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X-Ray Physics
Discovered by Mr. Wilhelm Rortgen on November 8 , 1895
1.1The X-Ray Tube Assembly
With small x-ray tubes the electrical energy has to be limited to prevent
melting of the anode surface. Larger x-ray tubes providing a nominal tube
load of more than 10kW use rotating anodes.
1.1.4 Collimator
The collimator used to limit the radiation field to the size actually needed.
Sets of lead plates serve for radiation absorption and the definition of the
radiation field.
1.2X-Ray Physics
1.2.3.1 Effect of kV
When lowering the tube voltage, both the maximum energy and the
radiation intensity are affected. The influence of kV on dose output is
nonlinear.
1.2.3.2 Effect of mA
Reducing the tube current means reducing the number of electrons.
Therefore, only the intensity of radiation is affected. Tube current has a
linear influence on radiation output.
1.2.3.3 Effect of Filtration
The emission spectrum can only exist in the vacuum of the tube .
The Photons of the radiation beam have to penetrate:
the tube envelope
the insulating oil
the tube window
and the collimator.
This effect of filtration is rather helpful since the soft, low energy, radiation is
rather harmful and contributes little to the image. The minimum filtration
must be equivalent to 2.5mm AL.
1.3X-Ray Interaction with Matter
X-rays are used to make a radiograph. It is detected and processed by the
image receiver.
2. Radiobiology
Effect Radiation
The radiobiological effects are caused by interaction of radiation with matter,
stimulating or ionizing atoms.
2.1Radiation Hazard
Possible for the cell to have its hereditary disposition changed (mutation)
resulting in
somatic effects (cancer) or
genetic effects (mutation) when germ cells are affected.
The radiation hazards are classified into those which are
predictable (deterministic)
may happen (stochastic)
2.1.1 Deterministic Hazard
2.1.1.1 Deterministic Somatic Radiation Hazard
The predictable radiation hazards are the result of cells that were killed.
3. Radiation Protection
3.1 Controlled Area
The examination room is a Controlled Area. The walls of an examination room
are designed to absorb the scattered radiation.
Alumunium
Aluminum has an absorbing effect on radiation as shown by the
lower spectrum.
Soft radiation, however, is more affected than hard radiation. So it
is used as filter
material.
Copper
Copper shows a significant amount of absorption. For effective
protection against
radiation, however, thick layers of material are required. It is used
as filter material in collimators with varying thickness from 0.1mm
to 0.9mm to "harden up" the radiation beam for radiation
protection. Service engineers use Cu filters to simulate absorbers.
Lead
Due to the high atomic number, lead is a very effective absorber.
So, it's the material of choice for protective barriers.
3.2.2 Energy Dependency
The tube output drastically increases with increasing the tube voltage. We
get both
more energy and
more intensity.
In general, the amount of absorption is stated for 100kV. Reducing the tube
voltage to 70kV, as done normally during tests, increases the efficiency of a
protective barrier significantly. Under the conditions stated, no radiation can
be measured behind a protective barrier.
3.2.3 Personal Radiation Protection
as "lead equivalent" of mm Pb. Because of the energy dependency of the
absorption the
measurements are done at 100kV.
3.3General Rules
Activation
Work with "SS OFF" in general. Activate radiation only if really needed.
Before activating radiation, be sure that no person will be exposed.
Duration
The personal equivalent dose accumulates with duration of exposure.
Turn off radiation when no longer needed.
Distance
The inverse square law proves distance to be a good protection. Put as
much distance as possible between yourself and the radiation beam.
Protective Device
Do use the protective devices present:
o Leaded screens
o Leaded curtains
o Lead aprons
Scattered Radiation
Whenever Radiation penetrates an absorber, scattered radiation
results. Its amount is
directly proportional to the volume irradiated. For adjustments use
copper filters, attached to the collimator output. Use water only if
absolutely necessary.
Beam Collimation
Make it a habit to limit the field size to what is really needed to cover
the dominant.
This is a must with scattered radiation.
Working in the Beam
There is no need to work in the radiation beam!
Patient Dummy
We don't use patient dummies for technical test. We use test devices
instead, getting
reliable results for image quality assessment. The radiologist, however,
requires patient radiographs for image quality evaluation. That is his
problem. We don't present ourselves as patient dummies.
Protective Apparel
If you can't avoid working close to the radiation beam, always wear a
lead apron. That may be annoying, but Radiation induced injuries are
troublesome. Consider your position to the radiation source. When
standing with your back towards the radiation, put the apron on
backwards.
Checking
Activate your brain before you activate radiation! Never turn on
radiation mindlessly! You don't see radiation. So, use your imagination!
4.1.1 Patient(1)
While not a part of the x-ray system, the patient is still the center of all
our effort. Without a
patient, there is no need for an x-ray System.
Floating Table Top
The Patient is positioned by moving the floating table top rather than
moving the patient
himself.
4.1.2 The X-Ray Tube(2)
The x-ray tube converts the energy of highly accelerated electrons into
radiation that
penetrates tissue and bones, revealing information from inside the body.
The radiation emerges from the focal spot where the electrons emitted
from the cathode hit
the anode.
4.1.3 High Voltage Transformer(3)
This is the power supply of the x-ray tube. The high voltage is rectified
and, on the cathode
side, the AC-voltage for filament heating is added.
High Voltage Cables
The specially designed high voltage cables provide insulation between the
inner core holding up to 75kV and the outer shielding. The inner core is
made of several wires with low voltage insulation, needed to connect to
the tube filament.
4.1.4 Operation Console(4)
The operation console or operation desk is the interface between the
operator and the system. Here, all the exposure data needed are entered.
kV sets the image contrast and mAs the amount of radiation.
attenuation factor
image receiver dose
4.1.11Exposure Control(11)
Setting kV and mAs means controlling the tube output and hoping for
correct exposure of the film. Modern systems employ automatic exposure
control instead. For this the dose is
measured directly in front of the cassette by means of an ionization
chamber. Using a light localizer for positioning and a cassette as imaging
system is called direct technique.
4.1.12Viewing Box(12)
After exposure, the x-ray film has a latent (invisible) image. Only after
processing can it be
evaluated on a viewing box.
So, the complete imaging system is comprised of:
intensifying screens,
film,
film processing and
viewing box.
4.1.13Image Intensifier(13)
The image intensifier is an alternate image receiver. The input screen
creates an electron image which is projected towards the output screen by
means of an electron lens. By concentrating the electrons on a rather
small output screen, a bright image results; hence: image intensifier.
Using an image intensifier is called indirect technique. The former Bucky
tray becomes a spotfilm device.
4.1.14TV-System(14)
The TV camera picks up the image and presents it on a monitor screen in
real time. During fluoroscopy, the patient is screened at a low dose rate
and the image is displayed on the monitor for positioning. During
exposure, the image is accumulated on the pick-up device and then
transferred into digital memory. From there it is read out continuously.
4.1.15Automatic Dose Regulation (ADR)(15)
When using the image intensifier for imaging, the exposure control is
based on the light
output of the image intensifier rather than on the dose at its input. The
electron lens allows for varying the size of the active area on the input
screen resulting in image magnification or zoom. The ratio of output
luminance to input dose rate is referred to as the conversion factor or GX.
5. Imaging Systems
5.1Film-Screen-System
5.1.1 Direct Technique
In direct technique, the film cassette holds the x-ray film that will be
exposed. After processing inside the film processor, the radiograph is
evaluated on the viewing
box. On a radiograph, unexposed areas are transparent. Every amount of
exposure
contributes to film blackening. So, bones are displayed in "white" and
tissue in all shades of gray.
5.1.2 X-ray Film
Basically, the x-ray film is composed of a (Polyester) base and the light
(radiation) sensitive
emulsion. X-rays are attenuated differently by tissue or bones resulting in
an x-ray image which is invisible for the time being. The residual radiation
is registered by silver bromide crystals inside the emulsion. Thus the
latent image is formed. It is turned visible by film development and made
durable by fixation.
5.1.3 Efiiciency
This kind of image receiver isn't very efficient. For correct exposure a lot
of radiation is
required. Because of its very high spatial resolution (ability to see small
details), this system
is still used for some dental examinations. It is also used in material
testing where dose
6.1.2 Magnification
The geometrical magnification is given by the ratio of
Source-Image-Distance to
Source-Object-Distance.
Since over-table units provide larger SIDs (i.e. less magnification) than undertable units the image quality in general is better with OT-units. The amount of
blurring increases with the distance from the object. For geometrical
magnification techniques, with a large distance between object and image
receiver, the large focal spot is useless. With the image receiver just behind
the patient, however, the amount of blurring is drastically reduced. Here, the
large focal spot proves helpful providing short exposure time minimizing
blurring due to organ movement. For good image quality, the spotfilm device
should provide a short distance between patient and image receiver.
6.2Heel Effect
6.2.1 Radiation Intensity
This is true for the nominal focal size as well as for the radiation intensity.
Radiation spreads out from the focal spot linearly and with the speed of
light. The rays emerging perpendicular to the anode surface are of highest
intensity. Obliquely emerging radiation is of less intensity, while rays
nearly parallel to the anode surface are already absorbed by the anode.
The resulting intensity curve resembles the shape of a heel.
7. The Generator
Basically, the generator is the power supply to the x-ray tube. It's main tasks
are to set the
radiation quality (kV)
the dose (mAs)
provide shortest possible exposure time (ms)
without destroying the anode
7.1Focal Spot
7.3Subassemblies
7.3.1 Filament Heating
The emission of electrons required to provide the tube current selected is
obtained by heating up the filament to a specific temperature. The
filament current to produce the tube current desired is calculated by the
controller. Measuring the inverter current, the filament is heated up to the
correct temperature. During radiation the actual tube current is
measured and used to control the filament heating. So, there is no direct
control of the
tube current. It can be done only indirectly by controlling the filament
current.
7.4Collimator
7.4.1 Multileaf Collimator
The simple collimator provides one set of collimating plates only. Because
all parts of the focal spot emit radiation, the edges of the radiation field
are blurred. The field collimation is improved by use of a second set of
collimation plates located somewhat distant. Both sets of plates are
operated synchronously.
7.4.1.1 Rectangular Collimation
Operating the horizontal and vertical sets of plates separately, any width
and height of radiation field can be set. For radiation protection, the
maximum field size is limited to the cassette format.
7.4.1.2 Iris Collimation
In combination with an image intensifier, an additional set of collimating
plates, rotated by
45, serves for a nearly round field of radiation. For radiation protection
and to verify the
correct function, the limiting plates should just be visible at the image
border.
7.4.2 Filtration
Due to radiation protection regulations the inherent filtration of the tube
assembly has to be equivalent to 2.5mm Al or greater. Using additional
filters, the amount of soft radiation can be reduced further making the
radiation less harmful. The loss of intensity is compensated by the
Automatic Dose rate Control. The beam hardening effect becomes
apparent.
7.4.3 Light Localizer
With exposure units providing no fluoroscopy, a light localizer is used to
simulate the size and location of the radiation field.
7.5Anti Scatter Grid
Whenever X-rays penetrate a patient, scattered radiation is produced. The
scattered radiation
causes a fog-like layer over the entire image reducing the image contrast.
Using an anti scatter
grid, this effect is minimized. The grid is composed of fine lead stripes held in
place by interspacing material that is radio-lucent. The lead stripes are
aligned towards the focal spot,
allowing the radiation to pass nearly unhindered. The undirected scattered
radiation emerging from the patient, however, is absorbed by the lead
stripes. The grid can be moved during exposure, so the lead stripes do not
show up on the film.
7.6X-Ray Measurement
7.6.1 kV Measurement
There are two ways to measure the tube
voltage.
The direct measurement, preferred by the service engineer and
The non invasive measurement used by the physicist.
7.6.2 mA Measurement
For the tube current measurement a test point is provided in the
generator. The tube current is a vital parameter for the operation of the xray tube. However it is not really necessary to measure it. More important
may be the measurement of the mAs product which can also be measured
at a test point provided.
7.6.3 Dose Measurement
Dose Terms
For reliable dose measurement, radiation quality and test conditions have
to be specified.
This is what we use:
8. Mammography
8.1.1 Compression
The standard range of exposure voltages doesn't give assessment of the
glandular tissue of the breast; only extreme low voltage in the range of 20
to 30kV makes the structures show up. However, the inherent
characteristics of this soft radiation are worth noticing. This very low
energy radiation is not able to penetrate thicker tissue and contribute to
the radiograph, but only damages cells in the breast tissue. An
improvement is achieved by compressing the breast. With the maximum
absorber at 4.5cm, sufficient dose levels are to be expected throughout
the image
the absorbed dose is still acceptable. Lower energies would provide better
contrast, however, at unacceptable levels of absorbed dose.
Mo/Mo
Starting with a combination of molybdenum anode and molybdenum filter
at 26kV. Notice the significant amount of imaging photons in the range of
20 to 26keV, which was only a minor part of the original spectrum.
Mo/Ro
For medium dense breasts, the molybdenum spectrum can be utilized far
better by shifting the k-edge towards higher energies. This is done by
switching the molybdenum filter with a rhodium filter, having its k-edge at
23keV. With this combination of a molybdenum
anode and a rhodium filter a third peak shows up in the range from 20
through
23keV, which reduces both the absorbed dose and the exposure time
without sacrificing the image quality significantly.
W/Ro
The best match for this heavy absorber is the combination of tungsten
anode and rhodium filter since the tungsten spectrum isn't dominated by
the characteristic radiation. Additionally, the higher dose yield of the
tungsten anode allows for more effective filtration.
8.1.6 Magnification
If an area of micro calcifications is examined under standard geometric
conditions, the very small size of the structures makes evaluation difficult.
In this case, magnification may be helpful. The amount of blurring can be
reduced by using the micro focus. Which is used only in combination with
magnification technique. Due to the short focus-skin distance, the
glandular dose is significantly increased. Which is compensated by the
small image size used with magnification. An anti scatter grid is not
needed in this case.