forceps biopsy: Forceps may be used to biopsy either a visible lesion in the airway or a
lung lesion. Abnormal tissue that is visible in the airway is usually easily biopsied.
However, a mass that is in the lung tissue is deep within the lung and usually requires a
biopsy using special x- ray guidance (fluoroscopy). Specimens obtained are sent to a
pathologist for inspection under a microscope.

After a bronchoscope procedure:

 Patients are taken to an observation area for monitoring for one to two hours until any
medication given adequately wears off and patients are able to swallow safely.
 A family member or a friend must take the patient home after the outpatient procedure.
 Patients are not allowed to drive or operate heavy machinery for the rest of the day
because their reflexes and judgment may be impaired.
 Some patients may cough up dark-brown blood for the next one to two days after the
procedure.
 This is expected and should not be alarming.
 However, if there is persistent bright red blood in the sputum, the doctor must be
consulted immediately.
 A follow-up visit with the doctor is scheduled to review the laboratory results, which are
typically available within one week.
Role of Nanoparticles in Medical Imaging:

 Nanoparticles as Image Enhancing Agents for Ultrasonography: Ultrasonography

uses sound waves to create an image for many different purposes. These sounds waves
are transmitted through the body and bounce off of tissue and return to a receiver. This
receiver measures the time it takes for the sound wave to reflect and return to the place of
origin, which is perceived as a distance and is converted into an electrical signal, which is
then converted into an image by the computer. This type of medical imaging is used in
many branches of medicine spanning from obstetrics to oncology. Unfortunately, with
ultrasonography minor details could be missed because the image may not be of the best
quality. Nanoparticles have been found to help increase the contrast of the image
produced by the ultrasonography particularly when imaging tumors. The particles used
are called per fluorocarbon emulsion nanoparticles (PFC) and are about 250 nm in
diameter. The size of these particles is very important. According to Liu et al. the smaller
particles, particularly ones with surface alteration, have an extended half-life in the
circulation and increase the number of passes through tumor vasculature. This is
important when helping to get a clear image of a tumor. These particles, due to their size,
can be deposited at targeted sites and help increase the acoustic reflectivity because
tumor vasculature exhibits an enhanced permeability and retention effect (Liu et al.). The
increase in reflectivity arises from the difference in acoustic impedance between the
tissue and particles. The acoustic reflectivity caused by the retention of the nanoparticles
helps to create a better image of the tumor and a better diagnosis. Liu et al. (2006) were
able to test these hypotheses by performing experiments in which they injected
intravenously the nanoparticles in a suspension of saline into mice. By performing these
experiments on a living animal model, their results suggest it could have an application in
humans. They were able to conclude from these experiments that the brightness, also
called the mean grey scale level, increases with concentration and particle size. The
increase in image quality from ultrasonography, due to nanoparticles, can help in many
branches of medicine because ultrasonography can be considered more economical than
other noninvasive imaging technologies and can help with diagnosis.

 Iron Oxide Nanoparticles for High-Resolution T1 Magnetic Resonance Imaging

Contrast Agents: Magnetic Resonance Imaging, otherwise known as MRI, is a widely
used technique to noninvasively see into the human body. Even though MRI has
improved diagnostic medicine, there can be some problems with it. The images that
MRIs produce can sometimes leave out important details. Contrast agents are important
in helping to see the details that can sometimes be lost with just MRI technology. “The
MRI contrast agents are generally categorized according to their effects on longitudinal
(T1) and transversal (T2) relaxations, and their ability is referred to as relaxivity (r1, r2).
The area wherein fast T1 relaxation takes place appears bright whereas T2 relaxation
results in the dark contrast in the MR images” (Kim et al., 2011). Increasing the effects of
the contrast agents on the T1 relaxation is important because it will create bright spots in
the image that could otherwise not have been seen. If these spots cannot be seen a
diagnosis could be inconclusive or incorrect. According to Kim et al. (2011), “…uniform
and extremely small-sized iron oxide nanoparticles…” are successful as T1 contrast
agents for MRI. The size and shape are important because they affect certain properties
 of the particle. Larger particles give a larger magnetic effect. The nanoparticles that are
used have a biocompatible shell with a magnetic core. The larger the particle the larger
the magnetic core within the nanoparticles. These nanoparticles also move and rotate
within the fields that they create, which increase T1 effects. In addition to creating a
clearer image because of the nanoparticles’ size, another reason that they are used as a
contrast agent is because these particles also have a long half-life. Iron oxide
nanoparticles have been found to have a greater half-life than traditional gadolinium
based contrast agents. The optimal size is based upon blood half-life rather than magnetic
effect. The nanoparticles “…can be good T1 contrast agent for steady-state imaging
because they have a long blood half-life derived from their optimal particle size” (Kim et
al., 2011). The longer half-life allows for MRI to be used to track blood pooling in a
patient. This is important because it shows that MRI can be used as a more accurate
diagnostic tool for problems pertaining to the circulatory system. Overall, iron oxide
nanoparticles are successful as a contrast agent because their unique size and half-life
allows for improved detail in magnetic resonance images.

 Laser-Induced Explosion of Gold Nanoparticles: Potential Role for Treatment of

Cancer: Cancer is a deadly disease, and researchers are constantly looking for a cure or
treatment for it. Cancer cells along with bacteria, viruses and DNA can be damaged by
nanophotothermolysis with lasers and gold nanoparticles (Letfullin et al., 2006). This is a
promising technique because cancer is very invasive and if one cell is left behind it can
cause the cancer to regrow. Being able to target individual cells gives a better chance of
remission. This technique may also be applied to other diseases in the future because of
its ability to target specific cells. “When nanoparticles are irradiated by short laser pulses,
their temperature rises very quickly to possibly reach thresholds for nonlinear effects
(e.g., microbubble formation, acoustic and shock wave generation) leading to irreparable
target (e.g., abnormal cell) damage” (Letfullin et al., 2006). The nanoparticles in contact
with the cells creates bubbles due to the extreme temperature change. The temperature
change is due to the conduction; the particle is excited by the energy conducted from the
laser. These bubbles can then burst, sending out shockwaves through the
area. The force from the shock wave can disrupt the cell membrane of the target cells
damaging them and causing them to lyse. This technique also allows healthy tissue to be
spared, because the gold nanospheres can be created to select only cancer cells or other
abnormal cells. They select only cancer cells through many different techniques including
the use of monoclonal antibodies, recognize the marker found only on the cancer cells
and bind to that cell along with the gold nanosphere that it is conjugated to. This specific
selection allows for healthy tissue to be spared. Sparing healthy tissue is essential to
remission because cancer can damage tissue and cause organ failure. Healthy tissue will
at times grow and replace the tissue damaged by cancer. Unfortunately, this technique
has low efficiency in “dense solid tumor, bones, atherosclerotic plaques and other targets
with a lack of sufficient amount of liquid for efficient bubble generation” (Letfullin et al.,
2006). The generation of bubbles in the cancer cell from this technique is important
because it disrupts the cell, resulting in damage. According to Letfullin et al. (2006), the
success of this technique depends on the laser’s wavelength, pulse duration, particle size
and particle shape. All of these factors are vital in creating localized damage of the cancer
cells and sparing healthy tissue.
 Carbon Nanotubes for Orthopaedic Implants: Orthopedic implants are used daily in
many surgical procedures. The purpose of an orthopedic implant is to replace or support a
damaged bone or joint. These implants are used to help patients achieve a better quality
of life. Orthopedic implants are not without limitations. According to Spear and Cameron
(2008), “Limitations in structural and biological compatibility with natural bone tissue
can cause bone loss from the implantation site and subsequent loosening of the implant,
implant failures and complicated revision surgeries.” The use of carbon nanotubes in
orthopedic implants is being studied as apossible solution for these limitations. Carbon
nanotubes, about 0.7-100 nm in length, depending on ifthey are single wall or multiwall,
can be used to improve the lifespan of an orthopedic implant. These nanotubes are made
up of carbon atoms and they resemble collagen fibers of regular bone tissue in properties,
morphology and dimension (Spear and Cameron 2008). The resemblance of the carbon
nanotubes and the collagen fibers allow for improved bone regeneration and adherence to
the implant, which in turn creates a more stable implant. Carbon nanotubes have been
used in two branches of bone and tissue engineering. They have been used to create
mechanical reinforcement for a ceramics and polymers composite used as implants and as
coating to improve the surface of the implants so they are more bio-reactive (Spear and
Cameron, 2008). By helping with mechanical reinforcement, carbon nanotubes can help
implants withstand the day to day pressure the human body places on them. In addition,
creation of more bio-reactive surfaces can also help with the day to day pressure because
the natural bone tissue surrounding the implant would better adhere to it. Both of these
uses create a more stable implant overall. Carbon nanotubes in orthopedic implants also
have some challenges. One of these challenges is that these coatings and composites may
lead to the production of nanotubes as “wear debris” (Spear and Cameron, 2008), which
may trigger an immune response. With any immune response there could be a number of
side effects that could limit the effectiveness of these implants. Overall, the use of carbon
nanotubes in orthopedic implants is still being researched, and ideas are being tested due
to the many positive outcomes that could be occur with their application in bone and
tissue engineering.

 Energy Dependence of Gold Nanoparticles Radio sensitization in Plasmid DNA:

Cancer is commonly treated with x-ray radiation. “The aim of radiotherapy is to deliver a
lethal dose to tumor volumes while at the same time avoiding exposure to healthy tissue”
(McMahon et al., 2011). Nanoparticles are being used to increase radio sensitization,
which is when the cells become more susceptible to radiation damage. “Gold
nanoparticles (GNPs) are of considerable interest for use as a radio sensitizer, because of
their biocompatibility and their ability to increase dose deposited because of their high
mass energy absorption coefficient” (McMahon et al., 2011). Biocompatibility is
important because the particles are used within the human body and for them to be
beneficial they should not harm healthy tissue. These particles accumulate in tumor cells,
which make them useful therapeutic agents for the treatment of cancer (McMahon et al.,
2011). The gold nanoparticles are respectable radiosenitizers because they absorb “10 to
150 time more energy per unit mass than soft tissue” (McMahon et al., 2011). When the
particles absorb more energy, more damage is caused to the tumor cells by the ionization
of water molecules and creation of free radicals near DNA in the tumor cells. “These
 radicals cause the majority of DNA damage observed in this system, and as a result, a
significant overproduction of these species would lead to a corresponding increase in
damage” (McMahon et al., 2011). Radicals are created when gold nanoparticles absorb
the energy from radiation, which causes electrons to become excited and to create the
free radicals. These free radicals then damage the DNA and cause breakage in the
strands. The damage to the DNA inhibits cellular reproduction and growth. Overall, gold
nanoparticles are considered promising radio sensitizers because they are selective to
tumor cells and cause damage to the DNA within the tumor cells.

 Gold nanoparticles in biomedical imaging (computer tomography): X-ray computer

tomography (CT), is a commonly used diagnostic imaging tool offering broad availability
and relatively modest cost. X-ray CT is used to visualize tissue density differences that
provide image contrast by X-ray attenuation between soft tissues and electron-dense
bone. It is desirable to enhance the contrast of diseased tissue with the use of X-ray
contrast agents to increase the contrast between normal and cancerous tissue . At present,
highly water-soluble small organic iodinated molecules are typically used as CT contrast
enhancers. These tend to suffer from very short imaging times owing to rapid renal
clearance and nonspecific vascular permeation.