Lecture 1 Background Fundamentals for Diagnostic Radiology Objectives: Discuss the basic concepts and principles of x-ray production

n Discuss the human response to ionizing radiation, radiation doses and radiation protection Describe the various radiologic imaging techniques and their applications MATTER is anything that occupies space and has mass (quantity of matter within a physical object) ATOMS AND MOLECULES are the fundamental, complex binding blocks of matter ENERGY is the ability to do work and can exist in many forms: Potential energy, Kinetic energy, Chemical energy, Electrical energy, Thermal energy, Nuclear energy, Electromagnetic energy Electromagnetic Energy Most important form of energy in radiography because it is the type of energy in the x-ray ELECTROMAGNETIC RADIATION Electromagnetic energy emitted by a source and transferred through space ROENTGEN RAYS form of electromagnetic energy of very short wavelengths (0.5 to 0.6A or less) have the ability to penetrate matter hence used in the study of body tissues

terminals of the tube so that a negative charge is applied to the heated filament and a positive charge to the anode; the electrons will be repelled from the cathode and forced towards the anode. The electrons travel at a very high speed and the stream continues as long as the current is applied. A focusing cup within the tube directs the electrons toward the target in the anode terminal. The terminals are usually made of tungsten metal because of its high melting point. When highspeed electrons are stopped by the tungsten target, the major portion of their energy is transformed into heat and only a small part, less than 1% into Roentgen rays.

X-RAY PRODUCTION X-rays are generated by two different processes: (1)Bremsstrahlung radiation (braking) x-rays are produced when incident electrons interact with nuclear electric fields , which slow them down (brake) and change their direction (2) Characteristic radiation is the result of ionization and is produced when inner-shell electrons of the anode target are ejected by the incident electrons IONIZATION occurs when an electron is ejected from a neutral atom, leaving behind a positive ion. Electromagnetic radiation with sufficient energy to remove electrons is called IONIZING RADIATION Ionizing radiation includes x-rays and gamma rays SOURCES OF IONIZING RADIATION Natural sources of ionizing radiation 1.Cosmic rays - emitted by the sun and stars 2.Terrestial radiation -emitted from deposits of uranium, thorium & other radioactive substances in the earth Radon-largest component of terrestial radiation 3. Radionuclides mainly potassium-40 - part of human metabolism 1 of 4 | P a g e

Electromagnetic Spectrum
Physical manifestations are classified in the M spectrum based on energy (E) and wavelength (l) and comprise the following general categories: Radiant heat, radio waves, microwaves Light infrared, visible and ultraviolet X-rays and gamma-rays (high energy M emitted from the nucleus) Wilhelm Conrad Roentgen November 8, 1895 Wrzburg University, Germany Roentgens experimental apparatus (Crookes tube) led to the discovery of the new radiation. He demonstrated that the radiation was not due to charged particles, but due to an as yet unknown source, hence x radiation or x-rays the radiograph of Bertha Roentgens hand taken Dec. 22, 1895 X-RAY PRODUCTION The x-ray tube is a glass-encased vacuum bulb. An electrode is at either end. Then a high-voltage current is applied to the

-2(3) Those transmitted through the patient without interaction Units of Ionizing Radiation Roentgen (R) or Coulomb/kilogram (C/kg) - unit of radiation intensity in air - output of x-ray units is specified in milliroentgens (mR) Rad or Gray (Gy) - rad (radiation absorbed dose) - quantity of radiation received by a patient Rem or Sievert (Sv) - rem (radiation equivalent man) - quantity of radiation received by radiation workers (radiographers and nuclear power plant personnel) Curie (Ci) or Becquerel (Bq) - quantity of radioactive material and has nothing to do with radiation emitted - used in nuclear medicine Human Responses to Ionizing Radiation RADIOBIOLOGY study of the effects of ionizing radiation on biologic tissue EARLY EFFECTS - radiation response occurs within minutes or days after the radiation exposure LATE EFFECTS - if the human injury is not observable for many months or years EARLY EFFECTS 1. Acute Radiation Syndrome a. Hematologic Syndrome b. Gastrointestinal Syndrome c. Central Nervous System Syndrome 2. Local Tissue Damage a. Skin b. Gonads c. Extremities 3. Hematologic depression 4. Cytogenetic damage Syndromes are dose related Three stages of acute radiation lethality 1. Prodromal stage 2. Latent period 3. Manifest illness stage Acute radiation Lethality 200-1000 rad Hematologic 1000-5000 rad Gastrointestinal (10-50 Gy) >5000 rad CNS (50 Gy) Local Tissue damage Skin - erythema, epilation, atrophy - damage basal cells Gonads - most radiosensitive cell: spermatogonia in males and oocyte in the mature follicle in females 10 rad : minimal aspermia/delay menstruation 200 rad: temporary sterility/ 2 of 4| P a g e

Man-made sources of ionizing radiation 1. Medical x-rays constitute the largest source of manmade ionizing radiation 2. Nuclear power plants and industrial source 3. Consumer items like watch dials, smoke detectors, TVs and airport surveillance system Natural radiation sources contribute approximately 360 mrad to the average absorbed dose to each human Medical x-rays on average contribute 40 mrad

Basic interactions between X-rays and Matter

Coherent Scattering Photoelectric Effect Compton Scattering Pair Production Photodisintegration Coherent Scattering interaction between low-energy x-rays and atoms x-ray loses no energy but changes direction slightly no energy transfer and therefore no ionization little importance to diagnostic radiology Compton Scattering interaction between moderate energy x-rays and outer-shell electrons results in ionization of the target atom, change in photon direction and reduction of photon energy produce a uniform optical density on radiograph (fog) which results in reduced image contrast Photoelectric Effect x-ray interact with inner-shell electrons and is totally absorbed provide diagnostic information to the film; do not reach the film, absorbed by the anatomic structure being x-rayed Pair Production photon interacts with the nuclear force field creating two oppositely charged electrons Photodisintegration high energy x-ray photons escape interaction with the electron cloud and the nuclear force field and be absorbed directly by the nucleus, raising it to an excited state and instantaneously emit a nucleon or nuclear fragment Three types of x-rays which are important to the making of a radiograph are: (1) Those scattered by Compton interaction (2) Those absorbed photoelectrically

-3500 rad: sterility Hematologic Depression Lymphocytes - first cells to become affected after exposure, most radiosensitive cell, reduced in number, very slow to recover Granulocytopenia Thrombocytopenia Erythrocytes less sensitive LATE EFFECTS 1. Leukemia atomic bomb survivors 2. Malignancy a. Bone radium watch dial painters b. Lung exposure to radon in mines c. Thyroid irradiation in childhood d. Breast atomic bomb survivors, acute postpartum mastitis The over-all absolute risk of developing malignant disease is 10 cases/1,000,000 persons/rad/year 3. Local Tissue Damage skin, gonads, eyes 4. Lifespan shortening reduced life span of 10 days for every rad of radiation exposure 5. Genetic damage - Radiation-induced genetic mutations at the levels used in diagnostic imaging today are essentially zero EFFECTS OF FETAL IRRADIATION 1. Prenatal death 2. Neonatal death 3. Congenital malformation 4. Childhood malignancy 5. Diminished growth and development These abnormalities are based on doses greater than 100 rad. There is no evidence at either the human or animal level to indicate that the levels of radiation exposure currently experienced occupationally or medically are responsible for any such effects on fetal growth and development. ALARA (As Low As Reasonably Achievable) 1966 International Council of Radiation Protection (ICRP) concept has no specific numerical guidelines Basic Tenets of ALARA: 1. Radiation exposure must have a specific benefit 2. All exposure should be kept as low as reasonably achievable 3. Dose of individuals shall not exceed limits for appropriate circumstances Cardinal Principles for Radiation Protection Minimize TIME MAXIMIZE DISTANCE MAXIMIZE SHIELDING

The dose to an individual is directly related to the duration of exposure. If the time of exposure to radiation is doubled, the exposure will be doubled. Inverse Square Law: As the distance between the source of radiation and a person increases, the radiation exposure decreases rapidly. Positioning shielding between the radiation source and persons exposed greatly reduces the level of exposure Primary devices for minimizing radiation Filtration Collimation Intensifying screens Protective barriers lead-lined walls or lead-glass windows Protective apparel aprons, gloves, thyroid, gonadal shields IMAGING TECHNIQUES/MODALITIES Conventional Radiography Conventional Tomography Fluoroscopy Angiography Ultrasound Computed Tomography Magnetic Resonance Imaging Radioisotope Scanning CONVENTIONAL RADIOGRAPHY Five basic radiographic densities a. Very radiolucent air or gas b. Moderately radiolucent fatty tissues c. Intermediate radiolucent soft tissue d. Moderately radiopaque bone e. Very radiopaque metal Thick structures attenuate more radiation than thin structures of the same composition CONVENTIONAL TOMOGRAPHY - Provides radiographic slices of a living patient done by simultaneously moving the x-ray tube or film about a pivot point centered in the patient in a plane of anatomic structures to be studied. - The structures above and below the focal plane are blurred by motion of the tube and film while objects within the focal plane are visualized with improved detail - Seldom done today FLUOROSCOPY - Allows real time radiographic visualization of moving anatomic structures with continuous x-ray beam passing through the patient and falls onto a continuous fluorescing screen where it is amplified electronically by an image intensifier and the image is displayed on the TV screen - More radiation given to the patient Indications: 3 of 4| P a g e

-4Evaluation of GIT, GUT (e.g.Contrast studies) Evaluation of the dynamics of the cardiovascular system and respiration - Evaluation of diaphragmatic movement - Monitor catheter placement - Intra-operative guidance ANGIOGRAPHY - Vascular system is imaged by x-ray during intravascular injection of iodinated contrast agents - Images of arterial structures are called ARTERIOGRAMS and venous structures are called VENOGRAMS ULTRASONOGRAPHY - Performed by using pulse echo technique, whereby the transducer converts electrical energy to a brief pulse of high frequency sound energy that is transmitted into the patient tissues and at the same time becomes the receiver detecting echoes of sound energy reflected from the tissues - Images are viewed in real-time Principles of interpretation - Solid tissues demonstrate speckled pattern of tissue texture e.g. liver, spleen - Hypoechoic lesion with lower echogenicity compared to surrounding parenchyma - Hyperechoic lesion with greater echogenicity compared to surrounding parenchyma - Anechoic complete absence of echoes e.g. Simple cyst - Complex lesions with solid and cystic components Frequency of transducers 1. High frequency transducers (5-10Mhz) - best for superficial structures like thyroid, breast, testes; for infants 2. Low frequency transducers (1-3.5 Mhz) - good for abdomen, pelvic organs Advantages of Ultrasound o Examination is done fast o No radiation to the patient o Allows real-time images of moving patient tissues o Cost-effective o Can differentiate solid from cystic structures Disadvantages of Ultrasound o Limited by bone and gas o Poor tissue delineation in obese patients o Operator-dependent COMPUTED TOMOGRAPHY (CT scan) Also called CAT (computerized axial tomography) scan Gives focused radiographic information about one cross-sectional slice of the patient, without confusing superimposed images Gives a range of density values for a particular chosen slice of the patient Contrast media may be used to enhance the difference in density of various structures -

Advantages of CT versus MRI 1. Rapid scan acquisition 2. Superior bone detail 3. Demonstration of calcification Disadvantages of CT versus MRI 1. Generally limited to axial plane 2. More radiation to the patient MAGNETIC RESONANCE IMAGING (MRI) Based upon the ability of a small number of protons within the body to absorb and emit radiowave energy when the body is placed within a strong magnetic field Like ultrasound, it doesnt use ionizing radiation Advantages of MRI versus CT 1. Outstanding soft tissue contrast resolution 2. Ability to provide images on any anatomic plane 3. Absence of radiation Disadvantages of MRI versus CT 1. Inability to demonstrate dense bone detail or calcification 2. Long imaging time 3. Limited spatial resolution 4. Unavailability and expense 5. Contraindicated in patients with electrically, magnetically or mechanically activated implants RADIOISOTOPE SCANNING (NUCLEAR IMAGING) - Living organs and tissues are visualized after injection of a radioactive isotope (radionuclide) that stays within the organ for quite sometime - The selected chemical substance by which the isotope has been attached is normally involved in the physiologic metabolism of that organ or will remain there long enough to be imaged - An image is obtained because the radioactive isotope emits gamma rays for a brief period of time - The emitted rays are recorded by a gamma camera or less commonly by a rectilinear scanner during the period of gamma emission

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