Summary of important points on atomic structure

In the neutral atom, the number of orbiting electrons is equal to the number of protons
in the nucleus. Since the number of electrons determines the chemical behaviour of an
atom, the atomic number (Z) also determines this chemical behaviour. Each element
has different chemical properties and thus each element has a different atomic
number. These form the basis of the periodic table.
Atoms in the ground state are electrically neutral because the number of positive
charges (protons) is balanced by the number of negative charges (electrons).
If an electron is removed, the atom is no longer neutral, but becomes positively
charged and is referred to as a positive ion.The process of removing an electron from
an atom is called ionization.
If an electron is displaced from an inner shell to an outer shell (i.e. to a higher energy
level), the atom remains neutral but is in an excited state. This process is called
excitation.
The unit of energy in the atomic system is the electron volt (eV), 1 eV= 1.6x 1019
joules.
Interaction of X-rays with matter
When X-rays strike matter, such as a patient's tissues, the photons have four possible fates,
shown diagrammatically in Figure 2.9. The photons may be:
Completely scattered with no loss of energy
Absorbed with total loss of energy
Scattered with some absorption and loss of energy
Transmitted unchanged.
Definition of terms used in X-ray interactions
Scattering change in direction of a photon with or without a loss of energy
Absorption deposition of energy, i.e. removal of energy from the beam
Attenuation reduction in the intensity of the main X-ray beam caused by
absorption and Scattering.
Attenuation = Absorption + Scattering
lonization removal of an electron from a neutral atom producing a negative ion
(the electron) and a positive ion (the remaining atom).
Interaction of X-rays at the atomic level
There are four main interactions at the atomic level, depending on the energy of the incoming
photon, these include:
Unmodified or Rayleigh scattering pure scatter
Photoelectric effect pure absorption
Compton effect scatter and absorption
Pair production pure absorption.

Only two interactions are important in the X-ray energy range used in dentistry:
Photoelectric effect
Compton effect.

Photoelectric effect
The photoelectric effect is a pure absorptioninteraction predominating with low-energy
photons (see Fig. 2.10).

Summary of the stages in the photoelectric effect

1. The incoming X-ray photon interacts with a bound inner-shell electron of the tissue
atom.
2. The inner-shell electron is ejected with considerable energy (now called a
photoelectrori) into the tissues and will undergo further interactions (see below).
3. The X-ray photon disappears having deposited all its energy; the process is therefore
one of pure absorption.
4. The vacancy which now exists in the inner electron shell is filled by outer-shell
electrons dropping from one shell to another.
5. This cascade of electrons to new energy levels results in the emission of excess
energy in the form of light or heat.
6. Atomic stability is finally achieved by the capture of a free electron to return the atom
to its neutral state.
7. The high-energy ejected photoelectron behaves like the original high-energy X-ray
photon, undergoing many similar interactions and ejecting other electrons as it passes
through the tissues. It is these ejected high-energy electrons that are responsible for
the majority of the ionization interactions within tissue, and the possible resulting
damage attributable to X-rays.

Compton effect
The Compton effect is an absorption and scattering process predominating with higherenergyphotons (see Fig. 2.11).

Summary of the stages in the Compton effect

1. The incoming X-ray photon interacts with a free or loosely bound outer-shell
electron of the tissue atom.
2. The outer-shell electron is ejected (nowcalled the Compton recoil electron) with
some of the energy of the incoming photon, i.e. there is some absorption. The
ejected electron then undergoes further ionizing interactions within the tissues (as
before).
3. The remainder of the incoming photon energy is deflected or scattered from its
original path as a scattered photon.
4. The scattered photon may then:
Undergo further Compton interactions within the tissues
Undergo photoelectric interactions within the tissues
Escape from the tissues it is these photons that form the scatter
radiation of concern in the clinical environment.
5. Atomic stability is again achieved by the capture of another free electron.

An individual's average dose from background radiation is estimated at approximately 2

mSv per year in the UK, while in the USA it is estimated at approximately 3.6 tnSv. These
figures are useful to remember when considering the magnitude of the doses associated
with various diagnostic procedures (see later).

Classification of the biological effects

The biologicallydamaging effects of ionizing radiation are classified into three main
categories:
Somatic DETERMINISTIC effects
Somatic STOCHASTIC effects.
Genetic STOCHASTIC effects.
The somatic effects are further subdivided into:
Acute or immediate effects appearing shortly after exposure, e.g. as a result of
large whole body doses (Table 4.1)
Chronic or long-term effects becoming evident after a long period of time, the
socalled latent period (20 years or more), e.g. leukaemia.

Somatic deterministic effects

These are the damaging effects to the body of the person exposed that will definitely result
from a specific high dose of radiation. Examples include skin reddening and cataract
formation. The severity of the effect is proportional to the dose received, and in most cases a
threshold dose exists below which there will be no effect.
Somatic stochastic effects
Stochastic effects are those that may develop. Their development is random and depends on
the laws of chance or probability. Examples of somatic stochastic effects include leukaemia
and certain tumours.
These damaging effects may be induced when the body is exposed to any dose of radiation.
Experimentally it has not been possible to establish a safe dose i.e. a dose below which
stochastic effects do not develop. It is therefore assumed that there is no threshold dose, and
that every exposure to ionizing radiation carries with it the possibility of inducing a
stochastic effect.
The lower the radiation dose, the lower the probability of cell damage. However, the severity
of the damage is not related to the size of the inducing dose. This is the underlying
philosophy behind present radiation protection recommendations (see Ch. 6).
Genetic stochastic effects
Mutations result from any
sudden change to a gene or
chromosome. They can be
caused by external factors, such
as radiation or may occur
spontaneously.
Radiation to the reproductive
organs may damage the DNA of
the sperm or egg cells. This may
result
in
a
congenital
abnormality in the offspring of
the person irradiated. However,
there is no certainty that these
effects will happen, so all
genetic effects are described as
stochastic. A cause-and-effect
relationship is difficult, if not
impossible, to prove. Although
ionizing radiation has the
potential to cause genetic
damage, there are no human data
that show convincing evidence
of a direct link with radiation.
Risk estimates have been based mainly on experiments with mice. It is estimated that a dose
to the gonads of 0.5-1.0 Sv would double the spontaneous mutation rate. Once again it is
assumed that there is no threshold dose.

*Intraoral radiography
Tube voltage should not be lower than 50 kV. New equipment should operate
within the range 60-70 kV.
All equipment should operate within 10% of the stated or selected kV setting.
Beam diameter should not exceed 60 mm at the patient end of the spacer cone
or beamindicating device.
Rectangular collimation should be provided on new equipment and fitted to
existing equipment at the earliest opportunity and the beam size should not
exceed 40 by 50 mm.
Total beam filtration (inherent and added) should be 1.5 mm of aluminium for
sets operating below 70 kV and 2.5 mm of aluminium for sets operating above
70 kV and should be marked on the tube housing.
The focal spot position should be marked on the outer casing of the tubehead.
Focal spot to skin distance (FSD) should be at least 100 mm for sets operating
below 60 kV and 200 mm for sets operating above 60 kV.
Film speed controls and finely adjustable exposure time settings should be
provided.
The fastest film available (E or F speed) that will produce satisfactory
diagnostic images should be used.

Ionizing radiation is the subject of considerable safety legislation designed to minimize the
risks to radiation workers and to patients. The International Commission on Radiological
Protection (ICRP) regularly publishes data and general recommendations based on the
following general principles:
No practice shall be adopted unless its introduction produces a positive net benefit
(Justification)
All exposures shall be kept as low as reasonably practicable (ALARP), taking
economic and social factors into account (Optimization)
The dose equivalent to individuals shall not exceed the limits recommended by the
ICRP (Limitation)