Essentials of

Radiologic
Science
Essentials of

Radiologic
Science
Robert Fosbinder
Denise Orth
Acquisitions Editor: Pete Sabatini
Product Director: Eric Branger
Product Manager: Amy Millholen
Marketing Manager: Shauna Kelley
Artist: Jonathan Dimes
Compositor: SPi Global
Printer: C&C Offset

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Library of Congress Cataloging-in-Publication Data

Fosbinder, Robert.
Essentials of radiologic science / Robert Fosbinder, Denise Orth.
p. ; cm.
Includes index.
Summary: “LWW is proud to introduce Essentials of Radiologic Science, a core, comprehen-
sive textbook for radiologic technology students. Focusing on covering the crucial components and
minimizing extraneous content, this text will help prepare students for success on the The American
Registry of Radiologic Technologists Examination in Radiography and beyond into practice. Topics
covered include radiation protection, equipment operation and quality control, image production and
evaluation, and patient care. This is a key and crucial resource for radiologic technology programs,
focusing on providing relevancy and offering tools and resource to students of multiple learning types.
These include a full suite of ancillary products, a variety of pedagogical features imbedded in the text,
and a strong focus on the practical application of the concepts presented”—Provided by publisher.
ISBN 978-0-7817-7554-0
1. Radiography, Medical—Textbooks. 2. Radiologic technologists—Textbooks. I. Orth, Denise.
II. Title.
[DNLM: 1. Technology, Radiologic. 2. Radiation Protection. WN 160]
RC78.F575 2010
616.07'572—dc22
2010030972

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12
1 2 3 4 5 6 7 8 9 10
 Preface

Essentials of Radiologic Science has been designed with the instructor’s current syllabus. We believe the area of
students and educators in mind. The textbook is designed to Patient Positioning and Procedures is so extensive and
distill the information in each of the content-specific areas complex that it requires a separate text.
down to the essentials and to present them to the student It is our hope that this text will exceed the expectations
in an easy-to-understand format. We have always believed of students and educators in their use of this book. We
that the difference between professional radiographers and hope that instructors find this book easy for their students
“button pushers” is that the former understand the science to read and understand, and we know they will find it a
and technology of radiographic imaging. To produce qual- useful addition to their courses.
ity images, a student must develop an understanding of
the theories and concepts related to the various aspects of
using radiation. They should not rely on preprogrammed
equipment and blindly set technical factors, as this is the Features
practice of “button pushers.” We have made a special effort
to design a text that will help the students achieve tech-
The text has many features that are beneficial to students
nical competence and build their professional demeanor.
as they learn about the fascinating world of radiography.
We have placed the chapters in an order to help the stu-
Key terms are highlighted with bold text and are located at
dent and educator progress from one topic to another. The
the beginning of each chapter as well as inside the chapter
chapters can be used in consecutive order to build compre-
material. A glossary provides definitions for each key term.
hension; however, each chapter can stand alone and can
Other features include objectives, full-color design, in-text
be used in the order that is appropriate for any program.
case studies with critical thinking questions, critical think-
From the discovery of x-rays by Wilhelm Roentgen
ing boxes with clinical/practical application questions and
to modern day, there have been major changes in how
examples, video and animation callouts, chapter summa-
radiography is performed and the responsibilities of the
ries, and chapter review questions. One of the most excit-
radiographer. The advancement of digital imaging and
ing features of this text is the use of over 250 illustrations,
the elimination of film in a majority of imaging depart-
radiographic images, photographs, and charts that provide
ments in the country have changed the required knowl-
graphic demonstration of the concepts of radiologic science
edge base for radiographers, which is different today than
while making the text visually appealing and interesting.
just a few years ago. This text addresses those changes and
the way radiography students must be educated.
Our goal is to make this text a valuable resource for
radiography students during their program of study and
in the future. To this end, the text covers four of the five Ancillaries
content-specific areas contained in the registry examina-
tion: Physics, Radiographic Image Production, Radiation The text has ancillary resources available to the students
Protection, and Patient Care. The sections are inde- to further assist their comprehension of the material.
pendent and designed to be combined in whatever fits Student ancillaries include full text online, a registry

v
vi Preface

exam–style question bank, a chapter review question

bank, videos, and animations. These animations comple- Workbook
ment the text with action-packed visual stimuli to explain
complex physics concepts. For example, the topic of x-ray
An Essentials of Radiologic Science Workbook is
interactions contains an animation demonstrating the
available separately to supplement the text and to help
x-ray photon entering the patient and then undergoing
the students apply knowledge they are learning. The
photoelectric absorption, Compton scattering, or through
Workbook provides additional practice and preparation
transmission. Thus, the student can see how the exit radi-
for the ARRT exam and includes registry-style review
ation is made up of a combination of through transmitted
questions, as well as other exercises (crossword puzzles,
and scattered photons. Videos provide the student with
image labeling) and a laboratory experiments section. All
the “real world” example of different scenarios includ-
the questions in the Workbook are correlated directly with
ing venipuncture, taking vital signs, using correct body
the text. Use of the Workbook will enhance learning and
mechanics, hand hygiene, and patient rights.
the enjoyment of radiologic science concepts.
We have also included valuable resources for educa-
tors to use in the classroom. Instructor resources include
Robert Fosbinder
PowerPoint slides, lesson plans, image bank, test genera-
Denise Orth
tor, answer key for text review questions, and Workbook
answer key. Their purpose is to provide instructors with
detailed lecture notes that tie together the textbook and
all the other resources we are offering with it.
x User’s Guide

Additional Learning Resources

Valuable ancillary resources for both students and instructors are available on
thePoint companion website at http://thepoint.lww.com/FosbinderText. See the
inside front cover for details on how to access these resources.

Student Resources include a registry exam-style question bank, a chapter review

question bank, videos, and animations.

Instructor Resources include PowerPoint slides, lesson plans, image bank, test
generator, answer key for text Review Questions, and answer key for Workbook
questions.
 Reviewers

John H. Clouse, MSR, RT Catherine E. Nobles, RT (R), MEd

Deputy Director Didactic/Clinical Instructor
Center for Disaster Medicine Preparedness Radiography Program
Department of Emergency Medicine Houston Community College System
University of Louisville School of Medicine Houston, Texas
Louisville, Kentucky
George Pales, PhD, RT (R) (MR) (T)
Anthony E. Gendill, BA, BS, DC Radiography Program Director
Medical Instructor/Award Winning Faculty Member Health Physics and Clinical Sciences
Allied Health Department University of Nevada, Las Vegas
Institute of Business and Medical Careers Las Vegas, Nevada
Fort Collins, Colorado
Lisa F. Schmidt, PhD, RT (R) (M)
Kelli Haynes, MSRS, RT (R) Program Director
Director of Undergraduate Studies/Associate Professor/ Radiography
Graduate Faculty Pima Medical Institute
Radiologic Sciences Chula Vista, California
Northwestern State University
Shreveport, Louisiana Deena Slockett, MBA
Program Coordinator/Associate Professor
Judy Lewis, MEd Radiologic Sciences
Program Director/Instructor Florida Hospital College of Health Sciences
Radiologic Technology Orlando, Florida
Mississippi Gulf Coast Community College
Gautier, Mississippi

xi
Acknowledgements

I would like to thank all of my former students for their whose dedicated work and professionalism are evident
help in reading the book. I would also like to thank my in the quality of their work. Special thanks to Jonathan
family: my mother Kay; my sisters, Carol and Linda; my Dimes for his wonderful illustrations and vision. I would
brother, Tom; and my wife, Tracy, for all of her help in also like to extend my appreciation to Starla Mason for
typing. developing the Workbook and ancillary resources. Many
thanks to my colleagues for their encouragement and
Robert Fosbinder support.
Finally, to my husband Mark and our family, I wish
I would like to acknowledge those individuals who to express my true appreciation for your unwavering sup-
have helped develop and publish this text. First, thank port, encouragement, and understanding during the pro-
you, Peter Sabatini and Amy Millholen, for providing cess of writing this text.
the assistance, encouragement, and support needed to
complete this text. Thanks also to the production staff Denise Orth

xii
 Contents

Preface v

User’s Guide vii

Reviewers xi

Acknowledgements xii

PART I: BASIC PHYSICS

Chapter 1 Radiation Units, Atoms, and Atomic Structure 2

Chapter 2 Electromagnetic Radiation, Magnetism, and Electrostatics 14

Chapter 3 Electric Currents and Electricity 30

PART II: CIRCUITS AND X-RAY

PRODUCTION
Chapter 4 Transformers, Circuits, and Automatic Exposure Control (AEC) 45

Chapter 5 X-Ray Tubes 60

Chapter 6 X-Ray Production 72

Chapter 7 X-Ray Interactions 81

PART III: IMAGE FORMATION

Chapter 8 Intensifying Screens 92
xiii
xiv Contents

Chapter 9 Film and Processing 102

Chapter 10 Density and Contrast 122

Chapter 11 Image Formation 139

Chapter 12 Grids and Scatter Reduction 164

PART IV: SPECIAL IMAGING TECHNIQUES

Chapter 13 Fluoroscopy, Conventional and Digital 184

Chapter 14 Digital Imaging 204

Chapter 15 Quality Control 221

Chapter 16 Mammography 240

Chapter 17 Computed Tomography 253

Chapter 18 Magnetic Resonance Imaging 271

PART V: RADIATION PROTECTION

Chapter 19 Radiation Biology 286

Chapter 20 Radiation Protection and Regulations 308

Chapter 21 Minimizing Patient Exposure and Personnel Exposure 320

PART VI: PATIENT CARE

Chapter 22 Medical and Professional Ethics 335

Chapter 23 Patient Care, Medications, Vital Signs, and Body Mechanics 346

Glossary 361

Index 367
 PART I

Basic Physics
 1

Radiation Units, Atoms,

and Atomic Structure

Objectives Key Terms

Upon completion of this chapter, the student ● absorbed dose ● electron volt
will be able to: ● activity ● exposure
1. Identify the units of exposure, dose, and ● alpha particle ● half-life
effective dose. ● atomic mass num- ● ion
2. Define atomic mass and atomic number. ber (A) ● ionization
● atomic number (Z) ● isotopes
3. Describe the Bohr model of the atom and its
components. ● beta particle ● nucleons
● effective dose ● radioactive decay
4. Define electron binding energy.
● electron binding ● radioisotopes
5. Describe the process of ionization. energy
6. Identify the types of ionizing radiation.

2
 Chapter 1: Radiation Units, Atoms, and Atomic Structure 3

smaller unit, the milliroentgen (mR), is more commonly

Introduction used. One mR is 1,000 times smaller than a roentgen.

An understanding of nuclear and atomic

structure together with how nuclei and atoms Absorbed Dose
interact is fundamental to an understanding of The units of absorbed dose or absorbed energy are the
how medical imaging uses radiation to produce gray (Gy) in the SI system and the rad (radiation absorbed
diagnostic images. In this chapter, we discuss dose) in the conventional system. Absorbed dose measures
the fundamental units of radiation and how the amount of energy deposited in the patient by the x-rays.
atomic structure and the ionization of atoms One gray is equivalent to 100 rads and 1 rad equals 10 mGy.
affect the formation of the radiographic image. Because the gray and rad are so large, the milligray (mGy)
and the millirad (mrad) are more commonly used.

Effective Dose
Units of Radiation The effective dose relates the risk from irradiating a part of
the body to the risk of total body irradiation. In other words,
Historically, the quantities and units utilized to measure the tissues of the body are not equally affected by ionizing
ionizing radiation included the roentgen (R), the rad, radiation. Some tissues are more sensitive to the effects of
and the rem. In 1948, an international system of units ionizing radiation. We know that a dose of 6 sievert (Sv) to
based on the metric system was developed. These units the entire body is fatal. However, a dose of 6 Sv to a patient’s
are called SI units or Systems Internationale d’Unites. hand or foot is not fatal. The harm from a radiation dose
Although the SI units were formally adopted, the older depends on both the amount of radiation or dose and the
traditional units are still in use today. This may cause part of the body irradiated. The combination of the dose and
confusion in understanding which units to use and how the body parts irradiated is measured by the effective dose.
they are related to each other. The following discussion The effective dose is calculated by using weighting fac-
reviews both systems of measurement. tors (wet) for various organs or tissues. The weighting fac-
Radiography utilizes the units of radiation to deter- tors are based on the organ sensitivities and importance of
mine the amount of exposure that reached the patient, the organ to survival. The calculation multiplies the dose
how much radiation was deposited in tissue, and how to the organ by its weighting factor. The effective dose has
much damage occurred. The four fundamental units of units of Sv in the SI system or rem (radiation equivalent
radiation used in radiology are: man) in the conventional system. One sievert is equal to
100 rem. Because the units are so large, the millisievert
1. Exposure (mSv) and the millirem (mrem) are often used.
2. Absorbed Dose The units in the conventional system are arranged so
3. Effective dose that 1 R is equal to 1 rad, which is equal to 1 rem.
4. Activity
Activity
Exposure Radioactive atoms spontaneously decay by transforming or
Exposure is defined as the amount of ionization produced disintegrating into different atoms. The amount of radioac-
by radiation in a unit mass of air. We could count the num- tive atoms present is measured by their activity or the num-
ber of x-rays, but it is easier to measure the amount of ion- ber of disintegrations per second, dps. The units of activity
ization produced by the x-rays. Ionization is discussed in are the Becquerel (Bq) in the SI system and the Curie (Ci)
more detail later in this chapter. Exposure is measured in in the conventional system. One becquerel is equal to one
the SI system by coulombs per kilogram (C/kg) or in the disintegration per second. The Curie is based on the num-
conventional system using roentgens (R). The relationship ber of disintegrations per second from 1 g of radium. One
between the roentgen and coulombs per kilogram is 1 R Curie is equal to 3.7 × 1010 dps. Because the Curie is so
= 2.58 × 10−4 C/kg. The roentgen is a fairly large unit so a large, the millicurie (mCi) is normally used (Table 1.1).
4 Part I: Basic Physics

TABLE 1.1 UNITS OF RADIATION

Quantity SI Unit Conventional Unit Ratio of SI to Conventional

Exposure Coulomb/kilogram (C/kg) Roentgen (R) 2.58 × 10−4 C/kg = 1 R

Dose Gray (Gy) rad 1 Gy = 100 rad
Effective Dose Sievert (Sv) rem 1 Sv = 100 rem
Activity Becquerel (Bq) Curie (Ci) 3.7 × 1010 Bq = 1 Ci

positive nucleus resulting in the collapse of the atom.

Atomic Models Bohr said that in an atom, electrons could only exist in
shells or orbits around the nucleus and were forbidden to
exist anywhere else. Although the Bohr model has been
radically revised, his early model of the atom adequately
An animation for this topic can be viewed describes the relationship of the nucleus of the atom to
at http://thepoint.lww.com/FosbinderText the orbital shells.
Most of the space in an atom is empty. If the nucleus
were the size of a pin head, the atom diameter would be
There have been many atomic models, beginning with the length of a football field. Figure 1.1 illustrates the
those of the Greeks who believed there were four types of essential features of the Bohr model of the atom. In the
atoms: air, earth, fire and water. In the early 1920s, scien- Bohr model, electrons move in orbits or shells around
tists knew that atoms contained electrons and were elec- a dense central nucleus. The electrons are negative and
trically neutral. Two of the most popular models were the nucleus is positive.
the “plum pudding model” in which the electrons were
distributed inside a positive cloud like chocolate chips in
a muffin and the Bohr model. The Bohr model describes
the atom as a central dense positive nucleus surrounded
Atomic Structure
by electrons moving around the nucleus. The Bohr model
more accurately describes the experimental observations To understand the effects of ionizing radiation on a tis-
and so is widely accepted today. sue, one must first grasp the concept of matter.
The major problem with the Bohr model was that the
negative electrons would be strongly attracted into the Matter
In nature, matter is commonly found as a mixture of two or
more substances. A substance is defined as a material that
= Proton
L shell
has a definite, constant composition. Pure salt, sodium
= Electron
chloride, is an example of a substance. Substances may
K shell = Neutron be either simple or complex. Simple substances, known
as elements, cannot be broken down into a simpler sub-
stance by chemical means.
The periodic table of elements lists 92 naturally occur-
ring elements. When two or more elements are chemically
combined a complex substance or compound is formed.
A well-known example of a compound is salt. When an
Dense positive equal proportion of the element sodium (Na) is chemically
nucleus
combined with the element chlorine (Cl) salt is formed.
The smallest particle of salt is called a molecule; therefore,
Figure 1.1. Bohr model. each molecule of salt consists of an atom of sodium and
 Chapter 1: Radiation Units, Atoms, and Atomic Structure 5

an atom of chlorine. Atoms are the fundamental building TABLE 1.2 ATOMIC ELECTRON SHELLS
blocks of nature which can combine to form elements.
Maximum Electron
Atoms are too small to see even with the most powerful Shell Letter Shell Number Number
microscopes. Instead of describing the atom by what we
see, models are used to describe the atom. K 1 2
L 2 8
Atomic Nucleus M
N
3
4
18
32
At the center of the atom, the nucleus contains nuclear O 5 50
particles called nucleons. Nucleons are either protons or P 6 72
neutrons. Protons have a single positive charge, neutrons Q 7 98
have zero charge. The nucleons make up the majority
of the mass of an atom. Revolving around the nucleus of
the atom are the orbital electrons. The electrons carry a
negative charge and add slightly to the mass of the atom. The shells are identified by shell number or letters of
the alphabet: the closest shell to the nucleus is No. 1 and
Electron Shells is called the K shell, the No. 2 shell is called the L shell,
Electrons in an atom move around the nucleus in spe- and so on to shell No. 7 the Q shell in order of increas-
cific orbits or shells. The number of shells occupied in a ing distance from the nucleus. The order of the shell is
particular atom depends on how many protons are there important because the shell number designates the maxi-
in the nucleus. There is a limit to how many electrons mum number of electrons the shell can hold.
can occupy each shell. The shell closest to the nucleus is The maximum number of electrons that can be con-
called the K shell and can hold no more than two elec- tained in a shell is given by the equation:
trons. If an atom has more than two protons within the
nucleus, the additional electrons are located in shells fur- Maximum number = 2n2.
ther from the nucleus. Atoms with more protons in the
nucleus have more electrons in the surrounding shells. where n is the shell number. For shell number 3, called
The number of electrons in the shells must equal the the M shell, the maximum number of electrons that can
number of protons in the nucleus of a neutral atom. occupy the shell is 18 (Table 1.2).

NA
H C

K shell L shell L shell

M shell
K shell K shell

= Proton
= Electron
= Neutron

Figure 1.2. Electron shell structure of hydrogen, calcium, and sodium. (H) The electron shell
structure of hydrogen (Z = 1). (C) Electron shell for carbon (Z = 6). (NA) Electron shell for
sodium (Z = 11).
6 Part I: Basic Physics

Maximum number = 2[3]2 Even though the maximum number of electrons that
a shell can hold is 2n2, there is another rule that may
= 2´9
override the maximum number. That overriding rule is
= 18 electrons. the octet rule which states that the outer shell of a stable
atom can never contain more than eight electrons.
Figure 1.2 illustrates the shell structure for hydrogen,
carbon, and sodium. Hydrogen has a single electron in
its shell. Carbon has six protons in the nucleus. It has
Electron Binding Energy
two electrons in the K shell and four electrons in the L Electron binding energy describes how tightly the elec-
shell. Sodium has eleven electrons contained in three tron is held in its shell. The negative electron is attracted
shells, two in the K shell, eight in the L shell, and one in to the positive nucleus by electrostatic forces. Electrons
the M shell. in shells closer to the nucleus have a stronger attraction.

Hydrogen Molybdenum Iodine

K 0 0

N N
1e– 1P
M M
~0.02 KeV
L L

K K

42 P 53 P
1e– 13e– 18e– 8e– 2e– 7e– 18e– 18e– 8e– 2e–
56 N 74 N

~20.00 KeV ~33.17 KeV

~2.87 KeV ~5.19 KeV

~0.51 KeV ~1.07 KeV

~0.6 KeV ~0.19 KeV

Tungsten Lead

P P

0 0

N N

M M

L L

K K

74 P 82 P
2e– 12e– 32e– 18e– 8e– 2e– 4e– 18e– 32e– 18e– 8e– 2e–
110 N 126 N

~69.5 KeV ~88.01 KeV

~12.10 KeV ~15.86 KeV

~2.82 KeV ~3.86 KeV

~0.59 KeV ~0.89 KeV

~0.08 KeV ~0.15 KeV

Figure 1.3. Binding shell energy. Electrons close to the nucleus will have the greatest binding energy.
 Chapter 1: Radiation Units, Atoms, and Atomic Structure 7

Negative ion
= Proton X-ray photon (ejected negative electron)
= Electron
= Neutron

13 + 13 +
14 n 14 n

Neutral atom – 13 protons, 13 electrons Positive ion – 13 protons, 12 electrons

Figure 1.4. Ion pair.

The electron binding energy is the energy required to is removed from an atom or when an electron is added
remove the electron from its shell and is measured in a to an atom, the atom becomes electrically charged and
unit called an electron volt (eV). An eV is a very small is called an ion. Therefore, if an electron is added, the
unit of energy. Electron binding energies can be as small atom is a negative ion because the atom has an extra
as a few electron volts or as large as thousands of electron negative charge, and if an electron is removed, the atom
volts. A pencil falling from a desk has an energy of about is a positive ion because it has an extra positive charge.
5 × 1011 eV. Figure 1.4 shows the formation of a positive and a nega-
The binding energy of electrons decreases as the tive ion, also termed an ion pair. The energy available
orbital shells get farther away from the nucleus. The to form the positive and negative ions must be sufficient
K shell always has the highest binding energy because to overcome the binding energy of the orbital electron
its electrons are closest to the nucleus, and the Q shell or ionization cannot occur. Ionization always results in
has the lowest binding energy because it is farthest from the formation of a positive ion and a negative ion. Ions
the nucleus. Therefore, it takes less energy to remove a can expose film, activate radiation detectors, and produce
Q-shell orbital electron than a K-shell orbital electron. biological effects.
Atoms with fewer protons in the nucleus have lower
binding energies, while atoms with more protons in the
nucleus have higher binding energies. The difference
in binding energies is because atoms with more pro- Atoms
tons have an increased positive charge. This means that
electrons in atoms of high atomic number elements are Now that you have an understanding of the compo-
bound more tightly than electrons in lower atomic num- nents of an atom, we discuss the characteristics that
ber elements (Fig. 1.3). The binding energy of K-shell determine the placement of an element on the periodic
electrons in lead is much higher than the binding energy table.
of K-shell electrons of hydrogen.

Ionization Atomic Mass

Ionization is the process of adding or removing an Because the proton and neutron masses are so small, the
electron from its shell in the atom. When an electron atomic mass unit (AMU) is used to describe the mass of
8 Part I: Basic Physics

TABLE 1.3 ATOMIC MASS AND CHARGE for the element. The symbol for carbon with six protons
and six neutrons is 126 C. The atomic number, Z, is always
Particle Mass in kilograms Mass in AMU Charge
smaller than the atomic mass number A except for hydro-
Proton 1.6726 × 10−27 kg 1 +1 (positive) gen where A and Z are equal. Table 1.4 gives the chemical
Neutron 1.6749 × 10−27 kg 1 0 (neutral) symbol, atomic mass in AMU, atomic number, and
Electron 9.109 × 10−31 kg 0 −1 (negative)
K-shell binding energies of some elements of interest in
radiology. Larger atoms with higher atomic numbers and
larger atomic mass numbers have higher binding energies.
an atom instead of the kilogram. The proton and neu- The density and atomic numbers are important in radio-
tron weigh almost exactly 1 AMU. The electron is about graphic imaging because elements with higher densities
2,000 times lighter. Table 1.3 gives the atomic mass in and higher atomic numbers are more effective in attenuat-
kilograms and in AMU and the charge of the electron, ing x-rays. Differences in densities produce contrast differ-
the proton, and the neutron. ences which are visible on the radiographic image.
The atomic mass number, A, is the mass of the atom
in AMU. It is the sum of the protons and neutrons in the Periodic Table
nucleus. The mass of the orbital electrons in an atom is
so small that their contribution to the atomic mass is usu- The periodic table of elements lists the elements in
ally ignored. The atomic mass number is symbolized by ascending order of atomic number.
“A.” The atomic mass number is written above and to the In the periodic table the atomic number is located
left of the chemical symbol. An element Y with atomic above the chemical symbol and the atomic weight is
mass A is written as AY. listed below the symbol. The atomic weight shown on
the periodic table is an average of the different isotope
masses and is usually not a whole number. The chemical
Atomic Number symbol for calcium is "Ca". Its atomic number is 20 and
The atomic number, Z, is equal to the number of protons its atomic weight is 40.08 AMU.
in the nucleus. The atomic number is symbolized by “Z.” Figure 1.5 presents the periodic table. The periodic
Element Y with an atomic number Z and atomic mass table is arranged so that elements with similar chemical
A would be written as ZAY, where Y is the chemical symbol characteristics lie underneath one another in a group or

TABLE 1.4 ELEMENTS OF INTEREST IN RADIOLOGY

Element Symbol Atomic Mass (A) Atomic Number (Z) K-shell binding energy (keV)
1
Hydrogen 1 H 1 1 0.014
12
Carbon 6 C 12 6 0.28
14
Nitrogen 7 N 14 7 0.40
16
Oxygen 8 O 16 8 0.54
27
Aluminum 13 Al 27 13 1.56
40
Calcium 20 Ca 40 20 4.04
98
Molybdenum 42 Mo 98 42 20.0
127
Iodine 53 I 127 53 33.2
137
Barium 56 Ba 137 56 37.4
184
Tungsten 74 W 184 74 69.6
207
Lead 82 Pb 207 82 88.0
238
Uranium 92 U 238 92 115.6
 Chapter 1: Radiation Units, Atoms, and Atomic Structure 9

Group I II III IV V VI VII VIII

1

Nobel gases
Alkaline - earth metals

Halogen
H
1.00797
74 = atomic number (Z)
Alkali metals

K1 W
183.85 = atomic mass
2
He
4.0026
3 4 5 6 7 8 9 10
L2 Li Be B C N O F Ne
6.939 9.0122 10.811 12.01115 14.0067 15.9994 18.9984 20.183
11 12 13 14 15 16 17 18
M3 Na Mg Transitional elements Al Si P S Cl A
22.9898 24.312 26.9815 28.086 30.9738 32.064 35.453 39.948

19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36
N4 K Ca Sc Ti V Cr Mn Fe Co Ni Cu Zn Ga Ge As Se Br Kr
Period

39.102 40.08 44.956 47.90 50.942 51.996 54.9380 55.847 58.9332 58.71 63.54 65.37 69.72 72.59 74.9216 78.96 79.909 83.80
37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54
O5 Rb Sr Y Zr Nb Mo Tc Ru Rh Pd Ag Cd In Sn Sb Te I Xe
88.47 87.62 88.905 91.22 92.906 95.94 [99]* 101.07 102.905 106.4 107.870 112.40 114.82 118.69 121.75 127.60 126.9044 131.30
55 56 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86
P6 Cs Ba Hf Ta W Re Os Ir Pt Au Hg Ti Pb Bi Po At Rn
132.905 137.34 57-71 178.49 180.948 183.85 186.2 190.2 192.2 195.09 196.967 200.59 204.37 207.19 208.980 [210]* [210]* [222]*
87 88
Q7 Fr Ra + * A value given in brackets denotes the mass numer of the most stable isotope
[223]* [226]* 89-103
Rare earth metals
+ Actinide metals
Figure 1.5. Periodic table.

column. Fluorine, chlorine, bromine, and iodine all have inert nonreactive gas. They are inert because their outer
similar chemical properties. That is, when combined electron shell is filled with eight electrons and thus has
with hydrogen, they form acids, and when they combine no need to combine with other atoms.
with sodium, they form salts.
The periodic table gets its name from the fact that the
chemical properties of the elements are repeated periodi-
Isotopes
cally. The simplest element is hydrogen and has an atomic Atoms of the same element whose nuclei contain the same
number of 1. The next heavier element is helium, a light number of protons but a different number of neutrons are
inert gas with an atomic number of 2 and an atomic mass called isotopes. Such atoms have different mass numbers.
of 4. The first row of the periodic table is unusual because Isotopes have the same chemical characteristics because
it contains only two elements. The first element in the they all have the same number of outer shell electrons.
second row is lithium. Lithium has an atomic number of Table 1.5 shows some of the different isotopes of calcium.
3 and has one electron in the L shell. This lone electron
in the outer shell makes lithium chemically reactive.
TABLE 1.5 ISOTOPES OF CALCIUM
If the atomic number is increased by 1, the number of
electrons in the outer shells also increases by 1 because Atomic Number Number
atoms in nature are electrically neutral. Elements lying Isotope Mass (A) of protons of Neutrons Abundance %
beneath one another in the periodic table have the same 39
20
Ca 39 20 19 0.0
number of electrons in their outer shell. Their chemi- 40
Ca 40 20 20 96.9
cal characteristics are similar because the chemical char- 20
41
Ca 41 20 21 0.0
acteristics are determined by the number of electrons 20

in the outer shell. The first elements in the next three

42
20
Ca 42 20 22 0.6
rows of the periodic table are sodium, potassium, and
43
20
Ca 43 20 23 0.15
rubidium. Each of these elements has a single electron 44
20
Ca 44 20 24 2.1
in the outer shell and has chemical characteristics similar 45
20
Ca 45 20 25 0.0
to lithium. Each row in the periodic table ends with an
10 Part I: Basic Physics

Some isotopes do not occur in nature and must be arti- electromagnetic radiation and differ only in their source
ficially produced. Their natural abundance is zero. or origin. Alpha particles and beta particles are forms of
particulate radiation. X-rays and gamma rays are the most
penetrating of the radiations from radioactive decay.
Radioisotopes Most radioisotopes emit gamma rays. Gamma rays and
Most isotopes are stable, but some are unstable and spon- x-rays are both electromagnetic radiations and are often
taneously transform into a different element. Unstable called photons. Gamma rays are produced in the nucleus
isotopes are termed radioisotopes or radioactive isotopes. and are useful in nuclear medicine examinations. X-rays
Their nuclei have either a deficiency or an excess number of are produced through interactions in atomic shells.
neutrons. Radioactivity is the spontaneous transformation X-rays are important in radiography because their energy
of one element into another element and is accompanied and quantity can be controlled. Due to their low ioniza-
by the release of electromagnetic or particulate radiation. tion rate in tissue, x-rays are useful for medical imaging
The atomic number of radioactive nuclei changes during procedures.
the nuclear transformation. The transformation of radio-
active nuclei into a different element is also termed radio- Alpha Particles
active decay. The unit of activity is the Becquerel, which
is one disintegration per second. The older, conventional An alpha particle is a form of particulate radiation which
unit is the curie. 1 Ci = 3.7 × 1010 dps. consists of two protons and two neutrons. It has an atomic
mass of 4 and an atomic number of 2. It is identical to
the nucleus of a helium atom. Alpha particles are emit-
Half-Life ted from the nuclei of very heavy elements when they
undergo radioactive decay. The alpha particle is very
The half-life of a radioisotope is the time required to
large compared to other types of radiation but is not very
decay one half of the activity of the radioisotope. The
penetrating. They cannot even penetrate the outer skin
half-life depends on the radioisotope. For example, 39Ca
layer. Because of its size, the alpha particle only travels a
has a half-life of 0.8 seconds, the half-life of 41Ca is
short range in matter, only a few millimeters. Alpha par-
8 × 104 years, and the half-life of 45Ca is 2.7 minutes. A
ticles have no applications in diagnostic radiology.
sample with an initial activity of 100 mCi of 39Ca will
have an activity after time T as shown in Table 1.6.
Beta Particles
Radiations from Radioactive A beta particle is identical to an electron except for
Decay its origin. Beta particles are emitted from the nuclei of
radioactive material, while electrons exist in orbital shells
A radioisotope can release different forms of ionizing around the nucleus. It has a single negative charge and
radiation which can be either electromagnetic or par- a mass of 1/2,000 AMU. The beta particle is more pen-
ticulate radiation. X-rays and gamma rays are forms of etrating than an alpha particle but less penetrating than
a gamma ray or an x-ray. The beta particle can penetrate
TABLE 1.6 CA-39 RADIOACTIVITY REMAINING through several millimeters of tissue. Beta particles are
AFTER TIME T encountered in nuclear medicine applications.
Time Number of Remaining
(seconds) Half Lives Radioactivity %

0 0 100
0.8 1 50
1.6 2 25
2.4 3 12.5
3.2 4 6.25
4.0 5 3.13
 Chapter 1: Radiation Units, Atoms, and Atomic Structure 11

Chapter Summary The chemical characteristics of the elements

are repeated periodically and elements which
The Bohr model of the atom consists of a dense lie in the same column of the periodic table
positive nucleus surrounded by electrons in have similar chemical properties. Radioiso-
shells. The nucleus contains nucleons which topes undergo spontaneous transformation.
are either protons or neutrons. The proton has The atomic number and the atomic weight
a positive charge and an atomic mass of 1 AMU. can change during radioactive transformation
The neutron has zero charge and an atomic or decay. The half-life of a radioisotope is the
mass of 1 AMU. The atomic number (Z) is time required for half the material to transform.
equal to the number of protons in the nucleus. Radioisotopes can emit electromagnetic radia-
The atomic mass (A) is equal to the sum of the tion, beta particles, or alpha particles. The unit
neutrons and protons in the nucleus. The elec- of radioactive decay is the Becquerel or curie.
tron has a negative charge and a mass of almost
zero. Electrons in an atom only move in spe-
cific orbits. Each orbit or shell has its own bind-
ing energy. The binding energy is the energy
required to remove an electron from its shell.
Case Study
The shells closer to the nucleus have higher An x-ray photon with energy of 3.86 keV inter-
binding energies. Ionization occurs when an acts with an atom of lead.
electron is removed from an atom. This results
in an ion pair made up of one positive and
one negative ion. Ionizing radiation consists Critical Thinking Questions
of electromagnetic and particulate radiations
with enough energy to ionize atoms. X-rays The energy is sufficient to remove an electron
and gamma rays are forms of electromagnetic from which shell?
radiation. Alpha and beta radiations are forms of
particulate radiation. How many keV are required to remove an
There are two systems of radiation units, the O-shell electron?
SI and the conventional. The units of exposure
are the roentgen (R) and the coulombs per What is the maximum number of electrons
kilogram (C/kg). The units of dose are the gray found in the L shell?
and the rad. The units of the effective dose are
the sievert and the rem.
Elements with similar electron shell struc- Electrons in the L shell have a binding
tures have similar chemical properties. Isotopes energy of 3.86 keV. It will take an x-ray photon
are elements with the same atomic number but with this same energy to remove an electron
different atomic masses. Isotopes have the same from the M shell. Less energy is required to
chemical properties. The atomic weight of an remove an O-shell electron because the O shell
element is the average of the atomic masses of is farther away from the nucleus than the M
naturally occurring isotopes. When elements shell; therefore, 0.15 keV is required to remove
are arranged in order of increasing atomic num- an O-shell electron. The L shell of a lead atom
ber, they form the periodic table of elements. has 8 electrons.
Review Questions

4. The nucleus of an atom contains which of the

Multiple Choice following?
1. Protons
2. Neutrons
1. The Bohr model of the atom consists of a dense 3. Electrons
_______________. 4. Gamma rays
A. positive nucleus surrounded by a diffuse cloud of A. 1
negative charge B. 1 and 2
B. positive nucleus surrounded by electrons in defi- C. 2 and 3
nite shells D. 1, 2, and 3
C. negative nucleus surrounded by a diffuse cloud of
positive charge 5. The periodic table of elements lists the elements
D. negative nucleus surrounded by protons in defi- in order of increasing
nite shells A. atomic number
B. atomic weight
2. The electron binding energy is
C. atomic neutrons
A. the energy of attraction between electrons in the D. atomic ionization
shells
B. the energy required to remove the nucleus from 6. The atomic mass of an element is designated by
an atom which letter?
C. the energy required to remove an electron from A. A
the nucleus B. M
D. the energy required to remove an electron from C. Z
its orbital shell D. K
3. The atomic number is the number of __________ 7. Which types of particulate radiation are given off
in the nucleus. when a radioisotope decays?
A. protons 1. Beta
B. neutrons 2. Gamma
C. protons and electrons 3. Alpha
D. protons and neutrons
A. 1 only
B. 2 only
C. 1 and 2
D. 1 and 3
 Chapter 1: Radiation Units, Atoms, and Atomic Structure 13

8. How many electrons does an element have when 4. Define element.

there are five orbital shells?
A. 48
B. 50
C. 72
D. 98
5. Who developed the concept of the atom with the
9. Which electron shell has the highest binding electrons orbiting the atom?
energy?
A. P shell
B. L shell
C. K shell
D. Q shell
6. What is a compound? Write the chemical equa-
10. What is the conventional unit of absorbed dose? tion for water.

A. Curie
B. rad
C. rem
D. Roentgen

7. Explain the half-life of an isotope.

Short Answer

1. Explain the difference between alpha and beta 8. Define the octet rule.
particles.

9. What is electron binding energy?

2. What are the three units of radiation measurement
and their associated conventional and SI units?

10. Could atoms be ionized by changing the number

of protons?
3. List the fundamental particles found in an atom.
 2

Electromagnetic Radiation,
Magnetism, and Electrostatics

Objectives Key Terms

Upon completion of this chapter, the student ● amplitude (of a ● intensity
will be able to: wave) ● inverse square law
1. Name the different types of electromagnetic ● bipolar ● magnetic dipole
radiation and describe each. ● coulomb ● magnetic domain
2. Describe the characteristics of electromagnetic ● Coulomb’s law ● magnetic field
waves. ● diamagnetic ● magnetic induction
materials
3. Describe the relationships between ● magnetism
● electric field
frequency, wavelength, velocity, and energy of ● nonmagnetic
electromagnetic radiation. ● electrification materials
● electromagnetic ● paramagnetic
4. Define radiation intensity and describe how it
spectrum materials
varies with distance from the radiation source.
● electrostatics ● period (of a wave)
5. State the laws and units of magnetism.
● ferromagnetic ● photon
6. Identify the different types of magnetic materials
● spin magnetic
materials. ● frequency (of a moment
7. Describe the methods of electrification. wave)
● tesla (T)
● gauss (G)
8. State the laws of electrostatics. ● wavelength
9. State Coulomb’s law.

14
 Chapter 2: Electromagnetic Radiation, Magnetism, and Electrostatics 15

Introduction Electric field Magnetic field

All radiologic equipment is based on the

laws of electricity and magnetism. Thus, an
understanding of the underlying principles of
electricity and magnetism aids in understand-
ing radiologic equipment and image produc-
tion. In this chapter, we review the types and
characteristics of electromagnetic radiation Figure 2.1. Electromagnetic waveform illustrates the electric
and discuss properties of magnetism, including and magnetic waves which make up the electromagnetic wave-
types of magnetic materials, magnetic fields, form. Typically, only the electric wave is shown in illustrations.
and the laws and units of magnetism. Magnetic
resonance imaging (MRI) has developed into its energy. The entire band of electromagnetic energies is
a diagnostic imaging tool for imaging the body. known as the electromagnetic spectrum.
In radiography, the properties of magnetism are The electromagnetic spectrum lists the different
used to make the anode rotate in the x-ray tube. types of electromagnetic radiations varying in energy,
Finally, we consider the laws of electrostatics frequency, and wavelengths. The energy of the radiation
and the study of stationary electric charges. is measured in electron volts or eV. Figure 2.2 illustrates
A thorough understanding of the principles of the different forms of the electromagnetic spectrum
stationary charges will assist the student in under- from long-wavelength, low-energy radio waves, to short-
standing how electricity is used in the x-ray tube. wavelength, high-energy gamma rays. Although Figure
2.2 appears to indicate sharp transitions between the types
of radiations, there are no clear boundaries between the
various regions in the electromagnetic spectrum.
Electromagnetic Radio Waves
Radiation Radio waves are long-wavelength (1–10,000 m), low-
energy radiation waves. A radio wave that is 10,000 m in
length is equivalent to placing approximately 92 football
fields end-to-end. Radio frequency radiation is used in
An animation for this topic can be viewed MRI. Cell phones utilize radio waves to transmit infor-
at http://thepoint.lww.com/FosbinderText mation from one cell tower to another and finally to a
cell phone. Television antennae receive the electromag-
netic wave from the broadcast station and the image is
displayed on the television screen. Music can be heard
Types of Electromagnetic Radiation because it reaches our ears in the form of a radio wave.
All electromagnetic radiation consists of simultaneous Radar and Microwaves
electric and magnetic waves. Typically, only one of these Radar and microwaves have shorter wavelengths (10−1–
waves is used in illustrations. These waves are really fluc- 10−4m) and higher energy than radio waves. Microwaves
tuations caused by vibrating electrons within the fields. are used in ovens, in transportation, and by law enforce-
The amount of vibrations of the electrons will determine ment officers to monitor the speed of cars. In a microwave
the frequency and wavelength for the various types of oven, the microwave energy forces the water molecules
electromagnetic radiations. Electromagnetic radiation in food to rapidly vibrate, thus heating the food.
travels at the speed of light, and each type has its own
unique frequency and wavelength (Fig. 2.1). Infrared Radiation
Electromagnetic radiation may appear in the form of Infrared radiation, or heat, has shorter wavelengths and
visible light, x-rays, infrared, or radio waves, depending on higher energy than radar and microwaves (10−1–10−4 m).
16 Part I: Basic Physics

103 102 101 1 10-1 10-2 10-3 10-4 10-5 10-6 10-7 10-8 10-9 10-10 10-11 10-12

Long Wavelength (in meters) Short

Bacteria
Protein
This dot
Water
Football field Baseball Cell molecule
Gamma
Size of a wavelength Rays
House Virus

Visible

Ultraviolet
Radio Radar Infrared X-rays

X-ray Radioactive
machines elements
AM
Radio
Microwave
oven
FM
Radio Light bulb
Radar
Sources
106 107 108 109 1010 1011 1012 1013 1014 1015 1016 1017 1018 1019 1020

Low Frequency (waves per second) High

10-9 10-8 10-7 10-6 10-5 10-4 10-3 10-2 10-1 1 101 102 103 104 105 106

Low Energy of one photon (electron volts) High

Figure 2.2. Electromagnetic spectrum illustrates the range of electromagnetic radiation.

Infrared radiation can heat nearby objects. For example, bacteria, and they are believed to be responsible for the
you can feel the heat from your toaster, which uses infra- majority of sunburn and skin cancer.
red radiation. The high-energy end of the infrared region
is visible and can be seen in the red heating elements of X-Rays and Gamma Rays
your toaster. X-rays and gamma rays have wavelengths between 10−9
and 10−16 m. They are very short wavelength, high-
Visible Light frequency, high-energy radiation. The energy is measured
Visible light selectively activates cells in the eye. It occu- in thousands of electron volts (keV) and is capable of
pies a narrow band in the electromagnetic spectrum, ionization. Ionizing radiation such as x-rays and gamma
with wavelengths between 10−6 and 10−7 m. The color rays has enough energy to remove an electron from its
red has the longest wavelength and lowest energy. Blue orbital shell.
and violet colors have the highest energy and the shortest The only difference between x-rays and gamma rays is
wavelengths in the visible spectrum. their origin. X-rays in radiology come from interactions
with electron orbits. Gamma rays come from nuclear
Ultraviolet transformations (decay) and are released from the
Ultraviolet is the part of the spectrum just beyond the nucleus of a radioactive atom. Some x-rays in radiology
higher energy end of the visible light region. Ultraviolet have higher energy than some gamma rays and are used
wavelengths range from 10−7 to 10−9 m. Ultraviolet lights in radiation therapy to treat cancer. X-radiation is utilized
are used in biological laboratories to destroy airborne in various industries including for screening baggage in
 Chapter 2: Electromagnetic Radiation, Magnetism, and Electrostatics 17

airport security and large crates of merchandise at ports of

1 cycle
entry as well as for imaging chest plates the military will
use in combat.

Characteristics of Electromagnetic Time (s)

Radiation
Electromagnetic radiation consists of vibrations in
electric and magnetic fields. It has no charge and no Frequency = 2 cycles/s
Period = 0.5 s
mass and travels at the speed of light. The waves move
in a sinusoidal (sine) waveform in electric and magnetic Figure 2.3. The relationship between frequency and period
fields. Electromagnetic radiation is described in terms of of a waveform.
the following characteristics:

● Velocity: how fast the radiation moves per second has a period of one-half second; that is, one
● Frequency: how many cycles per second are in the complete wave cycle occurs each half second. Figure 2.3
wave illustrates the relationship between frequency and period
● Period: the time for one complete cycle (time) in a sine wave.
● Wavelength: the distance between corresponding
parts of the wave Wavelength
● Amplitude: the magnitude of the wave The distance between adjacent peaks or adjacent val-
● Energy: the amount of energy in the wave leys of a wave is the wavelength and is represented by
● Intensity: the flux of energy lambda (l). Wavelength is one of the important char-
acteristics in determining the properties of x-rays. Elec-
Velocity tromagnetic radiation with shorter wavelengths has
All electromagnetic radiation travels in a vacuum or in higher energy and frequencies and greater penetration.
air at 3 × 108 m/s (186,000 miles/s), regardless of whether Wavelength is measured in meters, centimeters, or
it is in a wave or particle form. Even though this is incred- millimeters. Figure 2.4 illustrates the relation between
ibly fast, light requires some time to travel huge distances. wavelength and frequency.
For example, it takes 8 minutes for light from the Sun to Electromagnetic wave velocity, frequency, and wave-
reach the Earth. length are related and a change in one factor causes a
change in one or both of the other factors. The wave is
Frequency demonstrated with this formula:
The frequency of a wave is the number of cycles per
second. That is, the frequency is the number of peaks or c= fl
valleys occurring each second. The unit of frequency is
hertz (Hz), which is one cycle per second. In the United where c (velocity) is the speed of light (3 × 108 m/s, in
States, electricity has a frequency of 60 Hz, that is, 60 air), f is the frequency, and lambda (l) is the wavelength.
cycles per second. A typical radio wave has 700,000 Hz Note that the product of frequency and wavelength must
(700 kHz). A 1,000 Hz is equal to 1 kHz. One megahertz always equal the velocity. Thus, frequency and wave-
(MHz) is equal to one million (106) Hz or cycles per length are inversely proportional. Therefore, if the fre-
second. quency increases, the wavelength must decrease, and if
the frequency decreases, the wavelength must increase.
Period For example, if frequency is doubled, the wavelength is
The period of a wave is the time required for one halved, and if the frequency is tripled, the wavelength is
complete cycle. A wave with a frequency of two cycles reduced by one third.
18 Part I: Basic Physics

1 wavelength
Short wavelength
High frequency

Distance from
wave source

A 1 cycle

1 wavelength

Distance from
wave source

Long wavelength
Low frequency
1 cycle = 1 hertz
B

Figure 2.4. (A) Demonstrates the relationship between frequency and wavelength. When a short wavelength is seen, there is
a greater number of vibrations. Note how the peaks are closer together. This waveform has high penetrability and represents
an x-ray waveform. (B) In the bottom waveform, note the distance between the peaks. As the distance between the peaks
increases, the wavelength becomes longer and there are fewer peaks. This waveform has low penetrability.

CRITICAL THINKING CRITICAL THINKING

A radio station is broadcasting a signal with a What is the frequency in MHz of a cell phone signal
frequency of 27,000 kHz. What is the wavelength of if the wavelength is 333 mm = 3 × 108 m/s?
the signal in meters?
Answer
Answer
l = 333mm
c = 3 ´ 108 m/ s 3 ´ 108 m/ s
f = 27,000 kHz f =
333mm
3 ´ 108 m/ s 3 ´ 108 m 1
l= f = -3
=
27,000 kHz 333 ´ 10 m s
3 ´ 108 m/ s 3 ´ 108 m
l= f =
2.7 ´ 104 333 ´ 10 -3 m
l = 11.1m f = 0.009 ´ 105 Hz or 900MHz
 Chapter 2: Electromagnetic Radiation, Magnetism, and Electrostatics 19

1 cycle

Amplitude
Distance from
wave source
Amplitude

1 cycle

Amplitude
Distance from
Amplitude wave source

Figure 2.5. (A) A bowling ball is dropped into a tank of smooth water. The weight of the object causes the water to have
large ripples with lots of energy. (B) This wave represents the effect if a baseball were dropped into smooth water, and the
ripples are smaller and therefore have less energy.

Amplitude
The amplitude of a wave is the maximum height of the CRITICAL THINKING
peaks or valleys (in either direction) from zero. As the
energy of the wave increases, the height of the wave also
What is the frequency of a 56-keV x-ray photon?
increases. Figure 2.5 compares the amplitudes of two
electromagnetic waves as a function of time. Answer
E=h´f
Energy: Electromagnetic Radiation as a Particle E
Electromagnetic radiation usually acts as a wave, but f =
h
sometimes it acts as a particle. When electromagnetic 56 keV
radiation acts as a wave, it has a definite frequency, f =
4.15 ´ 10 -15 eVs
period, and wavelength. When electromagnetic radiation 56 ´ 104 eV
acts as a particle, it is called a photon or quanta. We use f =
4.15 ´ 10 -15 eVs
the photons or bundles of energy to produce x-radiation.
f = 1.34 ´ 1019 Hz
The energy and frequency of the photons are directly
proportional, but wavelength and energy are inversely
proportional. Thus, the higher the energy, the shorter the
wavelength and the higher the frequency. The formula CRITICAL THINKING
that describes the relationship between photon energy
and frequency is expressed as: How much energy is found in one photon of radia-
tion during a cell phone transmission of 900 kHz?
E = hf
Answer
where E is photon energy in electron volts, h is a conversion E=h´f
factor called Planck’s constant (4.15 × 10−15 eVs), and f is E = (4.15 ´ 10 -15 e V s)(9 ´ 105 s)
the photon frequency. E = 3.7 ´ 10 -9 eV
20 Part I: Basic Physics

Radiation Intensity and the Inverse Square Law where I1, old intensity; I2, new intensity; d12, old distance
All electromagnetic radiation travels at the speed of light squared; d22, new distance squared. If the distance from
and diverges from the source at which it is emitted. Inten- the x-ray source is doubled, the intensity decreases by a
sity is energy flow per second and is measured in watts/ factor of 4. That is, the intensity at twice the distance is
cm2. The intensity of the radiation decreases with an one-fourth the original value. If the distance from the
increase in the distance from the source. This is because x-ray source is halved, the intensity is four times greater.
the x-ray energy is spread over a larger area. This relation The exposure and exposure rate from an x-ray source also
is known as the inverse square law. It is called the inverse follow the inverse square law. To decrease radiation expo-
square law because the intensity is inversely proportional sure during a fluoroscopic exam, a technologist needs to
to the square of the distance. Figure 2.6 illustrates how increase his or her distance from the x-ray tube. Every step
the intensity decreases as the distance from the source away from the tube decreases the amount of radiation the
increases. technologist will be exposed to.
Mathematically, the inverse square law is expressed as
follows:
2
æd ö I ´ d2
I2 = I1 ç 1 ÷ or I2 = 1 1 CRITICAL THINKING
è d2 ø d2

What is the exposure rate 4 m from a source that has

an exposure rate of 32 mR/h at a distance of 1 m from
the source?
Radiation source Answer
If I1 is the exposure rate at 1 m and I2 is the exposure
rate at 4 m, then
2 2
æd ö æ1ö
I2 = I1 ç 1 ÷ I2 = I1 ç ÷
è d2 ø è4ø
æ 1ö
= 32 ç ÷
è 16 ø
= 2mR/ h

Distance 1

CRITICAL THINKING

The x-ray intensity is measured at 40 mR/h at 36 in.

What is the intensity at 72 in?
Answer
Distance 2
I1 ´ d12
I2 =
d2
36 = 1,296
2

722 = 5,184
Figure 2.6. The inverse square law relates the radiation inten- [40 ´ 1,296]
= 10mR/ h
sity to the distance from the source. As distance is increased, 5,184
the intensity of the radiation is decreased by one fourth.
 Chapter 2: Electromagnetic Radiation, Magnetism, and Electrostatics 21

Magnetism
Nonmagnetized
Early man discovered that some rocks seemed to have
magical powers. They were called lodestones. Lodestones
are natural magnets and attract pieces of iron. Magne-
tism is the ability of a lodestone or magnetic material to
Magnetized - domains lined in one direction
attract iron, nickel, and cobalt. This magnetic property is
used in medical imaging. Figure 2.7. Illustrates the magnetic domain alignment of
magnetic and nonmagnetic materials.
Types of Magnetic Materials
Different types of materials respond differently to domains are aligned in the same direction, which means
magnetic fields. There are four types of magnetic they cannot be permanently magnetized and do not
materials: retain any magnetism after the magnetic field is removed.
Aluminum and platinum are examples of paramagnetic
1. ferromagnetic materials, which react strongly with materials. MRI contrast agent, gadolinium, is also a para-
magnets or in a magnetic field magnetic material.
2. paramagnetic materials, which are weakly attracted
to magnets
Diamagnetic Materials
3. diamagnetic materials, which are weakly repelled
Diamagnetic materials are weakly repelled by a magnet.
by all magnetic fields
4. nonmagnetic materials, which do not react in a Copper, beryllium, bismuth, and lead are examples of
magnetic field diamagnetic materials.

Each of these is discussed in detail below. Nonmagnetic Materials

Nonmagnetic materials do not react with magnetic
Ferromagnetic Materials fields. Wood, glass, rubber, and plastics are examples of
Ferromagnetic materials are attracted to a magnet. Fer- nonmagnetic materials. In this type of material, there is
romagnetic materials—including iron, cobalt, and nick- an equal number of dipoles spinning in both directions;
el—are made up of small groups of atoms called magnetic therefore, the material is not attracted to magnetic fields.
domains. These domains act like tiny magnets inside Materials in the magnetic resonance room must be non-
the material. In the nonmagnetized state the domains magnetic.
are randomly oriented, so there is no net magnetization.
When a ferromagnetic material is placed in a magnetic Magnetic Fields
field the domains are aligned. After the magnetic field
A magnetic field is the space surrounding a magnet or
is removed, the domains remain aligned forming a per-
moving electric current in which magnetic forces are
manent magnet. Alnico is an alloy made of aluminum,
detectable. All magnets are surrounded by a magnetic
nickel, and cobalt. It contains the magnetic properties of
field. A magnetic material placed in a magnetic field
each metal to form a strong magnet. Figure 2.7 illustrates
experiences a force. This magnetic force will align the
how ferromagnetic materials are magnetized by align-
domains along the magnetic field. To understand the
ing the domains inside the material. Heating a magnet phenomenon of magnetism, it is important to study
can destroy its magnetism because heat rearranges the atomic structure and the effects of particle movement
domains into a random orientation, resulting in a loss of around a nucleus.
permanent magnetism. When a charged particle is in motion, a magnetic force
Paramagnetic Materials field is created. This force field moves perpendicular to
Paramagnetic materials are weakly attracted to magnetic the charged particle and is represented as field lines. In
fields. When placed in a magnetic field, some of the every magnet the lines of the magnetic field are in closed
22 Part I: Basic Physics

Atom Force field

Figure 2.8. Magnetic field lines around an atom. Demon-

strates the path of the magnetic field lines surrounding a Figure 2.9. Effect of dividing a magnet into increasing
magnet. smaller pieces. Each piece, no matter how small, retains the
original magnetic properties.

loops (Fig. 2.8). Every magnet is bipolar, having two Laws of Magnetism
poles: a north pole and a south pole.
All atoms have orbital electrons which spin on their The laws of magnetism include the following:
axes around the nucleus of the atom. This effect cre-
ated by the movement of these electrons is called spin Repulsion–Attraction: Like poles repel, unlike poles
magnetic moment. The disruption of this axial spinning attract.
and the energy released as it reorients itself are the basis Magnetic poles: Every magnet has a north pole and a
behind MRI. Each atom acts as a very small magnet and south pole.
is called a magnetic dipole. A group of such atoms with
their dipoles aligned in the same direction creates a mag- Inverse square law: The magnetic force between two
netic domain. Atoms having an odd number of electrons magnetic fields is directly proportional to the prod-
which are all spinning in the same direction will exhibit uct of their magnitudes and inversely proportional
a net magnetic field. to the square of the distance between them.
Typically, magnetic domains are arranged randomly
in an object. When the object is acted upon by an The first law of magnetism, like poles repel and unlike
external force field, the dipoles will become oriented poles attract, is true because when a magnet is placed in
to the field. If enough of the dipoles become aligned the force field of another magnet it is acted upon by that
in the same direction, the object will exhibit a strong force field. An example of this law may be seen when the
magnetic field and will then be called a magnet. These north pole of one bar magnet is placed near the south
force fields are also called lines of force, lines of flux, pole of another bar magnet their opposite field lines will
or the magnetic field. These magnetic field lines flow be attracted to each other. Likewise, when the north poles
from the north pole to the south pole on the outside of of two bar magnets are placed close together, the lines of
the magnet. Within the magnet the field lines flow from force are in the same direction and will repel each other
the south pole to the north pole. The number and con- (Fig. 2.10). It is critical that this law is observed in an MRI
centration of field lines will determine the strength of department where the strength of the magnet will attract
the magnet; the stronger the magnetic field, the greater metallic objects and the metal objects will be attracted to
the number of field lines and the more concentrated the or pulled into the magnet.
field lines are at the poles. The second law of magnetism, every magnet has a
Breaking a magnet in half produces two smaller north pole and a south pole. No matter how many times
magnets, each with a north and a south pole. The pieces the magnet is divided, even into individual electrons,
of the magnet can be divided multiple times and every both poles will continue to exist. Perhaps the most dra-
time the pieces will be bipolar. Figure 2.9 illustrates how matic example of this law is the Earth itself, which is
a magnet that is broken in half will produce two smaller actually a giant magnet. Imagine that the Earth’s core
magnets, each with its own north and south poles. is a very large bar magnet, as illustrated in Figure 2.11.
 Chapter 2: Electromagnetic Radiation, Magnetism, and Electrostatics 23

Like poles repel inverse square law. An example of this law is demon-
strated when opposite poles of two magnets are placed
within 1 inch of each other. When the force fields of
the two magnets influence each other, the magnets
will be pulled together. Now take the two magnets and
Opposite poles attract
place them 2 inches apart, and if the force fields are
strong enough, they may still interact with each other
but first they must overcome the distance between the
magnets. As distance is doubled between two magnetic
Figure 2.10. Repulsion-attraction of magnets. When the objects, the attraction will be one-fourth the original
like poles of two magnets are close to each other, their force attraction.
fields will repel each other. No matter how hard you try,
you will not be able to make the two magnets touch. If you
take one of the magnets and turn it so that the opposite Units of Magnetism
pole is now facing the other magnet, their unlike poles will
attract each other and the magnets will slam together. It The SI units of magnetism are the gauss (G) and the tesla
will take a lot of force to separate these two magnets. (T). One tesla is equal to 10,000 gauss. The Earth’s mag-
netic field is about 0.5 G or 5 × 10−5 T. A refrigerator magnet
is about 10 G or 0.001 T. MRI units typically have magnetic
The Earth’s south magnetic pole lies under the ice in
fields of 0.1 to 3 T. MRI is discussed in Chapter 19.
northern Canada while the north magnetic pole lies near
Australia. The Earth’s magnetic poles should not be con-
fused with the “geographic poles.” The north magnetic Magnetic Induction
pole of a compass (marked “N”) will point toward the When a nonmagnetized iron bar is brought within the flux
Earth’s south magnetic pole. lines of a strong magnet, the dipoles in the iron bar will tem-
The third law of magnetism, the magnetic force porarily align themselves with the flux lines passing through
between two magnets decreases as the square of the dis- the iron bar. The iron bar will become temporarily magne-
tance between the magnets increases, is based on the tized. When the strong magnetic flux lines are removed,
the dipoles in the iron bar will return to their original ran-
South
North Pole dom state. This process is called magnetic induction and
magnetic it will work with any ferromagnetic material.
pole
S

Electrostatics
Electrostatics is the study of stationary or resting elec-
tric charges. Another name for stationary charges is static
electricity.
As we discussed in Chapter 1, the concept of electric
charges can be seen at the atomic level, in positively
charged protons and negatively charged electrons. The
Compass negatively charged electrons travel around atoms in
North N
pointing orbital shells. Loosely bound electrons can be made to
north
magnetic jump or move from one object to another object. The
pole
South Pole most familiar example of this is static electricity. In this
Figure 2.11. The Earth is a giant magnet and like all chapter, we discuss how the movement of electrons,
other magnets, it has two magnetic poles, one north and which are the basic charged particles, can cause electric
one south. charges on a larger level. A discussion of electrostatics
24 Part I: Basic Physics

must begin with an understanding of electric fields and wall, which has a primarily positive charge, the buildup of
the various forms of electrification. electrons will allow the balloon to stick to the wall.

Contact
Electric Fields Electrification by contact occurs when two objects touch,
An electric field describes the electrical force exerted on a allowing electrons to move from one object to another.
charge. An electric field exists around all electric charges. When an object charged by friction touches an uncharged
The electric field is directed away from positive charges and object, the uncharged object will acquire a similar charge.
toward negative charges. When two charges are brought If the first object is positively charged, it will remove elec-
near each other, their fields interact. The resulting force of trons from the uncharged object, causing it to be positively
attraction or repulsion depends on the sign of the charges. charged. Likewise, if a negatively charged object touches an
There is no electric field around neutral objects, however; uncharged object, it will give up some of its electrons, mak-
neutral objects are affected by strongly charged objects. ing the second object negatively charged. Therefore, we con-
clude that a charged body confers the same kind of charge
Electrification on any uncharged body with which it comes in contact.
Electrons move in an attempt to equalize the charged
Electrification occurs when electrons are added to or body. An example of this equalization can be seen when a per-
subtracted from an object; therefore an object can be son wearing socks walks across a wool rug and then touches
negatively charged or positively charged. An object hav- a metal lamp. Electrons from the rug are transferred to the
ing more electrons than another object is considered to be socks and eventually to the body, giving the person a nega-
negatively charged. The concept of a positively charged tive charge. Reaching out toward a metal lamp will cause a
object does not mean the object has only positive charges static discharge to jump between your hand and the metal
or protons. We know this is true because atoms have lamp. The electrons move from a location of a high nega-
orbital electrons; therefore, a positively charged object tive charge to an area of low negative charge. This transfer of
has a weaker negative charge. When discussing electric- excess electrons will neutralize the person (Fig. 2.13).
ity, it is important to remember that the two objects are
being compared, not their actual atomic charges. The Induction
three methods of electrification include friction, contact, Electrification by induction is the process of electrical
and induction (Fig. 2.12). fields acting on one another without making contact.
A charged object has a force field surrounding it, and if this
Friction force field is strong enough, it can cause electrification of
Electrification by friction involves the removal of electrons a weakly charged object. The force field is called an elec-
from one object by rubbing it with another object. A famil- tric field. A neutral metallic object experiences a shift in
iar game that children play is to rub a balloon on their electrons in the direction toward an opposite charge when
hair. Electrons from the hair will be transferred to the bal-
loon causing the hair to be positively electrified. When
the negatively electrified balloon is placed on a smooth
Uncharged
Charged object
object

+ + Both objects
++ charged
+ +

Positively charged Negatively charged

object object

Figure 2.12. Positively charged object. Negatively charged

object. Figure 2.13. Electrification by contact.
 Chapter 2: Electromagnetic Radiation, Magnetism, and Electrostatics 25

brought into the electric field of a charged object. Keep in + + + +

+
mind that a neutral object has an equal number of protons Negatively +
and electrons and when acted upon by a strongly charged charged
metallic object, only the electrons will move. + + + + +
As seen in Fig. 2.14, a negatively charged bar magnet
is brought close to a neutral or uncharged metal ball but
does not touch it. Excess electrons from the bar magnet Figure 2.15. Grounding of electrical charges will allow
will repel the electrons on the side of the ball which is excess electrons to flow into the Earth. This principle can
be used to temporarily magnetize a metal object.
closest to the bar magnet. This leaves the side of the ball
closest to the bar magnet positively charged. The reverse
occurs when a positively charged bar magnet is brought Unit of Charge
close to an uncharged metal ball. The electrons from the
metal ball are attracted to the positive charge of the bar To quantify these electric charges, a basic unit of
magnet, thus leaving the side of the ball closest to the measure is needed. Although the basic charged particle
bar magnet with a negative charge. In both examples, is the electron, the standard unit of charge is the cou-
the electrification by induction is a temporary opposite lomb. One coulomb is much larger than the charge on
charge and the electrons will return to their original posi- an electron. There are 6.3 × 1018 electron charges in one
tions when the charged object is withdrawn (Fig. 2.14). coulomb. Thus, the charge of one electron is 1.6 × 10−19
Electrification by induction can also be used to coulomb.
semipermanently change the charge of an object. This is
accomplished by connecting the end of a metallic object Electrostatic Laws
to the ground. The Earth is a huge neutral object and an
Certain physical laws govern how these electrostatic
infinite reservoir of electrons and can be used to neutralize
charges interact. The major laws of electrostatics are as
any charged object. In Figure 2.15, a neutral metal ball
follows:
is connected to ground. A negatively charged bar mag-
net is brought close to the neutral metal ball. The forces Repulsion–Attraction: Like charges repel and unlike
of repulsion move the negative charges from the side of charges attract.
the metal ball closest to the bar magnet to the opposite
Coulomb’s law: The electrostatic force between two
side of the metal ball. Because the metal ball is attached
charges is directly proportional to the product of
to ground, the excess negative charges will flow to the
their quantities and inversely proportional to the
ground. If the ground connection and bar magnet are
square of the distance between them.
removed, the metal ball will remain positively charged.
It will retain this charge until the metal ball is attached Distribution: Electric charges reside on the external
to ground at which point the electrons will move up from surface of a conductor.
the ground to neutralize the metal ball.
Concentration: Electric charges concentrate on the
surface of a conductor.
+ + + +
Negatively + + Movement: Only negative charges move along solid
Neutral
charged conductors.
+ +
+ + +
The first law, like charges repel and unlike charges
+ + + + attract, holds true because of the force field surrounding
+
Negatively + electrical charges. As previously discussed, the force field
charged or lines of force act to repel like charged objects away
+ + + + + from each other and to attract opposite charged objects
Figure 2.14. Electrification by induction. The force of together (Fig. 2.16).
one magnetic field on another magnetic field can cause the The second law, the force between two charges is
objects to either repel or attract each other. directly proportional to the product of their quantities
26 Part I: Basic Physics

Radiation source
+
F F
Unlike charges attract

+ +
F F

F F
Like charges repel

Figure 2.16. The law of attraction and repulsion of electric

charges.
Distance 1

and inversely proportional to the square of the distance

between them.
Coulomb’s law describes the force between two
charges. Coulomb’s law states that doubling the distance
between two charges reduces the force by a factor of 4.
Two charges of the same sign, either positive or negative,
always have a repulsive force between them. Two charges
of opposite signs always have an attractive force between
them. The force between two charges increases as the Distance 2
strength of the charge increases. Likewise, the force
between the charges increases as the distance between
them decreases (Fig. 2.17)
This law is written as follows:
Figure 2.17. Coulomb’s law.
QQ
F = k 12 2
d collect at the sharpest point. If enough negative charges
where F is the force, k is a proportionality constant, and d collect, they can cause ionization in the air and discharge
is the distance between charges Q1 and Q2. to the closest point of low concentration in an attempt to
The third law, electric charges reside on the external neutralize the excess negative charges.
surface of a conductor, is true because when a metal The fifth law, only negative charges move along solid
wire is charged, all the negative charges (electrons) move conductors because the positive charges do not drift in
to the outside of the wire leaving the inside of the wire solid conductors. The positive charges or protons are
uncharged (Fig. 2.18). This distribution occurs as the tightly bound inside the atom’s nucleus and are not easily
electrons attempt to get as far away from each other as moved. The electrons, which orbit the atom, can be easily
possible. In a solid conductor, this occurs on the surface removed with the appropriate amount of force.
because the surface area is larger which allows the
electrons to be repelled from one another.
Conductor
Figure 2.18 illustrates the electrostatic law of distribution Current
– – – –
of charged particles. –
–
–
– – – –
The fourth law, electric charges concentrate on –
– – –
–
the surface of a conductor. Figure 2.19 illustrates how – – – –
– –
the electric charges will concentrate at the sharpest – – – –
point on an object. This is also caused by the law of Electrons
repulsion-attraction. Each negative charge is repelled Figure 2.18. Electrostatic law of distribution. Negative
by other negative charges, which causes the charges to charges will reside on the surface of a solid conductor.
 Chapter 2: Electromagnetic Radiation, Magnetism, and Electrostatics 27

– –
– –
– attraction to magnets, magnetic fields, the laws
–
–
– that govern magnets, and the units used to
– –
– measure magnetic flux.
–
–
– Electrostatics is the study of stationary
–
– electric charges and is governed primarily by
–
–
– five laws, which describe how charges interact.
–
–
– You learned about the methods of electrifica-
–
– – –
– tion and how each influence electric charges.
These concepts are further explored in Chapter
Figure 2.19. Electrostatic law of concentration. Due to 3: Electric Currents and Electricity.
repulsion, negative charges will concentrate to the sharpest
point on a curved object.

These laws are used in radiographic imaging equipment,

including image intensifier tubes, x-ray tubes, and image
Case Study
display systems. These systems can only operate through John is being escorted into the MRI department
the use of electricity, and electricity cannot exist without for an exam. Prior to taking John into the exam
utilizing the principles of electrostatics and moving nega- room, Elizabeth, the MRI technologist, asked
tive charges. Radiographic equipment uses electricity to John to place his wrist watch, belt, keys, and any
power equipment and to create, drive, and focus elec- metal object he had into a locker in the dressing
trons within the x-ray tube and image intensifier tube. room. She explained that this was a policy of the
These concepts are built upon in subsequent chapters for hospital and was for the patient’s safety.
a comprehensive understanding of the whole process of
producing a radiographic image.
Critical Thinking Questions
Why did Elizabeth ask John to remove these
Chapter Summary objects and not take them into the MRI room?
This chapter has continued to present
Which law is Elizabeth thinking about when
foundational information that is essential for you
she makes this request?
to understand the science behind radiology and
to prepare you for the later, more applied chap-
ters. Electromagnetic radiation ranges from low-
MRI magnets are extremely powerful and
energy, low-frequency, long-wavelength radio
have the ability to attract ferromagnetic objects
waves to high-energy, high-frequency, short-
that are brought into the MRI exam room. If a
wavelength gamma rays, all of which form an
metallic object is brought into proximity of the
electromagnetic spectrum. Waves are character-
MRI magnet, the powerful magnetic field lines
ized by velocity, frequency, period, wavelength,
of the magnet will attract the object and it will
and amplitude. The inverse square law describes
become a flying projectile! This poses a lethal
how electromagnetic radiation intensity changes
risk to any person standing between the magnet
with distance. As the distance increases, the
and the metal object. The law of repulsion/
electromagnetic radiation intensity decreases.
attraction teaches us this lesson, and because of
Magnetism pertains to the attracting of iron
the impact of this law, only nonferromagnetic
by a magnet or moving electrical current. You
materials are allowed in the exam room. Spe-
have learned about four types of materials
cial wheelchairs, IV poles, and crash carts have
(ferromagnetic, paramagnetic, diamagnetic,
been developed for safe usage in the MRI room.
and nonmagnetic) and their varying degree of
Review Questions

6. The field lines of a magnet flow _____________ to

Multiple Choice the magnet.
A. parallel
B. perpendicular
1. What is the basic charged particle?
C. either parallel or perpendicular
A. Electron D. neither is correct
B. Neutron
C. Volt 7. A spin magnetic moment is best described as
D. Coulomb
A. the domains in a magnetic material are all
oriented in the same direction
2. The first electrostatic law states that
B. the spinning of electrons on their axes as they
A. a proton will repel a neutron orbit an atom
B. an electron will repel a proton C. a group of atoms whose dipoles are aligned in the
C. an electron will repel an electron same direction
D. a neutron will repel a neutron D. the domains in a magnetic material are randomly
oriented
3. Which statement is not one of the laws of magne-
tism? 8. The Earth’s north magnetic pole is located
A. Like poles repel A. at the north geographic pole
B. Unlike poles attract B. in northern Canada
C. Stronger magnets have larger poles C. near the south geographic pole
D. The force between magnets decreases with the D. near Australia
square of the distance between them
9. One gauss is equivalent to _____ tesla?
4. The frequency of an electromagnet wave is mea-
A. 10−6
sured in
B. 10−9
A. the height of the wave C. 10−4
B. the number of cycles per second D. 10−3
C. the distance between adjacent peaks
D. the length of time it takes to complete one cycle 10. The electric charges on a curved surface will
concentrate
5. Which type of magnetic material is weakly repelled
A. at the sharpest curvature
by other magnetic fields?
B. at the area of least resistance
A. Diamagnetic C. near the widest curvature
B. Ferromagnetic D. where the resistance is the greatest
C. Paramagnetic
D. Nonmagnetic
 Chapter 2: Electromagnetic Radiation, Magnetism, and Electrostatics 29

6. Give an example of electrification by contact and

Short Answer explain the principles of this type of electrifica-
tion.

1. Which type of electromagnetic radiation has

the lowest energy and frequency but the longest
wavelength?

7. What properties of x-rays are suitable for produc-

ing an image?

2. Describe the change in intensity if the distance

between two magnified objects is doubled?

8. If the frequency of a sine wave is decreased, what

happens to the wavelength?

3. How do x-rays and gamma rays differ from each

other?

9. How is the amplitude of a sine wave related to the

energy of the wave?

4. Which electrostatic law deals with the force

between two objects? Briefly describe this law.

10. Which magnetic material is not affected by a

magnetic field?

5. Describe the third law of magnetism.

 3

Electric Currents and Electricity

Objectives Key Terms

Upon completion of this chapter, the student ● alternating current ● insulator
will be able to: (AC) ● motor
1. Identify the four types of electrical materials. ● ampere ● mutual induction
● capacitor ● ohm
2. Describe the direction and movement of
current flow. ● conductor ● potential difference
● current ● power
3. Define current, voltage, and electric power
and identify their units. ● direct current (DC) ● resistance
● electrodynamics ● rotor
4. Identify Ohm’s law and state the relationship
● electromagnet ● semiconductor
between current, voltage, and resistance.
● electromagnetic ● stator
5. Distinguish between alternating and direct induction
current. ● superconductor
● electromagnetism
● voltage
6. Describe current induction. ● electromotive force
● volts
7. Distinguish between electric generators and (EMF)
motors. ● generator

30
 Chapter 3: Electric Currents and Electricity 31

Semiconductors
Introduction Semiconductors can act as either conductors or insulators,
In Chapter 2, you learned about electrostatic depending on how they are made and their environment.
charges and the laws of electric charges at rest. Rectifiers in an x-ray circuit are made of semiconduct-
In this chapter, we will build on these prin- ing material. They conduct electrons in one direction but
ciples as we study the movement of electric not in the other direction. Some semiconductors conduct
charges or electricity. An understanding of the or insulate, depending on surrounding conditions. A pho-
underlying principles of electricity and electric todiode is a semiconductor that is an insulator in the dark
current aids in understanding radiologic equip- but becomes a conductor when exposed to light.
ment and image production. In this chapter,
we identify different types of electrical materi-
als and define current, voltage, resistance, and Superconductors
electric power. We also discuss the difference Superconductors are materials that conduct electrons with
between alternating current (AC) and direct zero resistance when they are cooled to very low tempera-
current (DC), and induction. tures. Superconductors are used to produce the magnetic
fields in magnetic resonance imaging units. Table 3.1
summarizes the four types of electrical materials.

Types of Electrical
Materials Electrodynamics
The study of moving electric charges is called electrody-
There are four types of electrical materials: conductors, namics. Moving electric charges or electric current can
insulators, semiconductors, and superconductors. Each occur in a variety of conditions. Electrons can move in a
is discussed in detail below. vacuum, gas, isotonic solution, and metallic conductor.
Of these, we will focus on the principles necessary for
Conductors electrons to flow in a wire or metal conductor.
Electrons move freely through a conductor. Tap water
containing impurities and most metals are good electrical Movement of Electric Charges
conductors. Copper and silver are very good conductors.
Electric current will flow easily through conductors. Electric charges will move when an electrical poten-
tial energy difference exists along a conductor. An
electrical potential energy difference occurs when one
Insulators end of a conductor has an excess of electrons while
The electrons in an insulator are held tightly in place the other end has a deficiency of electrons. When this
and are not free to move. Rubber, wood, glass, and many occurs electrons will move from the area of excess to
plastics are good insulators. Electric current will not flow the area of deficiency, which causes an electric current
in insulators. to flow.

TABLE 3.1 FOUR TYPES OF ELECTRICAL MATERIALS

Type of Material Characteristics Examples

Conductor Electrons move freely Copper, silver

Insulator Electrons are fixed; no current can flow Wood, plastic, glass
Semiconductor Can be either a conductor or an insulator, depending on the conditions Silicon, germanium
Superconductor Zero resistance to low temperatures; current will flow continuously once started Special metal alloys
32 Part I: Basic Physics

TABLE 3.2. TYPICAL CURRENTS ASSOCIATED

WITH THE FILAMENT AND X-RAY TUBE
Voltage
Voltage is the force or electrical pressure that produces
Location Current
electron movement and current flow. A voltage increase
X-ray filament 2–5 A results in an increase in current flow, just as higher water
X-ray tube 50–800 mA pressure increases the amount of water flow. Electrons
flow in response to the difference in pressure or potential
difference (PD) in the circuit.

Unit of Current
Unit of Voltage
An electric current is a flow of electrons over a set amount
of time. The ampere (A) is the unit of current and is The unit of voltage or electrical PD is measured in volts
defined as one coulomb of electric charge flowing per (V) and is sometimes called the electromotive force
second (1 A = 1 C/1 s). The milliampere (mA) is a smaller (EMF). EMF is the maximum PD between two points
unit of current; it is equal to 1/1,000 of an ampere (10−3 A). on a circuit. Therefore, the force with which electrons
Diagnostic radiographic equipment uses a variety of mA move can be described by the terms PD, EMF, or volt-
units to regulate the number of electrons needed to pro- age (V). Higher voltages give electrons higher energies.
duce x-ray photons. Different current values are used in Voltages of 20,000 to 120,000 V are used in x-ray circuits
different parts of x-ray circuits (Table 3.2). to produce high-energy x-rays. One kilovolt (kV) is equal
The filament of an x-ray tube is supplied with a high to 1,000 (103) volts.
current, which heats the filament and causes electrons to There does not have to be current flow for a voltage
be boiled off the filament. X-ray tubes are discussed more to exist, just as there can be water pressure in a pipe but
completely in Chapter 6. no water flow if the valve is closed. Figure 3.2 illustrates
how voltage is similar to water pressure in a hose. Higher
water pressure causes more water to flow, and higher volt-
Direction of Current Flow age produces more current flow.
When Ben Franklin was working with electricity, he spec-
ulated about whether positive or negative charges come Resistance
out of the battery. Unfortunately, he guessed wrong. He
thought that positive charges flow from the positive termi- Resistance is the opposition to current flow in a circuit.
nal (the anode) of a battery to the negative terminal (the The unit of resistance is the ohm and the symbol is the
cathode). What really happens is that negative charges omega (W). The composition of the circuit will determine
(electrons) flow from the negative cathode to the posi- the amount of resistance that is present. There are four
tive anode. In practice, all drawings of electric circuits factors which affect the amount of resistance in a circuit:
are based on Ben Franklin’s theory. We assume that cur-
rent is flowing from positive to negative, even though we 1. Conductive material
know that electrons are actually flowing in the opposite 2. Length of conductor
direction. Figure 3.1 illustrates the direction of current 3. Cross-sectional diameter
and electron flow in a wire. 4. Temperature

Conductive Material
Current direction
As previously discussed, the conductive ability of the
– – –
–
– – –
–
material will have a direct effect on the flow of electrons.
– –
–
– –
–
The least amount of resistance is found in a wire which
– –
is made of a good conductive material like copper.
Electron direction
Electron Length
Figure 3.1. In an electric circuit, electrons flow in one The length of the conductor is directly proportional to
direction and positive current flows in the opposite direction. the amount of resistance in the wire. As the length of a
 Chapter 3: Electric Currents and Electricity 33

Figure 3.2. Voltage is like water pressure

in a hose.

conductor increases, so does the resistance. If the length doubles, the resistance will be halved. A wire with a large
of a water pipe doubles, the resistance to the flow of water diameter has more area for electron flow and therefore
will also double (Fig. 3.3). offers a small amount of resistance to the flow of elec-
trons. This principle is utilized when it is desirable to
Cross-sectional Diameter decrease the overall resistance in a wire while maintain-
The cross-sectional diameter of the wire is inversely pro- ing the length of the wire (Fig. 3.4).
portional to the resistance. As the cross-sectional diameter
Temperature
When electrons flow along a conductor, heat is pro-
duced. As the heat builds on the conductor the electrons
Greater resistance
due to length of tube,
electrons slow down
– – – – – – – – – – – – – –
– –
– – –
– – – – – –
– – –
Greater resistance
– – – – ––
– – – – – – – – – – in the narrower tube

– – – –
Electron flow
– –
– – – more easily in
– – – shorter tube
– –

Electron direction Electron direction

Figure 3.3. Long pipe = high resistance. Short pipe = low Figure 3.4. Illustrates the effect of cross-sectional area on
resistance. resistance.
34 Part I: Basic Physics

Cold
–
– – – – – – –
CRITICAL THINKING
– – –
– – – –
– – – – – – – –
Calculate the current in a circuit with a voltage of
9 V and a resistance of 2 W. From Ohm’s law, if the
Electrons resistance and voltage are known, the current can be
calculated (Fig. 3.6).
Heat
Answer
– – – – – –
– – – –
– –
– – – – V
– – – – – – – – I=
R
9
I=
2
Figure 3.5. High temperature = more resistance. I = 4.5 A

have collisions with other electrons, which produce more

resistance. Therefore, higher resistance leads to less cur-
rent flow (Fig. 3.5).

Ohm’s law CRITICAL THINKING

What is the resistance of a circuit if the voltage is

German physicist Georg Ohm studied the relationships 100 V and the current is 5 A?
between voltage, current, and resistance. These relation-
ships are expressed mathematically as: Answer
V
V = IR R=
I
V 100
I= R=
R 5
V R = 20 W
R=
I

where V, voltage; I, current; and R, resistance.

Ohm’s law states that the voltage (V) is equal to the prod-
uct of the current (I) flowing through a conductor and the
resistance (R) of the conductor. Higher voltage and lower
resistance result in higher current flow. As you can see,
when one factor is changed it affects the remaining factors. V
CRITICAL THINKING

What is the voltage in a circuit if current is 300 A and

I R
resistance is 4 W?
Answer
V = IR Figure 3.6. Shows the circle of Ohm. This is an excellent
V = 300 ´ 4 way to remember the various combinations of Ohm’s law.
V = 1200 V The figure shows that V = IR or I = V/R or R = V/I. Remem-
ber that V is always on top.
 Chapter 3: Electric Currents and Electricity 35

positive half cycle is 1/120 seconds (s). The duration of

Direct and Alternating the negative half cycle is also 1/120 seconds. One cycle
per second is also known as one hertz (Hz).
Currents
Current flow is demonstrated by using a sinusoidal or sine Electric Power
waveform. The vertical axis represents the amplitude of
the current while the horizontal axis represents time. The
Electric power is measured in watts (W). Power is the rate
sinusoidal wave is used to demonstrate current flow as either
of energy used and describes the amount of work done or
positive flow or negative flow. In DC circuits, electrons flow
the amount of energy used per second. This is true for both
only in one direction. The waveform begins on the line or
AC and DC circuits. One watt is produced by one ampere
at zero amplitude when the electrons are at rest. As the elec-
of current flowing with an electrical pressure of one volt.
trons begin to move in the positive direction their potential
The relationship between power, current, and voltage is:
increases until they reach the maximum potential which is
represented by the peak of the waveform. Once the electrons P = IV
have reached this peak, they begin to slow down until they
again reach zero potential. For DC the electron flow will where P, power in watts; I, current in amperes; and V,
continue in this manner until the electricity is turned off. PD in volts.
AC flows half of the time in one direction, and the
other half of the time in the other direction. The first half
of the AC sine waveform is identical to the DC waveform
CRITICAL THINKING
and consists of positive current flow. Once the positive
direction flow has stopped and the electrons are at rest, the
electron flow then reverses and flows in the negative direc- The power expended in a light bulb in a 100 V circuit
tion with increasing potential until maximum is reached. with 0.6 A flowing is
Once this occurs, the potential of the electron flow will Answer
decrease until zero potential is achieved. AC waveforms P = IV
will continue this oscillation as long as a PD exists. P = 0.6 ´ 100
Figure 3.7 shows how AC changes direction with time P = 60 W
and how DC has a constant direction.
In the United States, standard AC electric current has
a frequency of 60 cycles per second. The duration of the
CRITICAL THINKING
Direct current
100
If a mobile x-ray machine operates from a 110 V wall
Current (A)

outlet and is rated at a total resistance of 26 W, how

0 much current does it draw during a 1-second expo-
Time
sure? How much power does it use per second?
Answer
Alternating current V
100 I=
R
Current (A)

110
0 I=
Time 26
I = 4.2 A
–100 P = IV
P = 4.2 ´ 110
P = 462 W
Figure 3.7. Alternating and direct currents.
36 Part I: Basic Physics

Single turn on coil

Current

– – – Helix
– – – – –
– – – A
– – –
– –

Electrons Many turns on coil

Figure 3.8. A magnetic field is always present around a

wire that is carrying a current.
+ terminal
Solenoid

Electromagnetism – terminal

Electromagnetism deals with the relationship between

electricity and magnetism. A current flowing in a conduc- B
tor creates a magnetic field around the conductor. Figure
3.8 shows the magnetic field around a current-carrying
Ferromagnetic
conductor. The accompanying magnetic field is a funda- core added
mental property of electric currents. The strength of the
magnetic field increases with an increase in the current.
When the conductor is coiled in a loop it forms a helix
and when current is supplied to the helix it makes a sole- + terminal
noid. The magnetic fields from different parts of the coil Electromagnet
add together and increase the magnetic field in the center
of the coil. Increasing the current or the number of turns – terminal
in the coil produces a stronger magnetic field in the cen-
ter of the coil. This occurs because the magnetic fields
will interact with each other, which creates a stronger cur-
rent flow. Adding a ferromagnetic material such as iron C
in the center of the coil also increases the magnetic field Figure 3.9. (A) Helix. (B) Helix + flowing current = solenoid.
strength by concentrating the field through the center of (C) Solenoid + iron core = electromagnet.
the iron. The ferromagnetic iron becomes magnetized
and its magnetic field lines interact with the electric field
of the solenoid. This produces a powerful electromagnet, induction and is the basis of transformer operation. A
which is utilized in radiographic equipment. The electro- changing magnetic field produces an electric field.
magnet will produce electric current as long as the helix is This electric field will cause electrons to flow in a con-
supplied with electricity; once the electricity is turned off, ductor. Electromagnetic induction is the production of
the electromagnet will no longer produce current. There- a current in a conductor by a changing magnetic field
fore, an electromagnet is a temporary magnet. Figure 3.9 near the conductor. The magnetic field must be chang-
shows how the magnetic field in the center of a coil is ing. A steady magnetic field does not induce an electric
increased by adding turns to the coil and adding ferromag- current.
netic material to the center of the coil. The magnitude of the induced EMF depends on the
number of magnetic field lines crossed or cut per sec-
ond. There are four factors that regulate the strength of
Electromagnetic Induction induced current. Maximizing these variables will pro-
The relationship between current, a ferromagnetic core, duce the highest possible voltage for the materials used
and changing magnetic fields is called electromagnetic in the conductor. These four factors are:
 Chapter 3: Electric Currents and Electricity 37

1. The strength of the magnetic field. Increasing the Current

magnetic field strength will produce stronger field
lines, which will then produce a more powerful
EMF in the conductor.
2. The speed of the motion between field lines and the
conductor. As the rate or speed at which the con-
ductor crosses the magnetic field lines increases, a
higher EMF will be produced because more field
lines will be cut per second. Conductor
3. The angle between the magnetic field lines and
the conductor. Magnetic field lines that are at a Magnetic field

90-degree angle to the conductor will produce the

greatest amount of EMF because the conductor
is crossing through the maximum number of field
lines possible per second.
4. The number of turns in the conducting coil. Con- Figure 3.10. Demonstrates the three ways in which current
can be induced in a conductor.
ductors with more turns or coils will produce
greater EMF because each turn or coil will pro-
duce its own EMF, which will then interact with on the strength of the magnetic field and how fast it is
the other turns, thereby increasing the EMF even changing (Fig. 3.10).
more. The induced EMF is directly proportional
to the number of turns in the coil. Mutual Induction
An electric current can be induced in a conductor in Mutual induction occurs when two coils are placed close
three ways. to each other and a varying current supplied to the first
One way is to move a magnet near a stationary con- or primary coil induces a similar current flow in the sec-
ductor. As the magnet approaches the conductor, the ond or secondary coil. AC in an electromagnet produces
magnetic field around the conductor increases. As the a changing magnetic field. As the magnetic field lines
magnet moves away from the conductor, the magnetic expand and contract in the primary coil, they are provid-
field decreases. The change in the magnetic field as the ing the relative motion necessary to induce AC flow in
magnet approaches and recedes induces a current to flow the secondary wire. This is the principle of transformer
in the conductor. operation (Fig. 3.11).
A second way to induce a current is by moving a con-
ductor near a stationary magnet. In this case, the magnetic
field is stationary and the conductor moves. The relative Electric Generators
motion between the magnet and the conductor is the
same regardless of which moves and which is stationary. In
either case, a current is induced to flow in the conductor.
A third way of inducing a current is to hold the con- An animation for this topic can be viewed
at http://thepoint.lww.com/FosbinderText
ductor stationary and generate the magnetic field with a
stationary AC electromagnet. The magnetic field from
the electromagnet expands and contracts. This changing
magnetic field induces a current to flow in the conductor. An electric generator converts mechanical energy into
AC flowing in a conducting coil will produce a changing electrical energy. A simple generator is made of a con-
magnetic field in the center of the coil. ductor and magnets arranged as shown in Figure 3.12.
In every case, the change in the magnetic field induces The conductor is a coil of wire called an armature, and
the current. The amount of induced current depends the armature is set between the opposing magnetic poles.
38 Part I: Basic Physics

Alternately expanding Mechanical crank

and contracting
magnetic field Magnetic
field

Supplied AC Induced AC

Secondary circuit
Primary circuit

Motion
of wire

Current
direction
–

+ –

Figure 3.11. Mutual induction. When the primary coil is Figure 3.12. AC generator. Mechanical energy rotates
supplied with AC, lines of force are induced in the primary the shaft that is attached to the armature. As the armature
coil. These expanding and contracting lines of force then rotates through the magnetic fields, it crosses through the
interact with the nearby secondary coil, thereby inducing magnetic lines of force and produces electric current.
AC flow in the secondary coil.

As the armature is turned by a mechanical method, a A DC generator utilizes the same design as an AC
current is induced in the armature that is moved through generator, except that the slip rings are replaced with a
a magnetic field across or perpendicular to the magnetic commutator ring. A commutator ring is a single ring that
field lines. If the conductor or armature moves parallel is divided in half with the halves separated by an insu-
to the magnetic field, there is no current induced in the lator. Each half of the commutator ring is connected
conductor. The conductor must cut through the mag- to one end of the armature. The armature is turned
netic field lines in order to induce a current. It is crucial mechanically and moves through the magnetic field
to note the method by which the induced current flows lines inducing a current. Although the action of the DC
in a circuit. Each end of the armature is connected to generator is the same as an AC generator, the result-
brushes, which allow constant contact with a set of slip ing sine wave is routed differently. As the commutator
rings. The slip rings are stationary and allow the armature ring rotates the armature through the magnetic field,
to rotate within the magnetic fields. The induced cur- the polarity of each half of the ring will alternate. This
rent flows from the armature through the slip rings to the allows the current to flow first in one direction and then
brushes and finally through the circuit (Fig. 3.12). Thus, in the reverse direction resulting in current flowing out
this type of generator produces AC. of the commutator in one direction. This is illustrated
As the coil rotates in a magnetic field, the induced in Figure 3.14.
current rises to a maximum, drops to zero, and then
increases to a maximum in the opposite direction. No
current is induced when the wire is moving parallel to
the magnetic field. The induced current is an AC. Addi-
tional loops in the coil increase the voltage induced in
Electric Motors
the coil. Figure 3.13 shows how a coil rotating in a mag-
netic field produces an AC. In a generator, the mechan- A motor converts electrical energy into mechanical
ical energy of rotation is converted into electric energy. energy. A current-carrying coil or armature is surrounded
 Chapter 3: Electric Currents and Electricity 39

B D F H

A C E G I
Increasing voltage
this direction

Figure 3.13. Rotating coil of wire

0

0° 45° 90° 135° 180° 215° 270° 315° 360°

Increasing voltage

Time produces an AC. Notice how the

this direction

placement of the armature in relation

to the magnetic field is demonstrated
on the sine wave.

by a magnetic field. If this armature is placed in an be repelled by the external magnetic field if the external
external magnetic field, or between the north and south lines of force are in the same direction as the magnetic
poles of a horseshoe magnet, the external magnetic field lines of force surrounding the armature or attracted to the
and the magnetic field of the coil interact. The laws of external magnetic field if the lines of force are in opposite
repulsion and attraction will determine the direction in directions to the armature’s magnetic field. The result will
which the armature will rotate. The armature will either be that the armature is pulled upward or downward. The

A B C D E
Increasing voltage
0

0° 90° 180° 270° 360°

Time
Angle between conductor and magnetic lines of flux

Figure 3.14. DC generator.

40 Part I: Basic Physics

Magnetic motor. The components of an induction motor include

field
a rotor and a stator. The rotor is in the center of the
induction motor and consists of copper bars arranged
around a cylindrical iron core. The stator has an even
number of stationary electromagnets placed around the
rotor. Both the rotor and the anode are sealed inside an
evacuated glass envelope. The stator, located outside
Motion the glass tube, is supplied with AC (multiphase current)
of wire
which produces changing magnetic fields by switching
Current the current in each set of electromagnets. The electro-
direction +
To power magnets of the stator are energized in sequence, creat-
– source
– ing magnetic fields that induce current in the copper
bars. As the magnetic fields of the copper bars reach a
point, they are equalized with the electromagnets mag-
netic field, the next set of electromagnets is activated by
Figure 3.15. The simple electric motor has the same basic the multiphase current, thus forcing the rotor to follow
construction as a DC generator, except there is an external the external magnetic fields of the stator, thereby pull-
power source supplying current to the commutator ring. The
commutator ring directs the flow of current to the armature.
ing the rotor to the next position. This sequence contin-
As the magnetic field of the armature is attracted to the ues to occur as long as there is multiphase current being
external magnet, the armature will rotate through the exter- supplied to the stator.
nal magnet’s magnetic field. Just as the armature becomes
aligned with the external magnet, the commutator switches
the direction of current flow through the armature, thereby
reversing the armature’s required alignment. At this point the Capacitors
magnetic fields of the external magnet and armature are
the same, which will cause the armature to be repelled by
the external magnet, moving the armature out of the external Capacitors are used to temporarily store electric charge.
magnet’s field. The armature will rotate 180 degrees toward A capacitor consists of two conducting plates separated by
the other pole of the external magnet, seeking alignment with an insulator. The two conducting plates are connected to
that pole, which is the opposite polarity of the armature’s the two terminals of a DC source. Positive charges flow
magnetic field. As the armature moves into the magnetic to one plate; negative charges flow to the other plate. The
field, the commutator will again switch the current flow to
capacitor will accept a charge until it equals the DC volt-
force the armature to rotate again. This process will continue
repeatedly keeping the armature rotating continuously. age. When the DC source is removed, the positive and
negative charges on the plates remain attracted to each
other, and the capacitor remains charged. If the capacitor
interaction will continue as long as a current is supplied is connected to a conductor such as a light bulb, a current
to the armature. Once the current is turned off, the mag- will briefly flow from the positive to the negative plate of
netic field surrounding the armature will collapse and it the capacitor until the positive and negative charges are
will no longer move. Figure 3.15 illustrates the force on balanced. The current flow from a capacitor usually takes
a current-carrying coil in a magnetic field. only a fraction of a second. Capacitors are used to store
electric energy in some portable x-ray units.

Induction Motors
Induction motors are AC motors which operate on the
principle of mutual induction. In an x-ray tube, the rotat-
ing anode is driven by a rotor attached to an induction
 Chapter 3: Electric Currents and Electricity 41

Chapter Summary Critical Thinking Questions

In this chapter, you have learned the process of When designing the circuit, which factors must
making current flow by using the principles of Liz utilize to decrease the total amount of resis-
electromagnetism. Electrons moving through a tance in the circuit?
conductor make up an electric current. Current
is the amount of electrons moving in a conductor Which type of material will provide the most
per second and is measured in amperes or mil- conduction of the electrons?
liamperes. Current flows from the positive to the
negative terminal in an electric circuit. Electrons How do these factors affect Liz’s design of the
flow from the negative to the positive terminal. circuit?
Voltage is the electrical pressure or EMF applied
What type of wire configuration must be used
to the electrons in the conductor and is mea-
to dissipate heat buildup from electron
sured in volts. Resistance, which is the opposition
collisions?
to current flow, is measured in ohms. Ohm’s law,
written V = IR, states the relationship between
voltage, current, and resistance. DC flows only When designing a circuit, the factors which
in one direction. One cycle of AC consists of must be considered are type of material, cross-
current flow in one direction for half of the time sectional diameter, length, and temperature.
and in the other direction for the other half of the When designing the circuit, Liz must remem-
time. One cycle per second is one hertz. ber how each of these factors will affect the
Power is the rate at which energy is used. The total amount of resistance in the circuit. Liz
equation for electric power is P = VI. Power is mea- must first use a conductive material that will
sured in watts. Electromagnetic induction is the allow the flow of electrons. Ferromagnetic
principle of electrons moving through a conductor materials, like copper, provide excellent con-
and creating a magnetic field around the conduc- duction of electrons because there is minimal
tor. A changing magnetic field induces a current in resistance to the free flow of the electrons. The
a conductor. This is known as mutual induction. conductor Liz chooses must be of sufficient
A generator converts mechanical energy length for the circuit without being overly
into electric energy. Either AC or DC can be long; long wires or conductors have more
produced through the use of either slip rings resistance so Liz will need to use the short-
or commutator ring. A motor converts electric est length of wire possible. Liz also realizes
energy into mechanical energy. The compo- that the conductor must have a large enough
nents are essentially the same as the generator diameter so that the electrons will flow unim-
and operate on the same principles only in peded along the conductor. Finally, Liz must
reverse. An induction motor is used to rotate remember that when electrons collide with
the anode inside an x-ray tube. each other the by-product is heat so Liz will
need to use a wire with the following: shortest
length, largest diameter, and conductive mate-
rial, all of which will decrease the amount of
Case Study electron collisions and thereby heat. By utiliz-
ing all these factors, Liz will be able to make
Liz is designing a circuit for a new radiographic a circuit with the least amount of resistance
unit. There are many aspects that Liz must while allowing significant amount of voltage
think about. Answering the following questions and current to flow.
will help her design an appropriate circuit.
Review Questions

6. Increasing the resistance in a circuit results in

Multiple Choice a(n)
A. increase in current
B. increase in voltage
1. The unit of electric current is the
C. decrease in current
A. watt D. decrease in voltage
B. ampere
C. volt 7. As the length of the wire increases, the resistance
D. ohm of the wire
A. increases
2. The unit of electrical potential is the
B. decreases
A. watt C. stays the same
B. ampere
C. volt 8. Which of the following factors is inversely propor-
D. ohm tional to the resistance in a circuit?
A. Magnetic field strength
3. Electrons move from
B. Diameter of the conductor
A. positive to negative C. Length of the conductor
B. negative to positive D. Temperature
C. neutral to positive
D. neutral to negative 9. An electric motor has current supplied to the
_____.
4. An electronic device that is used to store an elec-
A. commutator ring
tric charge is called a
B. armature
A. motor C. slip rings
B. rectifier D. brushes
C. transformer
D. capacitor 10. In an induction motor, which component(s) is/are
responsible for making the anode spin?
5. One kilovolt is equal to _____ V.
A. The EMF applied to the sets of electromagnets of
A. 1/1,000 the stator
B. 1/100 B. An energized sequence of the electromagnets
C. 1/10 C. The rotor moving in response to the electromag-
D. 1,000 nets
D. Each of the above is partially responsible for the
anode spinning
 Chapter 3: Electric Currents and Electricity 43

6. Explain how an electric motor works.

Short Answer

1. Describe what a solenoid is.

7. What is the resistance in a circuit with 12,000 V

and 65 A?

2. List the four factors that relate to the magnitude of

induced current.

8. How much power was used in a mobile radio-

graphic unit with 220 V and .8 A?

3. What is an electromagnet?

9. List the components of a generator.

4. Explain what mutual induction is.

10. Write the Ohm’s law formulas.

5. Define the four types of conducting materials.

PART II

Circuits and
X-Ray Production
 4

Transformers, Circuits, and

Automatic Exposure Control (AEC)

Objectives Key Terms

Upon completion of this chapter, the student ● air core transformer ● ripple
will be able to: ● autotransformer ● shell type
1. Identify the difference between alternating and ● closed core trans- transformer
direct current. former ● single-phase circuits
● half-wave ● step-down
2. Identify single-phase, three-phase, and
rectification transformer
high-frequency waveforms.
● open core ● step-up transformer
3. Describe the relationship between current and transformer
voltage in the primary and secondary sides of ● three-phase circuit
● rectifiers ● tranformers
step-up and step-down transformers.
4. Identify the components of a typical x-ray
circuit and their purpose.
5. Describe the purpose and operation of a
rectifier.
6. Describe the operation of a transformer.
7. Define voltage ripple.

45
46 Part II: Circuits and X-Ray Production

Introduction Alternating current

100
X-ray circuits convert electric energy into

Voltage (V)
x-ray energy. Knowledge of the components 0
Time
of an x-ray circuit will assist the technologist
–100
in detecting and correcting problems with the
technical settings used to produce the x-ray
image. X-ray circuits generate x-rays using Figure 4.2. AC sinusoidal waveform.
transformers that convert low voltage (100–400
volts [V]) into high voltage (thousands of volts). The current flows in one direction at all times. In an
X-ray circuits utilize transformers to change the AC circuit, shown in Figure 4.2, the current flows in the
voltage, rectifiers to convert alternating current positive direction half of the time and in the negative direc-
(AC) into direct current (DC), and autotrans- tion, the other half of the time. During the positive half of
formers to select the milliamperes and kilovolts the AC sine wave the current flow begins at zero potential
peak applied to the x-ray tube. X-ray circuits when the electrons are at rest; the electrons begin to rise
were previously referred to as x-ray genera- to the maximum positive potential; the electrons begin to
tors. However, the term generator used in this slow down and flow back to zero. At this point the electrons
context has nothing to do with the generators reverse the motion or change the direction and begin to
described in Chapter 3, which are used to gen- flow in the negative direction; the electrons flow in the
erate electric currents. negative direction until they reach the maximum negative
potential; the electrons then slow down and flow back to
zero. The electrons will continue to oscillate from positive
to negative in a sinusoidal manner, with each wave requir-
ing 1/60 seconds. The voltage is measured at the peaks of
Direct and Alternating the AC cycle. An AC voltage of 2,000 V is referred to as

Currents 2 kVp, where kVp means kilovolt peak.

AC is used in most electrical appliances. The x-ray
machine utilizes AC in the high voltage circuits. In the
Electric current describes the amount of electric charge United States, the current frequency for AC is 60 Hz.
moving through a conductor and is measured in amperes
or milliamperes. The two types of electric current are DC
and AC. DC flows in only one direction. Batteries and recti-
fiers produce DC. DC is used in TV sets, microwave ovens,
High Voltage
and x-ray tubes. Figure 4.1 is a graph of DC as a function of Components
time. It also demonstrates the sine wave of DC.
Components of the high-voltage circuit include the
Direct current primary and secondary windings of the step-up, high-
voltage transformer, the primary and secondary windings
of the step-down transformer, and the rectifiers. Each of
Voltage (V)

100
these types of transformers is necessary to produce the
appropriate amount of voltage and amperage needed to
0
Time produce x-rays.

An animation for this topic can be viewed

Figure 4.1. DC flows in one direction beginning at zero at http://thepoint.lww.com/FosbinderText
potential, upon reaching peak potential it then moves back to
zero. This pattern is continued as long as the switch is open.
 Chapter 4: Transformers, Circuits, and Automatic Exposure Control (AEC) 47

Transformers The voltage in the secondary coil of a transformer is

related to the voltage in the primary coil by the trans-
Transformers are used to change low voltages into former law for voltage:
higher voltages or vice versa in an AC circuit. A trans-
former consists of a pair of wire coils joined together Vs = Vp (Ns/Np)
around an iron core. This iron core provides coupling
where V is the potential difference in volts, N is the
of the magnetic fields between the coils. Transformers
number of turns of wire in the coil, p is the primary coil,
operate on the principle of mutual induction. Trans-
and s is the secondary coil. The turns ratio, Ns/Np, is the
formers can operate only with AC, not with DC. As the
ratio of the number of turns in the secondary coil to
AC moves from positive to negative and back again, the
the number of turns in the primary coil.
flow of electrons causes a magnetic field to continu-
ously build and collapse around the wire carrying the
AC. This action combined with the principles of mutual CRITICAL THINKING
induction and Ohm’s law provides the basic functions
of a transformer. Figure 4.3 illustrates the components
If a transformer is supplied with 500 V to the primary
of a transformer: primary coil, secondary coil, and fer-
coil, has 200 turns of wire in the primary coil and
romagnetic core. 40,000 turns of wire on the secondary coil, what will
An AC supplied to the primary coil changes the be the voltage in the secondary coil?
magnetic field around the coil. The changing magnetic
field from the primary coil, or input, induces a current in Answer
the secondary coil, or output. This is the principle of mutual ⎛N ⎞
Vs = Vp ⎜ s ⎟
induction. The magnetic fields surrounding the primary ⎜ Np ⎟
⎝ ⎠
and secondary coils will continue to expand and collapse, ⎛ 40,000 ⎞
thereby causing mutual induction in each coil. The input Vs = 500 ⎜ ⎟
⎝ 200 ⎠
voltage and current on the primary coil differ from the out- Vs = 500(200)
put voltage and current on the secondary coil. Vs = 100,000 V or 100 kV
The secondary coil of a transformer is linked to the
primary coil by an iron core to improve its efficiency. The
iron core acts as an electromagnet when current is sup-
plied to the primary coil. When the magnetic fields of
the primary coil interact with the iron core, the iron core CRITICAL THINKING
will then produce a magnetic field. This magnetic field
will then interact with the primary and secondary coils, There are 140 turns on the primary side of a trans-
therefore increasing the amount of mutual induction and former and 20,000 turns on the secondary side of
ultimately increasing the amount of current flowing in a transformer. What is the turns ratio for this trans-
the secondary coil. former?
Answer
⎛ Ns ⎞
⎜⎜ ⎟⎟
⎝ Np ⎠
20,000
= 142.8 or a turns ratio of 143
Primary coil Secondary coil 140

The output voltage in the secondary coil depends on

the turns ratio and on the primary voltage. Increasing the
number of turns in the secondary coil of a transformer
increases the output voltage and decreases the output
Ferromagnetic core current. According to Ohm’s law, the induced voltage
Figure 4.3. Components of a simple transformer. and current in the transformer coils are inversely related:
48 Part II: Circuits and X-Ray Production

higher voltages in the secondary coil are accompanied by increase or decrease in voltage is directly related to the
lower currents or amperage in the secondary coil. This number of primary and secondary turns. Therefore, a
occurs because the power output of the transformer can- step-up transformer will have more turns in the second-
not exceed the power input. When the secondary voltage ary coil which means higher voltage and lower amper-
is higher than the primary voltage, the secondary current age. A step-down transformer will have fewer turns in the
must be less than the primary current. If the secondary secondary coil than the primary coil which provides a
lower voltage and higher amperage in the secondary coil.
voltage is lower than the primary voltage, the secondary
As you can see, when voltage changes, amperage must
current is higher than the primary current.
have a corresponding change to keep power equal.
Transformers are used to change voltage; however,
Ohm’s law is in effect and the effect of the transformer Transformer Efficiency
on voltage, amperage, and number of turns in the coil
can be determined by combining the transformer law Although transformer efficiency is typically above 95%,
with Ohm’s law. The following formulas demonstrate the several factors influence how much energy is lost. The
combination of the two laws: high-voltage transformer used in x-ray equipment must step
⎛ Np ⎞ up voltage into the kilovolt range through the use of vast
Transformer law for current Is = Ip ⎜ ⎟ amount of wires that make up the secondary windings. The
⎝ Ns ⎠ high voltage and vast amounts of wires cause some problems
⎛ Vp ⎞ which affect the efficiency or energy loss of the transformer.
Transformer law for voltage and current Is = Ip ⎜ ⎟ The three principal causes of transformer energy loss are:
⎝ Vs ⎠
where I is amperage, V is voltage, N the number of 1. I2R loss: Electric current in copper wire experi-
turns, p is the primary coil, and s is secondary coil. ences resistance that results in heat generation.
This is also called copper loss.
2. Hysteresis loss: Results from energy expended as
CRITICAL THINKING the continually changing AC current magnetizes,
demagnetizes, and remagnetizes the core material.
3. Eddy currents loss: These currents oppose the mag-
The turns ratio in a filament transformer is 0.175, and netic field that induced them, thereby creating a
0.6 A of current is flowing through the primary coil. loss of transformer efficiency.
What will be the filament current?
Answer The current flowing through the coils produces heat
⎛ Np ⎞ in the transformer, which must be dissipated. X-ray trans-
Is = Ip ⎜ ⎟ formers are usually placed inside a metal box about the
⎝ Ns ⎠
size of a kitchen table or a desk. The box is filled with oil
⎛ 1 ⎞
Is = 0.6 ⎜ ⎟ to provide electrical and thermal insulation to prevent
⎝ 0.175 ⎠
Is = 0.6 × 5.7 electric shock and to cool the transformer.
Is = 3.4 A of current flowing through the
secondary coil of the filament transformer.
Types of Transformer Cores
There are many different ways to build a transformer to
improve efficiency and each has a different type of core
When working with transformers, it is helpful to configuration. A simple transformer made with two coils
remember that voltage and the number of turns are of wire in close proximity to facilitate mutual induction
directly proportional, while voltage and amperage are is called an air core transformer. When the primary and
inversely proportional. Therefore, the amperage and secondary coils have an iron core placed within them,
number of turns also have an inverse relationship. In the strength of the magnetic field is greatly increased,
a step-up transformer the voltage is increased but the forming an open core transformer. The open ends of
amperage must decrease to keep the power constant. this type of transformer allow the magnetic field lines to
Conversely, a step-down transformer will decrease volt- diverge at which point the field lines are only interacting
age from the primary coil to the secondary coil, with a with air. The closed core transformer was designed to
corresponding increase in amperage. The amount of correct the difficulties with an open core transformer by
 Chapter 4: Transformers, Circuits, and Automatic Exposure Control (AEC) 49

– – – – – – –
– –
– –
– –
– –
– –
– –
– –
Air core – –
– –
A C Closed core
– – – – – – –

– – – – – – – – –
– – – –
– – – –
– – – –
– – – –
– – –
– – –
– – –
– – –
– – –
– – – – – – – – –
B Open core D Shell core
Figure 4.4. Types of transformer cores. (A) Air core; (B) open core; (C) closed core; and (D) shell type.

placing an iron bar on the top and bottom of the open of primary and secondary windings on their coils and a
core. This configuration will direct the field lines from fixed turns ratio. If the turns ratio is constant, the only
primary to secondary cores toward each other, which way to change the output of a transformer is to change
results in a significantly higher increase in field strength. the input voltage. Figure 4.5 shows a schematic of the
The shell type transformer uses a central iron core with three types of transformers used in x-ray circuits.
both the primary and secondary wires wrapping around
the iron core. The primary and secondary wires are Autotransformers
heavily insulated to prevent the bare wires from touch- The function of an autotransformer is to provide different
ing each other. Placing the wires around the iron core voltages for input to the step-up and step-down transformers.
decreases the distance between the coils, which allows The output of the autotransformer is connected to the
for maximum mutual induction to occur (Fig. 4.4). primary coil of the step-up or step-down transformer.
An autotransformer has an iron core with only one coil,
Types of Transformers which serves as both primary and secondary transformer
windings. The primary side has output connections
There are three types of transformers used in x-ray circuits:
which are made at different points on the coil of an auto-
autotransformers, step-up transformers, and step-down
transformer; these connections are called output taps. In
transformers. Autotransformers allow the selection of an x-ray circuit, the output of an autotransformer is used
input voltage to step-up and step-down transformers. to change the voltage in the primary coils of the step-up
Step-up transformers are used to provide high voltage and step-down transformers. Different output voltages
to the x-ray tube. Step-down transformers are used to are obtained by selecting different autotransformer output
provide high current to the x-ray tube filament. Both taps; therefore changing the input voltage to the step-up or
step-up and step-down transformers have a fixed number step-down transformer. Varying the voltage to the step-up
50 Part II: Circuits and X-Ray Production

Step-up transformer Step-down transformer

Secondary coil

Secondary coil
Primary coil

Primary coil
Input Output
Input Output

A B

Autotransformer

Output tap

Secondary coil
Primary coil

Input

Figure 4.5. Three types of transformers. (A) Step-up transformer; (B) step-down transformer; and (C) autotransformer.

or step-down transformer allows for changes to the output transformer. Step-up transformers have more turns in the
voltage. As an example, if the input voltage of the auto- secondary coil than in the primary coil. The output volt-
transformer is 220 V and the output tap is selected for half age of a step-up transformer is higher than the input volt-
the voltage, the input voltage to the primary coil of the age, and the output current is always less than the input
step-up or step-down transformer is 110 V. current. Step-up transformers are used to supply high
Step-up Transformers voltages to the x-ray tube. Figure 4.6 shows the input and
A step-up transformer converts a lower AC voltage into output voltages and currents from a step-up transformer.
a higher AC voltage and is also called the high-voltage Notice that an increase in voltage has a corresponding

Input Output
Voltage

Voltage

Time Time
Current

Current

Time Time

Figure 4.6. Voltage and current

on the primary and secondary
sides of a step-up transformer.
 Chapter 4: Transformers, Circuits, and Automatic Exposure Control (AEC) 51

Input Output
Voltage

Voltage
Time Time
Current

Current
Time Time

Figure 4.7. Voltage and current

on the primary and secondary
sides of a step-down transformer.

decrease in amperage. This occurs due to Ohm’s law, is greater than the input current. Step-down transformers
which states that as voltage is increased there must be a are used to supply high currents to the tube filament.
corresponding decrease in amperage. Figure 4.7 shows the input and output voltages and cur-
rents from a step-down transformer.
Step-down Transformers As discussed, there are three important transformers in
A step-down transformer produces an output voltage the x-ray circuit (Fig. 4.8). The autotransformer is used
that is lower than the input voltage. The number of turns to vary the incoming line voltage for the high-voltage
on the secondary coil of a step-down transformer is less step-up transformer. The high-voltage step-up transformer
than the number of turns on the primary coil. The output is used to increase the incoming line voltage to the kilo-
current in the secondary coil of a step-down transformer voltage range which is necessary for x-ray production.

High-voltage
Control panel components High-voltage components X-ray tube
Autotransformer transformer

Time
control

X-ray tube
– +
Rectifier Anode Roter
kVp
meter

Cathode Filament Stator

mA
selector

Filament
transformer

Figure 4.8. Schematic representation of transformers in an x-ray circuit.

52 Part II: Circuits and X-Ray Production

Current
trodes; one electrode allows the easy flow of electrons,
Electrode while the other electrode opposes the flow of electrons.
Figure 4.9 illustrates the current flow through a typical
rectifier.
Half-wave Rectification
Electrode
No current
Half-wave rectification uses solid-state diodes to
effectively suppress the negative portion of the AC sine
Figure 4.9. This symbol for a diode represents the flow of wave. The positive portion of the sine wave is utilized to
current through a rectifier. The current flows easily out of produce pulsating DC (Fig. 4.10).
the point of the electrode. The other electrode blocks the
flow of current.
Full-wave Rectification
The output current shown in Figure 4.11 is known as
The filament step-down transformer is used to decrease
full-wave-rectified circuit because the negative part of the
the incoming line voltage to 5 to 15 V and 3 to 5 A
range to heat the x-ray tube filament. A rheostat is the AC sine wave is converted to positive current. With full-
component which varies current resistance and acts as wave rectification, the positive flow remains the same
a variable milliampere (mA) selector for the filament but the negative portion is converted to positive current
circuit. This allows the technologist to select mA for flowing in only one direction, or DC. This produces a
various radiographic examinations. more uniform pulsating DC sine wave.

Rectifiers
Rectifiers are solid-state devices that allow current to Circuits
flow in only one direction. They are used to convert
high-voltage AC from the secondary side of the step-up X-ray equipment has utilized various types of circuits to
transformer to high-voltage DC, which is applied to the provide DC to the x-ray tube. Historically, x-ray equip-
x-ray tube. Current flows from the positive terminal of ment has evolved from a simple unit, which used single-
the x-ray tube, which is called the anode, to the nega- phase circuits, which were not very efficient, to more
tive terminal of the x-ray tube, which is called the cath- advanced three-phase, which allows the x-ray circuits to
ode. operate in the most efficient manner possible.
Although current is said to flow from positive to neg-
ative, in an x-ray tube electrons actually flow from the
cathode to the anode or negative to positive. X-ray tubes Single-Phase Circuits
operate best when receiving DC because if the tube were
supplied with high-voltage AC, the electrons would flow Single-phase circuits use single-phase power that results in
in the wrong direction and cause significant damage to a pulsating x-ray beam. This pulsation is caused by the alter-
the tube. The construction and operation of x-ray tubes nating change in voltage from zero to maximum potential
are discussed more completely in Chapter 5. Rectifiers 120 times each second in a full-wave rectified circuit. The
are sometimes called diodes because they have two elec- x-rays produced when the voltage is near zero are of little
Current

Time (s)

Figure 4.10. Half-wave rectification.

 Chapter 4: Transformers, Circuits, and Automatic Exposure Control (AEC) 53
Input current

Current
Time
Time 2

3
A
Output current

Figure 4.13. Current flow of a three-phase circuit.

Time
the number of pulses in the waveform by using a
B 3-phase, 12-pulse circuit increases the average voltage
but does not increase the maximum voltage. Figure 4.14
Figure 4.11. Output current for full-wave rectified circuit.
demonstrates the evolution from single-phase and three-
phase waveforms with no rectification and a rectified
diagnostic value as their energy is too low to adequately three-phase waveform. Notice how the voltage becomes
penetrate the tissue. The solution to this problem was to more consistent with the three-phase six-pulse waveform.
develop a method for using three simultaneous voltage Table 4.1 presents the number of rectifiers used in dif-
waveforms out of step with one another. ferent forms of x-ray circuits.
The AC shown in Figure 4.12 is a single-phase cur-
rent. By adding more circuit elements, it is possible to High-Frequency Circuits
add two more phases to form a three-phase circuit. The
Transformers operate more efficiently at higher frequen-
major advantage of a three-phase circuit is that the cur-
cies because the coupling between the primary and
rent and voltage are more nearly constant, which results
secondary windings is more effective. A high-frequency
in more efficient x-ray production (Fig. 4.13).
transformer operating at 3,000 Hz is much smaller and
lighter than one designed to operate at 60 Hz.
Three-Phase Circuits
By the addition of two more circuits made up of transform-
ers and rectifiers, 120 degrees out of phase with each other
and with the first circuit, the output voltage and current
can be made more constant. The result, known as a three- Half wave
phase circuit, provides more efficient x-ray production.
The three-phase six-pulse circuit requires six rectifi-
ers to produce six usable pulses per cycle. The result is
a waveform which never reaches zero, thereby providing Full wave

an increased voltage. By adding additional components,

it is possible to produce 3-phase, 12-pulse voltage. This
provides a more constant voltage waveform. Increasing Three phase,
six pulse =

Three pulse
twelve pulse =
Input current

Time
High
frequency =

Figure 4.12. Single-phase current. Figure 4.14. Single phase and three-phase waveforms.
54 Part II: Circuits and X-Ray Production

TABLE 4.1 RECTIFIERS USED IN DIFFERENT make spiral CT practical. Most x-ray units installed today
FORMS OF X-RAY CIRCUITS have high-frequency circuits.
Type of Circuit Number of Rectifiers
Ripple
Single-phase, full-wave 2 or 4
Three-phase, six-pulse 6 Ripple measures the amount of variation between
Three-phase, twelve-pulse 12 maximum and minimum voltage. Because most x-ray
production occurs when the applied voltage is at
maximum, the percent ripple provides a good indication
High-frequency circuits first change the input frequency of how much variation there is in the x-ray output. Lower-
from 60 Hz to a higher frequency (500–3,000 Hz) using a ripple circuits have more constant x-ray output and higher
voltage inverter. The inverter converts the low-voltage average voltage. As seen in Table 4.2, the percent of ripple
AC to low-voltage DC using rectifiers, then switching the has declined with each improvement of the circuit. This
low-voltage DC on and off rapidly. This switching con- provides a nearly constant voltage to the circuit.
verts the low-voltage DC to low-voltage high-frequency The amount of ripple actually present at the x-ray tube
AC. A transformer then increases the voltage (to 20,000– depends on the length and type of x-ray cables and the
150,000 V), and a rectifier converts the AC into DC, details of the high-voltage circuit.
which is applied to the x-ray tube. Figure 4.15 illustrates Three-phase high-frequency circuits produce higher
the basic operation of the high-frequency x-ray circuit. average voltage, but single-phase and three-phase circuits
Although there are many different design details, all have the same maximum voltage. At higher voltages, the
high-frequency circuits switch the low-voltage (200 V) x-ray production process is more efficient and the x-rays
DC rapidly on and off to produce high-frequency but are more penetrating, so three-phase and high-frequency
still low-voltage AC. This is applied to the primary of a circuits require fewer milliamperes or less time to obtain
step-up transformer to produce a high-frequency high- the same image density.
voltage output. The secondary voltage from the step-up
transformer is then rectified to produce high-voltage DC,
which is applied to the x-ray tube.
The advantages gained from the high-frequency cir-
cuit outweigh the cost and added complexity of the extra
High-Voltage Circuits
stages. The advantages of high-frequency circuits are
smaller size, less weight, and improved x-ray production. High-voltage x-ray circuits contain transformers, kVp and
Modern computed tomography (CT) scanners have high- mA selectors, rectifiers, and timing circuits. X-ray tubes
frequency circuits mounted in the rotating gantry. High- operate only with DC. In diagnostic radiology, the voltage
frequency circuits with their lightweight transformers across the x-ray tube can be set at values from 20,000 to

Rectifier High-frequency Transformer Rectifier

Inverter

A B C A
High-voltage DC
Voltage

Low-frequency DC Low-voltage,
high-frequency AC High-voltage,
Low-frequency AC high-frequency AC

Figure 4.15. High-frequency x-ray circuit converts incoming AC to high voltage DC.
 Chapter 4: Transformers, Circuits, and Automatic Exposure Control (AEC) 55

TABLE 4.2 THE AVERAGE VOLTAGE AND

AMOUNT OF RIPPLE FROM DIFFERENT TYPES
Timing Circuits
OF X-RAY CIRCUITS Timing circuits shut off the high voltage to terminate
Max % the x-ray exposure after a selected exposure time. The
Type of Circuit Voltage Percent Ripple timer opens a switch to cut off the high voltage from the
x-ray tube and stop x-ray production. Exposure times are
Single-phase 0.71 Vmax 100 selected from the control panel to control the amount of
Three-phase, six-pulse 0.95 Vmax 13
3-phase, 12-pulse 0.99 Vmax 3
x-rays produced. Short exposure times should be selected
High-frequency generator 1.00 Vmax 1 to minimize patient motion artifacts.

Automatic Exposure Control

120,000 V or 20 to 120 kVp. This high voltage is required
Circuits
in order to produce diagnostic x-rays. A transformer is An AEC circuit measures the amount of radiation leav-
used to produce the high voltage. Transformers oper- ing the patient and turns off the x-ray beam when the cor-
ate by mutual induction; they can work only with AC. rect amount of radiation has reached the detector. The
A transformer converts an input voltage of a few hundred AEC circuit is calibrated to produce the proper image
volts to an output voltage of many thousands of volts; rec- density regardless of patient size. Figure 4.17 illustrates
tifiers then convert the high-voltage AC to high-voltage the operation of an AEC circuit.
DC. Finally, the high-voltage DC is applied to the x-ray The purpose of the AEC unit is to provide the correct
tube and x-rays are produced. exposure regardless of patient size. At the control panel,
Understanding the components of the x-ray circuit is the exposure mA and time can be selected independently,
important because changes in the circuit controls will or the milliampere-time (mAs), which is the combination
alter the radiographic image. Figure 4.16 illustrates a of milliamperes and time, can be selected, in which case
typical x-ray circuit. the control circuits choose the highest mA and the short-
est time allowed. The AEC detector is placed between
the patient and the film cassette or image receptor.
Control Panel In operation, the AEC circuit acts as the timer for
the x-ray circuit. Rather than turning off the x-ray beam
Components when a fixed time has been reached, the AEC unit turns
off the x-ray beam when the proper amount of radiation
has reached the image receptor. The AEC circuit still
The control panel components of the x-ray circuit appear requires the technologist to set the mA and kVp correctly,
on the left side of Figure 4.16. The control panel com- although some units automatically select the highest
ponents include the kVp, time and mA selectors, and the mA allowable in order to reduce the exposure time and
automatic exposure control (AEC) circuit. reduce the effects of patient motion.
Typical AEC systems have three rectangular-shaped
detectors placed roughly at the corners of a triangle. In
kVp and mA Selectors the past, AEC circuits were called phototimers because
The incoming electrical supply is connected to the auto- the detectors used were photomultiplying devices instead
transformer. The kVp and mA selectors are also connected of ionization chambers. Figure 4.18 shows a picture of
to the autotransformer. The only way to change the output an image receptor holder with the position of the AEC
detectors indicated.
voltage of a transformer is to change its input voltage. The
The three detector cells can be selected to oper-
autotransformer is used to select the input voltage to either
ate singly, in pairs, or all together, depending on the
the step-up or the step-down transformer. The step-up or examination and patient orientation. A vast majority of
high-voltage transformer generates the high voltage used to examinations utilize the center detector. The detectors
produce the x-rays. The step-down or filament transformer can be ionization chambers, scintillators, or solid-state
produces the mA tube current. Different autotransformers detectors. Regardless of the type of detector used, the AEC
are used as the kVp and mA selectors. unit keeps the x-ray beam on until enough x-rays have
56 Part II: Circuits and X-Ray Production

Primary or low voltage circuit Secondary or high voltage circuit

Step-up
Autotransformer transformer Cable
(kV selector)
Exposure Timer
switch circuit

X-ray
tube

Kilovolt- MA Rectifier
meter

Rheostat
(mA selector) Filament
ammeter

Step-down filament
transformer

Figure 4.16. Schematic diagram of a typical x-ray circuit.

passed through the patient to provide proper exposure be recalibrated. Positioning is critical to allow the radiation
for the film or detector. The AEC unit must initially be to be detected through the part under examination.
calibrated for the film/screen combination used. If the AEC units have a provision for adjustments to give
film/screen combination is changed, the AEC unit must the technologist a way of modifying the overall density

Detector

X-ray timer

AEG Circuit
Film
cassette
Figure 4.18. Photograph of an image receptor (vertical
Figure 4.17. AEC circuit. Bucky) with the outline of the AEC cell locations indicated.
 Chapter 4: Transformers, Circuits, and Automatic Exposure Control (AEC) 57

or blackness of the film. Each adjustment step produces

about a 30% change in density. The backup timer prevents damage to the x-ray
tube if the AEC circuit does not terminate the
Backup Timer exposure before the tube limits are reached.

The backup timer terminates the exposure when the backup

time is reached. It is necessary to set the backup timer in
case something goes wrong. If the x-ray beam does not reach
the AEC detectors, excess radiation could reach the patient Case Study
and the tube could be damaged. This could happen if the
Bill is assisting his imaging department in decid-
x-ray beam and the detectors were not aligned. If the verti-
ing which type of x-ray equipment would meet
cal Bucky AEC is selected and the x-ray beam is directed at
their needs. He has researched 3-phase 6-pulse,
the table, the x-ray beam will not turn off. The backup timer
3-phase 12-pulse, and high-frequency generator
terminates the exposure before the tube limits are exceeded.
in his quest to find the best equipment for the
Backup timers are usually set at 5 seconds.
procedures the department performs.

Chapter Summary Critical Thinking Questions

DC flows in only one direction. AC flows in two What is the percentage of ripple for each type
opposite directions, half one way and half the of circuit?
other way. X-ray circuits convert low-voltage AC
input to high-voltage DC, which is applied to What type of transformer will be used by the
the x-ray tube. The kVp selector is an autotrans- equipment?
former that changes the input to the step-up or
high-voltage transformer. The mA selector is an What component changes the incoming line
autotransformer that changes the input to the voltage into usable voltage in the x-ray tube?
step-down, or mA, transformer to control the fil-
ament current. The ratio of the number of turns How is the filament protected from damage?
on the secondary to the number of turns on the
primary is called the turns ratio. A transformer
with a turns ratio >1 is a step-up transformer; Three-phase six-pulse has a 13% ripple,
the output voltage is greater than the input volt- three-phase twelve-pulse has a 3% ripple, and
age. A transformer with a turns ratio less than 1 high-frequency generator has a 1% ripple. To
is a step-down transformer; the output voltage is produce the voltage needed for these types of
less than the input voltage. equipment, an autotransformer is necessary to
Ripple is a measure of the variation between increase incoming line voltage to the kilovolts
the maximum and minimum voltage. Circuits necessary for radiographic examinations. Volt-
with low ripple produce a more constant x-ray age is increased by using a step-up transformer
output. Three-phase and high-frequency x-ray to produce the high voltages needed to operate
circuits have less ripple and produce more con- the equipment. The x-ray tube must operate on
stant output than single-phase x-ray circuits but DC and the autotransformer utilizes rectifiers
do not change the maximum voltage. to change AC to DC. The autotransformer also
Automatic exposure detectors are placed uses a step-down transformer to reduce voltage
between the patient and the image receptor to to 10 to 15 V and increases amperage to 3 to
terminate the x-ray exposure when the proper 5 A. This change is necessary because the fila-
image density is reached. Selection of the ment is a fine wire that cannot withstand high
proper combination of detector cells is based voltage. Decreasing the voltage protects the fila-
on the examination and patient orientation. ment from breaking.
Review Questions

6. Which type of transformer has a primary and sec-

Multiple Choice ondary coil only?
A. closed core
B. shell type
1. The automatic exposure control circuit
C. air core
A. turns off the x-ray beam when the proper expo- D. open core
sure is reached
B. measures the amount of radiation striking the 7. Ripple measures
patient
A. total tube voltage
C. measures the amount of radiation leaving the
B. variation between maximum and minimum mA
cathode
C. variation between maximum and minimum volt-
D. turns off the filament cooling circuit when the
ages
proper exposure is reached
D. total mA
2. A rectifier in an x-ray circuit
8. What is the output voltage of a transformer with a
A. prevents positive charge from reaching the primary voltage of 150 V and with 500 turns on the
anode primary and 400,000 turns on the secondary?
B. converts AC to DC
C. prevents excess grid bias on the anode A. 20,000 V
B. 120,000 V
3. A transformer can operate only on C. 250,000 V
A. AC D. 400,000 V
B. DC
9. The transformer that has a single winding that
4. An x-ray tube can operate only on acts as both the primary and secondary windings is
A. AC called a(n)
B. DC A. autotransformer
5. An autotransformer functions as a(n) B. step-down transformer
C. step-up transformer
A. line-voltage compensator
B. kVp or mA selector 10. A transformer with more turns in its primary
C. filament transformers winding than in its secondary winding would be
D. automatic exposure controller expected to
A. increase the voltage and decrease the amperage
B. increase the voltage and increase the amperage
C. decrease the voltage and decrease the amperage
D. decrease the voltage and increase the amperage
 Chapter 4: Transformers, Circuits, and Automatic Exposure Control (AEC) 59

11. What is the turns ratio if the number of windings 4. Describe the process of mutual induction.
on the primary coil is 800 and the number of wind-
ings on the secondary coil is 600,000?
A. 400
B. 750
C. 375
D. 650 5. Describe a rectifier and how it changes AC to
DC.
12. If a transformer is supplied with 700 V to the pri-
mary coil and has 400 turns of wire on the primary
coil and 60,000 turns of wire on the secondary coil,
what will be the kilovoltage in the secondary coil?
A. 105,000
B. 4.6 6. What is the relationship between the number of
C. 0.0046 coils in a winding and the amount of voltage and
D. 105 amperage that is produced?

Short Answer
7. Explain the purpose of oil in a transformer.
1. List the four main components of the control
panel.

8. Define full-wave rectification.

2. What is the purpose of the filament step-down

transformer?

9. Compare a single-phase circuit to a three-phase

six-pulse circuit.

3. Write the transformer law formula for current and

voltage.

10. Describe how an AEC operates.

 5

X-Ray Tubes

Objectives Key Terms

Upon completion of this chapter, the student ● actual focal spot ● heel effect
will be able to: ● anode ● leakage radiation
1. Define thermionic emission. ● anode angle ● line focus principle
2. Describe the line focus principle and the heel ● cathode ● off-focus radiation
effect. ● effective focal spot ● rotating anode

3. Define anode heat units. ● filament ● rotor

● focal spot ● SID
4. Recognize allowed and forbidden tube heat
● focal spot blooming ● space charge effect
loads.
● focal track ● thermionic
● focusing cup emission

60
 Chapter 5: X-Ray Tubes 61

are sealed inside an evacuated glass or metal envelope.

Introduction The vacuum allows the electrons to travel freely from the
negative cathode to the positive anode.
This chapter covers the components, operation,
and limitations of x-ray tubes.
The purpose of the x-ray tube is to produce an Tube Housing
x-ray beam. The x-ray tube contains a negative During the production of x-rays, they are emitted in all
electrode that when the current is applied to it, directions within the tube. The x-rays that are emitted
will produce a mass of electrons that will inter- through the thin window of the tube housing make up
act with a positive electrode in order to produce the primary beam. The thin window allows for the maxi-
x-rays. The negative electrode is on one side of the mum amount of x-rays to be transmitted with very little
x-ray tube. It is called the cathode. The cathode absorption in the beam direction. The remaining x-rays
contains a filament. The positive electrode is on are absorbed by oil, which provides electrical insulation
the opposite side of the x-ray tube. It is called the and cooling for the tube. The x-ray tube and oil are con-
anode. The anode contains a focal spot where the tained in a metal housing. The housing protects against
electrons interact to produce the x-rays. electric shock and absorbs leakage radiation emitted out-
side the x-ray beam. The leakage radiation is a source of
unnecessary exposure for the radiographer and patient.
Regulations require that the leakage radiation through
X-Ray Tube the tube housing be less than 100 mR/h at one meter from
the tube. A fan is often used to transfer the heat from the
housing to the room air by convection (Fig. 5.1).
An animation for this topic can be viewed
at http://thepoint.lww.com/FosbinderText Glass Envelope
The x-ray tube is a vacuum tube with two electrodes: the
cathode and the anode. These components are housed
The cathode contains the filament, which is heated to in an evacuated glass envelope made of Pyrex glass to
boil off the projectile electrons. The cathode is shaped withstand the tremendous heat generated by the produc-
like a cup to focus the projectile electrons onto the posi- tion of x-rays. All air is removed from the glass envelope
tive anode. The anode contains a focal spot, which has an creating a vacuum which allows electrons to flow from
area of only a few square millimeters. In order to spread the cathode to the anode. The vacuum allows an effi-
the heat from the projectile electrons over a larger area cient production of x-rays and also extends the life of the
of the anode, the anode rotates. The tube components tube.

Glass envelope

Stator

Anode
Cathode

Roter

Filament

Focusing cup

Figure 5.1. Components of a

typical x-ray tube. Molybdenum shaft Window
62 Part II: Circuits and X-Ray Production

Modern x-ray tubes are commonly designed with a metal

envelope. They prolong the tube life and eliminate tung-
sten vaporization which coats the inside of the envelope.
This coating can result in electrons arcing which causes
tube failure. The metal envelope avoids this from happen-
ing because there is a constant electrical potential between
the electrons in the tube current and the envelope.

Cathode
Front view

The cathode is the negative electrode of the x-ray tube.

Oblique view, cut
The function of the cathode is to produce a thermionic at level of red line
cloud, conduct the high voltage to the space between the
cathode and anode, and focus the electron stream as it Figure 5.2. Dual focus system.
speeds toward the anode. It contains the filament or fila-
0.4- to 1.2-mm focal spots, and small filaments produce
ments, focusing cup, and wiring for filament current
focal spots of 0.1 to 0.5 mm. Focal spot size is selected
automatically by selecting larger or smaller mA stations
Filament or manually by the focal spot size selection.
The purpose of the filament is to provide projectile elec-
trons for acceleration to the positive anode. The filament, Filament Current
a coil of tungsten alloy wire, is heated to boil off electrons.
Upon turning on the x-ray machine, a low current flows
Tungsten is the material of choice because it has a high
through the filament to warm and prepare it for the high
melting point and resists vaporization; rhenium and molyb-
mA necessary to form a thermionic cloud. The x-ray
denum are also suitable materials. Vaporization produces
tube has fixed mA stations of 100, 200, 300, and so on
particles that deposit on surfaces inside the tube, which
to provide the necessary mA for a multitude of various
reduces the vacuum in the tube. Changes in the filament
exposures. When the filament current is high enough for
current, termed milliamperes (mA), produce changes in
thermionic emission, a small increase in filament current
the filament temperature. This causes a change in the
results in a large increase in tube current.
number of projectile electrons boiled off the filament in
a process called thermionic emission. Thermionic emis- Focusing Cup
sion causes electrons to be boiled off the filament wire and
to form a thermionic cloud. Upon depression of the expo- The focusing cup is made of nickel and has two shal-
sure switch, the electron cloud is driven toward the anode low depressions which contain the filaments. Electrons
target where x-ray photons are produced. An increase or with their negative charge tend to diverge in a wide pat-
decrease in the number of projectile electrons striking the tern because of electrostatic repulsion. The low negative
anode changes the number of x-rays produced. charge on the focusing cup surface forces the projectile
The size of the focal spot is determined by the size electrons together into a narrow beam as they are acceler-
of the filament coil. Modern diagnostic x-ray tubes have ated toward the anode. The anode region where the pro-
two filaments, one large and one small, called a dual jectile electrons strike is called the focal spot. Figure 5.3
focus system (Fig. 5.2). The large filament is used when shows the focusing action of a typical dual focus cup.
high x-ray production is needed. The larger filament When sufficient mA is applied, the electrons begin to
produces a larger focal spot to distribute the heat over build up into a cloud around the filament; this is called
a larger area which allows higher tube currents without a space charge. The electrons reach a point where their
damaging the anode. The smaller filament produces a negative charges begin to oppose the emission of addi-
small focal spot when sharper images or better spatial res- tional electrons in a phenomenon called space charge
olution is required. Lower tube currents should be used effect. The space charge effect limits x-ray tubes to maxi-
with small focal spots. Large filaments typically produce mum mA ranges of 1,000 to 1,200.
 Chapter 5: X-Ray Tubes 63

Anode Tungsten-rhenium alloy

Cathode

Focusing cup
–––––––
Electron – ––
beam

Focal
– ––
spot ––––––– Molybdenum
Graphite
Negative charge

Figure 5.3. Focusing action of a typical dual focus cup. Figure 5.4. Typical anode construction.

operating temperatures. Tungsten also conducts heat

very well, which helps the anode cool down. Heat from
Anode the focal spot is carried to the remainder of the anode by
conduction. Anode heat is transferred from the anode to
the walls of the tube housing by radiation. The housing
The positive anode contains the focal spot, which is the
walls are cooled by convection of room air, which may
area where the projectile electrons stop. The anode is
be increased by fans mounted on the housing (Fig. 5.4).
located on the positive side of the x-ray tube and it has In addition to tungsten, molybdenum or graphite are
three functions: it serves as a target surface for high-voltage layered under the tungsten target. Both molybdenum
electrons from the filament and is the source of x-ray and graphite are less dense metals than tungsten, which
photons; it conducts the high voltage from the cathode makes it easier to rotate the anode. Molybdenum also has
back into the x-ray circuitry; and it serves as the primary a high melting point while graphite-backed anodes can
thermal conductor. When the projectile electrons hit the double the heat loading capacities without increasing
anode, more than 99% of the electron energy is deposited wear to the bearings.
in the anode as heat. Only about 1% of the projectile
electron energy is converted to x-ray photons. Rotating Anode
The rotating anode consists of a target, shaft, and rotor.
Anode Materials Rotating anodes spread the heat produced when the
The focal spot on the anode can reach temperatures electrons bombard a circular track (Fig. 5.5) rather than
>3,000°C during an x-ray exposure. The anode must be concentrating the energy in a single spot on the anode
made of a material with a high melting point because surface. The x-ray source remains fixed relative to the
most metals melt at these temperatures. Tungsten-
rhenium alloys, which melt at 3,400°C, are commonly
used as the target focal track material in anode construc-
tion. Tungsten is the metal of choice for three reasons:

1. high atomic number

2. high melting point
3. heat conduction ability

Tungsten’s atomic number of 74 results in production of

diagnostic-range photons. There are tremendous temper-
atures created with each x-ray exposure, and tungsten’s Focal spot

high melting point allows it to withstand normal use and Figure 5.5. Focal spot on anode.
64 Part II: Circuits and X-Ray Production

patient, but the heat is spread over a circular track as the the tube never begins at zero because you must take into
anode rotates. Most anodes rotate at about 3,600 revo- account the distance from the target to the image receptor.
lutions per minute (rpm); some high-speed tubes rotate In the rotating anode the circular path that will be bom-
at 10,000 rpm for greater heat dissipation. Changing the barded with the electron beam is called the focal track. The
anode rotation speed changes the anode heat capacity terms target, focal point, and focal spot all refer to the area on
but does not change the focal spot size. the focal track where the electron beam will strike. Two other
The anode, shaft, and rotor are sealed inside an evacu- terms we must discuss are actual focal spot and effective focal
ated tube. Conventional motors using slip rings to provide spot. Actual focal spot is used to describe the actual area on
electrical contact with the rotor are not used to drive the the focal track which is impacted. The effective focal spot
anode because the slip rings would destroy the vacuum describes the area of the focal spot that is projected out of the
inside the tube. Instead, an induction motor is used to tube and toward the object being imaged (Fig. 5.6).
rotate the anode. The rotor is made up of a shaft of cop-
per bars with an iron core in the middle. Electromagnets
called stators are fixed on the outside of the glass envelope Line Focus Principle
and are activated by an electric current in a synchronized
arrangement. The magnetic field of the electric current sets Tilting the anode surface so there is an angle between the
up around the stator and interacts with the ferromagnetic
surface and the x-ray beam spreads the heat over a larger area
rotor, causing the rotor to turn in synch with the stator.
while maintaining a smaller focal spot for sharper images.
The shaft, connecting the rotating anode to the rotor,
is made of molybdenum and is supported by bearings. This is known as the line focus principle. The sharpness
Molybdenum is a strong metal with low heat conductiv- of the final x-ray image is determined by the focal spot size.
ity. Its low thermal conductivity prevents the anode heat Smaller focal spots produce sharper images. The size of the
from reaching and damaging the rotor bearings. Bearing focal spot, as seen by the patient or image receptor, is known
damage is a major cause of tube failure. as the effective focal spot size and is smaller than the actual
focal spot size because of the line focus principle. The sur-
Target Area face of the anode is angled to spread the heat from the pro-
The portion of the anode where the high-voltage electron jectile electrons over a larger area. The angle between the
stream will impact is called by the following names: the tar- anode surface and the x-ray beam shown in Figure 5.7 is
get, the focal point, the focal spot, or the focal track. This called the anode angle. Figure 5.7 illustrates how reducing
is the area where the x-ray photons are created. Since the the anode angle reduces the effective focal spot size, while
target is the point where x-ray photons are created, it is this maintaining the same area on the anode surface (actual focal
exact point at which all tube-to-object and image-receptor spot). Radiographic tubes have anode angles from 12 to 17
distances are measured. The tape measure located on degrees. The smaller target angle results in a smaller effec-
tive focal spot size, better detailed images, and decreased
heat capacity in the anode. Spreading the heat over a larger
area allows for increased mA values. The line focus princi-
ple produces sharper images because the effective focal spot
Incident
is always smaller than the actual focal spot. The anode angle
electron
beam
is set during tube construction by the manufacturer. Unfor-
Incident tunately, reducing the target area on the anode by applying
electron
beam the line focus principle also increases the heel effect.
Large actual
focal point

Heel Effect
15° 15° Small actual
focal point

Larger effective Smaller effective

focal point focal point
The heel effect produces an intensity variation between
Central ray Central ray the cathode and anode sides of the x-ray field. This causes
Figure 5.6. Actual focal spot. Effective focal spot. a variation in density across the image from the anode side
 Chapter 5: X-Ray Tubes 65

15°

30°

Figure 5.7. Use of the line focus

principle to obtain an effective Actual focal point Actual focal point
focal spot which is smaller than the Effective focal point Effective focal point
actual focal spot.

to cathode side, where the radiation intensity is greater on Figure 5.8 shows how x-rays emitted toward the cath-
the cathode side. The heel effect is caused because most ode side of the x-ray tube pass through less anode material
x-rays are produced below the anode surface. The x-ray than x-rays emitted toward the anode side of the field. The
intensity is decreased toward the anode side of the tube heel effect can produce intensity variations of more than
because the x-rays emitted in that direction must pass 40% between the anode and cathode sides of the field.
through more anode material than x-rays emitted toward The heel effect is more noticeable with smaller anode
angles, larger field sizes, and shorter source to image
the cathode side of the field.
receptor distances (SIDs).
Smaller field sizes and larger SID reduce the heel effect.
The heel effect is applied in clinical situations to achieve a
more uniform density when there is a large variation of body
Anode
thickness across the x-ray field. The anode is recognized as
the “head” end of the table to more fully utilize the heel
effect to the best advantage. The cathode side of the tube is
placed over the thicker or more dense body part. An example
of this would be imaging the thoracic spine in an AP projec-
tion. The cathode side would be placed over the lower tho-
Cathode racic spine with the anode toward the upper thoracic area to
produce a more uniform density of the entire thoracic spine
(Fig. 5.8).

Off-focus Radiation
Off-focus radiation consists of x-rays produced at locations
other than the focal spot. It occurs when projectile elec-
trons strike other parts of the anode away from the focal
spot. Off-focus radiation causes radiographic images to
appear unsharp, decreases overall image quality by reduc-
75 80 90 100 105 110 120
Central ray
ing image contrast, and exposes the patient’s tissue outside
the intended imaging area (Fig. 5.9). Most off-focus radia-
Approximate intensity (%)
tion is attenuated by the tube housing and the first-stage
Figure 5.8. Approximate intensity of x-ray beam. collimator located near the window of the tube housing.
66 Part II: Circuits and X-Ray Production

Radiographic Tube Rating Charts

Sometimes called tube rating charts, these charts are the
most important charts because they guide the radiographer
in determining the maximum technical factor combina-
tion that can be used without overloading the tube. Each
filament of each tube has a unique tube rating chart to
assist in plotting milliamperes, kilovoltage, and time for an
exposure. Each chart plots the kilovoltage on the y-axis and
exposure time in seconds on the x-axis. The various mA
stations are plotted within the chart and for any exposure
with a combination of kVp and time which falls below or to
the left of the mA station is considered safe. If an exposure
is made with a combination of kVp and time which falls
above or to the right of the mA station, the exposure is
unsafe and may result in sudden tube failure (Fig. 5.10).

60 Hertz Stator Operation

Effective Focal Spot Size - 0.6 mm
150
140
Figure 5.9. Effect of off-focus radiation. 130
125 MA
120
110
150 MA
Peak kilovolts

100
90

Focal Spot Blooming 80

70
200 MA

250 MA
60
Electrostatic repulsion forces the negative electrons to 50
repel each other while traveling from cathode to anode. 40
Focal spot blooming refers to an increase in the focal 30
.01 .02 .04 .06 0.1 0.2 0.4 0.6 1 2 4 6 10
spot size with an increase in mA caused by this electro- Maximum exposure time in seconds
static repulsion. Focal spot blooming is important only
with very high mA values and lower kilovoltage (kVp) Figure 5.10. Tube rating charts.
settings.
CRITICAL THINKING

Tube Rating Charts Referring to Figure 5.10, which of the following sets
of exposure factors are safe and which are unsafe?
and Cooling Curves Answer
a. 0.6-mm focal spot: 100 kVp, 125 mA, 0.5 second
Each radiographic unit has a set of charts which help the
(unsafe)
radiographer use the x-ray tube within a set of acceptable b. 0.6-mm focal spot: 85 kVp, 0.05 second,
exposures to avoid damage to the x-ray tube. The three 200 mA (safe)
types of tube rating charts are: c. 0.6-mm focal spot: 115 kVp, 0.1 second,
200 mA (safe)
1. radiographic tube rating charts d. 0.6-mm focal spot: 100 kVp, 0.2 second,
2. anode cooling curves or charts 250 mA (unsafe)
3. housing cooling charts
 Chapter 5: X-Ray Tubes 67

Anode Cooling Curves

CRITICAL THINKING
Anode cooling curves or charts allow the calculation of the
time necessary for the anode to cool enough for additional
exposures to be made. The heat deposited in the anode Five abdominal films are exposed with a three-
by the projectile electrons depends on the mA, kVp, and phase, six-pulse circuit using 85 kVp and 135 mAs.
exposure time. Exposures with higher applied voltages, What are the total HU generated?
higher tube currents, and longer exposure times deposit Answer
more heat on the anode focal spot. The heat deposited in
HU = kVp × mA × time × 1.35
the anode is measured in heat units (HU). The number of HU = 85 × 135 × 1.35
HU is obtained by using the following formulas: HU = 15,491
Total HU = 5 × 15,491 HU
Single-phase: HU = kVp × mA × time
77,455 HU generated for five sequential
abdominal films.
3-phase, six-pulse: HU = kVp × mA × time × 1.35
Modern x-ray circuits have safety circuits to prevent
the selection of a single unallowed exposure, or
3-phase, 12-pulse or high-frequency: HU = kVp × multiple unallowed exposures with no cooling between
mA × time × 1.41 exposures. It is essential to wait between multiple expo-
sures to allow the anode to cool if each exposure is near
1.35 and 1.41 are the factors that adjust for the difference
the maximum heat capacity of the anode. Many x-ray cir-
in heat deposited in the anode because of the different
electrical waveform utilized by x-ray circuitry. cuits will prevent additional exposures from being made
until the anode has had sufficient time to cool. Figure 5.11
represents an anode cooling curve with a maximum heat

CRITICAL THINKING
60 Hertz Stator Operation
Effective Focal Spot Size - 0.6 mm
What is the heat load in HU from a single-phase
exposure with technical factors of 100 kVp, 200 mA,
and 0.1 second?
Answer 300

HU = kVp × mA × time
250
HU = 100 × 200 × 0.1
HU = 2,000
Heat units X 1000

200

150
CRITICAL THINKING
100

What are the HU if the exposure is made with a

high-frequency circuit, 100 kVp, 200 mA, and 0.1 50
second?
Answer 0
0 2 4 6 8 10 12 14 16
HU = kVp × mA × time × 1.41 Time in minutes
HU = 100 × 200 × 0.1 × 1.41
HU = 2,820 Figure 5.11. Anode cooling curve.
68 Part II: Circuits and X-Ray Production

capacity of 350,000 HU. The chart is used to determine the mum allowed heat that has been deposited in the anode.
amount of time it will take for the anode to completely The monitor uses the mA, time, and kVp settings to
cool after an exposure. The initial cooling is quite rapid calculate the HU for each exposure. The anode cooling
but as the anode cools the rate of cooling slows down. For rate is included in the calculation.
example, a cup of steaming hot chocolate is placed on the
counter at room temperature of 70°F. There is a vast dif-
ference between the hot chocolate temperature and room
temperature, and the hot chocolate will begin to dissipate
Tube Life and
its heat rapidly. As the hot chocolate cools down, there is less Warm-up Procedures
heat to dissipate; therefore, the cooling process slows down.
It occurs the same way with the cooling of the anode.
An x-ray tube costs about the same as a full-size new car. It
Another use for the anode cooling curve is to deter-
is important to extend the life of the tube by properly warm-
mine if a set of exposures will overload the anode. Using
Figure 5.11 again, how long would it take after an initial ing up the tube before beginning clinical exposures. Tubes
load of 300,000 HU before a series of exposures equal fail because of heat damage, either to the bearings or to the
to 100,000 HU could be made? The maximum HU is anode surface. Excessive heat can cause filament failure,
350,000, and the anode must cool to 250,000 HU in order bearing damage, and anode cracks. Proper tube warm-up
to take the additional 100,000 HU. Solve the following: will extend the tube life. Figure 5.12 shows an anode after
a heat-induced crack split the anode into two pieces.
Proper warm-up exposures eliminate anode crack-
CRITICAL THINKING ing by spreading the heat over the entire target surface.
A proper warm-up procedure uses at least a 1-second
exposure to include many rotations of the anode dur-
Using the anode cooling curve in Figure 5.11, cal- ing the exposure. A very short exposure on a cold anode
culate the length of time it will take for the anode concentrates the heat on a fraction of the anode surface.
to cool from 350,000 HU to accept a series of expo- This can cause uneven thermal expansion of the anode
sures totaling 100,000 HU on a single-phase unit? and may crack the anode. A typical warm-up procedure
Answer would consist of two 70 kVp with several low mA long
exposures and 2-second exposures. Tube warm-up proce-
350,000 HU − 100,000 HU = 250,000 HU dures should be performed whenever the x-ray tube has
(anode must cool to this level) not been used for several hours.
350,000 HU = 0 minute While the x-ray unit is on, it remains in the standby
250,000 HU = 1.3 minutes mode with a filament current of a few amperes keeping
It will take 1.3 minutes (1.3–0 minutes) before the the filament warm and ready to be heated to its operating
next set of exposures can be made. temperature. Just before the exposure is made, the anode
begins rotating and the filament is heated to operating

Housing Cooling Charts

The housing cooling charts for the x-ray tube allow the cal-
culations to determine how long it will take to cool the hous-
ing so additional exposures can be made. The charts are very
similar to anode cooling charts and are used exactly the same
way. In all actuality, the anode will overheat long before the
tube housing as the tube housing has a forced-air fan to dis-
sipate the heat which has built up on the tube housing.

Anode Heat Monitors

Modern x-ray circuits are equipped with an anode heat Figure 5.12. Anode damage from not properly warming
monitor. This monitor displays the percent of maxi- anode.
 Chapter 5: X-Ray Tubes 69

temperature by the boost current. This is termed the prep

stage of exposure. A safety circuit prevents exposure prior to proper warm-up procedures. Heat limit curves
the anode reaching full rotation speed. The boost current demonstrate the allowed and unallowed expo-
raises the filament temperature to begin thermionic emis- sure regions for tubes. There are separate curves
sion. The boost current is present while the exposure switch for the large and small focal spots.
is activated. Maintaining the tube in the boost mode or prep
stage after the x-ray exposure is completed can significantly
shorten tube life by burning out the filament. The exposure
switch should be released as soon as the exposure is com-
pleted. The standby mode does not shorten tube life. Case Study
Heat is the primary cause of tube failure. Heat increases Mark is performing a barium study on a patient.
rotor bearing wear and damages the anode surface. When During the exam the high-frequency x-ray
tube bearings begin to fail, they emit a grinding noise
machine stopped producing the x-ray beam
noticeable after every exposure.
because the maximum amount of heat units,
350,000, was used during fluoroscopy. Mark
Chapter Summary needs to produce seven more images using
100 kVp and 250 mA.
The negative cathode of the x-ray tube contains
the filament. Thermionic emission from the
heated filament produces projectile electrons Critical Thinking Questions
which are accelerated to the positive anode.
The positive anode is a disk-shaped structure What is the formula to determine heat units?
constructed of a high atomic number alloy
with high thermal conductivity and has a high How many heat units will this set of exposures
melting point. The anode and cathode are con- produce?
tained in an evacuated glass tube surrounded
by oil inside a metal housing. The oil provides Using the anode cooling curve in Figure 5.11,
electrical insulation and cooling. The projectile how long must the anode cool before the
electrons stop in the anode and produce x-rays additional exposures can be made?
photons. More than 99% of the electron energy
is converted to heat in the anode; the remainder
is converted to x-ray photons. X-ray tubes utilize The formula is kVp × mAs × rectification
rotating anodes to distribute the heat around a constant x number of exposures
circular track on the anode surface. HU = 100 kVp × 250 mAs × 1.41 × 7
The line focus principle uses an angled anode = 199,500.
to spread the heat over a larger area (the actual
focal spot) while still maintaining a smaller This set of exposures will produce approxi-
effective focal spot as seen by the patient. mately 200,000 HU. Using the anode cooling
The heel effect causes different x-rays intensi- chart, now determine how much time must
ties at the cathode and anode ends of the tube that elapse before Mark can make the additional
limit the useful field size. The heel effect is caused exposures. The maximum amount of heat units
because some of the x-rays are produced below the was already used so you must subtract the addi-
anode surface. These x-rays are attenuated as they tional heat units from the maximum heat units.
leave the anode. The intensity at the anode end is 350,000 HU − 200,000 HU = 150,000 HU. On
less than at the cathode end of the field. the cooling curve 350,000 HU corresponds with
HU are the product of the kVp, the mA, and 0 minute and 150,000 HU corresponds with
the exposure time. HU depend on the focal 2.5 minutes. It will take 2.5 minutes for the
spot size and the type of x-ray circuit used. It is anode to cool enough to make the additional
important to extend the tube life by following exposures.
Review Questions

6. Which metal is used on the target of the anode?

Multiple Choice A. Molybdenum
B. Rhenium
C. Graphite
1. The Heel effect D. Tungsten alloy
A. causes greater radiation intensity on the cathode 7. The _____ is used to determine the maximum
side number of heat units an x-ray machine can
B. is caused because x-rays produced inside the cath- handle.
ode are attenuated
C. depends on mA and kVp A. anode cooling curve
D. is reduced by dual focal spots B. housing cooling chart
C. tube rating chart
2. The line focus principle D. all of the above
A. makes the focal spot appear larger than it really
is 8. Which best describes thermionic emission?
B. makes use of an angled cathode structure A. The point where an electron’s negative charge
C. produces x-ray lines begins to oppose the emission of additional elec-
D. spreads the heat over a larger part of the anode trons
B. The electrons boil off the filament and form a
3. The purpose of the cathode focusing cup is to cloud, which is propelled toward the anode
A. alter the filament size C. Photons that were not produced at the focal spot
B. group the electrons for their passage to the D. The electrons boil off the anode prior to impact-
anode ing the cathode
C. regulate the anode rotation speed
D. increase the heat capacity of the tube 9. Which of the following is not a reason to use
tungsten in an x-ray tube?
4. Most x-ray tubes have two filaments
A. Tungsten has a high melting point
A. because the second filament can be used as a B. It has a relatively high atomic number
spare when the first burns out. C. It efficiently dissipates heat which was produced
B. to provide two focal spot sizes during the exposure
C. to allow for cooling of the filament by alternating D. Doubles the heat loading capacity of the anode
exposures
D. to improve tube cooling by sharing the heat 10. Which metal is combined with tungsten to form
between the two filaments an alloy for the anode target?
5. The Heel effect is more pronounced A. Rhenium
B. Graphite
A. further from the focal spot C. Molybdenum
B. with a large focal spot D. Copper
C. with a small cassette
D. with a small target angle
 ChapterChapter
5: Film 5:
andX-Ray
Processing
Tubes 71

5. Briefly describe how to use a tube rating chart.

Short Answer

1. Describe the type of radiation which does not 6. What is the purpose of the focusing cup?
contribute diagnostic information to the image
but rather results in unnecessary exposure to the
patient and radiographer.

7. Define leakage radiation.

2. Define the heel effect and describe how it can be

used to the radiographer’s advantage.
8. List the parts of the cathode.

3. What is the purpose of having two filaments? 9. Why is the filament embedded in a focusing cup?

4. Explain line focus principle. 10. Define an x-ray photon?

 6

X-Ray Production

Objectives Key Terms

Upon completion of this chapter, the student ● bremsstrahlung in- ● keV
will be able to: teractions ● kVp
1. Describe the bremsstrahlung x-ray production ● characteristic ● x-ray beam
process. cascade quality
● characteristic inter- ● x-ray beam
2. Describe the characteristic x-ray production
actions quantity
process.
● incident electron
3. Identify the information contained in an x-ray
spectrum.
4. Identify the changes in x-ray beam quality and
quantity resulting from changes in kVp, mA,
filtration, x-ray circuit waveform, and anode
material.

72
 Chapter 6: X-Ray Production 73

interacts with the force field of the nucleus. The incident

Introduction electron with its negative charge is attracted to the posi-
tively charged nucleus. The incident electron must have
This chapter covers the two x-ray production enough energy to penetrate the orbital shells of the atom.
processes that take place in the anode, the When the incident electron gets close to the nucleus,
bremsstrahlung and characteristic processes. the powerful nuclear force field is much too great for the
The amount and energy distribution of the incident electron to penetrate. The force field makes the
x-rays from these processes are different and electron slow down or brake and then causes the electron
influence the appearance of the final image. to change directions. As the electron slows down, it will
This chapter describes the two x-ray production lose energy that is emitted as an x-ray photon.
processes and the changes in the x-ray beam The bremsstrahlung process produces x-rays of much
produced by changes in the kVp, mA, filtration, different energy because the incident electrons are
x-ray circuit waveform, and anode material. slowed down at different rates. Figure 6.1 illustrates how
incident electrons produce bremsstrahlung radiation of
different energies.
Projectile or incident electrons that pass very close
X-Ray Production to the nucleus of the anode target atoms produce
higher energy x-rays than those that pass further away.
Projectile electrons produced by thermionic emission in These x-ray photons are called bremsstrahlung photons
the cathode are accelerated by the high voltage to the and their energy is the difference between the kinetic
anode where either bremsstrahlung or characteristic radi- energy of the incident photon and the kinetic energy of
ation is produced. The bremsstrahlung process produces the brems photon. The amount of kinetic energy that
more than 90% of diagnostic x-rays. The remaining per- is lost is dependent upon how close the incident elec-
centage are characteristic x-rays. tron gets to the nucleus. When the incident electron is
The kinetic energy of the projectile electrons is con- farther away from the nucleus, very little energy will be
verted into heat and x-ray energy. Most of the projectile lost, resulting in a low-energy brems photon. When the
electron energy is converted into heat energy, only about incident electron is closer to the nucleus, more energy
1% is converted into electromagnetic energy or x-rays.
The interaction that will occur depends on the electron M shell

kinetic energy and the electron binding energy of the L shell

electron shells.
K shell

Bremsstrahlung 90 keV

Interactions

An animation for this topic can be viewed

at http://thepoint.lww.com/FosbinderText 10 keV
N shell
= Proton
= Electron
Bremsstrahlung is the German word for “braking or
= Neutron
slowing radiation”. Bremsstrahlung, also referred to as
“brems,” is radiation that is produced when projectile 80 keV
electrons are slowed down in the anode. Bremsstrahlung Figure 6.1. Demonstrates projectile electrons producing
interactions may only occur when the incident electron bremsstrahlung radiation of different energies.
74 Part II: Circuits and X-Ray Production

is lost, resulting in a higher energy brems photon. These

incident electrons have the ability to interact with many Ulfiltered beam

Number of x-rays having

target atoms and to cause many brems interactions.
Average energy = 23 keV
Each interaction will decrease the kinetic energy of the

energy E
incident electron until the electron has no more kinetic
energy and drifts away to join the current flow. The Filtered beam
vast majority of diagnostic x-rays are produced by the
bremsstrahlung process. Emax

10 20 50 70

Bremsstrahlung X-Ray Spectrum X-ray energy (keV)

A plot of the number of bremsstrahlung x-rays as a func- Figure 6.2. Shows the number of x-rays with different
tion of their different x-ray energies is known as an x-ray energies in the x-ray beam emitted from the anode.
spectrum. It plots how many x-ray energies there are from
zero to the peak electron energy.
The maximum x-ray energy (Emax) produced by the Characteristic
bremsstrahlung process is equal to the energy of the pro-
jectile electrons, and that is why it is called kVp or peak Interactions
kilovoltage. The bremsstrahlung process produces a con-
tinuous spectrum of x-ray energies; that is, there are no
sharp peaks or valleys in the curve. An animation for this topic can be viewed
Low-energy x-rays are filtered out or stopped before they at http://thepoint.lww.com/FosbinderText
reach the patient. The dotted line shows an unfiltered x-ray
spectrum which would be observed at the anode surface.
All x-ray tubes have added filtration to absorb low-energy
x-rays. These lower energy x-rays cannot penetrate through Characteristic interactions occur in a tungsten anode
the patient and would not contribute any information to when an orbital electron fills a vacancy in a shell of
the x-ray image but will contribute to patient dose. The a tungsten atom. When a projectile or incident elec-
average energy of the x-ray beam depends on many fac- tron has sufficient energy to ionize or remove an
tors. The majority of x-rays produced have an average of orbital electron from an inner electron shell, a vacancy
approximately one third of the maximumenergy (Emax). is created and the atom becomes unstable. A higher
energy outer-shell electron will immediately fill the
keV and kVp lower energy vacancy that creates a characteristic x-ray
photon. The difference in energy between the bind-
There are two energies associated with x-ray production. ing energy of the vacant shell and the outer shell is
One is the energy of the individual x-rays; the other is the the characteristic x-ray energy. The vacancy is usually
energy of the projectile electrons, which is determined by filled by an electron in the next outer shell, but it is
the voltage applied to the x-ray tube. possible to have transitions to the vacancy from shells
The energy of the individual x-rays is measured in kilo- further from the nucleus. This transition of electrons
electron volts (keV) and is distributed from zero to Emax, between shells creates a process called a characteristic
the maximum energy of the projectile electrons. The cascade, which can produce many x-ray photons for
voltage applied to the x-ray tube is known as kilovoltage each electron that leaves the atom. The characteristic
peak (kVp) and is equal to the energy of the projectile interactions created at the anode target are called pri-
electrons. kVp is equal to the maximum energy of the mary radiation.
x-rays, called Emax. Figure 6.2 shows that an applied volt- In diagnostic x-ray tubes, with tungsten alloy anodes, the
age of 70 kVp produces an x-ray spectrum with an Emax most common transition is from the L shell to the vacant
equal to 70 keV with an average x-ray energy of about 23 K shell. Only K-shell vacancies from high–atomic num-
keV. ber elements produce characteristic x-ray photons with
 Chapter 6: X-Ray Production 75

M shell (2)
of the K-shell tungsten atom is 69.53 keV. Thus, the
projectile electron must have an energy slightly >69.53 keV
L shell (12) to remove a K-shell electron from a tungsten atom and pro-
K shell (69) duce K characteristic radiation. K characteristic x-rays are
only produced at 70 to 120 kVp. In diagnostic x-rays, in
70 keV
the range of 110 to 120 kVp, about 15% of the x-ray beam
consists of K characteristic x-rays. The energy of the char-
acteristic x-ray does not change with changes in the kVp.

X-Ray Beam Quality

N shell (1)
and Quantity
57 keV X-ray beam quality describes the penetrating ability
Figure 6.3. Illustrates the filling of a tungsten K-shell of the x-ray beam. It depends on the average x-ray
vacancy with an L-shell or M-shell electron. energy of the x-ray beam, which is controlled by the
kVp setting. X-ray beam quantity or the amount of
x-ray photons in the beam is related to x-ray intensity.
high enough energy to be useful in diagnostic radiology. Recall that intensity is a measure of the amount of x-ray
K characteristic x-ray photons produce a discrete spec- energy flowing through an area each second. Intensity
trum, meaning that only x-rays with the characteristic ener- depends on the number and energy of x-ray photons
gies are present (Fig. 6.3). in the beam. X-ray beam quantity is controlled by the
All characteristic x-rays resulting from L to K transitions mA setting. Information about both beam quantity and
in a tungsten anode have an energy of 57 keV. This is beam quality is contained in the x-ray spectra curve.
the predominant characteristic x-ray from tungsten. The intensity or quantity is represented by the area
A less likely transition would be an M-shell electron under the curve; the average energy is indicated by the
filling the K-shell vacancy. M to K transitions produce peak of the curve. Figure 6.5 illustrates the intensity and
67 keV characteristic x-rays (Fig. 6.4). average energy of two x-ray beams, one with a tungsten
To produce K characteristic x-rays, the K-shell orbital anode and the other with a molybdenum anode. The
electron must be removed. The electron binding energy molybdenum anode tube is used in mammography.
Number of x-rays having
Number of x-rays having

Characteristic x-rays

Average energy
energy E
energy E

Tungsten
M–K
L–K

Molybdenum
Emax

58 67 20 40 60 80 100
X-ray energy (keV) Photon energy (keV)

Figure 6.4. Demonstrates the average energy of character- Figure 6.5. Shows x-ray spectra produced from tungsten
istic x-rays from a tungsten anode. and molybdenum anodes.
76 Part II: Circuits and X-Ray Production

X-Ray Spectra from Different

Anode Materials Average energy

Number of x-rays
Different anode materials produce different characteristic
High kVp
x-ray energies and different amounts of bremsstrahlung
Low kVp
radiation. Tungsten alloy anodes are used in most diag-
nostic x-ray tubes, although molybdenum anode tubes Emax Emax
are used in mammography. Tungsten has 58 and 67 keV
50 70 100
characteristic x-ray energies and molybdenum has 17 and Photon energy (keV)
19 keV characteristic x-rays. Molybdenum anodes are
used in mammography because their characteristic x-rays Figure 6.6. Shows the x-ray spectra resulting from expo-
provide good contrast for breast imaging. The smooth sures at 70 and 110 kVp. Note how the curve shifts to the
curves represent the bremsstrahlung portions of the x-ray right or high-energy side when higher kVp is used.
production curve, and the discrete or sharp peaks rep-
resent the characteristic radiations from tungsten and
The characteristic x-ray energy does not change with a
molybdenum. The position of the sharp peaks indicates
change in kVp.
the energy of the characteristic x-rays.
This increase in energy reflects a nearly doubled
In addition to the anode material, the four other fac-
amount of energy. More x-rays are being emitted at all
tors that can influence the x-ray spectra are shown in
energies and this causes more density to appear on the
Table 6.1.
image. Many radiographers use this process to decrease
the amount of mAs used during an exposure. The rule of
kVp thumb which is used is called the 15% rule, which states
Changes in the applied kVp change the average energy that an increase in kVp of 15% is equivalent to doubling
and the maximum energy of the x-ray beam. The quan- the mAs. This phenomenon occurs because the x-ray
tity also changes with kVp because bremsstrahlung pro- beam has more penetrability, which means that less of
duction increases with increasing projectile electron the radiation is absorbed by the patient and more radia-
energy. Figure 6.6 shows the x-ray spectra resulting from tion reaches the image receptor.
exposures at 70 and 110 kVp. The x-ray intensity or area
under the curve, the average energy, and the maximum
energy (Emax) all increase when the kVp is increased.
mA
Changes in mA change the quantity but not the energy
(quality) of the x-ray beam. Changing the mA does not
TABLE 6.1 FOUR ADDITIONAL FACTORS THAT change the average energy or the maximum x-ray beam
INFLUENCE THE X-RAY SPECTRA energy. The number of characteristic x-rays increases with
increasing mA, but the characteristic x-ray energy does
kVp The applied voltage controls the projectile not change. The quantity of the x-ray beam is directly
electron energy, the intensity, the Emax, proportional to the mA; doubling the mA doubles the
and the average energy of the x-ray beam.
intensity and quantity of the x-ray beam (Fig. 6.7).
Changing the kVp does not change the
energy of the characteristic x-rays.
mA The mA controls the number of projectile
electrons striking the anode and the intensity Time
of the x-ray beam.
Time has the same effect on x-ray production as mA.
Beam Beam filtration influences the intensity and
filtration average energy of the x-ray beam. Increasing the time increases the number of x-rays reach-
Circuit The waveform influences the intensity and the ing the patient and the image receptor but does not
waveform average energy of the x-ray beam. change the quality or penetration characteristic of the
x-ray beam.
 Chapter 6: X-Ray Production 77

Average energy Average

energy High frequency
Number of x-rays

Three phase

Intensity
200 mA
Single phase

100 mA
Emax Emax

110 110
Photon energy (keV) Photon energy (keV)

Figure 6.7. Illustrates the increase in x-ray quantity when Figure 6.9. Illustrates an x-ray spectrum from single-
the mA is increased from 100 to 200 mA. The increase in phase, three-phase, and high-frequency x-ray circuits.
mA results in a proportionate increase in the amplitude of
the x-ray spectrum at all energies.

Filtration X-Ray Circuit Waveform

When an x-ray beam is produced, there is a wide range of X-ray production depends on the type of x-ray circuit
energies and wavelengths; the beam can be called poly- waveform. There are different types of circuits utilized
energetic or heterogeneous. The purpose of filtration is for various x-ray equipment, such as single-phase, three-
to remove low-energy x-rays before they strike the patient. phase, and high-frequency circuits. As seen in Figure
The filter is made of thin sheets of aluminum or other 6.9, circuits that allow for more constant voltage result
metal attached to the output port of the tube housing. in higher intensity and higher average energies for the
Adding filtration is also called hardening the x-ray beam. same mA and kVp settings. The Emax does not change
The filtration selectively removes more low-energy than with changes in waveform. All modern x-ray equipment
high-energy x-ray photons (Fig. 6.8), thereby making the utilizes high-frequency circuits.
beam more homogeneous. Adding filtration increases
the average x-ray energy and decreases the beam inten-
sity. Filtration changes do not change the Emax of the x-ray
beam or the energy of the characteristic x-rays.
Chapter Summary
X-rays are produced by either the bremsstrahl-
ung process or the characteristic x-ray process.
Bremsstrahlung x-rays are produced when
the projectile or incident electrons are slowed
Average energy down or stopped in the anode. Approximately
90% of diagnostic x-rays are produced by the
Intensity

2 mm added filtration
bremsstrahlung process. Characteristic x-rays
4 mm Al are produced by transitions of orbital electrons
which fill vacancies in atomic shells. The char-
Emax
acteristic x-ray energy depends only on the
Photon energy anode material. An x-ray spectrum is a plot of
x-ray intensity as a function of x-ray energy. The
Figure 6.8. Illustrates the change in the x-ray spectrum energy of individual x-rays is measured in keV.
resulting from added filtration.
78 Part II: Circuits and X-Ray Production

The kVp is the voltage applied to the x-ray tube.

The kVp is equal to the Emax. The average energy Case Study
of the x-ray beam is one-third to one-half Emax. Figure 6.6 demonstrates the x-ray spectrum that
The x-ray spectrum depends on the kVp, resulted from two exposures, one at 70 kVp and
mA, time, filtration, and x-ray circuit waveform. the other at 110 kVp.
Increasing the kVp increases the quantity, the
average beam energy, and the Emax. Increasing
the mA increases the quantity but does not Critical Thinking Questions
change the average energy or Emax. Increasing
the filtration decreases the quantity and increases What is the main factor that changed the Emax?
the average beam energy but does not change the
Emax. Changing from single- to multiphase x-ray How does this factor affect the average and
circuits increases the quantity and the average maximum energies?
energy of the x-ray beam but does not change
the Emax. How does it change the appearance of the
curves in the graph?

What change in energy occurs when the factor

is decreased?

kVp is the main factor that changes the

appearance of the energy on the graph. When
kVp is increased, the average and maximum
energies will also increase. This increase in kVp
is seen as a widening of the curve. When the
kVp is decreased, the average and maximum
energies will decrease and this will be seen on
the graph as a narrowing of the curve.
 Chapter 6: X-Ray Production 79

Review Questions

6. Interactions that produce x-rays in the anode

Multiple Choice include
1. coherent
1. The bremsstrahlung process produces x-rays when 2. Compton
3. bremsstrahlung
A. electrons are stopped in the cathode 4. pair production
B. a vacancy in an electron orbit is filled 5. characteristic
C. a vacancy in the nucleus is filled
D. electrons are stopped or slowed down in the anode A. 1, 3, and 5
B. 2 and 4
2. Characteristic radiation is produced when C. 3 and 5
D. 1, 2, 3, 4, and 5
A. electrons are stopped in the cathode
B. a vacancy in an electron orbit is filled 7. The quality of the beam is primarily determined
C. a vacancy in the nucleus is filled by
D. electrons are stopped in the anode
A. mA
3. About _____% of the electron energy is converted B. kVp
to x-ray energy. C. focal spot size
D. target angle
A. 1
B. 10 8. An atom of tungsten has shell binding energies of
C. 25 K shell 69, L shell 11, M shell 2, and N shell 1.
D. 99 Incident electrons must have an energy of at least
_____ keV to produce K characteristic x-rays from
4. The x-ray tube filtration filters out tungsten.
A. low-energy electrons A. 50
B. high-energy x-rays B. 70
C. high-energy electrons C. 67
D. low-energy x-rays D. 58

5. The energy of the photon is known as the 9. A technologist can control the quantity of x-rays
A. kVp striking the patient by adjusting the
B. keV A. mA
B. kVp
C. mA and kVp
D. mA, kVp, and anode material
E. mA, kVp, rectification, and anode material
80 Part II: Circuits and X-Ray Production

10. The maximum kinetic energy of an incident electron 5. Describe the characteristic interaction.
accelerated across an x-ray tube depends on the
A. atomic number (Z) of the target
B. size of the focal spot
C. kilovoltage
D. type of rectification
6. The majority of electron energy in the x-ray tube is
converted to which form of energy?
Short Answer

1. Define and explain the 15% rule.

7. Describe the bremsstrahlung interaction.

2. Using Figure 6.3, calculate energy of the charac-

teristic x-ray if the K-shell electron is replaced by
8. Explain what the characteristic cascade is.
an L-shell electron.

9. What is an incident electron?

3. Which type of interaction produces diagnostic
x-rays?

10. Explain how the x-ray circuit influences the

production of x-rays.
4. What factors have an effect on the x-ray spectrum
and describe how the spectrum is affected by each
factor.
 7

X-Ray Interactions

Objectives Key Terms

Upon completion of this chapter, the student ● absorption ● pair production
will be able to: ● attenuation ● photodisintegration
1. Distinguish between absorption, scattering, ● beam quality ● photoelectric effect
and transmission of x-ray photons. ● beam quantity ● photoelectron
2. Identify the factors that affect the amount ● coherent scattering ● radiolucent
of attenuation. ● Compton scattering ● radiopaque
3. Define half-value layer. ● half-value layer ● scattering

4. State five ways in which x-rays interact with

matter.
5. Describe the two x-ray interactions important
in image formation.

81
82 Part II: Circuits and X-Ray Production

complete or partial loss of the x-ray photon energy in the

Introduction patient. Some x-ray photons will pass completely through
the patient without interacting with the tissue (Fig. 7.1).
X-ray photons entering a patient can be Other x-ray photons will interact with an orbital electron,
absorbed, scattered, or transmitted. When an the whole atom, or just the nucleus. Upon interacting with
x-ray photon is absorbed in a patient, all of the tissue there will be either complete energy loss termed
energy is transferred to the patient’s tissue. Scat- absorption and partial energy loss called scattering. When
tering changes the x-ray photon direction and the photon energy is absorbed and completely transferred
reduces its energy. Scatter contributes to radia- to the tissue, the photon will no longer exist. A photon that
tion fog and reduces image contrast. Transmitted interacts and then scatters still has enough energy to go on
x-ray photons pass through the patient without to interact with another atom. This process will continue
interaction and form the radiographic image. until the photon is completely out of energy and absorbed
Most diagnostic x-ray photons are absorbed or into the tissue (Fig. 7.2).
scattered. Only about 1% of the x-ray photons The amount of attenuation depends on the:
are transmitted through the patient. Radiation
leaving the patient is termed exit radiation. Exit 1. x-ray photon energy
radiation consists of transmitted and scattered 2. tissue thickness
x-ray photons. Throughout the chapter the stu- 3. tissue density
dent will learn all these concepts and how they 4. tissue material (atomic number)
occur during an x-ray exposure (Fig. 7.1).
These factors all influence the final radiographic image.

X-Ray Photon Energy

Attenuation Higher x-ray photon energies (shorter wavelengths)
have greater penetration and lower attenuation values.
Attenuation is the removal of x-ray photons from the beam
by either absorption or scattering. Attenuation occurs
when the x-ray beam passes through matter and there is a

Transmission Absorption Scattering

Heart

Lung

Lung

Spine Absorbed rays

Scattered rays
Image receptor
Figure 7.2. Shows how both absorption and scattering
Figure 7.1. Shows absorption, scatter, and transmission. contribute to attenuation.
 Chapter 7: X-Ray Interactions 83

Changing the x-ray photon energy, the keV, by changing TABLE 7.1 ATTENUATION CHARACTERISTICS OF
the kVp will alter the penetration of the x-ray beam. SOME MATERIALS IMPORTANT IN RADIOLOGY
Lower energy x-ray photons have higher attenuation and Material Density (g/cm3) Atomic Number
lower penetration values.
Air 0.0013 7.6
Lung 0.32 7.4
Beam Quality and Quantity Fat 0.91 6.3
Muscle 1.0 7.4
Beam quality describes the penetration of the x-ray Bone 1.9 13.8
beam. Higher kVp x-ray beams have higher penetration Iodine 4.9 53
meaning they can pass completely through the patient Barium 3.5 56
with little or no absorption. Beam quantity describes the Lead 11.4 82
amount of x-ray photons in the x-ray beam. Beams with
higher beam quantity produce images with less noise.
The amount of photons in the beam is controlled by the
amount of mAs used to make the exposure. often introduced into the body to improve image contrast.
They are effective because their atomic numbers or their
densities are significantly higher from the surround-
Tissue Thickness ing body tissues. Substances that are highly attenuating
As the tissue thickness increases, more x-ray photons are are termed radiopaque and easily absorb x-ray photons.
attenuated, either by absorption or scattering. More x-ray Bone, barium, and iodine are examples of radiopaque
photons are attenuated by 22 cm of the tissue than by 16 substances. Substances having low attenuation values are
cm of the tissue. Technical exposure factors (mAs and termed radiolucent. Air, bowel gas, and lung tissue are
kVp) must be adjusted to compensate for different tis- relatively radiolucent and are easily penetrated by x-ray
sue thicknesses. Modern fixed x-ray units have automatic photons. Lung is a combination of air spaces and tissue
exposure control circuits designed to adjust the mAs to and has a density between air and muscle.
compensate for different patient thicknesses. Exposure
factors used with portable units must be selected by the
radiographer.
Half-value Layer
Mass or Tissue Density The half-value layer (HVL) is defined as the amount of
Mass density or subject density refers to how closely material required to reduce the x-ray beam intensity to
packed the atoms are in a tissue. Density is measured in one-half its original value. The HVL is affected by the
grams per cubic centimeter (g/cm3). X-ray photon attenu- amount of kVp and filtration in the beam. Twice the thick-
ation is increased in dense tissue. Air or gas has the lowest ness of material does not produce twice the attenuation
density in the body. Muscle is more dense than fat. The because the average energy of the x-ray beam changes as
attenuation of 1 cm of muscle is >1 cm of fat. Bone is it passes through the body. The lower energy, less pen-
denser than muscle. One centimeter of bone has more etrating x-ray photons are removed from the beam so the
attenuation than 1 cm of muscle or fat. Table 7.1 lists the exit beam is more penetrating and has a higher average
densities of some body tissues and materials important in energy than the entrance beam. This removal of “soft”
radiology. x-ray photons results in a hardening of the beam, which
increases the ability of the x-ray photons to penetrate
tissue. At diagnostic x-ray energies the HVL of soft tis-
Tissue Material sue is about four centimeters. Four centimeters of tissue
Materials with higher atomic numbers (Z) have higher reduces the x-ray intensity to one-half its original value.
attenuation values. Table 7.1 presents the atomic num- The HVL describes the x-ray beam quality or penetration
ber of some tissues and materials common in diagnostic of the beam. More penetrating x-ray beams have greater
radiology. Air, iodine, and barium are contrast materials HVLs (Fig. 7.3).
84 Part II: Circuits and X-Ray Production

L shell
Incident x-ray
K shell

100% x-rays 50% x-rays 25% x-rays

4cm 4cm

Figure 7.3. Demonstrates how two HVLs reduce the intensity

of the x-ray beam to one quarter of its original value.
Wavelength
Scattered x-ray

Figure 7.4. Illustrates coherent scattering, which does

Types of X-Ray not produce ionization. Classical scattering occurs when
an incident photon interacts with an orbital electron and
Interactions excites the electron. The x-ray photon does not lose any
energy but changes direction and leaves the atom.

The five x-ray interactions possible in tissue are: other interactions transfer some energy from the incident
photons to tissue and do produce ionization.
1. coherent scattering
2. photoelectric effect
3. Compton scattering The Photoelectric Effect
4. pair production
5. photodisintegration An animation for this topic can be viewed
at http://thepoint.lww.com/FosbinderText
These interactions take place between the x-ray photons
and the target atoms in the tissue. Only the photoelectric
and Compton interactions are important in diagnostic
In a photoelectric effect or interaction, the incident
radiology.
photon is completely absorbed by the atom. The photon
energy is totally transferred to an inner-shell electron.
Coherent Scattering The atom is ionized when this electron is ejected from
the atom. The ejected electron is called a photoelectron.
An animation for this topic can be viewed The photoelectron has kinetic energy which is equal
at http://thepoint.lww.com/FosbinderText to the difference between the incident photon and the
binding energy of the inner-shell electron. This is shown
mathematically in the equation:
Coherent scattering, also called classical scattering, occurs
when the incident photon interacts with electrons in an Ei = Eb + Eke
atom causing the electrons to become excited and vibrate.
The excited atom immediately releases the excess energy where, Ei is the energy of the incident photon, Eb is the
as a scattered x-ray photon with the same wavelength as binding energy of the electron, and Eke is the kinetic
the incident photon. As seen in Figure 7.4, coherent scat- energy of the photoelectron. For the interaction to occur,
tering produces a change in x-ray photon direction with the incident photon needs an energy that is slightly greater
no change in energy. It occurs primarily at energies below than the binding energy of the electron. Most of the atoms
10 keV and is not important in diagnostic radiology. The in tissue are very low atomic number elements and have
 Chapter 7: X-Ray Interactions 85

Incoming x-ray
Vacancy
Photoelectron L shell characteristic radiation

Incident x-ray

K shell

K shell L shell K shell

L shell L shell

Figure 7.5. The photoelectric effect.

very low K-shell binding energies. The photoelectron is

made up of matter and travels <1 mm in tissue. This type 10

of localized absorption causes biological changes. 9

When the electron is removed from the atom it causes
the atom to become unstable. The vacancy in the K shell 5
will be filled with an electron from the L shell, M shell, or
a free electron. Filling the inner-shell vacancy produces
3
characteristic x-ray photons. Characteristic photons from
tissue elements (carbon, nitrogen, and oxygen) have very
low energies. They are called secondary radiation and act 2
like scatter radiation. Most characteristic x-rays from the
tissue do not exit the patient because of their extremely
Attenuation

low energies (Fig. 7.5). The final result of the photo- 1

electric effect is the complete absorption of the incident 0.9

photon. There is no exit radiation after a photoelectric
interaction. The photoelectric effect produces the lighter
0.5
densities on conventional x-ray images.

Variation of the Photoelectric Soft Bone

Effect with Atomic Number 0.3

tissue

The photoelectric effect increases with increasing atomic

number (Z). Atoms with higher atomic numbers absorb 0.2

more x-ray photons. Bone absorbs more photons than mus-

cle because bone has a higher atomic number than muscle.
0.1
The attenuation of bone is four times greater than the atten- 20 40 60 80 100
uation of muscle at an x-ray energy of 40 keV (Fig. 7.6). Energy (keV)

Barium and iodine are used as contrast agents because of

their high atomic numbers. This results in an increased pho- Figure 7.6. Shows that the photoelectric effect in bone is
toelectric effect. Structures containing these radiopaque greater than in muscle.
86 Part II: Circuits and X-Ray Production

contrast agents appear lighter or brighter on conventional The Compton effect is represented by the following
radiographic images. formula:

Ei = Es + Eb + Eke
Variation of Photoelectric Effect
with X-Ray Energy where, Ei is the energy of the incident photon, Es is the
The photoelectric effect decreases as the x-ray energy energy of the Compton scattered photon, Eb is the elec-
increases. Figure 7.7 shows the photoelectric effect in tron binding energy, and Eke is the kinetic energy given to
bone and muscle as a function of energy. At higher kVp the Compton electron.
settings there is less photoelectric effect in low atomic
number structures such as soft tissues.

CRITICAL THINKING
Compton Scattering
A 35-keV x-ray photon ionizes an atom of iodine
An animation for this topic can be viewed by ejecting an M-shell electron that has a binding
at http://thepoint.lww.com/FosbinderText energy of 1.07 with 16 keV of kinetic energy. What is
the energy of the scattered x-ray photon?
Answer
In Compton scattering, the incident x-ray photon
interacts with a loosely bound outer-shell electron. The 35 keV = Es + (1.07 + 16 keV)
incident x-ray photon ionizes the atom by removing an
outer-shell electron, and then the photon continues in a Es = 35 keV - (1.07 + 16 keV)
different direction. The energy of the incident photon is Es = 35 keV - 17.07 keV
shared between the Compton or recoil scattered electron Es = 17.93 keV Compton scattered photon
and the scattered x-ray photon. The Compton scattered
x-ray photon has lower energy and longer wavelength
than the incident photon (Fig. 7.7).
Compton scattering is almost independent of changes
in material and atomic number. During radiographic
Incident x-ray Compton recoil examinations of larger areas of the body more tissues are
electron
irradiated due to the larger field sizes, this produces more
Compton scattering. The scatter radiation emitted from
the patient is the primary cause of occupational exposure
for the radiographer. Fluoroscopic examinations pose a
Wavelength serious radiation hazard due to the large amount of radia-
tion that is scattered from the patient. This is why it is
crucial for the radiographer to wear a lead apron, thyroid
shield, and gloves during all fluoroscopic examinations.
The amount of Compton scattering increases with
increasing x-ray energy. Compton scattered photons
K shell can be scattered in any direction up to 180 degrees. The
angle of deflection is influenced by the energy of the
L shell
initial photon. At a deflection of 0 degrees no energy is
transferred because the photon does not change its path
Scattered photon from the original direction. As the deflection increases to
Figure 7.7. Illustrates Compton scattering of an incident 180 degrees, more energy is given to the recoil electron
x-ray by an outer-shell electron. and less energy stays with the scattered photon. When a
 Chapter 7: X-Ray Interactions 87

1.02 MeV L shell

100
K shell
Compton
Relative importance (%)

50 0.51 MeV
positron
Photoelectric

10 20 30 40 50
X-ray energy (keV)
0.51 MeV electron
Figure 7.8. Demonstrates the relative importance of the
photoelectric and Compton interactions as a function of Figure 7.9. Pair production occurs with x-ray photons
x-ray energy. having an energy of 1.02 MeV or greater. Upon interaction
with the nuclear force field, the photon disappears and two
oppositely charged electrons take its place.
scattered photon is scattered back in the direction of the
incident photon, it is called backscatter radiation. Back-
scatter radiation can cause artifacts on the radiographic production the incident x-ray photon is transformed
image and decrease image quality. The backscatter radia- into a positive and a negative electron pair when the
tion deposits unwanted exposure on the image and is high energy photon passes near the electrostatic force
called radiation fog. The increase in radiation fog causes field of an atomic nucleus, causing the photon to
a decrease in radiographic contrast. disappear. In its place one positive and one negative
Only photoelectric and Compton interactions are electron share the incident photon energy (Fig. 7.9).
important in diagnostic radiology. At low energies, the Pair production does not occur at diagnostic radiology
Compton scattering and the photoelectric effect have energies.
nearly the same ratio of interactions, while at higher
energies Compton scattering dominates (Fig. 7.8). As
demonstrated in Figure 7.8, when the incident x-ray pho-
ton energy is increased, the relative amount of the photo-
electric interaction decreases and the relative amount of
Photodisintegration
Compton scattering increases.
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at http://thepoint.lww.com/FosbinderText

Pair Production
In photodisintegration, the incident x-ray photon
has enough energy (>10 MeV) to break up the atomic
An animation for this topic can be viewed nucleus. When the incident photon strikes the nucleus
at http://thepoint.lww.com/FosbinderText it gives up all its energy to the nucleus; this interaction
excites the nucleus. The excited nucleus then emits a
nuclear fragment (Fig. 7.10). Both pair production and
The incident x-ray photon must have energy of least photodisintegration require extremely high-energy x-rays
1.02 MeV for pair production to occur. In pair and are not utilized in diagnostic radiology.
88 Part II: Circuits and X-Ray Production

Case Study
L shell
10 MeV

K shell
During the photoelectric effect the incident
x-ray photon is completely absorbed by the
atom. The energy from the photon is transferred
to an inner-shell electron causing ionization of
the atom and a resultant ejected electron.

Critical Thinking Questions

Nuclear
fragment How far will the photoelectron travel in tissue?
Figure 7.10. Illustrates the emergence of a nuclear frag-
ment after the incident photon has gone through the What happens when the inner-shell vacancy is
process of photonuclear disintegration. filled?

What will eventually happen to the

Chapter Summary photoelectron?

X-rays entering a patient can be transmit- How does the photoelectric effect change the
ted, absorbed, or scattered. Attenuation is the radiographic image?
combination of absorption and scattering.
Attenuation depends on energy, tissue material
(atomic number), tissue thickness, and tissue When the photoelectron is ejected, it has very
density. The HVL is the amount of material low energy and will only travel about 1 mm
required to reduce the intensity to one-half in tissue. The vacancy left by the ejected pho-
its original value. The HVL of tissue is about toelectron will be filled by an electron from a
four centimeters. Of the five possible types of higher level shell, resulting in the production
interactions in tissues only the photoelectric of a characteristic x-ray photon. These charac-
and Compton interactions are important in teristic photons have very low energy and act as
diagnostic radiology. The photoelectric effect scatter radiation; however, they do not leave the
results in complete absorption of the incident body. The photoelectron will continue to inter-
x-ray photon. Photoelectric effects decrease act with inner-shell electrons until the photo-
with increasing x-ray energy and increase with electron has lost all its energy and is completely
increasing atomic number (Z). Compton scat- absorbed. The photoelectric effect produces the
tering changes the direction and energy of the lighter densities on the radiographic image.
x-ray photon. Compton scattering contributes to
the loss of contrast on the image and to occupa-
tional dose. Photoelectric interactions are most
important at lower x-ray photon energies, and
Compton scattering is more important at higher
x-ray energies.
Review Questions

6. The interaction that involves no loss of energy or

Multiple Choice ionization is
A. coherent
1. What is(are) the product(s) of Compton scattering? B. photoelectric
C. pair production
A. Electron D. Compton
B. Recoil electron and scattered x-ray photon E. photodisintegration
C. Electron and positive electron
D. Scattered x-ray photon 7. Photodisintegration produces a _____ when the
incident photon energy is
2. Compton scattering
A. nuclear fragment, deflected
A. produces scattering and degrades image contrast B. scattered electron, partially absorbed
B. increases contrast in radiographs C. scattered photon, completely absorbed
C. produces x-rays in the rotating anode D. nuclear fragment, completely absorbed
D. is more important at lower energies
8. During pair production the resulting electrons
3. Photoelectric interaction have how much energy?
A. involves changes in energy and direction A. 44 keV
B. involves complete absorption of the photoelec- B. 51 keV
tron C. 36 keV
C. involves complete absorption of the incident D. 15 keV
x-ray
D. requires at least 1.02 MeV energy 9. Which x-ray interaction is the most hazardous to
the patient and radiographer?
4. Materials with small attenuation values are called
A. Photoelectric
A. radiopaque B. Coherent scattering
B. radiolucent C. Photodisintegration
D. Compton scattering
5. What percent of an incident x-ray beam is trans-
mitted through a patient? 10. When the ejected photoelectron leaves an inner-
A. 1 shell vacancy, which type of x-ray photons are pro-
B. 10 duced?
C. 50 A. Bremsstrahlung
D. 90 B. Characteristic
C. Coherent
D. Compton
90 Part II: Circuits and X-Ray Production

11. Which type of tissue will attenuate the greatest 6. What type of scattering is a change of direction of
number of x-ray photons? an x-ray photon without a change in the photons
energy?
A. Fat
B. Muscle
C. Lung
D. Bone

7. Write the formula for the photoelectric effect and

explain why it is used.
Short Answer

1. In which interaction is a secondary electron

found?
8. Describe the coherent scatter interaction.

2. Photodisintegration involves incident photon

energies greater than _____. 9. X-ray photon interaction with the force field of the
nucleus produces _____.

3. Describe backscatter.
10. Is there an increase or decrease in Compton scat-
tering if the incident photon energy is increased?

4. Define attenuation.

5. How does the atomic number of tissue affect

absorption?
 PART III

Image Formation
 8

Intensifying Screens

Objectives Key Terms

Upon completion of this chapter, the student ● base ● phosphor layer
will be able to: ● conversion ● phosphorescence
1. Describe the purpose and construction of efficiency ● protective coat
intensifying screens. ● fluorescence ● quantum mottle
2. Describe the characteristics of intensifying ● intensifying screen ● rare earth screens
earth screens. ● luminescence ● reflective layer
3. Identify the factors that affect screen speed and ● orthochromatic ● spatial resolution
spatial resolution. ● panchromatic
4. Explain the construction of cassettes and how
to care for cassettes.
5. Describe luminescence, fluorescence, and
phosphorescence.

92
 Chapter 8: Intensifying Screens 93

Introduction Intensifying screen

X-rays that penetrate through a thick patient will

easily pass through the image receptor which is
only a few millimeters thick. This means that
there are few interactions in the image receptor.
To increase the number of x-rays absorbed, and
reduce the patient dose, intensifying screens
convert x-rays into light, which then interact in
the image receptor. Today essentially all radio-
graphic images are formed using intensifying
screens. This chapter covers the construction CR cassette
and characteristics of intensifying screens.

Intensifying Screens
The purpose of an intensifying screen is to increase the
efficiency of x-ray absorption and decrease the dose to
the patient. An intensifying screen converts a single x-ray
photon into thousands of lower energy light photons that
interact more efficiently with the image receptor. The
conversion of x-ray energy into light energy reduces the
amount of radiation required to produce an acceptable Figure 8.2. Shows a CR cassette with the detector located
image. Most x-ray photons that pass through a 30-cm-thick next to its intensifying screens.
patient have no trouble passing through the image recep-
tor a few millimeters thick. Only about 1% of the interac- CR system, a detector plate is in close contact with the
tions in the image receptor are produced directly by x-ray intensifying screens (Fig. 8.2).
photons, the other 99% result from intensifying screen
light. This light is produced when an x-ray photon inter-
acts with the phosphor crystals in the screen (Fig. 8.1). Intensifying Screen
The intensifying screens are typically used in pairs
and are mounted inside the top and bottom of a light
Construction
proof cassette. In a standard x-ray cassette, the film is
held in a light proof cassette, while in a direct imaging or
An animation for this topic can be viewed
at http://thepoint.lww.com/FosbinderText
X-ray photon

Absorption by intensifying screen phosphors An intensifying screen consists of a plastic base support-
ing a reflective layer, a phosphor layer, and a protective
Emission of many photons of visible light coat (Fig. 8.3).

Exposure of film
● Base
● Reflective Layer
Figure 8.1. Illustrates the steps involved in converting ● Phosphor Layer
a single x-ray photon into many visible light photons. ● Protective Coat
94 Part III: Image Formation

diverging light photons that have a longer wavelength,

Base which reduces image sharpness.
1000um

Reflective
Phosphor Layer
25um
layer
150-300um The active layer of the intensifying screen is the phosphor
Phosphor
110-20um layer which is made up of crystals embedded in a clear
Protective
coating plastic support layer. The phosphor crystals convert
incident x-ray photons into visible light photons. The
Figure 8.3. Illustrates the construction of a typical intensi-
fying screen. phosphor layer varies from 150 to 300 mm, depending on
the speed and resolving power of the screen.
The material, size, and distribution of the phosphor
crystals and the thickness of the phosphor layer deter-
Base mine the speed and resolution of the intensifying screen.
A 1-mm-thick polyester plastic screen base provides sup- There is a trade-off between speed, patient dose, and res-
port for the other components of the screen. It is flexible yet olution. Thicker screens have higher speed and require
tough, rigid, and chemically inert and is uniformly radiolu- lower patient dose but have poorer spatial resolution. Dif-
cent. The base must be flexible enough to fit snuggly when ferent film screen combinations are chosen for different
sandwiched between the top and bottom of the cassette. clinical applications.
It is necessary for the base to be chemically inert so that
it will not react with the phosphor layer or interfere with Protective Coat
the conversion of x-ray photons to light photons. The base
The protective coat is a thin plastic layer about 25 mm
material must also be uniformly radiolucent to allow the
thick that protects the phosphor layer from abrasion. The
transmission of x-ray photons without causing artifacts to
protective layer cannot withstand scratches from finger
the image.
nails, rings, or hard objects. As seen in Figure 8.5, scratches
that remove the protective layer also remove the phosphor
Reflective Layer layer producing white, negative density artifacts.
The reflective layer is made up a special reflective mate-
rial such as magnesium oxide or titanium dioxide that
is approximately 25 mm thick. The screen phosphor Phosphor Materials
crystals emit light with equal intensity in all directions
upon interaction with an x-ray photon. Less than half the The primary characteristics of phosphor materials that
light produced by the screen phosphor crystals is directed are important to radiography are:
toward the film. The reflective layer redirects the light
from the phosphor toward the film, thereby increasing ● atomic number
the efficiency of the intensifying screen (Fig. 8.4). Some ● conversion efficiency
intensifying screens use dyes to selectively absorb the ● luminescence

X-ray photon X-ray photon

Base
Reflective
Phosphor layer

Film

Visible light Visible light

Figure 8.4. Shows how the reflective
layer redirects screen light back toward
No reflective layer Reflective layer the film.
 Chapter 8: Intensifying Screens 95

Spectral Matching
Spectral matching refers to matching the wavelength
or color of the light from the screen to the film sensitiv-
ity. Figure 8.6 compares the light output from calcium
tungstate (CaWO4) and rare earth screens.
Different screen phosphors emit light of different colors
or wavelengths. The response of the film must be matched
to the light wavelength of the intensifying screen. There
Figure 8.5. Illustrates an artifact produced by a scratch on are two classes of intensifying screens, those that emit blue
the intensifying screen. light and those that emit green light. CaWO4 and some
rare earth materials emit blue light. Other rare earth mate-
rials emit green light. There are two general groups of film
Atomic Number whose sensitivities are designed to match the light from
the different types of intensifying screens. Blue-sensitive,
Intensifying screens are made of higher atomic number or panchromatic, film is used with calcium tungstate
(higher Z) phosphors to increase x-ray interaction. About and other blue-light-emitting screens. Green-sensitive, or
5,000 light photons are produced by each x-ray photon orthochromatic, film is used with green-light-emitting
absorbed by the phosphor crystal. To permit photoelec- rare earth intensifying screens. A mismatch between
tric and Compton interactions, the phosphor must have intensifying screens and film results in reduced efficiency
a high atomic number. and increased patient dose. Table 8.1 presents representa-
tive screen materials, their K-shell absorption edge energy,
Conversion Efficiency and the color of light emitted.

The number of light photons produced by one x-ray pho-

ton is described by the conversion efficiency. It is a mea-
sure of the screen’s efficiency in converting x-ray energy Rare Earth Screens
into light energy. As the conversion efficiency increases,
the radiation dose to the patient decreases. The intensifying screens developed by Thomas Edison
in the early 1900s used CaWO4 crystals as the phosphor.
Luminescence CaWO4 crystals give off blue light and are 3% to 5% effi-
cient in converting x-ray energy into light (Fig. 8.6). They
Luminescence is the ability of a material to emit light in were in common use until the mid-1970s when rare
response to excitation. Luminescent materials will emit earth screens were introduced. Rare earth screens use
light with a wavelength that is specific to that particular elements from the rare earth section (Z = 57−70) of the
luminescent material. The result is light emission of a periodic table. Rare earth elements used in intensifying
specific characteristic color. There are two mechanisms
that produce light, fluorescence and phosphorescence.
TABLE 8.1 SCREEN MATERIALS AND THEIR
Fluorescence is the production of light during the stimu- CHARACTERISTICS
lation of the phosphor by the x-ray photons. Fluorescence
is an instantaneous emission of light. Phosphorescence Phosphor Material K-edge Energy Emitted Light Color
is the continuation of light emission after the stimulation
Calcium tungstate 70 Blue
ceases. Most of the light output from intensifying screens Gadolinium 50 Green
is due to fluorescence. Delayed phosphorescence cre- Lanthanum 39 Blue
ates screen lag or afterglow and becomes increasingly Yttrium 17 Blue
more pronounced as the phosphor ages.
96 Part III: Image Formation
X-ray absorption

Rare earth
Calcium tungstate

0 50 70 100
Energy (keV)
K-shell binding energy K-shell binding energy Figure 8.6. Absorption of x-ray
for rare earth for calcium tungstate photons by calcium tungstate and
typical rare earth screen materials.

screens include gadolinium, lanthanum, and yttrium. three types of screens. The mAs must be changed to
They are 15% to 20% efficient in converting x-ray energy compensate for a change in screen speed. The amount
into light as compared to the calcium tungstate (CaWO4) of change is given by the ratio of the screen speed:
because their K absorption edges are closer to the average
energy of diagnostic x-ray beams. æ old screenspeed ö
mAs2 = mAs1 ç ÷
è new screenspeed ø

Screen Speed where mAs2 is the new mAs and the mAs1 is the old or
original mAs used.
The automatic exposure circuit (AEC) must be cali-
Screen speed or sensitivity is a term used to describe how brated for a particular film/screen combination. Using a
much light is obtained from a given x-ray exposure. Stan- cassette with a screen speed other than that for which the
dard speed is set as a speed of 100 for historical reasons. AEC is set, will produce an image with improper density.
The speed is controlled by phosphor size, layer thickness, For example, if a detail screen is used with an AEC set for
kVp, and temperature. An increase in phosphor size and
layer thickness will also increase the screen speed. When
kVp is increased, the screen speed will also be increased.
Intensifying screen phosphors have a high atomic num-
CRITICAL THINKING
ber so increasing kVp will increase the likelihood of light
producing interactions within the phosphors. Increases Changing from high-speed to detail screens requires
in temperature can cause a significant decrease in screen an increase in mAs to maintain the same optical den-
speed, especially in hot climates. sity. As an example, if a 400-speed screen is replaced
by a 50-speed screen, if the original mAs was 5 mAs
with the 400-speed screen, what is the new mAs for
Types of Screens the 50-speed screen?
Film/screen systems range in speeds from 50 to 1,000. Answer
There are three types of screens: detail, medium or par
speed, and high speed. Detailed screens, valued at 50, æ 400 ö
mAs2 = mAs1 ç ÷
are used for higher-resolution imaging, such as extremity è 50 ø
examinations. Medium- or par-speed screens, valued at mAs2 = mAs1 (8)
100, are used for routine imaging. High-speed screens,
valued at 200 to 1,000, are used for examinations that mAs2 = 5 ´ 8
require short exposure times. Table 8.2 illustrates the mAs2 = 40mAs
screen types and speeds associated with each of the
 Chapter 8: Intensifying Screens 97

TABLE 8.2 SCREEN TYPES AND SPEEDS correlates to more light being emitted by the rare earth
screens.
Screen Type Speed

Detail 50
Medium speed 100
High speed 200–1,000 Radiographic Noise
and Quantum Mottle
medium-speed screens, the image will appear too light
because the detail screens would require a higher expo- Radiographic noise or quantum mottle is the random
sure than that produced by the AEC. Thicker screens speckled appearance of an image. It is similar to the “salt
have more phosphor crystals available for interaction and pepper” or “snow” seen with poor TV reception. It
with the x-rays and are faster because they absorb more is caused by the statistical fluctuations in x-ray interac-
x-rays. Fewer x-rays are needed to produce the same opti- tions. Quantum mottle is noticeable when the number of
cal density when the faster screens are used, resulting in x-ray photons forming the image is too low. Screens with
lower patient dose (Table 8.2). greater conversion efficiency convert more x-ray photons
into light so they require fewer photons and produce
K-shell Absorption Edge images with more noise. Radiographic noise or quantum
mottle depends on the number of x-ray photons interact-
CaWO4 screens will absorb approximately 30% of the inci- ing with the phosphor crystals in the screen. Faster screen
dent beam, while rare earth screens will absorb approxi- images have more image noise because they require fewer
mately 50% to 60%. The percentage varies depending x-ray photons to produce the image. The technical factor
on the keV of the incident beam. Practically all of the that influences the amount of image noise or quantum
absorption takes place during photoelectric absorption. mottle is mAs. The radiographer controls the quantity of
Photoelectric absorption in the screen depends on the the photons with the mAs setting. Increasing the mAs set-
x-ray photon energy and the K-shell binding energy of ting will effectively eliminate quantum mottle. Quantum
the specific phosphor material. The K-shell absorption mottle is commonly seen in fluoroscopy due to the low
energy refers to the x-ray photon energy just high enough mA settings. The image appears to be very grainy on the
to remove a K-shell electron from its orbit. In a CaWO4 monitor. The radiographer can increase kVp, but this
screen, the tungsten has an atomic number of 74 and often results in lower subject contrast; however, increas-
a K-shell binding energy of 70 keV; therefore, the inci- ing the mA setting and exposure rate will improve the
dent x-ray photon must have energy of at least 70 keV fluoroscopic image.
to remove the K-shell electron. When the incident x-ray
photon matches the K-shell binding energy, there is a
dramatic increase in characteristic photon production,
which is called K-shell absorption edge.
Spatial Resolution
The sharp rise in x-ray absorption occurs at the K-edge
binding energy. X-ray energies above the K-shell binding Spatial resolution is the minimum distance between two
energy have enough energy to interact with and remove objects at which they can be recognized as two separate
a K-shell electron. X-ray energies below the K-shell bind- objects. Spatial resolution is measured using a line pair
ing energy can only remove L-, M-, or N-shell electrons. test pattern and has units of line pairs per millimeter
If the x-ray energy is above the K-edge, energy absorp- (lp/mm). Spatial resolution of the intensifying screen
tion is much higher. Rare earth phosphor materials depends on the thickness of the layer, the phosphor size,
are chosen because their K-edge energies occur in the and the concentration of the crystals. Intensifying screens
diagnostic energy range of 35 to 70 keV. Additionally, with smaller crystals and a thinner layer increase resolu-
rare earth screens absorb approximately five times more tion but cause a decrease in screen speed. Thicker layers
x-ray photons than the calcium tungstate screens, which with larger crystals have poorer spatial resolution because
98 Part III: Image Formation

X-ray photons X-ray photons TABLE 8.3 STANDARD CASSETTE SIZES

Size in cm Size in inches

18 × 24 8 × 10
Phosphor
24 × 30 10 × 12
28 × 35 11 × 14
Film 35 × 43 14 × 17

Visible light photons

Figure 8.7. Illustrates how thicker screens have poorer side of the cassette is constructed of low atomic number
spatial resolution. material to reduce attenuation of the x-rays entering the
cassette. The cassette also contains a thin layer of lead
the light spreads sideways and blurs out the edges of an foil in the back to attenuate exit radiation. For this reason,
image but increase screen speed (Fig. 8.7). As described, the tube side is always indicated on the cassette. Film cas-
the phosphor crystal size and layer thickness are both settes come in a variety of sizes. Standard sizes are given
inversely related to resolution and directly related to in Table 8.3.
screen speed. Thicker high-speed screens have poorer
spatial resolution than slower speed screens. A screen with Film/Screen Contact
a larger concentration of crystals will have an increase in
both spatial resolution and screen speed; therefore, phos- Poor film/screen contact destroys detail and spatial reso-
phor concentration is directly related to spatial resolution lution because the light from the screen diffuses before
and screen speed. it reaches the film. Many cassettes have a slight curve on
the door side of the cassette so that pressure is applied
when the cassette is closed. This extra pressure ensures

Film/Screen Cassettes good film/screen contact. Film/screen contact can be

evaluated using the wire mesh test. A screen like wire
mesh embedded in plastic is placed over the film cassette
Diagnostic films are held inside of film cassettes. A cas- to be tested. After exposure, the film is developed. Any
sette has a pair of intensifying screens glued to the interior areas of poor film/screen contact will appear as blurred or
front and back. The purpose of the cassette is to provide unsharp areas on the image. Figure 8.8 shows an image
a lightproof holder for the film. Proper film/screen con- of a wire mesh test pattern showing good and poor film/
tact is necessary to achieve good image detail. The front screen contact.

A B

Figure 8.8. Examples of good (A) and poor (B) film/screen contact.
 Chapter 8: Intensifying Screens 99

Cassette Care detail and spatial resolution with some areas

Every screen cassette has an identification number that of blurring. Before repeating the image, Chase
appears on every exposed film and can be used to trace arti- needs to determine what happened to the image
facts to a particular cassette. For example, a series of fogged and how to correct the problems before a repeat
films caused by a light leak due to a dropped cassette, or a image is obtained.
white area on the film caused by removal of the intensifying
phosphor by a scratch on the screen, can be readily traced to
the damaged cassette. Screens should be cleaned regularly Critical Thinking Questions
and whenever artifacts appear on the images. Dirt on the
screens will result in white or negative density spots on the Why are some areas of the image blurred and
image. Areas of darker density are called positive densities. what may be the cause?

What could be causing the lack of detail and

Chapter Summary spatial resolution?

Intensifying screens convert x-ray photon energy Was the cassette loaded with the proper film
into light energy. Modern intensifying screens to match the intensifying screens? What must
utilize rare earth phosphors whose K absorption Chase do before taking the repeat image to
edges are matched to diagnostic x-ray ener- ensure that a diagnostic image is taken?
gies. Upon stimulation by x-ray photons these
phosphors emit green or blue light, which is
matched to the spectral sensitivity of the film. The areas of blurring are likely caused by poor
There are three classes of screen speeds: film/screen contact. A wire mesh test must
high, medium, and detail. High-speed screens be performed to determine if there is proper
require fewer x-rays resulting in lower patient contact between the film and screen. Until
doses but have greater quantum noise. Detail this test can be completed, Chase must take
screens produce superior spatial resolution but the cassette out of use so that no one else uses
require increased patient dose. a potentially defective cassette. The lack of
Cassettes, which provide a light tight con- detail and spatial resolution could be caused
tainer for the film, must be cleaned and checked from the wrong type of film being loaded in
regularly for good film/screen contact. Cassettes the cassette. In a facility with various speeds
utilize intensifying screens to improve the image and types of film and screens, it is common
quality through increasing the number of con- for the wrong film to be loaded in a cassette.
versions from x-ray photons to light photons. It is essential to have correct spectral match-
ing of the screen phosphors and the film
phosphors; incorrect spectral matching occurs
when the phosphors are sensitive to differ-
Case Study ent types of light. This can cause a decrease
Chase works in a facility that uses various film/ in efficiency in converting x-ray photons to
screen combinations and speeds with some light when exposing the film. Chase must get
being rare earth screens that emit blue light another cassette and double check the speed
while others emit green light. Chase produced of the cassette and then load it with the proper
an image of the hand using a 100-speed rare film. Only in this way can he be sure that he
earth film/screen system sensitive to blue light. has the correct imaging system for the hand
Upon reviewing the image there was a lack of image.
Review Questions

5. Radiographic noise or quantum mottle can be

Multiple Choice reduced by using
A. high kVp and a small focal spot
B. low kVp and high mAs
1. In order to increase the spatial resolution of a film/ C. high kVp and low mAs
screen system, the most important factor would be D. low mAs and large focal spot
to change
6. What is the purpose of the phosphor layer in the
A. to a faster film intensifying screen?
B. to a faster-speed film
C. to a slower-speed film A. To decrease the conversion from x-ray photons to
D. to extended processing light photons
B. To aid in increasing mAs
2. Film/screen contact is evaluated by a C. To protect the screen base from harm
D. To increase the number of conversions from x-ray
A. line pair test
photons to light photons
B. densitometer
C. wire mesh test 7. Which part of the intensifying screen intercepts
D. sensitometer light photons going in various directions and redi-
rects them to the film?
3. Which of the following are rare earth phosphor
materials? A. Reflective layer
B. Base
1. Calcium tungstate
C. Phosphor layer
2. Gadolinium
D. All of the above redirect light
3. Lanthanum
4. Yttrium 8. A spotted, grainy image is best called
A. 1, 2, and 3 A. spatial resolution
B. 2, 3, and 4 B. radiographic noise
C. 1, 3, and 4 C. quantum mottle
D. 1, 2, 3, and 4 D. luminescence
4. When changing from a detail screen to a high-
speed screen, the mAs should be
A. increased
B. decreased
C. not changed
D. none of the above
 Chapter 8: Intensifying screens 101

9. The reflective layer utilizes which of the following 5. Name the properties of an intensifying screen
materials? base.

1. magnesium oxide
2. calcium tungstate
3. titanium dioxide
A. 1 and 2
B. 2 and 3 6. Describe the relationship between resolution and
C. 1 and 3 phosphor crystal size, layer thickness, and phos-
D. 1, 2, and 3 phor concentration.

10. Dirt trapped inside a cassette will have a _____

or _____ appearance on the film.
A. white, positive
B. black, negative
C. black, positive 7. Describe the difference between panchromatic
D. white, negative and orthochromatic.

Short Answer
8. Discuss the process of luminescence.
1. The intensifying screens serve what purpose in the
radiographic cassette.

9. Why is it necessary to have the film and intensify-

ing screen spectrally matched? List the rare earth
phosphors and their colors.
2. Describe the difference between fluorescence and
phosphorescence.

10. How do intensifying screens reduce patient dose?

3. List the four layers that make up the intensifying
screen.

4. Why is afterglow not desirable for a radiographic

image?
 9

Film and Processing

Objectives Key Terms

Upon completion of this chapter, the student ● activator ● latent image
will be able to: ● base plus fog ● latitude
1. Discuss the components of a radiographic ● characteristic curve ● optical density
film. ● clearing agent ● penetrometer
2. Identify the stages of image formation. ● crossover effect ● phenidone

3. List and describe the important portions of the ● crossover network ● preservative
characteristic curve. ● Dmax ● restrainer
● densitometer ● sensitivity speck
4. Identify the optical density, speed, contrast,
and latitude of a radiographic film. ● developing ● sensitometer
● drive system ● sensitometry
5. Identify the stages in film processing.
● emulsion layer ● shoulder region
6. List the components and describe the
● film contrast ● solvent
operation of automatic film processors.
● film speed ● straight-line portion
● fixing ● toe region
● Gurney Mott theory ● transport racks
● hardener ● transport system
● hydroquinone

102
 Chapter 9: Film and Processing 103

Introduction Protective
supercoat Emulsion

In this chapter, we address the composition Adhesive Plastic base

of an x-ray film, the formation of the latent
image, and the film characteristic curve. The Emulsion
Protective
film characteristic curve contains information supercoat
on the speed, contrast, and latitude of a film. It
Figure 9.1. Shows a cross section of a typical double-
is important for the student to understand the emulsion film.
characteristics of an x-ray film and how changes
in the film characteristics can change the
appearance of the x-ray image.
Radiographic film is becoming obsolete in Polyester Base
the radiology department. This is because of
The polyester base provides support for the emulsion.
the advent of Computed Radiography (CR) and
The primary purpose of the base is to provide a rigid yet
Digital Radiography (DR) as the new imag-
flexible structure for the emulsion to be adhered to. It
ing devices that save and store the image on
is constructed from polyester plastic about 150 to 200
a computer and the image is sent to a Picture
mm thick. The base layer is strong, flexible, and trans-
Archiving and Communication (PAC) system,
parent, so there is no underlying pattern on the base,
which can then be transferred to a CD ROM
which would cause artifact on the image. It is usually
or sent via dedicated telephone line to other
tinted blue to reduce viewer eyestrain and fatigue.
physicians.
The film base is also coated with a substance to pre-
vent light photons from one screen crossing over to the
other screen. This reflection of light photons is called

Film Construction the crossover effect, causing blurring of the image.

Emulsion Layer
Radiographic film is produced in a variety of sizes
(Table 9.1). The emulsion layer is made up of silver halide crystals
Radiographic film is composed of a layer of emulsion uniformly distributed in a clear gelatin. The emulsion
applied to one or both sides of a transparent polyester layer thickness ranges from 5 to 10 mm. The gelatin
plastic base. The emulsion is attached to the polyester holds the silver halide crystals in place and acts as a neu-
base by a thin layer of transparent adhesive. The adhesive tral lucent suspension medium that separates the silver
layer provides uniform adhesion of the emulsion to the halide crystals. Gelatin distributes the silver halide crys-
base. The soft emulsion layer is covered by a supercoat of tals uniformly over the base, preventing the crystals from
hard gelatin. The supercoat layer protects the emulsion clumping in one area and causing excessive photosensi-
from scratching, pressure, and contamination during tivity in one area. Other necessary properties of the gela-
storage, loading, and handling (Fig. 9.1). tin include it being clear to permit light to travel through
it without interference and it must be flexible enough to
TABLE 9.1 STANDARD CASSETTE SIZES bend without causing distortion to the recorded image.
Each silver halide crystal is made up of silver, bro-
Sizes in cm Sizes in inches mine, and iodide atoms in a crystal lattice. All the
atoms are in an ionic form. The silver ion is positive
18 ´ 24 8 ´ 10
24 ´ 30 10 ´ 12 because it has one electron missing from its outer shell.
28 ´ 35 11 ´ 14 The bromine and iodine ions are negative because they
35 ´ 43 14 ´ 17 have an extra electron in their outer shells. The pres-
ence of bromine and iodine ions in the crystal results
104 Part III: Image Formation

TABLE 9.2 RELATIONSHIP OF CRYSTAL SIZE AND light. These films are matched to the spectrum of light
EMULSION TO FILM FACTORS emitted from the intensifying screens. The construction
Crystal Size Emulsion Layer and application of intensifying screens are covered in
Chapter 8.
Small Large Thin Thick

Speed Slow Fast Slow Fast Latent Image Formation

Resolution High Low High Low
When the remnant radiation exits the patient, it hits
the radiographic film and deposits energy into the silver
halide crystals. The energy is deposited in a pattern that
in a negative charge on the crystal surface. Although represents the part of the anatomy being radiographed;
each company has an exact formula, the typical at this point, the image is not visible and is called a
emulsion consists of 95% to 98% silver bromide, with latent image. The Gurney Mott theory indicates that
the remainder consisting of silver iodide. x-rays and visible light cause ionization of the atoms in
Impurities are added to the silver halide crystals to the crystal. Ionized crystals are said to be exposed. The
form a sensitivity speck. The sensitivity speck provides free electrons from the ionization are attracted to the
film sensitivity and during processing of the radio- sensitivity speck. The collection of negative electrons
graphic image, the silver atoms are attracted to and at the sensitivity speck attracts positive silver ions (Ag+)
concentrate at the location of the sensitivity speck. to the sensitivity speck, where they are neutralized to
Changing the size and mixture of the silver halide crys- form silver atoms. When silver atoms are collected at
tals changes the response characteristics of the film. the sensitivity speck, the charge structure outside the
Films with larger crystals generally are faster—that is, crystal is altered and the exposed crystal becomes part
they are more sensitive to radiation and light—than of the latent image. The latent image is the distribu-
films with smaller crystals. As seen in Table 9.2, the tion of exposed and unexposed crystals in the unde-
relationships between crystal size and emulsion layer veloped film, caused by differential absorption in the
thickness directly affect the resolution and speed of the patient. The latent image must be developed to become
imaging system. visible. Developing converts the silver ions in the
The silver halide crystals are designed to be sensi- exposed crystals to black metallic silver, thereby mak-
tive to different wavelengths or colors of light. Conven- ing the radiographic image visible. Figure 9.2 illustrates
tional blue-sensitive, or panchromatic, film is sensitive the migration of silver ions to the sensitivity speck where
to blue wavelengths or light. Green-sensitive, or ortho- they form silver atoms, altering the charge pattern of the
chromatic, film is sensitive to green wavelengths of silver halide crystal.

Negative charge or Silver is attracted to electrons at

electrons released from sensitivity speck, this process is
outer surface of crystal Light repeated until there is a buildup
due to light exposure of silver on the crystal
– – – – – – – – – – –
– – – –
– – – –
– – – –
– – – –
– – – Ag+ –
– – – –
– – – –
e –
– – – – e– –
– – – – e– Ag+ –
– – – e– – –
e– e –
– – – – –
Sensitivity – – – – –
speck – – – – –
– – – – – – – – – – – – –
Unexposed crystal Exposed crystal Ag+ + e– = Ag

Figure 9.2. The charge patterns surrounding silver halide crystals in the emulsion are changed
after exposure.
 Chapter 9: Film and Processing 105

Densitometer
Sensitometry and A densitometer measures the blackness or density of the
Densitometry step wedge increments in units of optical density. Darker
films have higher optical densities. Optical density is
obtained by measuring the light transmission through
The sensitometer and densitometer are utilized in radi-
a film with the densitometer, which consists of a cali-
ology department quality assurance programs. Various
brated light source and a light detector. The densitom-
equipment is necessary to perform sensitometry pro-
eter compares the intensity of the light passing through a
cedures. A penetrometer or sensitometer is required to
point on the film to 100% light transmission. Figure 9.4
produce a uniform range of densities on a film. A densi-
shows a photograph of a sensitometer and densitometer,
tometer is required to provide an accurate reading of the
and Figure 9.5 shows an example of a gray scale pattern
densities or amount of light transmitted through the film.
produced by a sensitometer.
The resulting densities are measured and evaluated to
determine if the x-ray equipment is operating properly.
Optical Density
Penetrometer Optical density is defined as the logarithm of the ratio
A penetrometer is a series of increasingly thick, uniform of the incident light intensity on the film to the light
absorbers typically made of aluminum steps and is known intensity transmitted through the film (Fig. 9.6).
as a step wedge. The penetrometer is used to produce a
step wedge pattern on radiographic film during an expo-
sure of x-rays (Fig. 9.3). Due to the large number of vari-
ables in generating an x-ray beam, the penetrometer is not
recommended for use in a quality assurance program.

Sensitometer
Sensitometry is the measurement of a film’s response to
processing and different amounts of light. A sensitometer
is designed to expose the film to a reproducible, uniform
light through a series of progressively darker filters or opti- A
cal step wedges. The image formed by the sensitometer is
a series of steps progressing from clear to black. The sen-
sitometer is the preferred device because it reproduces
the same amount of light each time it is used. Factors
that might cause the intensity of the x-ray beam to fluctu-
ate are controlled by the circuitry that provides the exact
quantity of power each time the sensitometer is used.

Figure 9.3. Penetrometer. Figure 9.4. (A) Sensitometer. (B) Densitometer.

106 Part III: Image Formation

TABLE 9.3 RANGE OF OPTICAL DENSITIES

Opacity OD Number Percentage of Light Transmitted

1 0.0 100
2 0.3 50
4 0.6 25
8 0.9 12.5
10 1.0 10
20 1.3 5
40 1.6 2.5
80 1.9 1.25
100 2.0 1
200 2.3 0.05
400 2.6 0.025
800 2.9 0.125
1,000 3.0 0.1
2,000 3.3 0.05
4,000 3.6 0.025
8,000 3.9 0.0125
10,000 4.0 0.01

Table 9.3 shows the range of light transmission as it

Figure 9.5. Grayscale image produced corresponds to various levels of optical density. The abil-
by the sensitometer. ity of a film to stop light transmission is called opacity.
In mathematical terms, optical density is defined as: Darker films have smaller transmission values and higher
optical density or opacity values. Most diagnostic films in
OD = log10 (Io/It) radiology have optical densities in the range of 0.0 to 4.0.
An optical density of 0.0 is clear, and an optical density
where Io is the incident light intensity and It is the trans- of 4.0 is very black.
mitted light intensity.
Optical density is useful because the human eye has a log-
arithmic response. If film A has an optical density one-half CRITICAL THINKING
that of film B, then film A will appear as bright as film B.
A film transmits 10% of the incident light. What is
the optical density?
Answer
OD = log10 (Io/It)
Light OD = log10 (100/10)
source 1% OD = log10 (10)
OD = 1

100%
Using Table 9.3, it is easy to determine that with an
OD of 1.0 only 10% of light is transmitted through the
Figure 9.6. Shows the transmission of light through a film film and there is a corresponding opacity of 10. If the
that transmits 1% of the incident light and has an OD of 2. OD number was increased to 1.3, the percentage of light
 Chapter 9: Film and Processing 107

transmitted through the film would be 5% or one-half. before processing ranges from 0.05 to 0.10. Processing
This change means that less light was transmitted through typically adds OD 0.05 to 0.10 in fog density. The total
the film so the opacity of the film is doubled to 20. This base plus fog should not exceed OD 0.20. In the toe
demonstrates that changes of 0.3 increments in OD num- region, only a few of the silver halide crystals have been
bers represent a doubling or halving in opacity. exposed. The toe region represents the area of low expo-
sure levels. The optical density in the toe region ranges
from 0.2 to 0.5.
In the straight-line portion of the curve, there is a linear
Characteristic Curve relationship between optical density and the logarithm of
the relative exposure (log relative exposure). The straight-
line portion of the characteristic curve is the range used
The three most important characteristics of a radio-
in radiology. The optical density of the straight-line por-
graphic film are speed, contrast, and latitude. A plot of
tion of the curve ranges from 0.5 to 2.5.
the optical density as a function of the logarithm of the
In the shoulder region of the curve, most of the silver
exposure is called the characteristic curve. The charac-
halide crystals have been exposed and any additional
teristic curve shows the speed, contrast, and latitude of a
exposure does not produce much additional blacken-
particular film. Changing the emulsion thickness or the
ing. The shoulder region represents the area of high
size or distribution of the silver halide crystals changes
exposure levels. The optical density in the shoulder
the film characteristics. The characteristic curves are also
region is >2.5.
known as the sensitometric, D log E, or H&D curves.
Dmax is the maximum density the film is capable of
Figure 9.7 shows a typical characteristic curve. The
recording. It is the highest point of the characteristic
four regions of the characteristic curve are the base plug
curve and represents the region where all the silver halide
fog, toe region, straight-line portion, shoulder region,
crystals are completely covered in silver atoms and can-
and maximum density (Dmax).
not accept any more. Additional exposure will result in
The base plus fog region describes the initial film
less density because the silver atoms will become ionized
density before exposure to x-ray photons. Base plus fog
again, which will reverse their charge and cause them to
arises from the tint of the polyester support base plus any
be repelled from the sensitivity speck. This principle is
fog the film has been exposed to. Fog may be caused
utilized with duplication film where the film has been
from exposure to background radiation, heat, and chem-
pre-exposed to Dmax and additional exposure will cause a
icals during storage. The optical density in the film base
reversed, duplicated image.

3
Shoulder
Dmax Film Speed
Film speed describes the ability of an x-ray film to respond
to an x-ray exposure. Speed is determined by the film’s
2 sensitivity to exposure and is controlled by the activity of
Optical density

phenidone which affects the toe portion of the character-

Straight-line istic curve. The position of the toe will determine how
portion
soon the straight-line portion will begin, which is an indi-
1 cation of the speed of the film (Fig. 9.8). The sensitivity
of the film is determined by the size of the silver halide
Toe crystals, the number of sensitivity specks, and the thick-
.02 Base + fog
ness of the emulsion. Larger crystal size with increased
1.0 2.0 3.0 4.0
numbers of sensitivity specks suspended in a thick emul-
Log relative exposure (mR) sion, all increase the speed of the film.
The speed point of a film describes the exposure
Figure 9.7. Characteristic curve. required to produce an optical density of 1.0 above base
108 Part III: Image Formation

3 4
A B

3
2
Optical density

Optical density
Speed
points 2
Diagnostically
useful
1 densities
1

0
0.5 1.0 2.0 3.0 0.3 0.6 0.9 1.2 1.5 1.8 2.1 2.4 2.7 3.0
Log relative exposure (mR) Log relative exposure (mR)

Figure 9.8. Shows the characteristic curves for two films Figure 9.9. Contrast is reduced when an exposure results
with different speeds. Film A is faster, and film B is slower. in densities that lie in the toe or shoulder regions. The
Film A is faster than film B because it requires less expo- radiographer must control exposure factors to produce
sure to achieve an OD of 1 above the base plus fog level. optical densities in the diagnostic range.

plus fog. The terms faster and slower survive from the increases latitude will decrease. Wide-latitude films have
early days of photography; when portrait photos required low contrast; narrow-latitude films have higher contrast.
sitting still for long periods of time. Using a faster film Wide-latitude images are termed long grayscale con-
meant a shorter sitting time because the film required trast and produce images with high kVp setting. They
less exposure. A faster film requires less exposure and a produce acceptable images over a greater range of tech-
lower mAs setting to produce the same optical density. nical factors. There is more margin of error in the mAs
settings with wide-latitude images. Conversely, an image
Film Contrast
Film contrast is the difference in optical density between
two areas in the image. The contrast of a particular radio-
graphic film is fixed by the manufacturer. Film contrast 3
is measured on the slope of the straight-line portion of
the characteristic curve at the speed point, which is also Film B

called the film gamma. Films with exposures between

Optical density

2
OD 0.5 and 2.5 exhibit contrast in the diagnostic range.
Film A
Films with optical density in the toe or shoulder portion
of the characteristic curve demonstrate a loss of contrast
(Fig. 9.9). Films with steeper straight-line portions have 1

higher contrast (Fig. 9.10).

Latitude 0
0.3 0.6 0.9 1.2 1.5 1.8 2.1 2.4 2.7 3.0 3.3 3.6
Log relative exposure (mR)
Latitude describes the range of exposures that produce
an acceptable radiograph with densities in the diagnostic Figure 9.10. Comparison of film contrast. Film A has
range. Films can have wide or narrow latitude. Latitude higher contrast because it has a greater slope of the
and contrast are inversely related meaning that as contrast straight-line portion.
 Chapter 9: Film and Processing 109

one side of the base, and so small objects and sharp edges
3
are not blurred as much. In addition, there is a possibility
A B that light from one intensifying screen will pass through
the emulsion and film base to expose the opposite emul-
sion. Such “crossover” light is spread out and reduces the
2
Optical density

sharpness of the image.

It is possible to identify the emulsion side, even in the
darkroom under safelights, because light reflection makes
1 the emulsion side look dull and the base side appear shiny.
The manufacturers place notches on one edge of single-
emulsion film to aid in identification of the emulsion side
in the dark. When the film is positioned with the notches
at the upper right corner of the film, the emulsion is fac-
0.5 1.0 2.0 3.0
Log relative exposure (mR) ing up. It is important to have the emulsion side of single-
emulsion film facing the intensifying screen, which is the
Figure 9.11. Characteristic curves of films having different light source. If the film is facing backward, the image will
latitude values. be blurred because the light must pass through the base
before reaching the emulsion.
with a narrow latitude requires the mAs and kVp to be set
close to the optimal settings and are caused by using low Mammographic Film
kVp. Narrow-latitude images are termed short grayscale
Mammographic film is a single-emulsion film with very
contrast or high contrast and there is less margin of error
fine crystals. Mammographic films are a compromise
with the mAs and kVp settings. Figure 9.11 shows the
between the need for high sensitivity with low patient
characteristic curves of films with different latitudes.
dose and very high spatial resolution. Mammographic
Film A has a narrower latitude and a higher contrast
films are designed to be used with a single high-resolution
than film B. Films with narrow latitudes produce high-
screen. The emulsion is always placed in contact with
contrast images. Film B has a wider latitude and pro-
the intensifying screen (Fig. 9.12).
duces lower-contrast images. Generally, higher-speed
films have higher contrast and narrower latitude; slower-
speed films have lower contrast and wider latitude. Duplication Film
Duplication film is a specialty film that is used to pro-
duce copies of conventional radiographs. It is available
Specialty Types in the same standard sizes as conventional film. Dupli-
cation film is a single-emulsion film that is designed to
of Film be sensitive to ultraviolet (UV) light from the duplicat-
ing machine. The duplicating film is placed in contact
Specialty types of film used in radiology include mam-
mographic, hard copy, and duplication. All specialty
films are single-emulsion films. A single-emulsion film Overcoat
has emulsion on only one side of the polyester film base. Emulsion
Adhesive
Single-emulsion film is processed in the same manner as
double-emulsion film. It provides better resolution than Plastic base
double-emulsion film because with double-emulsion
film, the images from the two sides are not exactly
superimposed unless they are viewed directly head on, Figure 9.12. Illustration of a single-emulsion
whereas with single-emulsion film, the image is on only mammographic film.
110 Part III: Image Formation

3
Film Storage
and Handling
2
Optical density

Film is very sensitive to storage and handling conditions.

Improper storage or handling can produce fog or artifacts.
1
Fog is an increase in density over the entire film. Artifacts are
unwanted local densities on the final image. Radiographic
film is sensitive to light, temperature, humidity, radiation,
and improper handling. Exposed but undeveloped film is
0 much more sensitive to radiation than unexposed film.
1.0 2.0 3.0 4.0
Relative exposure

Figure 9.13. Shows H and D curves for duplicating film.

Light
Radiographic film is designed to be sensitive to light
from the intensifying screens. It is also sensitive to vis-
with the original film and exposed in the duplicator for a ible light and will fog if it is exposed to room lights. It
few seconds. No x-rays are used. The duplication film is must be handled and loaded in a darkroom. Darkrooms
then processed in the usual manner. Duplication film is are equipped with safelights. Safelights are designed to
designed so that clear areas on the original film produce filter out light that is energetic enough to exposure the
clear areas on the duplicate film. It is sometimes called film. Blue-sensitive film is not sensitive to amber light, so
reversal film because its response to light is reversed from an amber safelight filter is used with blue-sensitive film.
that of normal film (Fig. 9.13). With normal film, longer Green-sensitive, or orthochromatic, film is sensitive to an
exposures result in darker images; with duplication film, ordinary amber safelight and therefore requires a special
longer exposures produce lighter images. Duplicating deep red safelight filter such as a GBX filter (Fig. 9.14).
film uses UV light to expose the film.
Temperature, Humidity,
Hard Copy, Laser Printer, and Storage
or Multiformat Film
Film should be stored in a cool, dry place with a temper-
Hard copy film is used to provide a permanent record of ature <68°F and with <60% relative humidity. Storage
an electronically displayed image. Digital images from under heat conditions above 75°F will increase the fog
computed tomography, ultrasound, nuclear medicine, or and decrease the image contrast. Storage under condi-
magnetic resonance imaging units are initially presented tions of low humidity, less than about 40%, will increase
on monitors or on electronic “soft” displays, and only static artifacts.
certain images are selected for the permanent hard copy Storage of film should not be longer than the expira-
record. Hard copies can be produced by a laser printer or a tion date on the box of film. Forty-five days should be
multiformat camera. In a laser printer, the intensity of the the average storage time. Film must be stored on end,
laser beam depends upon the strength of the electronic not flat. Film boxes must be carefully opened and the
image signal in a process called laser-beam modulation. film and cardboard insert should be removed carefully to
While the beam is modulated the laser beam writes in a avoid abrasion artifacts.
raster fashion over the entire film. The spatial resolution
of the laser printer is superior to that of the multiformat
camera. The number of images on one film, known as
Radiation
the image format, can be selected by the operator. Typical Film must be shielded from radiation exposure. Even a
image formats are 4, 6, or 12 images on one film. few milliroentgens will produce a noticeable increase in
 Chapter 9: Film and Processing 111

GBX or Red Safe Light

Orthochromatic film

Filter absorption
Light absorption

Green sensitive film

300 400 500 600 700

Blue Green Yellow Red Figure 9.14. Safelight curves for
different types of film

fog. Exposure to scattered radiation in fluoroscopy rooms film processing can change the appearance of the final
is a possible source of radiation fog. To decrease the image.
chance of unwanted radiation exposure the film bin is
lined with lead and the darkroom must have lead shield-
ing in the walls if the darkroom is located next to a radio-
graphic room.
Automatic Film
Processing
Improper Handling of Film
Unexposed film is sensitive to shock, pressure, and
improper handling. Dropping a box of unexposed film
can cause artifacts on the edge or corner that strikes the An animation for this topic can be viewed
floor. The sensitivity of film to pressure can be demon- at http://thepoint.lww.com/FosbinderText
strated by placing a piece of paper over an undeveloped
film and writing on the paper. The pressure of the pen
through the paper will alter the emulsion so that the writ- Processing a film transforms the invisible latent image
ing will show after the film is developed. Hands need to into a permanent visible image. The visible image is
be clean and free from lotions or creams prior to handling produced by reducing silver ions in the exposed crystals
film. Creams and oils from the hands cause fingerprint to black metallic silver. The metallic silver on the film
artifacts on the film emulsion. Film boxes should always appears black instead of the familiar shiny silver color
be stored on end to avoid abrasion and pressure artifacts. because the silver crystals are so small that they scatter
Rough handling can cause crease densities to appear on light instead of reflecting it. Film processing consists
the developed film. Rapid removal of unexposed film of four stages: developing, fixing, washing, and drying.
from the storage box can produce static artifacts. Each stage of processing is essential in the production of
After the invisible latent image is formed on the film, a diagnostic quality radiograph.
it is necessary to develop the film. This involves reducing
the exposed silver halide crystals of the latent image to
metallic silver and dissolving away the unexposed silver
Developing
halide crystals. This development is a chemical process Developing is the first step in processing a film. The devel-
that is usually done in an automatic film processor. It is oper is a water-based solution containing chemicals that
important for the student to recognize how changes in will reduce the exposed silver halide crystals to metallic
112 Part III: Image Formation

silver without changing the unexposed silver halide crystals. called fixing. The fixer stops the reducing action of
The reducing agents used in automatic processors are the developer and removes the unexposed silver halide
phenidone and hydroquinone. Phenidone rapidly reduces crystals. The fixer solution is also called the clearing agent
silver and enhances fine detail and subtle shades of gray. because it removes unexposed and undeveloped silver
It is not able to reduce heavily exposed areas of an image. halide crystals from the emulsion. The clearing agent in
Hydroquinone slowly reduces silver and produces areas of the fixer solution is ammonium thiosulfate. The action of
heavy density or the darkest shades. Combining these two the clearing agent prepares the film for archiving. If the
chemicals creates a solution with exceptional reducing fixer does not completely remove the unexposed silver
abilities that controls the optical density of the processed halide crystals, the film will have a milky appearance and
radiograph. Other chemicals are used during the develop- will not stand up to the archival conditions. Although
ing stage, which assist in producing a radiographic image. the clearing agent is the primary agent in the fixer, other
chemicals are also used to complete the fixation process
● Activator: Enhances developer solution by maintain- (Table 9.4).
ing an alkaline state
● Restrainer: Added to developer solution to restrict ● Activator: Acetic acid maintains the pH to enhance
the reducing agent the clearing agent
● Preservative: Helps reduce oxidation when reduc- ● Preservative: Dissolves silver from the ammonium
ing agents are combined with air thiosulfate
● Hardener: Controls swelling of gelatin, maintains ● Hardener: Prevents scratches and abrasions during
uniform thickness, and hardens emulsion; insufficient processing; insufficient hardener causes films to
hardener causes films to have moist, soft surfaces have moist, soft surfaces
● Solvent: Filtered water that dissolves chemicals ● Solvent: Dissolves other chemicals
prior to use
Washing
Fixing Developer or fixer chemicals that are left in the emulsion
The action of the developer must be stopped before the will slowly be oxidized by the air and will turn the film
film can be exposed to light; this is done by a process brown. The washing stage removes all chemicals remaining

TABLE 9.4 CHEMICALS CONTAINED IN THE DEVELOPER AND FIXER SOLUTION

AND THEIR FUNCTIONS

Chemical Function
Developer
Hydroquinone Reducing Agent, slowly produces dark areas
Phenidone Reducing Agent, rapidly produces fine detail shades of gray
Sodium carbonate Activator, swells gelatin, maintain alkaline pH
Potassium bromide Restrainer, decreases reducing agent activity, antifogging
Sodium sulfite Preservative, controls oxidation
Glutaraldehyde Hardener, hardens emulsion, controls emulsion swelling
Water Solvent, dissolves chemicals for use

Fixer
Ammonium thiosulfate Clearing Agent, removes undeveloped silver halide crystals
from emulsion
Acetic acid Activator , provides acidic pH
Potassium alum Hardener, hardens and shrinks emulsion
Sodium sulfite Preservative, maintains acidic pH
Water Solvent, dissolves chemicals
 Chapter 9: Film and Processing 113

in the emulsion. The incoming wash water is filtered before and turns on the transport system and the pumps to
it enters the wash tank. The water is constantly circulated replenish the developer and fixer solutions. The micro-
and drained to ensure that it is clean. Unremoved fixer can switch remains on for the length of time that it takes the
combine with metallic silver crystals to form silver sulfide film to travel through the microswitch.
or dichroitic stains. Incomplete removal of the fixer solu- The processing of each film uses up small amounts of
tion is known as hyporetention. Degradation of the image the developer and fixer chemicals. The replenishment
quality of stored films as a result of incomplete washing system automatically maintains the correct chemical con-
will appear only after several years. centration. Each time a film is processed, the microswitch
activates the replenishment pumps to add developer and
Drying fixer solutions. The replenishment solutions are contained
in large replenishment tanks located near the processor.
Most of the wash water is removed by the processor rollers Copy films are different from conventional films.
as the film is transported into the drying chamber. The Replenishment rates adjusted for conventional double-
final drying of the film is done by blowing hot air over emulsion films will not maintain the proper chemical con-
both sides of the film as it begins to exit the processor. centrations after a large number of copy films have been
Drying removes the remnants of the water on the film. processed because copy film has only a single-emulsion
It also shrinks and hardens the emulsion and seals the layer. This is especially important if the processor is also
supercoat to protect the film during handling and storage. used to develop mammography films, which require crit-
In order to sufficiently dry the film, the hot air must be ical control of processor chemistry.
between 120°F and 150°F (43°C–65°C). Automatic processors have a standby switch that turns
the transport roller drive motor off after a few minutes of
Contamination inactivity. This motor must be restarted before another
Contamination of the basic developer by the acid fixer film can be processed.
lowers the pH, reducing the effectiveness of the devel-
oper and producing lower-contrast, “washed-out” images.
Contamination can occur when new chemicals are
added or during the cleaning of film transport compo-
nents. Drops of warm fixer can condense and contami-
Film Transport System
nate the developer solution when the processor is turned
off. For this reason, the lid of the processor should always The film transport system carries the film through the
be lifted and propped partially open when the processor developer, fixer, and wash tanks and through the dryer
is turned off. This will allow vapors to escape and reduce chamber. The film transport system regulates the amount
cross-contamination and corrosion of processor parts. of time the film is immersed in each solution and agitates
Contamination of the fixer by the developer is not the chemicals to ensure maximum reaction. The feed
a problem. Some developer is inevitably carried along tray at the entrance to the automatic processor guides the
when the film is transferred into the fixer tank. The film into the processor. Entrance rollers grip the film as it
processor system is designed to compensate for this begins the trip through the processor. At this point, there
contamination. is also a microswitch that is activated by the film. When
feeding films in the processor, it is necessary to place the
film on the tray so that the short axis enters the processor.
Recirculation and Replenishment This allows for the least amount of chemicals to be used
The developer and fixer solutions must be constantly to adequately process the film. When feeding multiple
mixed to ensure that their chemical strength is uniform. films into the processor, it is also necessary to alternate
Mixing also ensures that fresh chemicals come in contact sides from film to film. This allows for even wear of the
with the emulsion. This mixing or agitation is produced transport system components. The transport system con-
by circulation pumps. A microswitch on the first set of sists of three distinct subsystems: transport racks, cross-
transport rollers senses each film as it enters the processor over network, and drive system.
114 Part III: Image Formation

Transport Racks Crossover Networks

There are three types of rollers used in the transport As seen in Figure 9.17, at the top of each tank, the film
racks: transport rollers, master rollers, and planetary roll- is carried across to the next tank by a crossover net-
ers. Transport rollers, 1 inch in diameter, grip the film at work. The crossover network also contains rollers and
the feed tray and guide the film into the processor. guide shoes. The rollers squeeze out the chemicals in
As seen in Figure 9.15, the rollers are positioned oppo- the emulsion prior to the film entering the next tank.
site each other in pairs or are offset from one another; this The assembly is similar to that in the transport racks. If
provides constant tension to move the film down into and the guide shoes become misaligned, the film emulsion
up out of the processing tanks. When the film reaches will be scratched. The primary cause of guide-shoe mis-
the end of a series of rollers, it must be bent and turned alignment is the improper seating of the transport racks
to travel in the reverse direction. At the bottom of each and crossover networks.
vertical rack there is a turnaround assembly containing a
large master roller, smaller planetary rollers, and guide
shoes that hold the film against the master roller while
Drive System
the film reverses direction. The guide shoes have ribs to The drive system is a series of mechanical devices designed
reduce friction and keep the film in alignment. Guide- to turn the rollers in the processor. The speed of the drive
shoe misalignment can remove some of the soft emul- system is usually set to move the film from the entrance
sion, causing processor artifacts, which appear as white rollers to the output bin. The transport system drive motor
scratch lines in the direction of film travel (Fig. 9.16). and gears are usually set for 90-second processing. The
After the film has cleared the master roller, it will then speed controls the length of time the film spends in each
be pointing upward and will be pulled along by the next solution. After washing, the film passes through the dryer
set of offset rollers. When the film reaches the top of the and is deposited in the output bin. The film transport roll-
transport rack, it is guided into the next set of racks by a ers, crossover racks, and guide shoes must be periodically
crossover network. cleaned to maintain good quality images.

Crossover racks

Feed tray

Receiving
bin

Transport
rollers

Guide shoe

Developer Fixer Wash Dryer

Figure 9.15. Illustrates the transport system that takes the film from the feed tray through a series of
rollers into the development tank, the fixer tank, the wash tank, and finally the drying chamber.
 Chapter 9: Film and Processing 115

Crossover racks Guide shoes

Transport
rollers

Turnaround
assembly

Guide shoes

Figure 9.17. An expanded view of the transport system

guide shoes and crossover rack.

A thermostat controls heating elements to maintain

the developer and fixer at the proper temperature. The
thermostat is set to maintain the developer temperature
Figure 9.16. Image shows artifacts produced by misaligned in the range between 92°F and 95°F in 90-second auto-
guide shoes. matic processors. Developer temperatures below this
range result in slower chemical reactions and an under-
developed film with decreased density and low contrast.
Temperatures above this range result in rapid chemical
Effect of Concentration, Time, reactions, overdeveloped film, increased image density,
and Temperature and a high-contrast, narrow-latitude image.
Any change in developer concentration, developing
time, or developing temperature will change the speed, Rapid Processing
contrast, and base fog of the image. An increase in time, By increasing the temperature and chemical concen-
temperature, or concentration will increase the film trations, the total processing time can be reduced to
speed and base plus fog. An increase in the time, tem- 45 seconds. The sensitometric characteristics of rapid
perature, or concentration will also increase the contrast processing films are designed to be identical to conven-
of the film. tional 90-second processed film.
The speed of the transport motor controls the amount
of time the film is immersed in the developer, fixer, and
wash tanks. Time and temperature are inversely propor-
Extended Processing
tional; as one is increased, the other must be decreased to Extended processing is used in mammography to increase
maintain the same optical density for the same exposure. the film contrast and speed and reduce the patient dose.
116 Part III: Image Formation

Standard chemicals and temperatures are used, but the

processing time is extended to 3 minutes by slowing the
film transport speed.

Processor Quality Assurance

Processing is the last in a long series of careful steps designed
to produce a diagnostic quality image. Any error in process-
ing will prevent the production of high-quality radiographs.
Processor cleanliness, temperature, and chemical effec-
tiveness must be maintained within strict limits. The roll-
ers and gears must be periodically inspected for wear and
replaced before their degradation affects image quality.

The Darkroom Figure 9.18. Result from a darkroom safelight test.

The darkroom is an essential part of a radiology depart-

ment. The darkroom entrance should be designed so
that entry does not inadvertently expose films. Lightproof
Silver Recovery
mazes, rotating doors, interlocks, and double entry doors
are used to eliminate the possibility of exposure of an The final processed film contains only about half the silver
undeveloped film to light. The darkroom temperature contained in the original emulsion. Silver is classified as a
and humidity must be controlled to avoid artifacts. toxic heavy metal by the Environmental Protection Agency.
Environmental laws restrict the amount of silver discharged
in waste liquid to <5 parts per million. Therefore, the silver
Darkroom Safelights must be removed from the fixer solution before that solu-
An exposed film is much more sensitive than an unex- tion is discarded as waste. The most common method of sil-
posed film because some silver halide crystals may have ver removal is the electrolytic recovery system. This system
been partially exposed. Darkrooms do not have to be is attached to the drain or waste line of the fixer tank; the
totally dark, but the light level must be very low. Safelights used fixer solution circulates through the recovery system
provide low-level illumination without exposing the film. where an electric current removes the silver ions from the
A safelight contains a low-wattage (7–15 W) light bulb fixer solution and converts them into metallic silver. The
with a special filter to maintain low light intensity. An recovered silver can be sold to commercial companies.
amber filter is used with a blue-sensitive film. The GBX
filters produce a deep red light. Red light from the GBX
filter has low energy and is safe for green-sensitive ortho-
chromatic films. The safelight must be 4 ft from the work Daylight Processing
area to prevent safelight fogging of the film.
A test can be performed to determine the amount of safe-
Systems
light fogging. Half of a uniformly exposed but undeveloped
film is covered with a piece of cardboard, and the film is left With daylight processing systems, a darkroom is not
on the darkroom table under the safelight for 2 minutes. The required in order to load and unload the film cassettes.
film is then developed in the usual way. After processing, All film handling is done automatically inside the day-
the difference in the optical density between the covered light processor. An exposed cassette is placed in the
and uncovered sides should be <0.05 OD (Figure 9.18). entrance slot, and the cassette is drawn into the daylight
 Chapter 9: Film and Processing 117

Figure 9.19. Daylight

processing system.

processor and opened. The film is removed from the

cassette and started through the processing cycle. The
cassette is then reloaded with an unexposed film, which
is stored in a bulk magazine inside the daylight proces-
sor, and returned ready for another exposure (Fig. 9.19).
The daylight processor has a storage magazine for each
size film used by the department. Of course, a darkroom
is still needed to load the daylight processor’s magazines.
The development, fixing, washing, and drying cycles are
the same as in a conventional automatic processor.

Dry Processing Film

Dry processing film (Fig. 9.20) is used to permanently
record digital images from computed tomography, mag-
netic resonance imaging, ultrasound, and digital radio-
graphic systems. The digital image data are transferred
with a laser beam onto a special film, which is then pro-
cessed using heat to fix the image on the film. There are
no chemicals used for dry processing and there is no need
for silver reclamation. Figure 9.20. Dry film processing system.
118 Part III: Image Formation

Chapter Summary darkroom safelight and filter must match the

characteristics of the film used. The processing
Radiographic films consist of an emulsion chemicals are classified as hazardous materials
containing silver halide crystals coated on a and must be disposed of in an approved manner.
polyester base. Exposure to x-rays and visible Daylight processors permit the development
light produces changes in the silver halide of exposed film without the need to open the
crystals to form a latent image. The latent image exposed cassette in a darkroom. Dry film systems
is the distribution of exposed and unexposed do not require developing solutions; instead,
silver halide crystals on the film. Developing they use heat to fix the image on the film.
the film changes the latent image into a perma-
nent visible image. Film development converts
exposed silver halide crystals to black metallic
silver and removes the unexposed crystals. The
transmission of light through a radiographic film
Case Study
is described by the film’s optical density. Optical Janet has just arrived at 6:00 am for her shift
density is a measure of the degree of darkness of and turned on the processor. There is an
the film. Higher-speed films require less expo- emergency room patient who must have a
sure to produce a given density. High-contrast single-view chest exam STAT. She performed
films produce large density differences for small the exam and has run the film through the
differences in exposure. Films with wide latitude automatic processor. When the film drops into
produce acceptable image densities over a wide the output bin, Janet notices that the film has
range of exposures. Orthochromatic film is sensi- scratch lines in the direction the film traveled
tive to green light and requires a special deep red through the processor. The film also has a
safelight filter. Radiographic film is sensitive to decreased amount of density and lower contrast
light, temperature, humidity, radiation, and pres- than Janet expected. Using your knowledge of
sure during storage and handling. Improper stor- automatic processing determine answers to the
age and handling can produce artifacts and fog following questions.
that produces unwanted densities on the film.
Film processing consists of developing, fixing,
washing, and drying. Film processing converts Critical Thinking Questions
the latent image in the emulsion into a per-
manent visible image by reducing the exposed How did scratch lines get on the film?
silver halide grains to black metallic silver.
Chemical agents in the basic developer solution Is this an adjustment Janet can make?
include two reducing agents, hydroquinone and
phenidone. The fixer is an acidic solution that What has changed the appearance of the image?
stops the developer action. It contains ammo-
nium thiosulfate, which dissolves away the Did Janet use enough kVp and mAs?
unexposed silver halide crystals. Changing the
developer chemical concentrations, the time, or Or is it another problem?
the temperature will change the speed, contrast,
and base fog of the final image.
Film must be processed in the dark, either in The scratch lines occur when the guide shoes
a darkroom or in a daylight film processor. The are not in alignment as the film travels through
 Chapter 9: Film and Processing 119

the automatic processor, the guide shoes help are properly seated in the processor. This will
to move the film around a roller. If the guide fix the problems of the scratches. Janet checks
shoes are misaligned, they will leave scratch the temperature of the processor and it shows a
lines in the film. When the transport racks were temperature of 88°F. She knows the processor
cleaned, the guide shoes must have become must be warmed to 92°F to 95°F to properly
misaligned, and the processor repair man process the films. The film is underdeveloped
needs to be called to realign the guide shoes. because the developer has not reached the
In regard to the appearance of the images, Janet optimum temperature to ensure that proper
believes that it is not a problem with the tech- chemical reactions take place between the
nique she used since she followed the tech- developer chemicals and film emulsion. This
nique chart for body part and body habitus. She error has reminded Janet that she must check
next turns her attention to the automatic pro- the temperature of the processor before run-
cessor. Since it is so early in the morning, the ning films, the decreased density on the film
processor may not have been properly warmed meant that she would need to repeat the film,
up before she ran the processor. She will need which results in additional radiation dose for
to check the crossover racks and make sure they the patient.
120 Part III: Image Formation

Review Questions

6. The developer solution

Multiple Choice A. softens the emulsion
B. reduces the exposed silver halide crystals to black
1. Which region of the characteristic curve represents metallic silver
the inherent density in the film? C. produces an alkaline pH
D. does all of the above
A. Base plus fog
B. Toe region 7. Replenishment systems in an automatic processor
C. Shoulder replenish
D. Straight line portion
A. unexposed film emulsion
2. On the characteristic curve the toe region will B. developer and fixer solutions
display optical densities in which range? C. used wash water
D. drying racks
A. 0.1 to 4.0
B. 0.4 to 6.0
8. Which of the following is a reducing agent?
C. 0.0 to 3.5
D. 0.2 to 5.0 A. Glutaraldehyde
B. Hydroquinone
3. What is the relationship between optical density and C. Acetic acid
the log relative exposure on the characteristic curve? D. Alum
A. Non-linear
B. Linear 9. The hardening agent in the fixer is
C. Curvilinear A. glutaraldehyde
D. Non-curvilinear B. sodium sulfite
C. potassium alum
4. Which area on the characteristic curve represents D. ammonium thiosulfate
high exposure levels?
A. Toe region 10. The purpose of the guide shoes in the transport
B. Straight line portion racks is to
C. Shoulder A. allow the film to move up or down
D. Dmax B. to force the edge of the film around the master
roller
5. A high-contrast film has a _____ latitude.
C. to bend the film in the crossover network
A. wide D. pull the film from the film tray into the transport
B. narrow rack
 Chapter 9: Film and Processing 121

11. The GBX filter is safe for use with which type of 5. Radiographic film that has emulsion on both sides
film? is _____.

A. Films that are sensitive to blue light

B. Films that are sensitive to green light

12. What effect does increased developer solution

temperature have on the film?
6. Explain how photoelectric and Compton interac-
A. The speed of the film will decrease tions relate to latent image formation.
B. The amount of fog on the film will be decreased
C. The amount of contrast will be unchanged
D. The amount of contrast will be increased

13. The emulsion layer must have a thickness of

A. 5 to 10 mm 7. Explain the difference between panchromatic and
B. 10 to 20 mm orthochromatic films.
C. 25 to 30 mm
D. 150 to 300 mm

Short Answer 8. What is sensitometry? List the devices necessary

for sensitometry.

1. List the four primary steps in automatic processing.

9. Which type of image archival requires a laser beam

and high heat?
2. What is the problem with the developer solution if
the film drops into the output bin damp or wet?

10. When the characteristic curve shows a steep slope,

there is _____ contrast on the film. What type
of contrast is on the film when the slope is less
3. What is the purpose of the fixer tank?
steep?

4. Explain the relationship between film resolution

and the size of the silver halide crystals.
 10

Density and Contrast

Objectives Key Terms

Upon completion of this chapter, the student ● contrast ● optical density
will be able to: ● contrast agent ● radiographic
1. Identify the factors that affect image density. ● differential absorp- contrast
tion ● SID
2. Describe the operation of an automatic
exposure control system. ● film contrast ● subject contrast
● filtration
3. Identify the factors that make up radiographic
contrast. ● optical
densitometer
4. Identify the factors that make up subject
contrast.
5. Describe the difference between long-scale
and short-scale contrast images.

122
 Chapter 10: Density and Contrast 123

Introduction
The appearance of an x-ray image used for a 10%
Transmitted light
diagnosis depends on both the characteristics of 100%
the patient—that is, the x-ray interactions that Incident light

occur in the different tissues of the patient—

and the characteristics of the detector, usually
film. These two factors—the subject contrast
due to the patient and the film or detector
OD = 1
contrast—combine to make up the overall or
radiographic contrast. This chapter discusses
the factors that influence radiographic contrast
and image density and how the radiographer
can alter the technical settings, such as kVp and 1%
Transmitted light
mAs, to modify the image. 100%
Incident light

Optical Density OD = 2

Figure 10.1. OD is the logarithm of the ratio of incident

light intensity to transmitted light intensity. Films that
Optical density (OD), often called image density or simply transmit 10% and 1% of the incident light have OD of 1
density, describes the degree of darkness or blackening of and 2, respectively.
the x-ray image. OD is the logarithm of the ratio of the inci-
dent light intensity on the film to the light intensity trans-
mitted through the film. Figure 10.1 illustrates the incident
light intensity on and transmitted through the film.
The formula for the OD is:

OD = log10 (I0/I1)

where I0, is the incident light intensity and I1, is the

transmitted light intensity. In the example shown in Fig-
ure 10.1, the incident light is 100% and only 1% of the
light is transmitted through the film. The OD of the film
is equal to 2 because log 100 = 2.
OD is measured using an optical densitometer. This
instrument is shown in Figure 10.2.
OD is defined as a logarithm because the eye has a
logarithmic response to changes in brightness, and so an
image with twice the OD will appear twice as dark.
Images in diagnostic radiology have ODs that range
from 0.2 to 3.0, with most of the useful information in
the 0.5 to 1.5 range. It is just possible to read a newspaper Figure 10.2. Optical densitometer used to measure
through a film with a density of 1.0. density on a film.
124 Part III: Image Formation

the same. Different combinations of mA and exposure

Technical Factors time can be used to produce the same density on an image.
This is quite useful when imaging a patient who cannot
Affecting Density hold still; the mA can be increased and time decreased to
deliver the same amount of mAs with a shorter exposure
There is a wide range of technical factors which affect time, which will result in less motion on the film.
density. These factors are classified as either controlling Density can be affected by other factors, but mAs is the
(primary) or influencing. When a change is necessary to the factor of choice when it is necessary to control the amount
overall density of an image, the controlling or primary factor, of density on an image. To create a visible increase in
mAs, should be changed before any other change is made. density, the mAs must be increased by at least 30%; any
change less than this will not produce a visible increase
in density. Typically mAs is doubled or halved when an
mAs adjustment is needed. This is simple to do and produces
The mAs is the controlling or primary technical fac- an acceptable level of density on a repeat radiograph. If
tor used to control image density. mAs is defined as the an image was produced with 5 mAs and is too light, the
product of mA and exposure time. The mA controls the image should be repeated at 10 mAs. This will produce
number of x-ray photons in the beam or the quantity of an image with acceptable density (Fig. 10.3).
x-rays. Larger mA values produce more x-ray photons.
The exposure time controls the duration of the expo-
sure. Longer exposure times result in the production of
Influencing factors
more x-rays. Larger mA values or longer exposure times ● kVp
produce darker, high-density images. Doubling the mAs ● SID
produces an image with greater OD. Thicker body parts ● Filtration
require higher mAs values to achieve proper OD. ● Beam restriction
Image density should remain the same as long as the total ● Body part thickness
exposure to the image receptor and all other factors remain ● Grids

A B C

Figure 10.3. Three-foot images demonstrating a doubling of mAs with each image. (A) 65 kVp at 3 mAs. (B) 65 kVp at 6
mAs. (C) 65 kVp at 12 mAs. (Courtesy Christa Weigel, FHSU.)
 Chapter 10: Density and Contrast 125

kVp in the form of scatter radiation. Scatter radiation will

change the contrast on the image, which will increase
A factor that must be considered is kilovoltage and how the gray scale and may be detrimental to the image.
it affects image density. Kilovoltage controls the energy A skilled radiographer will be able to distinguish the
of the x-ray photons, and when the kVp is increased, the appropriate factor to use to make the desirable change
quality of the beam is increased and the x-ray photons are in exposure on an image while maintaining density and
able to penetrate the tissue of interest. Increasing kVp gray scale. As seen in Figure 10.4, the change in gray
also increases the amount of scatter radiation reaching scale on the image obscured the fine detail of the knee
the image receptor, thereby adding density to the image. anatomy, thereby compromising the final interpretation
An experienced radiographer will be able to determine if of the image.
the image requires a change in mAs or kVp to produce
optimum density. The general rule that is used is the
15% rule. The 15% rule states that a 15% increase in kVp SID
will equate to doubling the mAs on the image and a 15%
decrease will halve the mAs on the image. This rule can The intensity of the x-ray photons striking the film
be used for the following problem: depends on the source-to-image receptor distance (SID).
The SID is the distance between the image receptor
and the focal spot or x-ray photon source. Increasing
the SID decreases the number of x-ray photons striking
CRITICAL THINKING the film. This is a result of the inverse square law. Dou-
bling the SID decreases the intensity to one-fourth of
An image of a hand is produced using 3 mAs and the original intensity. Reducing the SID to one-half the
50 kVp. What kVp would be required to halve the mAs original value increases the intensity to four times the
to the image receptor while maintaining density? original intensity. This is mathematically represented by
Answer the formula:

50 kVp + (50 kVp × 15%) I1 D2

2

50 kVp + (50 kVp × 0.15) =

I2 D1 2
50 kVp + 7.5 kVp = 57.5 kVp
New factors: 58 kVp at 1.5 mAs

CRITICAL THINKING

The image of an abdomen was created using 10 mAs

and 70 kVp. What change in kVp would be required
to double the mAs while maintaining density?
Answer
70 kVp − (70 kVp × 15%)
70 kVp − (70 kVp × 0.15)
70 kVp − 10.5 kVp = 59.5 kVp A B
New factors: 60 kVp at 20 mAs
Figure 10.4. (A) AP Knee using 70 kVp at 4 mAs. (B) AP
Knee using 80 kVp at 2 mAs. Using the 15% rule to
increase kVp and using half the mAs resulted in a long
When using kVp to add density to the image, one must scale of gray which obscured the fine bony detail and a
be careful because the additional kVp will add density nondiagnostic image. (Courtesy Christa Weigel, FHSU.)
126 Part III: Image Formation

where I1 is old intensity, I2 is new intensity, D12 is old x-ray tube to the image receptor were changed frequently.
distance squared, and D22 is new distance squared. In As seen with the formulas, a change in SID creates a
radiography, it is common to change the distance for an change in mAs which is often detrimental to the overall
image while the same density is needed on the image. To density of the image, possibly creating an image that is not
maintain the density on the image, mAs must be changed of diagnostic quality. The standard distances used in diag-
to compensate for the change in distance; this is called nostic imaging are 100 cm (40 in) and 180 cm (72 in).
the exposure maintenance formula or density main- Figure 10.5 demonstrates the effect to the density on an
tenance formula. This formula is similar to the inverse image when SID is changed and all other factors remain
square law but is reversed to a direct square law because as the same. The mAs is used to change OD at one of the
already stated, the mAs must increase when the distance standard SIDs.
is increased or vice versa to maintain image density:
Filtration
mAs1 D1 2
= Filtration changes the beam by removing soft x-ray pho-
mAs2 D22
tons and hardening the beam which decreases image
where mAs1 is the original mAs, mAs2 is the new mAs, density. All types of filtration will change image density:
D12 is the old distance squared, and D22 is the new dis- inherent, added, and total filtration. When using filtra-
tance squared. The following examples will help explain tion, film density must be determined for filtered and
the density maintenance formula. unfiltered areas.

Beam Restriction
CRITICAL THINKING Restricting the beam size by using collimation reduces
the total number of photons available, which reduces the
amount of scatter radiation reaching the image recep-
A radiograph is produced using 16 mA at 72 inch (in) tor. This reduces the overall image density. Production
with adequate density. What mA will be required to of scatter radiation dramatically increases when a large
maintain the density at 40 in?
body part is imaged with high kVp levels. These two fac-
Answer tors will determine the amount of beam restriction which
2 must occur. The effect of beam restriction on image den-
mAs1 D1
= sity depends on the amount of scatter which reaches the
mAs2 D22 image receptor. When imaging very large patients or when
16m As 722 using high ratio grids, some of the scatter may not reach
= 2
m As2 40 the image receptor and will not affect image density.
16m As 5,184
=
m As2 1,600 Body Part Thickness
16m As ×1,600
m As2 = The patient will attenuate much of the beam and the part
5,184 being imaged has a great influence on the image receptor
25,600 exposure and density. The amount of the beam which is
m As2 =
5,184 attenuated depends on the thickness and type of tissue
m As2 = 4.9 m As being imaged. Tissue has an atomic number and den-
sity which determines the amount of the beam which is
attenuated into the tissue; bone attenuates more beam
than lung tissue because bone has a higher atomic num-
Even though changes in the SID change the OD of the ber. The use of contrast media changes the atomic num-
film, the SID is usually not adjusted to change the OD. ber of the tissue and affects the image density. Pathology
Multiple problems would arise if the distance from the can also alter tissue thickness and type.
 Chapter 10: Density and Contrast 127

A B

Figure 10.5. All three images were produced using the

same kVp and mAs. (A) The SID was 30 in and resulted
in an overexposed image. (B) A 40 in SID produced an
image with optimum density. (C) The SID was at 60 in
C
which produced an image that was underexposed.

The relationship between part thickness/type and Grids

image density is inversely related. As tissue thick-
ness, atomic number, and tissue density increase, the Grids absorb scatter before it can reach the film and deposit
image density decreases. This is due to the differential unwanted density on the image. The more efficient the
absorption of the beam by the different types of tissues. grid, the lower the density on the image. There are vari-
Adjustments to the amount of mAs and kVp necessary ous grid ratios available; compensating for a specific grid
to properly image the patient is dependent upon the ratio typically requires an increase in mAs to maintain the
skill of the radiographer to identify when a change is density on the image. Grid ratios and their effect on scat-
needed. ter will be discussed in more detail in Chapter 12.
128 Part III: Image Formation

Image Receptor image receptor and terminates the exposure when the
proper number of x-ray photons have reached the film to
The type of image receptor, whether film or intensifying provide optimal density.
screen, used to produce an image will alter the image den- It is critically important that the kVp and mA be prop-
sity. When the silver halide crystals form the latent image, erly set because the AEC unit controls only the exposure
they are forming the areas that will be converted to black time; the highest mA station compatible with tube limits
metallic silver; this determines the amount of density in should be chosen to ensure that the AEC utilizes the
the image. The relative speed of the image receptor will shortest exposure time to achieve the desired OD while
also affect the amount of density in the image. As the rela- reducing motion unsharpness.
tive speed of the image receptor increases, the amount of
mAs required to maintain the same film density decreases.
The following formula is used to maintain film density:
AEC Detectors
Ion chambers, scintillation detectors, or solid-state detec-
RS1 × mAs1
mAs2 = tors are used as AEC detectors. Regardless of the type of
RS2
detector used, there are usually three detectors located in
where mAs1 is old mAs, mAs2 is the new mAs, RS1 is old a triangular configuration. The two outer detectors are
relative speed, and RS2 is the new relative speed. located on either side of the central detector.
The technologist is responsible for properly selecting
the appropriate detectors and positioning the patient or
the body part over the active detectors. Positioning the
CRITICAL THINKING patient over the photocell must be accurate to ensure
proper exposure. When the patient’s anatomy does
What is the new mAs when using a 100 RS system not completely cover the photo cell, the primary beam
when technical factors of 75 kVp and 14 mAs pro- will expose the phototime device and the exposure will
duce an acceptable image with a 400 RS system?
Answer
RS1 × mAs1
mAs2 =
RS2
400 ×14
mAs2 =
100
5,600
mAs2 =
100
mAs2 = 56mAs

The new mAs is higher because a slower speed screen

was used.

Automatic Exposure
Control
The automatic exposure control (AEC) adjusts the expo-
sure time to produce acceptable image densities. The Figure 10.6. Control panel with various combinations of
AEC measures the amount of exit radiation striking the detectors.
 Chapter 10: Density and Contrast 129

terminate prematurely. The result will be a lack of density not change the image density. The AEC circuit changes
in the image, likely resulting in a repeat exposure. The the exposure time to maintain the same density following
type of examination determines which detectors should changes in mA, kVp, or distance.
be selected. For example, the posteroanterior chest exami-
nation employs the two outer detectors to ensure proper
density of the lung field rather than the spine, whereas the
lateral chest examination uses only the central detector.
Contrast
Most examinations utilize the central detector when the
central ray is centered through the part. Contrast is the difference in density between two areas
Figure 10.6 illustrates a typical control panel showing on the image. Contrast is the radiographic quality that
how various combinations of detectors can be selected. allows the radiographer to identify different areas of anat-
Careful positioning and selection of the proper combina- omy. When there is no difference in contrast within an
tion of detectors are essential in producing a satisfactory image, the human eye will not be able to visualize the
radiograph with the AEC unit. With an AEC circuit in image; likewise if there are minimal differences in con-
operation, changing the mA setting will not change the trast, very little information will be available. Contrast is
image density, because the AEC circuit will adjust the the result of differences in attenuation of the x-ray pho-
exposure time to obtain the same image density. Chang- tons with various tissues in the body; the density of the
ing the kVp will change the image contrast but not the tissue will affect the amount of attenuation. Contrast is
image density when an AEC circuit is operating. one of the most important factors in producing a quality
diagnostic image.

Backup Timer
Long-Scale and Short-Scale
The backup timer is designed to prevent catastrophic
tube damage by terminating the exposure after a max-
Contrast Images
imum time if the AEC fails. A backup timer is always A diagnostic image is produced when the x-ray beam
set in case something goes wrong with the AEC circuit. has sufficiently penetrated the tissue. The penetrability
A typical backup timer setting is 5,000 milliseconds (ms). of the primary x-ray beam is controlled by kilovoltage,
This means that the backup timer shuts off the x-ray beam therefore kVp is the controlling factor for contrast on an
after a 5-second(s) exposure. This might happen, for image. When considering the amount of contrast on an
example, if a technologist neglected to empty a patient’s image, the radiographer must determine if a short or long
pockets and there was a radiopaque object in one pocket scale of gray is most appropriate for the anatomy to be
that shielded the detector. Another common situation imaged. The number of densities from black to white on
in which the backup timer is essential is when the wall a radiographic image is an indication of the range of the
Bucky remains selected and the x-ray tube is directed scale of contrast. The terms long-scale and short-scale
toward the table Bucky. Without the backup timer, the describe the number of different densities between black
exposure would continue until the tube failed. and white on the image. The choice of mAs or SID will
not affect radiographic contrast. Figure 10.7 shows a step
wedge of graduated thickness to illustrate how higher
Density Controls kVp examinations penetrate greater thicknesses and pro-
The AEC density controls of −2, −1, N, +1, and +2 per- duce long-scale contrast images. Low-kVp examinations
mit adjustment of the image density to suit the prefer- penetrate fewer thicknesses and have only a few steps
ences of individual radiologists. N is the normal setting. between black and white, and so produce short-scale
Each incremental step changes the image density by contrast images.
about 30%. A properly calibrated AEC unit should not When the primary beam penetrates through tissue
require adjustment of the density controls to produce an with adjacent densities which have great differences in
acceptable radiograph. Changing the mA or kVp selec- contrast, the image is described as high contrast. The
tors on an x-ray unit with a properly functioning AEC will image will have few shades of gray. A short-scale contrast
130 Part III: Image Formation

Low kVp High kVp

Long wavelength Short wavelength

White White White Light Gray Black Black Light Dark Gray Light White
gray black gray gray

Short-scale contrast Long-scale contrast

Figure 10.7. An increase in the thickness of the step wedge decreases the number of x-ray photons
reaching the film. Notice the wavelength of the photons for low kVp versus high kVp. Higher kVp
photons have more energy and a short wavelength which allows more photons to pass through the
step wedge.

image has fewer steps between black and white and is optimum contrast because the soft tissue of the abdomen
a high-contrast image. Low-kVp examinations produce is clearly visible, and it is easy to distinguish the borders
short-scale contrast images. This is the preferred scale of the kidneys, liver, and psoas muscles. C has the high-
of contrast when imaging bone anatomy as this demon- est contrast, which is excellent for spine imaging, but the
strates the fine trabecular markings and fractures the best. outlines of the organs are not visible.
A zebra is a great example of high contrast because it has Table 10.1 provides a comparison of high contrast and
black and white stripes. low contrast and the terms used to describe both. It is
Imaging the abdomen requires a long scale of gray critical for the radiographer to have an excellent under-
because the anatomy of the abdomen is comprised of standing of the scales of gray, how each is produced, and
soft tissue and vital organs with minor density differ- which scale is appropriate for specific anatomy.
ences. These images will have few differences in contrast
because the differences between adjacent densities are
small; this is referred to as a long-scale contrast image Image or Radiographic
which has many steps between black and white and is a
low-contrast image. Using higher kVp will produce more Contrast
shades of gray which will allow for better visualization
of abdomen anatomy. A herd of elephants is an excel- Radiographic contrast is made up of the total amount of
lent example of a long gray scale; each elephant will have contrast acquired from both the subject contrast and film
a slightly different color than other elephants; however, contrast. Film contrast is the difference in OD between
they are all some shade of gray. different areas on the film. Subject contrast describes
Figure 10.8 demonstrates three abdomen images. A has the different amounts of exit radiation through different
the lowest contrast which is obscuring the outlines of soft parts of the body. kVp is the primary controlling factor for
tissue organs like the kidneys and liver. B demonstrates radiographic contrast. Changing the mA, the exposure
 Chapter 10: Density and Contrast 131

A B

Figure 10.8. (A) Low contrast hides soft tissue

structures. (B) Optimum contrast allows visualiza-
tion of abdomen structures. (C) High contrast is
C not effective for soft tissue structures.

time, or the SID does affect radiographic contrast, and Film Contrast
this will be discussed in more detail later in the chap-
ter. Figure 10.9 illustrates how bone, soft tissue, and lung Film contrast is the range of densities the film is capa-
have different amounts of exit radiation and different sub- ble of recording. Film contrast is represented as the
ject contrast. slope of the characteristic curve. The four factors that
132 Part III: Image Formation

TABLE 10.1 TERMS USED TO DESCRIBE the contrast is increased. Various processing factors will
CONTRAST affect the amount of contrast on the film. Increasing the
Low Contrast High Contrast amount of time the film is in the developer, the devel-
oper temperature, or developer replenishment rate will
Many shades of gray Few shades of gray increase the amount of chemical fog on the image. Each
Decreased or low contrast Increased or high contrast of these changes will increase the base fog and decrease
High kVp Low kVp
contrast of the image.
Long scale of contrast Short scale of contrast

Subject Contrast
Subject contrast depends on differential absorption of
affect film contrast are intensifying screens, film density,
the x-ray beam. Differential absorption occurs because
characteristic curve, and processing. Intensifying screens
different areas of the body have different transmission and
create a higher contrast image due to the exposure of
attenuation effects on the x-ray beam. Structures in the
light to the film. Film density is changed when there
body that highly attenuate x-ray photons, such as bone,
is a change in the film contrast. There is an optimum
are called radiopaque structures. The tissues that only
range of densities for each film which allows maximum
partially attenuate x-ray photons and allow a majority of
visualization. Images which have too much or too little
them to be transmitted, such as lung, are called radio-
density demonstrate a decrease in contrast. When a film
lucent. There are many factors that affect differential
is exposed to the correct exposure factors, the film den-
absorption and subject contrast: the thickness of the tis-
sities will fall within the diagnostic range of densities in
sue, the atomic number and type of the tissue, the density
the slope portion on the characteristic curve. Densities
of the tissue, the kVp setting, contrast media, and scatter
which fall in the toe or shoulder portion decrease the con-
radiation. Table 10.2 lists the factors that influence sub-
trast on the image. The slope of the characteristic curve
ject contrast.
also affects contrast. As the slope becomes steeper, the
range of diagnostic densities becomes compressed and
Tissue Thickness
Thicker parts of the body attenuate more x-rays. An
increase of 4 cm in soft tissue thickness decreases the exit
radiation by about a factor of 2. Two parts of the body
with different tissue thicknesses will produce a difference
in subject contrast. This difference in absorption between
the two thicknesses will influence the amount of subject
Soft contrast. The two tissues will appear as two different den-
tissue
sities on the radiograph. As body part thickness increases,
Heart the amount of attenuation also increases, and when there
is little difference in the thickness of adjacent body parts,
Lung
the subject contrast will be decreased.

TABLE 10.2 FACTORS THAT INFLUENCE SUBJECT

CONTRAST

1. Tissue thickness
2. Tissue type and atomic number
Spine
3. Tissue density
Figure 10.9. Subject contrast depends on different 4. kVp or x-ray beam energy
amounts of exit radiation in adjacent areas, which is called 5. Contrast agents
differential absorption. Subject contrast describes how differ- 6. Scatter radiation
ent areas of a patient attenuate x-ray photons differently.
 Chapter 10: Density and Contrast 133

TABLE 10.3 DENSITIES AND ATOMIC NUMBERS X-ray Energy

OF TISSUES AND CONTRAST MEDIUMS The kVp controls the energy of the x-ray beam.
ENCOUNTERED IN RADIOLOGY
Higher-energy x-ray photons have less differential absorp-
Material Mass Density Atomic Number tion because they are more penetrating. Higher-energy
x-ray-photons also produce more Compton scattering than
Air 0.13 7.6
lower-energy x-rays because Compton scattering predomi-
Lung 0.32 7.4
Fat 0.91 6.3 nates at higher x-ray energies. This combination of less
Soft tissue 1.0 7.4 differential absorption and more scattering results in less
Bone 1.9 13.8 subject contrast at higher energies. Subject contrast depends
Iodine 4.9 53 on the average energy of the x-ray beam. Increasing the
Barium 3.5 56 average energy of the x-ray beam by increasing the kVp or
the beam filtration lowers the subject contrast. Lower kVp
results in x-ray photons with less energy and more differen-
tial absorption will occur, resulting in higher subject con-
Tissue Type and Atomic Number trast. Mammography utilizes a lower kVp to increase the
Tissues with higher atomic numbers have greater attenu- subject contrast of the breast tissue. Figure 10.10 illustrates
ation values than tissues with lower atomic numbers. the change in subject contrast when the average energy of
Bone, soft tissue, and fat all have different attenuation the beam is changed by changing the kVp.
values. Bone has greater attenuation because bone has
a higher atomic number than fat or soft tissue. Bone will
appear as a higher density than soft tissue on the radio- Contrast Agent
graph, demonstrating a large difference in subject con- The vessels and organs are soft tissue structures with simi-
trast. Table 10.3 demonstrates the density and atomic lar densities and are not easily visualized on a radiographic
number of tissues in the body and contrast mediums uti- image. To make these structures visible, a substance with
lized to image the body. a higher density must be used. Adding a higher atomic
number contrast agent to vessels or organs in the body
Tissue Density increases the differential absorption and results in body
The density of the body part in grams per cubic centi- structures becoming more visible. Iodine and barium
meter (g/cm3) affects the amount of attenuation. Fat has are commonly used as contrast agents because they have
lower density than soft tissue, so 1 cm of soft tissue attenu- high atomic numbers and high densities. Introducing
ates more than an equal thickness of fat. Bone is more barium into the intestines and introducing iodine into
dense and has a higher atomic number than soft tissue, the kidneys are examples of the use of contrast agents in
so 1 cm of bone has more attenuation than 1 cm of soft radiology. Barium and iodine are radiopaque substances
tissue. Tissue density or mass density should not be con- which absorb the x-ray photons. The increased attenua-
fused with OD. Mass density is the quantity of matter per tion makes the structures containing the contrast agent
unit of volume. When mass density is doubled, nearly appear lighter than the surrounding tissues and increases
twice as many x-ray photons will be absorbed and scat- subject contrast. The differences in subject contrast
tered in bone as in soft tissue. between the soft tissue and the structure filled with the
When the difference in density between adjacent tis- barium or iodine allow us to visualize the outline of the
sues is great, the subject contrast will be increased, and vessel or organ. Air is also used as a contrast agent. Air also
when the differences in density are small, the subject increases differential absorption because its lower density
contrast is decreased. For example, bone tissue is denser increases transmission through the air-filled structures.
than lung tissue, so it makes sense that there is great sub- Air is a radiolucent contrast agent which allows us to visu-
ject contrast between bone and lung tissue. As you can alize lung tissue as well as the ribs and mediastinum out-
see, the principles of tissue type and density are alike in line. Air increases subject contrast and provides a short
how they affect contrast. scale of contrast to better visualize structures.
134 Part III: Image Formation

A B
Figure 10.10. Change in subject contrast produced by a change in average x-ray beam energy, demonstrated by radio-
graphs of an anteroposterior knee phantom. (A) Demonstrates a shorter scale of contrast which is preferred for imaging
bone. (B) Demonstrates a longer scale of gray which obscures the bony markings.

Scatter film fog that results in a long scale of gray. Grids are
Scatter is radiation that has undergone one or more devices used to absorb and reduce the scatter before it
Compton interactions in the body. As kVp is increased, reaches the film, thereby increasing contrast. Grids are
the percentage of Compton interactions also increases, used when imaging with a high kVp; low kVp imaging
and the result is an increased amount of scatter reach- does not produce the high percentage of Compton inter-
ing the image receptor. The presence of scatter reduces actions and does not require a grid to absorb the scatter
radiographic contrast because the scatter increases the before it reaches the film.
 Chapter 10: Density and Contrast 135

mAs
CRITICAL THINKING
mAs changes the exposure to the image receptor and
density of the image, thereby affecting contrast. When
A patient’s ankle was imaged using 64 kVp and 8 the exposure is changed sufficiently enough to move the
mAs. The resultant contrast scale was too short. What film density out of the diagnostic range, whether under-
changes should be made in the repeat technique? exposed or overexposed, the image contrast is decreased.
Use the 15% rule to determine the answer.
Answer
SID
Increasing kVp by 15%:
64 kVp × 0.15 = 9.6 kVp (round up to 10) As the SID changes, the intensity of the beam also
New kVp is 64 + 10 = 74 kVp changes. The inverse square law governs the amount
of change which will occur. Greater distances from
mAs must be reduced by one-half to keep the
the image receptor will cause less density on the image
same density on the image
because the intensity of the beam is diminished, result-
8 mAs × 0.5 = 4 mAs ing in decreased contrast. Using shorter SID will increase
Repeat technique: 74 kVp at 4 mAs contrast. This occurs because the intensity of the beam is
greater when the SID is closer to the image receptor.

Filtration
CRITICAL THINKING
All types of filtration will alter the image receptor expo-
sure contrast. Filtration acts to absorb the weaker pho-
A clavicle was imaged using 80 kVp and 4 mA. The tons that produce a more energetic beam. The increased
image was overly gray and did not adequately show beam energy will cause more Compton interactions and
the bony detail of the clavicle. What change should
scatter radiation, both of which will decrease contrast.
be made on the repeat radiograph?
Answer
Decrease kVp by 15% and double mAs to maintain
Beam Restriction
density Collimating, restricting the beam, or making the primary
field size smaller all contribute to reducing the total
80 kVp × 0.15 = 12 kVp
New kVp is 80 − 12 = 68 kVp number of photons available for an exposure. The beam
New mAs is 4 × 2 = 8 mAs restriction acts to reduce the amount of scatter radiation
Repeat technique: 68 kVp at 8 mAs which will reach the image receptor, thereby increasing
contrast.

Technical Factors Chapter Summary

Image density or OD describes the degree
Affecting Contrast of blackness of the radiographic image. OD
is the logarithm of the ratio of the incident
When imaging the body, a sufficient amount of contrast light intensity to the light intensity transmitted
improves visibility of tissues within the body. As previ- through a film. The most important technical
ously discussed, kVp is the controlling factor for contrast. factor influencing image density is mAs. The
Other factors that influence contrast are mAs, SID, filtra- mAs is the primary controlling factor for OD.
tion, and beam restriction.
136 Part III: Image Formation

Increasing the mA or exposure time increases changed to produce an image with a short scale
image density. Increasing the SID decreases of contrast?
image density. The purpose of an AEC circuit
is to maintain the proper image density despite Should mAs or kVp be changed?
different patient thicknesses. The AEC detec-
tors located between the patient and the image Which factors influence the density of the
receptor terminate the exposure time when the image?
proper density is achieved.
Which is the controlling factor for image
Contrast is the difference in optical densities
between adjacent areas of the image. Radio- density?
graphic contrast is a combination of subject and
What percentage of change in mAs is necessary
film contrast. Subject contrast arises from differ-
to make a visible change in the image density?
ences in exit radiation from different areas of the
body. Film contrast is the difference in optical What will be the new technical factors?
densities on the film. Subject contrast is influ-
enced by tissue thickness differences, tissue type,
atomic number, tissue density, x-ray beam energy Upon critically evaluating the image, Aaron
and kVp, contrast media, and scatter. The num- noted that the spine was adequately penetrated
ber of densities between black and white deter- to demonstrate the lumbar spine; however,
mines the contrast scale. A long-scale contrast the appearance of the spine was grayer than
image is a low-contrast image with many density he wanted and the spinous processes were not
differences between black and white. High seen as well as they should be. He selected the
kVp examinations produce long-scale contrast technical factors because he wanted to reduce
images. A short-scale contrast image is a high- the amount of mAs for this patient, but in doing
contrast image with fewer density differences so, he sacrificed image quality. Aaron deduced
between black and white. A low kVp examina- that there were two problems with the image;
tion produces short-scale contrast images. the mAs was not high enough to adequately
image the thick lumbar spine and the lack of
collimation allowed excessive scatter to fog
Case Study the film. Because the anatomy was adequately
penetrated, the kVp Aaron used was correct.
Aaron performed a lumbar spine exam on a Aaron also remembered that collimating the
19-year-old female patient. He used 80 kVp and beam effectively reduced the low energy pho-
10 mAs for the AP image and did not collimate. tons and increased the average intensity of the
The final image demonstrated adequate pen- beam. On the repeat image he collimated the
etration of the spine but was lacking sufficient beam to decrease the number of photons reach-
density to visualize all the bony anatomy of the ing the image receptor. mAs is the controlling
lumbar spine. Additionally, the selected techni- factor for density on an image, so Aaron knew
cal factors produced an image with a long scale he must change the mAs. Aaron also knew that
of contrast. the mAs must be changed at least 30% to make
the change in density visible. The repeat image
was accomplished with 80 kVp and 13 mAs, the
Critical Thinking Questions image demonstrated an acceptable short scale
of gray for the lumbar spine, and the change in
When considering the overall density of the mAs provided the density necessary to visualize
image, which factor or factors need to be all the bony structures of the lumbar spine.
Review Questions

6. Which rule is used to determine how much kVp

Multiple Choice should be changed to allow for mA to be halved?
A. 30% rule
1. Radiographic contrast depends on B. 50% rule
C. 15% rule
A. tissue thickness D. 25% rule
B. tissue density
C. kVp 7. An image is produced with 110 kVp and 4 mAs at
D. all of the above 72 in. To maintain density, what will be the new
mAs if the distance is reduced to 40 in?
2. Radiographic contrast is defined as
A. 8 mAs
A. the difference in densities between adjacent areas B. 1.2 mAs
B. the difference in attenuation between adjacent C. 5 mAs
areas D. 2.8 mAs
C. the difference in scattering between adjacent areas
D. the difference in bremsstrahlung between adja- 8. _____ is the degree of blackening on the film.
cent areas
A. OD
3. What effect does the presence of scatter have on B. Radiographic density
contrast? C. Subject contrast
D. Tissue thickness
A. Improves contrast
B. Degrades contrast 9. Which interaction will predominate when kVp is
C. Has no effect on contrast increased?

4. A short-scale contrast radiograph can be obtained A. Bremsstrahlung

by using B. Photoelectric
C. Charteristic
A. high kVp. D. Compton
B. lower kVp.
10. Increasing the amount of filtration will have what
5. List in order of increasing x-ray attenuation impact on contrast and density
1. Bone A. increase contrast, increase density
2. Fat B. decrease contrast, decrease density
3. Soft tissue C. increase contrast, decrease density
4. Lung D. decrease contrast, increase density
A. 1, 2, 3, 4
B. 2, 4, 3, 1
C. 4, 3, 2, 1
D. 4, 2, 3, 1
138 Part III: Image Formation

11. The most critical factor in obtaining diagnostic qual- 4. An increase in SID will cause a _____ in OD.
ity images using an AEC circuit is the use of correct
A. positioning
B. focal spot size
C. SID
D. backup time
5. What effect does a grid have on contrast?
12. Tissues with a higher atomic number have greater
A. attenuation
B. Bremsstrahlung
C. transmission
D. tissue thickness
6. Write the formula for film density maintenance.
13. If the OD of the film is maintained the same, an
image obtained with higher mA and an appropriate
reduction in time is expected to have _____ contrast.
A. higher
B. lower 7. What is the controlling factor for density and how
C. the same does it affect it?

14. When utilizing the AEC, changing the mA from

100 to 300 will result in
A. more density
B. less contrast
C. less distortion 8. High kVp produces _____ scale or _____ contrast
D. a shorter exposure time while low kVp produces _____ scale or _____
contrast.

Short Answer

1. Describe a long scale of contrast and the factor

that affects the scale. 9. Filtration changes the beam by removing _____
photons and _____ the beam which _____ image
density.

2. How do variations in the anatomical part affect

density?
10. How much of a change in kVp is needed to decrease
mAs by one-half? To double mAs?

3. How are OD and mA related?

 11

Image Formation

Objectives Key Terms

Upon completion of this chapter, the student ● angulation ● magnification
will be able to: ● bone mineral ● object plane
densitometry ● reciprocity law
1. Define the factors that affect image detail.
● detail ● recorded detail
2. Describe the various types of image distortion.
● distortion ● section interval
3. Explain the principles of magnification ● elongation ● section level
radiography.
● exposure angle ● section thickness
4. Describe the principles of linear tomography. ● focal plane ● spatial resolution
5. Describe the various geometric factors. ● foreshortening ● tomographic angle
6. Discuss appropriate techniques to prevent ● fulcrum ● tomography
motion. ● involuntary motion ● voluntary motion

139
140 Part III: Image Formation

appearance, in the image. The mA selector determines

Introduction the number of x-ray photons produced and controls the
noise in the image. Noise is simply background infor-
Conventional radiography forms a two- mation that the image receptor receives. As long as the
dimensional image from projections through a background noise is significantly less than the amount
three-dimensional patient. This chapter covers of information coming into the image receptor, the
the factors that influence the appearance of the noise can be filtered out. Changes in the mA control
radiographic image. There are many ways in the number of electrons flowing from the cathode to
which the x-ray images can be distorted and it the anode in the x-ray tube. This results in changes in
is important for the student to be able to recog- the quantity of x-ray photons produced. Doubling the
nize such distortions lest they result in missed mA doubles the number of x-ray photons. Milliampere
or misleading diagnoses. The appearance of selections on modern x-ray generators range from 25 to
the final radiographic image is affected by the 1,000 mA (Fig. 11.1).
technical factors of milliamperes, exposure
time, kVp, distance, focal spot size, and the
orientation of the x-ray beam with the patient. Exposure Time
We will begin with a review of the proper selec- Exposure time also influences beam quantity. Exposure
tion of these factors by the technologist as this is time can be expressed in milliseconds, or as a decimal, or a
an essential step in the production of diagnostic fraction of a second. Longer exposure times result in more
quality radiographs. The student will also learn x-ray photons striking the patient. Doubling the exposure
about magnification radiography and tomogra- time doubles the number of x-ray photons. Exposure times
phy because these types of distortion are uti- should be selected to allow for the shortest or fastest expo-
lized to produce a diagnostic image. sure time to minimize patient motion artifacts.

Milliampere Second (mAs)

Technical Factors mAs is the product of mA and time which determines the
number of x-ray photons reaching the image receptor.
mAs is obtained by multiplying mA times the exposure
There are various technical factors which affect the time. An increase in mA or time results in an increase
appearance of the final image. It is important for the in x-ray photon quantity, which produces an increase in
student to have a thorough understanding of each of the number of x-rays photons and a decrease in image
these factors. Many of these factors have been discussed noise. To maintain the same noise level, the mA must be
throughout the textbook; however, it is appropriate to increased if the time is decreased.
mention each here because a misstep with just one can Different combinations of mA and time can be selected
compromise the image. to give the same mAs value and same image noise. This is
known as the reciprocity law. To decrease patient motion
on an image, larger mA values with a shorter time are used
Milliamperes to produce a set density on the image. This same density
The quantity or number of x-ray photons reaching can be accomplished by using smaller mA values with a
the image receptor determines the noise, or a snowy longer time. Longer exposure times are beneficial when

mA
10 25 50 75 100 125 150 200 300 400 500 600
Figure 11.1. Shows the mA
selector on a modern control
panel.
 Chapter 11: Image Formation 141

TABLE 11.1 PRESENTS THE RELATIONSHIP BETWEEN THE DIFFERENT

METHODS OF EXPRESSING mAs, WITH SOME TYPICAL mA VALUES AND
EXPOSURE TIMES

Time mAs from

Milliseconds Decimals Fractions 25 mA 100 mA 300 mA 400 mA

10 0.01 1/100 0.25 1 3 4

25 0.025 1/40 0.625 2.5 7.5 10
50 0.050 1/20 1.25 5.0 15 20
100 0.1 1/10 2.5 10 30 40
200 0.2 1/5 5.0 20 60 80
250 0.25 1/4 6.25 25 75 100
333 0.33 1/3 7.5 33 99 132
500 0.50 1/2 12.5 50 150 200
1,000 1.0 1 25 100 300 400

imaging anatomy that requires a breathing technique; high kVp images have a long-scale contrast and smaller
this effectively blurs anatomy which superimposes the density differences between black and white. The mAs
anatomy of interest (Table 11.1). was adjusted to maintain the same central density for
each image. The number of density differences visible
Kilovoltage in the 55 kVp image is less than the number of density
differences visible in the 75 kVp image. The 75 kVp
Changes in the kVp alter the penetration or quality of image is a long-scale contrast, low-contrast image. The
the x-ray beam. Radiographic contrast depends on the 55 kVp image is a short-scale contrast, high-contrast
quality of the x-ray beam. Increasing the kVp increases image.
the amount of exit radiation through the patient and
decreases differential absorption. Higher energy x-rays
are more penetrating and produce more scatter radiation
Distance
by way of increased Compton interactions. The distance between the x-ray source or focal spot and
The kVp setting is the primary controlling factor of the image receptor influences the image density. This
radiographic contrast. Figure 11.2 demonstrates how distance is termed the source to image receptor distance

A B C

Figure 11.2. Demonstrates images of an aluminum step wedge and a knee phantom. (A) 55 kVp at 2 mAs. (B) 65 kVp at
2 mAs. (C) 75 kVp at 2 mAs. (Courtesy Christa Weigel, FHSU.)
142 Part III: Image Formation

(SID). Changes in SID influence the quality of the

beam and the radiographic contrast; therefore, a change
in distance requires a change in mAs to maintain beam
intensity.
The x-ray intensity decreases with the square of the
distance from the x-ray source. Doubling the distance SID = 40%
decreases the x-ray intensity by a factor of 4. The x-rays are
spread out over a larger area as the distance to the source
increases. The variation of x-ray intensity as a function of
distance is given by the inverse square law:

2
éD ù SID = 80%
I2 = I1 ê 1 ú
ë D2 û

or

I1 D22
=
I2 D12

Figure 11.3. Illustrates the decrease in x-ray intensity as

where I2 is the new intensity, I1 is the old intensity, D2 is the distance to the source increases.
the new distance, and D1 is the old distance. This rela-
tion is known as the inverse square law because the new As demonstrated, the beam is one-fourth the intensity
intensity is inversely related to the ratio of the distances of the beam at the original distance.
squared. An increase in distance results in a decrease in Figure 11.3 illustrates how the beam is changed with
intensity. an increase or decrease in SID. A decrease in the SID
results in an increase in the number of x-ray photons
striking the image receptor because the intensity is much
greater and more easily penetrates the anatomy. As seen
CRITICAL THINKING in the Critical Thinking exercise, when the distance is

An exposure was made with 60 mR at 40 inch SID.

What is the intensity of the beam if the new distance CRITICAL THINKING
is 80 inches?
Answer
60 mR is used to make an exposure at 80 inches. Deter-
éD ù
2
mine the new intensity when the SID is decreased to
I2 = I1 ê 1 ú 40 inches.
ë D2 û
é 40 ù
2 Answer
I2 = 60mR ê ú 2
ë 80 û éD ù
é1 ù
2 I2 = I1 ê 2 ú
I2 = 60mR ê ú ë D1 û
ë2û é 80 ù
2

é1ù
2
I2 = 60mR ê ú
I2 = 60 ê ú ë 40 û
ë4û I2 = 60mR[2]2
I2 = 15mR I2 = 240mR
 Chapter 11: Image Formation 143

decreased by one-half, the x-ray intensity will increase by The relation between mAs and distance is directly
four times. proportional and is opposite of the inverse relation
between intensity and distance. In the mAs-distance
Optical Density, mAs, and SID relationship, the mAs must be increased to compensate
for an increase in distance.
Changes in SID will change the optical density unless
the mAs is altered to compensate for changes in distance.
To maintain the same optical density, the mAs must be kVp and Image Density
increased if the distance is increased. If the distance is
decreased, the mAs must be decreased. In diagnostic radi- A change in kVp will alter the image density because the
ology, the SID is standardized at either 40 inches (100 penetration or quality of the x-ray photons changes. An
cm) or 72 inches (180 cm). The SID is not utilized or increase in kVp results in an increase in exit radiation.
changed to compensate for changes in optical density; When the x-ray quality is increased with higher kVp, less
the mAs is the primary controlling factor for density. x-ray quantity is needed due to the higher penetration of
If the distance is doubled, the mAs must be increased the beam, so fewer x-ray photons are needed to produce
by a factor of 4 to compensate for the decrease in inten- the same optical density. A 15% change in kVp is equiva-
sity caused by the greater distance. lent to changing the mAs by a factor of 2. This is termed
To calculate the amount of mAs change required to the 15 percent rule for kVp. If the kVp is decreased from
compensate for changes in SID, the mAs-distance formula 100 to 85 kVp, the mAs must be doubled to maintain
is used: the same image density. The same is true if the kVp is
increased by 15%, the mAs should be decreased by a
factor of 2.
2
éD ù
mAs 2 = mAs1 ê 2 ú
ë D1 û

CRITICAL THINKING
Here, the mAs2 is the new mAs, mAs1 is the old mAs,
D2 is the new SID, and D1 is the old SID.
An IV contrast study of the urinary system which
is obtained at 80 kVp and 10 mAs has acceptable
density but lacks sufficient contrast. What mAs should
CRITICAL THINKING be chosen if the new kVp is 15% less?
Answer
A lateral c-spine projection examination in the The calculation is set up as
emergency room was taken at 40 inches, 70 kVp,
and 10 mAs and produced an image with satisfac- 80 kVp × 0.15 = 12 kVp
tory density. A follow-up lateral is to be taken in 80 kVp − 12 = 68 kVp
a general x-ray room where a 72 inch SID is uti- New mAs = old mAs × 2
lized. What new mAs should be selected for this Old mAs × 2 = New mAs
new distance? 10 mAs × 2 = 20 mAs
New kVp = 68 kVp; new mAs = 20 mAs
Answer
The new mAs is given by
2
é 72 ù The original image had a long scale of contrast, the
mAs2 = mAs1 ê ú kVp must be lowered to increase the contrast. A 15%
ë 40 û 2
mAs2 = 10 mAs [1.80] decrease from 80 kVp resulted in the new kilovoltage of
mAs2 = 10 [3.2] 68 kVp. To compensate for the 15% decrease in kVp, the
mAs2 = 32 mAs mAs must be doubled to maintain image density. The
new mAs would be 20 mAs.
144 Part III: Image Formation

exposure time and patient motion artifacts. It is often

CRITICAL THINKING possible to obtain further reduction in exposure time by
increasing the kVp by 15% and reducing the mAs by one-
half. The skilled radiographer will be able to determine
A technologist reduces the mAs by half to reduce
when this change will not affect the diagnostic quality of
motion artifacts. What new kVp should be selected
the image.
to maintain the same density as obtained from 60 kVp
at 10 mAs?
Answer

New mAs =
old mAs Recorded Detail
2
10
New mAs =
2 The appearance of the radiographic image is governed
New mAs = 5 mAs by two primary geometric factors, recorded detail and
distortion. Recorded detail is the degree or amount of
The new kVp must be 15% higher than the old kVp
geometric sharpness of an object recorded as an image.
New kVp = 60 kVp × 0.15 = 9 kVp The recorded detail in an image is easy to evaluate and
New kVp = 60 kVp + 9 kVp = 69 kVp. adjust if you understand what comprises recorded detail.
New technical factors: Recorded detail is also referred to as definition, sharpness,
spatial resolution, or simply as detail. In this section, we
69 kVp at 5 mAs
will discuss the properties that affect recorded detail.

Changes in kVp will change radiographic contrast Image Sharpness

when utilizing the 15% rule with the appropriate change
Detail, Image Sharpness, and Spatial Resolution are
in mAs. These changes will result in changes in the image
terms used to describe the sharpness of the image and
contrast by creating a long scale of contrast (Table 11.2).
how well the system images small structures such as the
The technologist must select different combinations
edges or borders of structures which appear in hairline
of kVp or mAs to optimize image density and contrast.
fractures. Detail is defined as the smallest separation of
Higher mA settings should be chosen to minimize the
two lines or edges which can be recognized as separate
structures on the image. An image with adequate detail
TABLE 11.2 PRESENTS WAYS IN WHICH DENSITY will demonstrate even the smallest parts of the anatomy
AND CONTRAST ARE ALTERED BY A CHANGE IN which will allow the radiologist to visualize all the struc-
TECHNICAL FACTORS tures possible for a diagnosis.
Factor Density Change Contrast Change The degree of sharpness or spatial resolution is deter-
mined by line pairs per millimeter (lp/mm). A high
mA increase Increase Unchangeda contrast resolution phantom that has lead strips of dif-
mA decrease Decrease Unchangeda ferent widths and separations is used to produce the lp/
Time increase Increase Unchangeda
mm image (Fig. 11.4). The radiographer evaluates the
Time decrease Decrease Unchangeda
kVp increase Increase Decrease tool to determine which of the smallest lines are sepa-
kVp decrease Decrease Increase rated from one another while being easily discernable,
SID increase Decrease Unchangeda this represents lp/mm. A system with lines 0.5 mm wide
SID decrease Increase Unchangeda can image two objects 0.5 mm apart as distinct objects.
Focal spot increase Unchanged Unchanged Objects closer than 0.5 mm imaged with this system are
Focal spot decrease Unchanged Unchanged
blurred together and cannot be recognized as separate
a
When mAs is changed and a corresponding change in SID is made objects. Therefore, imaging systems with better resolu-
to maintain density. tion can resolve more line pairs per millimeter.
 Chapter 11: Image Formation 145

Figure 11.4. Illustrates the concept of spa-

tial resolution and line pairs per millimeter.

Factors That Affect Detail Distance (SID)

The distances between the x-ray source or focal spot
The x-ray beam originates at the focal spot on the anode (SOD), object (OID), and image receptor (SID) are all
and travels toward the patient. The focal spot is a small critical pieces that affect the amount of recorded detail.
point and produces a very narrow beam of photons. As
the photons travel toward the patient, the beam becomes
increasingly wider or more divergent. An example is to
turn on a flash light and place it against a wall. Imagine
the flash light is the focal spot and the wall is the image
receptor. As the flashlight is pulled away from the wall,
the circle of light becomes increasingly larger as the dis-
tance increases. In Figure 11.5, notice the size of the
beam as it leaves the tube and how the beam diverges to
the level of the image receptor. Factors related to beam
divergence are based on the inverse square law and a
thorough knowledge of each is critical in producing a
diagnostic image.
The visibility of detail in a radiographic image is con-
trolled by different factors. Each must be considered when
the image resolution is less than optimal. The geometric
factors of the x-ray beam are the most important factors
in producing an image with high resolution or recorded Heart

detail. The controlling factors that affect detail or sharp-

ness are as follows: Kidney
Spine
1. Eliminate patient motion.
2. Increase SID.
3. Reduce focal spot size.
4. Reduce object image distance (OID). Figure 11.5. Illustrates the divergence of the x-ray beam
5. Reduce intensifying screen phosphor size and as it travels from the anode to the image receptor, getting
concentration. progressively wider.
146 Part III: Image Formation

exams are performed with the part of interest directly

placed on the image receptor. Although this works well
for imaging anatomy <10 cm thick, it does not work well
for parts larger than 10 cm thick, which require a grid.
For such anatomy, the radiographer must consider the
surface supporting the anatomy and the image receptor.
The Bucky tray may be as much as 4 inches below the
table top which would significantly increase the OID
and cause a loss in detail.
Source to object Resolution will improve when SID is increased and
Source to image
receptor distance distance (SOD) will be degraded when SID is decreased. Consider a lat-
(SID) eral cervical spine image where there is significant OID
from the spine to the image receptor. The OID is signifi-
cant because the width of the shoulder prevents the spine
from being placed directly next to the Bucky. Because
of this, a 72 inch SID is used to produce a lateral image
where the size of the spine is comparable with the AP
projection, which has a much smaller OID. If the lateral
cervical spine were imaged with a 40 inch SID, the spine
would appear magnified compared with the AP projec-
tion and it would have a loss of detail.

Focal Spot Size

Object to image The line focus principle controls the focal spot size by
receptor distance reducing the effective focal spot. The angle of the anode
(OID)
has been designed to increase the actual focal spot to
Figure 11.6. Distances in radiography. absorb the heat produced with each exposure while
decreasing the size of the effective focal spot that is pro-
jected toward the patient. The line focus principle makes
As represented in Figure 11.6, SOD + OID = SID. use of an anode surface tilted or angled with respect to
When OID is reduced, the resolution is improved, and the x-ray beam. A small target angle produces an effective
when OID increases, the resolution is degraded. For focal spot that is smaller than the actual focal spot. The
this reason, the affected side or part of interest is typi- effective focal spot is the size of the focal spot as seen by
cally placed as close as possible to the image receptor. the patient. Because of the tilted anode angle, the effective
Upon reviewing an image, if an improvement in detail is focal spot is smaller on the anode side and larger on the
needed, the first factor to consider is OID. The minimum cathode side. The result is less focal spot blur on the anode
OID is used to improve detail. Positioning protocols were side and more blur on the cathode side of the image.
established with this factor in mind. The PA chest projec- X-rays diverging from different parts of the focal spot
tion is preferred because it places the heart closest to the will blur the edge of an image. This blur or unsharp
image receptor. The left lateral chest, AP kidney, and PA shadow along the edge of the image is called penum-
small bowel projections were all designed to place the bra. Larger focal spots produce greater amounts of pen-
part of interest as close as possible to the image receptor umbra or blur. The size of the focal spot is a major
to decrease OID. controller of image resolution because it controls the
The OID can also be minimized by performing an amount of focal spot blur. When the focal spot size
exam on the table top instead of in the Bucky. Extremity is decreased, the blur decreases, thereby increasing
 Chapter 11: Image Formation 147

resolution. The amount of blur is calculated by using

the following formula: CRITICAL THINKING
Focal spot size ´ OID
P= Calculate the size of focal spot blur for image taken
SOD
with a 1.0-mm focal spot, at a 72 inch SID and an
OID of 4 inches.
where P is the width of penumbra, OID is object to image
receptor distance, and SOD is source to object distance. Answer
Focal spot size ´ OID
P=
SOD
CRITICAL THINKING
Find the SOD first: 72−4 inches: = 68 inches
Determine the size of focal spot blur for an image 1.0 ´ 4
P=
taken with a 2.0-mm focal spot, at a 40 inch SID and 68
an OID of 4 inches. 4
P=
68
Answer P = 0.05 mm
Focal spot size ´ OID
P=
SOD
First determine the SOD by subtracting SID and CRITICAL THINKING
OID. 40−4 inches = 36 inch SOD.
2.0 ´ 4 inches Determine the amount of focal spot blur for an image
P=
36 taken with a 1.0-mm focal spot, at a 40 inch SID and
8 an OID of 9 inches.
P=
36
P = 0.22 mm Answer
Focal spot size ´ OID
P=
SOD
Determine the SOD first: 40−9 inches = 31 inches
CRITICAL THINKING
1.0 ´ 9
P=
Calculate the size of focal spot blur for an image 31
9
taken with a 1.0-mm focal spot size, at 40 inch SID P=
and an OID of 4 inches. 31
P = 0.29 mm
Answer
Focal spot size ´ OID
P= These examples demonstrate how the penumbra
SOD decreases when the SID increases. The penumbra will
If the SID is 72 inches and the OID is 4 inches, the also decrease when the focal spot size decreases and when
SOD = 40−4 inches = 36 inches. the OID decreases. Each of these changes will result in
1.0 ´ 4 inches increased resolution of the anatomy.
P= In Figure 11.7A, the effect of the focal spot size on
36
4 resolution is seen. When there is a large focal spot, the
P= penumbra area is larger, whereas the small focal spot
36
P = 0.11 mm has a much smaller area of penumbra. The smaller focal
spot size provides the best resolution possible because of
148 Part III: Image Formation

Focal spot blur

Focal spot blur
Large focal spot Small focal spot
Small SID Large SID
A B

SOD

SOD

OID

OID

Focal spot blur

Large OID Small OID
C Figure 11.7. Illustrations of focal spot blur.

less penumbra. Figure 11.7B demonstrates what occurs OID on penumbra. When there is increased OID, the
when the SID is changed. The small SID is so close to area of penumbra will be larger, causing more geomet-
the image receptor that it does not allow the beam to ric unsharpness and less resolution in the image. If pos-
fully diverge, producing a larger penumbra. The geom- sible, moving the OID closer to the image receptor will
etry of the beam allows the longer SID to produce a decrease the area of penumbra which improves resolu-
smaller area of penumbra, which increases resolution of tion. For all these reasons it is clear that the best resolu-
the object. Finally, Figure 11.7C represents the effect of tion can be achieved when the smallest OID and focal
 Chapter 11: Image Formation 149

spot size are used with the longer SID possible for the emitted light which produces the radiographic image.
anatomic area being imaged. When the image appears grainy or mottled, there were
not enough incident x-ray photons reaching the intensify-
Image Receptor ing screen; this causes an insufficient number of interac-
Film/screen combinations are classified by speed. When tions with the phosphors and the phosphors are not able
imaging the extremities, it is preferred to use a slow to emit enough light to completely cover the surface of
speed film/screen because these systems provide the best the film. Quantum mottle is only corrected by increasing
resolution possible to demonstrate the fine bony mark- mAs for the repeat image.
ings. This speed of film/screen would not be appropriate
for abdomen imaging where fine detail or high resolu- Motion
tion is not needed. Higher speed film/screens are uti- Motion affects the recorded detail because it appears as
lized because they reduce patient dose for examinations a blurred series of densities where no fine detail can be
which do not require the high resolution. Many facilities visualized. There are various types of motion; most are
utilize the different speeds of film/screen combinations controlled by the radiographer and include:
to produce the most diagnostic images possible while
being aware of decreasing patient exposure dose when- ● Voluntary motion
ever possible. ● Involuntary motion
The resolution of an intensifying screen is depen- ● Equipment motion
dent on phosphor size, phosphor layer thickness, and ● Communication
phosphor concentration. When phosphor size and ● Reduced exposure time
layer thickness decrease, the resolution will increase, ● Immobilization
but this comes with a corresponding increase in
patient dose. Increasing the phosphor concentrations Voluntary motion is motion that the patient directly
will result in an intensifying screen that records more controls. The radiographer must use effective commu-
detail, this in turn allows the radiographer to use lower nication when working with all patients to ensure that
mAs which reduces the patient’s dose (Table 11.3). As the patient understands the necessity of holding still for
previously stated, when the intensifying screen speed the exposure. For the majority of exams the patient is
is decreased, there is an increase in resolution, but able to comply with the positioning instructions as long
to offset the decrease in screen speed, the dose to the as they understand what they are to do. The responsibil-
patient must be increased. A skilled radiographer will ity of communicating in a professional and competent
be able to determine which type of system to use to pro- manner rests with the radiographer who must determine
vide maximum detail while not overly increasing the the method of communicating with the patient. Patients
patient’s dose of radiation. of all ages will respond to a gentle touch and comforting
Another factor that must be considered is the produc- tone. Never assume that the patient is not able to under-
tion of quantum mottle when low mAs is used with high- stand the instructions. Even very young children can be
speed intensifying screens. Many intensifying screens cooperative when they wish to be, and adults with mental
have been developed for use with low mAs settings; their impairments will be able to follow instructions when pro-
phosphors are more efficient in converting photons to vided in a simple, clear manner.

TABLE 11.3 SUMMARIZES THE EFFECTS ON IMAGE RESOLUTION WHEN

INTENSIFYING SCREEN FACTORS ARE INCREASED

Phosphor Image Resolution Patient Dose Film Density

Size − − +
Layer thickness − − +
Concentration + − +

+ is an increase, − is a decrease.
150 Part III: Image Formation

Involuntary motion is not under the control of the boards, mummy wrapping techniques, Pig-O-Stats, and
patient. Examples include the heartbeat, peristalsis of compression bands. Many experienced radiographers
the small and large intestines, and uncontrollable trem- believe that tape is the best immobilization aid for a vast
bling caused by a disease process. The radiographer can majority of exams. A strip of tape across the forehead
reduce the motion artifact caused by involuntary motion with the sticky side out and not touching the skin has
by using the shortest exposure time possible. helped avoid repeated headwork exposures. A skilled
Equipment motion can be caused by equipment radiographer will be able to determine if an immobiliza-
which is not functioning properly or is not properly main- tion aid is warranted or if communication will suffice.
tained. Movement of a reciprocating grid which causes As a last resort, the patient’s family may be asked to hold
the grid to vibrate in the Bucky or an x-ray tube that drifts the patient still. It is advised to have a male relative be
or vibrates are just a few examples of equipment motion. the first choice, female relatives are second, nonradiology
These types of motion artifact can be identified by review- personnel are third, and finally nonprofessional radiology
ing multiple images which were produced with the same personnel. Radiographers must always be the last choice
radiographic equipment. for holding a patient, as their radiation levels are signifi-
Communication is the most effective method of reduc- cantly higher than the above-listed people. It is crucial
ing motion artifact. The radiographer must use effec- to remember that no one radiographer should routinely
tive communication when using positioning aids such hold patients; the task should be shared by all radiogra-
as radiolucent pads, sponges, and sandbags so that the phers so that each radiographer can keep their radiation
patient understands the purpose of the positioning aids. exposure as low as reasonably achievable.
Clear breathing instructions and allowing the patient
enough time to comply with breathing instructions will
eliminate motion artifact in images of the thorax and
abdomen. With patients of all ages, the radiographer
must use instructions that are clear, concise, and easily
Distortion
understood.
Exposure time must be reduced when the patient is Distortion is the misrepresentation of the size or shape
not able to cooperate in holding still or in holding their of an object. This misrepresentation is known as either
breath for several seconds. Reducing exposure time and size or shape distortion. Distortion reduces the visibility
increasing mA will sufficiently maintain density of the of detail and resolution in an image. The radiographer
image while reducing motion artifact from involuntary must be familiar with normal radiographic anatomy to
motion. Other methods of decreasing exposure time assist in evaluating the diagnostic quality of the image.
while maintaining density include decreasing SID and Careful evaluation of the image typically reveals that the
using a higher speed film/screen system. distortion is directly related to positioning. The radiog-
Immobilization is used when communication and rapher must pay attention to using the proper SID, tube
reduced exposure time are not sufficient to reduce motion placement in relation to the anatomical part, proper cen-
artifact. Immobilization devices such as angled sponges, tral ray location, and accurate positioning of the part of
sandbags, and foam pads are routinely used to hold the interest to ensure the minimum OID. Size distortion is
patient in the necessary position. These devices can assist termed magnification. Shape distortion is termed either
an ill patient or a patient in pain with holding a position elongation or foreshortening.
because it allows the patient to rest the part of interest on
the pad, thereby reducing muscle fatigue and pain. The
use of positioning aids is part of providing a professional
Size Distortion/Magnification
service to the patient and should be utilized as frequently Magnification results from the represented object
as possible. appearing larger on the final radiographic image. The
Many examinations benefit greatly from immobiliza- majority of imaging procedures require the smallest
tion aids or devices that are specifically designed to hold amount of magnification possible; however, there are
the patient still. Some of these devices include pediatric limited situations when magnification is necessary. An
 Chapter 11: Image Formation 151

example would be performing a magnified image of the

scaphoid bone to identify hairline fractures. As routine
practice, magnification of a body part should be kept to
a minimum to avoid masking other structures. Magni-
fication is controlled by using the maximum SID pos-
sible for the examination and positioning the body part
to minimize OID.

Source-to-Image Receptor Distance

The greater the SID the smaller the magnification of the
anatomical part. Routine radiographic protocols have
been established to use a 40 inch SID for the majority
of examinations. This SID represents the amount of dis-
tance necessary to project the accurate size of the ana- Large OID
tomical part onto the image receptor. For extremity and
abdominal images, the 40 inch SID works exceptionally B
well; however when imaging with a horizontal beam, a Small OID C
72 inch SID is routinely used. Chest imaging has been
performed at 72 inch SID for many years to reduce the
size of the heart shadow, and lateral cervical spine image
also uses a 72 inch SID. The radiographer must deter-
mine the appropriate SID for the examination when posi- A

tioning the patient.

The majority of body parts have a certain amount of
OID over which the radiographer has limited control.
Figure 11.8. Demonstrates the effect of OID on image
The SID must be maximized to decrease the magnifi- size magnification. Structures A and C are the same size
cation created by the OID. Radiographic examinations but due to their OID their projected images are of signifi-
of body parts with large OID, such as the sternum and cantly different sizes. Structure B is significantly smaller
lateral cervical spine, use a large SID when possible. than C; however, their sizes appear identical because of B’s
greater OID.
Object-to-Image Receptor Distance
OID also plays a critical role in magnification and resolu-
tion. Figure 11.8 demonstrates two relationships of OID: Determining Size Distortion
location in the body and size of the part. As seen in this Size distortion is seen in each radiographic image as mag-
cross-sectional image, each anatomical structure is at a dif- nification. The magnification of an object is given by the
ferent level in the body, meaning that each has its own magnification factor which is the ratio between the SID
OID and will be projected onto the image as different and the SOD. The degree of magnification is mathemati-
sizes. The structures with the largest OID will be projected cally represented by:
with a larger size than structures that have a small OID.
Another size relationship controlled by OID is seen in SID
mF =
Figure 11.8. Structure B is a smaller object than structure SOD
C, but due to the inherent OID, structure B appears as
the same size as structure C on the image. A thorough where mF is the magnification factor. Images that are
knowledge of normal radiographic anatomy is necessary formed with small SOD values and short SID values
when making judgments about size relationships and in have larger magnification factors (Fig. 11.9). Remem-
determining the best position for achieving the minimum ber the SOD is the OID minus the SID. An object
OID for the specific anatomy. midway between the image plane and the source has a
152 Part III: Image Formation

CRITICAL THINKING

If the SID is 72 inches and the OID is 4 inches what

is the magnification factor? First you need to deter-
mine SOD.

SOD
Answer
SOD = SID - OID
SOD - 72 - 4 inches
SOD = 68 inches
SID
SID
mF =
SOD
72 inches
mF =
OID
68 inches
mF = 1.05

Magnification occurs with an increase in OID. As OID

increases SOD must decrease. SOD is inversely propor-
tional to SID; therefore decreasing SOD increases the
True object size
magnification factor. An example of this is the thoracic
Magnified image size
spine. In an anteroposterior projection, the thoracic spine
is placed very close to the image receptor. Now if the tho-
Figure 11.9. Shows magnification and its relationship racic spine is positioned in a lateral projection, the spine is
between the true object size and the image size.
further away from the image receptor yet closer to the x-ray
tube or source. As seen in the next examples, objects that
are closer to the source have a higher magnification factor.
magnification factor of 2. A magnification of 1 means the
image is the same size as the object. This occurs when
the object is in contact with the image receptor.
CRITICAL THINKING

An AP image of the thoracic spine was taken at 40 inch

CRITICAL THINKING SID and a 3 inch OID. What is the magnification
factor?

What is the magnification of an image taken at Answer

40 inch SID and 32 inch SOD? SOD = 40−3 inches
Answer SOD = 37 inches

SID SID
mF = mF =
SOD SOD
40 40 inches
mF = mF =
32 37 inches
mF = 1.25 mF = 1.08
The magnification is 1.25, which means the image The magnification will be 8% or the image will be
will appear 25% larger than the object. 108% of the object size.
 Chapter 11: Image Formation 153

Shape Distortion
CRITICAL THINKING Shape distortion depends on the alignment of the x-ray
tube, the body part, and the image receptor. Shape distor-
tion displaces the projected image of a structure from its
A lateral image of the thoracic spine was taken at 40
actual position.
inch SID with a 15 inch OID. What is the magnifica-
If the image is shorter in one direction than the object,
tion factor?
the image is said to be foreshortened. If the image is
Answer longer in one direction than the object, it is said to be
SOD = 40−15 inches elongated. Foreshortening occurs only when the part is
SOD = 25 inches improperly aligned with the tube and image receptor.
SID Elongation only occurs when the tube is angled. If the
mF = image is larger than the object in two directions, it is said
SOD
to be magnified (Fig. 11.10).
40 inches
mF = The central ray is the line connecting the focal spot to
25 inches
the center of the image receptor. The alignment of the
mF = 1.6 central ray is critical in reducing or eliminating shape
The magnification will be 60% or the image will be distortion. The central ray must be perpendicular to the
160% of the object size. image receptor and body part being examined to elimi-
The magnification factor allows for the calculation of nate shape distortion. This means that the body part and
the actual size of the structure, which is projected as image receptor must be parallel with each other. Another
an image by using the following formula: alignment issue that must be corrected is incorrect cen-
tering which occurs when the tube is off-centered to the
I
O= image receptor, when the image receptor is off-center
mF
to the tube, and when the anatomical part is incorrectly
where O is the object size, I is the image size, and mF positioned in relation to the tube and image receptor.
is the magnification factor. These relationships of misalignment are demonstrated in
Figure 11.11.
Proper alignment of the tube, the patient, and the
CRITICAL THINKING image receptor is particularly important in portable
examinations. It is important to be certain that all fac-
tors are in alignment with each other to produce an opti-
What is the size of an object radiographed at a 40 inch SID mal radiograph. Portable examinations create a unique
and a 10 inch OID if the image measures 2.4 inches? set of challenges to the radiographer as the patient may
Answer be lying on a mattress which causes the image receptor
Solution: image = 2.4 inches to be at an odd angle. Due diligence is necessary to be
SID = 40 inches certain that all aspects are properly aligned. There is no
OID = 10 inches shape distortion along the central ray. The central ray
SOD = 40−10 should be centered on the body part of interest. Objects
SOD = 30 distant from the central ray will be distorted due to the
40 divergent beam away from the central portion of the
mF = = 1.33
30 beam.
I
O=
mF Beam Angulation
2.4 inches Some clinical situations use shape distortion to reduce the
O= = 1.8 inches
1.33 inches superimposition of overlying structures such as angling
The actual size of the object is 1.8 inches and the the central ray in axial images. The amount of angulation
magnification factor was 1.33. is used to create a controlled or expected amount of shape
distortion. This will result in foreshortening or elongation
154 Part III: Image Formation

Elongated Foreshortened

Figure 11.10. Presents examples of foreshortening and elongation shape distortion due to changes in the alignment of the
central ray.

of the structures overlying the body part of interest. Some display of 40 inch SID, while an angle of 25 degrees
examples include imaging the skull, clavicle, and calca- requires the overhead display to read 36 inch SID. If the
neus. The amount of angulation will cause a change in the SID is not changed with greater tube angles, there will be
SID, more angulation creates longer SIDs than less angu- a decrease in image receptor exposure because the tube is
lation. An angle of 5 degrees will not change the overhead farther away from the image receptor.

Off-centering Incorrect positioning Off-centering of

of tube of part imaging receptor

Figure 11.11. Incorrect centering of tube, image receptor, and anatomy.

 Chapter 11: Image Formation 155

TABLE 11.4 IS A SUMMARY OF THE FACTORS THAT AFFECT RECORDED DETAIL AND DISTORTION. AS
THE FACTORS ARE INCREASED, THEIR AFFECT CAN BE IDENTIFIED UNDER
THE RESPECTIVE COLUMN

Factor Patient Dose Magnification Focal Spot Blur Motion Blur Film Density

Film speed Decrease Unchanged Unchanged Decrease Increase

Screen speed Decrease Unchanged Unchanged Decrease Increase
Grid ratio Increase Unchanged Unchanged Unchanged Decrease
Patient thickness Increase Increase Increase Unchanged Decrease
Focal spot size Unchanged Unchanged Increase Unchanged Unchanged
SID Decrease Decrease Decrease Unchanged Decrease
OID Unchanged Increase Increase Unchanged Unchanged
mAs Increase Unchanged Unchanged Unchanged Increase
Exposure time Increase Unchanged Unchanged Increase Increase
kVp Increase Unchanged Unchanged Unchanged Increase

Tube Angle Direction Shape distortion

The x-ray tube is commonly directed with the longitudinal Shape distortion is much easier to evaluate and is seen
axis of the table; this avoids issues with grid cutoff. The lon- as both elongation and foreshortening. Shape distortion
gitudinal angles are either cephalic or caudal. A cephalic can be used to our advantage but can be detrimental if
angle means the tube is angled toward the head of the used improperly or when not intended. Specific imaging
patient, while a caudal angle is toward the patient’s feet. protocols require the use of elongation to visualize the
The amount and direction of tube angle is specified by the bony anatomy such as with imaging the sacrum where
examination and patient position. Common oblique cer- the proper angle elongates the sacrum to enhance visual-
vical spine images are performed with the patient facing ization (Fig 11.13).
the tube and the tube is angled cephalic. If the patient’s
position is reversed, the angle of the tube must be reversed
to caudal. These principles are utilized to maintain the
visualization of expected anatomy (Table 11.4).
Tomography
Evaluating Image Distortion
An animation for this topic can be viewed
Critically evaluating the image for size and shape distor- at http://thepoint.lww.com/FosbinderText
tion requires the radiographer to apply their knowledge of
normal anatomy and the images for each position. The
evaluation for shape distortion is not as clear-cut as mag-
nification, and there is no formula that can be calculated Tomography is a special technique used to improve the
to tell us there is shape distortion. visualization of selected objects by blurring out structures
away from the objects of interest. In a conventional radio-
Size distortion graphic image, all the structures are seen with equal clar-
Size distortion is the magnification of the body part. ity even though the structures are superimposing each
All magnification degrades the resolution of the image. other. Tomography overcomes superimposition by utiliz-
As seen in Figure 11.12 of a PA hand at 40 inch SID, ing principles based on the synchronous movement of
the scaphoid bone is rather small. Decreasing the SID two of three elements: the x-ray tube, the object, and the
to 32 inches produces a magnified view of the schapoid image receptor.
bone, revealing hairline fractures which are difficult to The majority of units synchronize the movement of the
visualize without the magnification. x-ray tube and the image receptor. The x-ray tube and film
156 Part III: Image Formation

select each of the following to produce a tomographic

image:

● Fulcrum: pivot point of the tomographic image

● Object plane or focal plane: area which appears in
focus
● Tomographic angle or amplitude: total distance
the tube travels
● Exposure angle or amplitude: distance the tube
travels during the exposure
● Section thickness: width of the focal plane, con-
trolled by tomographic angle
● Sectional interval: distance between fulcrum
levels

Fulcrum
The x-ray tube and image receptor pivot at the fulcrum.
The location of the fulcrum defines the object plane
A or focal plane and controls section level. The fulcrum
may be fixed so that the patient is moved up and down
to change the section level. Modern equipment has an
adjustable fulcrum that moves up and down while the
patient remains stationary.

Object Plane or Focal Plane

Structures above and below the object plane appear
blurred, while objects in the object plane are sharp and
in focus in the tomographic images. The position of the
object plane is defined by the location of the fulcrum.
The position of the object plane is changed by changing
the location of the fulcrum. This is usually done by rais-
ing or lowering the table or the fulcrum. This is always in
increments of millimeters or centimeters and is changed
by the technologist to set the body part being examined
to within the object plane (Fig. 11.14).
B

Figure 11.12. Magnification size distortion of scaphoid bone. Tomographic Angle or Amplitude
(A) Routine PA hand image at 40 inch SID. (B) Decreasing
the SID will cause magnification of the anatomy. The tomographic angle, arc, or amplitude is the total
distance the tube travels. The tomographic angle deter-
image receptor are moved in opposite directions during mines the amount of tube and image receptor motion
the exposure. The exposure time must be long enough and is measured in degrees. Larger tomographic angles
to provide continuous exposure during the tomographic produce thinner tomographic cuts. Smaller tomographic
motion. Tomographic exposures employ longer expo- angles produce thicker tomographic cuts. A tomographic
sure times with lower mA values. In addition to selecting angle of 50 degrees produces a 1–mm-thick object plane,
the appropriate technical factors, the radiographer must a tomographic angle of 10 degrees produces a 6-mm
 Chapter 11: Image Formation 157

A B

Figure 11.13. Shape distortion. (A) Perpendicular

beam. (B) 30 degree cephalic angle. (C) 30 degree
C
caudal angle.

object plane. As seen in Figure 11.15, the tomographic Section Thickness

angle is longer than the exposure angle.
Section thickness defines the width of the focal plane
or the thickness of tissue that will not be blurred.
Exposure Angle or Amplitude The section thickness is controlled by the tomo-
The exposure angle is the total distance the tube travels graphic angle. As stated under tomographic angle,
during the exposure. When the exposure switch is large tomographic angles result in thinner cuts,
engaged, the x-ray tube will turn on and will remain on while small tomographic angles result in thicker cuts
during the entire exposure angle. (Fig. 11.16).
158 Part III: Image Formation

Tomographic
angle
Tomographic
angle
Exposure
angle

Object plane B Fulcrum

Object plane Fulcrum

A B B A
C C

Figure 11.14. Tomographic relationship of fulcrum, Figure 11.15. Tomographic angle or amplitude in
object plane, and tomographic angle. relation to exposure angle or amplitude.

Section Interval fulcrum. The exposure switch is fully depressed and the
exposure begins as the x-ray tube and image receptor
The section interval is the distance between fulcrum move simultaneously in opposite directions. The image
levels. The section interval should never exceed the sec- of the anatomic object lying in the object plane will
tion thickness. For example, when using a section thick- have a fixed position on the image throughout the tube
ness of 0.8 mm, the section interval should be 0.7 mm; as movement. The images of structures which lie above
the fulcrum level is changed for subsequent tomographic and below the object plane will have varying positions
slices, the tissue will overlap by 0.1 mm. This will provide on the image.
a complete imaging sequence of the affected area with- As seen in Figure 11.17, the images of points A and C
out missing any tissue. are spread over the entire image receptor, while the posi-
tion of B remains fixed on the image receptor throughout
the tomographic motion. Consequently, the margins of
Producing a Tomographic Image A and C will be overlapped and will appear blurred. The
Now that the fulcrum, tomographic angle, exposure blurring of objects lying outside the object plane is an
angle, section thickness, and interval have been set, example of motion blur caused by the motion of the x-ray
the radiographer is ready to produce an image. The tube. Of all the objects, object A has the most OID and
tomographic examination begins with the x-ray tube will experience increasing motion blur with increasing
and image receptor positioned on opposite sides of the distance from the object plane. Object C will experience
 Chapter 11: Image Formation 159

θ = 30°

θ = 60°

B
A

C
C

A B C C B A A B C C B A

Thinner focal plane Thicker focal plane

Figure 11.16. Tomographic angle determines section thickness. (A) The large angle results in a thin slice of tissue.
(B) The small angle results in a thick slice of tissue.

less motion blur than object A and object B should have

no motion blur. Bone Mineral
Densitometry
Types of Tomography
The tomographic motion where the tube and film image Bone mineral densitometry (BMD) measures the
receptor move in a straight line is known as linear tomog- density of bone mineralization to assist the diagnosis of
raphy. There are also more complicated motions such osteoporosis. BMD is different from a bone scan. A bone
as circular, elliptical, hypocyclodial, and trispiral. These scan involves injection of a radioactive isotope into the
more complicated motions are used to image smaller patient and imaging the areas where the isotope is con-
structures and eliminate artifacts. The principal advantage centrated. With BMD, a pencil beam of x-rays is scanned
of tomography is improved radiographic contrast due to through the spongy or trabeculated portion of the bone.
the blurring motion of tissues outside of the object plane. The patient’s vertebrae, proximal femur, distal radius, and
160 Part III: Image Formation

the SID. As an example, the intensity decreases

by a factor of 4 when the SID is doubled. Image
noise increases as intensity decreases. To com-
pensate for intensity changes produced by SID
changes the mAs must be changed. A 15%
Tomographic
angle change in kVp is equivalent to changing the
mAs by a factor of 2.
Image sharpness or recorded detail describes
how well small structures are recorded on the
A
image. Detail depends on focal spot size, SID,
OID, and motion. Sharp, high detail images
Object plane B Fulcrum
are obtained using small focal spots, minimum
OID, maximum SID, and short exposure times.
Distortion is the misrepresentation of the size or
C shape of an object. Magnification is size distor-
tion and depends on SID and OID. Magnifica-
tion increases geometric unsharpness. Shape
distortion depends on the alignment of the
central ray, the body part, and the image recep-
tor. Shape distortion can appear as elongation
A B B A
C C or foreshortening.
Tomographic motions selectively blur out
overlying structures to improve the contrast of
structures lying in the object plane. The thick-
Figure 11.17. Illustrates the principles of tomography. ness of the object plane is determined by the
tomographic angle. Thin tomographic cuts or
object planes are produced using large tomo-
ulna are most commonly scanned and analyzed. BMD graphic angles.
can detect bone mineral loss of a few percent, which may
indicate the beginnings of osteoporosis. Some BMD units
use two different x-ray energies to improve the analysis of
the data.

Case Study
Amanda performed an oblique hand image on
Chapter Summary a 78-year-old patient who had fallen and was
complaining of severe pain. She used 55 kVp,
X-ray quantity is determined by mAs which is
50 mA, 0.06 s, 40 inch SID, and did not use a
the product of milliamperes and time. Image
radiolucent sponge. When Amanda viewed the
noise is primarily controlled by mAs. Image
image, the metacarpals and phalanges demon-
contrast is primarily controlled by kVp. High
strated a blurring effect that partially obscured
kVp techniques produce images with long-scale
areas of the anatomy. The overall density of the
contrast and low contrast. Low kVp techniques
image is appropriate for this patient. Amanda
produce images with short-scale contrast and
decided to make some modifications and repeat
high contrast. The inverse square law states that
the radiograph.
x-ray intensity varies inversely with the square of
 Chapter 11: Image Formation 161

Critical Thinking Questions on. This simple maneuver will prevent muscle
fatigue and shaking and will provide a base of
What modifications to the exam should support for the patient’s hand. The next change
Amanda make? Amanda should make would be to change the
mA station and length of time for the exposure.
Should she use an immobilization aid? The density on the radiograph is acceptable and
so no change in kVp or mAs is needed; however,
Will she need to change kVp and mA or time? decreasing the length of the exposure will help
decrease motion blur on the image. Using a 100
How might communication help improve the mA station would allow the time to be decreased
next image? to 0.03 s, which will reduce any motion arti-
fact. Finally, Amanda needs to be sure to use
communication to let her patient know how
Because the patient is 78 years old and important it is to hold still for the image.
complaining of severe pain, she will likely not Communication is the best method of reduc-
be able to hold the oblique position for any ing motion artifact, because when the patient
length of time; this will cause fatigue in the mus- understands the need to hold still, they are more
cles and possibly shaking. To prevent any type likely to comply with the instructions.
of motion artifact, Amanda should use a radio-
lucent sponge for the patient to rest her hand
Review Questions

5. Changing the kVp from 60 to 70 kVp and decreas-

Multiple Choice ing the mAs by one-half results in
A. a shorter scale of contrast
B. increased optical density
1. In a radiographic image, focal spot blur is decreased C. a longer scale of contrast
by increasing D. decreased optical density
A. the size of the x-ray field 6. If the distance from the source is decreased by a
B. the size of the focal spot of the x-ray tube factor of 2, the mAs must be _____ to maintain the
C. the distance from the focal spot to the patient same image density.
D. the patient motion
A. increased by a factor of 2
2. Radiographs are obtained utilizing 70 kVp and B. decreased by a factor of 4
10 mAs for proper density. The kVp is decreased C. increased by a factor of 3
by 15%. In order to obtain the same film density, D. decreased by a factor of 3
the mAs must be
7. Which of the following would improve radio-
A. 2.5 graphic quality if patient motion is a problem?
B. 5
C. 20 A. 0.6 mm focal spot, 100 mA, 0.25 s
D. 40 B. 0.6 mm focal spot, 200 mA, 0.125 s
C. 0.6 mm focal spot, 300 mA, 0.083 s
3. If the distance from the source is increased from D. 1.2 mm focal spot, 500 mA, 0.050 s
36 to 72 inch SID, the exposure at 36 inch SID
used 70 kVp and 10 mAs, what new mAs should 8. The _____ is the pivot point for the tube and image
be chosen to maintain the same image density? receptor during a tomographic exposure.

A. 2.5 mAs A. tomographic angle

B. 5.0 mAs B. exposure angle
C. 20 mAs C. section thickness
D. 40 mAs D. fulcrum

4. The primary controlling factor for magnifica- 9. As the tomographic amplitude _____, a _____ slice
tion is of tissue will be imaged.

A. kVp A. larger, thicker

B. mAs B. smaller, thinner
C. focal spot size C. larger, thinner
D. OID D. amplitude has no relationship to slice thickness
 Chapter 11: Image Formation 163

10. The degree of spatial resolution is determined by 5. Name the factors that affect the resolving power of
intensifying screens.
A. line focus principle
B. line pairs per millimeter
C. spinning top test
D. wire mesh test

11. When a larger focal spot size is used, how will it

affect the focal spot blur? 6. How are tomographic angle and section thickness
related?
A. Increased
B. Decreased
C. No change

12. What is the magnification factor with a 40 inch

SID and a 30 inch SOD?
7. Explain how SID and OID affect size distortion.
A. 0.75
B. 1.33
C. 1.2
D. 0.80

8. What is the difference between elongation and

Short Answer foreshortening?

1. Why are tomographic images used as an alterna-

tive to conventional radiographic images?

9. Describe the three ways to produce the sharpest

recorded detail.

2. What is recorded detail?

10. What formula is used to determine the intensity of

the x-ray beam when the SID is changed?

3. What is the difference between voluntary and

involuntary motion?

4. Define fulcrum, focal plane, and tomographic

amplitude.
 12

Grids and Scatter Reduction

Objectives Key Terms

Upon completion of this chapter, the student ● air gap technique ● grid
will be able to: ● Bucky factor ● grid cutoff
1. Describe the effect of scatter on radiographic ● Bucky grids ● grid frequency
contrast. ● crossed grids ● grid ratio
● exit radiation ● oscillating grid
2. Identify the factors that affect the amount of
scatter. ● focused grids ● parallel grids

3. Identify methods of scatter reduction.

4. Describe the construction of an anti-scatter
grid.
5. Identify the types of grids.
6. Explain the types of grid errors.

164
 Chapter 12: Grids and Scatter Reduction 165

Introduction
Most of the x-ray photons entering a patient Absorbed
undergo Compton scattering before they exit radiation

the patient. Only those photons that do not

Scattered exit
have an interaction in the patient are useful in radiation
forming the diagnostic image. Scattered pho-
tons contain no useful information and create
fog on the image, which decreases the contrast
of the image. Contrast is one of the most impor-
tant characteristics of image production. Con-
trast provides the many shades of gray which
Transmitted exit
make a manifest image possible. Grids are the Image receptor radiation
most widely used anti-scatter devices in radiol-
ogy because they eliminate scatter before it can Figure 12.1. Illustrates how exit radiation is made up of
transmitted and scattered radiation while some photons are
reach the film.
absorbed in the tissue.

Purpose of the Grid Effect of Scatter on Contrast

Scattered radiation reduces radiographic contrast by
A grid is a device used to absorb scatter radiation before adding a general background density over the entire
it can reach the image receptor and fog the film. Grids image. Because the photons have changed direction they
are used with radiographic exams which require a high no longer relay anatomic information to the image recep-
kVp setting; this high kVp causes a high intensity beam tor. For this reason, scattered radiation provides no diag-
and results in more Compton interactions. Controlling nostic information. The presence of scatter lowers image
the amount of scatter radiation that reaches the image contrast which creates a long scale of gray that makes
receptor controls the contrast in the image. Therefore, objects more difficult to see in the radiographic image.
grids clean up scatter, which improves image contrast
and makes the manifest image visible. Factors That Affect the Amount
of Scatter
Exit Radiation Scatter depends on patient thickness, x-ray photon
Exit radiation is a combination of transmitted and scat- energy, and field size. Scatter does not depend on SID
tered radiation that passes through the patient. Transmit- or focal spot size. The technologist can change the x-ray
ted radiation undergoes no interaction in the patient. photon energy by changing the kVp and the field size by
The transmitted radiation passes through the patient with adjusting the collimator to reduce scatter. Careful selec-
no change in direction or loss of energy (Fig. 12.1). Scat- tion of the field size and kVp can significantly reduce the
tered radiation has undergone at least one Compton scat- amount of scatter and improve image quality.
tering interaction. The Compton interaction causes the
scattered radiation to change directions and lose energy Patient Thickness and Atomic Number
before leaving the patient. Scattered radiation has lower The patient is the source of scatter which is degrad-
energy and is emitted in all directions from the patient. ing the image. An increase in tissue thickness increases
The scattered radiation is the source of exposure to per- the amount of scatter because there are more atoms in
sonnel in the room during fluoroscopy and portable the thicker tissue available for interactions. The greater
examinations. number of these interactions produces more scatter. It is
166 Part III: Image Formation

sometimes possible to reduce the patient or part thickness energy and the amount of scatter. However, lower energy
and reduce the amount of scatter with some examinations. x-rays have decreased penetration and result in higher
Compression in mammography for example, reduces tis- patient doses because more x-rays are absorbed in the
sue thickness and scatter. patient. The kVp selected must be tailored to the body
The grid is designed to absorb the unwanted scatter part under examination.
radiation that occurs with larger, thicker body parts and
with procedures that use higher kVp techniques. Radiog- Field Size
raphers must keep in mind the following to determine if Images of smaller fields have less scatter because there are
a grid is needed for a given procedure: fewer interactions taking place. Larger field sizes produce
more scatter because the larger area results in more tissue
1. Body part thickness >10 cm being irradiated. Decreasing the field size decreases the area
2. kVp above 60 of tissue available for x-ray interactions. Smaller field sizes
result in less scattered radiation and higher image contrast.
When either of these factors applies to the patient, a
grid must be used to clean up scatter radiation. Another
source of scatter radiation is the type of tissue being irra-
Collimation
diated. Tissue with a higher atomic number will absorb The purpose of collimation is to define the size and
more of the x-ray beam than tissue with a lower atomic shape of the primary x-ray beam striking the patient and
number. Bone is an example of high atomic number tis- to provide a visible light field which outlines the x-ray
sue. Bone will absorb more of the beam and produce less field (Fig. 12.3).
scatter because bone absorbs more photons photoelec- A light-localizing collimator consists of two pairs of lead
trically. Soft tissue has a lower atomic number and less shutters that are adjusted to intercept x-ray photons out-
ability to absorb the photons, which then creates more side the desired x-ray field. The top pair of shutters absorbs
Compton scatter radiation (Fig. 12.2). off-focus radiation as it leaves the anode. The bottom set
of shutters has two sets of shutters which allow the radiog-
X-ray Beam Energy rapher to independently adjust the longitudinal and trans-
kVp is the factor that controls x-ray energy or the pen- verse edges of the field. This allows for infinite possibilities
etrability of the beam. Increasing the kVp results in more when matching the field size to the patient’s anatomy.
forward scatter exiting the patient and striking the image Some collimators have an iris-like shutter that can
receptor. Decreasing the kVp decreases the x-ray beam approximate a circular field. A light source is located off

Image receptor

Figure 12.2. Illustrates the increase in scatter as the patient thickness increases.
 Chapter 12: Grids and Scatter Reduction 167

size can be reduced to limit the field to the area of interest

and decrease scatter. Limiting the field size also improves
image quality and minimizes patient dose.

Scatter Reduction Techniques

The two most important methods of reducing scatter are
beam collimation and grids. As previously stated, reduc-
ing scatter radiation improves radiographic contrast.
Reducing the field size also reduces the amount of scatter
radiation produced.
Aluminum filtration

An animation for this topic can be viewed

at http://thepoint.lww.com/FosbinderText
Light Mirror
source

Grid Construction
In 1913, Dr. Gustave Bucky, an American radiologist,
designed a grid in an attempt to remove scatter and
improve contrast. The first grid was a rather crude design
Lead shutters
with strips running in two directions which left a check-
erboard pattern superimposed over the patient’s anatomy.
Figure 12.3. Shows a schematic view of a light-localizing Despite the checkerboard artifact, the grid removed scat-
collimator. ter and improved the contrast of the image.

the x-ray beam axis and a mirror directs the light through
the shutters. The x-ray beam passes through the mirror
Materials
with very little attenuation. The distance from the mir- A grid is a thin, flat, rectangular device that consists of
ror to the light source is equal to the distance from the alternating strips of radiopaque and radiolucent materials.
mirror to the tube focal spot, so the light and radiation The radiopaque material is usually lead foil due to its high
fields are the same distance from the patient surface. The atomic number and increased mass density. Lead foil is
collimator adjustment controls have indicators to show easy to shape and is relatively inexpensive; these proper-
the field size in centimeters or inches at different SIDs. ties along with the high atomic number make it the best
The size of the light field should never exceed the size of material to clean up scatter. A grid absorbs scatter from
the image receptor since this would cause primary radia- the exit radiation before it reaches the image receptor.
tion to directly strike the table and create more scatter. The grid is located between the patient and the image
Positive beam limitation (PBL) collimators automatically receptor. Scattered x-ray photons scatter in various angles
adjust the x-ray beam to the size of the image receptor. Sen- as they leave the patient and are preferentially attenuated
sors in the cassette holder (sometimes called the Bucky tray) by the lead foil strips, because they are not parallel to the
detect the size of the image receptor and adjust the collimator grid interspaces.
shutters to match the cassette size. A PBL collimator prevents The interspace material, which is the radiolucent
selecting a field larger than the image receptor. The field space between the lead strips, is made of plastic fiber or
168 Part III: Image Formation

Interspace Lead strips

material

h
h

D D

Interspace Figure 12.5. Illustrates the grid ratio from two different grids.
material Patient

The amount of scatter eliminated, often called the scatter

cleanup, depends on the grid ratio. The grid ratio is
the ratio of the height of the lead strips to the distance
between the lead strips or the thickness of the interspace
Grid (Fig. 12.5). The formula to determine the grid ratio is:

GR = h/D

When the height of the grid is constant, the grid ratio

can be increased by decreasing the space between the
Lead strips Film cassette
lead strips. To decrease the grid ratio of a grid with a
Figure 12.4. Illustrates the construction of a typical grid constant height, the lead strips would be placed farther
and the absorption of scatter. apart. High grid ratios are made by reducing the width
of the interspace material, increasing the height of the
lead strip, or using both methods. With high grid ratios
aluminum. Aluminum has a higher atomic number and
higher exposure factors are required to permit a sufficient
produces less visible grid lines on the image. The use of alu-
number of x-ray photons to reach the image receptor.
minum increases the absorption of primary x-ray photons
The higher ratio grids result in higher patient dose. Grid
in the interspace, especially at low kVp. Higher mAs factors
ratios typically range from 5:1 to 16:1. Grids with higher
are required to maintain image density but increase patient
grid ratios remove more scattered radiation but are much
dose by approximately 20%. Plastic fiber interspace mate-
more difficult to align properly. More attention must be
rials are preferred to aluminum interspace grids because
paid to make sure that the grid and x-ray tube are prop-
there is no need to increase patient dose with these types of
erly aligned to avoid errors in positioning. For this rea-
grids. There are positive and negative attributes to each type
son, portable examinations are usually taken using grid
of interspace material, therefore both are manufactured.
ratios of <12:1. General radiography examinations utilize
The radiolucent interspace materials allow transmitted
an 8:1 or 10:1 grid ratio. Figure 12.6 demonstrates the
x-rays to reach the image receptor while intercepting or
absorbing scattered x-ray photons. Only x-ray photons that
are parallel or almost parallel with the interspaces pass
through the grid. When to use a grid is a matter of profes-
sional judgment. As a general rule, grids are employed
when the body part is >10-cm thick (Fig. 12.4).

Grid Ratio
The grid ratio has a major influence on the grid’s ability Less angle, photon More angle is needed
to clean up scatter and improve contrast. The amount must be straighter for photon to go through

of scattered radiation removed by the grid depends on Figure 12.6. Grid ratio. Smaller angle = less scatter
the height of, and the distance between, the lead strips. reaching image receptor.
 Chapter 12: Grids and Scatter Reduction 169

effect of grid ratio and the angle of scatter photons. The strips that are parallel at the center of the grid, and as
high-ratio grid absorbs scatter that is at a small angle to the strips move away from the center of the grid, they
the lead strip, meaning that less scatter reaches the image become progressively more angled. If imaginary lines
receptor. were extended from the lead strips toward a fixed focal
distance, the lines would meet at a point, and this is
called the convergence line. The distance from the
front surface of the grid to the convergence line is
CRITICAL THINKING
called the grid radius. The focused grid is designed to
match the divergence of the x-ray beam. This distance
A grid is made of lead with 40 mm thick placed is known as the focal distance of the grid. The divergent
between aluminum interspace material 350 mm rays transmitted from the x-ray source pass through the
thick. The height of the grid is 3.5 mm. Determine focused grid interspaces while the scattered x-rays are
the grid ratio. (Hint: first change the grid height to intercepted.
micrometers.) When using a focused grid, the x-ray tube must be
Answer located along the length of the strips. If the tube were
placed so that the divergence of the beam ran perpen-
GR = h/D
GR = 3,500 mm/350 dicular to the strips, grid cutoff would occur. Grid cutoff
GR = 10:1 can affect a portion of the image or the whole image and
results in reduced density or total absence of film expo-
sure. The term defines what occurs to the primary x-ray
Grid Frequency photons, they are cut off from the image receptor. Grid
cutoff can also occur with parallel grids if the tube and
The grid frequency is the number of lead strips per centi- grid are misaligned.
meter or inch. Grids with thinner strips have higher grid
frequencies because the lead strips are closer together.
The lead strips of a high frequency grid are less visible Parallel Grids
on the radiographic image. The higher the grid fre- Parallel grid cutoff arises because parallel grids are con-
quency the thinner the strips of interspace material must structed with the lead strips parallel to the central axis of
be and the higher the grid ratio. Typical grid frequen- the x-ray beam, but x-ray photons diverge from the focal
cies range from 60 to 200 lines per inch. As the grid fre- spot. Grid cutoff occurs because x-rays near the edge of
quency increases, greater technical factors are required the field are not parallel to the lead strips and are attenu-
to produce an image with sufficient density; this results ated. Parallel grid cutoff is greatest when the grid is used
in greater patient dose. This occurs because as the grid with short SID or with a large image receptor because
frequency and grid ratio increase, there are more lead the x-ray beam has a wide divergence at a shorter SID.
strips absorbing the photons, which means fewer photons The pronounced angle of divergence will cause more of
are reaching the image receptor. the primary beam to be attenuated in the lead strips and
grid cutoff will be seen along the outer edges of the image
(Fig. 12.7).

Types of Grids Parallel grids should be used with smaller field sizes
and longer SIDs to reduce grid cutoff. The divergence
of the beam is less with longer a SID, in other words, the
There are two types of grids, parallel and focused. Par- beam will be straighter. This works well as the beam is
allel grids have parallel lead and interspace strips run- more parallel to the grid strips and less attenuation will
ning parallel to each other. Parallel grids are sometimes take place. Parallel grid cutoff produces a film which has
called linear grids because the lead and interspace the correct intensity in the center but is lighter at both
strips run in one direction. Focused grids have the lead edges.
170 Part III: Image Formation

Long SID

Short SID

Image
receptor

Grid
Grid cutoff Exposed area Grid cutoff Grid cutoff Exposed area Grid cutoff

Figure 12.7. Illustrates parallel grid cutoff.

Focused Grids
Focused grids eliminate grid cutoff at the edges of the
field because the lead strips are angled toward the center
and converge at the focal distance. When the x-ray
source is in line with the center of the grid and located
at the grid focal distance, there is no grid cutoff because
the transmitted radiation passes through the radiolucent
interspaces as seen in Figure 12.8. Focused grids are rec-
ommended for examinations that must use large fields
or short SIDs. An example would be abdominal imaging
that requires both the large field size and short SID to
produce an acceptable image. Typical focused grid dis-
tances are 100 and 180 cm (40 inch and 72 inch).
Each focused grid must be used with the appropriate
focal range for which it was designed. The focal range
includes short, medium, and long focal ranges where each
is designed to be used with a specific SID. Mammography
uses the short focal range grid, whereas chest radiography
requires the long focal range grid. Focused grids can be
used at distances within about 13 cm of the focal distance Figure 12.8. Illustrates the construction of a focused grid.
 Chapter 12: Grids and Scatter Reduction 171

Figure 12.9. Grid cutoff.

(A) 40 inch SID on center. (B) 40
A B inch SID, 6 cm off laterally.

with no noticeable grid cutoff. Low grid ratio focused 16:1 linear grid. The crossed grid is constructed by placing
grids allow more latitude or leeway in the alignment of two 8:1 linear grids together (Fig. 12.10). Although these
the tube to the grid before grid cutoff occurs. The higher grids are capable of cleaning up more scatter, the technol-
the grid ratio, the less latitude the radiographer has with ogist must use precise positioning of the center of the grid
grid and tube alignment.
Focused grids that are used at other than the proper
SIDs will show grid cutoff. Focused grids used outside
the focal range show a decreased intensity toward both
edges. Focused grids located off center or not perpendic-
ular to the central ray show reduced intensity on only one
side of the image.
The images in Figure 12.9 were taken with a 8:1 focused
grid at 40 inch SID; image A is centered appropriately,
while image B is off center 6 cm. Although the grid cutoff
is subtle, there is a noticeable blurring of bony markings.
The images demonstrate the increased degree of grid cut-
off when the tube is off-centered from the grid.

Crossed Grids
Crossed grids overcome the limitation of linear grids where
the grids clean up scatter in only one direction. These grids
are made by placing two linear grids on top of each other
with the grid lines perpendicular to each other. Crossed
grids are more efficient than linear grids at cleaning up
scatter. The crossed grids will clean up at least twice the
amount of scatter when compared to a linear or parallel Figure 12.10. Crossed grids constructed by placing two
grid. An 8:1 crossed grid will clean up more scatter than a linear grids together with their grid strips perpendicular.
172 Part III: Image Formation

to the center of the x-ray beam. Grid cutoff will occur if the At the time of the exposure, an electromagnet pulls
crossed grid and x-ray beam are not perfectly lined up. the grid to one side and then releases it. The grid
will oscillate in a circular motion within the grid
Stationary Grids frame for approximately 20 to 30 seconds before
ceasing motion.
Stationary grids are used in radiography departments for
mobile examinations, upright imaging, or horizontal
beam views. Most radiography departments have a supply Moving Grid Disadvantages
of stationary grids, some are directly mounted to the front and Advantages
of a cassette, while others are specially designed cassettes
with the grid built-in called a grid cassette. When using The early use of grids demonstrated grid lines or the
stationary grids, the radiographer must be aware of the checkerboard pattern largely due to the large, thick strips
grid ratio and type of grid, whether linear or focused. and interspace material. Although cleaning up scatter
and improving the contrast of the image, the grid lines
were not acceptable as they distracted from the image.
The moving grid was designed to remove the grid lines;
Grid Movement however, there were some disadvantages with the design
and placement of moving grids:

Stationary grids with low grid frequencies produce notice- ● Grid mechanism: mechanical mechanism that was
able grid lines on the final image. One way to eliminate subject to failure.
these grid lines is to move the grid during the exposure. This ● Increased OID: the distance between the patient
motion of the grid blurs out the grid lines, so they are not and film was increased due to the size of the
noticeable. Moving grids are termed Bucky grids, named grid mechanism. The increased OID creates
after one of the inventors, Dr. Gustave Bucky. Bucky’s grid magnification and blurring of the image.
design was improved upon by Dr. Hollis Potter, a Chicago ● Motion: the nature of the moving grid incre-
radiologist, in 1920 when he placed the strips in one direc- ased the motion of the film holder, if not operat-
tion, made the strips thinner and designed a device that ing perfectly the result would be additional image
allowed the grid to move during the exposure. The device blur.
is called the Potter-Bucky diaphragm, Bucky diaphragm, ● Longer exposure time: the exposure time must be
and Bucky grid. The design is still in use today. lengthened to allow the motion of the moving grid
to have the intended effect of removing the grid
Reciprocating and Oscillating lines. For some patients, this may be detrimental
Bucky grids are located directly under the table yet above due to their inability to hold still or to hold their
the image receptor. Moving grids are typically focused breath and the entire exposure.
grids which move when the exposure is being made.
There are two types of moving grids used today: The advantages of the moving grid have greatly improved
overall image quality and far outweigh the disadvantages.
● Reciprocating grid: the reciprocating grid is driven Advantages of the moving grid include the following:
by a motor. During the exposure, it moves back
and forth multiple times. The grid moves no more ● Motion blur: grid mechanisms which are operating
than 2 to 3 cm at a time. A selector at the control properly will completely blur out grid lines, mak-
panel activates the grid motor. If the motor is not ing the overall image more diagnostic.
activated, the grid is stationary during exposure and ● Use in radiography: the moving grid is consistently
grid lines will be apparent on the image. used in radiography for body parts which measure
● Oscillating grid: the oscillating grid is suspended >10 cm. This industry standard allows consistent
in the center of a frame by four spring-like devices. imaging from one facility to the next.
 Chapter 12: Grids and Scatter Reduction 173

Grids are very useful in radiographic exams where the TABLE 12.1 GRID RATIOS AND ASSOCIATED
tissue thickness is above 10 cm, as the tissue thickness BUCKY FACTORS OR GCF
increases so does the amount of scatter. A skilled Grid Ratio Bucky Factor or GCF
radiographer will be able to determine the proper grid for
the examination that will be performed. None 1
5:1 2
6:1 3
8:1 4
10:1 or 12:1 5

Grid Selection 16:1 6

Selecting the correct grid for a specific procedure with higher grid ratios and higher kVp settings. The Bucky
requires consideration for the type of examination and factor is mathematically represented as:
the amount of kVp to be used. Examinations that require mAs with the grid
kVp settings over 95 kVp require a high-ratio grid for max- GCF =
mAs without the grid
imum cleanup of scatter; higher kVp results in increased
amounts of scatter. High-ratio grids are more efficient at
absorbing scatter, which results in less exposure to the
image receptor. For some examinations, this could have a CRITICAL THINKING
negative effect on the image, so with high-ratio grids, the
exposure factors will need to be increased. mAs is typi- A satisfactory AP knee radiograph was produced using
cally increased to maintain image density and gray scale, 7 mAs at 75 kVp without a grid. A second image is
but the payoff is increased patient dose. In other words, requested using an 8:1 grid. Using Table 12.1, what
the more efficient the grid is at cleaning up scatter, the mAs is needed for the second image?
higher the dose to the patient. Answer
mAs with the grid
GCF =
Bucky Factor mAs without the grid
x mAs
The Bucky factor measures how much scatter is removed 4=
7mAs
by the grid and how the technique factors must be adjusted x = 4 ´ 7mAs
to produce the same optical density. Scattered radiation x = 28mAs
accounts for a portion of the density on the final radiograph.
If a grid removes some scatter, the exposure factors must be
increased to compensate for the decrease in x-ray photons Required Change in mAs
reaching the image receptor. The Bucky factor or grid con-
version factor (GCF) is the ratio of the mAs required with
Following a Change of Grids
the grid to the mAs without the grid to produce the same If a grid with a different grid ratio is used in a follow-up
optical density. The Bucky factor is always >1. The Bucky examination, the change in mAs is given by the ratios of
factor depends on the grid ratio and the grid frequency but the Bucky factors:
is usually in the range 3 to 5. This means that adding a grid
requires an increase in mAs by a factor of 3 to 5 to obtain æ GCF2 ö
the same optical density compared to a non-grid technique. mAs2 = mAs1 ç ÷
The use of a grid increases the patient dose by the Bucky è GCF1 ø
factor. The Bucky factor is used to calculate the necessary
change in mAs when a grid is added or when changing to where mAs1 is the original mAs, mAs2 is the new mAs,
a grid with a different grid ratio. The GCF will increase GCF1 is the original GCF, and GCF2 is the new GCF.
174 Part III: Image Formation

1. High grid ratios increase patient dose.

CRITICAL THINKING 2. High kVp examinations typically use high-ratio
grids.
3. Low kVp examinations result in increased patient
An examination taken in the department used 30 mAs
dose because more radiation is attenuated.
with a 12:1 grid. What mAs should be used for the
4. High kVp examinations result in decreased patient
follow-up portable examination taken with an 8:1 grid?
dose.
Answer
æ GCF2 ö The utilization of grids for many examinations has
mAs2 = mAs1 ç ÷ required an increase in technical factors when compared
è GCF1 ø
to non-grid technical factor settings. The exposure time,
æ4ö mA, or kVp must be increased to provide adequate optical
mAs2 = 30 ç ÷
è5ø density on the image. Of these factors, kVp has been stan-
= 24 mAs dardized in many departments and the mAs is changed to
The repeat image will require less mAs due to the compensate for the patient’s body habitus.
lower GCF.

CRITICAL THINKING
Grid Errors
Modern x-ray rooms use the moving grid in the table and
A satisfactory abdominal radiograph was produced upright Buckys. Improper usage of the moving Bucky
using an 8:1 grid, 25 mAs, and 90 kVp. Due to the will result in a poor radiographic image. Many errors
long scale of contrast in the image, a second image occur because the design is a focus grid where the likeli-
was requested with a 12:1 grid. Using Table 12.1,
hood of an error is more common. Grid errors can be
what will be the new mAs for the second image?
avoided if the technologist properly centers the x-ray tube
Answer with image receptor at the correct SID and if the moving
mechanism is function normally.
æ GCF2 ö
mAs2 = mAs1 ç ÷ The Potter-Bucky diaphragm or Bucky is mounted
è GCF1 ø underneath the table top directly above the image recep-
æ5ö tor. The grid in the Bucky must move side to side or in a
mAs2 = 25 ç ÷
è4ø circular pattern perpendicular to the lead strips to effec-
= 31.3mAs tively blur out the grid lines. If the Bucky were to move in
the same direction as the lead strips, the grid lines would
The second image will utilize a higher mAs setting
be visible on the image.
and there will be more cleanup of scatter resulting in
Improper positioning of the grid will always produce
an image with more contrast and less gray scale.
grid cutoff. The grid must be placed perpendicular to the
central ray to eliminate grid cutoff. The central ray can
As seen in the above examples, a change in mAs is be angled to the grid providing it is angled along the long
required when the grid ratio changes. The major dis- axis of the grid strips but not across or perpendicular to
advantage with using a high-ratio grid is the increased the lead strips.
patient dose (Fig. 12.11). When using low-ratio grids Grid cutoff rarely occurs in the radiology department
with low kVp, there is still a concern for patient dose. where fixed cassette holders or Bucky trays are routinely
The proper selection of the appropriate grid will increase used. Grid alignment is more critical with high grid ratios
image contrast and the diagnostic quality of the image. and can be a serious problem with portable radiographs.
The radiographer must remember the following factors Careful positioning of grids during portable examinations
when selecting the correct grid for the exam: is especially important because even slight misalignments
 Chapter 12: Grids and Scatter Reduction 175

B
A

Figure 12.11. Grid conversion. (A) The

AP image of the abdomen shows low con-
trast due to no grid being used. This is an
acceptable image for the soft tissue but
does not demonstrate the bone very well.
(B) The same image, except an 8:1 grid,
has been used. Notice the shorter scale of
gray which demonstrates the bone. (C) A
12:1 grid has been used; the scale of
contrast is too short to provide a diagnos-
tic image of either the bone or soft tissue.
C
(Courtesy Christa Weigel, FHSU.)

will produce noticeable grid cutoff. Grid cutoff during from improper tube or grid positioning. Improper tube
portable examinations is a major cause of retakes. positioning occurs when the central ray is directed across
Grid errors occur most frequently because of improper the long axis of the table. Improper grid positioning most
positioning of the x-ray tube and grid. The grid will func- commonly occurs with stationary grids which are used
tion correctly when the x-ray tube and grid are precisely for mobile procedures or decubitus imaging, for example,
lined up with each other. When the radiographer is not when a patient is lying on a grid for a mobile pelvis exam-
careful and misaligns the tube and grid, the following ination and the patient’s weight is not evenly distributed
errors will occur: on the grid causing the grid to angle underneath the
patient. When the vertical x-ray beam is aligned to the
● Off-level error angled grid, off-level grid error will occur. The image will
● Off-center error demonstrate a decrease in density over the whole image.
● Off-focus error Figure 12.12 illustrates the angle of the grid compared to
● Upside down error the vertical beam and the resultant radiographic image.

Off-level Error Off-center Error

An off-level error will occur when the x-ray tube is angled The x-ray tube must be centered along with the center
across or perpendicular to the grid strips. This can result of a focused grid to prevent off-center error, also called
176 Part III: Image Formation

A Lighter density
B
grid cutoff

Figure 12.12. Off-level error. (A) Diagram of off-level error. (B) A radiographic image
demonstrating off-level grid error.

off-axis and lateral decentering grid error. The center beam. When the x-ray tube is off-centered laterally, the
lead strips in a focused grid are perpendicular and the perpendicular portion of the x-ray beam will intersect the
lead strips become more angled away from center as the angled grid strips causing a decrease in exposure across
strips get closer to the edges of the grid. The focused the image. As demonstrated in Figure 12.13, the diver-
grid is designed to match the divergence of the x-ray gence of the beam will not line up with the angle of the

Focused
grid

Lighter density Image receptor

grid cutoff B
A
Figure 12.13. Off-center error. (A) Diagram of off-center error. (B) A radiographic image demonstrating
off-center grid error.
 Chapter 12: Grids and Scatter Reduction 177

Convergence point

X-ray beam

Focused
grid

Image receptor
A

Figure 12.14. Off-focus error. (A) Diagram of off-focus

B
error. (B) A radiographic image demonstrating off-focus grid
error.
178 Part III: Image Formation

X-ray beam

Focused
grid

Grid cutoff Exposed area Grid cutoff

A
Image receptor B

Figure 12.15. Upside-down error. (A) Diagram of upside down error. (B) A radiographic image dem-
onstrating upside-down grid error.

lead strips. This grid error can be avoided if the radiog- result will be severe grid cutoff on either side of the cen-
rapher correctly places the x-ray tube in the center of ter of the image. The x-ray beam will pass through the
the grid; in some equipment, the tube will lock in place central axis of the grid and will be attenuated by the lead
when correctly positioned to the detent in the middle of strips that are angled in the opposite direction of the
the table. beam divergence (Fig. 12.15). Focused grids are clearly
marked on the tube side of the grid. The radiographer has
to merely look at the grid to know which surface needs to
Off-focus Error face the tube.
The off-focus error results when the focused grid is used Table 12.2 presents the appearance of different forms
with a SID that is out of the focal range and not specified of grid cutoff and the possible causes.
for the grid. Figure 12.14 illustrates what happens when a
focused grid is not used in the proper focal range. Unlike TABLE 12.2 GRID ARTIFACT APPEARANCES
the other grid errors, off-focus grid errors are not uniform AND THEIR POSSIBLE CHANGES
across the entire image, rather there is severe grid cutoff
at the periphery of the image. Positioning the grid at the Optical Density Possible Causes
proper focal distance is more crucial with high-ratio grids Correct density in the Parallel grid at too short
because these grids have less positioning latitude than center, lower density SID
low-ratio grids. on both sides of image Upside-down focused grid
Focused grid outside focal
distance range
Upside-down Error Correct density in the Grid center not aligned with
center and on one side, central axis
This type of error is readily seen and identified imme- low density on one side Grid not perpendicular to
diately. When the grid is placed upside down, the lead central axis
strips are not angled toward the center of the grid. The
 Chapter 12: Grids and Scatter Reduction 179

the OID is increased, there is an increase in magnification

Alternative Method and a reduction in detail. To compensate for this, a lon-
ger SID is utilized with a small focal spot size. Because of
to Reduce Scatter the longer SID, the mAs must be increased to maintain
radiographic density. The patient dose does not increase
because the intensity of the x-ray beam will decrease with
Air Gap Technique the longer SID.
The air gap technique is an alternate scatter reduction
method and can be used instead of a grid. The air gap
technique uses an increased OID to reduce scatter reach-
ing the image receptor. This technique is used in lateral
Chapter Summary
C-Spine and chest radiographs. Remember that the Radiation leaving the patient is a combination
patient is the source of scatter and the increased OID of transmitted and scatter radiation. Scatter
causes much of the scattered radiation to miss the image decreases contrast and depends on field size,
receptor. This eliminates the need for using a grid to patient thickness, beam energy, or kVp. The
reduce scatter and to improve the contrast of the image. primary methods of scatter reduction are reduc-
A major disadvantage of the air gap technique is the loss tion in field size and the use of a grid. In special
of sharpness, which results from the increased OID. The applications, such as C-spine imaging, an air
air does NOT filter out the scattered x-rays. gap can be used to reduce scatter. Grids are
An OID of at least 6 in is required for effective scatter constructed of alternating strips of a radiopaque
reduction with the air gap technique (Fig. 12.16). When material such as lead and a radiolucent material
such as aluminum or plastic.
Using a grid with a higher grid ratio increases
the patient dose, increases the Bucky factor,
Scattered increases the film contrast, and requires an
rays
increase in mAs. The Bucky factor is the ratio
Image receptor
of mAs with the grid to mAs without the grid.
High grid ratios are not used in portable imag-
Patient ing because the alignment is very critical. The
types of grid errors include off-center, off-level,
off-focus, and placing the grid upside down.
These errors can be avoided when the radiogra-
pher properly centers the tube with the Bucky
and places the cassette properly with the tube
side of the cassette toward the patient.

Case Study
Todd performed a portable abdominal radio-
graph using a 40 inch SID, 5:1 grid, 85 kVp,
and 20 mAs. Upon reviewing the image, Todd
6“ OID
noticed that the overall appearance of the
Air gap anatomy was not what he expected. The image
Figure 12.16. Illustrates how the air gap technique lacked sufficient contrast and had a long scale of
reduces scatter.
180 Part III: Image Formation

gray which obscured some anatomy. There also kVp is above 80 kVp. He will need to use a
appeared to be less density over the whole image 12:1 grid for the repeat. This will correct the
than what he expected and the spine was not in lack of contrast by cleaning up more scatter
the middle of the image. Todd determined that and will produce a shorter scale of gray. When
the image would need to be repeated, but first converting from a 5:1 grid to a 12:1 grid, Todd
he had to decide the factors that would need to will need to make an increase in mAs. To
be changed to produce a diagnostic image. determine exactly how much he will need to
use the Bucky factor or grid conversion formula,
mAs2 = mAs1 (GCF2)/(GCF1). 20 mAs (5/2) =
Critical Thinking Questions 50 mAs will be the new mAs. The new factors
of 85 kVp and 50 mAs will provide the neces-
Did Todd use the correct grid ratio for the tech- sary amount of photons to have a lower contrast
nical factors he used? image. The placement of the spine indicated
that the grid was not placed completely under-
With a higher kVp exam, should Todd have neath the patient, and the lack of exposure
used a high-ratio grid? density indicated that the tube was not centered
with the grid, causing the grid to be off-centered
If a change in grid ratio is determined, what will toward one side. This error caused a decrease
the new mAs be? in density over the whole image. On the repeat,
Todd will need to make certain that the grid is
How will Todd address the placement of the placed equally underneath the patient and that
spine in the image and how does this relate to the tube is placed in the center of the patient.
the overall decrease in density on the image? This will place the spine in the center of the
image and will prevent the off-centering error
which decreased the amount of exposure to
Todd determined that using 85 kVp required the grid. Todd feels confident that with these
him to use a higher ratio grid, as a 5:1 grid changes the next abdomen radiograph will be a
will not effectively clean up scatter when the diagnostic image.
Review Questions

6. What is the grid ratio for a grid made with 20 mm

Multiple Choice of lead between 437 mm of aluminum interspace
material and a height of 3.5 mm?
A. 12:1
1. Exit radiation consists of B. 8:1
C. 5:1
A. transmitted radiation
D. 16:1
B. scattered radiation
C. transmitted plus scattered radiation 7. Which type of grid error occurs when the grid is
D. transmitted minus scattered radiation not perpendicular to the x-ray tube?
2. Increasing the field size will _____ the amount of A. Off-center
scatter. B. Off-focus
C. Upside-down
A. increase
D. Off-level
B. decrease
8. Which type of tissue will attenuate more photons
3. A grid is made of
and create less scatter?
A. alternating strips of muscle and fat
A. Soft tissue
B. alternating strips of lead and plastic
B. Adipose tissue
C. alternating strips of gelatin and emulsion
C. Bone
D. alternating strips of paper and plastic
D. All tissue creates the same amount of scatter
4. The number of lead strips per centimeter is called
9. A _____ grid has lead strips and interspace material
the
which run parallel to each other.
A. Bucky factor
A. focused
B. grid ratio
B. linear
C. grid frequency
D. grid focal factor 10. High frequency grids _____ patient dose and
typically have a_____ grid ratio.
5. An increase in patient thickness will increase the
amount of scatter. A. increase, higher
B. decrease, higher
A. True
C. decrease, lower
B. False
D. increase, lower
182 Part III: Image Formation

11. Which material is preferred for the radiopaque 6. Explain how the air gap technique improves
grid strips? contrast.

A. Gold foil
B. Platinum foil
C. Lead foil
D. Mangenese

7. As the ability of a grid to clean up scatter improves,

Short Answer what is the effect on patient dose?

1. How does a grid improve contrast?

8. How does scatter radiation affect contrast?

2. A grid should be used when this general rule is

applied.

9. What is the difference in the Bucky factor between

a non-grid and a 16:1? Refer to Table 12.1.

3. Gustave Bucky’s original grid was a _____ grid.

10. Explain the differences between a reciprocating

and oscillating grid.

4. Explain why lead is used as the grid strip

material.

5. What is the advantage of a moving grid?

 PART IV

Special Imaging
Techniques
 13

Fluoroscopy, Conventional
and Digital

Objectives Key Terms

Upon completion of this chapter, the student ● automatic bright- ● flux gain
will be able to: ness control (ABC) ● image intensifier
1. Identify the components of a fluoroscopic ● carriage ● magnification
system. ● cathode ray tube ● minification gain
● cine ● photocathode
2. Identify the components of an image
● ESE ● SSD
intensifier.
● fluoroscopy ● vignetting
3. Describe the purpose of an automatic
brightness control circuit.
4. Identify the factors that influence patient dose
during fluoroscopy.
5. Explain the effects of flux and minification
gain on total brightness gain.
6. Discuss the factors that affect fluoroscopic
image contrast, resolution, distortion and
quantum mottle.

184
 Chapter 13: Fluoroscopy, Conventional and Digital 185

Introduction Eye Physiology

Fluoroscopy is a live, moving x-ray technique
that is used to localize potential abnormali- Early fluoroscopic systems employed a phosphor coating
ties without recording the images on film. It on a lead glass plate. The image brightness of these sys-
gives a real-time or dynamic image as the x-rays tems was so low that they could be viewed only with
pass through the patient. An image intensifier a dark-adapted eye. The retina of the human eye has
converts x-ray energy into visible light energy. two types of light receptors, rods and cones. Cone vision
The image intensifier is used during fluoros- requires bright light or daylight, which is called photo-
copy for increasing sensitivity and brightness, pic vision. Rod vision is used in dim light or complete
thus reducing the patient radiation dose. Inside darkness, which is called scotopic vision. Cone vision
the image intensifier, the pattern of x-rays is has excellent spatial resolution with high visual acuity
converted into an electron pattern, and the because the cones are concentrated near the center of
electrons are accelerated onto an output phos- the retina. Cones are also better able to distinguish the
phor and converted into a brighter visible light difference in brightness levels, are sensitive to a wide
image. In this chapter, we cover the construc- range of wavelengths of light, and can perceive color.
tion and application of an image intensifier Rod vision has poor spatial resolution and is color
and the automatic brightness circuit of a fluoro- blind.
scopic system. During a fluoroscopic examination, maximum image
detail is necessary and image brightness must be high.
The image intensifier was developed by Bell Laboratories
to increase the brightness of the image so that the image
could be viewed with cone vision.
Historical Perspective
Thomas A. Edison invented the fluoroscope in 1896, Fluoroscopy
the year after Roentgen’s discovery of x-rays. The origi-
nal fluoroscope was held by hand above the patient’s Fluoroscopy is a dynamic imaging modality designed
body in the path of the x-ray beam. The radiologist had to observe moving structures in the body, in contrast to
to stand directly in front of the fluoroscope to view the conventional radiography that produces static images of
patient’s anatomy, which meant the radiologist’s head body structures. During fluoroscopy, a radiologist views
and eyes were in the direct path of the primary beam. the fluoroscopic image and obtains a diagnosis. Static
The fluoroscope emitted a very faint fluorescent image, digital images of the fluoroscopic image can be obtained
which required the radiologist to “dark adapt” his or her whenever a permanent record is needed. Fluoroscopy is
eyes. This meant the radiologist had to wear red goggles currently used for examinations that require observation
for up to 30 minutes prior to the examination to adjust of physiologic functions such as the movement of barium
his or her eyes and the examination had to be performed through the gastrointestinal tract, injection of contrast
in a completely dark room. These conditions permit- medium into a joint or blood vessels.
ted the radiologist to see the faint fluoroscopic image. Most fluoroscopic rooms also have an overhead tube
Obviously, there were many hazards to the radiologist for conventional radiography and are called radiographic
when viewing the fluoroscopic image. Eventually, the and fluoroscopic rooms or “R and F” rooms. The fluo-
fluoroscopic screen was replaced with an image intensi- roscopic x-ray tube and image intensifier are connected
fication tube, video cameras, and monitors for viewing in a c-arm configuration that allows synchronous move-
the image. ment (Fig. 13.1).
186 Part IV: Special Imaging Techniques

Video camera

Image intensifier tube

Spot film holder

Lead drape

Table

Under table tube

Figure 13.1. Shows a typical older model fluoroscopic room.

X-Ray Tube the table. The collimators adjust the size of the x-ray beam
and restrict x-rays to the image receptor, which is the image
Fluoroscopic x-ray tubes have the same design and con- intensifier. The source to skin distance (SSD) of a fixed fluo-
struction as conventional x-ray tubes, but they are oper- roscopic tube must be at least 38 centimeters (cm) (15 inches
ated for many minutes at a much lower milliampere (mA) [in]) and a portable C-arm fluoroscopic unit must have an
value. Figure 13.2 shows a modern “R and F” room. SSD of at least 30 cm (12 inches). This is to limit the radia-
Most of these rooms have digital capabilities; therefore, tion dose to the skin during fluoroscopic procedures.
spot film devices are not necessary. Typical fluoroscopic
tube currents are 0.5 to 5 mA, whereas radiographic tube
currents are 50 to 500 mA. Fluroscopic kilovoltage or
Table
kVp is adjusted on the control panel. High kVp is usually The table that supports the patient can be changed from
selected with low fluoroscopic mA. This kVp selector is a horizontal position into a vertical position for upright
separate from kVP used for conventional x-ray imaging. examinations. Some tables are constructed of carbon
All fluoroscopic and radiographic rooms have separate fiber materials, which have great strength, and reduce
mA and kVp controls, depending upon the selection of attenuation of the x-ray beam by the tabletop, thus reduc-
fluoroscopy or conventional x-ray imaging. The fluoro- ing patient exposure. The table is equipped with a remov-
scopic tube is operated by a foot switch that allows the able footboard for routine radiographic procedures. Care
radiologist to use both hands to move the fluoroscopic must be taken to properly secure the footboard on the
tower and to position the patient. When the equipment table for fluoroscopic examinations.
is set up for fluoroscopy, care must be taken to avoid step-
ping on the foot switch and inadvertently exposing the
patient and personnel to unnecessary radiation.
Image Intensifier Tower
The fluoroscopic tube is usually located beneath the The image intensifier tower contains the image intensifier
patient support table. Tube shielding and beam-limiting and a group of controls that allow the operator to adjust the
collimators are also located in the tube housing beneath field size, move the x-ray tube and table, and make spot
 Chapter 13: Fluoroscopy, Conventional and Digital 187

Image intensifier
and CCD

Control panel

Carriage

Lead drape
Footboard

Under table tube

Figure 13.2. Shows a modern “R and F” room.

film exposures. A lead drape hangs from the image intensi-

fier tower to attenuate radiation scattered from the patient. Output phosphor
This lead drape has 0.25 mm Pb (lead) equivalent. The TV
camera is mounted at the top of the image intensifier tower. Anode
The tower is connected to the x-ray tube mount, so that
both move together as a unit. The x-ray tube can be pushed
away from the table to allow access to the patient; however, Glass envelope
it must be locked in place for the beam to be energized and
directed toward the image intensifier (Fig. 13.3).

Electrostatic
focusing

Image Intensifier lenses

Components
An animation for this topic can be viewed
at http://thepoint.lww.com/FosbinderText Photocathode
Input
phosphor

The image intensifier is a sophisticated piece of electronic

equipment which greatly increases the brightness of the Figure 13.3. Illustrates a cross-sectional view of a typical
image. Modern image intensifiers can increase image image intensifier tube.
188 Part IV: Special Imaging Techniques

brightness up to 8,000 times. Figure 13.3 demonstrates phosphor is converted into a similar pattern of electrons
the components of a typical image intensification tube. leaving the photocathode. The pattern of photoelectrons
The input screen absorbs the x-ray photons and emits carries the latent image of the patient’s anatomy.
light photons. The photocathode immediately absorbs
the light photons and emits electrons. The electrons are Lenses
accelerated from the photocathode toward the anode
The electrostatic lenses are located along the inside of
and the output screen. The electrons are accelerated and
the image intensifier and are charged with a low voltage
focused by electrostatic lenses. The output screen absorbs
of 25 to 35 kVp to accelerate and focus the photoelec-
the electrons and emits light photons. These conversions
trons. Electrostatic lenses inside the image intensifier
and the properties which make them possible will be dis-
focus the negative photoelectrons from the photocath-
cussed in this section.
ode onto the output phosphor. The concave surface of
the photocathode reduces distortion by maintaining the
Input Phosphor distance between all points on the input screen and the
The input phosphor of the image intensifier tube is made output phosphor. As the photoelectrons travel to the out-
of glass, titanium, steel, or aluminum and coated with put phosphor, they will cross at the focal point where
cesium iodide (CsI) crystals because CsI has high x-ray the image is reversed, so the output phosphor image is
photon absorption and light emission characteristics. The reversed from the input phosphor. The focal point is
interactions in the input phosphor are similar to the inter- the precise location where the photoelectrons cross; this
actions in an intensifying screen. The input phosphor is location is changed when the image intensifier is used in
approximately 10 to 35 cm in diameter and absorbs about normal or magnification mode (Fig. 13.4).
60% of the exit radiation leaving the patient.
The input phosphor is concave to maintain the same
distance between each point on the input phosphor and Output phosphor
its matching location on the output phosphor. The con-
cave surface enhances the sharpness of the image. The
Anode
phosphor emits light in a vertical line, which improves
image detail and spatial resolution. The light emitted is
proportional to the absorption of the photons. Each x-ray
photon produces between 1,000 and 5,000 light photons.
The input phosphor and photocathode are bonded
together. The input phosphor is coated with a protective
coating to prevent a chemical interaction with the photo-
cathode materials. The photocathode is made of cesium and
antimony which emit electrons when stimulated by light.

Photocathode
The photocathode is located on top of the input phos-
Input
phor and also has a concave surface. The photocathode phosphor
is made of a special materials that emit photoelectrons
when it is struck by light. This phenomenon is known
as photoemission. Light from the input phosphor ejects Magnification
photoelectrons from the photocathode. The number of mode
6”
photoelectrons is proportional to the amount of light
striking the photocathode. Bright regions of the phosphor 9”
cause the photocathode to emit many photoelectrons. Normal mode

Dark regions of the phosphor result in the emission of few Figure 13.4. Illustrates the image intensifier focusing for a
photoelectrons. The pattern of x-ray photons at the input normal and a magnified image.
 Chapter 13: Fluoroscopy, Conventional and Digital 189

Anode and Output Phosphor Conversions Parts (Charge)

Light
Photoelectrons from the photocathode are accelerated Output phosphor
toward the positively charged anode by low voltage rang-
ing from 25 to 35 kVp, this kVp accelerates the photo- Anode (+)
electrons even more. This allows the photoelectrons
Focal point
to have high kinetic energy. The photoelectrons pass Glass envelope
through the anode and strike the output phosphor. The
output phosphor is approximately 2.5 to 5 cm in diam-
eter. The output phosphor is made of zinc cadmium
sulfide (ZnCdS), which efficiently converts photo- Photo- Electrostatic
electrons lenses (–)
electron energy into visible light. Each photoelectron
that reaches the output phosphor converts into 50 to
75 times more light photons (Fig. 13.5). The light pho-
tons are emitted in all directions which risks some light
photons being emitted toward the input phosphor, which Photocathode (–)
would degrade the image. The output phosphor has a Light
Input phosphor
thin aluminum coating that prevents the light photons
X-ray
photons

Figure 13.6. Summarizes the components of the image

3000 light intensifier and the process of converting remnant radiation
photons with the latent image into light photons at the output phos-
phor. A thorough knowledge of these concepts is critical in
Output phosphor understanding how an image intensifier works.

from leaking back across the image intensifier, thereby

decreasing the image noise and improving the resolution
1000 photo of the image (Fig. 13.6).
electrons

Brightness Gain
Photocathode
300 light Brightness gain is a measurement of the increase in
photons image brightness or intensification achieved by the con-
Input versions in the image intensification tube. The increased
phosphor illumination of the image is due to the multiplication
of the light photons at the output phosphor compared
to the incident x-ray photons which interact with the
One incident
x-ray input phosphor. Two factors are used to determine the
total brightness gain: flux gain and minification gain.
Figure 13.5. In the image intensifier tube, one incident The total gain in brightness comes from a combination
x-ray photon that interacts with the input phosphor results
in a large number of light photons at the output phosphor. of acceleration of the photoelectrons, called flux gain,
This figure demonstrates the flux gain of 3,000 light and compression of the image size, called minification
photons. gain.
190 Part IV: Special Imaging Techniques

Flux Gain
CRITICAL THINKING
Flux gain is the ratio of the number of light photons at
the output phosphor to the number of x-ray photons at
the input phosphor, thus producing the conversion of the What is the minification gain when the input
electron energy into light energy. If the output phosphor phosphor diameter is 9 inches and the output
produces 100 light photons for each photoelectron that phosphor diameter is 2 inches?
strikes it, the flux gain would be 100. Typical flux gains Answer
are 50 to 100.
Input phosphor diameter 2
Minification gain =
Number of output light photons Output phosphor diameter 2
Flux gain =
Number of input x- ray photons 92
Minification gain =
22
81
Minification gain =
4
CRITICAL THINKING Minification gain = 20.25

What is the flux gain if there are 50 x-ray photons at

the input screen and 4,500 light photons at the out-
put phosphor? Total Brightness Gain
Answer Total brightness gain is obtained by multiplying flux
Number of output light photons gain by minification gain. Typical image intensifiers
Flux gain = have brightness gains of 5,000 to 30,000. The out-
Number of input x-ray photons
put image at the output phosphor is over 5,000 times
4,500 brighter than the image at the input phosphor. The
Flux gain =
50 image intensifier will have decreased brightness as it
Flux gain = 90 ages, resulting in increased patient dose to maintain
brightness. The formula to determine the total bright-
ness gain is:

Minification Gain Brightness gain = flux gain × minification gain

Minification gain is the ratio of light from input phos-

phor to light at the output phosphor, thus producing
concentrated light from the larger input phosphor onto CRITICAL THINKING
the smaller output phosphor. Minification gains vary
from 40 to 90. For example, an input phosphor diameter
What is the total brightness gain if the flux gain is
of 10 to 35 cm results in the light being concentrated
70 and the minification gains is 81?
to an output phosphor diameter of 2.5 to 5 cm. Mini-
fication is an increase in brightness or intensity of the Answer
image; it is not an improvement in the quality or num- Brightness gain = flux gain × minification gain
ber of photons making up the image, as this information Brightness gain = 70 × 81
is contained in the latent image as the x-ray photons exit Brightness gain = 5,670
the patient.
In this example, the image at the output phosphor
Input phosphor diameter 2 is over 5,000 times brighter than the incident x-ray
Minification gain = photons.
Output phosphor diameter 2
 Chapter 13: Fluoroscopy, Conventional and Digital 191

Automatic Brightness Control which allows for better visualization of small structures.
The operator can change the magnification through the
The automatic brightness gain or the automatic bright- controls on the image intensifier tower. Selection of a
ness control (ABC) circuit maintains the fluoroscopic smaller portion of the input phosphor produces a magni-
image density and contrast at a constant brightness by fied image but results in a higher patient dose because
regulating the radiation output of the x-ray tube. This cir- there is less minification gain in the magnification mode.
cuit is also known as the automatic brightness stabilizer. When the magnification mode is selected either on a
A detector monitors the brightness level of the image inten- dual-focused or tri-focused image intensifier, the voltage
sifier output phosphor. The ABC adjusts the fluoroscopic supplied to the focusing electrodes inside the image inten-
mA to maintain a constant output brightness regardless of sifier is increased, which causes the focal point to move
the thickness or density of the body part being examined. closer to the input screen and the image to be magnified.
Fluoroscopic mA, 0.5 to 5 mA, is increased or decreased Figure 13.7 illustrates the area on the input phosphor
to compensate for various body thicknesses. The ABC has that is used in the magnification mode. Notice how the
a relatively slow response time which temporarily affects focal point has moved closer to the input phosphor; this
the image on the monitor. During a fluoroscopic exami- movement causes the magnification of the image.
nation, rapid changes in body thickness can cause the Only the electrons from the diameter of the selected
ABC to lag behind for a moment or two before the kVp input phosphor and photocathode are used to accelerate
and mA is adjusted to provide the appropriate amount of to the output phosphor. In the magnification mode, the
brightness for the tissue thickness. minification gain is reduced because there are fewer pho-
toelectrons reaching the output phosphor, resulting in a
dimmer image. This will cause the fluoroscopic mA to be
Magnification Tubes automatically increased to maintain the same brightness
Electrostatic lenses can change the magnification of the level, but it will also cause an increase in patient dose. In
image by changing the focal point of the photoelectrons. a dual-focused mode, selection of the magnification can
Dual- or multiple-mode image intensifiers provide dif- increase patient dose by two times. The increased patient
ferent magnifications for different applications. Mag- dose will result in better image quality because more
nification is an increase in the image size of an object, x-ray photons make up the latent image, which lowers

Focal point

Focal point

Low voltage High voltage

supplied to supplied to Figure 13.7. Voltage sup-
electrostatic electrostatic plied to the electrostatic
lenses lenses lenses controls the location
of the focal point. (A) Low
voltage supplied to lenses.
(B) High voltage supplied
to lenses. As the focal point
gets closer to the input
phosphor, the size of the
area of the input phosphor
A B
decreases.
192 Part IV: Special Imaging Techniques

image noise and increases contrast resolution. The ABC the input and output phosphors, and light scatter within
circuit increases the fluoroscopic mA to compensate for the image intensifier itself. Scattered radiation produces
the reduced minification gain. scatter photons at the input phosphor and also produces
Magnification image intensifiers are capable of 1.5 to limited background fog from incident x-ray photons
4 times magnification. The resolution of the image can which are transmitted through the image intensifier tube
be increased from 4 to 6 lp/mm when the magnification to the output screen. The output phosphor has an alumi-
mode is selected. To calculate the magnification factor, num filter that is designed to prevent backscatter from the
the following formula is used: output phosphor to the input phosphor, but in reality, it
does not block 100% of light photons from leaking back
Input screen diameter
Magnification = to the input phosphor. Each of these combine to create
Input screen diameter background fog that increases the base density of the
during magnification image. These principles are the same as discussed in film
processing where the base plus fog affects image contrast.
In a fluoroscopic image, the visible contrast is decreased.
CRITICAL THINKING
Resolution
What is the magnification for an image view with an
The resolution of the fluoroscopic image is directly affected
image intensification tube where the input screen
diameter is 9 inches and a 6 inches diameter is used by the video monitoring system. Many video monitoring
in magnification mode? systems are limited to a 525-line raster pattern where fluo-
roscopic geometric factors affect the overall resolution of
Answer the image. The fluoroscopic geometric factors include
Input screen diameter minification gain, flux gain, focal point, input and out-
Magnification =
Input screen diameter put phosphor diameter, size and thickness, viewing system
during magnification resolution, and OID.
9 inches
Magnification =
6 inches Distortion
Magnification =1.5 times Distortion in fluoroscopy has the same considerations as
distortion in routine radiography. Size distortion, caused
This means that the image will appear 1.5 times
by OID, makes the image appear to be more magnified
larger than normal.
under fluoroscopy especially when the image intensi-
fier is in magnification mode. The size distortion is the
same whether the image has been magnified or not, there
just appears to be more distortion because the image is
Image Quality larger and the distortion is easier to see. Shape distortion
is caused by the design of the image intensifier tube. The
concave curve of the input phosphor was designed to pro-
Creating a fluoroscopic image is a complex procedure
vide each electron with the same distance to travel to the
with many factors. Fluoroscopic images must also be
output phosphor. Although the concave curve improves
evaluated for appropriate contrast, resolution, distortion,
edge distortion, it does not completely get rid of it. The
and quantum mottle.
part of the image that is at the periphery of the image
intensifier is unfocused and has reduced brightness; this
Contrast effect is called vignetting. Vignetting also causes greater
Contrast in fluoroscopy is affected by the same factors as image intensity at the center of the image, which mini-
in static radiography. The contrast is affected by the scat- mizes distortion and improves contrast. Vignetting can
tered radiation coming from the patient, light scatter at be used to our advantage when using the magnification
 Chapter 13: Fluoroscopy, Conventional and Digital 193

mode of the image intensifier. Remember that when

using the magnification mode, the center of the input
phosphor is used. The resulting image has less shape dis-
Fluoroscopic Displays
tortion and improved spatial resolution.
The most commonly used method of viewing the
fluoroscopic image is the television monitor. Before the
Quantum Mottle image can be viewed, it must go through various types
Quantum mottle is the grainy appearance which is caused of equipment to make the electrical signal visible to the
by insufficient radiation to produce a uniform image. human eye. The image of the output phosphor of the
Quantum mottle is controlled by mA and time. In fluoros- image intensifier can be coupled to a TV camera for TV
copy, a minimum number of photons are used to activate monitor viewing or to a spot film camera or cine camera.
the fluoroscopy screen; this can create noise on the video A close-circuit TV system is used for dynamic imaging;
image and the grainy appearance. Various factors influ- cine and spot film images provide permanent records
ence quantum mottle and increasing the efficiency of of the examination. Figure 13.8 illustrates how the out-
any of the factors will assist in reducing quantum mottle. put phosphor of the image intensifier can be viewed or
The factors are radiation output, beam attenuation by the recorded in different ways. A beam-splitting mirror sends
patient, the conversion efficiency of the input phosphor, the output phosphor image to both the spot film camera
minification gain, flux gain, total brightness gain, and the and the TV system.
viewing system. Although several of these factors are out Figure 13.9A and B show an illustration of the target
of the control of the radiographer, the most useful solu- assembly. The target assembly of a typical TV camera tube
tion is to increase the mA setting to the fluoroscopy tube. shows a large video signal produced by a large amount of

Mirror optics
Output phosphor

Beam-splitting optics TV camera

Closed-circuit
video signal

Spot film camera

TV Monitor

Figure 13.8. Illustrates how the output phosphor of the image intensifier can be viewed or recorded in different
ways.
194 Part IV: Special Imaging Techniques

Signal
Target plate Window

A large
Electron beam amount of light

No light

A large video signal No video signal

A B
due to a lot of light

Figure 13.9. A, B shows an illustration of the target assembly when illuminated and the resulting video
signal.

light striking the window compared to no video signal plumbicon tube has a faster response time. The tubes
generated from no visible light striking the window of the have a glass envelope which maintains a vacuum and
target assembly. provides support for the internal components (Fig 13.10).
The synchronized image intensifier is viewed with a TV Inside the TV camera tube are a cathode and an electron
camera and displayed on a TV monitor. The TV camera gun, electrostatic or focusing coils, and the target assem-
is similar to a home video camera. The TV camera con- bly that is also the anode.
verts the light image from the output phosphor into elec-
trical signals that are displayed on a standard TV monitor. Cathode
The television camera is a glass tube usually about 1 inch The cathode has a heating assembly which forms an elec-
in diameter and approximately 6 inches in length. tron gun through the process of thermionic emission. The
electron gun forms an electron beam that is accelerated
toward the target and strikes the signal plate of the target
Video Camera Tubes where the light from the output phosphor has removed
The standard types are called the Vidicon and Plumbi- electrons from the target and the electron beams fills the
con or a charge-coupled device (CCD). The vidicon and vacancy left by the removed electrons. This generates an
plumbicon tubes are similar in operation; however, the electric signal that is amplified and sent to the television

Focusing coil Anode

Deflecting coil

Control grid Electron beam

Glass face plate

Signal plate

Target

Cathode
Video signal
Figure 13.10. A video camera
tube and its components.
 Chapter 13: Fluoroscopy, Conventional and Digital 195

monitor. As a result, the signal is generated from the Anode

conducted electrons that are the brightest area of the The anode in the vidicon or plumbicon tubes has a target
image and no signal from the dark areas of the image of assembly comprised of three layers: the glass face plate or
the output phosphor. window, signal plate, and target or photocathode. The
At the target, the electron beam passes through a wire glass face place acts as the window and is the thinnest part
mesh and interacts with the target assembly where the of the glass envelope. The signal plate is a thin coating of
beam is slowed down to a near standstill. The electrostatic graphite on the inside of the glass window. The coating is
coils focus the beam to a point so that resolution is main- thin enough to transmit light and yet thick enough to be
tained. As the beam strikes the target, it is deflected from an efficient electrical conductor to conduct the electronic
one side to the other by pairs of deflecting coils; this back signal out of the tube into the external video circuit.
and forth scan path is called a raster pattern (Fig. 13.11). The inside of the signal plate is coated with a pho-
The electron beam scans across the screen with extreme toconductive layer which comprises the target. Vidi-
speed that will cause the image to flicker. To avoid flicker, con tubes use antimony trisulfide and Plumicon tubes
the scan is divided in half, with the first half scanning use lead oxide. The photoconductive layer is capable
the odd-numbered lines and the second half scanning the of absorbing light photons and releasing the amount
even-numbered lines. This permits the scans to be pro- of electrons which are equivalent to the intensity of
jected in more frames per second and eliminates flicker. the absorbed light, thereby making up the video signal
Standard TV screens in the United States have (Fig. 13.12).
525 active trace lines at 1/30th of a second in a horizontal The vidicon tube is connected to the output phosphor
direction. The human eye cannot see any flicker slower of the image intensification tube by either fiber optics or
than a 30 time per second. This limits the resolution to an optical lens system. Of these methods, the fiber optics
about 2 line pairs per millimeter (lp/mm). The resolu- is only a few millimeters thick and contains thousands
tion of the image intensifier output phosphor is about of glass fibers. The small size of the fiber optics is an
5 lp/mm, so the TV display is the weak link in the imag- advantage when manipulating the image intensification
ing chain. Some fluoroscopic systems are equipped with tower. The fiber optics coupling allows the use of cas-
1,050-line display monitors to match the display to the settes to record spot films but it doesn’t allow the use of
resolution of the output phosphor. cine or spot film cameras. Cine and spot filming requires

1st scan 2nd scan 3rd scan

1 1
2 2
3 3
4 4
5 + = 5
6 6
7 7
8 8
9 9

2621/2 lines 2621/2 lines 525 lines

1/60 second 1/60 second 1/30 second

Figure 13.11. A video frame raster scan pattern. The electron beam scans the diagonal lines as active traces
and the horizontal lines as inactive traces. The horizontal lines set up the position of the electron beam for the
next scan. The electron beam scans 262½ alternate lines every 1/60 seconds until it reaches the bottom of the
screen where a complete television field is seen. To prepare for the next television field, the screen is vertically
retraced from bottom to top at which point the raster pattern scan takes place again and the next set of 262½
alternate lines are scanned every 1/60 seconds. The two scans are blended together to provide the 525 active
trace line or raster pattern. This sequence occurs every 1/30 seconds so that there will be no flicker in the image
when it is viewed.
196 Part IV: Special Imaging Techniques

Camera lens

TV camera/CCD

Beam splitting
mirror

Fiberoptics Objective
lens

Spot film camera

Image intensifier

A B
Figure 13.12. Video camera tubes are coupled to the image intensifier in two ways, (A) fiber optics and (B) mirror
lens system.

the optical lens system. Spot filming requires the use of Charge-Coupled Device
beam-splitting mirrors which permits the image to be
recorded while being viewed. As seen in Figure 13.12, Some fluoroscopy systems use a CCD instead of a video
optical lens systems are much larger than the fiber optics tube. The CCD is a semiconducting device capable of stor-
coupling and are easily identified by the large size of the ing a charge from light photons striking a photosensitive
housing on top of the image intensification tube. Careful surface. When light strikes the photoelectric cathode, elec-
handling to avoid trauma is essential to keep the mirror trons are released in response to the intensity of the inci-
and lens system precisely balanced. dent light. The CCD stores these electrons which make
 Chapter 13: Fluoroscopy, Conventional and Digital 197

up the latent image. A video signal is then emitted in a The input phosphor converts the x-ray photons to light
raster scanning pattern by discharging the stored electrons photons which are then converted to photoelectrons by
as pulses. The main advantage of the CCD is the extremely the photocathode. The photoelectrons are accelerated
fast discharge time which is useful in cardiac catheteriza- and focused by electrostatic lenses toward the anode. As
tion where high-speed imaging is critical to visualizing the photoelectrons pass through the anode, they come
blood flow. The CCD operates at a lower voltage which into contact with the output phosphor and are converted
prolongs its life, it is more sensitive than video tubes, and its into light photons. At this point, the latent image has
resolution is adequate for imaging structures in the body. gone through the image intensifier and is now ready to
pass through the video camera tube.
Cathode Ray Tube The video camera tube transforms the visible light image
of the output phosphor into an electrical video signal that
The cathode ray tube (CRT) is the type of monitor used to is created by a constant electron beam in the video camera
display the fluoroscopic image. Like a video tube, it consists tube. The video signal then varies the electron beam of the
of a vacuum tube, an electron gun (cathode) with focusing CRT and transforms the electron beam into a visible image
and deflecting electromagnets (Fig. 13.13) for steering the at the fluorescent screen of the CRT. Both electron beams,
electron beam. It is much larger than the video tube and the one in the video camera tube and the one in the CRT,
has an anode assembly with a fluorescent phosphor coated are precisely focused pencil beams that are synchronized
on the inside of the front screen. The electron gun follows by external electromagnetic coils of each tube. Both beams
the same raster pattern used by the video camera tube or are always at the same position at the same time and move
CCD and sprays the pulsed stream of electrons onto the in exactly the same fashion. This allows for an accurate
anode or screen phosphor. The phosphor crystals emit light image to be visualized by the technologist and radiologist.
when struck by the electron beam and transmit the light as
a visual image through the glass screen. At this point, the
image is a manifest image, meaning it can be viewed.
Archiving the
Fluoroscopic Image
The fluoroscopic image is formed through a complex set Fluoroscopic Image
of conversions beginning with the incident x-ray beam
and finishing as the visible image on the monitor. A sim- Fluoroscopic images are recorded using static spot film-
plified explanation will assist you in putting the pieces ing, digital display, a standard videocassette recorder
together. First, the incident x-ray beam is attenuated by (VCR), or a digital image recorder. VCRs and cine cam-
the patient and the resulting x-ray photons then inter- eras record dynamic images. VCR images are analog
act with the input phosphor of the image intensifier. images recorded on magnetic tape. Cine cameras record

TV monitor
Control grid
Focus coil Deflecting coil Flourescent
Cathode screen

Phosphor

Electron Electron
gun beam

Light
Anode Figure 13.13. A CRT and its components.
198 Part IV: Special Imaging Techniques

the images on a 35-mm movie film. Digital images Spot filming is a slow process due to the time required to
provide a permanent static image of the anatomy viewed place the cassette for the exposure. This type of imaging
during fluoroscopy. Fluoroscopic images can also be dig- causes the highest dose to the patient due to the increased
itized and stored as digital data. mAs and kVp necessary to produce a diagnostic image.

Spot Filming Videocassette Recording

Spot filming or imaging systems are necessary when a Videocassette recording makes a permanent record of the
permanent image of the fluoroscopic examination is dynamic fluoroscopic images on magnetic tape. VHS and
needed to document the anatomy. Spot filming is used high-resolution VHS-S videotape recorders are used to cre-
with almost every fluoroscopic examination when the ate the dynamic images. The VHS-S system requires high-
information is necessary to diagnose, either positively resolution cameras, recorders, tape and monitors which
or negatively. During the fluoroscopic examination, it is offer a significant increase in resolution that is desirable
possible to use spot filming to rapidly record a series of for viewing fluoroscopic examinations. These images are
static images so that when viewed, they provide a com- the same as those displayed on the TV monitor and can be
prehensive record of the patient’s anatomy and potential played back on a VCR unit similar to a home VCR player.
pathology. There are several methods for recording a spot
film, including standard cassettes and roll film. With the
advancement of more sophisticated equipment, roll film Cine Recording
has become obsolete and will not be discussed here. Fluoroscopic images can also be recorded on a 16- and
Standard radiographic cassettes allow the radiologist 35-mm movie film. Such recording is referred to as cine-
to record one image on a film or multiple images on a fluorography, or simply cine. The output phosphor image
film. Selections include 1-on-1, 2-on-1 vertical, 2-on-1 is directed to the cine camera by a beam-splitting mirror.
horizontal, or 4-on-1. Standard cassette sizes include Cine image recording uses a 16- or 35-mm film to record
8 × 10 inch, 9 × 9 inch, or 10 × 12 inch. The image inten- static images at a high speed typically at 30 or 60 frames
sifier has a lead-lined compartment where the cassette is per second. Special x-ray tubes and generators that pulse
stored (Fig. 13.14). At the time of a spot film exposure, the x-rays so that the x-ray beam is on only when the cine
the cassette is moved into the primary beam by controls film is in position and the camera shutter is open are
located in the fluoro carriage. The carriage controls allow required. Cine imaging is common in angiography and
selection of the area of the cassette to be exposed, auto- cardiac catheterization. The cine film can be viewed as
matically collimate the tube and spot image mask shutters both a movie and stop-action film. It must be shown at
to the correct size, and position the cassette properly. The 16 frames per second for smooth motion to occur. The
radiographer is responsible for replacing the cassettes that principal advantage of cine recording is the improved spa-
have been exposed with new cassettes for further imaging. tial resolution; however, radiation exposure rates are about
ten times greater than in conventional fluoroscopy.

Digital Recording
Spot film holder A majority of the new fluoroscopic units have digital
recording capabilities. The fluoroscopic images are
obtained in the conventional manner and then processed
and stored as digital data in a manner similar to that used
in computed tomography and magnetic resonance imag-
ing. The digital images can be enhanced by changing
the contrast or density prior to printing a hard copy. Ana-
Figure 13.14. Demonstrates the image intensifier with a log images from the TV camera are converted to digital
slot film device for a standard radiographic cassette. images and entered into computer files for later viewing.
 Chapter 13: Fluoroscopy, Conventional and Digital 199

The digital images can be manipulated as desired and intensifier, which looks like a “C.” The tube and image
transferred multiple times to various locations without intensifier can be moved to provide anteroposterior, pos-
any loss of quality. When viewing the digital images on a teroanterior, oblique, or lateral fluoroscopic examina-
monitor, the viewer is able to adjust the density and con- tions as needed. C-arm fluoroscopes are equipped with
trast in the image, magnify the whole image or a portion of last image hold and digital recording capabilities.
the image, and use filter or edge enhancements or other
techniques to improve visualization of the image. The dig-
ital image can be stored in multiple ways whether on the Last Image Hold
computer hard drive, compact disk, teleradiology systems, Some fluoroscopic units can display the last image when
or printed as a hard copy on a laser dry image processor. x-ray production is stopped. This is also known as “freeze
frame” capability. The output image is digitized and con-
tinuously displayed on the output monitor. Most portable
Mobile C-Arm C-arm fluoroscopic units have this capability. It allows
the operator to study the image without continuously
Fluoroscopy exposing the patient and staff to additional radiation.

Mobile C-arm units are portable fluoroscopy systems that

are used in the operating room, the emergency room,
Patient Dose
and many other areas when it is not possible to bring the
patient to the radiology department. Figure 13.15 shows The patient dose during fluoroscopy depends on the
a typical C-arm unit. The name comes from the physi- patient thickness, the exposure rate, and the duration
cal connection between the x-ray tube and the image of exposure. Higher exposure rates, thicker patients,

Image intensifier

X-ray tube

Figure 13.15. Shows a typical C-arm unit.

200 Part IV: Special Imaging Techniques

and longer fluoroscopic examinations produce higher long the examination lasts. There is no limit to the number
patient doses. of times the timer may be reset. Some departments record
The exposure of the patient depends on the thick- the fluoroscopy time in the patient’s record so that the fluo-
ness and density of the body part being examined, the roscopic total dose can be calculated as necessary.
distance from the image intensifier to the patient, and
the image intensifier magnification. A change in any
of these factors changes the exposure rate because the
ABC circuit adjusts the mA to maintain constant output
brightness. This mA adjustment changes the patient dose. Chapter Summary
Thicker, dense body parts are more difficult to penetrate
and require higher exposure rates, resulting in higher
Fluoroscopy is a method of viewing dynamic
patient doses.
moving structures. A fluoroscopic system
The x-ray intensity at the image intensifier depends on
contains an x-ray tube, a patient support table,
the source to image receptor distance (SID). Moving the
and an image intensifier. The image intensifier
image intensifier closer to the patient decreases the SID
produces a brighter image by converting x-ray
and increases the beam intensity at the surface of the
photons into visible light at the input phosphor,
input phosphor. This results in the ABC decreasing the
converting visible light into electrons at the
mA and producing a lower patient dose.
photocathode, accelerating and focusing the
In addition to patient dose, other factors must be con-
electrons onto the output phosphor, and finally
sidered when using a fluoroscopic system. The entrance
converting the electrons into visible light at the
skin exposure (ESE) for the patient is that part of the
output phosphor. An ABC circuit maintains the
patient which is closest to the x-ray source. For units
brightness of the output phosphor at a constant
with the x-ray tube under the table, the ESE is measured
level by adjusting the fluoroscopic mA.
from the patient surface next to the tabletop. With the
Brightness gain is a combination of flux gain
x-ray tube over the table, the ESE is measured from the
and minification gain. The output phosphor
patient surface closest to the fluoro carriage. The table-
is brighter than the input phosphor because of
top exposure rate should not exceed 10 R/min, with most
brightness gain. Flux gain is produced by the
units averaging from 1 to 3 R/min. The minimum source
acceleration of electrons in the image intensi-
to skin distance for mobile fluoroscopic equipment
fier tube. Minification gain is produced because
(c-arms) is 12 inches, while 15 inches is standard for sta-
the output phosphor is smaller than the input
tionary fluoroscopic equipment.
phosphor. A TV camera views the output
phosphor image and displays the image on a
standard TV monitor. Fluoroscopic images can
Fluoroscopic Timer be recorded on spot films, videotape, or cine
film. Patient dose is affected by patient size,
All fluoroscopic systems are equipped with a 5-minute the amount of magnification, and the distance
timer as required by law. The timer must audibly indicate between the patient and the image intensifier
when 5 minutes of fluoroscopy has elapsed; this serves as input surface. All fluoroscopic systems must
a reminder to the radiologist of how much total exposure have a timer to audibly indicate when 5 minutes
time has been used. This is a radiation safety device that of fluoroscopic beam on time has elapsed.
will terminate the beam after 5 minutes, no matter how
 Chapter 13: Fluoroscopy, Conventional and Digital 201

Case Study image intensifiers will increase patient dose

by two times but will provide the radiologist
Tami is the lead technologist in her radiology with some magnification options. The multiple
department. She is researching fluoroscopy mode will provide more magnification options
equipment so she can advise administration on for a broader scope of examinations; however, it
an upcoming purchase. She discovered that comes with increased patient dose as higher mA
there are many different types of machines but is needed to produce a quality image. Magnifi-
they were all very similar. The information Tami cation image intensifiers are capable of 1.5 to
discovered included image intensifiers with 4 times magnification and this is accomplished
variable magnification modes, different video by selecting a smaller portion of the input
camera tubes and CCDs, types of image display, screen. These controls are on the carriage of the
and how to archive the image. In her report, fluoro tower and must be easily manipulated.
Tami will answer the following questions. Tami learned that there are two basic types
of video camera tubes, the vidicon and plum-
bicon. Both provide the same basic functions;
Critical Thinking Questions however, the plumbicon operates at a faster
pace. A CCD is even faster than the video tubes
How does image intensifier compare in size? and provides high-speed imaging for imaging
small structures like coronary arteries. The type
How is magnification achieved? Which video of video camera purchased will depend upon
camera tube or CCD will meet the depart- the typical use it will get with fluoroscopic
ment’s work flow? examinations, whether standard barium studies
or more sophisticated interventional studies,
What types of archiving are available? where high-speed imaging is a necessity.
There are various ways to archive the images
produced during the fluoroscopic examinations.
There are various sizes of image intensifiers that There are static imaging where cassettes are
are commercially available. Various specifica- used and the equipment is capable of expos-
tions will need to be considered to determine ing the cassette multiple times, video cassette
if the R and F room is properly outfitted for the recording where a special playback unit, cine
new fluoroscopy equipment, including the fact filming to provide a non-stop view of the anat-
that electrical fittings in the room must be able omy or can be played back frame by frame, and
to accommodate the unit. The input screen finally digital imaging where the images will
size will need to be considered as it directly be stored on a computer. The type of archiving
relates to the variable magnification modes depends on whether the department is still
available. Dual or multiple-mode image intensi- using film/screen or has gone digital. As Tami
fiers provide variable magnification depending learned, there are a multitude of choices avail-
upon the examinations performed. Dual mode able when purchasing fluoroscopic equipment.
Review Questions

5. The TV camera converts the light image from the

Multiple Choice output phosphor into a
A. brighter image
1. Changing from standard to magnification mode B. high-resolution image
on an image intensifier C. magnified light image
D. electrical signal
1. increases the patient dose
2. decreases the patient dose 6. The input phosphor of an image intensifier is
3. produces a magnified image coated with which material?
4. decreases the minification gain
A. Zinc cadmium sulfide
A. 2, 3, and 4 B. Calcium tunstate
B. 1 and 3 C. Cesium iodide
C. 1, 3, and 4 D. Iron oxide
D. 2 and 4
7. Light photons are converted into electrons by
2. Brightness gain is the product of the __________ which part of the image intensifier?
gains.
A. Input phosphor
A. magnification and minification B. Anode
B. minification and flux C. Output phosphor
C. flux and magnification D. Photocathode
D. confiscation and flux
8. The focusing electrostatic lenses in the image
3. The _____ have good spatial resolution and are intensifier
used for viewing in bright light.
A. force photoelectrons to converge on the output
A. rods phosphor
B. cones B. convert photoelectrons into light photons
C. optic disc C. convert light photons into photoelectrons
D. olfactory bulb D. force photoelectrons to converge on the input
phosphor
4. Multiplying the flux gain by the minification gain
in the image intensifier will equal the total 9. The lead drape on the image intensifier tower
A. input phosphor size must have a minimum of
B. image size A. 50 mm Pb equivalent
C. output phosphor size B. 10 mm Pb equivalent
D. brightness gain C. 25 mm aluminum equivalent
D. 25 mm Pb equivalent
 Chapter 13: Fluoroscopy, Conventional and Digital 203

10. What is the flux gain if the input phosphor has 100 4. During a fluoroscopic examination, the radiologist
x-ray photons and the output phosphor has 6,000 sees something and would like to preserve that
light photons? image on a 2-on-1 __________.
A. 6
B. 60
C. 0.16
D. 16
5. What is the formula to determine brightness gain?
11. What is the total brightness gain if the flux gain is
47 and the minification gain is 80?
A. 2,500
B. 1.7
C. 3,760
D. 1,880 6. What are the basic components of the tube used in
a video camera?
12. The minimum distance between the source and
the patient skin surface for a mobile fluoroscopic
unit is _____ inches.
A. 15
B. 10 7. What is the difference between rod and cone
C. 25 vision? When is visual acuity greater? Define pho-
D. 12 topic and scotopic vision.

Short Answer
8. The cassette spot film is placed between the _____
1. Draw a diagram of an image intensifier tube and and the _____.
discuss the function of each part.

9. What is the purpose of the ABC?

2. What is vignetting?

10. What are the types of dynamic and static filming

3. The electron gun in a vidicon is a heated filament systems used to record the fluoroscopic image?
that supplies a constant electron current by:
 14

Digital Imaging

Objectives Key Terms

Upon completion of this chapter, the student ● analog-to-digital ● flat panel detector
will be able to: converter (ADC) ● matrix
1. Describe how a matrix of pixels is used to form ● digital imaging ● pixel
a digital image. and communica- ● signal-to-noise ratio
tionsin medicine (SNR)
2. Identify the relation between matrix size, pixel (DICOM)
size, and field of view. ● thin-film transistor
● digital-to-analog (TFT)
3. Identify the components of a digital imaging converter
system.
4. Describe the operation of a computed
radiography system.
5. Explain elements used in the digital
radiography system.

204
 Chapter 14: Digital Imaging 205

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Introduction 1
2
3
Digital images are used throughout radiology. 4

They appear as computed tomographic (CT), 5

6
magnetic resonance (MR), ultrasound, mammog- 7
raphy, computed radiography (CR), direct radiog- 8
9
raphy (DR), fluoroscopy, nuclear medicine (NM), 10
and diagnostic images. Unlike film images, whose 11
12
contrast, speed, and latitude are fixed during 13
processing, the appearance of digital images can 14
15
be altered after they have been recorded and 16
stored. Changes in the processing and display of 17

the digital data can enhance information and sup- 18

19
press noise in the final image. An understanding 20
of digital imaging systems will aid in producing 20 X 20 Matrix of pixels
diagnostic-quality digital images. The advantages Figure 14.1. Shows how a matrix of numbers can be used
of digital imaging include the ability to adjust the to form a digital image.
contrast after the image has been recorded, to pro-
cess the image to emphasize important features,
and to transfer the images to a remote site. small box must decrease to fit more boxes in the matrix.
The more small boxes or pixels there are in the matrix
the better the resolution of the image. Digital images
typically have between 25,000 and 1 million pixels. The
Digital Image more pixels there are the greater the image resolution.

Acquisition Picture Elements or Pixels

Each pixel in the matrix is capable of representing a wide
A digital image is a matrix of picture elements or pixels. range of shades of gray from white to black. The pixel
A matrix is a box of cells with numeric value arranged in contains bits of information and the number of bits per
rows and columns. Each cell corresponds to a specific pixel that determines the shade of the pixel is called the bit
location in the image. The numeric value represents depth. If a pixel has a bit depth of 10, then the number of
the level of brightness or intensity at that location in the gray shades the pixel can produce is 2 to the power of the
image. There are three numbers associated with each bit depth, or 210 which is 1,024 shades of gray. Most digi-
pixel, two to define its location and the third to repre- tal radiography systems use an 8, 10, or 12 bit depth. The
sent the intensity of the image at that location. An image human eye can only distinguish 32 shades of gray; how-
is formed by a matrix of pixels. The size of the matrix ever, the computer with sufficient capacity can distinguish
is described by the number of pixels in the rows and up to 4,096 bit depth (Fig. 14.2). The level of gray will be
columns (Fig. 14.1). A small matrix has a small number a determining factor in the overall quality of the image.
of pixels, and a large matrix has a larger number of pixels.
For example, a matrix with 256 pixels in each row and
48 2 4 48
column is called a 256 by 256 matrix (written 256 × 256);
one with 512 pixels in each row and column is called a 14 0 4 14

512 by 512 matrix. Some systems have a 1,024 by 1,024 14 0 4 14

matrix size which provides the smallest number of pixels
48 2 4 48
in the matrix. Think of the matrix as a box in which you
want to put in smaller boxes or pixels. In order to increase Figure 14.2. Zero represents white or no intensity while
the number of small boxes in the matrix the size of each higher numbers show darker shades of gray or more intensity.
206 Part IV: Special Imaging Techniques

Field of View
CRITICAL THINKING
The field of view (FOV) describes how much of the
patient is imaged in the matrix. A 200-mm FOV means
that a 200-mm-diameter portion of the patient is imaged. Change of matrix size from 256 × 256 to 512 × 512:
The matrix size and the FOV are independent. The What is the pixel size in millimeters of a 512 × 512
matrix size can be changed without affecting the FOV, matrix for an image with a FOV of 20 cm?
and the FOV can be changed without changing the Answer
matrix size. Changes in either the FOV or the matrix size
20 cm = 200 mm
will change the pixel size. 200 mm/512 pixels = 0.4 mm/pixel

Relation Between Field of View,

Matrix Size, and Pixel Size Spatial Resolution and Pixel Size
Spatial resolution describes the minimum separation
between two objects at which they can be distinguished as
CRITICAL THINKING two separate objects in the image. Specific to digital imag-
ing, spatial resolution describes the ability of an imaging sys-
tem to accurately display objects in two dimensions. Digital
Original Image Size: What is the pixel size in milli-
images with smaller pixel sizes have better spatial resolu-
meters (mm) of a 256 × 256 matrix for an image with
a 20 centimeter (cm) FOV? tion. In film/screen imaging the crystal size and thickness
of the phosphor layer determine resolution; in digital imag-
Answer ing pixel size will determine resolution. Spatial resolution is
20 cm = 200 mm measured in line pairs per millimeter (lp/mm). Two pixels
200 mm/256 pixels = 0.8 mm/pixel are required in order to image one line pair because a line
pair consists of one bright and one dark line. Increasing
If the field is changed and the matrix size stays the
the matrix size decreases the pixel size and improves spatial
same, the pixel size changes.
resolution, because there are more, but smaller, pixels in
the matrix. Typical matrix sizes in diagnostic radiology are
If the FOV increases and the matrix size remains 256, 512, and 1,024, with some matrices as small as 64 × 64
the same, the pixel size increases. If the FOV decreases or as large as 2,048 × 2,048 (Fig. 14.3).
and the matrix size remains the same, the pixel size
decreases.
If the FOV remains the same and the matrix size
changes, the pixel size changes. An increase in the matrix
Data Characteristics
size results in a decreased pixel size (Table 14.1).
The quality of the data acquired from the image recep-
tor is measured in frequency, contrast, and noise. These
characteristics must be considered to produce a diagnos-
CRITICAL THINKING tic image.

Change of FOV from 20 to 30 cm: What is the pixel Frequency

size in millimeters of a 256 × 256 matrix for an image The frequency data are the raw data to which an algo-
with a FOV of 30 cm?
rithmic formula is applied to create a digital image. The
Answer algorithmic formula is determined by the anatomy being
30 cm = 300 mm image. For example, a hand image will have a different
300 mm/256 pixels = 1.2 mm pixel algorithmic formula than a chest image. The acquired fre-
quency is a measurement of the total amount of contrast
 Chapter 14: Digital Imaging 207

32 x 32 64 x 64

A B

256 x 256 1,024 x 1,024

C D

Figure 14.3. Shows how the spatial resolution and appearance of a digital image change as the matrix size and pixel size
change. (A) Large pixels are easy to distinguish. (B) The pixels are twice as small but it is still easy to determine individual
pixels. (C) The pixels are even smaller and more difficult to see but the image has a blurred appearance. (D) Notice how
the structures in the image are sharp and clear, the individual pixels cannot be distinguished.

in an image. A high contrast image has a high frequency as different densities. Contrast depends on the size of
and a low contrast image has a low frequency. the pixels. Images with larger pixels have better contrast
because the pixels cover a large area and have more infor-
mation. In digital radiography, the contrast of an image
Contrast is described by the number of data values between black
Contrast describes the minimum density difference and white. A high-contrast image has few data values
between two tissues that can be detected in an image between black and white; a low-contrast image has many
208 Part IV: Special Imaging Techniques

TABLE 14.1 SHOWS THE RELATIONSHIP BETWEEN FOV, MATRIX SIZE, PIXEL SIZE, AND SPATIAL RESOLUTION

FOV Matrix Size Pixel Size Spatial Resolution

Increases Remains constant Remains constant Decreases

Decreases Remains constant Remains constant Increases
Remains constant Increases Decreases Increases
Remains constant Decreases Increases Decreases

data values between black and white. An image with only is sufficient contrast in the image for the computer to
two data values, black and white, has the highest con- distinguish acquired data from noise.
trast; pixels in the image are either black or white. An
image with four data values has pixels in the image that Window Level and Window
are black, dark gray, light gray, and white (Fig. 14.4). Width Controls
High-contrast images are short-scale contrast images.
They have superior contrast because it is easy to discrimi- The density and contrast of a digital image is controlled
nate between different densities. However, the image is by the numerical value of each pixel. The human eye
useful only over a limited range of densities. In digital can distinguish 32 shades of gray; however, the x-ray
radiography, there is a direct relationship between sub- photon beam that exits the patient contains over 1,000
ject contrast and acquired data contrast. When subject shades. The majority of digital image receptors are sen-
contrast is high the acquired data contrast will also be sitive to this large number of shades. This vast range of
high and vice versa for low subject contrast. densities can be manipulated by radiographers, and it is
their responsibility to choose the appropriate density and
contrast ranges to be displayed. When processing the dig-
Noise ital image, the radiographers must use care in manipulat-
Image noise is made up of random background informa- ing the image so that they donot inadvertently obscure
tion, due to the constant flow of current in the circuit, diagnostic information.
that is detected but does not contribute to the image The contrast scale of a digital image can be electroni-
quality. Noise can be seen as the static “white noise” cally altered by changing the window level and window
heard on certain frequencies between television stations. width controls. The window level control sets the density
The overall noise in an image is measured as the signal- value displayed as the center of the window or density
to-noise ratio (SNR). An image with high SNR has little range. As seen in Figure 14.5, the window level can be
noise to interfere with the appearance of the image. The moved up and down the density scale from white to black
noisiest component of most digital systems is the televi- while the window width can be widened or narrowed.
sion camera. Some commercial systems have an SNR of There is a direct relationship between image density and
200 while the high resolution systems used in digital fluo- window level; as the window level is increased the image
roscopy have a SNR between 500 and 1,000, therefore a density will increase. The window level must be set to
system with an SNR of 1,000 will have the least amount the diagnostic range for the anatomy being visualized so
of noise. that the proper level of diagnostically relevant informa-
On a digital image, noise looks like quantum mottle tion will be displayed. Any information not in the range
but it is really more like the effect of base plus fog on a will be obscured from view.
standard radiographic image. Image noise has an inverse The window width control sets the number of density
relationship to contrast. Increased noise decreases image differences between black and white that are displayed.
contrast, however increased image contrast tends to Window width controls image contrast therefore there
decrease noise. In digital systems there will not be added is an inverse relationship between window width and
density to the image because of noise, the computer image contrast. As the window width increases the image
will compensate for the lack of density as long as there contrast will decrease. When imaging the abdomen
 Chapter 14: Digital Imaging 209

(2 steps) (4 steps)

A B

(16 steps) (256 steps)

C D

Figure 14.4. Four images having different numbers of contrast densities. (A) This image represents a black and
white scale of contrast. Much of the detail of the image is obscured because there is not enough information to
form a complete image. (B) With four steps of gray scale, we can now begin to distinguish more areas of the picture.
(C) The sky, rocks, and lighthouse are beginning to demonstrate more detail because there are more shades of gray.
(D) An image with the maximum number of data values has pixels with densities covering a vast range; this provides
the most comprehensive set of data for the image.

more shades of gray are required to provide diagnostically the digital image a narrower window width is needed to
relevant information of the various soft tissues therefore adequately demonstrate the bony detail. Narrow win-
a wider window width is needed (Fig. 14.6). This results dow settings produce short-scale contrast, high-contrast
in a decrease of image contrast. When imaging bony images because there are few density differences between
anatomy a shorter scale of contrast is necessary so with black and white.
210 Part IV: Special Imaging Techniques

earliest detectors for digital systems, and one that is still

White widely used, is an image intensifier tube connected to a
–1000 fluoroscopic imaging system. Most portable C-arm fluo-
roscopes and modern fixed fluoroscopic units convert
image intensifier images into digital data. It is also pos-
sible to convert a conventional film/screen image into a
digital image using a film digitizer.
Window
Window
width
level
Image Acquisition
Image acquisition begins with performing an x-ray expo-
sure. The rules for positioning the part and correctly placing
the central ray hold true for traditional and digital radiogra-
phy. Digital systems cannot compensate for anatomy that
Black
+1000
is clipped or poorly positioned or for the lack of collima-
tion. It is the responsibility of the radiographer to properly
Figure 14.5. The window level can be moved up and position the part of interest, to select the correct technical
down the density scale to change the density in the image. factors for the exposure, and to correctly collimate to the
The window width can be widened or narrowed to change area of interest. Chronic overexposure should be avoided at
the amount of contrast in the image.
all times (Fig. 14.8). This only increases the dose of radia-
tion to the patient and does not result in a better image.
A skilled radiographer will be aware of the range of exposures
for the specific digital equipment in his or her department
Digital Imaging and will use the equipment with respect for patient safety.

Systems
Analog-To-Digital Converter
All direct digital systems initially convert the analog sig-
An animation for this topic can be viewed nal from the detector to a digital signal using an analog-
at http://thepoint.lww.com/FosbinderText to-digital converter (ADC). The digital data are then
available for processing, display, and storage.
Imaging detectors produce continuously varying sig-
Digital imaging systems replace the traditional film/ nals called analog signals, these signals make up the
screen systems with special detectors. There are two latent image. Digital systems represent the signal by a
basic groups of digital imaging systems, either “cassette series of discrete values which make up the intensity of
based” or “cassette-less.” Regardless of the system that the pixels. A digital signal can have either one value or
is used, the process of obtaining an image is basically the next value, but no value in between. Analog-to-digital
the same. After the primary x-ray beam passes through converters convert analog signals to digital signals. Ana-
the patient, the exit radiation is detected, and the signal log signals cannot be seen by the human eye and must
data are processed, displayed, and stored. Figure 14.7 be converted to digital signals for the manifest image to
illustrates the basic components of a digital imaging appear.
system. Digital-to-analog converters convert digital signals
Systems such as CR, MR, and CT collect image to analog signals. Digital signals with finer digitization
data directly as digital data (Table 14.2). These are (more discrete values) will more closely represent the
known as direct digital systems. If the imaging system analog signal. Conventional cable TV is an analog sig-
does not provide digital data directly, it is necessary nal because the voltage signal is continuously changing.
to convert the analog data to digital data. One of the Digital satellite TV is sent from the satellite to the home
 Chapter 14: Digital Imaging 211

A B

C D

Figure 14.6. Images represent how changing window width and window level controls affect image appearance. (A) High
contrast abdominal image. (B) Low contrast abdominal image. (C) Low contrast thorax. (D) High contrast thorax.

as a digital signal and then converted into an analog Computed Radiography

signal at the input to the home TV set (Fig. 14.9).
CR is a “cassette-based” system that uses a special solid-state
detector plate instead of a film inside a cassette. The exte-
TABLE 14.2 SHOWS THE FIVE MAJOR SOURCES OF rior dimensions and appearance of the CR cassette are the
DIGITAL IMAGES same as those of a conventional film cassette. The CR cas-
sette is placed in the Bucky tray or for portable examina-
1. Directly from MR, CT, or US
tions and exposed in the same manner as a conventional
2. Digitized fluoroscopic images
3. Computed radiographic plates film cassette. Most CR systems are set up to have the same
4. DR response as a 200-speed film per screen system, although
5. Digitized conventional film images this can be changed. The resolution of CR systems depends
on the pixel size but is not as good as that of conventional
212 Part IV: Special Imaging Techniques

X-ray tube

ADC DAC

Analog-to-Digital Digital-to-Analog
Converter Converter

Display
monitor
Computer

Figure 14.7. Shows the basic components of a digital imaging system.

film/screen systems. The contrast resolution of CR is of times, but will break if dropped. The imaging plate
superior to that of conventional film/screen systems. consists of several layers (Fig. 14.10):
The CR cassette contains a solid-state plate called a
photostimulable storage phosphor imaging plate (PSP) or ● Protective layer: This is a very thin, tough, clear
(IP) that responds to radiation by trapping energy in the plastic that protects the phosphor layer from han-
locations where the x-rays strike. The CR detector plate dling trauma.
is made of a thin, plastic material and is extremely fragile. ● Phosphor layer: This is the active layer. This is
CR plates and cassettes can be reused many thousands the layer of photostimulable phosphor that traps

A B C

Figure 14.8. Knee phantoms using CR system. (A) Underexposed. (B) Adequate exposure. (C) Overexposed.
 Chapter 14: Digital Imaging 213

Analog

Imaging
plate

Digital

CR casette

Figure 14.9. Illustrates an analog signal and the

corresponding digital signal.

electrons during exposure. It is typically made of

barium fluorohalide phosphors.
A
● Conductive layer: This layer grounds the plate to
reduce static electricity problems and to absorb
light to increase sharpness. Protective
supercoat
● Support layer: This is a semirigid material that pro- Phosphor
vides the imaging sheet with strength and is a base Conductor
for coating the other layers. Support
● Light shield layer: This prevents light from erasing Light shield
data on the imaging plate or striking through the B Backing
backing layer.
Figure 14.10. (A) CR imaging plate. (B) Photostimulable
● Backing layer: This is a soft polymer that protects phosphor imaging plate showing layers.
the back of the cassette.

The radiation dose from a CR exposure is usually set for hours or days; however, deterioration of the signal
to correspond to a comparable film/screen exposure. begins almost immediately, so it is vitally important to
The incident x-ray beam interacts with the photostimu- process the imaging plate immediately after exposure
lable phosphors that are in the active layer of the imag- (Fig. 14.11).
ing plate. The interaction stimulates the electrons in the
phosphors allowing the electrons to enter the conduc-
tive layer, where they are trapped in an area of the phos- An animation for this topic can be viewed
phor known as the phosphor center. This is the latent at http://thepoint.lww.com/FosbinderText
image that will create the digital image for the computer
to record and display. The trapped signal will remain
214 Part IV: Special Imaging Techniques

Exposure of
CR detector Viewing monitor
1

Laser dectector
Laser scanner
Analog 3

Hardcopy printer

ADC
CR detector in
processing module

Computer

Network stations

Figure 14.11. A diagram of the steps in forming and developing a CR image.

Reading the Imaging Plate The conversion is accomplished with an analog to digital
After the exposure, the CR cassette is placed in the converter.
processing reader to produce a visible image (Fig. 14.11). When the laser beam scans the plate each line of the
The processing reader opens the CR cassette and removes imaging plate correlates to one pixel dimension. The ana-
and scans the detector plate with a laser beam or solid- log signal emitted for each pixel has an infinite range of
state laser diodes. As the plate is fed through the process- values which the ADC must convert into discrete values
ing reader, a laser beam scans the plate with red light in which can be stored as digital code. This digital code will
a raster pattern and gives energy to the trapped electrons. determine the gray scale for each individual pixel. All the
The red laser light is emitted using 2 eV, which is needed pixel densities will be combined to represent the many
to energize the trapped electrons. The trapped electrons density values in the image which affects the density and
are now able to leave the active layer where they emit blue contrast of the image. Once the conversion is complete,
light photons as they return to a lower energy state. As the the light intensity and the position of the laser beam are
laser beam scans, the imaging plate lines of light intensity stored as digital data for each pixel. At this point, the
information will be detected by a photomultiplier tube. manifest image is now visible on the computer monitor.
The photomultiplier tube converts the visible light into Another variable related to pixels is spatial resolution, the
an electronic signal which is in analog form. The analog smaller the pixel the higher the spatial resolution. As pre-
signal must be converted to a digital signal for the com- viously discussed, matrices with more and smaller pixels
puter to apply algorithmic formulas to the information. have higher spatial resolution.
 Chapter 14: Digital Imaging 215

After the entire plate has been scanned, a high-intensity resolution. Film screen systems typically have resolutions
light source releases any remaining trapped energy to of 8-lp/mm.
prepare the plate for reuse. The cassette is then closed Direct radiography flat panel detectors or imaging
and returned to the ready bin for reuse. The entire pro- plates use a radiation conversion material or scintillator
cessing cycle requires about 60 seconds (s). It is never made of amorphous selenium (a-Se) which is a semi-
necessary to open the CR cassette or to handle the detec- conductor with excellent x-ray photon detection ability
tor plate. and spatial resolution. A high voltage charge is applied
The benefit of using CR in radiography is utilizing to the top surface of the selenium layer immediately
your existing equipment. The other benefit is storage. prior to the x-ray exposure. The ionization created by
Films take up a lot of room to store. They also can be mis- the x-ray photons results in the selenium atoms releas-
placed or lost. With a CR system, the images are stored ing electrons which are absorbed by the electrodes
on computer with a back-up system in place. For CR radi- at the bottom of the selenium layer. The electrons
ography, you are able to transmit images to remote sites. are transferred and stored in the TFT detectors. The
The radiologist has quick access to previous CR images thin-film transistor (TFT) is a photosensitive array
for comparison. This makes diagnosis of any abnormali- comprised of small pixels. Each pixel contains a pho-
ties more accurate. todiode that absorbs electrons and generates electrical
charges. A silicon TFT separates each pixel element
and sends the electrical charges to the image proces-
sor (Fig. 14.12). The TFTs are positioned in a matrix
Direct Radiography which allows the charge pattern to be read pixel by
DR is yet another way to record the x-ray exposure after pixel. This process is extremely fast where more than
it has passed through the patient. DR is used to describe 1 million pixels can be read and converted into a digi-
images which are recorded on an electronically read- tal image in <1 second. All this information is read
able device that is hard-wired directly to the computer with dedicated electronics that facilitate fast image
processing system. The detectors and sensors of a DR acquisition and processing.
system are contained inside a rigid protective housing. Digital radiography is similar to CR because it is film-
DR uses an array of small solid state detectors to convert less and the image is stored on the computer. It has the
incident x-ray photons to directly form the digital image. same benefit as CR. The image is displayed for the tech-
The major advantage of the DR system is that no han- nologist to check prior to the next exposure. The images
dling of a cassette is required as this is a “cassette-less”
system.
The image data are transferred directly to the com-
puter for processing. There are two forms of DR systems:
Carbon fiber case
one uses a linear array of detectors, which sweeps across
Electrode
the area to be imaged, the other has an array of detectors (high voltage)
formed into a matrix. The linear array records the posi-
Dielectric
tion of the array and the signal from each detector to form – – – – – – – – – – – –
Amorphous
the image. In the matrix system, each detector provides selenium
– + – +
data for one pixel. The linear array requires fewer detec- Charge collection
tors but a longer time to form each image. This increases electrodes

the tube heat load and the possibility of patient motion Thin film
transistor (TFT)
artifacts.
A matrix array system requires many more detectors Glass backing
than a linear array system to achieve the same spatial
resolution. For example, to image a 5 × 5-inch field with Signal out

a 5-lp/mm resolution requires 250,000 detectors, whereas Figure 14.12. Flat panel detector with direct conversion
a linear array requires only 500 detectors for the same amorphous selenium.
216 Part IV: Special Imaging Techniques

are then sent to a storage system. This storage system DICOM

allows for long term storage or the image can be printed
out on a laser printer to film. There are no cassettes with At the advent of computerization in radiology it became
digital radiography. The image is transferred directly onto necessary for medical facilities to have the ability to view
the computer. images and reports from other facilities. The Digital
When using CR or digital radiography imaging, both Imaging and Communications in Medicine (DICOM)
images are placed on computer. Once transferred, the standard was implemented. DICOM is a set of computer
images can be transferred electronically to “Picture software standards that permit a wide range of digital
Archiving and Communication System” (PACS). The imaging programs to understand each other. Prior to
images can then be sent to the radiologist and ordering DICOM-3 there were many medical imaging systems
physician. The images are then archived. designed by various manufacturers which were not able
to communicate with each other or share the same com-
puter network. DICOM-3 allows the interfacing of many
systems within an imaging department to share one net-
Film Digitization work without conflict. Digital images and reports can also
be archived on a CD to be viewed at another facility.
Any image recorded using a conventional film/screen
cassette can be converted into a digital image by a film
digitizer. A film digitizer measures the light transmitted at
each location on the film, converts the light intensity to a
Hard Copy Production
digital value, and records the location and intensity values
as an image pixel. The film is introduced into the feed tray Diagnostic interpretation can be made from the display
and transported through the digitizer while the image is monitor, called a soft copy display, or the image can be
scanned for digitization. After digitization, the image can printed on film, called a hard copy. Hard copies are pro-
be processed, displayed, or transmitted just like any other duced on multiformat cameras or laser printers.
digital image. A multiformat camera takes a picture of the display
screen. It is called a multiformat camera because multiple
images can be produced on a single sheet of film. A laser
Picture Archiving printer scans a laser beam across a sheet of film to expose
the image. The intensity of the laser beam, and hence
and Communications the density of the image, is controlled by the digital data.
System The laser printer can also produce multiple images on
the same film. Both the laser printer and the multiformat
camera are connected to an automatic film processor, so
No matter how the digital image is obtained, it can be sent their images are ready for immediate interpretation after
over either a dedicated line or conventional telephone the film is developed. The digital image data are stored
lines to other display sites in the hospital or elsewhere. in a computer and can be retrieved whenever required to
There is no limit to the number of monitor stations that produce additional hard copies or replace lost films.
can display the same image simultaneously. Images of a
trauma victim can be sent to the radiology, emergency,
and surgery departments at the same time. Such distri-
bution of images within a hospital is part of a PACS. It Dry Film Processors
is also possible to send images across the street, state, or
country. Once the image has been digitized there is no Images from digital data can be formed using the dry film
limit to the distance it can be sent. Sending images to processors that process and print the image in a single
remote sites is called teleradiology. step. Dry film processors require no chemical solutions to
 Chapter 14: Digital Imaging 217

produce a ready-to-interpret image on film. The special

Digital imaging systems include CR, DR, MR,
dry films can be loaded into the holding magazine with
CT, NM, and fluoroscopic units. Detectors used
the room lights on, because it is processed by a thermal
in digital imaging include fluoroscopic image
printer head. When a hard copy of the digital data is
intensifiers and scintillation crystals. Images on
formed in the dry processor, a sheet of the special film
film can be digitized and then processed and
is removed from the holding magazine and transported
transmitted in PACS or teleradiology systems. An
past the thermal head, which blackens the film. Pixel
ADC changes analog signals into digital signals.
locations with higher-intensities are displayed as darker
CR employs a thin solid-state detector plate
areas on the film. The special thermal film cannot be
inside a special CR cassette that is the same size
processed in a conventional automatic processor and can
and shape as a conventional film/screen cassette
be used only with digital data. Because the special dry
and can be used in the same Bucky holders.
film is activated by heat and is insensitive to room lights,
Data compression reduces the size of the image
no darkroom is needed with a dry film processor.
matrix and reduces the time required to transmit,
process, and retrieve the images and the memory
space required to store the images. Digital data
Data Compression can be displayed for interpretation on display
monitors, called soft displays, or printed on film,
Data compression reduces the number of pixels that called hard copies. Hard copies of digital data
are stored or processed in an image. Compression can be produced by multiformat cameras, laser
algorithms can reduce the size of the data in an image printers, or dry film processors.
matrix by a factor of 30 or more, while maintaining the
diagnostic content of the image. Compressed images
require less storage space and can be transmitted more
rapidly. This means that an original image requiring Case Study
30 minutes (min) to transmit can be sent in 1 min in a Jenny, a first year radiologic technology
compressed form. student, is giving a presentation about digital
radiography to her classmates. She has decided
to explain the cassette-based system. During
Chapter Summary the presentation, she will answer the following
questions.
A digital image is formed by a matrix of num-
bers called pixels. Each pixel specifies a unique
location and contains information about the Critical Thinking Questions
image intensity at that location. The FOV
describes how much of the patient is imaged. What are the components of the cassette-based
The spatial resolution of the digital image is lim- system?
ited by the pixel size. Smaller pixels provide bet-
ter spatial resolution. The contrast resolution of How does the imaging plate acquire an image?
a digital image is established by the number of
discrete values stored in the pixels. The window How is the imaging plate read?
width control determines the number of den-
sity differences between black and white in the What must occur for the latent image to
display. The window level control sets the center become visible on the computer screen?
density value in the display. A small number of
densities produce a high-contrast image. Where is the final image stored?
218 Part IV: Special Imaging Techniques

The cassette-based systems use a cassette which remove the imaging plate. The imaging plate
is loaded with a solid-state plated known as a is then scanned with a laser beam that has a
photostimulable storage phosphor imaging plate; red light, this red light energizes the trapped
it is called an IP. The IP is made of a thin, plastic electrons which allows them to emit blue
material with several layers of materials which light photons as they move to a lower energy
work together to form the latent image. The level. The blue light photons are detected
layers include a protective layer, phosphor layer, by a photomultiplier tube that converts the
conductive layer, support layer, light shield layer, light photons into an electronic signal. This
and backing layer. The phosphor layer is made of signal is an analog signal which must be con-
barium fluorohalide phosphors and is the active verted into a digital signal by an ADC so that
layer of the imaging plate. The image is acquired the computer can apply the correct imaging
when the x-ray beam comes into contact with the algorithms to the latent image. Once this is
phosphor layer and stimulates the electrons in the accomplished the image will be seen on the
phosphors. This allows the electrons to move to computer screen. The imaging plate is then
the conductive layer. The conductive layer then exposed to a high energy light which erases the
traps the electrons in the phosphor center; these plate and prepares it for another exposure. The
electrons make up the latent image. The imag- plate is placed back in the cassette; the cassette
ing plate will contain the latent image until the is closed and ejected from the reader. The final
cassette is placed in the reader and the image is image and all associated information will be
removed from the imaging plate. stored on a PACS system. The PACS system
The imaging plate is read by a set of actions. allows several people to have access to the
First the cassette must be placed in the reader image at the same time and at various locations
and then the reader must open the cassette and within the facility.
Review Questions

6. What is the pixel size in millimeters of a 512 matrix

Multiple Choice with a 15 cm FOV?
A. 0.03
1. If the FOV increases and the matrix size remains B. 0.3
unchanged, the contrast resolution will be C. 3.0
D. 30
A. improved
B. degraded 7. How many pixels are necessary to image one line
pair?
2. Spatial resolution describes
A. 1
A. the maximum separation of two objects that can B. 2
be distinguished as separate objects on the image C. 3
B. the minimum density difference between two D. 4
tissues that can be distinguished as separate tissues
C. the maximum density difference between two 8. PACS is the acronym for
tissues that can be distinguished as separate tissues.
D. the minimum separation of two objects that can A. primary access of compressed studies
be distinguished as separate objects on the image B. picture archiving and computer system
C. picture archiving and communications system
3. The window control sets the D. picture access to communications system

A. number of density differences in the display 9. The contrast in a digital image is best described
B. number of pixels in the matrix as
C. number of matrices in the pixel
D. density value in the middle of the display A. the maximum separation of two objects that can
be distinguished as separate objects on an image
4. PACS stands for B. the minimum separation of two objects that can
be distinguished as separate objects on the image
A. primary access of compressed studies C. the maximum density difference between two
B. picture archiving and computer system tissues that can be distinguished as separate tissues
C. picture archiving and communications system D. the minimum density difference between two
D. picture access to communications system tissues that can be distinguished as separate tissues

5. Computed radiographic systems use 10. A film digitizer is capable of creating a digital
A. detector plates that are read by a scanning laser image from an ordinary radiographic film.
beam A. True
B. detector plates of dry chemicals B. False
C. detector plates that are read by a thermal head
D. conventional screen cassettes
220 Part IV: Special Imaging Techniques

6. Which material is used in a flat panel detector to

Short Answer convert x-ray photons into electrons?

1. What are the principal advantages of digital radi-

ography over conventional radiography?

7. Explain how the imaging plate is read in a CR

system.

2. For the same FOV, spatial resolution will be _____

with a _____ image matrix.

8. What is the reason that all electronic devices are

inherently noise?

3. Explain how window level and window width can

change a digital image.

9. The human eye is capable of seeing approximately

_____ shades of gray.

4. What is image noise and how does it affect the

digital image?

10. A digital image with a 12-bit depth will contain

how many gray values?

5. Explain the function of two of the layers of a pho-

tostimulable phosphor imaging plate.
 15

Quality Control

Objectives Key Terms

Upon completion of this chapter, the student ● quality assurance ● quality control
will be able to:
1. State the factors included in radiographic
quality control (QC).
2. State the factors included in processor QC.
3. State the types and sources of film artifacts.
4. State the factors included in mammographic
QC.
5. State the factors included in fluroscopic QC.
6. State the factors included in computed
tomography QC.

221
222 Part IV: Special Imaging Techniques

Measurement of the Focal Spot

Introduction or Spatial Resolution
In the health care industry, the terms quality As the tube ages, the anode surface may become rough,
assurance and quality control have different resulting in a larger effective focal spot, because the rough
meanings. Quality assurance deals primar- surface leads to an increase in off-focus radiation. Degra-
ily with personnel and their interactions with dation of the focal spot can produce blurred structures
the patient and other staff. It is the term used on the radiograph. This is known as focal spot blur. The
to describe the process or program used to focal spot size or spatial resolution should be measured
maintain high-quality imaging. It is a many- annually or when the x-ray tube is replaced. For focal
step process that involves identifying goals, spots smaller than 0.8 mm, the size should be within
formulating plans to achieve these goals, ±50% of the nominal or stated focal spot size. Focal spots
implementing the plans, and evaluating the between 0.8 and 1.5 mm may be 40% larger than the
success of the program. Quality assurance also stated size and focal spots larger than 1.5 mm can be 30%
includes outcomes analysis, such as how often larger than the stated size. The pinhole camera and a star
the radiologist’s report agrees with the patient’s pattern phantom are used to measure the focal spot size.
condition. The most accurate method is the pinhole camera, which
Quality control (QC) refers to the mea- produces an image of the focal spot. However, the pin-
surement and evaluation of radiographic hole camera is extremely difficult and time-consuming to
equipment, together with the identification set up and use. The star pattern uses an image of a star to
and correction of problems associated with determine the focal spot size by using a formula to relate
the equipment. It includes periodic checks the diameter of the star image to the size of the focal spot
and monitoring of the operation of all equip- (Fig. 15.1).
ment, initial acceptance testing of equipment, The line pair resolution tool, an alternating series of
periodic testing of equipment performance, metal strips with different separations, gives the spatial
and the steps taken to correct deviations from resolution of the system directly. The advantage of the
expected performance. QC measurements line pair resolution tool is that it can readily detect deg-
often require specialized equipment. This radation of image quality. The resolution of a film screen
chapter discusses the factors that should be system should be >8 line pairs per millimeter (lp/mm).
monitored and the frequency of monitoring. Today almost all annual resolution monitoring tests are
Often regularly scheduled maintenance can performed with a line pair resolution tool.
detect and correct potential problems before
they affect image quality. Documentation
of all QC monitoring should include the Collimation
date, the type of test, the outcome, and iden- It is important that the light field and the radiation field
tification of the individual performing the coincide so that the x-ray field placement is correct. This
monitoring test. is called light-radiation field congruence. When the
fields are misaligned, anatomy in the light field will not
be imaged, while anatomy outside the light field will be
irradiated.
Radiographic Quality The alignment of the collimator that defines the x-ray

Control beam and the light field must be checked annually and
whenever the tube or field light is replaced. To measure
the light-radiation field congruence, a film cassette is
Radiographic QC consists of periodic monitoring of the placed on the tabletop. The edges of the light field are
x-ray tube, the associated electric circuits, the accuracy of marked on the cassette by placing metal markers such
the exposure factors, and the film processor (Table 15.1). as coins or paper clips at the edge of the light field.
 Chapter 15: Quality Control 223

TABLE 15.1 THE FACTORS THAT MUST BE MONITORED, THE TEST TOOLS USED, THE ACCEPTABLE LIM-
ITS, AND THE FREQUENCY OF MONITORING

Factor Monitoring Frequency Limits Test Tool

1. Focal spot size Annual greater or less than 50% Slit or pinhole camera
Spatial resolution Bar phantom
2. Collimation Annual >8 lp/mm Film + metal markers
3. kVp Annual greater or less than 4 kVp Penetrometer or step wedge
4. Filtration Annual >2.5 mm Al Aluminum sheets
5. Exposure time Annual <10 ms, greater or less than 20% Exposure meter or spinning top
Annual >10 ms, greater or less than 5%
6. Exposure reproducibility Annual greater or less than 5% Exposure meter or ion chamber
7. Exposure linearity Annual greater or less than 10% Exposure meter or ion chamber
8. AEC Annual None Exposure meter

An exposure is made, and the edges of the light and photons have greater penetration. The same principle
radiation fields are measured. The sum of the differences is used in modern electronic kVp meters (Fig. 15.2).
between the light and radiation field edges must be <2% Electronic detectors measure the penetration of the x-ray
of the source to image receptor distance (SID). The cen- beam through two different attenuating filters. The ratio
tering indicator should be within 1% of the light field of the readings from the two detectors is used to calcu-
central ray when the SID is at the correct distance. The late the kVp of the x-ray beam. Electronic kVp meters are
positive beam-limiting mechanism should never allow more accurate than penetrometers and are the preferred
the light field size to be larger than the image receptor method of measuring kVp. The kVp should be within
placed in the Bucky tray except when the override con- plus or minus 4 kVp and should be tested annually.
trol is active. Electronic kVp meters are accurate to plus or minus
1 kVp and give the maximum, average, and effective kVp
kVp Accuracy of the x-ray beam. kVp measurements are usually made
by the service engineer or the medical physicist.
If the kVp settings are incorrect, the patient dose may
be increased and the image contrast compromised. The
applied kVp can be measured directly using a voltage
Filtration
divider. This requires disconnecting the high-voltage The filtration of an x-ray beam is reported in terms of its
cables from the x-ray tube and should only be done by half-value layer (HVL), expressed in terms of aluminum
a trained service person. Measurement of the kVp can thickness. The HVL of the x-ray beam is measured annu-
also be made using a step wedge penetrometer. The opti- ally to ensure that the penetrability of the beam has not
cal density (OD) under the steps of the penetrometer is been degraded. The HVL is measured using thin sheets
related to the kVp of the beam because higher-kVp x-ray of aluminum (Al). A series of output measurements is

Figure 15.1. Shows photo-

graphs of the star and line pair
resolution tool together with the
star and line pair resolution tool
images used to measure the size
of the focal spot or determine the
resolution of the imaging system.
224 Part IV: Special Imaging Techniques

Figure 15.2. Shows an electronic kVp meter.

Figure 15.4. Synchronous motor.

made, first with no added aluminum in the beam, then
with added thicknesses of Al. The HVL is calculated from
the decrease in output as the Al thickness is increased. Today all timer measurements are made electronically.
An HVL of at least 2.5 millimeters (mm) Al equivalent A radiation detector measures the duration of the x-ray
is required for a tube operating at 70 kVp or higher. The exposure. Timer accuracy should be checked annually
tube window and light field mirror contribute about and must be within ±5% for exposure times >10 ms and
1 mm Al to the total filtration. within ±20% for exposure times <10 ms.

Exposure Time Exposure Reproducibility

If the timer settings are not accurate, the mAs values may Exposure reproducibility means that the radiation output
be incorrect, resulting in poor-quality images and poten- (measured in milliroentgens [mR]) should be the same
tially more patient dose. In the past, a spinning top with a for a series of exposures in which all the technical fac-
hole in a metal disk was used to check the timer stations. tors are held constant. Exposure reproducibility should
After an exposure of the spinning disk was made, the hole be measured annually using a radiation dosimeter.
in the disk appeared as a series of dots on the film because Exposure reciprocity means that each combination of
the x-rays are produced only at the peak of the voltage mA and time that results in the same mAs should give
cycle. The exposure time can be determined by counting the same radiation output (measured in milliroentgens)
the number of dots. For example, a 0.1-second (s) expo- within ±5% of the average output (Table 15.2).
sure would be expected to show an image with 12 dots, The differences in exposure as measured by the out-
representing 0.1 of the 120 pulses that occur each second put in milliroentgens arise from slight differences in the
with a single-phase full-wave-rectified circuit (Fig. 15.3). calibration of the time and mA stations. Unit A meets the
A synchronous motor was used to check the timer accu- exposure reproducibility requirements because all mAs
racy of three-phase and high frequency units (Fig. 15.4). values are within ±5% of the average.

TABLE 15.2 EXAMPLES FROM X-RAY UNIT A OF

HOW DIFFERENT COMBINATIONS OF TIME AND
mA CAN GIVE THE SAME mAs VALUE AND THE
SAME RADIATION OUTPUT

Time Set mA mAs Radiation Output (mR)

0.02 500 10 40
0.033 300 10 42
0.05 200 10 41
0.1 100 10 40
0.2 50 10 40
0.4 25 10 39
Figure 15.3. Spinning top test.
 Chapter 15: Quality Control 225

TABLE 15.3 EXAMPLES OF DIFFERENT

COMBINATIONS OF TIME AND mA AND
Viewbox
DIFFERENT mAs FROM X-RAY UNIT B Viewbox illumination testing should be performed annu-
Time mA mAs mR mR/mAs ally. The test is performed with a photometer which mea-
sures the light intensity at several areas of the viewbox. The
0.05 100 5 19 3.8 intensity should not vary by more than ±10%. If it is deter-
0.025 200 5 20 4.0 mined that the bulb is defective and needs to be replaced,
0.1 50 5 21 4.1
then all the bulbs should be replaced in the viewbox.
0.1 100 10 41 4.1
0.2 50 10 38 3.8 All viewboxes in a department should be consistent and
0.4 25 10 31 2.9 should use the same bulbs from the same manufacturer.
0.4 50 20 79 3.9
0.2 100 20 80 4.0
SID and Centering Accuracy
As x-ray machines age, the SID and locking mechanisms
tend to drift. These should be tested to determine if the
Exposure Linearity distance, centering locks, stops and detents are accurate.
SID indicators can be checked with a tape measure while
Exposure linearity is a measure of how the radiation centering indicators can be checked visually for the col-
output in milliroentgens increases with increasing mAs. limator light beam. SID indicators should be ±10% and
Prior to testing for exposure linearity it is necessary to centering indicators should be ±2%. If either of these indi-
test the exposure timer to be certain it is accurate, if it cators is not within limits, they will need to be adjusted.
is not it needs to be corrected before the linearity test
can be performed. The radiation output per mAs (mR/
mAs) should remain the same with ±10% as the mAs is Angle Accuracy
changed (Table 15.3). Equipment that angles must be checked periodically
Unit B does not meet the linearity requirement for accurate readings. The equipment includes the x-ray
because the 0.4 s, 25 mA entry differs from the average by table, Bucky units, and x-ray tubes. This is critical because
more than 10%. We know that the 25 mA station rather there are radiographic exams which require a specific
than the 0.4 s time station is faulty because the 0.4 s, tube angle to be used to image anatomy. The angle can
50 mA selection gave an mR/mAs value with ±10% of the be evaluated by using a protractor for angle measure-
average value. ments and a level to verify the locks, stops and detents are
set to horizontal and perpendicular. The angles must be
Intensifying Screens within ±1% for accuracy.

Intensifying screens should be checked periodically for

dust or other particles which enter cassettes when they are
Cassette Cleaning
opened for loading and unloading film. These particles will Radiographic cassettes and intensifying screens are
cause an artifact to appear on the image. Periodic cleaning exposed to dust and foreign objects during normal use.
of the screens with a soft, lint free cloth and cleaner from Periodic cleaning of the outside of the cassette will
the manufacturer should be performed in accordance remove dirt and grime which can lead to artifacts. The
with the work load of the imaging department but should intensifying screens on the inside of the cassettes must
be performed at least every other month. When cleaning also undergo periodic cleaning with a specially formu-
the cassette, it should be inspected for signs of wear at the lated antistatic solution to remove artifacts. In addition
corners and edges or for deformity of the screen, and if to the special solution, the cassettes should be cleaned
excessive wear or deformity is identified, a wire mesh test with a lint-free cloth. At the time the cassettes are being
must be performed to examine the extent of the damage. cleaned, they should also be inspected for wear at cor-
If there are areas of blurring on the wire mesh test image, ners, edges, and hinges. After the cassettes are cleaned,
the cassette should be taken out of service. they must be placed vertically on a surface and allowed
226 Part IV: Special Imaging Techniques

to air dry. Once the screens are dry, the cassette can be different in each unit. The equipment manuals must be
reloaded with film and placed in the film bin for use. referenced to know the exact range for the given unit.
Each cassette must be labeled with a number on the
outside and inside. This will allow technologists to iden- Response Capability
tify the cassette which produced an artifact on an image.
Each AEC has a minimum response time, and if it can-
At this time the cassette is cleaned to remove the artifact
not respond by the minimum time, the radiographer can-
and inspected for any structural problems.
not be sure the image will be produced with diagnostic
quality. The response capability is measured by using a
Lucite phantom with multiple layers. Multiple exposures
Automatic Exposure are made with the phantom thickness being reduced for
Control each exposure. The AEC should produce images with
intensity within ±10% of one another until a time below
the minimum exposure is used. If the minimum response
The automatic exposure control (AEC) is designed time is longer than specified the AEC should not be used
to compensate for differences in patient size by adjust- until the error has been corrected.
ing the time. The AEC measures the exit radiation and
adjusts the exposure time to produce a proper density Backup Timer Verification
image. The AEC circuit is tested annually to verify that
The AEC backup timer is used to terminate exposures
the mAs increases with increasing patient thickness.
when the x-ray beam has been activated for too long a time.
To test the backup timer a lead plate is placed over the
Exposure Reproducibility AEC ion chamber and an exposure is made. The backup
The reproducibility standards for the AEC are the same timer should terminate the exposure and a warning alarm
as diagnostic radiography. Radiographs must be produced should be sounded. If the timer or alarm fails the AEC
using a phantom and the densitometer readings of the should not be used until the problem has been fixed.
images produced with the AEC should be within OD
±0.1%. If the readings are not within limits, the AEC gen-
erator must be tested and recalibrated. Tomography Quality
Ion Chamber Sensitivity Control
AEC’s have three ion chambers and permit activation of
many combinations of the chambers during an exposure. In addition to standard radiography, QC testing units
Each ion chamber must be tested for its sensitivity and all with tomographic capabilities are required to have addi-
three chambers must be equally sensitive. All three cham- tional tests.
bers are tested with a reproducibility test utilizing very low
kVp. The next step is to block two chambers and produce Uniformity and Completeness
an image with the unblocked chamber. This test must of Tube Motion
be done on each chamber. Each chamber must respond
Tomography relies on the motion of the tube to make a
within ±10% from the other’s chambers to be in range.
sectional image of the object during the exposure. QC tests
must be completed to assure the smooth movement of the
Density Variation Control tube and to be sure the tube path is a complete path. To
AEC units have density variation controls to increase test tube movement a lead mask with a pinhole is placed
and decrease the density of the image by changing the several centimeters above the fulcrum and centered to the
sensitivity of the ion chamber. A mR/mAs measurement image receptor. A tomographic exposure will take place
is taken to verify the intensity differences for each con- and the resultant image should have demonstrated a dot
trol. Each unit is unique and the percentage of change is with a blurred line running through it. If the tube motion
 Chapter 15: Quality Control 227

Section Thickness
The section thickness of a tomogram is determined by
the arc of the tomographic motion. The equipment man-
ual will indicate the section thickness for each type of arc
available on the unit. The arc and resulting section thick-
ness are measured by using an angled wire mesh. When
the angled wire mesh is imaged, the section thickness is
determined by measuring the region of sharpness on the
image. If the section thickness is not accurate, a qualified
service engineer must be notified.
A B

Figure 15.5. Tomographic uniformity and completeness Resolution

of tube motion tested with a pinhole tracing image. Notice
how the line in A is smooth and has uniform density. Line Tomographic resolution is tested by imaging a resolu-
B has uneven densities along the pinhole exposure repre- tion test pattern. The test pattern is placed at the fulcrum
senting a problem with the tube motion. level, this is crucial because this is the only part of the
image which is not blurred by the motion of the tube.
were not complete there would not be a full length tracing. The image is then inspected to determine the resolving
If the tube motion were erratic, there would be uneven capability of the unit. If the resolution is not adequate,
densities along the pinhole exposure (Fig. 15.5). diagnostic QC tests should be performed to determine
what the problem is.
Section Depth Indicator
The area of interest that is placed at the fulcrum level
should appear sharp and in focus on the tomographic Processor Quality
image. All other structures above and below the fulcrum
level should appear blurred. The section depth indicator
Control
test is performed to assess the accuracy of the fulcrum level.
Using a commercial test tool with number levels, the ful- Processor QC is necessary to ensure that the processed films
crum level is set and a tomographic image is made. The produce consistently high quality images. Processor QC
number at the level of the fulcrum should appear sharp; if it consists of daily monitoring and periodic cleaning and main-
does not appear sharp, the fulcrum level must be adjusted. tenance of the processor. All efforts expended in obtaining
This way the radiographer can be sure that the anatomy of an excellent latent image are wasted if the latent image is
interest at specific fulcrum levels will be imaged. not processed in a reproducible manner (Table 15.4).

TABLE 15.4 LISTS THE PROCESSOR QUALITY ASSURANCE FACTORS TOGETHER WITH THEIR
RECOMMENDED MONITORING FREQUENCY

Factor Monitoring Frequency Limits Test Tools

Sensitometry/densitometry Daily Department limits Sensitometer

Densitometer
Temperature Daily greater or less than 2°F Digital thermometer
Crossover racks cleaning Daily Clean Visual inspection
Replenishment rates Weekly Manufacturer’s specifications Meter or gauge
Tanks and transport roller Depends on number of films/week Clean Visual inspection
cleaning
228 Part IV: Special Imaging Techniques

Processor Monitoring
The overall operation of the processor is most easily mon-
itored by preparing a sensitometric strip and processing it
in the processor each morning as soon as the processor is
warmed up.
The sensitometer is an instrument that exposes a test
film to light through a series of filters. Sensitometer elim-
inates any variations due to x-ray output variations. The
output of the sensitometer is a film with a series of den-
sities extending from base plus fog level to completely
black in discrete steps. For this reason, this process is also
called a step wedge exposure (Fig 15.6).
A densitometer is used to measure the OD of each step.
The background density (which is the base plus fog den-
sity), average speed, and contrast in the middensity range
are calculated from the measured OD values. These val-
ues are then recorded and compared with previous mea-
sured values. The OD values from the daily sensitometric
strip must be within acceptable limits, which are set by
the department. The base plus fog value must be <0.05
OD. If the readings are outside the acceptable limits, the Figure 15.7. Shows a sensitometer strip image.
processor cannot be used clinically until the problem is
corrected (Fig. 15.7).
replenishment rates should be monitored weekly and
The temperatures of the processor solutions, developer,
maintained within the supplier’s tolerances.
fixer, and wash water should be checked with a digital
thermometer and recorded daily. Mercury thermometers
should never be used to measure processor temperatures Image Artifacts
because mercury contamination of a processor is almost An artifact is an unwanted density or image on the radio-
impossible to eliminate. Slight changes in the tempera- graph. Film artifacts can be divided into three categories
ture of the developer solution will produce significant based on their source. The major sources of artifacts are
density changes in the final radiograph. The developer exposure artifacts, handling artifacts, and processor arti-
temperature should be maintained within greater or facts.
less than 2°F of the set value. The developer and fixer
Exposure Artifacts
An exposure artifact occurs during the exposure of the
patient rather than after the exposure has been made.
They can be present with both film and digital image
receptors. Exposure artifacts are caused by improper
positioning, technical factors, or patient motion. Grid
cutoff due to improper alignment of the grid also can
produce artifacts; these appear as lighter areas on one
or both sides of the image. Exposure artifact can also be
caused when the imaging receptor is not loaded with
the correct film for the intensification screen, poor film/
screen contract, warped cassettes and improper position-
Figure 15.6. Shows a sensitometer and a densitometer. ing of the grid.
 Chapter 15: Quality Control 229

Lack of patient preparation can also be a significant on the image. Light leaks can also occur in the darkroom
source of exposure artifacts. Failure to remove eyeglasses, if the safelight has an improper filter, if the safelight is too
jewelry, rings, watches, and hair clips will produce expo- bright or if the safelight is too close to the processing tray
sure artifacts. Hair, especially if braided or wet, can cause of the automatic processor. White light leaks can occur if
exposure artifacts. Exposure artifacts can be reduced or the darkroom door allows light to leak through the perim-
eliminated by careful attention to details before taking eter of the door or underneath the door. This white light
the exposure. Using excellent communication skills can will cause fog on the film as it is loaded into the cassette
prevent motion artifact caused by breathing or patient or as the film is placed on the processing tray.
movement (Fig. 15.8). Screens should be cleaned monthly with a special
cleaning fluid and lint-free wipes to remove any poten-
Handling and Storage Artifacts tial dust and to prevent static buildup. Static artifacts are
Handling artifacts occur because of improper handling caused by electrical discharges and appear as positive
and storage of the film. Handling artifacts include light dark lines on the image. They are most common in win-
leaks, static, crease marks, and fingerprints. The source ter, when the air is dry and relative humidity is low. The
of handling artifacts is usually easy to identify because three types of static artifacts are tree, which appear with
the cassettes must be light-tight; any physical damage branches; crown, which have many lines radiating from
or rough handling may destroy the light-tight integrity. a common area; and smudge, which appear as slightly
Light leaks appear as positive-density areas, darker areas positive areas on the image. Film should be stored under

Figure 15.8. Presents an example of an exposure artifact due to a necklace.

230 Part IV: Special Imaging Techniques

Tree Fingerprints

Crown

A Smudge

C Figure 15.9. (A–C) Presents examples of handling

artifacts.

conditions where the relative humidity is between 40% A deposit of dirt or chemicals on a portion of a roller
and 60% and the temperature is below 72°F. will make a dark or positive mark on the film on each
Rough handling of the undeveloped film can pro- revolution. These pi mark artifacts are perpendicular to
duce crease or kink marks, sometimes called fingernail the direction of film travel through the processor and
marks because they resemble fingernail clippings. These are spaced at pi, or 3.14-inch intervals. Typical transport
positive-density marks result from bending or creasing of rollers are 1 inch in diameter, so pi marks are usually
the film during loading, unloading, or processing. Han- 3.14 inches apart and represent one revolution of the
dling the film with sweaty, greasy, or oily hands can result roller. Regularly scheduled processor cleaning will elim-
in negative-density areas, or lighter areas, in the form of inate pi marks and many other processor artifacts. It is
fingerprint marks on the film (Fig. 15.9). essential to clean the crossover racks daily.
Guide-shoe marks are caused by the guide shoes,
Processor Artifacts which are used to reverse the direction of the film at
Processor artifacts occur as a result of improper processor the crossover rack assembly. Guide-shoe marks indicate
QC of the transport system. Processor artifacts include pi that the guide shoes are misaligned and are scratching
marks, guide-shoe marks, and chemical stains. the film emulsion. These marks appear as light lines or
 Chapter 15: Quality Control 231

sludge and other debris build up on rollers, they come

into contact with film as it is moved through the rollers.
The sludge and debris can then flake off onto the film
causing artifacts. This can be prevented by daily cleaning
of the crossover racks. The crossover racks are very easy
to remove and clean. Proper cleaning prevents the sludge
from building up and it also facilitates the movement of
the films through the rollers.
The processor must also have a weekly cleaning to
remove the transport rollers and crossover racks. The
processing tanks are cleaned and rinsed as well. This is
a fairly simple task to perform and should only take a
few minutes. A clean processor will produce high qual-
ity radiographs which are free from artifacts and will also
increase productivity because there will be no processor
down time due to jammed films.
Processor maintenance should be scheduled at regular
intervals in addition to daily and weekly cleaning. Sched-
uled maintenance is performed on a weekly or monthly
basis where the mechanical parts are observed for wear
and adjustment of belts, pulleys, and gears for proper
operation. Automatic processors should have a planned
Figure 15.10. Shows guideshoe marks. maintenance program where parts are replaced at regu-
lar intervals before the processor experiences failure and
downtime. Unexpected failure can lead to processor
negative densities parallel to the film direction. Realign- downtime, which severely affects productivity of the radi-
ment of the guide shoes will eliminate guide-shoe marks ography department. A proper program of scheduled and
(Fig. 15.10). preventative maintenance will ensure the proper opera-
Chemical fog can occur when there is improper tion of the processor and will keep unexpected failures to
chemistry in the processor. The chemical fog appears like a minimum.
light or radiation fog and has a dull gray appearance. The
chemical fog is called a dichroic stain and typically is
comprised of two colors. The stains can appear as yellow,
green, blue, or purple on the film. The chemical stains
occur when a slow processor does not properly remove
Computed
chemicals from the film and the excess chemicals run Radiography Quality
down the leading or trailing edges of the film.
Control
Processor Cleaning
As part of a computed radiography quality assurance
and Maintenance program, it is important to monitor the sensitivity and
Automatic processors operate at a high rate of film pro- dynamic range of the system annually to ensure that there
cessing and require weekly cleaning procedures to main- has been no degradation of the detector plates’ efficiency.
tain a properly operating processor. Processors operate at The dynamic range is the difference between the lowest
a high temperature with concentrated chemistry which and highest signals the system can process.
causes wear and corrosion of the transport system and can Artifacts in computed radiography (CR) systems are usu-
contaminate the chemistry with processing sludge. When ally produced by sudden failure of internal components.
232 Part IV: Special Imaging Techniques

Such artifacts are easy to detect because they occupy all Heat Blur
or a significant portion of the image and take the form
of streaks or lines. Other artifacts may appear on the CR Heat blur will occur when the image receptor is exposed
image and are classified according to where they occur in to intense heat.
the image processing sequence.

Phantom Images Fluoroscopy Quality

Phantom images may appear on an image and typically Control
result from an incomplete image plate erasure. The
image plate must be erased prior to the next exposure, There are two types of fluoroscopic units, stationary and
and in cases where an extreme overexposure was made, mobile. Stationary fluoroscopic units must be installed with
the plate may need to be run through the erasure process a source to skin distance (SSD) of at least 38 cm (15 inches)
more than once. at tabletop. Mobile C-arm fluoroscopy units must have an
SSD of at least 30 cm (12 inches). QC of fluoroscopic sys-
Permanent Artifacts tems consists of monitoring the radiation output exposure
rate, the spatial and contrast resolution, the operation of the
Imaging plates are prone to scratches just like normal automatic brightness control (ABC) of the system and other
cassettes. When scratches appear on an imaging plate, factors necessary to produce a quality fluoroscopic image.
the only solution is to replace the plate because the plate
cannot be repaired.
Radiation Output
or Exposure Rate
Light Spots
The exposure rate must be checked with an attenuation
CR cassettes are susceptible to exposure to dust and for- phantom placed in the beam to ensure that the mea-
eign materials which collect on the imaging plate and surements are made under conditions similar to those in
are visualized on the image as light spots. The imag- clinical practice. Typical entrance skin exposure (ESE)
ing plate can be cleaned according to manufacturer’s rates are about 3 rad/min, (3 milligray [mGy/min]).
specifications to remove dust and to avoid permanent Under normal conditions, the ESE should be <5 rad/min
damage. (50 mGy/min), and it must always be <10 rad/min (100
mGy/min). Because the ESE is higher with higher
Fogging magnification modes, it must be measured at all magni-
fication modes. The ESE of a fluoroscopic system must
Imaging plates are very sensitive and prone to fog- be measured annually. A general rule of thumb is that the
ging. Care must be taken to keep imaging plates away ESE is about 2 rad/min/mA.
from radiation or light sources when not in use. Imag-
ing plates which have not been used recently should
be erased to remove any potential fogging prior to an
Resolution
exposure. The spatial resolution of a fluoroscopic system is checked
by placing a resolution phantom in the beam and observ-
ing the system resolution. The resolution phantom con-
Quantum Mottle sists of a series of lead bars of differing separation labeled
Quantum mottle is considered an artifact. It is caused by in line pairs per millimeter. The higher the number of
an inadequate exposure where the mAs was not sufficient line pairs per millimeter visible, the better the resolution
for the part being imaged. Care must be taken to use the of the system. Modern fluoroscopic systems have resolu-
appropriate mAs for the anatomy being image to avoid tions between 1.2 and 2.5 lp/mm. The resolution must be
quantum mottle. checked annually at all magnification modes (Fig. 15.11).
 Chapter 15: Quality Control 233

images are affected not only by kVp, mAs, and the

sensitivity of the film/screen system but also by the charac-
teristics of the image intensifier. These images are recorded
on the film after the image has passed through the out-
put phosphor of the image intensifier tube. The ESE for
photofluorospot images is greatly reduced than cassette
spot films because of the properties of the image intensi-
Figure 15.11. Shows an example of an image obtained fier which brightens the image thousands of times which
with a fluoroscopic resolution phantom.
means the kVp and mAs used to create the image can be
much lower.
Automatic Brightness Control
Exposure Reproducibility
ABC circuits are designed to maintain constant image
brightness regardless of the thickness of the patient. Fluoroscopic spot film devices use AECs to record an
The operation of an ABC circuit is measured by placing image. The AECs should be evaluated according to
attenuators of different thicknesses in the beam. The mAs established protocols.
should increase with increasing attenuator thickness. The
operation of the backup timer in the radiographic mode Field Size and Beam Alignment
can be verified by placing a lead sheet in the beam. The
Fluoroscopic units use field size to image the patient,
beam should be terminated at the backup timer setting,
field size is the equivalent to collimation in diagnostic
usually about 500 mAs of 5 seconds. ABC circuits should
radiography. Just as in diagnostic radiography, fluoro-
be tested annually (Table 15.5).
scopic tubes should not be capable of irradiating tissue
outside the field size area. The accuracy of the field size
Spot Film Exposures in fluoroscopy should be within 1 cm of the edges of
Spot film images can be produced in two ways: cassette the image intensifier tube. The primary beam from the
spot film and photofluorospot. Proper exposure of the under-the-table x-ray tube must be aligned to the center
cassette spot film depends on the kVp, mAs, and sensitiv- of the image intensifier.
ity of the film/screen systems being used. Entrance skin
exposures vary widely; however, the ESE in mR is much Intensifier Viewing System
higher for cassette spot film than photofluorospot images.
This is due to the placement of the cassette between the
Resolution
patient and image intensifier. The cassette is exposed Resolution for proper visualization of anatomy and
with remnant radiation which has only passed through pathology is critical in fluoroscopic imaging just as in
the patient. Subsequently, greater exposure factors are radiographic or digital imaging. Fluoroscopic resolution
necessary to create a diagnostic image. is much poorer than radiographic resolution and must be
The photofluorospot images use film but require lower checked periodically to ensure adequate resolution and
patient dose to create diagnostic images. Photofluorospot to check for deterioration. A resolution pattern test tool

TABLE 15.5 SOME FLUOROSCOPIC QC TESTS AND THEIR LIMITS

Factor Frequency Limits Tools

Exposure rate Annual <10 rad/min Exposure meter

Resolution Annual None Resolution phantom
ABC Annual None Exposure meter
Protective apparel Annual No cracks or gaps Fluoroscope or film
234 Part IV: Special Imaging Techniques

or fluoroscopic mesh test tool can be imaged to visualize

the resolution of the system. Computed
Monitors and Recorders Tomography Quality
Modern fluoroscopic units use video systems to display Control
the image. The monitors and recorders must be tested
periodically to assess the resolution of the image on the Computed tomography has many moving parts which
monitors. The fluoroscopic mesh test tool or wire mesh could experience instability, misalignment, miscalibra-
tool can be used to test for resolution. The test tool is tion, and malfunction. These parts include the gantry,
imaged on the fluoroscope to allow visual measurement detectors, console, computer, and patient couch. Com-
of the system resolution on the monitor and to assess for puted tomographic QC includes annual tests of system
distortion of the image. noise and uniformity, linearity, spatial resolution, con-
trast resolution, slice thickness, patient exposure, laser
localizer, and support table increment accuracy. An
effective QC program will encompass daily, weekly,
Protective Apparel monthly and annual measurements, and visual inspec-
Quality Control tion which coincides with a preventive maintenance
program.

Protective aprons, gloves, gonadal shields and other radi-

ation shields must be checked for tears, gaps, holes, and
Noise and Uniformity
voids at least annually. All protective apparel should be The test for noise and uniformity is performed daily. A
visually inspected and also tested radiographically. This water phantom is scanned and the computer adjusts the
inspection may be performed fluoroscopically or by tak- system so that the value of water equals Hounsfield units
ing radiographs of the apparel. Any apparel which dem- (HU) of zero. The uniformity should be such that there
onstrates defects must be replaced (Fig. 15.12). is variation of <±10 HU across the image.

Figure 15.12. (A) Shows a photo-

graph of a normal-appearing lead
glove. (B) Shows a radiograph of
the same glove that shows a gap in
A B the protection because the internal
lead shielding is torn and shifted.
 Chapter 15: Quality Control 235

Linearity Slice Thickness

CT linearity is measured using a special phantom with A specially designed phantom which has a ramp, spiral,
plastic rods of different calibrated densities and HU. The or a step wedge is used to measure slice thickness. The
coefficient correlation for the relationship between the slice thickness should be ±1 mm of an expected 5 mm or
densities and HU should equal or exceed 0.96%. The greater slice thickness. A slice thickness <5 mm has a tol-
unit is initially calibrated so that water has a HU of 0 and erance of 0.5 mm. The assessment should be performed
air has a HU of −1000. on a semiannual basis.

Spatial Resolution Laser Localizer

Most CT scanners utilize internal and external laser
Monitoring spatial resolution is the most critical compo-
lights for patient positioning. There are several specially
nent of the CT program. It is crucial to ensure the spatial
designed phantoms for determining the accuracy of the
resolution is at a maximum. This ensures that the detec-
laser localizers. The accuracy should be tested semiannu-
tor array and reconstruction electronics are performing
ally and can be performed at the same time as the table
properly and that the mechanical components of the CT
movement evaluation.
unit are also performing as expected.
The QC tests for spatial resolution include imaging
an edge to get edge-response function (ERF) and the
Patient Dose
modulation-transfer function. A line pair test pattern can Due to the broad range of examinations in CT, there
also be used. The specific test used is the preference of are no maximum levels specified for the permissible
the medical physicist. The spatial resolution should be dose to the patient. The dose will vary according to the
assessed semiannually to be certain the unit stays within scan parameters with high resolution scanning requiring
the manufacturer’s specifications. increased dose. There are some examinations that utilize
a fixed technique from one patient to the next; for these
types of examinations, the patient dose should not vary by
Contrast Resolution more than ±10%. The testing for patient dose should be
The contrast resolution of the CT scanner is of superior performed on a semiannual basis and after the x-ray tube
quality. The specifications vary from one manufacturer has been replaced (Table 15.6).
to another and even between the different models. The
current standard for all scanners is the ability to resolve TABLE 15.6 LISTS THE QC TESTS FOR A CT
5 mm objects at 0.5% contrast. Contrast resolution test- SCANNER
ing should be performed semiannually and can be per- Factor Frequency Limits
formed with low-contrast phantoms which have built-in
analytical schemes. Noise Daily greater or less than
10 HU
Uniformity Daily greater or less than
Table Increment Accuracy 0.04%
Spatial resolution Annual greater or less than
The patient table or couch moves with precision through 20%
the gantry while the patient is scanned. It is imperative Contrast resolution Annual greater or less than
that the patient table be evaluation monthly to make sure 0.5%
it is working correctly. The test can be performed when Slice thicknesses Annual 0.5 mm
<5 mm
a patient is on the table. During the scan make note of
Slice thicknesses Annual 1 mm
the position of the table at the beginning and ending of >5 mm
the examination by using a tape measure on the table Support table indexing Annual greater or less than
rails. Compare the measurement with the expected table 1 mm
movement; it should be within ±2 mm.
236 Part IV: Special Imaging Techniques

TABLE 15.7 SHOWS THE TESTS AND THE

REQUIRED FREQUENCY OF EACH TEST FOR gradual degradation of image resolution. Spatial
MAMMOGRAPHY QC resolution should be >±8 lp/mm.
Regular processor QC tests are necessary
Test Frequency
to ensure that the processed films are of high
Darkroom cleanliness Daily quality. An exposure made with a sensitometer
Processor QC Daily and measured with a densitometer gives a good
Screen cleaning Weekly measure of processor operation. Artifacts are
View box cleaning Weekly unwanted densities or images on a radiograph.
Phantom image quality Weekly
Visual inspection of equipment Monthly
Pi marks are positive-density artifacts perpendic-
Repeat analysis Quarterly ular to the direction of film travel through the
Fixer retention Quarterly processor and separated by 3.14 inches. Guide-
Film/screen contact Semiannually shoe marks are negative-density straight-line
Compression device Semiannually artifacts parallel to the direction of film travel
Darkroom fog Semiannually through the processor.
CT quality assurance tests include daily
scanning of a water phantom to monitor HU
and field uniformity. Fluoroscopy QC involves
Mammographic monitoring the exposure rate and spatial resolu-
tion. The tabletop dose rate must be <0.01 Gy/
Quality control min (10 rad/min). Mammographic QC tests are
specified by the federal Mammographic Quality
Standards Act.
A facility must be accredited by a recognized agency to
perform mammographic examinations. The federal Mam-
mography Quality Standards Act sets out the standards
that accredited facilities must meet. The mammography
technologist is responsible for a series of daily, weekly,
monthly, quarterly, semiannual, and annual monitoring
Case Study
tests. These tests must be documented and records must Recently several radiographs have come out
be available for the annual inspection (Table 15.7). of the processor with static artifacts and guide-
shoe marks. Tess is the QC technologist and
she is responsible for determining the causes of
the artifacts and taking corrective action. After
reviewing the various artifacts, Tess must answer
Chapter Summary the following questions.
Quality assurance deals with personnel and the
performance of the team required to produce
high-quality radiographs. QC deals with equip-
Critical Thinking Questions
ment performance. Radiographic QC includes
What QC tests should be performed?
monitoring the components that affect radio-
logic image quality. These include focal spot
What is the cause of static artifacts?
size, kVp, the timer, exposure linearity, and
processor performance, including monitoring
How can static artifacts be avoided?
of processor temperature and replenishment
rate. The focal spot size or system resolution
What is the cause of the guide-shoe marks?
should be measured at least annually to detect
 Chapter 15: Quality Control 237

How frequently should the processor be happen if the crossover racks are not properly
cleaned? placed in the processor. The crossover rack
assembly should be cleaned daily and prop-
erly returned to its place. If guide-shoe marks
Tess must first look at the QC manual to are present on films, then the crossover rack
determine the last time QC was performed should be checked to see if it is properly
on the darkroom and processor. Tess needs seated in position. In addition to cleaning
to test the temperature and humidity in the the crossover racks daily the transport rollers
darkroom. She knows that static artifacts are must be cleaned weekly, the crossover racks
caused when the darkroom humidity is below are cleaned at the same time. The processor
40% and when the temperature is above 72°F. should also have monthly preventive mainte-
This problem is common in the winter months nance performed to check belts, pullies, and
when the air is dryer than normal. Static all mechanical parts for wear. Anytime the
artifacts can be avoided by leaning the inten- processor is dismantled and put back together,
sifying screens monthly since this decreases there is the risk of not properly placing the
the static buildup on the screens. Guide-shoe crossover racks. When guide-shoe marks are
marks are caused when the crossover rack seen, the first part of the processor to check is
assembly is not properly aligned. This can the crossover rack assembly.
Review Questions

6. Which QC test tool is used to determine blurring

Multiple Choice of an image?
A. Wire mesh test
1. An x-ray rube operating above 70 kVp must have B. Star test pattern
an HVL of at least _____ mm Al. C. Pinhole camera
D. ERF
A. 1.5
B. 2.5 7. The light intensity of a viewbox should not vary by
C. 3.5 more than _____ when comparing several areas.
D. 5
A. 1%
2. The developer temperature should be maintained B. 20%
within _____°F of the set value. C. 10%
D. 15%
A. ±2
B. ±4
8. Exposure reproducibility for an AEC should not
C. ±5
exceed
D. ±8
A. 8%
3. The _____________ can be used to measure timer B. 25%
accuracy. C. 0.5%
A. pinhole camera D. 0.1%
B. optical densitometer
9. Pi mark artifacts run ____________ to the direction
C. spinning top
of the film travel and at intervals of __________.
D. line pair test pattern
A. parallel, 3.14 inches
4. A 4-min fluoroscopic examination with a 1.5 mA B. perpendicular, 3.14 inches
tube current results in a patient dose of _____ rad. C. perpendicular, 2.58 cm
A. 4 D. parallel, 2.58 cm
B. 8
C. 12 10. The ESE of a fluoroscopic system is typically
D. 16 _____________.
A. 8 rad/min
5. Which combination of temperature and humidity
B. 3 mrad/min
should be used for film storage?
C. 3 mGy/min
A. 60% relative humidity, 10°F D. 6 mGy/min
B. 10% relative humidity, 10°F
C. 98% relative humidity, 68°F
D. 50% relative humidity, 68°F
 Chapter 15: Quality Control 239

6. What is the importance of preventive maintenance

Short Answer for an automatic processor?

1. Filtration is measured in radiography equipment

using _____.

7. Name the three QC tools used to measure focal

spot size.

2. The indicated kVp should fall within _____ of the

actual tested kVp.

8. List and briefly describe the seven parts of com-

puted tomography QC.

3. The _____ test is performed on intensifying

screens and cassettes to check for proper screen/
film contact.
9. Define linearity and provide the allowed varia-
tion.

4. The integrity of lead apparel should be checked

how frequently?
10. Refer to Table 15.1, list the parts of the radio-
graphic equipment that is tested regularly and give
the tolerance specifications for each.

5. The average skin dose during a fluoroscopic exami-

nation is __________.
 16

Mammography

Objectives Key Terms

Upon completion of this chapter, the student ● bias focusing ● molybdenum
will be able to: ● diagnostic ● rhodium
1. Describe the purpose of mammography. mammography ● screening
● mammography mammography
2. Describe the x-ray spectra used in
mammography.
3. Describe the film/screen systems used in
mammography.
4. State the reason for compression in
mammography.
5. Specify the ancillary components of the
mammography unit.
6. Explain the basic elements of digital
mammography.

240
 Chapter 16: Mammography 241

and high mAs. The main disadvantage to direct exposure

Introduction imaging was the extremely high mAs that was required
to produce a diagnostic image. In the late 1960s the first
Mammography is the radiologic examina- dedicated mammography unit was introduced. The use
tion of the breast and is utilized for the early of these units was widely accepted and the majority of
detection of cancer. It is one of the most chal- large radiology departments were performing mammog-
lenging radiographic examinations because it raphy. The equipment continued to change and improve
requires imaging of both small, high-contrast the diagnostic capabilities while the radiation dose was
calcifications and large, low-contrast masses. decreased.
For this reason, special x-ray tubes and films The American College of Radiology identified the
are used. need for high standards in breast imaging and in 1987
The differential absorption of fat, glandular developed an accreditation program which required
tissue, fibrous tissue, and cancerous tissue is mammography sites to voluntarily meet quality standards
very similar. Small microcalcifications are often to ensure that optimally exposed breast images were pro-
associated with cancer. All these tissues must duced at low radiation exposures to the patient. The fed-
be clearly imaged on a single film. The techni- eral government enacted the MQSA in 1994 to establish
cal factors of the examination must be tightly guidelines that required facilities to meet quality stan-
controlled to produce diagnostic-quality mam- dards. To date mammography is the only radiologic exam
mograms. The federal Mammographic Quality that is regulated by the federal government.
Standards Act (MQSA) sets strict guidelines to In early 2000, digital mammography was approved
ensure high-quality mammographic examina- for sale in the United States. Digital mammography is
tions. Only specially trained technologists are rapidly replacing standard mammography units because
permitted to perform mammographic examina- of its extremely high quality images. In this chapter,
tions. Mammography uses low-kVp values, in we discuss current aspects of mammography. A com-
the range from 20 to 40 kVp. This voltage is plete discussion of this specialized modality is outside the
lower than that for conventional radiography realm of this textbook; however, at the completion of the
to increase differential absorption and improve chapter, the reader should be well versed in the various
subject contrast. The poor penetration of the aspects of mammography.
low-energy x-rays is not a disadvantage because
most breasts are <10 centimeters (cm) thick.
Early detection of breast cancer can lead to
cure rates as high as 90%.
Breast Imaging
There are two types of mammographic examinations
performed. Screening mammography is performed on

Historical Overview asymptomatic women using the craniocaudad and medio-

lateral oblique views on each breast. These images are
performed yearly on women 40 years of age with family
Mammography is the visualization of breast tissue in history and for women age 50 who have no family history.
a radiographic image. The soft tissue structures of the Diagnostic mammography is performed on women who
breast require a low kVp and high mAs approach which are symptomatic or for women whose screening mam-
yields the highest resolution and contrast possible. Breast mogram demonstrated suspicious areas. This is used to
imaging was first performed in the 1920s and continued further evaluate the tissue for microcalcifications and
on to the 1960s with unreliable images due to the lack other pathologies. The diagnostic images can include
of sophisticated equipment. Dr. Robert Egan is credited magnification, spot compression, and rolled images to
with the use of direct exposure imaging using low kVp name a few.
242 Part IV: Special Imaging Techniques

X-ray tube Anode

Cathode

Greater Lesser
intensity intensity

Image
receptor

Figure 16.2. Shows the orientation of the cathode-anode

axis in relation to the chest wall.
Figure 16.1. Shows a typical mammographic unit.

bias focusing. Other units use two separate filaments for

the large and small focal spots.

X-Ray Tube Due to the high resolution needed in mammography,

a smaller effective focal spot size is needed. Additionally,
mammography uses a much shorter source to image recep-
The mammography x-ray tube is specially designed and tor distance (SID) of 24 to 30 inch which makes it necessary
dedicated for the imaging of breast tissue. Figure 16.1 to have small focal spots to reduce the increased geometric
illustrates a typical mammography unit. These units are unsharpness caused by the short SID. The typical large size
lightweight (under 500 lb) and are fully self-contained. focal spot of 0.3 mm is used for routine imaging, while a
A mammography unit is designed for flexibility in patient 0.1-mm small focal spot is used for magnification images.
positioning and can be modified to perform specialized The mammographic x-ray tube is designed to place
views of the breast. The design of the x-ray tube and ancil- the cathode at the chest wall where the heel effect will
lary components are capable of producing high resolu- have the greatest impact. The structures at the chest wall
tion and high contrast images with moderate radiation are difficult to visualize due to the thickness of the tissue
exposure. The unit must be capable of providing the high so placing the stronger part of the beam at the chest wall
contrast and resolution necessary to visualize microcalci- will aid in visualization of the posterior breast tissue and
fications and subtle changes to breast tissue. chest wall (Fig. 16.2).

Cathode Anode
The cathode has a standard helical-shaped tungsten fila- Mammography tubes utilize a rotating anode to take
ment in a focusing cup. This single filament is used for advantage of tube loading. This is beneficial in mammog-
both large and small focal spot sizes therefore it is called raphy because it allows the use of a higher mA to be used
 Chapter 16: Mammography 243

with exposure times of 1 second or less. The target angle which will improve visualization of breast anatomy. The
of the anode is greater than a conventional x-ray anode disadvantage to using a low kVp range is the increased
target angle. Mammography units use a target angle from radiation exposure to the patient. The increased dose is a
22 to 24 degrees. The larger angle is necessary to cover tradeoff with improved visualization of breast structures.
the 24 × 30 cm image receptor at the 24 to 30 inch SID. There are various advantages and disadvantages for
Some manufacturers have developed a tilted x-ray tube using a molybdenum target in the anode for mammogra-
which allows for the entire surface of the cassette to be phy tubes. The advantages are as follows:
covered while providing a narrower angle (Fig. 16.3)
Special mammographic x-ray units have molybdenum ● Increased number of low-energy photons are pro-
anodes to produce low-energy x-ray beams that are opti- duced.
mized for breast imaging. The molybdenum anode pro- ● High radiographic contrast is achieved.
duces K characteristic x-rays with energies of 17.4 to 19.9 ● Production of specific x-ray energies necessary for
kiloelectron volts (keV). This specific range of x-ray energies breast imaging.
is necessary to maximize subject contrast and to visualize
microcalcifications. Changing the applied kVp does not Disadvantages of a molybdenum target are the following:
change the energy of the K characteristic x-rays; however,
energies higher than this range will overpenetrate, scatter, ● Lower x-ray photon output.
and ultimately decrease contrast in the image. This range ● Increased mAs needed to maintain image receptor
is also necessary for creating the photoelectric absorption exposure.
interactions needed to produce the high contrast image ● Increased dose to the patient.

X-ray tube

Tumors

A B
Figure 16.3. (A) The heel effect is used in mammography to place the cathode toward the chest wall which pro-
vides more uniform optical density on the image. (B) A tilted x-ray tube will allow a narrower effective focal spot
to be used thereby improving spatial resolution.
244 Part IV: Special Imaging Techniques

Some mammographic units have provision to select

a rhodium anode and/or a rhodium filter. The binding
energies of the K and L shells in rhodium are slightly

Number of photons
higher than those of molybdenum. Rhodium produces
K characteristic x-rays with energies of 20 and 23 keV.
The beam from a tube with a rhodium filter and a molyb-
denum anode has slightly higher penetration than a beam
from a molybdenum anode with a molybdenum filter.
Rhodium filters and anodes are used for patients with
extremely dense or thick breasts. The patient dose and
10 17 20 30
image contrast are decreased with the use of rhodium
Energy (keV)
filters or anode. Tungsten anode tubes with aluminum
filters are not used in mammography. Figure 16.4. Illustrates the spectrum from a molybdenum
anode tube with a 0.03-mm molybdenum filter.
Focal Spot Sizes
Mammographic tubes have two focal spot sizes, a large
(0.3 mm) focal spot for routine mammography and a x-rays decrease image contrast by overpenetrating the
small (0.1 mm) focal spot for magnification mammog- tissue and exposing the image receptor to excessive scat-
raphy. MQSA requirements state that a mammographic ter radiation.
system must be able to image at least 13 line pairs per A 0.03-mm molybdenum filter allows the molybde-
millimeter (lp/mm) in the direction parallel to the cath- num characteristic x-ray photons to pass through while
ode-anode axis and 11 lp/mm in the direction perpen- filtering out both higher and lower energy x-ray photons
dicular to the cathode-anode axis. The effective focal spot (Fig. 16.4). Some tubes with molybdenum anodes can
is smaller than the actual focal spot because of the line be switched from molybdenum to rhodium filters when
focus principle. The effective focal spot is smaller toward imaging thick or dense breasts. The half-value layer
the anode or nipple side because the anode is tilted. (HVL) of mammographic x-ray units is typically 0.3 to
0.4 mm aluminum (Al) equivalent at 30 kVp. Note that
Heel Effect the HVL is expressed in millimeters of aluminum, even
Mammographic x-ray tubes are oriented with the though the filter itself is made of molybdenum.
cathode-anode axis perpendicular to the chest wall, with
the cathode at the chest wall side. This orientation pro-
duces an image with a more uniform density because the
heel effect produces greater intensity at the thicker chest
Exposure Factors
wall and less intensity toward the nipple.
The exposure factors used in mammography are the
Filtration typical kVp, mA, and time that the radiographer is accus-
tomed to radiography. The difference lies in the low kVp
The port of the mammography x-ray tube is typically and high mAs necessary to produce high quality mam-
made of beryllium because it has a low atomic number mographic images.
which permits the x-ray photons to exit the tube. The
proper type and thickness of filtration must be installed
as added filtration. The total beam filtration, added plus
kVp
inherent, should not exceed 0.4 mm aluminum equiva- When compared to conventional x-ray equipment, mam-
lent. The purpose of mammographic filter is to remove mography units use low kVp in the range of 25 to 28 kVp.
very low and high energy x-ray photons. Very low energy The advantage of using low kVp is the production of
x-ray photons, below 17 keV, do not penetrate through low energy or soft x-ray photons which are necessary to
the breast but increase the patient dose. Higher energy produce a high contrast image. The breast tissue is
 Chapter 16: Mammography 245

that the average dose to the breast be <3 milligray (mGy)

(300 millirad [mrad]) per view. The average glandular dose
Subcutaneous and
mammary fat
for each view imaged using a grid is usually about 1.4 mGy
(140 mrad). Typical screening examinations consist of a
Interlobular connective
Muscle
tissue
craniocaudad and a mediolateral view, resulting in a dose
to each breast of 2.8 mGy (280 mrad) per examination.
Lactiferous ducts
Ribs

Nipple
Ancillaries
Ampullae
The quality of the mammographic image is dependent
Glands upon many factors including the amount of compression
used, grids, AEC, film/screen combinations, resolution,
and film processing (Fig. 16.6).
Figure 16.5. Female breast architecture comprised of soft
tissue structures which creates inherent low subject contrast. Compression
Compression of the breast with a radiolucent compres-
considered soft tissue and is made up of glands, fibers,
sion device improves quality by reducing patient motion
and fat or adipose tissue that has very low subject contrast
and providing more uniform tissue thickness. Appro-
(Fig. 16.5). To properly evaluate the image, the radiolo-
priately applied compression is one of the most critical
gist must have a high contrast image to adequately visual-
components in the examination, and it is imperative the
ize microcalcifications as small as 0.1 to 0.3 mm as well
patient understands the need for adequate compression.
as other tissue structures. As previously stated, the major
Compression separates overlying tissue preventing
disadvantage of using low kVp is the high absorption of
the low energy x-ray photons in the tissue which adds sig-
nificantly to patient dose.

mA, Time, mAs

The generators used for mammography equipment have
variable mA stations of 20 to 100 mA. The mA station
selected is determined on the principle of keeping the
exposure time as short as possible to decrease patient
motion. The other part of the equation which must be
considered is the length of the exposure. The time should
not be too short as this could cause grid artifacts on the
image, resulting in a repeat image to be taken. Expo- Compression device
sure times in the clinical setting vary from 0.4 to over
1 second for standard projections. The length of time
and ultimately the mAs delivered during the exposure is
determined by the automatic exposure control (AEC)
Image
since it will terminate the exposure when the proper receptor
amount of radiation has reached the cells.

Radiation Dose
The radiation dose to the breast is reported as an average AEC detectors
glandular dose. Glandular breast tissue is the tissue at risk for Figure 16.6. Illustrates the relationship of the compres-
radiation-induced breast cancer. MQSA regulations require sion device, image receptor, AEC detectors, and x-ray tube.
246 Part IV: Special Imaging Techniques

superimposition of structures and it also places the tis- Compression Device

sue closer to the image receptor. As demonstrated in The compression device is made of a plastic that permits
Figure 16.7, the compressed breast has uniform thickness the transmission of low energy x-ray photons without
and this decreased breast thickness reduces scatter and attenuating the photons. The device has a straight chest
patient dose. Compression of the breast by 1 cm reduces wall edge to allow the device to properly grasp the breast
the dose by a factor of 2 because the HVL in tissue is tissue close to the chest wall. The amount of the com-
about 1 cm for mammographic energies. pression is controlled by the radiographer. The average
The use of compression has definite advantages for the amount of compression which is applied to the breast tis-
overall quality of the image. The advantages include the sue is between 25 to 45 lb of force. This is the amount
following: of force required to effectively compress the breast tissue
and immobilize the patient.
● More uniform image receptor exposure.
● Improved visualization of breast structures.
● Reduced motion blur due to breast being immobi-
Grids
lized. The purpose of grids is to remove scatter and improve
● Reduced tissue thickness. image contrast. Larger or more dense breasts create signifi-
● Reduced radiation exposure. cantly more scatter especially when higher kVp settings are
● Reduced magnification. used. Moving grids are used for routine mammographic
examinations. Grids are capable of creating artifact if the
exposure time is too short. The potential for grid artifact is
negated by using the proper mA setting which will allow the
Compression device AEC to use the appropriate length of time for the exposure.
Micro- Grid ratios of about 4:1 to 5:1 and grid frequencies of 30
calcifications to 50 lines per centimeter (cm) are routinely employed in
screening mammography. Using a grid in mammography
Lesion significantly improves contrast and increases the patient
dose by about a factor of two times or doubling the mAs.

Automatic Exposure Control

The correct selection of mAs exposure factors is critical
in producing a high-quality mammographic image. The
A Uncompressed
AEC circuit achieves proper image density by measuring
the amount of exit radiation and terminating the exposure
at the proper time. Breast tissue that has been compressed
to a set thickness has a wide range of tissue densities when
comparing women of similar age. Attaining proper den-
sity is a challenge when attempting to manually set the
exposure time because it is virtually impossible for the
technologist to estimate the composition of breast tissue.
The advent of the AEC on dedicated mammography
B Compressed
units has provided more uniform imaging and signifi-
cantly reduced the repeat rates for mammography.
Figure 16.7. Breast compression. (A) No compression The AEC detector is placed behind the film cassette to
means the tissue does not have uniform density and the
prevent imaging of the detector. Mammographic units have
OID of structures will cause magnification. (B) Adequately
compressed breast will have more uniform density, provisions for changing the position of the AEC detector
decreased tissue thickness, and decreased magnification, along the chest wall-nipple axis. Most detectors will have
all of which create greater resolution. 10 stops between the chest wall and nipple which allows
 Chapter 16: Mammography 247

X-ray

Base
Film
Emulsion

Phosphor
Screen
Base

Foam pressure pad

Figure 16.9. Cross-section of mammography cassette. The

Figure 16.8. Illustrates the possible positions of the AEC single screen is placed under the film. The single emulsion
detector cells. film has direct contact with the single emulsion screen.
This allows maximum absorption of the x-ray photons in the
for more accurate imaging. The AEC detector should be screen phosphors that are closest to the film emulsion. This
design reduces the spread of light emitted from the screen.
positioned under the portion of the breast with the greatest
density, to avoid underexposed regions (Fig. 16.8).
Mammographic generators are equipped with a backup
timer similar to conventional radiography generators. than conventional radiographic screens. A slow screen
When using grid techniques the backup timer is set at 600 speed offers reduced noise and increased resolution. The
and 300 mAs for non-grid and magnification techniques. use of the screen instead of direct exposure techniques
If the backup time is reached during an exposure the tech- significantly lowers the radiation exposure to the patient
nologist must select a higher kVp setting for the repeat while providing the maximum radiographic contrast
radiograph. Modern mammography generators have a available. The disadvantage of using a screen comes from
microprocessor which controls circuits to provide accurate the light emitted from the phosphors which can cause a
and reproducible film densities over the complete kVp reduction in resolution and increased image noise. Even
range. Some machines have the ability to change the kVp with these disadvantages using screens in mammography
to a higher setting during the actual exposure. The circuit has significantly reduced radiation exposure for women
adjusts the kVp by sensing the radiation intensity during and the sophisticated engineering of mammography units
the first 100 ms of the exposure which allows the film to has given high resolution despite the use of a screen.
be properly exposed. It also prevents the backup time from
being reached on a large or dense breast. Film/Screen Combinations
In mammography, single-emulsion film with a single-
Cassettes screen cassette is generally used to maintain high detail
imaging. A high-speed rare earth screen is used to reduce
Cassettes used in mammography have been specially
exposure time, patient motion, and radiation dose. The
designed for imaging the breast. The cassettes are made
film is positioned in front of the screen so that the exit
of plastic or low attenuation carbon fiber. The cassette
radiation from the breast strikes the film before reaching
has a screen which is placed on top of a pressure pad.
the intensifying screen. If the film/screen order were
The film is placed on top of the screen and when the
reversed, the interactions in the screen would be further
cassette is closed the film is at the top of the cassette and
from the film, and light diffusion through the greater
as close to the breast as possible (Fig. 16.9).
distance would degrade image resolution because the
spreading of light blurs the edges.
Screens Special double-emulsion mammographic films have
The screens are typically green emitting gadolinium been developed to further reduce exposure time and
oxysulfide. The mammography screens are much slower patient dose. These films are used with half-thickness
248 Part IV: Special Imaging Techniques

front screens and full-thickness back screens. The films

also have anti-crossover light properties which prevents
blurring of the image. Double-emulsion films have
almost twice the speed of a single-emulsion film with
nearly the same detail resolution. Single-emulsion film
is used in mammography because it has superior spatial
resolution compared with conventional double-emulsion
film. New digital mammography units are the CCD type
charged couple device (Digital Image). Light from the
screen is captured by fiber optics then to the CCD which
changes them into pixels.

Resolution
Mammography systems must be capable of providing a
minimum of 11 to 13 lp/mm of resolution. The dedicated
design of the various components of the mammographic
unit is crucial in achieving the high resolution necessary.
The current standards for high resolution, high contrast
images have been widely accepted by radiologists. Evalu-
ation of small structures in images to diagnose cancer and
other pathologies can be performed with routine images,
magnification images, specialty views, and through the
use of a magnifying glass. Figure 16.10. Shows an imaging plate and cassette from a
CR unit.

Film Processing
to 50 to 80 cm or 20 to 30 inch, so magnified images are
Mammographic film can be developed using conven-
obtained by decreasing the source to object distance (SOD)
tional or extended automatic processing. Extended
while increasing the object to image distance (OID). This
processing uses the same chemicals and temperatures
technique requires a raised platform which is placed on the
as regular processing, but the film processing time is
image receptor holder and the breast is placed on top of the
increased because the film is in the developer for a longer
platform and compressed for the exposure (Fig. 16.10).
time. Total processing time is increased from 90 seconds to
When magnification is used to image anatomy a loss
3 minutes by increasing the film transport time. Extended
of resolution is expected. A 0.1-mm focal spot is used to
processing increases film speed and contrast and allows
achieve good detail resolution. Magnification factors of 1.5
for a decrease in patient dose. However, extended pro-
to 2 are obtained using the 0.1-mm focal spot (60 cm or
cessing results in reduced film latitude, requiring careful
24 inch). This follows the magnification factor which is SID/
selection of exposure factors to eliminate retakes.
SOD = MF. The air gap between the breast and the film
cassette reduces scatter and eliminates the need for a grid.
Image enhancements due to magnification of the
Magnification breast include the following:
Mammography ● Increased resolution due to small focal spot size.
● Reduction is scatter reaching the film due to the air
Magnification images are used to examine suspicious areas gap technique.
of the breast or when structures overlap each other and have ● Improved visibility of detail resulting from a larger
to be separated. The SID is fixed in mammographic units field of view.
 Chapter 16: Mammography 249

Magnification mammography has a limited field of any abnormalities in the breast more accurate. Transmitting
view and is not able to image the entire breast, however, the images electronically is termed telemammography.
this technique is only used on suspicious areas of the breast
and it is not necessary to image the entire breast with Digital Mammography
magnification. Due to the breast being so much closer
to the x-ray tube, there is increased exposure to the breast Digital mammography is similar to CR because it is filmless
for each exposure, as much as two to three times. The and the image is stored on computer. It has the same benefit
increased exposure is also due to the reduction in mA, as CR. In digital mammography, the unit is dedicated digital
which is required of the 0.10 focal spot size, and increase equipment for mammography only. It can reduce the radia-
in exposure time. The increased exposure time could be tion dose to the breast by 50% and has a high digital resolu-
as high as 4 seconds. Due to the technique of placing the tion around 20 lp/mm. A phosphor flat panel system is used
breast on a platform and using longer exposure times, it is in digital mammography. The system consists of a large-area
necessary for the mammographer to explain the additional plate with photodiodes that are coated with thallium-
images and the procedure of acquiring the images. activated cesium iodide phosphors. At the time of exposure,
the photodiodes detect the light emitted by the phosphor and
create an electrical signal that is transferred to the computer

Digital workstation. The image is displayed for the technologist to

check prior to the next exposure. The images are then sent
Mammography to a storage system. This storage system allows for long term
storage or the image can be printed out on a laser printer
to film. There are no cassettes with digital mammography.
With digital mammography, there are four types of detec- The image is transferred directly onto the computer.
tors to capture images of the breast compared to film/
screen mammography. They are computed radiography
(CR), digital mammography (phosphor flat panel sys-
Phosphor CCD
tem), phosphor CCD, and selenium flat panel system. The phosphor CCD detector also uses cesium iodide.
All of these detectors replace film/screen imaging. Instead of using a large-area plate the detector is a nar-
row 1 × 24 cm2 in size. The x-ray beam is collimated to
Computed Radiography the size of the detector the breast is scanned with both
the detector and x-ray beam in unison. The light emitted
CR utilizes an imaging plate which replaces intensify- from the phosphor is sent to a CCD which then converts
ing screens and film. The imaging plate absorbs the exit the light into an electrical signal.
radiation and captures the signal in the energy traps of
the imaging plate (Fig. 16.10).
After the imaging plate is exposed, the plate is placed
Selenium Flat Panel
in a CR reader where a laser stimulates the stored image This final system uses an x-ray absorber made of
to give off light which is captured by the imaging plate amorphous selenium instead of a light emitting phos-
and converted to a digital signal which is stored and phor. During the exposure the x-ray photons are absorbed
displayed on a computer at a workstation or on laser by this material and converted into an electrical charge
printed film. The imaging plate is then automatically through a system of electrode pads.
erased and placed back into its cassette for reuse. When using any of the above systems, images have
The benefit of using CR for mammography is utiliz- been placed on computer for initial viewing by the
ing your existing equipment. The other benefit is storage. mammographer. Once the examination is complete,
Films take up a lot of room to store. They also can be mis- the images are transferred and placed electronically to
placed or lost. With a CR system, the images are stored Picture Archiving and Communications System (PACS)
on computer with a back-up system in place. for archiving purposes. The images can then be sent to
For CR mammography, you are able to transmit images the radiologist for interpretation or sent electronically to
to remote sites. The radiologist has quick access to previous other physicians, to other health care facilities for consul-
CR mammograms for comparison. This makes diagnosis of tation and teaching, and to the ordering physician.
250 Part IV: Special Imaging Techniques

Chapter Summary What is the anode angle in a horizontal x-ray

tube?
Mammography forms images of breast tissues with
low differential absorption and small microcalci- Tilted x-ray tube?
fications using a low-kVp technique. Mammo-
graphic tubes have special molybdenum anodes Of the various types of metals used in anode tar-
with 0.3- and 0.1-mm focal spots. The K character- gets, why is the molybdenum target preferred?
istic of x-ray photons of molybdenum has energies
of 17.4 and 19.9 keV. The 0.03-mm molybdenum What is the purpose and type of filtration used in
filters pass the K characteristic x-ray photons and the x-ray tube?
remove both higher and lower energy x-rays.
Single-screen cassettes are used with single-emul-
sion films to obtain high detail images. Moving The cathode side of the x-ray tube has the most
grids with 4:1 ratios remove scatter and improve intense portion of the beam. The tissue at the
image contrast. The AEC circuit, whose detectors chest wall is thicker than the rest of the breast
are placed behind the film cassette, terminates the tissue so the cathode should be placed toward
exposure to produce the correct image density. the chest wall. This is commonly referred
Compression of the breast during mammogra- to as the “heel effect.” In a horizontal x-ray
phy improves image quality by decreasing scat- tube placement the anode is angled 22 to 24
ter and reducing patient motion. Magnification degrees so that the entire image receptor can
mammography is used to study suspicious breast be bombarded with the x-ray photon beam. A
regions. Extended processing increases image narrower angle can be used if the x-ray tube is
contrast and speed while reducing film latitude tilted thereby placing the cathode and anode
and patient dose. The typical glandular dose is at an angle to the image receptor. This type
about 2.8 mGy for a typical two-view examination. of tube placement is necessary for narrower
Various forms of digital mammography are widely anode angles which results in a smaller effec-
accepted and provide the advantages of immedi- tive focal spot size. The molybdenum target is
ate visualization of the image. preferred for several reasons. No. 1 it increases
the number of low-energy photons, No. 2
increased image contrast is achieved, and No.
3 it produces the needed range of energies to
Case Study produce low kVp for soft tissue imaging. The
port of the x-ray tube is coated with beryllium
Mammographic x-ray tubes have a dedicated because of its low atomic number it allows
design for exclusively imaging breast tissue. photons to exit the tube. The total filtration in
Breast tissue is made up of soft tissue structures the tube should not exceed 0.4-mm aluminum
with little difference in the tissue densities; equivalent; this allows the adequate number
therefore, the cathode, anode, target material, of low energy photons to image the breast.
and filtration were all designed with the char- The filtration also removes the very low energy
acteristics of breast tissue in mind. The follow- photons because they do not have the energy
ing questions will aid you in understanding the to leave the tissue and only result in increased
mammographic x-ray tube. patient dose. Filtration also removes the high
energy photons which have enough energy to
penetrate the breast tissue but add excessive
Critical Thinking Questions scatter to the image which decreases image
contrast.
Why is the cathode placed toward the chest wall?
Review Questions

6. Magnification mammography is best used for

Multiple Choice which of the following?
A. Routine breast imaging
1. Mammographic tubes have _________ anodes and B. In the place of screening images
_________ filters. C. To examine suspicious areas
D. All of the above
A. tungsten, molybdenum
B. molybdenum, molybdenum 7. Which type of digital mammography system uses
C. molybdenum, aluminum electrode pads and _________ to absorb x-ray
D. aluminum, molybdenum photons?

2. Typical mammographic tube filtration placed in A. Computer radiography

the beam is B. Selenium flat panel
C. Phosphor CCD
A. 0.03 mm molybdenum D. Phosphor flat panel
B. 0.3 mm aluminum
C. 0.3 mm molybdenum 8. Which of the following mA ranges is used in mam-
D. 0.3 mm aluminum mography?

3. Compression of the breast during mammography A. 20 to 100 mA

B. 40 to 200 mA
A. reduces patient motion C. 100 to 400 mA
B. reduces scatter D. 400 to 800 mA
C. reduces patient dose
D. all of the above 9. Digital mammography was first approved for sale
in the United States in
4. Exit radiation passes through the _________ first
after exiting the breast. A. 1950
B. 1970
A. intensifying screen C. 1990
B. film D. 2000
C. AEC
D. cathode 10. The phosphor CCD in a digital mammography
unit utilizes a detector which is
5. The AEC detector is located
A. 24 × 35 cm
A. in front of the cassette B. 1 × 24 cm
B. behind the cassette C. 8 × 10 inch
C. above the patient’s breast D. 2 × 14 inch
252 Part IV: Special Imaging Techniques

6. What is the maximum pound of compression

Short Answer allowable on mammographic equipment?

1. What is the difference between a screening and

diagnostic mammogram?

7. The film is placed _____ to the x-ray tube.

2. What are three types of breast tissue?

8. Name the focal spot sizes used in mammography

and explain why they are needed.

3. Why does mammography require a low kVp

technique?

9. The emulsion surface of the film must always be

toward the _____.

4. List the advantages to using compression.

10. What does MQSA stand for?

5. Mammographic cassettes have a latching mecha-

nism which is designed for close film-screen con-
tact to minimize _________.
 17

Computed Tomography

Objectives Key Terms

Upon completion of this chapter, the student ● convolution ● pitch
will be able to: ● deconvolution ● scintillation
1. Compare the different generations of ● gas-filled ionization detectors
computed tomography (CT) scanners. detectors ● solid-state
● indexing detectors
2. Describe the operation of a CT scanner.
● photomultiplier ● voxel
3. Identify the components of a CT scanner.
(PM) tube
4. Define CT numbers.
5. Identify the factors that influence spatial and
contrast resolution.
6. Explain common CT artifacts.

253
254 Part IV: Special Imaging Techniques

Introduction
The invention of the computed tomography
(CT) scanner revolutionized radiographic
examinations because of the difference in
appearance and sensitivity of CT scans. CT
scanners produce cross-sectional images
of the body with the tissues and organs dis-
played separately, instead of superimposed
as in a conventional radiograph. CT scans
are much more sensitive to small differences
in tissue composition than are conventional
radiographs. CT views are perpendicular
to the body axis and are called transaxial
images.
A

Historical Perspective
Godfrey Hounsfield is credited with the invention of
computed tomography; however, early work on the
mathematics used to reconstruct CT images was done
by Allan Cormack, a physicist at Tufts University.
Hounsfield was an engineer with Electric and Musi-
cal Industries (EMI) Ltd. in England. His work with B
computed tomography in the early 1970s produced
a scanner that required 9 days to scan an object and
produce a single-section image. Hounsfield and Allan
Cormack were awarded the Nobel Prize in Physics
in 1979.

Scanning Projections
In CT, the scan produces a transverse or axial image.
C
This image is perpendicular to the long axis of the body.
Figure 17.1. Scanning Projections. (A) Sagittal.
Digital processing of the transverse data produces images
(B) Transverse. (C) Coronal.
in sagittal and coronal sections (Fig. 17.1). Using post-
acquisition algorithms, various images can be produced
without the need to rescan the patient and expose them
to additional radiation.
 Chapter 17: Computed Tomography 255

This process was performed 180 times for each scan. The
CT Scanner major drawback to the first generation units was that it
took nearly 5 minutes to complete one slice.
Generations
Second Generation
Since the original EMI scanner, there have been rapid
The second generation CT scanner used a single pro-
advancements in CT scanners. As technology has pro-
jection fan-shaped beam and a linear array with up to
gressed, the development of scanners has kept pace. Cur-
30 detectors (Fig. 17.3). The x-ray tube and detectors
rently, there are seven generations of scanners with each
move in unison just like the first-generation scanner.
generation providing faster scan times and improved
The translate-rotate mechanism was used, and with the
image manipulation.
increased number of detectors, there were fewer linear
movements. A scanner with 30 detectors could complete
First Generation a 180 degrees linear scan in six rotations compared with
The first generation CT scanner was a single ray system the first generation which required 180 rotations. Scan
designed to examine only the head. This scanner used time was reduced to approximately 10 to 90 seconds per
two detectors and a single x-ray tube which were con- slice; this allowed for the patient to hold his or her breath
nected in a c-arm fashion (Fig. 17.2). The detectors were long enough for a complete scan. With these advance-
sodium iodide scintillation crystals with photomultiplier ments, the rest of the body could be scanned.
tubes. CT scanners measure the transmission of the x-ray
beam through the body. Third Generation
The x-ray beam was a pencil thin slit field which scanned
A primary limitation with prior generations of scanners
180 degrees around the patient’s head. The first genera-
was the scanner’s inability to rotate in a 360 degrees arc
tion scanner used a translate-rotate system. The x-ray tube
around the patient. Third-generation scanners use a wider
and detectors were connected and moved synchronously
fan-shaped beam and a curved array of 250 to 750 detectors
from one side to the other while scanning the patient; this
which rotate 360 degrees within the gantry (Fig. 17.4). For
is called translation. The x-ray tube then rotates 1 degree
the first time, the detectors and x-ray tube had the ability to
into the next position and scans again. The x-ray beam
continuously rotate. The translate-rotate mechanism was
was turned on while scanning and off during rotation.
replaced with this rotate-rotate mechanism. The x-ray tube
Scan
and detectors both rotate in a circle around the patient,
90 and the x-ray beam slices through the body to produce the
Scan Scan
45 135

Tube
Collimator
Narrow
Beam
Detector fan
array beam

Scan Scan
135 45

Scan
90 Detector
array
Figure 17.2. Shows a schematic view of a first-generation
CT scanner. Figure 17.3. Second-generation CT scanner.
256 Part IV: Special Imaging Techniques

The tube first scans in a clockwise direction and then

counterclockwise; this motion continues until the exam
is complete. These scanners are capable of 1 second scan
times. A principle disadvantage of fourth-generation scan-
ners is the increased dose of radiation to the patient.

Fifth Generation
The fifth-generation scanner is a dedicated cardiac unit
designed around a rotating electron beam. This type of
scanner is also called the Electron Beam CT scanner
(EBCT). The design of the EBCT scanner produces
high-resolution images of moving organs such as the
Rotating detector system heart without motion artifact. The x-ray tube has been
Figure 17.4. Third-generation CT scanner. replaced with an electron gun which uses deflection coils
to direct a 30 degrees beam of electrons in an arc around
four adjacent tungsten target rings. These rings are sta-
image data. The support table and the patient advance, tionary and span a 20-degree arc. The arrangement of the
and the tube again rotates around the patient to generate detector array allows for either two slices to be acquired
data for the next image. With this generation of scanner, with one target ring or eight slices when all four target
the entire patient can be viewed with each scan. The scan rings are used in sequence. This scanner is ten times
time was reduced to 1 second per slice. faster than conventional CT scanners, which makes it fast
enough to provide real-time dynamic sectional images of
Fourth Generation the beating heart.

Fourth-generation scanners use a single projection fan-

shaped beam with 600 to 2,000 detectors mounted to Sixth Generation
an array which forms a 360 degrees ring on the inside
Generations one through four utilized cables to provide
of the gantry. The ring of detectors remains stationary,
the electricity necessary to move the components of the
while the x-ray tube rotates within the gantry (Fig. 17.5).
scanner while also providing kilovoltage for the x-ray
exposure. The cables limited the scanners because the
cables could only rotate a certain amount before they
had to be “unwound.” The sixth-generation scanner was
designed to use slip-ring technology to replace the cables.
The slip-ring technology allows continuous rotation of
the x-ray tube and detectors around the patient.
As the x-ray tube circles around the patient, the patient
table is continuously moved through the bore of the gan-
try. This allows for a continuous set of attenuation data to
be obtained in a helical or spiral manner; therefore, this
generation of scanner is referred to as a helical/spiral scan-
ner (Fig. 17.6). Spiral scanning differs from conventional
CT scanning in that the support table is not stopped at the
center of each slice location while the data are collected.
The primary advantage of the helical scanning is a dra-
Stationary detector system
matically shorter scan time; spiral CT examinations can
Figure 17.5. Fourth-generation CT scanner. be completed in <1 minute. Other advantages include
 Chapter 17: Computed Tomography 257

X-ray source

Figure 17.6. Illustrates how the

x-ray tube of a spiral CT scanner
rotates around the patient, while the
patient support table moves through
X-ray detector the CT scan plane.

the ability to complete the entire exam with the patient vascular studies of the arteries where contrast is moving
holding his or her breath one time, lower amount of con- quickly through the vessels.
trast media to produce a diagnostic image, and a decrease
in motion artifacts.
The acquisition time is the time required to collect the Seventh Generation
CT data. The acquisition time for conventional axial CT The seventh-generation CT scanners are most com-
scans is typically several seconds per slice. The acquisi- monly called multisection or multislice computer tomog-
tion time for spiral scans is about 30 seconds. The exami- raphy (MSCT). Multisection scanners are able to expose
nation time is the total time required to collect the CT multiple detectors simultaneously due to detector tech-
data. For spiral scanning, the acquisition time and the nology which permits an array of thousands of parallel
examination time are the same. For conventional axial bands of detectors to operate at the same time (Fig. 17.7).
CT scanning, the examination time includes the time for This coupled with helical scanning drastically reduces
both data acquisition and table indexing to the next slice the total exam time for an entire chest or abdomen to
position. A conventional axial CT examination requires
several minutes to complete, which is much longer than
a spiral CT examination.

Pitch Collimator
beam width
Pitch is the distance that the patient travels through the
CT scanner in the time the x-ray tube makes one full
360-degree rotation which is divided by the width of the Isocenter
slice. Pitch is a ratio of the tube movement to section
thickness. In a ratio, the second number is always 1 as
in 1:1 or 2:1. In a 1:1 ratio, the table movement is equal
to the section thickness. Faster tube travel and thicker
sections make for a faster scan, but the resolution is less. Detector
width
Most multislice spiral CT scans have rotation times of
1 second or less. This is utilized frequently when scanning Figure 17.7. Seventh-generation CT scanner.
258 Part IV: Special Imaging Techniques

Gantry

Rib

Pancreas

Aorta
Detectors
Verterbra

Left Kidney

Patient support table CT image of upper abdomen

Figure 17.8. Shows a schematic view of a CT scanner and the resultant image.

15 to 20 seconds. The MSCT is designed to be more The gantry frame maintains the proper alignment of the
efficient, reduce patient exposure to radiation, improve x-ray tube and detectors. The frame also contains the
image resolution, and allow unprecedented postacquisi- components necessary to perform scanning movements.
tion reconstruction of acquired data. The gantry has a 20- to 34-inch aperture for the patient to
Regardless of the generation of CT scanner the latent pass through during the scan. Inside the gantry cover is
image is acquired and archived in a similar manner. The a large ring that holds the detectors and the track for the
exit radiation is detected and converted into a digital sig- x-ray tube while it rotates around the patient.
nal by the analog-to-digital converter or ADC. Data from Most CT gantries can be angled up to 30 degrees to
many different entrance angles are processed in a com- permit positioning the patient for coronal images and
puter to determine the transmission and attenuation char- to align the slice plane to certain anatomy such as the
acteristics of the tissues in the section under examination base of the skull or lumbar spine curvature. The gantry
(Fig. 17.8). The data are stored in a matrix of pixels. The can be angled toward or away from the patient table and
digital pixel data are processed in a digital-to-analog con- may permit coronal scanning of body areas, especially the
verter (DAC) before being displayed. The DAC converts head. There are also positioning lights mounted on the
the digital data into an analog signal for display. gantry. There are intense white lights and low-power red
laser lights which assist the positioning of the body. The
body area of interest must be properly aligned and cen-

Components of a CT tered in the aperture. There can be three lights which are
used to accurately line the patient up for sagittal, coronal,
Scanner and transverse centering.
X-Ray Circuit
A CT scanner consists of a doughnut-shaped gantry, a There are two kinds of x-ray circuits: one operates at low
patient support table, a computer system, and an opera- frequency (60 hertz [Hz]) and is about the size of a large
tor’s console with display. (Fig. 17.9) office desk; and the other is a high-frequency circuit
(3,000 Hz) about the size of a suitcase. The 60 Hz circuit,
because of its size, must be located outside the gantry in
The Gantry the CT room and is connected to the rotating x-ray tube
The gantry is a doughnut-shaped structure containing by thick, flexible high-voltage cables. The cables prevent
the x-ray circuit, the x-ray tube, the radiation detectors, the tube from rotating >360 degrees without rewinding so
the high-voltage generator, and mechanical supports. axial CT examination collects data one slice at a time.
 Chapter 17: Computed Tomography 259

Gantry

Patient support table

Figure 17.9. Shows the gantry and patient support table of a modern CT scanner.

The high-frequency circuit is small enough to be the amount of tissue irradiated and the volume of each
mounted with the x-ray tube on the rotating frame inside pixel element (Fig. 17.10). The volume element is called
the gantry. Both the tube and the circuit rotate together a voxel. This is determined by the slice thickness. The
around the patient. The input voltage is connected to the collimator and detector geometry prevents most scattered
circuit through slip rings that allow the circuit and the x-rays from reaching the detectors.
x-ray tube to continuously rotate. Continuous rotation is
necessary for spiral CT scanning.
Radiation Detectors
X-Ray Tube The radiation detectors in the gantry can be mounted
The x-ray tube which produces a continuous beam is a either in a stationary ring around the gantry or on a sup-
high-heat capacity tube that is capable of operating up port frame called an array that rotates in a circle around
to 400 milliamperes (mA) and 120 to 150 peak kilovolts the patient opposite the x-ray tube. The fourth-generation
(kVp) for several seconds. Units with a pulsed beam tube scanners utilized the stationary ring configuration; how-
operate at 120 kVp and up to 1,000 mA. Many CT tubes ever, these are not commonly used and are no longer
are designed with anode heat capacities >1 million heat being manufactured with the advent of fifth-generation
units. In modern CT units, the x-ray beam is collimated scanners. In either system, the detectors measure the
into a fan-shaped beam. The thickness of the beam is set exit radiation transmitted through the patient at different
by adjustable collimators located at the exit of the x-ray angles around the patient. Systems with stationary detec-
tube housing. The x-ray beam is also collimated at the tors utilize >4,000 detectors. Rotating detector systems
detector entrance. The thickness of the beam determines use enough detectors to intercept the entire fan beam.
260 Part IV: Special Imaging Techniques

Photon

Crystal
Voxel

Light

Cathode
Pixel
Focus
electrode

Dynode
Photomultiplying
tube
Electron

Figure 17.10. Shows a fan-shaped beam from a CT

scanner and the relationship between an individual pixel Anode
and voxel.

The image quality, resolution, and efficiency of the

stationary and rotating detector systems are effectively Circuit
the same. Figure 17.11. Shows a typical scintillation detector.
CT scanners employ scintillation crystals, gas-filled
ionization chambers, or solid-state detectors as radiation
detectors. The image quality and detection efficiency but are not conducive to the modern scanners because
of the different types of detectors are approximately the of the phosphorescent afterglow properties of the scintil-
same. lation crystals. The sodium iodide was replaced by bis-
muth germanate and cesium iodide. The current crystal
Scintillation Detectors of choice is cadmium tungstate which has 90% efficiency
Scintillation detectors are comprised by sodium iodide but minimal afterglow.
crystals that give off a flash of light when an x-ray pho-
ton is absorbed by the crystal. The radiation produces Gas-Filled Ionization Detectors
light in proportion to the intensity of the photon and at Gas-filled ionization detectors use xenon gas to produce
the site where the photon struck the crystal. The light an electrical signal when x-ray photons pass through the
from the scintillation crystal is detected by a photomul- chamber. Thin tungsten plates spaced 1.5 mm apart make
tiplier (PM) tube (Fig. 17.11). The light photon strikes up the electrodes in the ionization chamber (Fig. 17.12).
the cathode of the PM tube where it is converted into The space between the electrodes acts as radiation detec-
electrons. The electrons are then amplified by a chain tors. Each electrode produces an electric field across the
of dynodes as they pass through the PM tube. The dyn- gas-filled chamber. X-ray photons produce ionization in
odes have progressively higher voltage which causes an the gas. The electric field pulls the negative ions to the
increase in the number of electrons as they move toward positive electrode and the positive ions to the negative
the anode. Once the electrons bombard the anode, they electrode. This flow of electrons is an electric current.
are converted into an amplified electrical signal which is The current produced is proportional to the ionization
then processed by the computer. The scintillation crystals in the chamber and the energy of the radiation passing
and PM tubes were used in early generations of scanners through the chamber. The detected energy makes up the
 Chapter 17: Computed Tomography 261

Ceramic Tungsten plate the divergence of the fan-shaped beam. This permits the
electrode
entire array of detectors to operate simultaneously. The
photodiode detects the light photons emitted by the scin-
tillator and converts them into an electrical signal which
is used by the computer to form the digital image.
The arrangement and type of detectors used in a par-
ticular CT scanner are selected by the manufacturer for
Xenon
(in interspace commercial reasons. The processing of the signal from
Charges
material) any type of detector is essentially the same in all CT scan-
Figure 17.12. Shows a typical gas-filled ionization detector. ners. The image quality of all modern CT scanners is
effectively the same.

digital signal that is sent to the computer. The detector

efficiency for an ionization chamber–type detector is
Collimation
approximately 50%. Collimation is required in CT scanning for exactly the
same reasons as in radiography. Proper collimation
Solid-State Detectors reduces patient dose by restricting the amount of tissue
Solid-state detectors are used in helical and MSCT which is irradiated. Collimation also enhances image
scanners. Solid-state detectors combine a calcium contrast by limiting scatter radiation. CT units often use
tungstate, yttrium, or gadolinium ceramic scintillator two collimators. The prepatient collimator is mounted on
with a photodetector. As seen in Figure 17.13, when the tube housing and limits the area of the patient that is
the x-ray photon interacts with the solid-state scintilla- exposed to the primary beam. This collimator determines
tor, light photons are emitted isotropically in proportion the slice thickness and patient dose. The postpatient col-
to the intensity of the light. The scintillator is able to limator restricts the x-ray field viewed by the detector
accept incoming x-ray photons because it is sensitive to array, thereby reducing scatter radiation on the detector.
This collimator helps to determine the slice thickness as
well. Since the postpatient collimator is placed between
X-ray beam
X-ray Large acceptance the patient and the detector array, it does not influence
angle
patient dose.

Patient Support Table

The CT table may be either curved or flat. The patient
support table is constructed of low atomic number carbon
graphite fiber to reduce attenuation of the x-ray beam.
The tabletop must be able to support the entire weight
of the patient when the table is moved into the gantry
aperture. Tabletops are rated for maximum weight and
are constructed to support patients weighing as much as
450 to 600+ lb. Attempting to move the tabletop with
Photodiode patients weighing more than the maximum weight can
Electrical signal Isotropically
emitted light result in extensive damage to the table. The table should
also be capable of moving up and down for ease in trans-
Figure 17.13. Solid-state detector. The photodiode is
ferring patients onto and off of the table and in positioning
coated with a scintillator. When the remnant x-ray pho-
tons activate the scintillator, light photons are emitted and the patient correctly in the aperture.
detected by the photodiode. The photodiode then gives off The positioning of the table is called indexing. Table
an electrical signal. indexing must be accurate and reproducible within
262 Part IV: Special Imaging Techniques

1 millimeter (mm). In conventional axial CT scanning, Display Console

the tube rotates around the patient to collect data for one
slice, the table indexes into the gantry at a preset distance, The display console is often part of the main control
and the tube rotates again to collect data for the next slice. and is a separate cathode ray tube or flat panel display
The x-ray beam is on only during tube rotation. A typical with controls. The console is a separate workstation that
axial CT examination involves collecting data from ten allows radiologists to display and manipulate images, and
or more sections and requires several minutes to com- to electronically dictate the results. CT display consoles
plete. In spiral scanning, the support table moves steadily permit a wide range of features to enhance the digital
through the gantry while the tube continuously rotates image. These features include:
around the table and the patient, and the entire spiral CT
examination can be completed in <1 minute. ● Scanogram: A scout image of the area to be scanned.
Dotted lines corresponding to the section intervals
provide a convenient reference guide when view-
Computer System ing the images.
The CT computer is a unique component of the CT ● Multiplanar Reconstructions (MPRs): A computer
system. The computer must have sufficient speed and process which stacks transverse images on top of each
memory to solve as many as 30,000 calculations simulta- other to form a three-dimensional (3D) set of data.
neously. The CT computer is designed to control data ● Reverse Display: Allows the image to be reverse
acquisition, processing, display, and storage. At the CT from right to left and to reverse density displays so
console, the technologist has access to software programs that black appears white and white appears black.
that allow processing and display of the images. The com- ● Magnification: Is available but will distort the
puter system calculates the attenuation of the individual image if used beyond three times magnification.
voxels using the x-ray exit radiation data collected at many ● Suppression: Allows a problem area to be outlined
different tube positions around the patient. These trans- and deleted from the reconstruction data.
mission data are converted into attenuation data for each ● Region of Interest (ROI): An area of an anatomic
voxel. The computer programs used to perform these cal- structure which is measured to display the average
culations are called algorithms. The calculations of the CT HU/CT number.
numbers must be very fast to produce images for immedi- ● Annotation: Text that is added to images for ana-
ate viewing. The digital data are stored for later recall on tomical labeling or descriptive purposes.
a computer server, magnetic tape, or CD-ROM. ● Maximum Intensity Projections (MIP): A type of 3D
procession by reconstructing an image by selecting
the highest value pixels along a line through the
Operator’s Console data set and exhibiting only those pixels.
The console permits control of all scan parameters ● Three-Dimensional Imaging: Specialized software
including selecting proper technical factors, movement and image processing units allow the manipulation
of the gantry and patient table, and computer commands of the image to visualize structures that are hidden.
that allow reconstruction and transfer of image data for The image can be rotated, tumbled, or tilted, and
storage in a data file. The CT console operates a menu of densities can be made more translucent or divided.
directory operations. The console is preprogrammed with
the kVp and mA values for individual anatomic sites. The
CT Numbers
technologist uses a keyboard and mouse to indicate the The CT number of each voxel is calculated from the
desired operation for the anatomy to be scanned. Each transmission data collected as the beam passes through
scan must have patient information, such as identifica- the patient at many different angles. Each pixel is dis-
tion and medical history entered prior to beginning the played on the video monitor as a level of brightness which
scan. Hard copy images are printed on film using a multi- corresponds to the level of optical density in the pixel.
format camera or laser printer. These images are reviewed The relative attenuation characteristics of a voxel are
for diagnostic interpretation by the radiologist. reported as a CT number and sometimes referred to as
 Chapter 17: Computed Tomography 263

TABLE 17.1 HOUNSFIELD UNITS OF VARIOUS

TISSUES
Spatial Resolution
Spatial resolution is defined as the minimum separation
Tissue Hounsfield Unit or CT Number
of two objects that can be distinguished in the image as
Air −1,000 two separate objects. Spatial resolution is measured in
Lung −150 to 400 line pairs per centimeter (lp/cm). Typical CT resolu-
Fat −100 tion depends on the design of the unit but is generally
Water 0 between 0.6 and 1.0 lp/cm. Two pixels are required to
Tumors +5 to 35
Blood +13 to 18
image one line pair. Increasing the matrix size decreases
Cerebrospinal fluid + 15 the pixel size and improves spatial resolution but
Gray matter +20 to 40 increases the time required for processing and storing the
White matter +36 to 46 images. Spatial resolution in CT scanning depends on a
Muscle +50 combination of factors, including focal spot size, beam
Liver +40 to 70 collimation, detector size, matrix size, pixel size, and sub-
Blood, clotted +55 to 75
Dense bone +1,000
ject contrast. Larger matrices with small pixels and high
subject contrast have better spatial resolution. Utilizing
small focal spots and narrow collimation provides better
spatial resolution.
Hounsfield units. The CT numbers range from −1,000 to
+1,000 for each pixel. Table 17.1 shows the CT values of Contrast Resolution
various tissues. Changing the size of either the matrix or
the slice thickness may change the CT number because One of the major advantages of CT scanning is its abil-
different tissues may be included in the voxel. The CT ity to image tissues with similar attenuation characteris-
number of a tissue is always calculated relative to the atten- tics. Contrast resolution is the ability to distinguish two
uation of water. The CT number of a tissue is given by: objects with similar attenuation values. CT images have
high contrast resolution, which is the biggest advantage
CT number of tissue = [(ump − mw)/umw)] × 1,000 of CT imaging. For example, Figure 17.14 demon-
strates how blood and liver are very close in attenuation
where mp is the linear attenuation coefficient of the pixel
and mw is the linear attenuation coefficient of water.
Because the CT number is based on the difference
between the linear attenuation coefficient of each pixel
and the attenuation coefficient of water, the CT number
of water is always equal to zero. Tissues with densities
greater than that of water have positive CT numbers; tis-
sues with densities less than that of water have negative
CT numbers. Tissues with negative CT numbers are dis-
played as darker objects. Tissues with positive CT num- Liver
bers appear as lighter densities.

Image Quality Aorta

Image quality is controlled by the resolution of the image

and the amount of noise in the image. There are four Figure 17.14. Demonstrates the difference in appearance
basic characteristics which determine the overall quality between blood in the aorta and liver tissue in a CT exami-
of a CT image. nation of the abdomen.
264 Part IV: Special Imaging Techniques

Fat –100 of the image. System noise should be evaluated daily by

scanning a phantom and using an ROI to measure the
Hounsfield units for control areas.

Linearity
The CT scanner must be calibrated so that water is consis-
tently represented as zero HU, and other tissues are repre-
sented by their appropriate CT value. A five-pin phantom
is scanned and the CT number for each pin is recorded.
When plotted on a graph, the CT number versus the lin-
ear attenuation coefficient should travel in a straight line
Liver +40-70 Dense bone +1000
going through zero. Any deviation from linearity is an indi-
cation of a malfunction or misalignment in the scanner.
Figure 17.15. The soft tissues in the abdomen are very
similar in density. The CT scanner is excellent in distin-
guishing between these small differences and allows a clear
image of all the structures. Scanning Parameters
characteristics but have different appearance on a
CT scan of the abdomen.
Section Interval and Thickness
Contrast resolution is determined by the number of The section interval is the distance between scan sec-
density differences stored in each matrix. A low-contrast tions, while the section thickness is the width of the
image has many density differences in the entire image, volume of tissue being imaged (voxel). The section
while a high-contrast image has few density differences. thickness is typically less than voxel width due to the
The level of contrast in each pixel is determined by the divergence of the x-ray beam. The divergence of the
absorption of x-ray photons in tissue which is characterized x-ray beam causes a problem where either overlapping
by the linear attenuation coefficient. Tissue with a higher or excluding tissue between sections occurs. The tech-
atomic number will attenuate more photons and will have nologist must take this into consideration when setting
a higher linear attenuation coefficient (Fig. 17.15). up the section interval and thickness for a given scan. If
CT examinations using iodinated contrast media are a voxel width of 5 mm is selected, then the section inter-
performed to image both arterial and venous phases of the val should be 11 mm; this will prevent any tissue from
circulatory system. Iodinated contrast media is injected being missed. CT units have preset programs which
either by hand or by a power injector. Power injectors, standardize scanning parameters for given procedures
or automatic injectors, permit more accurate timing of that take into account the correct amount of overlap
contrast delivery. Power injectors are also used in cardiol- needed; however, the parameters can be modified to
ogy and angiography to inject a known amount of con- accommodate special circumstances.
trast at a fixed rate. Typical CT contrast examinations are
performed first without contrast and then scanned again Exposure Factors
after contrast injection. This permits observation of the
structures under examination. Most CT scanners operate at a preset kVp. Because of
spiral scanning, time is not a factor because it is con-
trolled by the scanning program so that the sufficient
Noise exposure can be made to the detectors. The technologist
All digital images have problems with system noise. Noise can change the mA setting to control the primary beam.
in the CT image is directly related to the amount of data It is critical that the correct amount of mA be used to
collected by the detector. The noise is seen as quantum keep the dose to the patient as low as possible while pro-
mottle or graininess and makes up a small percentage viding optimum images.
 Chapter 17: Computed Tomography 265

Algorithms Helical Interpolation

When setting up a scan, the technologist must select the Helical scanning creates a “corkscrew” image where the
appropriate algorithm for the scan. The operator’s con- information is acquired at an angle. Typically if imaging, a
sole combines the correct algorithm with the scanning perpendicular plane is desirable. In helical scanning, inter-
procedure. The use of the correct algorithm will make polation is used to “straighten” the image. This process uses
it possible for the CT unit to filter unwanted artifacts so postacquisition algorithms to produce a new set of images.
they are not displayed in the final image. The process takes the raw data and projects or interpolates it
forward and backward into a new section or image. By using
Field of View interpolation, a new set of images can be produced without
exposing the patient to additional radiation (Fig. 17.16).
The field of view (FOV) or scan field size is set to accom-
modate the size of the body area being scanned. The Reformatting
matrix size is fixed, and when the FOV is increased, the
size of each pixel will be increased proportionally. When Reformatting uses data from a series of sectional images
the FOV is increased from 512 × 512 to 1024 × 1024, the to produce an image in a new scan plane without actu-
size of each pixel is smaller. As previously discussed, the ally scanning the patient. Reconstruction algorithms can
smaller the pixel size, the better the image resolution. take the scanned transverse sections and extract coro-
nal or sagittal images to provide additional views of the
patient’s anatomy (Fig. 17.17). Multidetector CT cou-
Image Reconstruction pled with reconstruction software excels in producing
two-dimensional multiplanar reformation (MPR). MPR
allows improved visualization of the normal anatomy and
As the patient is being scanned, the detectors send infor- anatomic variants as well as greater diagnostic accuracy
mation proportional to the attenuation coefficient of the in the evaluation of organs and blood vessels.
voxel of tissue lying between the detector and the x-ray
tube. The image is then reconstructed by the computer
using complicated mathematical algorithms called Fou- Artifacts
rier reconstruction. The reconstruction of the image
often takes up to 30 seconds; however, when an array
As with conventional imaging, CT images can be pro-
processor is used, the reconstruction time is reduced to
duced with various types of artifacts.
<1 second. The Fourier reconstruction is primarily used
in MRI to reconstruct images, while a modern CT scan- Raw data point
interpolated to Helical scan
ner uses filter back projection or convolution. reconstruction plane acquisition

Convolution and Deconvolution

Convolution is the process of modifying pixel values by
using a mathematical formula or filter. When viewing
the image, it is sometimes useful to enhance or suppress
the visual characteristics of an image. Convolution
is sometimes called a mask because the filter overlies
each pixel and changes the value of the pixel effectively
producing an image free of blurring or motion artifact. Reconstruction Selection
This operation can be repeated multiple times to dis- plane thickness
play a final modified image. Deconvolution is the pro- Figure 17.16. Helical interpolation. The dotted line
cess of returning the pixel values back to their original indicates the location where the raw data is projected. This
value. section forms the image that is displayed.
266 Part IV: Special Imaging Techniques

Metal or Star
Metallic materials in the patient can cause streak artifacts
but may also cause a star artifact (Fig. 17.18). The artifact
is caused when the metal object attenuates 100% of the
primary beam, thereby producing an incomplete projec-
tion. If the algorithm is not able to create a full set of sur-
rounding projections to smooth the edges of the object,
the star artifact will be visible.
Figure 17.19 demonstrates a metallic artifact. In this
image, the arrow is pointing to the area where there may
be a metallic object such as a Port-a-Cath implanted at the
chest wall. Because the metal is attenuating a large amount
of radiation in this area, there is not sufficient information for
the computer algorithm to adequately produce an image.

Figure 17.17. Sagittal image. Image produced from trans- Beam Hardening
verse plane with postacquisition algorithms. Beam hardening artifacts occur as the beam is attenuated
when it passes through the patient. This type of artifact
results from the beam being significantly attenuated as
Motion it passes through the patient. These artifacts appear as
broad dark bands or streaks in the image.
Motion artifact on a CT image appears as a streak through
the image. This type of artifact occurs when an error in
the algorithm does not detect the changes in attenua-
Partial Volume Effect
tion that occur at the edges of the moving part. The CT Partial volume effect occurs when tissue that is smaller
image will have blank pixels which appear as a streak in than the section thickness or voxel width is hidden from
the areas of algorithm error.

Figure 17.18. Star artifact. (Courtesy of Teal Sander, Fort Figure 17.19. Metal artifact. (Courtesy of Teal Sander,
Hays State University.) Fort Hays State University.)
 Chapter 17: Computed Tomography 267

A B

Figure 17.20. (A) Ring artifact. (B) Ring artifact in volume rendered 3D reconstructed image. (Courtesy of Teal
Sander, Fort Hays State University.)

the view on the image. This artifact is produced because

the data from the whole section thickness is averaged
together to form the image. This type of artifact can also
Radiation Dose from
occur if a tiny portion of a large structure is located in the CT Scanning
section thickness; the tiny portion is simply averaged in
with the rest of the information. Exposure to radiation during a CT scan is measured by
two means: (a) the computed tomography dose index
Ring Artifacts (CTDI) and (b) the multiple scan average dose (MSAD).
Ring artifacts occur when a single detector goes out of The CTDI measures the radiation dose in the primary
calibration and does not properly record attenuated data. beam that was delivered to the patient. The MSAD rep-
The detector error has a unique annular or ring appear- resents the average dose the patient received during the
ance in the image (Fig. 17.20). entire examination. Unlike radiography entrance skin
doses, these dose measurements reflect actual tissue
dose.

CT Fluoroscopy The radiation dose per slice is about 15 milligray

(mGy) (1,500 millirads [mrad]). This is delivered to a
point in the patient. The contribution because of scatter
Spiral CT allows the continuous imaging of a section of radiation from adjacent slices in a multislice examination
the body, or real-time CT fluoroscopy. CT fluoroscopy is doubles this dose. The dose to a point in the middle of
used for lesion drainage and biopsies. The tube continu- a ten-slice examination is about 30 mGy (3,000 mrad).
ously rotates around the patient, and the physician can A ten-slice scan is equal to 3 rad. Typical dose per examina-
control the position of the support table to move anatomy tion is equal to 3 to 5 rad; however, the dose is dependent
in or out of the field. Entrance exposure rates are two to upon the type of unit used. The dose from conventional
three times higher than conventional fluoroscopy. and spiral CT scans is approximately the same.
268 Part IV: Special Imaging Techniques

Chapter Summary additional radiation exposure. CT fluoroscopy is

the continuous imaging at a section of the body.
CT scanners provide cross-sectional images, also There are several artifacts which are unique
called transaxial images, of the body by measur- to computed tomography. The more common
ing the x-ray transmission through the body. The artifacts include motion, star, beam hardening,
x-ray tube is mounted on a circular frame inside partial volume effect, and ring artifacts.
the gantry together with the radiation detectors.
The detectors are mounted either on a stationary
ring or on a support frame that rotates opposite
the x-ray tube. The x-ray tube has collimators
to set the size of the x-ray beam and a high heat Case Study
capacity rotating anode. The high-voltage circuit CT scanners utilize radiation detectors to gather
is connected to the tube through thick cables if it remnant radiation which contains the latent
operates at 60 Hz or is mounted on the rotating image. Various generations of scanners have
ring with the tube if it is a high-frequency circuit. used scintillation detectors, gas-filled ionization
A thin x-ray beam is transmitted through the detectors, or solid-state detectors.
patient and detected by the radiation detectors.
Scintillators, gas-filled detectors, or solid-state
detectors intercept the radiation passing through Critical Thinking Questions
the patient and transmit the data to the computer.
The patient support table moves the patient Of the three types of detectors, which type is
through the gantry at preset increments in con- used in a helical scanner?
ventional CT scanning. In spiral CT scanning,
the tube and detectors rotate continuously while What materials are used in the detector?
the support table and patient are moved into
the gantry. Spiral CT scans produce a complete How is it different from the scintillation detectors?
examination in a shorter time because the tube
rotates continuously around the patient instead How is the digital image formed?
of starting and stopping for each slice. Typical
radiation doses for a CT scan are from 30 to
50 mGy (3,000–5,000 mrad) per examination. Helical or MSCT scanners use solid-state detec-
The spatial resolution of CT scans depends tors. Solid-state detectors use a photodiode which
on the focal spot size, pixel size, and matrix size. is combined with a scintillator that is made
Smaller pixel sizes give better spatial resolution. of calcium tungstate, yttrium, or gadolinium.
The CT number of a tissue describes the differ- Scintillation detectors use a PM tube to convert
ence in density between the tissue and water. x-ray photons into an electrical signal which the
The CT number of water is always 0. The CT computer uses to form the visible image. In a
numbers of fat and lung are <0; those of muscle solid-state detector, the scintillator gives off light
and bone are >0. In most CT displays, air is dark photons which are then detected by the pho-
and bone is white. Contrast resolution describes todiode and then converted into an electrical
how close in density two tissues can be and still be signal. The solid-state diode is preferred because
recognized as separate tissues. High mA CT scans its scintillator materials do not phosphoresce or
with large pixels have superior contrast resolution cause afterglow like the scintillation detectors.
because they have more x-ray counts in each pixel. The computer system uses the electrical signal
Helical CT units have the computer software and converts it to a digital signal. The computer
abilities to reconstruct or reformat data to display applies algorithms to the digital signal to form
various images. This permits additional images individual voxels of information. The voxels are
for the radiologist while sparing the patient stored in a matrix and make up the digital image.
Review Questions

5. The CT number of water is

Multiple Choice A. −1,000
B. −50
C. 0
1. CT scanning provides a(n) _____ view of the D. 1,000
body.
6. When the field of view increases and the matrix
A. axial size remains unchanged, the contrast resolution
B. linear will be
C. longitudinal
D. transaxial A. improved
B. degraded
2. The gantry of a spiral CT scanner contains C. unchanged
A. the tube 7. The number of pixels required to image one line
B. the detectors pair is
C. high-voltage circuit
D. all of the above A. 1
B. 2
3. The x-ray beam in a CT scanner is shaped into a C. 4
_____ beam. D. 8
A. pencil 8. The detector which employs a photomultiplier
B. circular tube in the detection circuit is
C. fan
D. hypocycloidal A. solid-state
B. gas-filled
4. In spiral CT scanning, pitch is the ratio of C. scintillation
D. all of the above
A. the rotation speed to the patient motion per
revolution 9. The patient support table is capable of a maximum
B. the amount of table advance per revolution to the weight of
section thickness
C. the section thickness to the revolutions per A. 450 lb
second B. 350 lb
D. the section thickness to the revolutions per patient C. 500 lb
motion D. 400 lb
270 Part IV: Special Imaging Techniques

10. The Hounsfield unit for blood is 5. Why is collimation important in CT scanning?
A. +60
B. −40
C. −300
D. +40

6. What are the components of the gantry?

Short Answer

1. Who is the person credited with the invention of

computed tomography?
7. Which device controls the slice thickness of a CT
scan?

2. The patient support table is made up of which

material?
8. The numerical information contained in each
pixel is a(n) _____ or _____.

3. Using Table 17.1, the CT number of −100 relates

to which type of tissue?
9. Define linearity and contrast resolution.

4. Explain why the CT computer must be high speed

10. Define the terms axial, translation, and reformatting.
and have a large capacity?
 18

Magnetic Resonance Imaging

Objectives Key Terms

Upon completion of this chapter, the student ● bore ● proton density
will be able to: ● Faraday cage ● RF pulse
1. State the physical process involved in magnetic ● fringe field ● shim coils
resonance imaging. ● gradient coils ● superconducting
● Larmor frequency magnets
2. Identify the components and describe the
● main magnetic coil ● surface coils
operation of a magnetic resonance (MR) unit.
● permanent magnets ● T1 relaxation time
3. Identify the difference between T1 and T2
● precession ● T2 relaxation time
relaxation times.
4. Describe the use of paramagnetic contrast
agents to improve image contrast.
5. Describe some safety hazards present near a
MR unit.

271
272 Part IV: Special Imaging Techniques

Magnetic field

Introduction
+
The human body consists of more than 85% + +
water, which consists of two hydrogen atoms +
and one oxygen atom (H2O). Magnetic reso- + +
nance imaging (MRI) uses radio frequency + +

+
(RF) signals from hydrogen protons in the body +
to form images of body structures. It does not
use x-rays or any other form of ionizing radia- Figure 18.1. Demonstrates how the protons line up in a
tion. The magnetic resonance (MR) magnet magnetic field.
provides a magnetic field to align the protons.
This magnetic field is called the external or protons with the magnetic field direction than in any
main magnetic field to distinguish it from the other direction (Fig. 18.1).
local magnetic fields in the immediate vicinity
of the individual protons. The strength of the Precession
main magnetic field is given the symbol B0.
The phenomenon of precession occurs whenever a spin-
The protons in body tissues are aligned in the
ning object is acted upon by a static external magnetic
magnetic field and then moved out of align-
field. When rapidly spinning hydrogen protons align
ment by RF pulses. Moving protons out of
themselves into the direction of the external magnetic
alignment is termed resonance, or the flipping
field, the nucleus will begin to wobble or rotate around
of the protons out of alignment. The frequency
the axis of rotation (Fig. 18.2). This rotation, or preces-
of the RF pulses is selected to resonate with
sion, into alignment with the magnetic field is similar
the protons in the body. Only protons with the
to the spinning action of a child’s top or gyroscope. The
correct resonant frequency are moved out of
precession of the spinning top is around the direction of
alignment with the external magnetic field. As
gravity; the precession of the protons is around the direc-
the out of alignment protons move back into
tion of the magnetic field’s lines of flux. When these pro-
alignment, they produce an RF signal, which is
tons precess into alignment with the external field, they
used to construct the MR image.
will rotate with the exact same frequency and will have
a horizontal orientation. A RF is given off as the protons
precess into alignment and induces MR (Fig. 18.3).
Proton Alignment
Larmor Frequency
Hydrogen is the most abundant element in the body. All protons in the body have a resonance frequency
Hydrogen nuclei, or protons, are constantly spinning on called the Larmor frequency. This means that all the
an axis of rotation. This spinning causes the protons to act protons of a specific element will rotate with the exact
like tiny magnets, which are called a magnetic moment. same frequency when placed in a static magnetic field.
In a magnetic field, the protons line up in the direction The Larmor frequency is the speed of the proton as it
of the magnetic field, similar to the way a compass lines
up in the earth’s magnetic field. All the protons pointing
in the direction of the magnetic field act together to pro-
duce a net magnetization, as if they were combined into
one larger magnet. When a patient’s body is placed in a
+ Axis of magnetic field

magnetic field, the hydrogen protons line up in the direc-

tion of that magnetic field. The protons are not all per-
fectly aligned along the external magnetic field—some Precess

point in other directions—but there are more aligned Figure 18.2. Example of precession.
 Chapter 18: Magnetic Resonance Imaging 273

Magnetic field field: parallel and antiparallel. The protons can be made
to alternate from parallel to antiparallel when an RF field,
that is alternating or resonating at its Larmor frequency,
+ + is applied to a static magnetic field. Magnetic resonance
is the emission of excess energy by antiparallel protons at
+ certain specific frequencies. Emission of the RF causes
+ the protons to flip or resonate out of alignment with the
+
external magnetic field.
+
RF Energy Radio and TV circuits are built to have selectable
resonance frequencies. These circuits respond to a sig-
Figure 18.3. How protons precess into alignment with the nal only at the selected resonance frequency and amplify
external magnetic field. only that signal. Resonance is used in TV sets to distin-
guish between, for example, signals from channels 4 and
wobbles in the external magnetic field. The Larmor 5 because channels 4 and 5 have different frequencies.
frequency depends on the magnetic field strength. Pro- A hydrogen proton in a 1 T field will react strongly to
tons in stronger magnetic fields have higher resonance energy from only 42.6 MHz RF pulses. Radio waves affect
frequencies. Magnetic field strengths are measured in the precessing nuclei because the time-varying magnetic
gauss (G) or tesla (T). The Larmor frequency of hydro- field of the radio waves changes or alternates at the same
gen is 42.6 megahertz per tesla (MHz/T). This means rate as the nuclei precesses. In other words, an RF pulse
that a proton in a magnetic field with strength of 1 T is a short burst of RF energy at a specific frequency. As
will have a resonant frequency of 42.6 MHz. As seen in the nucleus rotates the magnetic field, the RF pulse will
Table 18.1, each magnetic field strength has a unique appear at the proper time to have maximum effect in
Larmor frequency. Radio waves are used in MR because rotating the protons out of alignment with the external
the radio waves have the same Larmor frequency as the magnetic field. When the protons move back into align-
hydrogen protons. Other forms of electromagnetic waves ment with the external magnetic field, they give off RF
like microwaves and visible light have wavelengths which signals, which are used to form MR images (Fig. 18.4).
will not be in resonance with the precessing nuclei and If the RF pulse is not matched to the Larmor resonance
are not useful in creating the MR image. frequency of the protons, they will remain aligned with
the external magnetic field and will produce no signal.
Producing a Magnetic A common example of resonance is pushing a child
on a merry-go-round. When pushing a child on a merry-
Resonance Signal go-round we automatically push the child with the same
force as the merry-go-round returns to us. In other words,
we are matching the frequency of the merry-go-round with
Magnetic Resonance
Protons have the ability to either align with the exter- Magnetic field
nal magnetic field or against it, which creates two
proton orientations relative to the external magnetic
+
TABLE 18.1 LARMOR FREQUENCY AS A FUNCTION +
OF MAGNETIC FIELD STRENGTH
+
+ RF pulse

Magnetic Field Strength (T) Larmor Frequency

+ +
+

0.5 21.1
1.0 42.6
1.5 63.4 Figure 18.4. How an external RF pulse (called the excita-
2.0 84.6 tion pulse) can rotate the protons out of alignment with the
external magnetic field.
274 Part IV: Special Imaging Techniques

Transferral of energy
requires matching of
frequency

100

Percent
63
MRI
0 signal

Resonance

Figure 18.5. Example of resonance. T1

Time

an equal frequency that will allow the merry-go-round Figure 18.6. T1 or spin-lattice relaxation.
to move away from us (Fig. 18.5). If we use a different
frequency to push the merry-go-round, we will not have
the same effect.
bonds are different. These differences in T1 relaxation
times are used to form T1-weighted MR images.
Proton Density
Proton density is the quantity of hydrogen nuclei reso- T2 Relaxation Time
nating in a given volume of tissue. It is the determining
factor of the MR signal strength, which is sometimes Protons in a magnetic field also have a second relaxation
called image brightness. Proton density is also referred to time, called T2 or spin-spin relaxation time. T2 relax-
as spin density. The higher the number of protons emit- ation time is the time required for precessing nuclei
ting an RF signal, the greater the proton density will be. to lose 63% of their alignment with each other due to
Proton density images have a relatively low contrast due interactions with other spinning nuclei. The T2 relax-
to the slight differences in the amounts of hydrogen pres- ation time depends on interactions between the protons
ent within various tissues. in a small volume of tissue. When an RF excitation
pulse rotates the protons out of alignment, all the pro-
tons start to precess back into alignment at the Larmor
T1 Relaxation Time frequency. When the protons begin precessing, they all
The time it takes for a proton to precess into alignment point in the same direction at the same time. They are
with the external magnetic field is called the T1 relax- said to be in phase. Because the local magnetic fields
ation time. It is also referred to as spin-lattice relaxation near the different protons are not exactly the same,
time, longitudinal relaxation time, and thermal relaxation some protons precess faster and some slower than the
time. T1 relaxation occurs when the horizontal, spinning average. Because of these small differences in the local
nuclei begin to precess at smaller and smaller angles until magnetic fields, the protons gradually lose phase and
they have a more vertical orientation (Fig. 18.6). This no longer point in the same direction at the same time
process causes the MRI signal to decrease in strength. (Fig. 18.7). When the T2 relaxation occurs, the MRI
This defines the time required for the signal to decrease to signal will decrease in strength to 37% of its maximum
63% of its maximum value as T1. Differences in T1 relax- value. The T2 relaxation time of a tissue is the time it
ation times depend on binding of the protons in different takes for the protons to lose their phase (Table 18.2).
tissues. Protons in different types of tissues have different The T2 relaxation time of a tissue is always shorter than
relaxation times because their elasticity and chemical its T1 relaxation time.
 Chapter 18: Magnetic Resonance Imaging 275

100
Percent

37
MRI
0 signal

T2
Time

Figure 18.7. T2 or spin-spin relaxation.

Image Contrast A
MR images can be modified to emphasize either T1 or
T2 relaxation times by adjusting the RF excitation pulse.
These modifications result in either T1- or T2-weighted
images. The same anatomy can have different appear-
ances with T1- and T2-weighted images. Maximum
image contrast is obtained when the RF signal strength
is at its greatest difference between two tissues. All tissues
have two relaxation times, T1 and T2, and these are used
to distinguish different tissues in the MR images. T1- and
T2-weighted images of the same tissues often have dif-
ferent appearance (Fig. 18.8). The decision to obtain a
T1- or T2-weighted image is based upon the structures to
be imaged. Contrast resolution is more superior in MR
than in computed tomography (CT).

TABLE 18.2 T1 AND T2 VALUES FOR VARIOUS

ORGANS AT 1 T MAGNETIC FIELD STRENGTH

Organ T1 (ms) T2 (ms)

Fat 240–250 60–80 B
Liver 490 40 Figure 18.8. (A) T1-weighted image and (B) T2-weighted
Spleen 460 80 image. Notice how the images of the brain have different
Muscle 580 40 appearances.
White matter 350 80
Gray matter 500 100
Cerebrospinal fluid 2,200–2,400 500–1,400 Paramagnetic Contrast Agents
Blood 720 175
Water 2,500 2,500 Soft-tissue contrast with MRI is superior to that with
CT because of the T1 and T2 differences shown in
276 Part IV: Special Imaging Techniques

TABLE 18.3 THE APPEARANCE OF SOME BODY These magnets are stationary and must have extremely
TISSUES IN T1- AND T2-WEIGHTED MR IMAGES strong field strengths. Currently, field strengths range
Appearance in Appearance in from 0.10 to 7.0 T. The strength of a magnetic field is
Body Tissue T1-Weighted Image T2-Weighted Image measured in tesla or gauss. One tesla is equal to 10,000 G.
The earth’s magnetic field is about 0.5 G (5 × 10−5 T).
White matter Bright Dark A refrigerator magnet has a field strength of about 10 G.
Gray matter Dark Bright
Spinal fluid Dark Bright
The external magnetic field used to align the protons
Hematoma Bright Dark can be produced by either a permanent magnet or a
superconducting magnet. The external magnetic field
must be uniform to +50 microtesla (mT) so that a proton
Table 18.3; however, it is often beneficial to use the prop- in a particular tissue has the same Larmor resonance
erties of contrast agents to further enhance tissue. MRI frequency no matter where in the body it is located.
utilizes specialized paramagnetic contrast agents that are The magnetic field extending outside the bore and sur-
designed to enhance the T1 and T2 relaxation times of rounding the magnet is called the fringe field. Its strength
hydrogen nuclei. Various methods of administering the depends on the magnet type and the field strength. The
contrast agents have been developed, but at the present higher the field strength, the larger the fringe field. Sur-
time, the intravenous agents are predominantly used. rounding the magnet is a line, which specifies the area
Intravenous MR contrast agent gadolinium diethylenetri- where the static magnetic fields are higher than 5 G.
aminepentaacetic acid (Gd-DTPA) is used to improve Fields stronger than 5 G have the ability to turn metallic
MR image contrast because it has T1 and T2 values that objects into flying projectiles which will be pulled into
are very different from those of tissue. the bore of the magnet. The magnetic field that would
extend out from the sides of the magnet is reduced almost
to zero by special shielding coils.
Equipment
Permanent Magnets
Permanent magnets are made of a ferromagnetic metal
An MR imaging system consists of a magnet coil surround-
alloy that produces fields with strengths from 0.25 to
ing an opening called the bore, shim coils, gradient coils,
0.4 T. They are called ceramic magnets and are very large
surface coils, a patient support table, a computer, and a
in size. They require no current-carrying coils, need little
display system. The main magnet coil produces the exter-
maintenance, and have a large bore. This is an advan-
nal magnetic field used to align the hydrogen protons in
tage in scanning large patients or individuals who have
the body. The main magnetic field strength is represented
claustrophobia because most superconducting MR units
by B0. Shim coils are used to improve the uniformity of
have a 60-centimeter (cm) diameter bore and looks like a
the magnetic field near the edges of the bore. The patient
long tube. Permanent magnet MR units produce smaller
is placed within the bore of the magnet during the scan.
RF signals, which may result in longer scan times. These
The table supports the patient within the magnetic field
magnets have a minimal fringe field because they have
during the MR scan. The gradient coils are used to select
low field strength. They are often installed in private clin-
the imaging plane. Surface coils detect the weak RF sig-
ics because they are less expensive to install and operate
nals from the protons precessing back into alignment. The
than superconducting MRI units.
computer sets the times for the RF signals and processes
the precession RF signal data to form the MR images.
The display system allows viewing of the digital images on
Superconducting Magnets
Superconducting magnets employ coils made of a super-
a TV monitor or recording them as hard copies.
conducting material to produce the magnetic field. The
superconducting coils surround the bore of the magnet.
Magnets Typical superconducting bore diameters are 50 to 60 cm.
The two common types of magnets used in MR units are The bore diameter limits the size of patients who can
superconducting magnets and permanent magnets. be scanned in a superconducting magnet (Fig. 18.9).
 Chapter 18: Magnetic Resonance Imaging 277

Superconducting
Head coil magnet

Figure 18.9. A superconducting MRI

Support table unit with a surface coil designed for MR
scans of the head on the support table.
The superconducting coils, which have
zero electrical resistance, are surrounded
by liquid helium in a dewar to maintain
them at a temperature below 9.5 K.

The superconducting coils operate in the same way as Once the current is flowing in the superconducting coils,
a conventional electromagnet to generate the magnetic no additional electric power is needed to maintain the
field. The strong magnetic fields require enormous current flow because the coils have zero resistance. The
amounts of wire to accommodate the electricity needed magnetic field of a superconducting unit is never turned
for the magnet. A 1.5 T magnet may require 1,000 loops, off. Superconducting magnets produce magnetic fields
and each loop may carry up to 1,000 A. This amount of from 1 to 4 T or more.
amperage flowing in a circuit with all these loops will
produce an enormous amount of heat as well as consum-
ing a great deal of power. Current flowing in the super-
conducting coils produces the magnetic field.
Liquid helium Superconducting
The difference from conventional electromagnets is coil
that superconducting coils allow the current to flow with- Liquid
nitrogen
out any resistance at temperatures below 264°C (9.5 K).
RF coil
Cryogens must be used to achieve the extremely low
temperatures necessary for superconductive magnets.
Liquid helium is a cryogenic that has a boiling point of
4 K (−269°C) and is used to maintain this low tempera-
ture. The liquid helium is contained in a vacuum ves-
sel called a dewar which is an insulated chamber that Gradient
coils
provides thermal insulation for the electromagnetic
coils. The dewar acts as a giant insulated Thermos bot- Shim coils
tle. As seen in Figure 18.10, the liquid helium is then
surrounded by another dewar, which contains liquid Dewar vacuum
nitrogen that has a boiling point of 77 K (−196°C). The Figure 18.10. Cross-sectional view of the superconduct-
nitrogen acts as an additional insulator to help maintain ing magnet demonstrating the cryogenic dewars, coils, and
the temperature necessary for helium to remain a liquid. bore.
278 Part IV: Special Imaging Techniques

Gradient coils Shim coils Magnet

Figure 18.11. The location of

Gradient coils
the gradient coils in a typical MR
Shim coils
unit.

Shim Coils the type and locations of imaging planes (Fig. 18.11).
Coronal, sagittal, transverse, or oblique sections can
Superconducting magnets use shim coils to improve the be selected. Pulsing of the gradient coils during image
uniformity of the external magnetic field and improve acquisition produces the familiar knocking or rapping
the quality of the MR images. They concentrate the noise heard during MR scanning.
magnetic field through the bore. The shim coils can be
resistive or superconducting and are mounted around Surface Coils
the bore. Each shim coil is custom fitted for each MR
unit by adjusting the current to each shim coil. Current Both permanent and superconducting MR units use sur-
in the shim coils improves the uniformity of the external face coils to send the RF excitation pulses into the patient
magnetic field within the bore to +50 mT. and to detect the RF signal from the precessing protons.
It is essential to produce images with the best clarity of
Gradient Coils soft tissue as well as bony areas, and this is accomplished
by using surface coils. These coils are so named because
Gradient coils produce slight differences in the field
they are placed on the surface of the patient as close to
strength at different locations in the patient. They are the
the region of interest as possible. Head, neck, and extrem-
coils that determine the slice orientation—sagittal, coro-
ity surface coils are designed for imaging these specific
nal, transverse, or oblique. Slight differences in the field
regions of the body (Fig. 18.12). It is critical to select the
produce different Larmor frequencies at different loca-
correct surface coil for the area being imaged so that the
tions in the body. By selecting the proper gradient field,
RF signal can be focused on the area. Surface coils are
a specific slice location and orientation can be chosen.
also called signal coils or radiofrequency coils.
Only the protons at the selected location are rotated out of
alignment and contribute to the MR signal. Each image
slice requires a separate gradient setting. During an MRI
Patient Support Table
scan, the current through the gradient coils is automati- The patient table supports the patient and allows the
cally changed to collect data from the individual slices. patient to be moved into the bore for scanning. The table
The electronic indexing of the slice locations means that is curved for patient comfort so that it conforms to the
the patient is not moved during the scan. shape of the bore. The table must be capable of support-
Both permanent and superconducting MR units use ing at least 350 lb. The tables have a maximum weight
shim and gradient coils to allow the operator to select limit which should not be exceeded as damage will occur
 Chapter 18: Magnetic Resonance Imaging 279

Figure 18.12. An extremity

surface coil.

to the table. It is constructed of nonmagnetic material to tissue being imaged. Once the parameters are set, the MR
avoid altering the magnetic field. The table is not used to computer will begin the RF and magnetic field pulses to
move the patient during the scanning process as in CT acquire the selected sequence.
scanning because the scan slice location and orientation The matrix size is selected for the specific scan to be
are selected electronically using the gradient coils. The performed. An increased matrix size produces images
table is driven with a hydraulic system which allows it with higher resolution but increases the overall scan
to be raised and lowered to assist the patient in lying on time. The technologist also selects the field of view. The
the table and the hydraulic system also moves the patient field of view has a direct effect on resolution: the smaller
into the bore of the magnet. field of view increases image resolution. The section,
interval between sections, and the section thickness are
Computer all controlled by the technologist.
The computer is a major component in the formation of
MR images. It programs the gradient coils to select differ-
Display Console
The display console is used for image reconstruction. The
ent imaging planes, and it processes the RF signals from
MRI computer utilizes a set of sophisticated algorithms
surface coils into digital data to create the MR images.
to process the large quantities of data produced during
The digital MR images can be transmitted, stored, and
the scanning phase. The data can be manipulated into
displayed just like any other digital images on PACS.
oblique sections along with the routine sagittal, coronal,
Display systems allow viewing of the images on a TV
and 3D reconstructions. The display console also permits
monitor. A laser printer can be coupled to the computer
the application of filters to smooth the image, decrease
system to produce hard copies on film.
image noise, and for edge enhancement. The MRI display
Operating Console console permits density level windows and contrast widths
The MRI technologist controls the scanning parameters to be set with the digital image processing. The data can be
by selecting the RF, pulse sequence and pulsing time reformatted into transverse, sagittal, coronal, oblique, and
intervals, matrix size, number of acquisitions, field of 3D images without performing additional scans. Many of
view, and section parameters. The technologist adjusts these functions are similar to CT imaging; however, MR
the RF to the proper Larmor frequency for the specific collects a significantly greater amount of data.
280 Part IV: Special Imaging Techniques

proton precession varies depending on adjacent tissues in

RF Shielding the region of interest. This also determines the RF signal
that is emitted. By using the two weighted images, tissues
will have different appearances, which will help distinguish
The MR room is surrounded by a copper screen called a
normal and abnormal variances in various types of tissues.
Faraday cage. The Faraday cage prevents external RF sig-
nals from entering the room because the RF energy can- Motion Artifacts
not penetrate through the copper screen. RF shielding is
necessary because the RF signals from the precessing pro- Motion artifacts are a special problem in MRI because
tons in the patient are very weak. In order to detect their of the extremely long scan times. It can be very difficult
weak signals, external RF energy must be minimized. for patients to hold still for lengthy exams. Good commu-
Individuals in the scan room do not have to be shielded. nication with the patient is the best method of ensuring
the patient holds still, thereby reducing motion artifacts.
In addition to motion artifacts, some patients experience

Image Quality claustrophobia due to the small diameter and long length
of the bore. The percentage of these patients who cannot
be scanned is small. For these patients, an alternative to
As with other digital imaging, the quality of the final the closed bore MRI unit is the open MRI unit. These
image can be affected by several factors. One of these specially designed units do not have a long bore that the
factors is the brightness of the image which is actually patient is placed in but rather a more open design where
the density of the MR image. The primary factor which the patient is better able to manage their claustrophobia.
determines brightness is the RF signal strength.
Spatial Resolution
Magnetic Field Strength As mentioned in other chapters, resolution is the abil-
ity to distinguish one structure from another. In MRI,
Higher magnetic field strength produces a stronger RF the spatial resolution is determined by the homogeneity
signal. MR units come in a variety of magnetic strengths, of the static external magnetic field, the gradient fields,
and some units are more efficient than other units. The and the scan time. The signal-to-noise ratio has a definite
strength of the magnet will determine the scanning effect on the resolution; when the ratio is low, the image
parameters and resultant image. When scanning the quality begins to decrease.
same type of tissue in magnets with different strengths,
the images will have a very different appearance. The Signal-to-Noise Ratio
most efficient field has not been determined; however, The signal-to-noise ratio is determined by the voxel size
magnets with field strength between 1 and 3 T are con- and detection volume, the quantity of precessing protons,
sidered to produce better images. the pulse sequence, and the field strength. As with all
digital images, signal-to-noise ratio degrades the image by
reducing the visibility of low-contrast structures. It can be
Section Thickness enhanced by averaging a series of RF signals and by using
In MRI, section thickness is determined by the size or a stronger magnetic field.
depth of the tissue voxel. Section thickness is the primary
factor for image quality because all the RF signals from Scan Time
a single voxel are combined into one image value for
The scan time depends on the quantity of data that must
the voxel. In other words, the algorithms determine the
be processed by the computer. In MRI, it depends on the
smallest tissue differences that can be imaged in a voxel.
pulse sequences, number of phase encoding steps, and
the number of excitations. 3D imaging requires a much
MRI Imaging Parameters longer scan time to acquire all the data necessary to pro-
Presently MRI examinations include at least one T1-weighted duce the 3D images. Scan time can be reduced by using
image and one T2-weighted image. This is because the multisection and multiecho pulse sequences.
 Chapter 18: Magnetic Resonance Imaging 281

torqued aneurysm clip to open an artery and cause a fatal

Hazards hemorrhage. Patients with cardiac pacemakers should not
be near the magnet because the fringe field may interfere
with the pacemaker operation. Prior to each MRI exam, a
There is no ionizing radiation associated with MR imaging,
medical history must be obtained to determine if the patient
so none of the potential hazards of x-ray exposure are pres-
has any risk factors for metallic objects. Patients with a his-
ent during MR examinations. The strong magnetic fields
tory of working with metal may have x-ray screening images
and the energy from the RF signals are the major hazards
performed for the purpose of identifying any potential metal
in MR imaging. The effect of magnetic fields changes very
objects that the patient may not be aware of.
quickly in relation to the distance an object is from the
magnetic field. Individuals without knowledge of the prop-
erties of a magnetic field do not often understand the prin-
ciples of working safely in the MRI environment. In the Chapter Summary
MRI procedure room, ferromagnetic objects can become
The protons used in MRI are the hydrogen
projectiles when they are attracted into the bore of the
nuclei in the human body. Protons in a magnetic
magnet by the fringe field. Screwdrivers, IV poles, scissors,
field align in the direction of the magnetic field.
and oxygen bottles are some of the more common objects
Their Larmor resonance frequency depends on
that can become projectiles. Magnetic objects should not
the magnetic field strength. Protons in stronger
be brought into the MR room because they pose a lethal
magnetic fields have higher Larmor frequen-
threat to any person who is between the magnetic object
cies. An RF excitation pulse is used to rotate the
and the bore of the magnet. MRI units must have spe-
protons out of alignment with the magnetic field.
cialized medical equipment which can be brought into
As the protons precess back into alignment, they
the MRI room in case of an emergency. Crash carts and
give off RF energy at their Larmor frequency.
stretchers must be made from nonferromagnetic materials
These RF signals are used to form MR images.
so that they can be taken into the MRI room.
There are two relaxation times, T1 and T2,
When in the MRI unit, the closer you get to the unit
associated with the proton realignment. T1- and
the greater the attraction to the magnetic field will be.
T2-weighted images of the same tissues can have
Magnetic field strength is governed by the inverse cube
different appearances. Both T1- and T2-weighted
law where the strength of the field decreases exponentially
images provide excellent soft-tissue contrast. The
with the cube of the distance resulting in a rapid decrease
decision to obtain a T1- or T2-weighted image
of the magnetic field strength. A distance as small as 1 inch
is based upon the structures to be imaged. The
can make the difference between being able to hold onto
external magnetic field used to align the protons
an object and having it fly swiftly into the bore of the mag-
can be produced by either a permanent magnet
net. We would all benefit from remembering how incred-
or a superconducting magnet.
ibly powerful an extremely strong magnetic field can be.
Magnetic fields are measured in units of tesla
Superconductor magnets maintain their magnetic field
or gauss. Permanent magnet units have field
at all times and are therefore dangerous at all times. It is
strengths of 0.25 to 0.5 T. MR units with super-
important to treat the magnetic field as if it is on all the
conducting magnets have field strengths of 1.0
time and we should educate others about this fact so that
to 1.5 T. The coils of superconducting magnets
we can all have a healthy respect for the powerful magnet.
have zero electrical resistance. The coils are
Patients with metallic implants, even if they are not fer-
maintained at 4 K by liquid helium contained in a
romagnetic, such as metal prostheses, surgical clips, and
dewar vacuum container. Gradient coils are used
cochlear implants, may be excluded from MR scanning
to select the MRI planes. Surface coils emit the
because of possible interaction between the RF energy
excitation RF pulses and receive the RF signals
and the metal, just as may happen if a metal fork is left in
from the protons precessing back into alignment.
a microwave oven. It is also possible that these implanted
MRI image quality is affected by the strength
surgical objects may experience torque during the MRI
of the magnetic field. Section thickness, motion
exam with lethal consequences. It is entirely possible for a
282 Part IV: Special Imaging Techniques

artifacts, spatial resolution, and signal-to-noise 1.5 T has up to 1,000 loops of wire supplying
resolution all affect the overall quality of the MRI current or amperage to the magnet. Each loop
image. These parameters are controlled by the carries approximately 1,000 A of electricity. This
technologist at the operating console and when amount of amperage in all these loops will cre-
they select the correct RF for the procedure. ate a tremendous amount of heat in the mag-
No ferromagnetic objects should be brought net. The heat causes the magnet to use a great
into the MR room because of the strength of deal of power. A superconducting magnet needs
the magnetic field. Metallic implants may be to be super cooled to help dissipate the extreme
heated by the RF signals, causing thermal burns. amounts of heat. The superconducting magnet
A Faraday cage surrounding the room shields requires the unit to be cooled to <9.5 K because
the MR unit from external RF signals which will at this low temperature, the electricity can flow
interfere with the weak hydrogen protons. without any resistance and no heat will be pro-
duced. Liquid helium and liquid nitrogen are
used to cool the magnet.
There are three types of coils: shim coils,
gradient coils, and surface coils. The shim coils
Case Study focus the magnetic field lines through the bore
of the magnet, which creates a more uniform
Ana is an MRI technologist who is giving a pre- field and produces quality images. The gradi-
sentation about superconducting magnets to a ent coils create small differences in the field
seventh grade science class. She collected ques- strength at different locations in the patient’s
tions from the students in order to answer their tissue so that the specific area of interest has the
questions about a superconducting magnet. Ana hydrogen protons precessing to create the mag-
answered the following questions. netic signal. The gradient coils allow the tech-
nologist to select the slice orientation for the
examination being performed. The slice orien-
Critical Thinking Questions tations include sagittal, coronal, transverse, and
oblique. The gradient coils gather information
How big is the bore? from each slice to help form the image. The
surface coils are the smaller coils, which are
Is there a weight limit? placed directly on the patient. These coils help
Why does the magnet require extremely low to further focus the RF excitation pulses into
temperatures? the patient and to detect the RF signal from the
precessing protons. The magnetic field of the
How do the various coils work together to make superconducting magnet is very powerful and
the image? can attract metal objects into the center of the
bore. When metal objects are brought into the
Why can’t metal objects be brought close to the magnets room, the fringe field will attract these
magnet? metal objects and can make them fly with great
speed into the bore. This can be very dangerous
for anyone who is standing between the mag-
The bore is 50 to 60 cm in diameter and is sur- nets bore and the flying object. MRI technolo-
rounded by the superconducting coils. There is gists must be very cautious when entering the
a weight limit of 350 lb which must be followed magnets room, and they must also make sure
because of potential damage to the table if too that no one brings any metal into the room. It
much weight were placed on the table. The is part of their responsibilities to keep everyone
superconducting magnet with the strength of safe when they are close to the magnet.
Review Questions

6. Currently, magnetic field strengths range from

Multiple Choice A. 0.1 to 7 T
B. 0.3 to 4 T
1. Precession is C. 0.1 to 3 T
D. 1 to 7 T
A. the diameter of the bore
B. proton rotation around the magnetic field 7. The knocking or rapping noise during scanning is
direction caused by pulsing of the
C. spinning of the RF field
D. a unit of magnetic field strength A. magnet coil
B. gradient coils
2. The most abundant element in the human body C. signal coils
is D. shim coils

A. oxygen 8. The purpose of using liquid helium is

B. hydrogen
C. carbon A. to heat the superconducting coils
D. nitrogen B. used in permanent magnet MR units
C. to increase the rate of precession of protons
3. Shim coils are used to D. used to cool superconducting coils

A. select the slice to be imaged 9. The Larmor frequency of hydrogen is

B. produce and detect RF signals
C. prevent excess heating during scanning A. 13.8 MHz/T
D. improve the homogeneity of the magnetic field B. 23.7 MHz/T
C. 50 MHz/T
4. Safety concerns in MRI include D. 42.6 MHz/T

A. effects on pacemakers 10. The MR room is surrounded by a copper screen

B. ferromagnetic projectiles called a
C. heating of metallic implants
D. all of the above A. Faraday cage
B. Oersted cage
5. The MR room is shielded against C. Tesla cage
D. Bohr cage
A. ionizing radiation
B. RF energy leaving the room
C. RF energy entering the room
D. external magnetic fields
284 Part IV: Special Imaging Techniques

6. What is the contrast agent used the most frequently

Short Answer in MR imaging?

1. Explain why hydrogen atoms are used to create the

MR image.

7. Why do superconducting magnets use liquid

helium and liquid nitrogen?

2. Describe what a magnetic moment is and how it

affects the protons in a magnetic field.

8. How do shim coils improve the quality of MR

images?

3. What is the Larmor frequency?

9. _____ coils are placed directly on the patient in

the region of interest.

4. How does the proton density affect the magnetic

signal strength?

10. Which type of metal is used in a Faraday cage?

5. What is the T1 value for white matter?

 PART V

Radiation
Protection
 19

Radiation Biology

Objectives Key Terms

Upon completion of this chapter, the student ● carcinogen ● linear energy
will be able to: ● cataracts transfer (LET)
1. Describe the reproductive cycle of the human ● chromosomes ● LNT
cell. ● deoxyribonucleic ● manifest stage
2. Identify the relative radiation sensitivity of acid (DNA) ● meiosis
human cells, tissues, and organs. ● doubling dose ● mitosis

3. Describe the dose-response models. ● epilation ● oxygen enhance-

● erythema ment ratio (OER)
4. Identify the stages of acute radiation effects. ● prodromal stage
● gastrointestinal (GI)
5. Discuss target theory of radiobiology. syndrome ● relative biological
6. Relate the Law of Bergonie and Tribondeau. ● genetic cells effectiveness (RBE)
● GSD ● ribonucleic acid
7. List and discuss the biologic factors that affect
(RNA)
the degree of tissue damage in relation to ● germ cells
● somatic cells
radiation exposure. ● hematologic
syndrome ● stem cells
● latent period ● threshold dose
● LD50/30

286
 Chapter 19: Radiation Biology 287

Nuclear membrane

Introduction Endoplasmic
Nucleoli
Centrioles

Mitochondria
Radiation biology is the study of the effects of reticulum
ionizing radiation on biological tissue. Radiobi-
ology research is striving to accurately describe
the effects of radiation on humans so that safe
levels of exposure to radiation can be deter-
mined. The advent of using radiation to image Lysosome
the human body has provided unparalleled
Cell membrane
information for radiologists to diagnose and Ribosomes
image pathologies. Radiation must be used with Cytoplasm
respect for the potentially damaging effect it
can have on tissue. It is the responsibility of the Figure 19.1. The structure of a human cell.
radiographer, radiologist, and medical physicist
to produce high-quality images while using the information representing the cell. Germ cells contain all
least amount of radiation possible. With this the hereditary information for the whole individual. The
approach, there will be a lower risk of radiation cell’s genetic information is transferred by chromosomes,
exposure to patients and radiation workers. This which are clusters of DNA molecules. The cell nucleus
chapter examines the concepts of human biol- is surrounded by the cytoplasm. The cytoplasm contains
ogy and the body’s response to radiation. organelles that produce energy, synthesize proteins, and
eliminate waste and toxins. The entire cell contents are
contained within the cell membrane (Fig. 19.1).
The genetic information about a cell’s form and func-
tion is contained in the DNA molecule. This molecule is
Human Biology shaped in the form of a double helix. The two helices of
the DNA molecule are connected by base pairs attached
to the side chains like the rungs of a ladder (Fig. 19.2).
About 80% of the human body is water. The remainder
of the body consists of 15% proteins, 2% lipids, 1% car-
bohydrates, 1% nucleic acid, and 1% of other materials.
These constituents are combined into cells. The human S G C S
P P
body is made up of many different types of cells. The S T A S
cells of a specific type combine to form tissues, and tis- P
S
P
P P
sues combine to form organs. The functions of cells can S C G S
differ greatly, but all cells in the body have many com- P P
S T A S
mon features. They absorb nutrients, produce energy,
and synthesize molecular compounds. These activities S G C S
are called metabolism. There are two types of cells in the P P
S T A S
body: genetic and somatic. Genetic cells are cells of the S P
P
reproductive organs. Somatic cells are all the other cells S
S C G
in the human body (skin, nerve, muscle, etc.). P P
S G C S

DNA S T A
P
S

S C G S
The central nucleus of a human cell contains the genetic P P
S
code, which is held in large macromolecules of deoxyribo-
nucleic acid (DNA). The DNA contains all the hereditary Figure 19.2. A schematic diagram of a DNA molecule.
288 Part V: Radiation Protection

The rungs are made up of four different base pairs: TABLE 19.1 LISTS THE PHASES OF THE CELL
adenine, guanine, thymine, and cytosine. Adenine and CYCLE
guanine are purines. Thymine and cytosine are pyrimi- Phase of Cell Cycle Description
dines. The sequence of these bases and how they are con-
nected to the side chains encode the information in the M Mitosis or meiosis
DNA molecule. The adenine is bonded to thymine, and G1 Pre-DNA synthesis, cell growth
S DNA synthesis
the cytosine is bonded to the guanine. In this sequence of
G2 Cell growth following DNA synthesis
bases, no other bonding combination is possible.

RNA
Ribonucleic acid (RNA) molecules, which are contained prepares for DNA synthesis. During the S phase, each
in both the cell nucleus and the cytoplasm, are similar DNA molecule is duplicated to form two identical
to DNA molecules, but they have only a single strand daughter DNA molecules. These DNA molecules will
of nucleic acid, whereas the DNA molecules have two combine to form duplicate chromosomes during the S
strands. The RNA molecules serve as templates for the phase. After synthesis is completed, the cell enters into
replication of DNA molecules. There are two types of the post-DNA synthesis, or G2 phase, during which the
RNA cells: messenger RNA and transfer RNA. These cell continues to mature. At the end of the G2 phase, the
molecules are distinguished according to their biochemi- cell enters interphase. Interphase is the period of growth
cal functions. They are involved in the growth and devel- of the cell between divisions. At the end of interphase,
opment of the cell by way of protein synthesis and other the cell begins the cycle over and starts with the M phase,
biochemical pathways. where mitosis or meiosis occurs. Different cell types have
different cell cycle times. For example, some blood cells
progress through their cell cycle in a few days, which
other cells require many months to progress through
Cell Proliferation their cell cycle.

Cell proliferation is the act of a single cell or group of Mitosis

cells reproducing and multiplying in number. Cells go Mitosis describes the division of somatic cells. The cell
through a sequence or cycle during proliferation or divi- division, or M, phase of the cell cycle is divided into four
sion. The end result of the cycle is the division of a single subphases:
cell into two cells. Two types of cells exist in the human
body: somatic cells and genetic cells. The genetic cells ● First: Prophase
are the oogonium of the female and the spermatogonium ● Second: Metaphase
of the male, the rest of the cells are somatic cells. The ● Third: Anaphase
proliferation or division of somatic cells is called mitosis, ● Fourth: Telophase
and the proliferation or division of genetic cells is called
meiosis. Both mitosis and meiosis occur during one phase Before cell division begins, the cell has 46 chromosomes
of a well-defined cell cycle. Table 19.1 lists the phases arranged in 23 pairs. During prophase, the nucleus begins
a cell must cycle through for successful proliferation to to swell and the chromosomes become visible under a
occur. microscope. At metaphase, the chromosomes align them-
Cell division occurs during the M phase of the cell selves on fibers along the center of the nucleus. In ana-
cycle. At the beginning of the M phase, the DNA mol- phase, the chromosomes begin to divide at the centromere
ecules clump together to form visible chromosomes. so that two chromotids and a centromere are connected
Cell division results in two cells. After cell division, each by a fiber to the poles of the nucleus. The poles are called
new cell passes through a growth phase, G1, in which it spindles and the fibers are spindle fibers. This division
 Chapter 19: Radiation Biology 289

Double- the two daughter cells. Each daughter cell nucleus

structured
Chromosome Centriole chromosome contains 46 chromosomes and contains exactly the same
genetic material as the parent cell (Fig. 19.3). The newly
formed daughter cells are immature or young somatic
cells and are called stem cells. They remain stem cells
until they grow, develop, and mature.

A
Propose
B
Prometaphase
C
Metaphase Meiosis
Meiosis is the reduction and division process of genetic
cells. Immature genetic cells, called germ cells, begin
with the same number of chromosomes as somatic cells
have. However, genetic cell division during meiosis dif-
fers from somatic cell division during mitosis. During
Anaphase Telophase Daughter cells meiosis, the number of chromosomes is reduced to half
D E F
of the normal 46 so that each germ cell contains only
Figure 19.3. Mitosis is the phase of the cell cycle where the 23 chromosomes. Following conception, each of the two
chromosomes become visible, divide, and migrate to daugh-
ter cells. (A) Prophase. (B) Prometaphase. (C) Metaphase. germ cells contributes half of the chromosomes when
(D) Anaphase. (E) Telophase. (F) Daughter cells. (Reprinted they combine to form a daughter cell containing the stan-
with permission from Sadler T, Ph.D. Langman’s Medical dard number of 46 chromosomes. As seen in Figure 19.4,
Embryology. 9th Ed. Baltimore, MD: Lippincott Williams & genetic cells progress through the same phases in meiosis
Wilkins, 2003.) as somatic cells do in mitosis.

leaves each new cell with 23 pairs of chromosomes, which

migrate toward the nuclear spindle. Two sets of chromo-
somes have been formed. During telophase, the two sets Tissues and Organs
of chromosomes blend into two separate nuclei to form a
mass of DNA and the nuclear membrane completes its Cells in the body with similar structure and function
division. Each new cell has one half the cytoplasm of the combine to form specific tissues. These tissues com-
original cell and the new mass of DNA, thereby forming bine in a precise manner to form organs. Organ systems

Metaphase
Meiosis II
Early anaphase

Anaphase II
Metaphase II

Prophase II

Figure 19.4. Cell Meiosis. Meio-

sis is the process of reduction and
Interphase
Late anaphase division of germ cells. (Image from
Gametes
LifeART Super Anatomy Collection
Meiosis I 2, CD-ROM. Baltimore, MD: Lip-
pincott Williams & Wilkins.)
290 Part V: Radiation Protection

TABLE 19.2 RADIATION SENSITIVITY OF SOME 3. Mature cells are less radiosensitive.
CELLS, TISSUES, AND ORGANS 4. As the growth rate of cells increases, so does their
radiosensitivity.
Most sensitive Lymphocytes
Gonads
Spermatogonia These points are more important in diagnostic radiol-
Oogonia ogy because the fetus, which contains younger or imma-
Hemopoietic tissues/erythroblasts ture cells, and cells that are rapidly dividing, are more
Intermediate Intestine/intestinal crypt cells sensitive to radiation than adult cells. Cells are most
Bone/osteoblasts sensitive to radiation exposure during the M phase of
Skin/epithelial cells
the cell cycle when the proliferation and division are
Lens of eye/cornea
Thyroid occurring. They are most resistant to radiation exposure
Least sensitive Muscle cells in the S phase. Germ and stem cells are more radiosen-
Nerve cells sitive than mature cells of the same type. Stem cells of
Spinal cells a particular type are identified with the suffix-blast. For
Brain cells example, immature red blood cells are known as eryth-
roblasts, and bone stem cells are known as osteoblasts.
Blastic cells are more radiosensitive than mature cells
perform specific functions. Different types of tissues and of the same type. Cells that are less sensitive to radia-
organs have cells with different structures and functions. tion are called radioresistant. Radioresistant cells show
Examples of major organ systems include the nervous, fewer biologic effects of radiation than do radiosensitive
respiratory, digestive, endocrine, circulatory, and repro- cells. In keeping with the law of Bergonie and Tribon-
ductive systems. The effects of radiation exposure that deau, nerve cells of the brain and spinal cord are most
appear at the whole body level begin with damage at the radioresistant because once they are developed, these
cellular level and progress to the organ systems. nerve cells do not undergo further cell division. Lym-
The cells of a tissue system are characterized by their phocytes and gonadal cells are the most radiosensitive
rate of proliferation and their stage of development. because they undergo rapid cell division and are con-
Immature cells are called undifferentiated cells, precur- stantly developing.
sor cells, or stem cells. When the cell grows and matures,
it goes through various stages of differentiation into a
complete functional cell. The state of maturity and its
Factors Affecting Radiosensitivity
functional role in the organ system influence the cells’ When irradiating tissue, the response to the radiation is
sensitivity to radiation. Typically, immature cells are determined by the amount of energy deposited per unit
more sensitive to radiation than mature cells. Table 19.2 mass: the dose in rad (gray [Gy]). During experiments to
lists various types of cells according to their degree of sen- test the response of tissue to equal doses of radiation to
sitivity to radiation. equal tissue specimens, the results will vary depending
upon physical factors that affect the degree of response to
The Law of Bergonie the radiation dose.

and Tribondeau Linear Energy Transfer

Two French scientists, Bergonie and Tribondeau, studied the
effect of radiation on cells, tissues, and organs. Their obser-
vations relate to the sensitivity of cells, tissues, and organs, An animation for this topic can be viewed
which were being exposed to ionizing radiation. Important at http://thepoint.lww.com/FosbinderText
points of the Bergonie and Tribondeau law are as follows:

1. Younger or immature cells are more radiosensitive. The characteristics of particulate and electromagnetic
2. Rapidly dividing cells are more radiosensitive. radiation can affect the amount of biologic damage.
 Chapter 19: Radiation Biology 291

The radiation characteristic that is most important in TABLE 19.3 RADIATION WEIGHTING FACTORS
determining cell damage is the rate at which the radia-
Type and Energy Range Radiation Weighting Factor
tion deposits its energy.
The term linear energy transfer (LET) describes X- and gamma-rays 1
how the ionizing radiation energy is deposited along Electrons 1
a tract or path in tissue. LET has units of kiloelectron Neutrons 5–20
volts per micrometer (keV/mm). As the radiation passes Protons 5
Alpha particles 20
through tissue, it deposits energy and produces ioniza-
tion of the cells in the tissue. Different types of ionizing
radiation have different LET values. As high-LET radi-
ation passes through tissue, it deposits large amounts Relative Biological Effectiveness
of energy in a short distance. Accordingly, high-LET The biological effects of radiations with different LET val-
radiation has a greater biologic effect but very little ues are compared by comparing their relative biological
penetrating ability because it loses all its energy in a effectiveness (RBE) values. RBE is the ratio of doses of a
short distance. standard radiation to a test radiation required to produce
Low-LET radiation is very penetrating because it the same biologic effect. Diagnostic x- and gamma-rays
spreads its energy over large distances. There is little have a RBE value close to 1. High-LET radiations have
chance that a low-LET radiation will deposit more than higher RBE values because they produce the same effect
one ionization in any one cell. Current theories sug- at lower doses.
gest that two or three ionizations in a cell nucleus are When radiation is absorbed in biological material, the
required to produce biologic effects (Fig. 19.5). Because energy is deposited along the tracks of charged particles
the ionizations from low-LET radiation are spread over in a pattern that is characteristic of the type of radiation
many cells, this radiation does not usually cause signifi- involved. After exposure to x- or gamma-rays, the ioniza-
cant damage in any one cell. tion density would be quite low. After exposure to neu-
Alpha and beta particles and protons are types of trons, protons, or alpha particles, the ionization along
high-LET radiation, with alpha particles having the the tracks would occur much more frequently, thereby
highest LET. High-LET radiation has values from 10 to producing a much denser pattern of ionizations. These
200 keV/mm with ranges of a few millimeters in tissue. differences in density of ionizations are a major reason
X- and gamma-rays are types of low-LET radiation, with that neutrons, protons, and alpha particles produce more
values from 0.2 to 3 keV/mm and ranges of many centi- biological effects per unit of absorbed radiation dose
meters in tissue. than do more sparsely ionizing radiations such as x-rays,
gamma-rays, or electrons (Table 19.3).
Cells

High-LET
Types of Cell Damage
radiation Several things can happen when ionization occurs
within a cell. The cell can die and form scar tissue. The
cell can repair itself from the damage. Repaired cells
can continue to function normally after repair. Alterna-
Ionization
tively, the cell can be transformed into an abnormal cell.
Transformed cells may begin the process of becoming
Low-LET
radiation cancer cells.
If a large number of ionizations occur in a cell over a
short period of time, the cell’s repair mechanisms may be
overwhelmed and it may not be able to repair the damage.
Figure 19.5. The ionization along the tracks of a high and Biologic effects of low dose rate exposures are less than
a low LET radiation. those from high dose rate exposures. Long-term exposures
292 Part V: Radiation Protection

over months or years show about half the effect as those Tissue that is anoxic or hypoxic is less sensitive to the
caused by short-term exposures involving the same dose. effects of radiation. This characteristic of biologic tissue
is called the oxygen effect.
Radiosensitivity Factors
In addition to the physical factors, which affect radiosen-
Direct and Indirect Effects
sitivity, there are a number of biologic conditions, which
alter the tissues response to radiation. These factors have An animation for this topic can be viewed
to do with the state of the host such as age, gender, and at http://thepoint.lww.com/FosbinderText
metabolic rate. The age of the individual directly affects
his or her sensitivity to radiation. As seen in Figure 19.6,
humans are most radiosensitive in utero and as they The amount of cell damage depends on both the qual-
approach childhood, their radiosensitivity lowers. The ity of radiation and how the radiation is deposited in the
sensitivity is the lowest in adulthood when humans are cell. If the radiation directly damages the cell nucleus,
the most radioresistant to radiation-induced effects. Dur- the damage is called a direct effect. If the radiation depos-
ing the elder years, humans become somewhat more its its energy outside the nucleus, the damage is called an
radiosensitive but not to the same level as the fetus. These indirect effect.
factors explain the necessity to use proper radiation pro- Direct effects result from ionizing radiation deposit-
tection for patients during imaging procedures where ing its energy within the cell nucleus and breaking the
they will be exposed to ionizing radiation. DNA molecular bonds. The target for direct effects is the
The issue of gender and radiosensitivity has not gar- DNA molecule. High LET radiation primarily produces
nered conclusive evidence to predict with absolute cer- direct effects. High LET ionizations are deposited inside
tainty which gender is more resistant to the effects of the cell nucleus and damage so many DNA molecules
radiation. Although the results are not all in agreement, that the cell is unable to repair all the damage. High LET
the indication is that the female is less sensitive to radia- radiation usually results in cell death.
tion than the male. Indirect effects result from ionizing radiation deposit-
Another factor to consider is the amount of oxygen ing its energy within the cytoplasm outside of the cell
present in tissue. Tissue is more sensitive to radiation when nucleus. Low LET radiation primarily produces indirect
it is irradiated under aerobic or oxygenated conditions. effects. Free radicals have excess energy and when they
migrate to a target molecule, they transfer their energy,
which results in damage to the target molecule.
High

Radiolysis of Water
Sensitivity to radiation

Low LET radiation can damage the cell by producing an

intermediate, toxic product in the cytoplasm that then
interacts with the DNA in the nucleus. The human body
comprises 80% water molecules, and when irradiated,
the water molecules will dissociate into a toxic product.
The most common toxic product is produced by the radi-
Birth olysis of water. In radiolysis of water, the water molecule
Low is broken into two ionized particles: HOH+ and an elec-
In utero Childhood Adult Aged
tron. At this point, various reactions can occur (Fig. 19.7).
Radiation dose (rad)
First, the ion pair may rejoin into a stable water molecule
in which case no damage occurs. Second, the ions do
Figure 19.6. Radiosensitivity varies with the age of the
person. Research shows that the very young and the elderly
not rejoin and the negative ion (the electron) attaches
are the most sensitive to the effects of radiation. to another water molecule and produces yet another ion
 Chapter 19: Radiation Biology 293

H2O Unstable Ion Free

ions pair radicals
O HOH+ H+ OH* OH* + OH* = H2O2
H HOH– H– H*
H Hydrogen
peroxide

Figure 19.7. The formation of a free radical pair by radiolysis of water.

HOH−. The HOH+ and HOH− ions are unstable and can radioresistant because they are avascular, that is, they lack
dissociate into still smaller molecules as follows: an adequate blood supply.

HOH+ → H+ + OH∗ Target Theory

HOH- → OH- + H∗
Each cell in the body has an overabundance of cellular
Finally, radiolysis of water results in the formation of an components. When the cell is irradiated, one or more of
ion pair, H+ and OH−, and two free radicals, H∗ and OH∗. these components may be damaged. If the damaged com-
The ions can recombine, and there would be no biologic ponent cannot continue to support the function of the
damage. Although free radicals are uncharged, they have cell, other similar molecules would be available to take its
an unpaired electron in the valence or outer shell and place. Other molecules are vital to the function of the cell,
are very chemically reactive. Free radicals, which are pro- and in many cells, there may only be one such molecule.
duced primarily in the cytoplasm, have a short life, but Radiation damage to such a molecule could have a severe
they exist long enough to reach the nucleus and damage effect on the cell, and there would be no similar molecules
the DNA molecules by easily breaking the DNA bonds. to take its place. The concept of a key sensitive molecule is
Free radicals produced from the radiolysis of water can the foundation for target theory. Target theory suggests that
also combine to form hydrogen peroxide, H2O2, which for a cell to die after radiation exposure its target molecule
is toxic to cells. Most damage from low LET radiation is must be inactivated or damaged beyond repair.
caused by indirect effects because the low LET ioniza- In target theory, the target is considered to be an area of
tions are separated by distances much larger than a cell. a cell occupied by the target molecule, usually the DNA.
Free radicals are produced more readily when there is The act of irradiating the target molecule is completely
an abundance of oxygen present. The cytoplasm, which random, and its sensitivity to radiation is simply because
consists primarily of H2O, is an abundant reservoir of of its vital function in the cell. The interaction between
oxygen. The effect of oxygen is measured by the oxygen the radiation and target molecule can either be direct or
enhancement ratio (OER), which is the ratio of the radi- indirect as it is impossible to know for sure. Regardless
ation doses necessary to produce the same effect with- of the type of interaction, the target molecule is hit by
out and with oxygen present. OER values for high LET the radiation, which inactivates the target molecule and
radiations are close to 1 because the high LET radiations ultimately leads to cell death.
are so effective in producing damage that the presence or
absence of oxygen does not matter. Low LET radiations
typically have OER values of 2 to 3, meaning that oxygen
enhances the effects of radiation.
Cell Survival Curve
More indirect effects occur if there is more oxygen
present because free radicals are readily produced by ion- The number of cells that survive after being exposed to
izations in the presence of oxygen. Oxygen is a radiosen- radiation depends on the radiation dose. A cell survival
sitizer because cells in the presence of oxygen are more curve is a plot of the fraction of cells surviving as a func-
sensitive to radiation. Cells in tissues with a poor blood tion of radiation dose. It is obtained through a series of
supply are more resistant to radiation damage because experiments in which groups of cells are exposed to dif-
they have a diminished oxygen supply. Many tumors are ferent doses of radiation.
294 Part V: Radiation Protection

Different cell and tissue types have different DO and

Shoulder
1.0 DQ values. Radioresistant cells have large DO values
because they require a large radiation dose to reduce the
number of surviving cells to 37% of the original popula-
Fraction of cell surviving

tion. Radiosensitive cells have small DO values because

they require a smaller radiation dose to reduce the num-
0.1 St ber of surviving cells to this degree.
ra
igh
t-l
DQ
Stochastic Effects
ine
po
D0
rti

Stochastic effects are the frequency of a biological

on

0.01
response to radiation dose. Stochastic effects also occur
randomly in irradiated tissue. Stochastic effects are those
effects that occur by chance; they occur among unexposed
DQ as well as exposed individuals. In the context of radiation
0.001 exposure, stochastic effects mean cancer and genetic
200 400 600 800 1000
effects. The result of exposure to radiation increases the
Radiation dose (rad)
probability of occurrence of the effect, with the increase
in response being proportional to the size of the dose.
Figure 19.8. The fraction of surviving cells plotted against A larger exposure to radiation equates into a larger
the radiation dose.
potential for cell damage or biological response. The
incidence of the biological response in relation to the dis-
The cell survival curve can be divided into two parts: ease process will increase proportionally with the radia-
the S or shoulder region and the L or linear region. tion dose but there is no dose threshold. This means that
The shoulder of the curve in the S region indicates the no amount of radiation exposure is safe and that there is
amount of cell repair or recovery (Fig. 19.8). At very low always a chance for tissue damage to occur.
doses, almost 100% of the cells survive. As the dose is
increased, some of the cells are killed, but most recover
from the radiation damage and survive. The dose at Nonstochastic Effects
which an extrapolation of the straight-line portion of Nonstochastic effects or deterministic effects are the
the survival curve intersects the 100% survival line is biological response that will cause an effect because of
known as DQ the threshold dose. DQ is a measure of a threshold. In other words, a minimum dose of radia-
the width of the shoulder portion and is related to the tion will not cause any biological damage or any amount
amount of cellular repair or sublethal damage. Cells of radiation below the threshold is considered safe. The
with greater repair or recovery capability have a larger increase in biological damage will increase with an
shoulder region and a larger DQ value. High LET radia- increase in radiation dose after the threshold. Nonsto-
tions produce cell survival curves with almost no shoul- chastic effects are characterized by three qualities:
der region and very small DQ values. This is due to the
high LET radiations’ ability to overwhelm the cell’s 1. A certain minimum dose must be exceeded before
repair mechanism. the particular effect is observed.
The linear region occurs at higher doses where the 2. The magnitude of the effect increases with the size
survival curve becomes a straight line when cell survival of the dose.
is plotted on a logarithmic scale. In the L region, cell sur- 3. There is a causal relationship between exposure to
vival is inversely proportional to dose. An increase in dose radiation and an observed effect.
produces a decrease in cell survival. The dose required
to reduce the population of surviving cells to 37% of the The stochastic and nonstochastic effects are plotted on
original value is DO, the mean lethal dose. the linear and nonlinear dose-response models.
 Chapter 19: Radiation Biology 295

Dose-Response Models threshold dose, which is defined as the minimum dose at

which biologic effects become evident.
Radiation dose-response relationships have important
applications in radiology. First, these relationships are
used to design radiation therapy protocols for cancer
Linear Dose-Response Model
patients. Second, studies have been designed to deter- The linear dose-response model demonstrates that any
mine the effects of low-dose radiation. The data gathered dose of radiation will produce an effect. This model also
from these studies are the foundation for radiation con- demonstrates that there is a natural incidence in the
trol programs whose main goal is the reduction of radia- population of cancer, genetic diseases, and leukemia,
tion exposure in diagnostic imaging. which must be accounted for. A linear model predicts
A dose-response curve shows the relationship between a doubling of the biologic effect if the radiation dose is
the radiation dose and the resulting biologic effects. Bio- doubled. A linear model can have either a threshold or
logic data on humans are available only at doses greater a nonthreshold response with a stochastic effect. A linear
than about 1 Gy (100 rad). No biologic effects have been response that begins at zero demonstrates a nonthreshold
observed at doses of a few milligray. These are the dose response. The nonthreshold response demonstrates that
levels usually encountered in diagnostic radiology. any dose, regardless of its size, is expected to produce a
The dose-response models demonstrate the natural response. A linear response that rises at some dose greater
incidence of cancer in humans as well as the body’s than zero is a threshold response, meaning that for any
response to overexposure. There is a certain point on the dose below the threshold, no response will be demon-
dose-response models where there is no distinguishable strated. The type of response that the patient experiences
difference between people who have not been irradiated is stochastic. Figure 19.9 demonstrates a simple linear
and those who have received an overexposure. It should dose-response relationship.
be emphasized that although overexposure to radiation The linear model extrapolates by using a straight line
increases the likelihood of cancer, it is impossible to to connect the data for high doses to the 0 point of radia-
definitely identify any particular cancer with any given tion dose from the graph. The linear model predicts that
exposure. biologic effects are directly proportional to the radiation
Data obtained at higher doses can be extrapolated to dose. The magnitude of the effects gradually increases
lower doses to estimate biologic effects at the lower dose with increasing radiation dose until the two models pre-
levels. These extrapolations are done using dose-response dict the same biologic effects at high doses, where human
models. There are two types of dose-response models: the data are available. The linear nonthreshold (LNT) dose-
linear and nonlinear models. Either model can exhibit a response model is used to estimate radiation effects in the
Observed response

Observed response

Figure 19.9. The linear dose-

response model with and without a
threshold, (A) and (B) respectively.
N N Notice the natural incidence of
Radiation dose Radiation dose radiation effects on the bottom
of the chart and how the linear
A. Linear threshold B. Linear nonthreshold
response begins on this line.
296 Part V: Radiation Protection
Observed response

Observed response
Figure 19.10. The curves obtained
from the nonlinear model with and
without a threshold, (A) and (B)
N N respectively. In practice, almost all
Radiation dose Radiation dose nonlinear curves have a threshold
A. Nonlinear threshold B. Nonlinear nonthreshold below which there are no observable
biologic effects.

diagnostic energy range. Diagnostic x-rays are assumed to This report dealt with the somatic effects and genetic
follow a LNT dose response. effects of exposure to low doses of low-LET radiation. The
findings of the study are directly applicable to diagnostic
Nonlinear Dose-Response Model imaging. At this time, the committee concluded that effects
followed a linear, quadratic dose-response relationship
A nonlinear model predicts a different type of relation (Fig. 19.11). The linear quadratic model predicted small
between the dose and its effect; however, the effect will effects at low doses. Subsequent data that determined this
be stochastic or random in manifestation. A nonlinear type of dose-response relationship overestimated the risk
model can have either a threshold or a nonthreshold associated with diagnostic radiation. In 1990, the BEIR
response. The nonlinear, nonthreshold response curve committee revised its radiation risk estimates, leading to
represents that in a low-dose range, there will be very lit- the use of the linear, nonthreshold model as the most
tle biological response. At high doses, the same amount appropriate model to use for establishing radiation pro-
of dose will produce a much larger response. When the tection guidelines that reflect a safe approach.
nonlinear model has a threshold, the curve is moved to
the right on the graph to represent that a safe dose of radi-
ation can occur at the low range (Fig. 19.10).
Linear-quadratic

Linear, Quadratic Dose-Response

Model
Respose

In 1980, the Committee on Biological Effects of Ionizing Linear

Radiations (BEIR) of the National Academy of Sciences
completed a thorough review of scientific information
from several different studies including:

● The continuing studies of Japanese survivors of

nuclear bombings during World War II Radiation dose
● Radiation accidents
● Patients who were exposed to radiation during Figure 19.11. Linear, quadratic dose-response relation-
medical treatment ship. Applies to low dose low-LET radiation effects.
 Chapter 19: Radiation Biology 297

TABLE 19.4 LD50/30 FOR WHOLE BODY RADIATION Male Gonads

EXPOSURE Data collected from patients who have undergone
Species LD50/30 (rad) radiation therapy treatments for testicular cancer and
volunteer convicts determined that after high doses of
Pig 250 radiation, the testes will begin to atrophy. After irradia-
Dog 275 tion of the testes, the maturing cells (spermatocytes) and
Human 300
spermatids are relatively radioresistant and will continue
Guinea pig 425
Monkey 475 to mature. The spermatogonial stem cells are the most
Opossum 510 sensitive phase in development. There is no significant
Mouse 620 reduction in the number of spermatozoa until several
Hamster 700 weeks after exposure. Radiation doses as low as 100 mGy
Rat 710 (10 rad) can result in the reduction in the number of
Rabbit 725
spermatozoa. The reduction will continue to take place
Gerbil 1,050
Turtle 1,500 over a long period of time. Doses of up to 2 Gy (200 rad)
Armadillo 2,000 will produce temporary infertility, which will begin a full
2 months after irradiation and will last approximately
12 months. If the dose is 5 Gy (500 rad), permanent ste-
rility will occur. When radiation exposure to the testes is
LD50/30 approximately 100 mGy (10 rad), the male should refrain
from procreation for up to 4 months due to the increased
The LD50/30 is used to express the lethal dose of radiation risk of fetal abnormalities.
to humans. LD50/30 is a threshold response and nonlinear,
meaning any amount of radiation will elicit a biological
response. At lower dose of approximately 1 Gy (100 rad), Female Gonads
no exposed individual is expected to die. When the dose When the ovaries are exposed to radiation early in life,
is above approximately 6 Gy (600 rad), all individuals the ovaries will be reduced in size or will atrophy. After
irradiated would be expected to die unless immediate, puberty, irradiation can suppress and delay the menstrual
vigorous medical support is available. Irradiation doses cycle. The oocyte in the mature follicle is the most radi-
above 10 Gy (1,000 rad) will result in death regardless of osensitive cell in female reproduction. The effect that
medical treatment. If death does occur, it will likely hap- radiation has on the ovaries is somewhat dependent on
pen within 30 days of the exposure (Table 19.4). the age of the female when the irradiation occurred. Dur-
Acute radiation lethality is the radiation dose to the ing the fetal stage and early childhood, the ovaries are
whole body that will produce death in 50% of the exposed the most radiosensitive. The radiosensitivity will decline
population within 30 days. The LD50/30 for humans is to the lowest level when the woman is between 20 and
about 3 Gy (300 rad) for individuals without medical 30 years of age. After this, the radiosensitivity will begin
treatment and somewhat higher for individuals with to increase with continued age. Doses as low as 100 mGy
proper medical care. (10 rad) may cause suppression or delay in menstruation
in the mature female. Temporary sterility will occur with
a dose of approximately 2 Gy (200 rad) with permanent
Gonadal Effects sterility occurring at approximately 5 Gy (500 rad). In
The gonads have particular importance as target organs. addition to the destruction of fertility, irradiation of the
They are particularly sensitive to radiation with responses ovaries with moderate doses has shown to cause increase
at doses of 10 rad or less being reported. Data have in genetic mutations. Women are encouraged to abstain
been gathered from radiation therapy patients, radiation from procreation for several months after ovarian doses in
accident victims, and volunteer convicts to complete a excess of 100 mGy (10 rad) to minimize the possibility of
description of the response of gonads to radiation. genetic mutations in the offspring.
298 Part V: Radiation Protection

who are exposed to radiation levels >1 Gy (100 rad)

High-Dose Radiation usually show prodromal symptoms, which include vary-
ing degrees of nausea, vomiting, and diarrhea. The pro-
Effects dromal stage can begin within a few minutes to hours
following exposure and last for a few hours to a few
The early effects of high doses of radiation have been days. The time between the exposure and the onset of
studied in animals in the laboratory, and there is limited prodromal symptoms is an indication of the magnitude
information about human exposure. To date, no human of the exposure. Higher exposure levels result in shorter
has died from exposure to radiation following a diagnos- times to the onset of the prodromal symptoms. The
tic imaging procedure. The early pioneers in radiology severity of the symptoms is dose related, and at doses
were exposed to extremely high total radiation dose, exceeding 10 Gy (1,000 rad), the symptoms can be
which led to early deaths for some individuals. In mod- quite violent. The onset of prodromal symptoms shortly
ern diagnostic radiology departments, the exposures that after exposure indicates a major radiation exposure to
are made are not sufficiently intense enough to cause the whole body.
death.
Historically, there have been accidental exposures Latent Period
of persons to extremely high doses of radiation. In April
The second stage of high-dose effects is the latent period.
1986, an accident with a nuclear reactor at Chernobyl
During the latent period, the exposed individual has no
caused 134 people to be diagnosed with acute radiation
clinical symptoms or illness from the radiation exposure
syndrome; of these, 30 people died within 3 months
and appears to have recovered with no ill effects. How-
of the accident. Individuals exposed to the radioac-
ever, even though there are no visible symptoms, there
tive fallout from Chernobyl will be followed for years
may be ongoing cell damage. The latent period can
to come to gather data on the effects of the radiation
extend from a few hours to several days, depending on
exposure.
the dose. Higher doses result in shorter latent periods.
Acute radiation effects result from high radiation
doses delivered to the whole body in a few hours or
less. This is called acute radiation syndrome and leads Manifest Stage
to death within days or weeks. The clinical signs and During the manifest stage of radiation response, the
symptoms of radiation exposure present themselves in full clinical effects are evident. As seen in Figure 19.12,
four stages:

1. The prodromal stage

2. The latent period
3. The manifest stage
4. The final stage, resulting in recovery or death

The duration of each stage and the severity of each

stage depend on the radiation dose or whole body dose.

Prodromal Stage
The first stage of radiation response following an expo- Figure 19.12. Chernobyl victim suffering from acute
radiation syndrome a few weeks after the accident. Note
sure is the prodromal stage. The prodromal stage shows
the hair loss, indicating a radiation dose of several hundred
the clinical signs and symptoms resulting from radia- rem. Also, note injury to the skin of the lower extremi-
tion exposure to the whole body within hours of the ties as a result of high (a few thousand rem) doses of beta
exposure and can last up to a day or two. Individuals (nonpenetrating) radiation.
 Chapter 19: Radiation Biology 299

this victim of the Chernobyl nuclear power plant TABLE 19.5 DOSE LEVELS AT WHICH BIOLOGIC
accident has experienced hair loss and radiation burns EFFECTS APPEAR
from the exposure to a few thousand rem. The three Dose Level (Gy) Biologic Effect Latent Period
syndromes that become manifest during this stage are
the hematologic syndrome, the gastrointestinal (GI) <1 No observable effect
syndrome, and the central nervous system (CNS) syn- 1 Hematologic 2–4 wk
3 GI 10–14 d
drome. Certain effects are seen in all categories and
>50 CNS A few hours
include:

● Nausea and vomiting

● Malaise and fatigue
will appear. At very high doses, the CNS syndrome
● Increased temperature
becomes evident. Thus, an individual exposed to 10
● Blood changes
Gy (1,000 rad) will display the symptoms of all three
syndromes (Table 19.5).
Final Stage The dose necessary to produce a given syndrome and
related effects is often seen in a given range for each
The survival of an individual depends on many com-
syndrome. It is expected that patients will experience
plex factors, including the amount and distribution of
each phase of the syndrome; however, the sequence of
the radiation, the individual’s general health, individ-
events in each syndrome is not always seen (Fig. 19.13).
ual’s sensitivity to radiation, and the medical treatment
Exposure to very high radiation doses will often result in
obtained. No individual has survived whole body expo-
the latent period disappearing while very low doses may
sures of 10 Gy (1,000 rad) or greater. Human data on
have no prodromal stage and consequently no associated
exposures at these levels are sparse, but it appears that
latent period.
survival from doses of 6 to 7 Gy (600–700 rad) is pos-
sible with vigorous medical treatment that includes
large doses of antibiotics and maintenance of body flu- Hematologic Syndrome
ids and electrolyte balance. The mean survival time is In this syndrome, the effects are mainly on the blood-
the average time of survival and is dose related; higher forming tissues. The hematologic or hemopoietic syn-
doses have shorter mean survival times. Although there drome is characterized by depression or ablation of
are no absolute values, the mean survival time for the the bone marrow and the physiological consequences
hematologic syndrome is 45 days, for GI syndrome is of this damage. The major hematologic effect of radia-
8 days, and that for the CNS syndrome is 2 days. tion exposure is a decrease in leukocytes, erythrocytes,
thrombocytes, and lymphocytes. This means that the
body’s defenses against infection are reduced or elimi-
nated. Individuals exposed to whole body dose levels
Whole Body Radiation above about 1 Gy (100 rad) experience sudden nausea

Exposures and vomiting during the prodromal stage, which occurs

within several hours after the overexposure. The person
may experience loss of hair during the second or third
The whole body dose determines the effects that an week after exposure. Hematologic effects follow a latent
individual will display during each stage. At higher period of a few weeks. During the latent period, there are
dose levels, the effects observed may include more than no apparent symptoms characterized by a general feel-
one syndrome. The three syndromes resulting from ing of well-being, but blood cell damage is still being
high-dose whole body exposures are dose related. The expressed. The body’s defense mechanisms begin to
first syndrome to appear is the hematologic syndrome; recover about 30 days after exposure, and a full recov-
then, if the whole body dose is high, the GI syndrome ery may take as long as 6 months. When these defense
300 Part V: Radiation Protection

Figure 19.13. Whole body radiation

syndromes. At a dose of approximately 300
rad of whole body radiation, a syndrome
characterized by hematologic failure
develops within 2 weeks. In the vicinity of
1,000 rad, a GI syndrome with a latency
of only 3 days is seen. With doses of 2,000
rad or greater, disease of the CNS appears
within 1 hour, and death ensues rapidly.
(Image from Rubin E, M.D., Farber JL,
M.D. Pathology. 3rd Ed. Philadelphia,
PA: Lippincott Williams & Wilkins, 1999.)

mechanisms against infection are fully active, complete and bloody stools. Massive infection occurs as the
recovery can be expected. Individuals exposed to doses intestines break down, allowing a loss of body fluids and
as high as 6 Gy (600 rad) can recover if they are given an invasion of bacteria. This occurs just as the body’s
medical care to prevent infection. defenses are beginning to fail because of the hemato-
The main effects occur in the bone marrow and blood. logic effects. Death usually occurs about 2 weeks after
Marrow depression is seen at 2 Gy (200 rad); at about exposure.
4 to 6 Gy (400–600 rad), almost complete ablation of Death occurs primarily because of the severe dam-
the marrow occurs. Bone marrow can spontaneously age to the cells lining the intestines. These cells are
regrow if the victim survives the physiological effects of normally in a rapid state of proliferation and are con-
the denuding of the marrow. An exposure of 7 Gy (700 tinually being replaced by new cells. The normal process
rad) or higher leads to irreversible ablation of the mar- of cell proliferation is approximately 3 to 5 days. These
row. When the radiation injury is severe, the reduction cells are very sensitive to the effects of radiation and the
in blood cells will continue until the body can no lon- high dose of radiation will kill the most sensitive cells,
ger defend against infection. Death at these exposure the stem cells, and this determines the length of time
levels is due to infection, electrolyte imbalance, and until death. When the intestinal lining is completely
dehydration. denuded of cells, the result is uncontrollable passage of
fluids across the intestinal membrane, severe electrolyte
Gastrointestinal Syndrome imbalance, and dehydration. Bacteria are absorbed into
the blood stream via the small bowel wall. The patient
GI symptoms appear at whole body doses of 6 to 10 Gy will experience a severe septic infection and intensified
(600–1,000 rad). Whole body doses kill most of the stem dehydration. Even with aggressive, immediate medical
cells in the GI tract. The patient will experience all the care, death is likely in 2 weeks due to the failure of the
hematologic effects, but severe nausea, vomiting, and hematologic system.
diarrhea will begin very soon after exposure. The pro-
dromal stage occurs within hours of the exposure and Central Nervous System
may last as long as a day. Following the prodromal stage,
there is a latent period of about 3 to 5 days during which
Syndrome
the patient experiences no symptoms. After the latent At doses >10 Gy (1,000 rad), the radiation damages
period, the individual experiences another bout of nau- the nerve cells, and the body’s regulatory mecha-
sea, vomiting, and diarrhea with the patient becoming nisms begin to fail within minutes of the exposure and
lethargic and possibly prostrating. The diarrhea persists complete failure occurs within a few days. The onset
and increases in severity, leading to loose then watery of severe nausea and vomiting will occur in minutes
 Chapter 19: Radiation Biology 301

with the patient experiencing dehydration, drowsiness,

and brain edema. The patient will become lethargic
due to the edema in the brain and cell damage to
the cerebellum. Convulsions will likely ensue within
hours of the exposure. The latent period may be as
short as a few hours with very high doses. Higher doses
result in shorter latent periods. After the latent period,
the exposed individual loses consciousness and stops
breathing. Exposures at these dose levels always result
in death because the hematologic and GI systems have
also been destroyed.
A B

Effects of Partial Body

Irradiations
Exposure of localized portions of the body to radiation
produces different effects from exposure of the whole
body. Localized exposures show striking, but nonlethal
effects, including erythema, epilation, and cataracts. C D
Radiation exposures to limited portions of the body can
also induce cancer and leukemia. Figure 19.14. Time line of a major radiation injury. Early
Localized exposure to the skin will produce erythema, erythema and blistering at approximately 8 weeks are seen
or skin reddening, at dose levels near 6 Gy (600 rad). The in (A). This has resolved by approximately 20 weeks
(B); however, the tissue is necrotic. The tissue has broken
skin erythema dose for 50% of the population (SED50) is
down by 20 months (C). A skin graft was required
6 Gy (600 rad). The radiation causes local damage to the (D). (Reprinted with permission from Donald S. Baim.
skin stem cells, producing reddening of the skin within a Grossman’s Cardiac Catheterization, Angiography,
few days. The latent period for skin erythema is a few days. and Intervention. 7th Ed. Philadelphia, PA: Lippincott
Significant exposure to the skin can lead to damage at the Williams & Wilkins, 2006.)
cellular level where the cells have begun to necrose. As
seen in Figure 19.14, this localized skin lesion appeared
to heal; however, over the course of many months, the
skin has broken down and required a skin graft to treat
Late Somatic Effects
the lesion.
Epilation, or temporary hair loss, occurs at doses above Somatic cells, which are exposed to radiation often dem-
a threshold of 3 Gy (300 rad) with a latent period of a few onstrate an effect many months or years after the irradia-
weeks. Regrowth of the hair begins in about 2 months tion occurred. Late somatic effects can occur to the cells’
and is complete in about 6 months. response to either whole body or partial body exposure to
Cataracts, or cloudiness or opacity, of the eye are pro- high radiation doses, to individual low doses, or to chronic
duced by a single acute dose of 2 Gy (200 rad) to the lens low doses sustained over several years. The cells respond
of the eye. Exposures occurring over a period of months to the radiation by mutating into cancerous cells, which
or years demonstrate a threshold dose of 10 Gy (1,000 leads to various types of cancer. Carcinogenesis has an
rad). The latent period for cataract development is sev- increased frequency in the exposed population with long
eral years. latent periods of 20 to 30 years for solid tumors to appear.
302 Part V: Radiation Protection

As with other population exposed to radiation, there is 25 years. In an unexposed population of 1 million, there
a stochastic or random effect, so it is difficult to predict will be over 200,000 cancer deaths. The current best esti-
with absolute certainty which person will develop can- mate of the risk of dying from a radiation-induced cancer
cer. Various forms of cancer, which have been identified is 5%/Gy (0.05% per rad). In other words, if 1 million
include the following: individuals were exposed to 10 mGy (1 rad), an extra 500
deaths due to radiation-induced cancers would be pre-
● Breast cancer: Several studies followed women dicted. Deaths due to cancer would rise from 200,000 to
who had multiple exposures to their chests during 200,500 in the exposed population. These estimates are
TB testing and/or fluoroscopy to identify their rates based on the LNT dose-response model.
of breast cancer compared to women who did not
receive the same amount or type of radiation.
● Skin cancer: Early radiation workers were exposed
to large amounts of radiation to their hands. Radiation and
Chronic, severe doses of radiation resulted in skin
lesions. Pregnancy
● Bone cancer: Identified in radium watch dial
painters. The paint was laced with radium, which From early medical applications of radiation, there has
is a bone-seeking element. Patients developed been concern and apprehension in regard to the effect
osteogenic sarcoma as a direct result of ingesting radiation will have on the embryo and developing fetus.
the paint when they moistened the brush with The effects of radiation in utero are dose related and
their lips. time related. The effects include preimplantation death,
● Liver cancer: Thoratrast was used in medical imag- neonatal death, congenital abnormalities, malignancy
ing to image the liver. Patients ingested thorium induction, general impairment of growth, genetic effects,
for radiographic images of the liver. These patients and mental retardation. The embryo is very sensitive to
demonstrated an increase in liver cancer due to the radiation because it is made up of rapidly dividing cells.
thorium releasing alpha particles as the thorium The fetus is most sensitive to radiation during the first
decayed. trimester of pregnancy. The effects on the fetus depend
● Lung cancer: Uranium miners inhaled radioactive on the stage of fetal development at which the radiation
dust, which lead to their increased rates of lung exposure occurs and the fetus will experience an all or
and bronchial epithelium cancer. There was also nothing effect, either the fetus will develop an abnormal
an increased incidence of lung cancer in atomic defect or will be born without any sign of defect.
bomb survivors. High-dose radiation exposure during the preimplan-
● Cataractogenesis: Can occur with advanced age, but tation stage of the first 2 weeks will result in spontane-
there is an increased risk for individuals exposed to ous death or the fetus will be viable with no apparent
radiation. Latent period can be as long as 35 years. effects. It is during this time that the stem cells for major
organs are formed. Damage due to radiation will cause
irreversible congenital abnormalities. During the phase
Cancer and Leukemia Induction of organogenesis from weeks 2 to 8, skeletal and organ
Cancer is the second leading cause of death in the abnormalities can be induced. The fetus may exhibit
United States, exceeded only by cardiovascular disease. congenital or long-term effects. Abnormalities to the
More than one in five individuals will die from cancer. CNS cannot be detected until after birth. Radiation
Ionizing radiation can cause cancer and leukemia; it is exposure throughout the pregnancy can result in malig-
a carcinogen. Leukemia is a cancer of the blood. There nancy, mental retardation, neonatal death, genital defor-
are many other carcinogens, including smoking, diet, mities, and sense organ damage.
and environmental factors. It is difficult to determine There appears to be a threshold of about 0.1 Gy
the exact cause of any particular cancer because cancers (10 rad) for fetal damage. Routine diagnostic procedures
induced by radiation have latent periods of from 10 to never reach this level. There is no reason to recommend
 Chapter 19: Radiation Biology 303

an elective abortion if the dose to the fetus is <0.1 Gy delivered to every member of the population, would
(10 rad). At fetal doses above 0.25 Gy (25 rad), serious produce the same genetic effect as is produced by the
discussion with the parents is advisable. The overlying actual dose to the individual members of the population.
tissue and amniotic fluid provide significant shielding to Medical exposures contribute about 200 mGy (20 mrad)
the fetus. The dose to the fetus is usually about 25% of to the GSD in the United States.
the entrance skin dose. All institutions should have a pol-
icy regarding x-ray examinations of potentially pregnant Doubling Dose
patients to ensure that all patients are treated the same
way. Medically necessary examinations should never be The doubling dose is defined as that radiation dose that
delayed because of pregnancy as an examination that can produces twice the genetic mutation rate in a population
be postponed until the birth of the baby is not a necessary as is seen in the population without the radiation dose.
examination. The doubling dose is estimated to be between 0.5 and
The technologist should give special attention to 1 Gy (50 and 100 rad).
proper positioning and should seek to minimize the num-
ber of exposures. Shielding the abdomen of a pregnant
patient is not advisable. If the pelvis is being examined,
shielding will compromise the examination. If the pelvis
is not in the collimated direct beam, only internal scat-
tered radiation will reach the fetus. External shielding will Chapter Summary
not attenuate the internal scattered radiation. However, Cell division consists of four phases: M, G1, S,
providing a pregnant patient with an abdominal shield and G2. The M phase consists of mitosis or mei-
demonstrates commendable concerns for the safety of osis. Somatic cell division is called mitosis, and
her baby. the division of genetic cells is called meiosis.
Cells are most sensitive to radiation exposure
during the M phase and most radioresistant in
the late S phase. Immature somatic cells are
Genetic Effects called stem cells, and immature genetic cells
are called germ cells. Germ and stem cells are
more radiosensitive than mature cells. The law
There are 110,000 abnormalities per million live births of Bergonie and Tribondeau states that younger,
in a nonirradiated population. Many experiments have immature, and rapidly dividing cells are more
been conducted to evaluate the effect of radiation dam- radiosensitive. Direct effects result from ioniza-
age on future generations. Germ cells are radiosensitive tion and breaking of DNA molecule bonds in
because they are immature genetic cells. The extrapo- the cell nucleus. Indirect effects are produced
lated estimate of genetic damage is that an additional 100 when radiation interacts with the cytoplasm
abnormalities per million live births would be expected to produce free radicals that damage the cell.
if the reproductive organs of the parents were irradiated The effect of oxygen on tissue radiosensitivity
to 10 mGy (1 rad). That is, if the parents of 1 million is measured by the oxygen enhancement ratio.
babies were exposed to 10 mGy, the number of abnor- Well-vascularized tissues are more radiosensi-
malities would rise from 110,000 to 110,100. This is <1% tive than tissues with smaller blood supplies and
increase. less oxygen.
LET describes how energy is deposited along
Genetically Significant Dose the radiation path in tissue. High LET radiation
produces direct biologic effects; low LET radia-
The genetically significant dose (GSD) measures the tion produces biologic effects through indirect
effect on the genetic pool of radiation exposure to the effects. The effects of radiations with different
gonads. The GSD is defined as that dose which, if
304 Part V: Radiation Protection

LET values can be evaluated by comparing

their RBE values. X-rays and gamma radiations Case Study
are forms of low LET radiations. Alpha and beta Laura is a second year radiologic technology
particles are high LET radiations. student. During her course in radiation biology,
A cell survival curve plots the percentage she was assigned to perform research on people
of surviving cells against the radiation dose. A who have received a whole body exposure to
radiation dose-response curve plots the relation- 600 rad or 6 Gy of radiation. In her assignment,
ship between the radiation dose and the bio- she is to answer the following questions.
logic effects produced. Different dose-response
models use linear and nonlinear, threshold and
nonthreshold curves. The effects of diagnostic Critical Thinking Questions
radiation are assumed to follow the LNT dose-
response model. Acute effects from high-dose What does LD50/30 represent?
whole body radiation include the hematologic
effect, which appears at doses of about 1 Gy How does the level of radiation exposure
(100 rad); the GI effect, which appears at about correlate to patient survival? Which symptoms
3 Gy (300 rad); and the CNS effect, which will the patient likely experience?
appears at doses of about 50 Gy (5,000 rad).
Dose levels in diagnostic radiology are not high Which late effect syndromes will be identified
enough to produce acute effects. with this level of exposure?
Local effects and their threshold dose levels
include epilation (3 Gy [300 rad]), erythema
(6 Gy [600 rad]), and cataract formation (10 Gy LD50/30 is a measured used to express the
[1,000 rad]). The increase in cancer due to lethal dose of radiation to humans. If a given
radiation is estimated to be 5%/Gy. Radiation population is exposed to high doses of radiation,
doses to the male and female can affect the we would expect to see 50% of the population
person’s fertility. The oocyte in the female is the die within the first 30 days; this determines
most radiosensitive cell during the reproductive the LD50/30 for this specific radiation exposure.
cycle. After irradiation, the ovary will atrophy, Patients who receive a dose of approximately
which will have an impact on the number of 100 to 300 rad can be expected to survive if
viable ovum remaining. The testes will have a aggressive medical care is immediately avail-
reduction of spermatozoa after irradiation has able. Patients who receive the very low doses of
occurred. Doses of 200 rad can produce tempo- approximately 100 rad are expected to recover.
rary sterility while a dose of 500 rad to the testes Patients whose exposure is approximately 600
will produce permanent sterility. rad are not expected to survive past 30 days
During the gestational period, the fetus is even if vigorous medical treatment is available.
sensitive to the effects of radiation. No ill effects An exposure of 600 rad will produce the rather
on the fetus have been observed at doses <100 swift development of a multitude of symptoms.
mGy (10 rad). Genetic effects are described by With this level of exposure, the patient will
the GSD. The doubling dose is about 0.5 Gy. begin to experience symptoms in a matter
 Chapter 19: Radiation Biology 305

of minutes, and during this prodromal stage, tissues have been damaged. The bone marrow
the patient will experience nausea, vomiting, has been ablated or severely depressed resulting
and diarrhea. After several minutes to hours, the in a decrease in leukocytes, erythrocytes, throm-
patient may experience the next stage where the bocytes, and lymphocytes. At this point, the
symptoms seem to go away and the patient feels body’s defenses against infection are reduced or
better, this is the latent stage. This stage will not eliminated, which means these patients must
last as there is significant damage at the cel- have antibiotic medications to help prevent
lular level, which will manifest itself in a new infection. The other syndrome that will be
round of symptoms during the manifest stage. seen is the GI syndrome. In this syndrome, the
The nausea, vomiting, and diarrhea will begin symptoms will progress especially manifesting
again in addition to malaise, fatigue, increased in very loose, watery, and bloody diarrhea. This
temperature, and blood changes. These symp- occurs because the lining of the small intestine
toms may subside with vigorous medical treat- has been denuded and can no longer absorb
ment; however, the overall health of the patient liquid produced in the body. The intestinal
prior to the exposure will also determine if the wall breaks down allowing bacteria to enter
patient will survive this level of exposure. The the blood stream, which produces massive
late effect syndromes, which will be seen are infection. The patient will likely not survive
the hematologic and GI. The hematologic syn- more than 2 weeks with this level of radiation
drome is identified because the blood-forming exposure.
Review Questions

5. The first stage of radiation response following an

Multiple Choice exposure is the _____ stage.
A. prodromal
B. latent
1. The most radiosensitive tissues and organs are C. acute
D. final
1. muscle
2. nerve 6. Alpha particles have which of the following prop-
3. gonads erties?
4. intestine
1. Emitted from uranium and radium
A. 1 and 3 2. Large particles
B. 1 and 2 3. Deep penetrating power
C. 1 and 4
D. 3 and 4 A. 1 only
B. 1 and 2
2. A direct effect of radiation exposure to the cell C. 2 and 3
involves the D. 1, 2, and 3
A. DNA bond 7. Which of the following will have the highest LET?
B. cell membrane
C. cytoplasm A. Alpha particles
D. organelles B. X-rays
C. Beta particles
3. The fetus is most sensitive to radiation during the D. Fast neutrons
_____ trimester of pregnancy.
8. If the quality factor of ionizing radiation is higher,
A. first the RBE
B. second
C. third A. is also higher
D. fourth B. is lower
C. remains the same
4. The LD50/30 represents a radiation dose that will D. changes with LET
kill
9. Biologic material is MOST sensitive to irradiation
A. 30 people in 50 days under which of the following conditions?
B. 30% of the cells in 50 days
C. 50% of the people in 30 days A. Anoxic
D. 50% of the cells in 30 days B. Hypoxic
C. Oxygenated
D. Deoxygenated
 Chapter 19: Radiation Biology 307

10. What unit of measure expresses the amount of 4. Define acute radiation syndrome. What was the
energy to which tissue has been subjected? outcome of the 30 people who were diagnosed
with acute radiation syndrome after the Chernobyl
A. roentgen (C/kg)
nuclear power plant accident?
B. rad (Gy)
C. rem (Sv)
D. RBE

11. During radiolysis of water, which type of toxic

chemical can be produced when free radicals com-
bine? 5. The clinical signs and symptoms of the manifest
illness stage of acute radiation lethality can be clas-
A. Water
sified into what groups?
B. Sulfahydryls
C. Oxygen
D. Hydrogen Peroxide

12. _____ refers to damage in a DNA nucleotide

sequence as a result of radiation exposure.
6. Which stage of acute radiation syndrome simulates
A. Target theory recovery?
B. Radiolysis
C. Compton interaction
D. Mitosis

7. Define early and late effects of radiation exposure.

Short Answer
1. Who were the French scientists who theorized
about the radiosensitivity of human tissue? Explain
the law that bears their names. 8. What are the stages of cell division in a somatic
cell?

2. How does age of the host affect the radiosensitivity

of the tissue? 9. Give a definition of RBE.

3. What is target theory in radiology? 10. If the initial ionizing event occurs on a molecule,
the effect is said to be _____.
 20

Radiation Protection
and Regulations

Objectives Key Terms

Upon completion of this chapter, the student ● film badge ● primary radiation
will be able to: dosimeters ● scintillation
● Geiger-Muller detectors
1. State the requirements for personnel
counters ● secondary radiation
monitoring.
● HVL ● TLD
2. Describe the construction of protective
● ion chambers ● TVL
barriers and identify factors that determine the
thickness of lead in the barriers. ● OSL

3. Identify devices used to detect and measure

radiation.
4. State the requirements for construction of
radiographic equipment.
5. Describe safety requirements of mobile and
fluoroscopic equipment.

308
 Chapter 20: Radiation Protection and Regulations 309

Introduction Leakage
radiation
100 mR/hr

Designing a radiographic room is the basis for

protecting the patient and radiologic technologist
Collimator
from unnecessary exposure to radiation. Room 2%
design includes protective barriers for the walls
and control booth, x-ray tube design, and fluoro-
scopic equipment design. Many of the principles
SID
also apply to mobile radiographic procedures. 2%
During radiographic procedures, personnel
monitoring devices are required to monitor the
amount and type of radiation a technologist is
exposed to on a daily basis. At the conclusion of
this chapter, the student will have a thorough
knowledge of radiographic room design.

PBL
2%

Equipment Figure 20.1. Current acceptable limits.

Regulations Collimator
Radiographic equipment must have a variable aperture
There are federal and state regulations on radiation-pro- rectangular collimator with a light beam to specify the
ducing equipment. Modern x-ray equipment has vari- size of the x-ray beam. The x-ray beam and light beam
ous radiation protection devices that must comply with must be within 2% of the SID. The collimator shutters
standard regulations for safety. Following is a description must attenuate the same amount of useful beam as the
for the devices which are required for all radiographic protective housing (Fig. 20.1).
equipment.

Positive Beam Limitation

Protective X-ray Tube Housing
Modern x-ray equipment contains positive beam limita-
The x-ray tube is contained within a protective housing. tion (PBL) devices which open the collimator shutters
The leakage radiation from the housing of the x-ray tube to the exact size of the image receptor. The PBL devices
must be <1 mSv/h (100 mR/h) at a distance of 1 m. must be adjusted so that for all standard SIDs the shutters
will open to match the image receptor size (Fig. 20.2).
Source-to-Image Receptor The PBL must be accurate to 2% of the SID.
Distance Indicator
The source-to-image receptor distance (SID) indicator
Beam Alignment
must be provided on each piece of radiographic equip- Improper alignment of the x-ray tube and image receptor will
ment. Typically, it is a simple tape measure which is produce an unacceptable image and lead to a repeat image.
attached to the tube housing. Modern equipment may Each x-ray tube must have a beam indicator alignment to
have laser light or digital displays to indicate the SID. assist the radiographer in lining up the x-ray tube with the
Regardless of the method for measuring the SID, it must image receptor. Lining up the x-ray tube with the image
be accurate to within 2% of the indicated SID. receptor will prevent a repeat image for this type of error.
310 Part V: Radiation Protection

X-ray tube

Collimator

A B
Figure 20.2. (A) Properly collimated field size. (B) Improperly collimated field size. A PBL which
is working properly will minimize the amount of scatter radiation produced because the entire use-
ful beam is intersecting with the patient and image receptor.

Total Filtration intensity must remain constant. The radiation intensity is

expressed in units of mR/mAs with a maximum accept-
All general purpose x-ray tubes must have a total filtration able variation of 10%.
(inherent plus added) of at least 2.5 mm aluminum
when operated above 70 kVp. Tubes operated between
50 and 70 kVp must have at least 1.5 mm aluminum, and
Exposure Switch
tubes operating below 50 kVp must have a minimum of The exposure switch must be located in the protected con-
0.5 mm aluminum total filtration. trol area. The switch must either be fixed to the control
panel or on a short cord. Under no circumstances should
Exposure Reproducibility the radiographer be able to stand in the exam room and
make an exposure. If the need arises for the technologist
Exposure reproducibility is crucial in consistently pro- to be in the room with the patient, they must wear pro-
ducing high-quality images. A radiographic technique is tective apparel and another technologist must make the
selected and an exposure is made, the intensity of the out- exposure.
put radiation will be measured. Several more exposures
will be made with the same exposure techniques and the Mobile Radiography Unit
technologist will measure the average variation of these
exposures. The average variation of radiation intensity During all mobile radiographic exams, the radiographer
must not exceed 5%. must wear protective apparel. The exposure switch must
be attached to a long cord to allow the technologist to
stand at least 180 cm from the x-ray tube during the
mA Station Linearity exposure. Additionally, the radiographer must use care
When using adjacent mA stations with adjusted expo- to make certain the x-ray tube is not directed toward the
sure times to produce constant mAs, the output radiation radiographer or other personnel.
 Chapter 20: Radiation Protection and Regulations 311

Fluoroscopic Equipment design that prevents the x-ray tube from operating when
the carriage is in the parked position.
X-ray Beam Intensity
Fixed fluoroscopy units must have dose rates of <100 mSv/ Total Filtration
min (10 R/min) at the tabletop, unless there is an audible The total filtration of the fluoroscope must be at least
alarm that sounds during the high dose rate mode. The 2.5 mm aluminum equivalent. The total filtration
high dose rate fluoroscopy unit has a maximum tabletop includes the tabletop and any material located between
intensity of 10 R/min. the x-ray tube and table top.

Source-to-Skin Distance Collimation

To avoid excessive entrance exposure to the patient and The fluoroscopic x-ray beam collimators must be adjusted
to reduce the total exposure to both the patient and to show a border around the image when it is viewed on the
radiographer, the source to tabletop distance recommen- monitor. When the radiologist uses the primary beam length
dations must be followed. Fixed fluoroscopic units must and width collimators to confine the field size, the patient’s
have a 38 cm (15 inch) distance between the focal spot dose decreases significantly. Some fluoroscopic units have
and the tabletop. A 30 cm (12 inch) minimum distance is automatic collimating devices so that the border is automati-
required, but a 38 cm (15 inch) minimum distance is pre- cally adjusted with varying heights of the image intensifier.
ferred for all image intensification systems (Fig. 20.3).
Remember that the x-ray tube is located in the bottom Exposure Switch
of the x-ray table and if the fluoroscopic tube was <38 cm The fluoroscopic exposure switch (foot pedal) must be a
below the table the patient would experience a higher dead-man type switch. The purpose of this type of switch
skin entrance dose. Increasing the distance between the is that when a person steps on the switch it activates the
fluoroscopic tube and the patient will result in a lower x-ray beam. If the person were to suddenly drop dead, the
patient dose. C-arm and portable fluoroscopic units must exposure would be terminated.
have 30 cm (12 inch) distance between the focal spot and
the patient entrance surface. Bucky Slot Cover
The table Bucky must be moved to the foot of the table for
Primary Protective Barrier the fluoroscopic exam. A Bucky slot shielding device of at
The image intensifier carriage acts as a primary protective least 0.25 mm lead equivalent should automatically cover
barrier and must have 2 mm lead equivalent. The carriage the Bucky slot. This shielding provides the radiologist and
must be attached to the x-ray tube and include a safety radiographer with protection at the gonadal level.

Exit dose

Entrance dose

Figure 20.3. When the x-ray tube is placed close to the tabletop, the patient will have a higher skin entrance dose.
312 Part V: Radiation Protection

100 mR/hr
50 mR/hr
500 mR/hr 5 mR/hr

3’ 2’ 1’ 3’ 2’ 1’
A B
Figure 20.4. (A) When no protective curtain or Bucky slot cover is used, the fluoroscopist will receive a
significant dose of radiation. (B) With the protective curtain and Bucky slot cover properly used, the radia-
tion dose is significantly decreased.

Protective Curtain the protective barrier depends on the distance from the
The image intensifier carriage has a protective curtain radiation source, the workload, the use of the space on
or panel of at least 0.25 mm lead equivalent that is posi- the other side of the wall, and the amount of time the
tioned between the fluoroscopist and the patient. With- beam is pointed at the wall. Room shielding must protect
out the use of the protective curtain and the Bucky against both primary and secondary radiation.
slot cover, the exposure of radiology personnel exceeds
100 mR/h at 2 ft (Fig. 20.4). Using these devices decreases Primary Barriers
the exposure to 5 mR/h.
In each radiographic imaging room, there are three types
Fluoroscopic Timer of radiation which must be considered when determining
There must be a cumulative timer that sounds an audi- the protective barriers (Fig. 20.5): primary, scatter, and
ble alarm or temporarily interrupts the x-ray beam after leakage. Primary radiation is the direct, collimated, use-
5 minutes of fluoroscopy beam on time. It makes the radi- ful x-ray beam. Typical primary barrier in diagnostic room
ologist aware of the amount of time for which the patient walls is 1/16th inch of lead. The wall on which the vertical
has received radiation exposure. When the fluoroscope Bucky is mounted is always a primary barrier. This barrier
is activated for shorter amounts of time, the patient, radi- needs to extend 7 ft upward from the floor when the x-ray
ologist, and radiographer all receive less exposure. tube is 5 to 7 ft from the wall. The floors and ceilings of
diagnostic x-ray rooms do not require additional shielding
if they are made of concrete because the thickness of con-
crete required supporting the floor also provides adequate
Room Shielding shielding against scattered radiation. The primary beam
is never directed at a secondary barrier.

Room shielding is designed to prevent the transmission

of radiation through the room walls. Almost all diagnostic
Secondary Barriers
and fluoroscopic rooms have shielding in at least some of Secondary radiation is made up of scattered and leakage
the walls. The radiation shielding required is specified in radiation. Secondary barriers protect against secondary
terms of thickness of lead or concrete. The thickness of radiation. Secondary radiation has lower energy than the
 Chapter 20: Radiation Protection and Regulations 313

between the source and barrier the less the exposure rate
to the barrier, thus the barrier can be made of less thickness
Leakage
of lead. If the design of the room allows the x-ray tube to be
positioned by a wall, then this wall will likely require more
Primary shielding because of the hazard of leakage radiation.
Useful beam
Secondary
Useful beam Occupancy Factor
Leakage
Scatter The rooms in a hospital are considered to be either an
uncontrolled area or controlled area. Uncontrolled areas
are those areas where the general public can be found.
This includes waiting rooms, stairways, hallways, the out-
Scatter side of the hospital, and restrooms with general hospital
access. Uncontrolled areas also include individuals who
work in a hospital yet outside of the imaging department.
The term controlled area includes areas occupied by per-
sonnel who have been trained in radiation safety proce-
dures and who wear radiation-monitoring devices. The
Figure 20.5. The three types of radiation which are controlled area required the barrier reduce the exposure
considered when designing protective barriers for imaging rate in the area to <100 mR/wk. The uncontrolled area
rooms. has a maximum allowed rate of 2 mR/wk.

primary beam, and so less shielding thickness is required. Workload

The required thickness of lead is 1/32nd inch. The control The amount of shielding required for an x-ray room
booth also has a window for viewing the patient during the depends on the amount of procedures performed in the
exposure. This window can either be made of glass or clear room. The higher the number of procedures performed
plastic that is impregnated with 30% lead by weight. To each week the thicker the shielding must be. The work-
ensure maximum protection during exposures, it is crucial load is a combination of the number of patients and the
for personnel to remain completely behind the barrier. technical exposure factors used. The workload is mea-
The wall of the control booth and its window are always sured in milliampere-minutes per week. If the number
a secondary barrier because the beam is never directed at of procedures performed in a room is increased, the
the control booth. Secondary radiation includes scatter workload values per week will also be higher. Such a
from the patient and leakage radiation escaping through room requires thicker shielding to maintain within levels
the tube housing in all directions. Regulations require that of cumulative absorbed dose equivalent to those occupy-
leakage radiation be <100 mR/h at 1 m. Leakage radiation ing areas adjacent to the room for any long period of time.
is not a problem with modern x-ray tubes because they are Workloads are typically meant to be an overestimation of
manufactured with adequate shielding in their housing. the amount of procedures performed in a given room so
that shielding will be more than adequate to ensure the
Protective Barrier Thickness protection of personnel and the public.

Considerations Use Factor

Several factors must be considered when determining the The use factor indicates the amount of time during which
thickness requirements for protective barriers. These factors the x-ray beam will be energized and directed toward a
include distance, occupancy, workload, and use factor. particular barrier. The NCRP recommends that primary
wall barriers be assigned a use factor of ¼ and the floor a
Distance use factor of 1. Secondary and leakage radiation are pres-
The thickness of the barrier depends on the distance from ent 100% of the time the x-ray tube is energized; thus,
the x-ray source to the barrier. The greater the distance secondary barriers are given a use factor of 1. The ceiling
314 Part V: Radiation Protection

is most often considered to be a secondary barrier for

radiographic procedures.

Half-Value Layer
The half-value layer (HVL) is that amount of shielding
required to reduce the radiation intensity to half the origi-
nal value. The tenth-value layer (TVL) is the amount of
shielding required to reduce the radiation to one tenth
its original value. The TVL is used in determining the
amount of shielding required for primary and secondary
barriers.

Figure 20.6. Portable Geiger-Muller counters and ion

chambers used for radiation surveys.
Radiation Detectors
There are various dose-measuring devices which are
used to measure or detect radiation exposure from x-rays.
Scintillation Detectors
Dose-measuring devices are also known as dosimeters. Scintillation detectors use crystals that give off light
These devices are classified as field survey instruments or when struck by radiation. The amount of light depends
personnel monitoring devices. on the radiation energy deposited in the crystal. Higher
radiation energy deposited results in greater light emis-
sion. The light emitted by the crystal is detected by a pho-
Gas-Filled Detectors tomultiplier tube, which converts the light output into an
Ion chambers and Geiger-Muller counters are gas-filled electrical output signal, which is then measured. Scintil-
detectors that collect the ions produced by ionizing radia- lators are used as detectors in CT scanners and nuclear
tion. The ions are collected, measured, and amplified to medicine gamma cameras.
produce the output signal. Geiger-Muller counters are
most efficient in detecting charged particles like beta
particles but are inefficient in detecting x- and gamma-
Personnel Monitors
radiation. Geiger-Muller counters are sensitive to low People who work in imaging departments and who are
levels of radiation. They are used in survey instruments routinely exposed to ionizing radiation should be sup-
to detect radioactive contamination in a nuclear medi- plied with personnel monitoring devices which will
cine department, as detectors in CT scanners, and as estimate the amount of exposure they received. The
calibration instruments for the calibration of x-ray tubes personnel monitoring device measures the quantity of
and nuclear medicine dose calibrators. exposure it has received during the technologists’ occu-
The ion chambers are primarily used to measure the pational duties (Fig. 20.7). The radiographer is typically
primary and secondary radiation beam for the purposes of given one personnel monitoring device to wear and
evaluating equipment performance, assessment of scatter it should be worn on the anterior surface of the body
and leakage radiation, and to measure patient dose. The between the chest and waist level. Some of these devices
ionization chamber has a certain volume of air and an are meant to be worn at the level of the throat. Regardless
electrode. This chamber works on the principle that when of the location, the personnel monitoring devices must
radiation interacts with the electrons in the air, positive be worn each day while the radiographer is producing
ions are produced. These positive ions then produce an x-radiation and the device should be worn at the same
electrical charge that can then be measured (Fig. 20.6). location every day.
 Chapter 20: Radiation Protection and Regulations 315

Figure 20.7. A variety of

personnel monitors.

There are several types of personnel monitors: film Thermoluminescent Dosimeters

badge dosimeters, thermoluminescent dosimeter (TLD), A TLD uses a lithium fluoride crystal as the radiation
pocket dosimeter, and optically stimulated luminescent detector. When it is exposed to x-rays, the lithium fluoride
(OSL) dosimeters. crystal traps the radiation energy. This trapped energy can
be released as light by heating the crystals to over 100°C.
Film Badge Dosimeters The light is detected by a photomultiplier tube and con-
Film badge dosimeters contain a small piece of film verted into an electrical output signal. These dosimeters
that will have a specific optical density after exposure are called TLDs because they give off light after heat-
to radiation and development. The silver halide in the ing. The amount of light is proportional to the radiation
film emulsion makes the film response very sensitive to dose absorbed in the crystal (Fig. 20.8). Lithium fluoride
x-ray energy. Radiation energies near the K-edge of silver has almost exactly the same energy response to radia-
are preferentially absorbed and produce correspondingly tion as human tissue. TLDs are very small and typically
higher optical densities. The higher the exposure, the used in ring badges to monitor radiation exposure to the
greater the optical density. Personnel monitors using film extremities.
as a detector have copper, cadmium, and aluminum fil-
ters to estimate the energy of the incident radiation.
An energy correction, obtained from the optical PM
X-ray photons Light tube
densities under the filters, is applied to calculate the radia-
tion dose from the unfiltered optical density. Film badges Phosphor
measure exposures ranging from approximately 0.1 mSv
(10 mrem) to 20 Sv (2,000 rem) and are used to measure
total body exposure. Readings lower than 0.1 mSv are
generally not detectable and may be reported as minimal
Metal planchet
on a film badge dosimetry report.
Film is sensitive to heat, light, and moisture as well B Heat C
A
as radiation. Personnel monitor dosimeters that use film Figure 20.8. The process of reporting the exposure
must be kept dry and cool. Storing them in a hot car absorbed by a TLD. (A) Crystal is exposed to ionizing radia-
during the summer or passing them through a washing tion. (B) Crystal is heated and emits visible light.
machine will render them useless. (C) Photomultiplier tube measures intensity of light.
316 Part V: Radiation Protection

Pocket Dosimeters is over, the film badge dosimeter or TLD monitor is

Pocket dosimeters are the most sensitive personnel returned to the supplier for reading. The film is devel-
monitoring devices. The pocket dosimeter looks like an oped, and the optical density is converted to a radiation
ordinary writing pen but contains a thimble ionization dose in tissue. The lithium fluoride crystal from the TLD
chamber. There are two types of pocket dosimeters: the monitor is heated to over 100°C, and the amount of light
self-reading device which contains a built-in electro- released is converted to a radiation dose in tissue. Both
meter and the non–self-reading type which requires a types of personnel monitors can detect radiation levels
special accessory electrometer to read the device. Both below about 20 mrad. The personnel monitor must be
types detect the presence and sign of an electric charge. worn on the collar outside the protective apparel. The
There are multiple ranges available but the one usually clip on the monitor should be closest to the body, with
used in radiography has a range of 0 to 200 mR. the face of the monitor directed outward away from the
The use of the pocket dosimeter can be time con- body. Pregnant technologists must be issued a second
suming because before it is used, it must be charged badge to be worn at the abdominal level under the apron
to a preset voltage which sets the scale reading to 0. to estimate the dose to the fetus. Radiation received as
When exposed to radiation, the charge in the chamber a patient is not included in the occupational exposure.
becomes neutralized. The chamber is analyzed at the An individual’s personnel monitoring badge must not be
end of each workday to determine the remaining charge worn during an x-ray examination as a patient.
in the chamber, and this indicates the amount of radia- The supplier generates a report which is sent to the
tion exposure. facility. The report includes participant identification
Pocket ionization chambers are not routinely used in information, the type of dosimeter used, and the radia-
diagnostic imaging because each day the pocket dosi- tion exposures that were received. The radiation expo-
meters must by charged, read, and the facility must keep sure is given as the dose equivalent in millirem for the
records of the exposure. This can all be quite time con- wear period, a quarterly accumulated dose equivalent, a
suming. In addition, they do not have the type of range year to date dose equivalent, and a lifetime dose equiv-
necessary for measuring exposure to radiation. If an expo- alent for each participant. The report also provides
sure was above the range of the pocket dosimeter, the exposure rates for deep dose, lens of the eye, and shal-
precise level of exposure would not be known. low dose equivalents. The report should be reviewed
by each participant for each wear date period.
Optically stimulated luminescence
When using OSL, the detector material is aluminum
oxide in a crystal form. Some of the electrons are
stimulated by the amount of radiation exposure. The
OSL is processed using green light either by laser or
Chapter Summary
light-emitting diode which causes the electrons to return Radiographic rooms and equipment must
to their normal state. This will result in a blue light emit- comply with federal and state requirements
ted from the Al2O3 electrons. The intensity of the visible for safety in radiation departments. Stationary
light emission is proportional to the amount of radiation radiographic equipment has a separate set of
exposure. The OSL reports doses as low as 1 mrad which regulations than mobile radiographic equip-
makes them more sensitive than TLDs. The OSL can ment. Primary radiation is the direct x-ray
also have further analysis for confirmation of dose. beam. Primary barriers protect against primary
radiation; secondary barriers protect against
secondary radiation, which includes scatter and
Monitoring Period leakage radiation. Leakage radiation must be
<100 mR/h at a distance of 1 m from the tube
The monitoring period for personnel dosimeters is usu- housing. Scatter radiation is lower in intensity
ally 1 month; however, the wear date periods can range and energy than the primary beam. The HVL is
from weekly to quarterly. After the monitoring period
 Chapter 20: Radiation Protection and Regulations 317

the amount of shielding required to reduce the How will John test exposure reproducibility?
intensity to one-half its original value. The TVL
is the amount of shielding required to reduce What is mA station linearity?
the intensity to one tenth its original value. The
primary barriers are those walls which have an For these questions include the established
upright Bucky or where the x-ray tube is stored. guidelines.
The primary barrier will protect people on the
opposite side of the wall from leakage radiation
and radiation due to exposures. John must check multiple aspects of each
Personnel who work in radiation depart- x-ray tube. The tubes need to be checked for
ments are required to wear radiation-monitoring leakage radiation. The amount of leakage
devices. The personnel monitor should be worn radiation must be <100 mR/h at 1 m from
on the outside of the protective apparel near the the tube. Next, he needs to check the SID to
collar. Gas-filled detectors are used to calibrate make sure the distance from the source to the
x-ray units. TLDs are used in personnel moni- tabletop is accurate. It must be accurate within
tors and must be heated to obtain a reading. 2% from indicated distance. The collimator
Film badge dosimeters use a piece of film and must be checked to make sure the size of the
specialized filters to absorb incident radiation. light field matches the size of the x-ray beam,
The OSL uses an aluminum oxide crystal to this measurement must be within 2%. Next
absorb radiation, and when exposed to a green he will need to check the PBL and make any
laser, the crystal will emit light with an intensity required adjustments. The PBL devices must
proportional to the radiation exposure. be adjusted so that for all standard SIDs, the
shutters will open to match the image recep-
tor size. The PBL must be accurate to 2% of
the SID.
Case Study The alignment of the x-ray tube to the table
John is a biomedical technician who is respon- Bucky and upright Bucky must be checked and
sible for performing annual maintenance on the adjustments made if the alignment is not per-
x-ray equipment in his facility. He is responsible fect. When the tube and Bucky are not aligned
for checking the x-ray tube and making sure it is properly, the image receptor will not receive or
operating within federal guidelines. John must be exposed to the whole x-ray beam but only a
also test the mA stations and radiation output of portion; this causes repeat imaging because of
the equipment. the missed anatomy. To test for reproducibil-
ity, John will need to make multiple exposures
using the same mA, time, and kVp factors. The
Critical Thinking Questions output radiation intensity for each exposure will
be measured with the read outs not varying by
Which aspects related to the x-ray tube must he more than 5% of each other. John will also need
check? to check the mA station linearity. To do this, he
must select multiple mA stations in sequence
Will he need to check alignment of the tube, and use a set exposure time for each station
table Bucky, and upright Bucky? so that the same mAs is produced each time.
The output radiation will be measured for each
If so, what is the purpose of testing alignment? exposure and must not vary more than 10%.
Review Questions

b. reduces
5. Which thefollowing
of the exposed silver halide crystals
is a primary barrier?to black
Multiple Choice metallic silver
1. Wall with vertical Bucky cassette holder
c. is basicproduces an alkaline pH
2. Wall of the control booth
d. is/does all of the above
In the characteristic curve shown below, identify the 3. Floor
1. Federal
regions (usedgovernment
for questions specifi
1-4) cations recommend a 7. Replenishment systems in automatic processor
A. 1
minimum total aluminum equivalent filtration of replenish
B. 1 and 3
1. _____ for plus
The base fluoroscopic
fog regionunits.
of the curve is
C. 2 and 3
a. unexposed film emulsion
A. 11.0 mm
a. D. 1, 2, 3, and 4
b. developer and fixer solutions
B. 21.5 mm
b. c. used wash water
C. 32.0 mm
c. 6. Fixed fluoroscopic systems require a source-to-
d. drying racks
D. 42.5 mm
d. tabletop distance of at least _____ but prefer a
distance of not less than _____.
8. Which of the following is a reducing agent?
personnelregion
2. The shoulder monitor should
of the beisworn
curve
A. 15 cm, 30 cm
a. Glutaraldehyde
A. 1under the protective apparel near the waist
a. B. 30 cm, 38 cm
b. Hydroquinone
B. 2outside the protective apparel near the collar
b. C. 38 cm, 45 cm
c. Acetic acid
C. 3under the protective apparel near the collar
c. D. 23 cm, 30 cm
d. Alum
D. 4outside the protective apparel near the waist
d.
7. When the radiologist limits fluoroscopic field size
9. The hardening agent in the fixer is
Primary
3. The barriersofprotect
toe region against
the curve is _____ radiation. to include only the area of clinical interest
a. Glutaraldehyde
A. 1direct
a. A. exposure factors must be increased significantly
b. Sodium sulfite
B. 2leakage and scatter
b. to provide adequate compensation
c. Potassium alum
c. 3 B. patient dose increases somewhat
d. Ammonium thiosulfate
4. Secondary
d. 4 radiation is made up of _____ radia- C. patient dose decreases significantly
tion. D. patient
10. The doseofremains
purpose the same
the guide shoes in the transport
4. The straight-line region of the curve is racks is to
A. leakage and scattered
8. Both alignment and length and width dimensions
B. 1primary, leakage, and scattered
a. a. the
allowradiographic
the film to move
of and up or down
light beams must corre-
C. 2scattered and secondary
b. b. to force the edge of the film around the master
spond to within
D. 3leakage and primary
c. roller
d. 4 A. 1% of SID
c. to bend the film in the crossover network
B. 10% of SID
d. pull the film from the film tray into the transport
5. A high-contrast film has a _____ latitude C. 5% of SID
rack
D. 2% of SID
a. wide
b. narrow

6. The developer solution

a. softens the emulsion
 Chapter 20: Radiation Protection and Regulations 319

9. HVL may be defined as the thickness of a designated 4. Describe how reproducibility and linearity are
absorber required to different when measuring the intensity of the x-ray
beam.
A. decrease the intensity of the primary beam by
50% of its initial value
B. decrease the intensity of the primary beam by
25% of its initial value
C. increase the intensity of the primary beam by
50% of its initial value
D. increase the intensity of the primary beam by 5. How long must the exposure cord be for a mobile
25% of its initial value radiographic unit?

10. A cumulative timing device times the x-ray expo-

sure and sounds an audible alarm after the fluoro-
scope has been activated for
A. 1 minute
B. 3 minutes 6. How are film badge dosimeters to be worn and
C. 5 minutes where are they placed on the body?
D. 7 minutes

Short Answer
7. What exposure data are included in the personnel
1. What are the four factors that are taken into con- monitoring report?
sideration when determining a barrier for a radio-
graphic room?

8. Why is the use factor for secondary barriers

always 1?
2. Define controlled and uncontrolled areas in a
hospital.

9. What are the three types of radiation exposure

that are of concern when determining protective
3. _____ is the limit of leakage radiation from the barriers?
x-ray tube during an exposure.

10. During both fluoroscopy and radiography, the _____

is the single most important scattering object.
 21

Minimizing Patient Exposure

and Personnel Exposure

Objectives Key Terms

Upon completion of this chapter, the student ● ALARA ● protective apparel
will be able to: ● effective dose ● skin entrance
1. Describe the methods of reducing radiation ● occupationally exposure
exposure. exposed workers ● 10-day rule
2. Describe ALARA.
3. State the three methods of radiation reduction
to staff.
4. Name the dose limits for occupational and
nonoccupational workers.
5. Discuss the radiosensitivity of pregnancy.

320
 Chapter 21: Minimizing Patient Exposure and Personnel Exposure 321

or localized dose for a particular x-ray examination.

Introduction Effective dose is introduced to account for the irradiation
of different parts of the body. The hazardous effects of
Reducing patient and personnel exposure whole-body radiation have been extensively studied. Irra-
should follow the ALARA principle to keep the diating a portion of the body does not produce the same
exposure to the patient and personnel to As Low ill effects as a whole-body exposure to the same dose.
As Reasonably Achievable. There are many A whole-body exposure of 7 Gy (700 rad) is a lethal dose,
ways this exposure level can be reduced. In but if the radiation dose is delivered to a localized portion
this chapter the exposure to radiographers and of the body, the effects are less severe. Radiation therapy
patients will be discussed. Protective apparel patients routinely receive 70 Gy (7,000 rad) to portions of
is an integral aspect of keeping radiation dose their body during cancer treatment and survive for many
as low as possible as well as using appropriate years.
technical factors. At the conclusion the stu- Effective dose is expressed in units of millisieverts
dent will have learned about dose limits for the (mSv) and is the basis for our dose limits. As seen in
occupationally and nonoccupationally exposed Table 21.1, the radiation weighting factor is dependent
individual. upon the type of LET associated with the different types
of radiation. Radiation which deposits more radiation
in the tissue (high LET) has a higher weighting factor
than radiation which deposits a low amount of radiation.
Reducing Exposure Also of importance is the sensitivity of different tissues
in the body. Table 21.2 has the tissue weighting factor
to Ionizing Radiation which accounts for the relative radiosensitivity of vari-
ous tissues and organs. The effective dose is obtained by
As discussed in previous chapter material, exposure multiplying the dose to a particular organ by a weighing
to ionizing radiation carries a risk of biological effects. factor.
Due to these effects, it is necessary to reduce or limit The effective dose from a posteroanterior (PA) chest
the amount of radiation exposure to radiation workers examination is about 0.1 mSv (10 millirem [mrem])
and the public. For radiation protection purposes indi- although the entrance dose is about 0.70 mSv (70 mrem).
viduals will be divided into two main groups. The first The difference between the entrance dose and the effec-
group comprises the individuals who work with radiation tive dose occurs because many of the organs used to cal-
and because of their duties they are routinely exposed culate the effective dose are not exposed to the primary
to radiation. These individuals are called radiation work- beam during the examination.
ers or occupationally exposed workers. Radiation work-
ers receive special instruction and training regarding the
hazards to radiation exposure and proper radiation pro- TABLE 21.1 RADIATION WEIGHTING FACTOR
tection practices. The second group includes members FOR TYPES OF RADIATION
of the general public. Radiation Weighting
The technologist has several means of reducing radia- Type and Energy Range Factor (Wr)
tion exposure to himself or herself, the patient, and radi-
ologist. This reduction is accomplished by using basic X- and gamma-rays, electrons 1
Neutrons, energy
principles in radiation safety while being in the radio-
<10 keV 1
graphic room during an exposure. 10–100 keV 10
>100 keV–2 MeV 20
Effective Dose >29 MeV
Protons
10
2
The effective dose of an examination is that dose to the Alpha particles 20
whole body that would cause the same harm as a partial
322 Part V: Radiation Protection

TABLE 21.2 WEIGHTING FACTORS USED require issuing a personnel dose monitor to any staff
IN CALCULATING EFFECTIVE DOSE member who might be exposed to more than 10% of the
Tissue/Organ Tissue Weighting Factor (Wt) limits listed in Table 21.3. Most radiology departments
change the personnel monitors monthly, but the moni-
Gonads 0.20 toring interval can be as long as 3 months. The personnel
Active bone marrow 0.12 monitoring reports should be available for review by all
Colon 0.12
monitored individuals.
Lungs 0.12
Stomach 0.12 For members of the general public the recommended
Bladder 0.05 dose limits are established as one tenth of the effective
Esophagus 0.05 dose limit for the occupationally exposed worker. Indi-
Liver 0.05 viduals who have infrequent exposure to radiation have a
Thyroid 0.05 dose limit of 5 mSv (0.5 rem) and for frequent exposure
Bone surfaces 0.01
the limit is 1 mSv (0.1 rem). These limits do not include
Skin 0.01
Remainder 0.05 any exposure received from medical procedures. Individ-
uals who work in education and training have the same
dose limits as the general public who receive frequent
Dose Limit Regulations exposure, 1 mSv (0.1 rem).

Federal and state regulations have been established to

limit occupational exposures. An occupational exposure ALARA
is radiation exposure received during normal work duties. All radiation protection programs must operate under
There are limits on the whole body dose, the dose to the the principle of keeping the radiation exposure to staff,
lens of the eye, and the dose to any other organ of the patients, and public As Low As Reasonably Achievable
body. The employer must ensure that no worker’s annual (ALARA). This means that it is the responsibility of the
dose exceeds these limits. radiographer that steps must be taken to reduce radiation
The limit on the whole body dose for a radiation worker is exposure well below maximum regulatory limits. Techni-
50 mSv (5 rem or 5,000 mrem) per year. The dose limit per cal factors such as kVp, mA, length of exposure, distance,
quarter is 12.5 mSv (1.25 rem or 1,250 mrem). There is also shielding, filtration, collimation, SID, beam area, and
a limit on the total dose that can be accumulated in a life- type of image receptor all influence the radiation levels
time, which is called the cumulative limit. The cumulative to the staff and public.
effective dose limit (E) is the age in years (N) times 10 mSv.

CRITICAL THINKING
Reduction of Radiation
Exposure to Staff
What is the cumulative limit for a 32-year-old
technologist?
Basic Principles
Answer
When performing radiographic procedures the radiogra-
E = N × 10 mSv pher must apply the three methods or cardinal rules for
E = 32 × 10 mSv radiation protection. The three methods of reducing the
E = 320 mSv (32 rem) radiation exposure of the staff are to:

Although most x-ray technologists never receive even 1. Reduce time spent in the vicinity of radiation
a small fraction of the annual dose limit, they are still 2. Increase distance from the radiation source
issued personnel radiation monitors. The regulations 3. Wear appropriate shielding to attenuate radiation
 Chapter 21: Minimizing Patient Exposure and Personnel Exposure 323

TABLE 21.3 EFFECTIVE DOSE LIMIT RECOMMENDATIONS

Dose Limit Values

Occupational Exposures
Effective dose limits
a. Annual 50 mSv (5 rem)
b. Cumulative 10 mSv × age (1 rem × age)
Equivalent annual dose limits for tissues and organs
a. Lens of eye 150 mSv (15 rem)
b. Skin, hands, and feet 500 mSv (50 rem)
Public Exposure (Annual)
Effective dose limit
a. continuous or frequent exposure 1 mSv (0.1 rem)
b. infrequent exposure 5 mSv (0.5 rem)
Equivalent dose limits for tissues and organs
a. Lens of eye 15 mSv (1.5 rem)
b. Skin, hands, and feet 50 mSv (5 rem)
Embryo/Fetus Exposures
a. Total equivalent dose limit 5 mSv (0.5 rem)
b. Monthly equivalent dose limit 0.05 mSv (0.05 rem)
Education and Training Exposures (Annual)
Effective dose limit 1 mSv (0.1 rem)
Equivalent dose limits for tissues and organs
a. Lens of eye 15 mSv (1.5 rem)
b. Skin, hands, and feet 50 mSv (5 rem)

The radiation exposure of the technologist and radiologist to as long as an hour or more. The dose to an individual
can be decreased by reducing the time the individual is is directly related to the length of time the beam is on. If
exposed to radiation, increasing the individual’s distance the length of the exposure to radiation is doubled then
from the radiation source, and increasing the amount of the exposure to the person will also be doubled.
shielding between the radiation source and the individual. Patient exposure during fluoroscopy is determined
The major source of radiation to the radiologist and tech- by the length of time the patient is in the x-ray beam.
nologist is scatter from the patient. The diagnostic x-ray Shorter fluoroscopic exposure times result in lower doses
beam should always be collimated to the smallest field size to patients and staff. Regulations require that fluoroscopic
applicable for each examination. Smaller field sizes pro- units be equipped with a timer to indicate the total fluoro-
duce less scatter because less tissue is irradiated. The tech- scopic beam on time. This timer must provide an audible
nologist should never be in the direct beam or in the room reminder to indicate when 5 minutes of beam on time has
during a diagnostic radiographic exposure. The technolo- elapsed. Most fluoroscopic procedures require <5 min-
gist should never hold a patient during the exposure. utes, although the timer can be reset when necessary.
During fluoroscopy the patient’s dose and therefore
Time the dose to the radiographer can be reduced if pulsed
Routine radiographic procedures utilize extremely short fluoroscopy is used. This prevents the beam from being
exposure time to minimize motion artifact and during on continuously while still providing the physician with
these procedures the technologist should not be in the the image necessary for the exam. If the fluoroscopy unit
room with the patient. During fluoroscopy procedures, does not have pulsing capability, the radiologist should
whether in the x-ray room or surgery, the radiographer is alternate between beam on and beam off during the
often required to be operating equipment while the beam course of the procedure. This will decrease the dose to
is turned on. The length of time can be several minutes the patient and all persons in the room.
324 Part V: Radiation Protection

Distance in a manner which would prevent the x-ray tube from

During fluoroscopy, when the technologist must be emitting primary radiation toward the portable unit or
in the room while the beam is on, the patient is the technologist.
source of scattered radiation. The intensity of scattered
radiation is less than that of the primary beam by a Shielding
factor of 1,000. That is, the intensity of the scattered Shielding is used when the technologist must be in the
radiation 1 meter (m) from the patient is 1/1,000 of the room when the x-ray beam is turned on. Placing pro-
primary beam intensity. During the procedure the tech- tective shielding between the radiation source and the
nologist should stand as far away from the patient and technologist will greatly reduce the level of exposure.
fluoroscope as possible while still being able to render Shielding in the radiography department typically con-
assistance to the patient when needed. Increasing the sists of lead apparel, mobile shields, and building mate-
distance from the patient decreases the scattered radia- rials which are all designed to provide the maximum
tion reaching the staff. According to the inverse square protection possible to shield the technologist from radia-
law, doubling the distance from the source reduces tion. The lead apparel and mobile shields must be used
the radiation intensity to one fourth its original value any time it is not possible to take advantage of the fixed
(Fig. 21.1). Moving one step away from the edge of the structural barriers.
fluoroscopic table reduces the radiation exposure sig-
nificantly. If the patient does not require assistance dur-
ing the procedure the technologist must stand in the
Protective Apparel
control area and as far away from the scattered radiation Radiographers are trained to wear protective apparel for
as possible. The technologist should be wearing appro- examinations where they will be exposed to ionizing radi-
priate protective apparel so that if he or she needs to ation. Protective aprons have equivalent lead thicknesses
assist the patient there will not be a delay in providing of 0.25, 0.5, or 1 millimeter (mm) lead. The protection is
that assistance. equivalent to that of pure lead of the thickness indicated.
The patient is also the source of scatter during por- Drapes hanging from the image intensifier, protective
table examinations. Increasing the distance from the aprons, gloves, Bucky slot covers, and fold-up shields are
patient during portable examinations decreases scattered designed to intercept the scattered radiation and reduce
radiation to the technologist. Portable units are equipped the radiation exposure of the staff. The Bucky tray should
with an exposure switch on the end of a 180-centimeter be moved to the foot of the table when possible to ensure
(cm) (6-foot [ft]) cord to allow the technologist to move that the Bucky slot cover is in place. Lead glasses and
away from the patient before making the exposure. The thyroid shields can also be used to protect specific areas
technologist must use caution to place the portable unit of the body.

100 mR/h

10 mR/h

Figure 21.1. Typical exposure levels at various distances from a fluoroscopic table.
 Chapter 21: Minimizing Patient Exposure and Personnel Exposure 325

TABLE 21.4 PROTECTIVE APPAREL THICKNESS vinyl surface to aid in cleaning. The interior vinyl-lead
IN MILLIMETERS LEAD EQUIVALENT AND composition is flexible but will crack if it is bent too far
ATTENUATION VALUES
or bent repeatedly in the same location. Lead aprons
Apparel Thickness (mm) Attenuation (%) must never be tossed in a heap or folded over for stor-
age. They must be stored properly on reinforced hanging
Apron 0.50 99.9 racks or laid flat on a table (Fig. 21.2). Because they are
Gloves 0.25 99
Thyroid 0.50 99
so susceptible to cracking when stored improperly, lead
Glasses 0.35 99 aprons and other protective apparel should be inspected
Fluoroscopic drape 0.25 99 annually, both visually and under fluoroscopy or by tak-
ing radiographs. This inspection must be documented. If
a defect in a protective apron, glove, or shield is detected,
Scatter radiation to the lens of the eyes can be the item must be immediately removed from service.
substantially reduced by wearing protective eyeglasses Because there is no protective barrier present, lead
with optically clear lenses that contain a minimum lead aprons must always be worn by radiographers during
equivalent protection of 0.35 mm. mobile radiographic procedures. A protective apron
Table 21.4 presents the types of protective shielding, should be assigned to every portable unit. If no lead
their equivalent lead thickness, and the approximate apron is present on a portable unit the technologist must
attenuation of scattered radiation. locate a lead apron to use for the procedure. Aprons
Lead aprons are worn to protect vital organs. They vary in weight from a few pounds to approximately 25 lb
are made of a vinyl-lead mixture covered with a smooth depending on the design and lead content. Figure 21.3

Figure 21.2. (A) A photograph of a

hanging rack with protective aprons.
A B
(B) Photograph of a glove.
326 Part V: Radiation Protection

Figure 21.3. Lead apron and thyroid shield.

is an example of a lead apron that covers the front of the

body, wraps around the sides, and extends from the shoul- Figure 21.4. Two-piece lead apron and thyroid shield.
ders to the knees. Lead aprons with 1 mm lead equivalent
will possess a significant weight and will cause fatigue for
the radiographer if the apron is worn for extended periods
Figure 21.4, the weight of the apron is divided between
of time. This type of apron is commonly used for fluoro-
the shoulders and pelvis while providing complete wrap-
scopic and mobile procedures but lacks protection for the
around protection.
persons back. The protective aprons must have a minimum
of 0.5 mm lead equivalent when used for procedures where
the x-ray beam peak energy will reach 100 kVp. Most Proximity to Radiation
departments will use aprons with 0.5 mm lead equivalent During any fluoroscopic exam, radiographers should
as a balance between weight and protection. remain at least one or two steps back from the table if their
Protective aprons for interventional suites or cardiac assistance is not required. Additionally, if radiographers
catheterization labs should be of the wrap around type. are wearing the apron shown in Figure 21.3, they must be
The procedures which are performed in these settings aware of keeping their backs turned away from the source
require personnel to move around the room where their of radiation since their backs are not protected.
back may be exposed to scatter radiation from the patient.
Technologists who work in these areas must wear their
lead aprons for a significant portion of each day which
Holding the Patient
can lead to fatigue in the shoulders and back. To provide Radiographers should never stand in the primary or
complete protection and to minimize fatigue a two-piece useful beam to immobilize or hold a patient during an
wraparound lead equivalent apron is preferred. As seen in exposure. There may be instances when the radiographer
 Chapter 21: Minimizing Patient Exposure and Personnel Exposure 327

must hold a patient during an exposure. The radiographer a faster film/screen combination when one is available,
should stand at right angles or 90 degrees to the scatter- will reduce retakes due to patient motion. Increasing the
ing object, when the protection factors of distance and kVp is always associated with decreased mAs to obtain
shielding have been accounted for, this is where the least an acceptable optical density which results in a reduced
amount of scattered radiation will be received. Nonoccu- exposure to radiation. The relationship between mAs and
pational persons who are wearing appropriate protective patient dose is linear, as the mAs decreases so does the
apparel or mechanical immobilization devices should be dose the patient receives. When selecting technical fac-
used to perform this function when required. tors the radiographer must use care to select the appropri-
Holding a patient may be necessary when an ill or ate kVp because using kVp which is too high will produce
injured person is not able to physically support himself a poor quality image that will likely not provide the radi-
or herself. For example, weak elderly patients may be ologist with the necessary quality to make a diagnosis.
unable to stand alone and raise their arms above their Using good collimation practices is essential to good
head for a lateral chest x-ray. In this situation, a relative or radiographic technique. The radiographer has the ability
friend may need to hold the patient in position during the to reduce the field size for each radiographic image. By
exposure. A mechanical immobilization device may be reducing field size the patient receives a lower dose of
used to hold an infant in the proper upright position for radiation and the image quality will also be improved due
chest radiographs. Supine imaging of the chest will not to the reduction of scatter radiation.
result in the maximum quality necessary for diagnosing
pneumonia or fluids in the lungs, only an upright posi-
tion will demonstrate the air-fluid levels appropriately. If
Repeat Radiographs
the infant is too small for the immobilizer or the device The single most important factor in reducing the patient
is not available, appropriate nonoccupational individuals dose is limiting or eliminating retakes. A retake doubles
would be needed to hold the child upright during the the patient dose to obtain information that should have
exposure. been obtained with the initial exposure. Retakes can be
When nonoccupational individuals such as nurses, reduced by careful patient positioning, selection of cor-
orderlies, relatives, or friends assist in holding the patient rect exposure techniques, and good communication so
during an exposure, suitable protective apparel should be that the patient knows what is expected of her or him.
worn by each person participating in the examination. Causes of repeat examinations are typically improper
The radiographer must be sure the person does not stand positioning and poor radiographic technique resulting
in the useful beam. Pregnant females should never be in an image that is too light or too dark. Some repeat
permitted to assist in holding a patient during an exposure examinations are caused by processor artifacts, chemical
as this could result in exposure to the embryo or fetus. fog, light leaks, grid errors, multiple exposures on one
image, motion, and improper collimation. Careful atten-
tion to detail will result in the production of a quality
Reduction of Radiation radiographic image.

Dose to the Patient Shielding Devices

The radiation dose to the patient can be reduced by care- The nature of radiographic examinations results in a
ful selection of exposure techniques and adherence to partial-body exposure to radiation. To ensure the other
good radiographic procedures. Selection of higher-kVp, areas of the body are spared exposure to radiation the
lower-mAs techniques reduces the patient dose. technologist can use collimation and area shielding. The
use of area shielding is indicated when an organ or tissue
which is radiosensitive will be near or in the useful beam.
Radiographic Techniques Gonadal shielding should be considered as a secondary
Reducing the exposure time by using a higher mA sta- measure against radiation exposure to the reproductive
tion with a corresponding shorter time or by selecting organs and not a substitute for a properly collimated
328 Part V: Radiation Protection

beam. Proper collimation of the useful beam must always Radiographic procedures of the lumbar spine, pelvis,
be the first step in gonadal protection. and hip have the highest ESE due to the higher kVp and
The gonads (ovaries and testes) are frequently shielded mAs that is required for quality images of the dense bone
from primary radiation to minimize the possibility of any in these areas. When performing these examinations,
genetic effect occurring with future children. Gonadal the radiographer must carefully consider the purpose for
shielding is only necessary for use on pediatric patients and the examination, correct positioning protocols, patient
adults of childbearing age. Gonadal shields are made in instructions, optimal technical factors based on body
two basic types: flat contact shields and shadow shields. habitus, and shielding. Each of these factors plays a vital
role in producing a quality image the first time the expo-
Flat Contact Shields sure is made. The ESE of a patient who measured 23 cm
Flat contact shields are flat, flexible shields made of lead thick and who had an AP Lumbar spine is 342 mR, while
strips or lead-impregnated materials. These shields are a PA chest film on a patient who measured 23 cm pro-
placed directly over the patient’s reproductive organs. duces an ESE of 9 mR. There is a significantly higher
Flat contact shields are most effective when used for ESE for one AP Lumbar spine image, and with this high
patients who are recumbent on the radiographic exam of an ESE it is easy to determine why it is so critical that
table whether in the anteroposterior (AP) or PA posi- the radiographer practices good judgment in positioning
tion. Flat contact shields are not suitable for use during and exposing the patient.
upright imaging and fluoroscopy examinations.

Shadow Shields
Pediatric Considerations
Shadow shields are made of a radiopaque material. When considering the potential for biological damage
These shields are suspended above the collimator and from exposure to ionizing radiation, children are more
are placed within the light field over the area of clinical vulnerable to late somatic effects and genetic effects than
interest to cast a shadow over the patient’s reproductive adults. Imaging children requires special consideration
organs. To ensure proper placement of the shadow shield to make sure the principles of ALARA are followed as
the light field must be properly positioned. In this man- well as appropriate shielding.
ner the shadow shield will not interfere with adjacent tis- To image a child smaller doses of radiation are used
sue. Improper positioning of the shadow shield can result to obtain diagnostic quality images than the doses used
in a repeat radiograph which causes an increase in dose for adults. The entrance exposure below 5 mR will result
to the patient. from an AP projection of an infant’s chest where the
same projection of an adult’s chest will yield an entrance
exposure ranging from 12 to 26 mR.
Radiation Dose Patient motion is the most common problem encoun-
Each year more and more individuals are undergoing tered in pediatric radiography. When working with chil-
diagnostic radiologic procedures which equates into dren the radiographer needs to be aware of the child’s
more irradiation of the general population. Because there limited ability to understand the procedure, to cooper-
is great concern about the risks associated with irradia- ate, or to remain still for the exposure. To minimize this
tion, it is imperative that risk to the patients be reduced problem the radiographer must use communication to
whenever possible. In Chapter 19, the effects of whole explain what the child is to do and to elicit cooperation
body irradiation were discussed and were mainly con- from the child. If the child is not able to hold completely
cerned with genetic effects or somatic effects. In addition still the radiographer will need to utilize various immo-
to these considerations we must consider the effect to the bilization devices. There are specially designed pediatric
skin during a radiographic procedure where only a por- immobilization devices on the market to hold the patient
tion of the body is receiving radiation. It is obvious that securely and safely in the required position. The use of
the maximum exposure occurs at the skin entrance to the such devices along with the use of appropriate technical
body and not at the area of interest. This is called the skin factors greatly reduces or eliminates the need for repeat
entrance exposure or ESE. images that increase patient dose. The techniques of
 Chapter 21: Minimizing Patient Exposure and Personnel Exposure 329

gonadal shielding must also be applied to the pediatric on a separate record with the waist device being identified
patient. as exposure to the fetus. Historically, review of these addi-
tional monitors consistently reflects that exposures to the
fetus are insignificant.

Reducing Exposure Fetal Dose

During Pregnancy The NRC regulations state that the dose equivalent to
the embryo or fetus during the entire pregnancy cannot
In medical imaging there is heightened concern for the exceed 5 mSv. The NRCP recommends that the fetal
damaging effects of irradiation to the developing embryo exposure be restricted to an equivalent dose of 0.5 mSv
or fetus. Special care is taken in medical radiography (0.05 rem or 50 mrem) per month. These two limits com-
to prevent unnecessary exposure of the abdominal area plement each other since the normal gestation period is
of pregnant females. There is concern for the pregnant 10 months; therefore, 0.5 mSv/mo equates to 5 mSv for
radiographer and for the pregnant patient. the entire pregnancy.

Pregnant Radiographer Pregnant Patient

The pregnant radiographer has the right to choose Unfortunately, most women are not aware that they are
whether or not to declare her pregnancy. When the preg- pregnant during the earliest stage of pregnancy so there
nant radiographer notifies her supervisor in writing of is concern over the exposure of the abdominal area in
her pregnancy, the pregnancy becomes declared and the potentially pregnant women. To minimize the possible
dose limit for the pregnancy becomes 0.5 mSv/mo. The exposure to an embryo in the earliest days of a pregnancy
equivalent dose limit for the fetus is 5 mSv for the entire a guideline known as the 10-day rule has been recom-
pregnancy which is a dose level the majority of radiogra- mended by various advisory agencies. This guideline
phers do not reach. Most radiographers receive <1 mSv/y states that elective abdominal x-ray examinations for
as determined with a personnel monitoring device which women of childbearing age must be postponed until the
is worn at the collar outside of protective lead aprons. The 10-day period following the onset of menstruation. It is
exposure at the waist under the protective apron will not considered unlikely that a woman would be pregnant
normally exceed 10% of the dose registered at the collar. during these 10 days. Because on our current under-
Lead aprons with 0.5 mm lead equivalent provide standing of radiobiology of radiation and pregnancy, the
approximately 90% attenuation of radiation at 75 kVp 10-day rule is obsolete. This is primarily because the
which will sufficiently protect the pregnancy. Some egg for the next cycle reaches maximum sensitivity dur-
aprons have a 1mm lead equivalent; however, such thick- ing this 10-day period. The risks of injury resulting from
ness creates a heavier apron which could cause back irradiation in utero are small. The physician ordering the
problems during pregnancy. A wrap-around lead apron radiologic examination will carefully weigh the risks of
will provide maximum protection while distributing the the irradiation to the fetus with the benefits of the exam.
weight to the shoulders resulting in fewer back problems. It should be noted that only medically necessary exam-
A facility should make a special effort to provide an apron inations should be performed. The radiographer per-
of proper size for the pregnant technologist to wear. forming the examination must use precisely collimated
It is reasonable for a pregnant technologist to request field sizes and should carefully position protective shields
a second personnel monitoring device to be worn under where appropriate. High kVp techniques are most appro-
lead aprons and at the waist level. The report for both the priate in these situations so that the dose, mAs, can be
collar and waist monitoring devices should be maintained kept low.
330 Part V: Radiation Protection

Chapter Summary primary radiation. These shielding devices are

used on pediatric patients and those adults who
This chapter has described the need for are of child-bearing age.
protecting the patient during radiographic Care must be taken to reduce radiation
procedures and the various tools and techniques exposure to any pregnant woman, including
used in radiography. To reduce the dose to pregnant or potentially pregnant patients and
patients, the radiographer should use increased pregnant radiographers. The current recom-
kVp, lower mAs, and faster film/screen combi- mendation for equivalent dose limit for the
nations. Decreased exposure time will reduce embryo or fetus is 0.05 mSv for any month after
patient motion artifacts. Careful positioning the pregnancy has been declared.
and good communication with the patient will
reduce retakes. The effective dose relates the
actual dose given to a portion of the body to
the dose that would produce the same harm
if delivered to the entire body.
Case Study
The three methods for reducing radiation Jessica is preparing to perform a fluoroscopic
exposure to personnel are reduction of exposure procedure on a 25-year-old patient. She has
time, increased distance, and increased shield- explained the examination to the patient and has
ing. All radiation exposure should follow the answered the patient’s questions. Jessica is cer-
ALARA principle. The single most important tain the patient understands the expectations for
factor for reducing the patient dose is to limit the procedure. As Jessica is putting on her pro-
the amount of retakes for the image. Retakes tective apparel she is thinking of safe radiation
double the patient dose. Careful positioning practices she can take during the procedure.
and good communication with the patient
also helps reduce patient dose.
The radiographer must use safe practices Critical Thinking Questions
when performing examinations. These prac-
tices include wearing protective apparel when Name the primary practices Jessica is thinking
remaining in the room while the x-ray beam of.
is turned on and standing as far away from the
radiation source as possible during exposures. What is the purpose of putting on protective
Nonoccupational individuals should hold apparel?
patients when necessary for an exposure. The
use of immobilization devices should be incor- Which apparel should she put on?
porated into examinations where they will hold
the patient still in order to prevent a potential What is another method she can use to further
repeat exposure. The radiographer must also decrease her exposure to scatter radiation?
use the correct technical factors for the age
and body habitus of the patient as a measure of If Jessica were to stand close to the patient,
preventing a repeat radiograph due to inappro- in which location would she receive the least
priate technical factors. exposure to scatter radiation?
The use of shielding devices is widely
accepted in radiography departments. There are
flat contact shields and shadow shields which Jessica is thinking of the ALARA concept
are used to protect the gonads from exposure to of radiation protection and the three cardinal
 Chapter 21: Minimizing Patient Exposure and Personnel Exposure 331

rules. She must keep her exposure as low as wrap-around lead apron to provide a barrier
reasonably achievable while following safe between her and the radiation. In addition
radiation practices. Additionally she must to wearing a lead apron, Jessica also knows
comply with the three cardinal rules of time, that when she stands farther away from the
distance, and shielding. She knows she must patient her exposure to radiation is significantly
only be in the area of exposure for the short- reduced. She will only stand as close to the
est time possible and the radiologist should patient as needed for proper assistance. Jessica
use only the lowest necessary amount of radia- also knows that the majority of scatter radiation
tion possible for the procedure. Jessica knows emitted by the patient is at varying angles from
she must wear protective apparel because of the patient and the area of least exposure is at a
the significant amount of scatter radiation 90 degree angle. By following the ALARA con-
which is produced during fluoroscopic stud- cept and the three cardinal rules, Jessica will
ies. She decides to put on a thyroid shield and significantly decrease her exposure to radiation.
Review Questions

5. A
b. protective
reduces theapron should
exposed silver be assigned
halide crystalstoto_____
black
Multiple Choice portable units.
metallic silver
c. all
A. is basicproduces an alkaline pH
d. most
B. is/does all of the above
In1. the
Methods to reduce
characteristic radiation
curve shownexposure to the staff
below, identify the
include
regions (used for questions 1-4) C. many
7. Replenishment systems in automatic processor
D. no
1. Reduce time replenish
1. The base plus
2. Increase fog region of the curve is
distance 6. Whenever scattered
a. unexposed radiation decreases, the radiog-
film emulsion
3. 1Reduce shielding
a. rapher’s exposure
b. developer and fixer solutions
4. 2Reduce field size
b. c. decreases
A. used wash water
c.
A. 31, 2, 3, and 4 d. increases
drying racks
d. B. slightly
B. 41, 2, and 4 C. remains the same
C. 2, 3, and 4 8. Which of the following is a reducing agent?
2. The shoulder region of the curve is D. increases 100 times
D. 1 and 2
a. Glutaraldehyde
a. 1 7. If
b. the peak energy of the x-ray beam is 140 kVp,
Hydroquinone
2. b.
ALARA
2 means the
c. Acetic acidprotective barrier should consist of
primary
c.
A. 3as low as readily achievable _____
d. Alum and extend _____ upward from the floor of
d.
B. 4as low as reasonably achievable the x-ray room when the tube is 5 to 7 ft from the
C. always low and really achievable wall hardening
9. The in question.agent in the fixer is
3. The toe region of the curve is
D. always low and readily accessible A.
a. 1/32 in lead, 10 ft
Glutaraldehyde
a. 1 B. 1/32 in lead,
b. Sodium 7 ft
sulfite
3. b.
Lead
2 aprons and other protective apparel should C.
c. 1/16 in lead,
Potassium 7 ft
alum
c. 3inspected for hidden cracks at least
be
D. 1/16 in lead, 10 ft
d. Ammonium thiosulfate
d.
A. 4daily
B. weekly 8. The cord
10. leading
purpose to the
of the exposure
guide shoesswitch
in theoftransport
a mobile
4. The straight-line region of the curve is radiographic
racks is to unit should be long enough to per-
C. monthly
D. 1annually
a. mit the radiographer to stand at least _____ from
a. allow
the the the
patient, filmx-ray
to move
tube,upand
or down
the useful beam to
b. 2 b. to force the edge of the film around the master
4. c.
The3 major source of radiation exposure to radiol- reduce occupational exposure.
roller
ogy4personnel is the
d. A. to
c. 1m (3 ft)the film in the crossover network
bend
A. primary beam B. pull
d. 2 m (6 theft)film from the film tray into the transport
5. A high-contrast film has a _____ latitude C. rack
3 m (9 ft)
B. Bucky
C. wide
a. image intensifier D. 5 m (15 ft)
D. narrow
b. patient

6. The developer solution

a. softens the emulsion
 Chapter 21: Minimizing Patient Exposure and Personnel Exposure 333

9. When performing a mobile radiographic examination, 4. Which two examination procedures does the
if the protection factors of distance and shielding are highest radiation dose occur for diagnostic imag-
equal, the radiographer should stand at _____ to the ing personnel?
scattering object.
A. a 30 degree angle
B. a 45 degree angle
C. a right angle
D. a 75 degree angle
5. Explain the importance of gonadal dose.
10. If the intensity of the x-ray beam is inversely pro-
portional to the square of the distance, when the
distance from a point source of radiation is tripled,
the intensity
A. increases by a factor of 3 at the new distance
B. increases by a factor of 9 at the new distance 6. Name the standard thickness of protective
C. decreases by a factor of 3 at the new distance apparel.
D. decreases by a factor of 9 at the new distance

Short Answer
7. Explain the procedure for holding patients during
x-ray examinations.
1. Explain the purpose of the 5-minute reset timer on
all fluoroscopy units.

8. Define tissue weighting factor (Wt).

2. List the three cardinal rules of radiation protec-

tion. How are they applied to diagnostic imaging?

9. What is the whole body occupational dose limit

for radiography students under 18 years old?

3. Using Table 21.3 what is the annual dose limit

recommendation for a 37-year-old radiographer.

10. List the four concepts of patient shielding during

x-ray examinations.
PART VI

Patient Care
 22

Medical and
Professional Ethics

Objectives Key Terms

Upon completion of this chapter, the student ● assault ● libel
will be able to: ● autonomy ● malpractice
1. Describe medical ethics. ● battery ● morals
2. Understand legal aspects for the Radiologic ● beneficence ● negligence
Technologist. ● ethics ● nonmaleficence
3. Identify Health Insurance Portability and ● false imprisonment ● slander
Accountability Act and its components. ● fidelity ● tort
4. Understand patient records, charting, and ● justice ● veracity
medical histories.
5. Identify patient rights and responsibilities.
6. Describe intentional and unintentional
misconduct that may occur in a radiology
department.

335
336 Part VI: Patient Care

their duties. Professionalism encompasses dedicated

Introduction study to one’s profession throughout one’s career. Learn-
ing does not stop when the students have completed their
Patient care is a vital part of Radiography and program of study, but rather they are required to continue
Radiologic Technology. Patient care is included their education in the field of radiology so that they may
on the National Registry Exam which makes up provide the highest quality examination possible for their
five content specific areas for the A.R.R.T exam. patients.
This chapter covers medical ethics, profession-
alism, professional ethics, Health Insurance
Portability and Accountability Act (HIPAA) Professional Organizations
information, legal considerations, and recording One hallmark of a profession is to have an established
patient information in the medical record. professional organization. The professional organiza-
tion for the radiologic sciences is the American Soci-
ety of Radiologic Technologists (ASRT). The ASRT
Radiography as was founded to advance the profession and to promote
high standards of education and patient care. The
a Profession ASRT and the International Society of Radiographers
and Radiological Technologists (ISRRT) both hold
Radiologic technology has been utilized in medical high standards for their members and the profession
facilities since x-rays were discovered in 1895. Over the on a global scale. The American Registry of Radiologic
course of these many years, radiologic technology has Technologists is the agency that oversees certification
evolved from a vocational program into a profession with and registration of technologists who practice the vari-
a set curriculum. Students who are training in radiologic ous imaging modalities. Other organizations which are
technology programs are required to have extended train- affiliated with the ASRT but which serve special profes-
ing and specialized education in the theories and prac- sional interests include American Healthcare Radiol-
tices of radiography. Students are taught to uphold the ogy Administrators (AHRA), which provides a network
highest standards of the profession and to continue this and resources for administrators, and the Association
practice as radiologic technologists. These individuals of Collegiate Educators in Radiologic Technology and
strive to improve the profession through a commitment the Association of Educators in Imaging and Radiologi-
to truth and to providing patients with excellent service. cal Sciences (AEIRS), which provide guidance to tech-
Radiologic technology has grown into a profession whose nologists who teach the radiological sciences. Other
members have specialized skills and serve a specific need organizations exist for technologists who practice in
for society. specialized modalities such as the Society of Diagnostic
A profession is organized to govern itself. To effectively Medical Sonography, the Society of Nuclear Medicine,
set standards of professional behavior, scopes of practice and the Association of Vascular and Interventional
for technologists, education, qualifications to practice, Radiographers.
and the ability to enforce those standards with its mem-
bers. A profession will also advance the knowledge of the Practice Standards
profession by having a peer reviewed journal or publica-
tion because this allows the profession to advance and to The ASRT is the only nationally recognized professional
continually review and challenge the base of knowledge society representing all radiologic technologists in the
on which it functions. Unites States today. The ASRT has worked for many years
to advance the radiologic profession and to attain profes-
sional status for radiologic technologists. To attain this
Professionalism goal the ASRT developed a set of practice standards and
Individuals who work in a profession are expected to scopes of practice to outline duties and responsibilities
uphold the highest level of professionalism in performing of radiologic technologists. The document which defines
 Chapter 22: Medical and Professional Ethics 337

clinical practice, performance standards, and quality Standards of Ethics

standards is called The Practice Standards for Medical
Imaging and Radiation Therapy. These standards are
for Radiographers
used by technologists, administrators, and lawyers to The Standards of Ethics is made up of two separate parts:
determine the accepted level of care and to determine the Code of Ethics and the Rules of Ethics. The ASRT
if the professional standard has been met by radiologic and ARRT joined forces to develop, revise, and adopt the
technologists in the performance of their duties. Code of Ethics in 1998. This document serves as a guide
to maintain ethical conduct in all areas of the radiologi-
cal sciences. The Rules of Ethics were added in 2001, all
radiologic technologists must comply with these rules and
Medical and the ARRT enforces the Rules of Ethics. The Rules of Eth-
Professional Ethics ics promote protection, safely, and comfort of the patient.
Technologists who violate the Rules of Ethics are subject
to sanctions by the ARRT and may have their certifications
In society today, it has become common place for indi- revoked.
viduals to seek litigation to recoup real or imagined dam-
ages. The radiologic technologists must be ever aware of ARRT Code of Ethics
the implications of their actions when caring for patients. The American Registry of Radiologic Technologist has
They must be familiar with the moral, ethical, and legal listed ten separate principles for the technologist to follow.
consequences of their actions. They are listed in the Code of Ethics for the Radiologic
Technology profession. They are as follows:
Principle 1. The Radiologic Technologist functions
Morals and Ethics efficiently and effectively, demonstrating conduct and
For some people morals and ethics mean basically the attitudes reflecting the profession.
same things when in fact they are quite different. Our
1.1. Responds to patient needs
moral compass is based on lessons of right and wrong we
1.2. Performs tasks competently
learned at an early age. These lessons are based on a set of
1.3. Supports colleagues and associates in providing
standards or morals which govern how we relate to other
quality patient care.
people and how we get along with society. There are also
group morals which govern our relationships as profes-
Principle 2. The Radiologic Technologist acts to
sionals and how we perform duties for our patients which
advance the principal objective of the profession to provide
include providing proper care, maintaining professional
services to humanity with full respect for the dignity of
competence, and maintaining confidential patient infor-
humankind.
mation.
Ethics are defined as a set of moral principles that gov- 2.1. Participates in and actively supports the profes-
ern our course of action. Each person has his or her own sional organizations for radiologic technology
personal code of ethics that are based on cultural and 2.2. Acts as a representative for the profession and the
environmental background. Our upbringing is strongly tenants for which it stands
based on rights and wrongs that are set forth by our cul- 2.3. Serves as an advocate of professional policy and
tural group or society. Our ethics also help us place value procedure to colleagues and associates in the
on behaviors and determine if a given action is either good health care delivery system
or bad. Each of us makes decisions which are influenced
by our morals and ethics; sometimes, our personal morals Principle 3. The Radiologic Technologist provides ser-
and ethics are in conflict with our professional. It is up vice to patients without discrimination.
to each individual to balance his or her personal ethics
with the professional ethics which govern all radiologic 3.1. Exhibits no prejudice for sex, race, creed,
technologists. religion
338 Part VI: Patient Care

3.2. Provides service without regard to social or 8.1. Protects the patient’s right to quality radiologic
economic status technology care
3.3. Delivers care unrestricted by concerns for per- 8.2. Provides the public with information related to
sonal attributes, nature of the disease or illness the profession and its functions
8.3. Supports the profession by maintain and upgrad-
Principle 4. The Radiologic Technologist practices ing professional standards
technology founded on scientific basis.
Principle 9. The Radiologic Technologist respects con-
4.1. Applies theoretical knowledge and concepts fidences entrusted in the course of professional practice.
in the performance of tasks appropriate to the
practice 9.1. Protects the patient’s right to privacy
4.2. Utilizes equipment and accessories consistent with 9.2. Keeps confidential information relating to
the purpose for which it has been designed patients, colleagues, and associates
4.3. Employs procedures and techniques appropri- 9.3. Reveals confidential information only as
ately, efficiently, and effectively required by law or to protect the welfare of the
individual or the community
Principle 5. The Radiologic Technologist exercises care,
discretion, and judgment in the practice of the profession. Principle 10. The Radiologic Technologist recognizes
that continuing education is vital to maintaining and
5.1. Assumes responsibility for professional decisions advancing the profession.
5.2. Assess situations and acts in the best interest of
the patient 10.1. Participates as a student in learning activities
appropriate to specific areas of responsibility as
Principle 6. The Radiologic Technologist provides the well as to the Scope of Practice
physician with pertinent information related to diagnosis 10.2. Shares knowledge with colleagues
and treatment management of the patient. 10.3. Investigates new and innovative aspects of pro-
fessional practice
6.1. Complies with the fact that diagnosis and inter-
pretation are outside the scope of practice for the
profession Ethical Judgments and Conflicts
6.2. Acts as an agent to obtain medical informa-
tion through observation and communication During the course of a radiologic technologists career,
to aid the physician in diagnosis and treatment there will be situations that will require the technologist
management to analyze the ethics of the situation and whether correc-
tive action is needed. Many situations which occur are
Principle 7. The Radiologic Technologist is respon- obviously unethical and unacceptable to most everyone;
sible for protecting the patient, self, and others from however, there are circumstances that make each of us
unnecessary radiation. question our moral compass and ethics. Often our per-
sonal ethics are in conflict with another person’s ethics
7.1. Performs service with competence and expertise which poses a dilemma. You must be prepared to assess
7.2. Utilizes equipment and accessories to limit radia- the conflict objectively and to determine the best course
tion to the affected area of the patient of action for all interested parties. There are four steps
7.3. Employs techniques and procedures to minimize you can take to help you solve an ethical dilemma:
radiation exposure to self and other members of
the health care team ● Identify the problem
● Develop alternative solutions
Principle 8. The Radiologic Technologist practices ● Select the best solution
ethical conduct befitting the profession. ● Defend your rationale and selection
 Chapter 22: Medical and Professional Ethics 339

Following these four steps with the Code of Ethics not let the patient’s morals detract from performing
and Rules of Ethics as your ethical compass will assist their duties with compassion, respect, and tolerance
you in making the best decision possible. In addition, the for the patient’s moral beliefs. The professional stan-
technologists have the Practice Standards and Scopes of dards assure us that ethical judgments can be made
Practice to aid them in making a decision. with confidence that a person in a similar situation
would make the same decision.

Ethical Principles
Ethics can be a double edged sword because there Patient Rights and Responsibilities
are times when our professional ethics are in conflict
with a patient’s claim to his or her rights. To assist the A video for this topic can be viewed at
radiographer in solving the ethical dilemma, we have http://thepoint.lww.com/FosbinderText
six ethical principles which are accepted as guides to
the right action which should be respected by others As health care consumers, patients have rights with which
unless they have a compelling ethical or moral reason to all health care personnel must comply. Radiographers
discount it. The six principles are as follows: must be aware of these rights so that they do not infringe
upon the patient’s rights lest they be held legally liable.
1. Autonomy: Defined as self-determination. All persons Examples of some rights include the following:
have the right to make rational decisions concerning
their lives and you must respect those decisions. ● Providing patients with a diagnosis, impression, or
2. Beneficence: Goodness. All actions that bring the results of an examination
about a good result or are beneficial are considered ● Providing patient considerate and respectful care
right. ● Identifying the correct patient before performing
3. Nonmaleficence: The duty to prevent harm or the an examination
obligation to not inflict harm. Radiographers are ● Maintaining the patient’s modesty and privacy
obligated to practice in a safe manner at all times during examinations
and to not inflict harm on a patient. ● Maintaining the highest quality images possible
4. Veracity: An obligation to tell the truth and be hon- while using the lowest possible amount of radiation
est in all aspects of your professional life.
5. Fidelity: Faithfulness. The duty to fulfill your com- A radiographer must never assume the role of other
mitments and applies to both stated and implied medical personnel in the hospital. It is not within the scope
promises. Radiographers must not promise patients of practice for a radiographer to read radiographic images
results that you cannot achieve. and provide an explanation of the results to patients or
6. Justice: Treating all persons fairly and equally. You their family. Finally, the radiographer is responsible for the
must treat all patients the same regardless of your physical care of the patient. If the patient has been injured
personal feelings. while in the radiographers care, a physician must assess the
patient before they are dismissed from the department.
With these principles as a guide, the radiographer Patients also have responsibilities for their care and
can develop a better understanding of the patient’s interaction with health care personnel. The patient must
point of view while in our care. The patient may find also abide by the Patient Bill of Rights which includes
his or her morals and ethics are in conflict with the the following:
individuals who are administering care to them. Ethi-
cal conflicts can be troublesome when our ethics do ● The patient has the obligation to provide an
not match the ethics of the patient or the ethics of the accurate and complete health history.
group we work with. Professionals must not let their ● The patient is responsible for her or his own actions
personal morality to supersede the group’s moral duty when refusing treatment or not following his or her
to provide quality patient care. Professionals also must physician’s instructions.
340 Part VI: Patient Care

● The patient is responsible for following hospital This will educate the patient and allow the radiographer
policies and regulations regarding patient care and to efficiently complete the ordered exam.
conduct. Battery is the unlawful touching of a person with-
● The patient is responsible for being considerate for out his or her consent. If the patient refuses to undergo
the rights of others and to respect other people’s the exam, his or her choice should be respected. If the
property. radiographer did the exam despite the patient’s refusal,
the radiographer could be charged with battery. Assault
The American Hospital Association developed the and battery are often linked together, meaning a threat of
Patient’s Bill of Rights and is responsible for maintaining harm existed before the actual contact was made.
the document and recommending changes. Libel and Slander: Libel and/or slander occurs when
patient information is maliciously spread without a
patient’s consent, and the end result defames that patient’s
character or damages his or her reputation. Libel refers to
Legal Aspects written information. Slander refers to verbal information.

for Radiologic Any violation of confidentiality; in particular, the mali-

cious spread of information is a direct violation of HIPAA.
Technologists False imprisonment is the unjustifiable detention of
a person against his or her will. This becomes an issue
when the patient wishes to leave and is not allowed to
Radiographers must abide by the laws which govern the do so. Patients can claim false imprisonment if they
delivery of health care, the professional practice of radi- are restrained against their will. Many hospitals have a
ography, and interpersonal interactions. Laws are divided no restraining policy without a physician’s direct order.
into two major categories: criminal law and civil law. Restraints are commonly applied if it is demonstrated
Criminal law is an offense against society, a person, or that the patient will be harmed by their actions. Using
the government. Criminal law is further defined by the the side rails on hospital beds and stretchers is a method
seriousness of the crime. A serious crime is a felony and of restraining a patient without physical restraints.
potentially punishable with imprisonment. A less serious The radiographer is responsible to maintain patient
crime is a misdemeanor, which is punishable by a fine or confidentiality at all times and not disclose confidential
by imprisonment for <1 year. patient information without the patient’s written consent.
Civil law deals with the rights and duties of individuals Invasion of privacy can be charged if the patient’s con-
with respect for others. The punishment for those individu- fidentiality has not been maintained or if the patient’s
als found guilty of breaking civil law can be paying a sum of body has been improperly and unnecessarily exposed or
money to offset the damages of the crime. A civil law that is touched. Hospitals and their employees must be mindful
committed against a person or property is called a tort. of the health information they have access to and must
make certain that the information remains protected. In
1996, the Health Insurance Portability and Accountabil-
Torts ity Act came into effect. This Federal legislation provides
Tort law involves personal injury or damage to property, guarantees that a patient’s financial and health informa-
which results in civil litigation to obtain payment for the tion will be private and secure in any format that the
damages. A tort may be committed intentionally or unin- information is stored. HIPAA protects a patient’s privacy
tentionally. An intentional tort or misconduct of the tech- when medical information is transmitted outside the aus-
nologist can include assault, libel, slander, battery, false pices of the patient’s healthcare providers. Medical and
imprisonment, and invasion of privacy. financial information cannot be released to employers,
Assault is the unlawful threat of touching a person in financial institutions, or other medical facilities without
an injurious way; actual physical contact is not made. the express written consent of the patient.
As a radiographer, you should explain what is going to Additionally, the patient’s modesty must be protected
occur to the patient prior to performing a procedure. while the patient is in the care of the hospital. Many
 Chapter 22: Medical and Professional Ethics 341

radiographic procedures require a certain amount of can avoid a possible malpractice claim. Establishing a
exposing the patient for the purposes of performing the professional, trusting relationship with the patient has
examination. It is the radiographer’s duty to maintain the proven effective in avoiding a malpractice lawsuit. Radiog-
patient’s modesty as much as possible. raphers who clarify patient identification, accurately
Unintentional torts include negligence and malprac- administer medications, and comply with patient safety
tice. Negligence is the neglect or omission of reason- requirements have taken positive steps to provide optimal
able care or caution. The standard of care is based on patient care and to avoid potential malpractice lawsuits.
principle of the reasonably prudent person and if they Radiographers who understand that their limitations and
would have performed in a similar manner under simi- lack of experience are opportunities to learn from expe-
lar circumstances. A radiographer has the duty to provide rienced care givers minimize the risk of harming their
reasonable care to a patient. In a court of law the radiog- patients and of having a malpractice claim against them.
rapher will be held to the standard of care and skill of a
reasonable radiographer in a similar situation.
Negligence is further delineated by gross negligence,
contributory negligence, and corporate negligence. Gross
negligence is an act that demonstrates reckless disregard
Patient Records,
for life and limb. This is the highest degree of negligence Charting, and
and results in more serious penalties. Contributory negli-
gence refers to an act of negligence in which the behavior
Medical History
of the injured person contributed in some manner to the
injury. Corporate negligence applies when the hospital Health care facilities utilize many forms of patient chart-
is negligent. ing. Patient charting is used for communication (i.e.,
Four conditions must be found true to establish a claim physician’s orders), between all providers. Patient history,
of malpractice: admitting and discharge diagnosis, physician progress
notes, nurse’s notes, physical therapy notes, occupational
1. The person being sued had a duty to provide therapy notes, laboratory examinations, and radiology
reasonable care to the patient. reports are all examples of different types of charting that
2. The patient suffered injury or some loss. are contained within the patient’s main chart. The radiog-
3. The person being sued is the party responsible for rapher’s charting may include medications administered
the loss. during a procedure, identification of contrast agents
4. The loss is directly attributed to negligence or injected, type and amount of contrast agents used, timing
improper practice. of the procedure, and any sort of reaction that the patient
may have had to the use of contrast media. The radiogra-
Negligence is proven when the court is convinced pher is responsible for obtaining a complete and accurate
that the loss or injury is a result of negligent care or treat- history of the patient, the reason for the ordered exami-
ment. This must be proven before the patient is entitled nation, identification of the examination performed and
to damages. To prove negligence, the court will have completed, and the patient’s reaction or actions during
to determine if the radiographer performed his or her the procedure itself.
duty in accordance with current, acceptable practice. As a radiographer, you are accountable for document-
To avoid an accusation of negligence, the radiographer ing the number of images for the exam, exposure factors
must be aware of professional ethics and practice within or CR/DR numbers, and the amount of fluoroscopic
established guidelines. time used for the procedure. You are also responsible for
taking a pertinent medical history for the examination
which has been ordered for the patient. Many procedures
Malpractice Prevention require a baseline set of vital signs as well as monitoring
Radiographers who practice with the best interest of the throughout the procedure, verification of a female’s last
patient in mind and who are cautious in their actions menstrual cycle and possibility of pregnancy, history of
342 Part VI: Patient Care

allergies, trauma, types and amounts of contrast media ● Always use the four digits for the year when dating
given, and patient education that was provided before written forms.
and after the examination. Each of these must be placed ● Date and sign entries you make include your title
in the patient’s medical record to document the continu- or credentials.
ity of care the patient received and the demonstration of
following established protocols and guidelines. Following these simple rules will ensure the entries you
make are beneficial to the medical record. Remember
Requirements for Entries that all information in patient records is confidential and
in the Medical Record must not be left where unauthorized individuals can read
it. The chart is a legal document that can substantiate or
Great care must be taken when charting. A radiographer’s refute charges of negligence or malpractice. The course
subjective comments have no place in charting. For exam- of treatment and quality of care the patient received are
ple, stating “patient is drunk for his examination” is not a reflected in the chart.
valid history. “Patient staggered into exam room. Strong
odor of alcohol noted on patient’s breath. Patient unco-
operative during examination by refusing to hold breath”
are acceptable forms of objective charting. Entries in
Chapter Summary
a chart should be complete, objective, consistent, leg- Radiography is a medical field with a set of
ible, and accurate. When documenting information on professional standards, ethics, and organizations
paper forms the notations must be legible, written in ink, that set the ethical standards for the profession.
and must be dated and signed by the person making the Radiographers are required to practice with
notation, including your title or credentials. the Code of Ethics and Rules of Ethics. It is
Computerized medical records provide access to essential for radiographers to be responsible for
patient health history for the radiographer. Access to their actions and the safety and well being of
electronic medical records is protected and radiog- their patients. All health care personnel must
raphers will be required to log onto the system with also comply with protecting the privacy of our
their own password or by using a barcode identifica- patients. Privacy of patients’ condition and
tion which is scanned. The files and types of informa- their records is protected by HIPAA, the Health
tion that you are authorized to access may be limited. Insurance Portability and Accountability Act.
When finished entering information into the com- Ethics are moral standards that oversee the con-
puter, be sure to log off so as to not permit another duct of the radiologic technologist.
person from using your password to access confidential Professional behavior involves moral, legal,
medical records. and ethical implications for our actions. Radiog-
raphers must use sound ethical judgment to
resolve conflicts between their personal moral
Correcting Entries in the beliefs and ethics and the moral beliefs and
Medical Record ethics of other persons. Radiographers must
When an entry needs to be corrected, there are sev- not impose their ethical or moral beliefs on a
eral rules that should be followed. They include the patient as each patient has the right to his or her
following: own beliefs. The Patients Bill of Rights assures
patients the sanctity of their rights while in a
● To delete an entry, simply draw a line through it; healthcare facility. Patients also have certain
do not erase or use corrective fluid. responsibilities for their care which they must
● Always initial and date corrections. be aware of.
● Never leave blanks on the form. Insert NA or draw Criminal law deals with felonies and mis-
a line through the blank followed by your initials. demeanors, crimes against the state which are
● Never insert loose slips of paper.
 Chapter 22: Medical and Professional Ethics 343

punishable by imprisonment or fines. Felonies are me! That is completely a lie. My husband is
serious crimes committed against a person or the not drunk! He is a diabetic and the nurses were
state and are punishable by imprisonment. Misde- giving him glucose because he was having an
meanors are lesser crimes which are punishable insulin reaction. I am going to report you to
by fines and rarely result in imprisonment. Human Resources for spreading slanderous
Torts are violations of civil law, intentional rumors about my husband.”
misconduct, or negligence. Torts result in harm
or injury to a patient or other person while
in our care. Intentional misconduct includes Critical Thinking Questions
assault, battery, false imprisonment, invasion
of privacy, libel, and slander. Negligence is Were Sara’s comments wrong?
the neglect of reasonable care which is based
If so, what did she do wrong?
on professional practice standards of care of a
prudent person. Which medical ethics did Jenny and Sara
Radiographers should be aware of their violate?
responsibilities to accurately report information
in the patient’s medical record. Medical records Was she out of line and being rude or is there
may be in paper form or on a computer, regard- probable cause for litigation?
less the radiographer must follow the accepted Should Jenny and Sara have been discussing
criteria for documenting aspects of the patients the patient outside the radiology department?
care during an examination. The medical
record includes reports from the lab, radiol-
ogy, nurse’s notes, doctor’s notes, and physical Sara’s comments were unjustified and
therapy. The radiographer has the responsibil- inappropriate. She did not protect the patient’s
ity to protect the patient’s information from private information because she was discussing
unauthorized individuals. a patient’s medical information where anyone
could hear her. She used poor ethical judgment
and didn’t comply with the following Code of
Ethics: Principle 8.3, 9.1, 9.2, and 9.3 because
Case Study she didn’t uphold current professional standards
While walking to the cafeteria, Jenny and Sara and she didn’t protect the patient’s right to pri-
were discussing a patient they had performed vacy. She acted unprofessionally when she inten-
an exam on this morning. Jenny and Sara tionally spread malicious information about Mr.
work as radiographers in the radiology depart- Johnson. Sara and/or Jenny could be accused of
ment. “What is the story with the drunk patient violating civil tort law which is punishable with
in the emergency room?” Jenny asked. Sara a fine. Mrs. Johnson may have a legal case of
replied, “another technologist told me that slander as well as a violation of HIPAA policies.
Mr. Johnson owns a bank in town. He was so Sara and Jenny should not have been discussing
drunk this morning that he was slurring his a patient outside the radiology department. Shar-
speech and stumbled and hit his head on the ing patient information must be done in an area
marble floor at the bank! When we got to the where unauthorized personnel cannot overhear
emergency room there was blood everywhere what is being said about the patient. In fact, if a
and the nurses were giving him some type of radiographer is not directly involved in the exam
medication to calm him down.” Suddenly from they are guilty of unprofessional behavior when
behind them they heard a rather loud “Excuse they discuss details about the patient and/or the
exam with another radiographer.
Review Questions

6. The use of arm and leg restraints without the

Multiple Choice express order of the physician or the patient’s
permission could result in charges of
A. battery
1. The professional society for radiologic technolo- B. false imprisonment
gist in the United States is C. invasion of privacy
D. assault
A. ASRT
B. ISRRT 7. _________ is the omission of reasonable care in
C. AEIRS the constructs of a professional relationship.
D. ARRT
A. nonmaleficence
2. HIPAA protects the patient’s B. misdemeanor
C. malpractice
A. pain
D. neglect
B. asthma
C. privacy 8. Which of the following is NOT a cause for
D. family malpractice?
3. Assault is the unlawful A. The patient did not fully disclose his or her
medical condition of COPD.
A. touching of the patient without his or her consent
B. The patient suffered injury or some loss.
B. patient information spread without the patient’s
C. The person being sued is the party responsible for
consent
the loss.
C. yelling at the patient
D. The loss is directly attributed to negligence or
D. none of the above
improper practice.
4. Principle 9 for the technologist refers to
9. When correcting entries in the medical record,
A. performs service with competence and expertise which of the following must be completed?
B. exhibits no prejudice
A. Use four digits for the year in the date of the
C. protects the patient’s right to privacy
entry.
D. performs tasks competently
B. Always initial and date corrections.
C. Never leave any blanks on the form.
5. Which of the following protects the patient’s
D. All of the above must be done.
medical information?
A. Misconduct
B. HIPAA
C. Medical history
D. Slander
 Chapter 22: Medical and Professional Ethics 345

10. __________ is defined as a person’s right to make 6. Which federal policies are guidelines for protecting
rational decisions concerning his or her life. patient’s health information?

A. Veracity
B. Fidelity
C. Autonomy
D. Beneficence

7. When a radiographer administers the incorrect

medication to a patient, the radiographer may be
Short Answer guilty of __________.

1. The radiologic technology field has two major pro-

fessional organizations which are __________ and
__________.
8. Define beneficence.

2. What are the criteria of a profession? How does

9. _________ and ________ are often committed at
radiologic technology meet these criteria?
the same time.

3. Define professional ethics.

10. The Radiologic Technologist practices ethical
conduct befitting the profession is which ethical
principle?

4. Provide an example of an unintentional tort.

5. Explain the purpose for patient rights and

responsibilities.
 23

Patient Care, Medications,

Vital Signs, and Body Mechanics

Objectives Key Terms

Upon completion of this chapter, the student ● base of support ● infiltration
will be able to: ● bradycardia ● ionic
1. Understand the proper administration of ● bradypnea ● line of gravity
giving medications and contrast media. ● BUN ● nonionic
2. Identify the different contrast media and the ● center of gravity ● sphygmomanometer
common patient reactions. ● creatinine ● tachycardia
3. Understand and be able to perform proper ● dyspnea ● tachypnea
vital signs. ● extravasation ● venipuncture
4. Describe and apply proper body mechanics ● hemostasis
used in lifting and transferring patients.

346
 Chapter 23: Patient Care, Medications, Vital Signs, and Body Mechanics 347

A video for this topic can be viewed at

Introduction http://thepoint.lww.com/FosbinderText

Patient care is a vital part of Radiography and The technologist is responsible for applying these five
Radiologic Technology. Patient care is included rights to every patient who will be receiving medication.
on the National Registry Exam which makes up In addition, the radiographer must document the admin-
five content-specific areas for the A.R.R.T exam. istration of medication in the patient’s medical record.
This chapter covers intravenous (IV) injection The documentation should include the five rights of
of various contrast agents, needles, syringes, administration, any reaction the patient had to the medi-
injection sites, vital signs, body mechanics, and cation, course of treatment for the reaction, and outcome
patient transfer. of the treatment.
The radiologic technologist would give very little con-
trolled medication. The special procedure or interven-
tional technologist might administer diazepam (Valium)
Administration intravenously to a patient sometimes, but a lot of radio-

of Medications logic technologists will administer contrast agents IV for

a lot of different exams.
CT, MRI, and urinary studies, such as IVPs, require the
In the radiology department, various types of medications administration of contrast media to adequately visualize
are administered to patients for imaging examinations. anatomy. Any time iodinated contrast media is given there
Contrast media is considered a pharmaceutical agent is always a possibility of contrast reactions. The technolo-
because it causes effects in the body. The radiologic gist needs to have all supplies necessary to aid the patient
technologist must be competent in administering routine for any reaction that could occur. Medications and con-
medications in a safe manner for patients. The radiogra- trast administration routes consist of IV injections, oral,
pher’s role is to work with existing IV lines or to start an and intramuscular injections. The technologist should
IV for the procedure. In the acute care or short stay sur- assemble all necessary supplies to perform venipuncture
gery environment, many patients will have an established so the IV can be established.
IV line for administration of fluids and medications. The
radiographer will need to know how to use existing IV
lines connected to infusion pumps to safely inject con-
Needle Sizes and Types
trast media for radiographic examinations. Needle size is measured in gauge sizes. They come in
When preparing to administer medication to a patient gauge sizes of 18, 20, 21, 22, and 26 for most needles.
the technologist must verify the patient identification and The smaller the gauge size, is the larger circumference of
check the order to determine the dosage of medication the needle. For example, an 18 gauge is a larger needle
to be given. Second, the medication and expiration date than a 21 gauge. Most IV injections performed in radiol-
must be verified. Third, check the patient’s chart for a his- ogy for contrast injection uses a 21 gauge needle and an
tory of allergies or obtain the information from the patient. 18 gauge for arterial injections. The 26-gauge needle is
Finally, the technologist must perform hand hygiene prior routinely used for placing a wheal of medication into the
to handling the medication. There is a proper practice we superficial layers of the skin as in a TB skin test. In the
follow when we must administer any medications. This is radiology department the radiologist often places a wheal
called the five rights of medication administration: of lidocaine in the area where a needle puncture will be
made. This is done to numb the skin and decrease the
1. The right dose amount of pain the patient experiences.
2. The right patient There are different types of needles to choose from
3. The right medication and the type of injection will determine the type and size
4. The right time of needle which will be used. The straight steel needle
5. The right route has a hub which is attached to a Luer-Lock syringe
348 Part VI: Patient Care

18 Gauge

Figure 23.3. Photo of angiocath needle.

into a vein. Once the needle is properly placed in the vein,

21 Gauge the wings can be taped to the skin to secure the needle in
place. The tubing comes in various lengths to connect to
a handheld syringe or an automatic injector syringe.
Angiocath (peripheral) is a needle with a flexible cath-
eter surrounding it (Fig. 23.3). Once inserted, the needle
is removed and the catheter remains in the vein. This
26 Gauge also has a hub with a Luer-Lock device. The purpose of a
flexible angiocath is to allow movement of the arm at the
Figure 23.1. Photo of straight needles and different gauges.
insertion site. This is commonly used in CT, MRI, and
interventional radiology where movement of the arm is
(Fig. 23.1). This type of lock provides a secure connection necessary.
of the needle to a syringe.
Winged needles come with one or two wings com- Insertion of a Needle
monly referred to as the butterfly needle. This needle also The method of inserting a needle is dependent upon the
has a short tubing with a hub at the opposite end from the parenteral route which is most appropriate for the medi-
needle. The hub can either be a Luer-Lock or tapered cation. In radiography we typically use a superficial vein
end; each is designed to fit a corresponding syringe. in the arm which requires the needle to be inserted at
The Luer-Lock hub is attached to a Luer-Lock syringe approximately a 15- to 30-degree angle. Needles have
(Fig. 23.2). The wings of the butterfly needle provide a a beveled side where the bore of the needle is. As seen
secure method of holding onto the needle as it is inserted in Figure 23.4, during insertion the bevel side must be

18 Gauge 21 Gauge 26 Gauge

Figure 23.2. Photo of wing type

needles.
 Chapter 23: Patient Care, Medications, Vital Signs, and Body Mechanics 349

syringe; the contrast comes in a 50-mL amount. This

allows room for the 60-mL syringe plunger to be pulled
back to 50 mL.
Needle Skin
15-30˚

Vein Venipuncture
A video for this topic can be viewed at
Figure 23.4. Diagram of a beveled needle piercing the http://thepoint.lww.com/FosbinderText
vein at a 15 to 30 degree angle.
The IV route is used most frequently to deliver an injec-
tion of contrast media for a radiographic examination.
facing up to make the insertion into the vein easier. This
Venipuncture is used to establish an IV site for this injec-
bevel should puncture the skin first and then the vein.
tion. Venipuncture can be accomplished with a butterfly
set, angiocath, or angioset. There are several steps involved
Syringes in performing venipuncture and are explained below.
Most injections in radiology utilize plastic syringes
because they are disposed off after they are used for injec- Venipuncture Sites
tions. They basically have three parts to each syringe
The medication or contrast agents are injected into a
(Fig. 23.5). The tip where the needle is attached, the
vein. The most common site for venipuncture injection
barrel where the milliliters marking are placed, and the
in radiology is the basilica vein on the medial side of the
plunger located on the inside of the syringe.
anterior surface of the forearm and elbow. Superior from
Syringes come in different sizes or milliliter volume.
the basilica vein on the medial side of the forearm is the
The milliliter markings are placed on the syringes. General
median cubital or antecubital vein. The lateral side of the
syringe sizes in radiology are 5, 10, 20, 60, and 100 mL.
forearm even with the antecubital vein is the cephalic vein
Most syringes are the Luer-Lock kind. They have a lock-
(Fig. 23.6). Selecting a vein can be a challenge especially
ing device at the tip which holds the hub of the needle.
on children or elderly adults; however if these simple
Most IV contrast is injected intravenously with a 60-mL
steps are followed, it will make the selection easier.

● Apply tourniquet 3 to 4 inches proximal to antecu-

bital area.
● Vein must be readily seen and palpated.
● Vein must be at least two times the diameter of the
needle.
● Vein does not appear to curve for a distance equal
to the length of the needle.
Luer-Lock
Connection Barrel Plunger ● If the vein is not apparent, let the arm hang down
for a few seconds to engorge veins.
● If a vein is still not seen remove the tourniquet and
repeat this process with the other arm.

ml markings
A video for this topic can be viewed at
Figure 23.5. Photo of a typical syringe with its parts http://thepoint.lww.com/FosbinderText
marked.
350 Part VI: Patient Care

site. An alcohol wipe may be used on the site instead of

antiseptic solution. The skin is to be cleansed in a circu-
lar motion from the inside to the outside; this prevents
oils and pathogens from being placed over the cleansed
area. The puncture site is now ready and should not be
touched with the technologist’s gloved finger (Fig. 23.7).

Cephalic v. Injection
Basilic v.
Brachial a. When injecting a drug or contrast media by IV injection,
Median the site should be observed for any signs of extravasation
cubital v. or infiltration. Extravasation occurs when the contrast
Accesory
cephalic v. media has leaked out of the vessel and has been injected
into surrounding tissue out of the vein. When this occurs
Basilic v. the injection should be stopped immediately, the needle
should be removed and apply pressure to the site until
bleeding has stopped. If the patient is experiencing pain
Cephalic v. at the injection site a cold compress is applied to relieve
Median
antebrachial any discomfort. The extravasation should be attended
vein to before the technologist proceeds with an injection at
another site. After the injection is complete, the IV site
must be maintained until the end of the procedure. If the
patient has a reaction to the contrast media or medica-
tion that was injected, the physician has an established
IV that can be used to inject medication to counteract
the reaction. When the examination is completed the
Figure 23.6. Veins used for venipuncture. needle is removed and hemostasis is achieved before the
patient is dismissed. The needle must remain attached
Once the vein is selected the skin needs to be cleansed to the syringe and uncapped when placed in the sharps
in preparation for the puncture. All supplies should be container, this will prevent an accidental needle stick.
close by so that there is no delay in puncturing the vein.
Supplies needed include:

● Needle Contrast Media

● Antiseptic solutions
● Cotton ball
● Tape Aqueous or water soluble iodinated contrast media is
● Band-aid used for injection into arteries and veins. This contrast
● Syringe filled with contrast media media has an iodine content which is bound chemically,
● Gloves uses water as the principal solvent, and uses meglumine
salts to improve solubility. These contrast agents readily
mix with blood and body fluids. The iodine absorbs radia-
tion to a greater degree than soft tissue or vessels causing
Skin Preparation the structure to appear white on the radiographic image.
The injection site must be prepared by using a ster- This white appearance allows the visualization of the soft
ile method and the use of antiseptic solution which is tissue structures and vessels for the purpose of providing
a disinfectant that kills pathogenic bacteria on the skin a diagnosis.
 Chapter 23: Patient Care, Medications, Vital Signs, and Body Mechanics 351

B
A

C D

Figure 23.7. (A) Place tourniquet and select vein.

(B) Cleanse area. (C) Anchor skin for puncture. (D) Tape
needle in position. (E) Remove needle and hold pressure
E over site.

Ionic Versus Nonionic resist disassociation when mixed with blood. This results
in fewer, less severe contrast reactions. Nonionic contrast
Contrast Media media is primarily used because they are safer for the
There are two types of iodinated contrast media: ionic patient without having to compromise on the quality of
and nonionic. Ionic contrast media contains three par- the image.
ticles of iodine and three side chains on the benzoic acid
ring. Upon injection into the vessel this benzoic ring
disassociates or breaks apart. This results in a higher num-
Precautions
ber of contrast media reactions. Nonionic contrast media Compromised renal function impairs the kidneys abil-
also contains the three particles of iodine and three side ity to eliminate contrast media and may result in a toxic
chains on the benzoic ring; the primary difference is in response. The patient’s kidneys can still be affected
the chemical compounds of the three side chains which by either type of contrast that is used; this is why the
352 Part VI: Patient Care

patient has to have prior laboratory test to determine reassurance; ongoing patient observation and monitoring
the creatinine levels and the BUN (Blood, Urea, and is essential during any IV contrast injection. The tech-
Nitrogen) levels. If these levels are high prior to the nologist should take a complete history on the patient
contrast exam, the exam could be cancelled until these prior to any contrast injection and notify the radiologist
levels become normal. The normal values for the BUN of any potential contraindications.
is 8.0 to 24.0 and the normal values for creatnine is 0.8
to 1.3. Any iodine containing contrast media can cause
a reaction at any time, even if the patient has been given
contrast media before without any reaction. A contrast
Vital Signs
media reaction is known as anaphylaxis and must be
treated immediately.
A video for this topic can be viewed at
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Contrast Media Reactions
Iodinated contrast media reactions can be mild, moder- Vital signs include the patient’s blood pressure, pulse
ate, or severe. The radiographer must observe the patient rate, respiratory rate, and body temperature. Vital signs
after the injection for at least 20 minutes for any sign of measure the proper homeostasis, or internal environ-
a reaction. If a reaction is seen the radiologist must be ment, of the body. It is very important that the radiog-
notified immediately in order for a course of treatment rapher understands vital signs and is able to obtain
to counteract the reaction to be determined. The type of accurate vital sign readings. During any type of contrast
symptoms the patient experiences will indicate the level media reaction, the technologist will be asked to obtain
of severity for the reactions. Symptoms of these reactions the patient’s vital signs. Even with minor patient anxi-
are listed on Table 23.1. ety, the patient’s blood pressure can change and his or
Any of these contrast reactions need appropriate her respirations can increase. The patient should receive
patient care such as medication to counteract the symp- reassurance from the technologist. Listed are the normal
toms. These include giving oxygen, nitroglycerine, atro- values for the vital signs.
pine, epinephrine, rapid IV fluids, and taking vitals signs.
The radiographer should provide positive support and
Blood Pressure
TABLE 23.1 CONTRAST MEDIA REACTIONS Blood pressure readings are obtained with a sphygmoma-
nometer and a stethoscope (Fig. 23.8). The sphygmoma-
Mild Severe nometer is also known as a blood pressure cuff. The cuff
Urticaria Laryngeal edema is placed on the upper arm or humerus above the antecu-
Flushing Unresponsiveness bital space. To inflate the cuff, a bulb is used which is part
Chills Convulsion
Edema of eyes and face Arrhythmias
of the sphygmomanometer. When the bulb is pumped up
Sneezing Cyanosis to approximately 180 mm Hg, the cuff fills with air and
Coughing Dyspnea cuts off the systolic pressure by collapsing the brachial
Head ache Profound shock artery. When the cuff is deflated slowly, the needle on the
Nausea, vomiting Respiratory arrest gauge will move slowly and arterial sound can be heard
Itching Sudden drop in blood pressure through the stethoscope. The first sound heard is the sys-
Diaphoresis Apnea
Cardiac arrest
tolic pressure. When this sound fades and goes away, this
Moderate pressure is the diastolic. Blood pressures are measured by
Wheezing systolic over diastolic. The new normal blood pressure
Excessive urticaria
Hypotension, hypertension
for an adult is 119 over 79 mm Hg. When the systolic
Bronchospasms pressure is between 120 and 139 mm Hg and the dia-
Bradycardia, tachycardia stolic pressure is between 80 and 89 mm Hg the patient
is considered to have prehypertension. Prehypertension
 Chapter 23: Patient Care, Medications, Vital Signs, and Body Mechanics 353

Blood Pressure Cuff

Blood pressure gauge Stethoscope Temporal

Bulb pump
Carotid

Apical

Radial
Femoral

Popliteal

Pedal
Figure 23.8. Illustration of the placement of a blood pres-
sure cuff and stethoscope.
Figure 23.9. Pulse points on the body.

is likely to increase the risk of a heart attack or stroke if

left untreated. When the systolic and diastolic values are femoral artery, apical or apex of the heart, and pedal
higher than 140 systolic and 90 diastolic, this is known as pulses in the feet. Normal pulse rates are 60 to 100
hypertension or high blood pressure. When the values beats/min in the resting adult. Children have rates
are low, systolic pressure below 90 mm Hg and diastolic of 70 to 120 beats/min. When the adult pulse rates
below 50 mm Hg, it is known as hypotension. This is an are over 100 beats/min, this is known as tachycardia.
indication of shock and must be treated immediately as When the pulse rate is below normal or very decreased
shock is a life threatening occurrence. it is known as bradycardia.

Pulse Rate Respiration Rates

Pulse rate is the patient’s heart rate. The pulse rate is Respiration rate is the number of breaths a patient
measured by placing the forefinger and middle finger takes per minute. When a patient shows evidence of
over a superficial artery. There are three common sites respiratory distress, a respiratory rate will aid in making
for measuring a patient’s pulse rate: the radial artery on an assessment. The normal cycles of respiration for an
the thumb side of the anterior wrist, brachial artery on adult at rest are 12 to 20 breaths/min. Children are 14 to
the anterior side of the antecubital part of the elbow, 30 breaths/min. Slow breathing with fewer than 12 breaths/
and the carotid artery in the neck region (Fig. 23.9). min is called bradypnea and rapid breathing in excess of
The radial artery is the most commonly used artery 20 breaths/min is called tachypnea. When a patient com-
for alert patients while the carotid artery is used for plains of having a difficult time breathing (dyspnea) or
unconscious patients. Other pulse points include the exhibits an abnormal respiratory rate, the radiologist must
354 Part VI: Patient Care

be notified immediately. The radiographer must prepare TABLE 23.2 RULES OF BODY MECHANICS
supplemental oxygen equipment for immediate use if the
radiologist orders it. Provide a broad base of support.
Work at a comfortable height with the table or bed.
Bend your knees and keep your back straight when lifting.
Body Temperature Keep the load close to your body and well balanced.
An accurate temperature reading provides important Roll or pull a heavy object. Avoid pushing or lifting.
information about the body’s metabolic state. In the
medical imaging department the technologist is rarely
required to take a patient’s temperature, however they
must be able to do so competently. The normal body
Principles of Body Mechanics
temperature varies from 98.6°F to 99.8°F when taken Standard ways of proper body mechanics include the
orally. The technologist can take the patient tempera- base of support, center of gravity, and line of gravity.
ture by various methods: oral, axillary, rectal, tympanic,
or temporal artery. Temperatures can be measured in 1. Base of support: The portion of the body that is in
Fahrenheit (F) or in Celsius (C). The axillary tempera- contact with the floor. It is important to have a secure
ture is usually 1 degree lower than oral and the rectal base of support and this is when the technologist stands
temperature is 1 degree higher. Radiographers are rarely with his or her feet spread. A broad base of support
required to obtain a rectal temperature. In the past, the provides stability for body position and movement.
rectal route was routinely used for pediatric patients but 2. Center of gravity: This is the point at which your body
this has been mostly replaced by using tympanic or tem- weight is balanced, typically at the pelvis or lower
poral artery thermometers. abdomen. The body is most stable when the center of
The glass thermometers are no longer used in clinical gravity is nearest the center of the base of support.
settings because of regulations which strictly limit the use 3. Line of gravity: This is a vertical line passing through
of any device that contains mercury. These thermometers the center of gravity. The body is most stable when
have been replaced with electronic digital thermometers the line of gravity intersects with the base of support.
which are safer for patients and which provide a reading
in a few seconds. Using these concepts, the technologist will minimize
the risks of injury when moving patients. There are five
simple rules that should be followed to safely move
patients (Table 23.2). Also avoid bending and twisting at

Body Mechanics the waist when lifting objects because this will cause back
strain (Fig. 23.10). A broad and stable base of support is
accomplished by standing with the feet approximately
shoulder width apart with one foot slightly advanced. The
A video for this topic can be viewed at knees should also be slightly bent to engage the strong
http://thepoint.lww.com/FosbinderText thigh muscles. Planning ahead and using the resources
available to you will help decrease injury for all members
The principles of proper body alignment, movement, of the team when transferring patients.
and balance are called body mechanics. Using proper
body mechanics minimizes the amount of effort required
to perform tasks that require stooping, lifting, pushing, Transferring Patients
pulling, and carrying objects or patients. It is important
to know the proper way to lift and transfer patients to
avoid injury to the patient or to yourself. The most com- Patients are often transported to radiology by wheelchair
mon injury occurs in the back; in particular, the lumbar or cart. Some patients are capable of ambulating with-
spine. out any difficulty and do not need a wheelchair or cart.
 Chapter 23: Patient Care, Medications, Vital Signs, and Body Mechanics 355

move forward in the wheelchair, and have the patient

stand up and pivot with the patient’s back toward the table
and hands holding the table. Then assist the patient on the
table in a seated position prior to lying down.
If the table height is fixed, position a step stool with a
tall handle nearby. After the patient has stood up, have
the patient place one hand on the stool handle and hold-
ing your hand with his or her other hand. Your free hand
should be placed around the patient’s waist for support.
The patient should step up onto the stool, pivoting with
his or her back to the table. Assist the patient to sit and
then lie down on the table.
To return the patient to his or her wheelchair, the pro-
cess will be reversed. Special care must be taken if the
patient has one leg that is weaker than the other leg. For
this type of patient, remember this saying, “The good leg
goes up and the bad leg goes down.” In other words, when
assisting the patient up onto the table, the “good leg” goes
up onto the step stool first because it is the strongest. When
assisting the patient off the table, the “bad leg” goes down
first, and you will be standing on the patient’s “bad” side
Figure 23.10. Proper body mechanics while lifting. to support him or her much like using a crutch.

When lifting or transferring a patient, the technologist Cart Transfers

establishes a proper stable base of support. The limb
muscles should be used to lift the patient. Always let the A cart or stretcher is used to transport any patient who
patient do as much of the transferring as possible. This is not able to stand safely. For the cart or stretcher trans-
would occur with the independent patients. The wheel- fer, place the cart along side the table and lock the
chair and cart are routinely used for transferring patients wheels. If the patient is capable of self-transfer, allow
to the radiology department. Using this equipment may the patient to move on his or her own and provide sup-
seem elementary, but care must be taken to prevent falls port. When you are alone, it is advisable to place one
and accidents. arm underneath the patient’s shoulders and the other
arm under the patient’s pelvis. On your command, have
the patient push with his or her feet and elbows as you
Wheelchair Transfers lift and pull the patient toward the stretcher. If this can-
not be done safely, seek assistance from another health
A video for this topic can be viewed at care professional.
http://thepoint.lww.com/FosbinderText If the patient cannot move with assistance, there are
various techniques that can be used depending on the
When preparing to transfer a patient from his or her wheel- patient’s weight and ability to assist. When planning a
chair to the x-ray table, always place the wheelchair parallel transfer, it is best to have adequate staff available to help
to the table with the wheels locked and move the foot- move the patient. Two methods of transfer involve the use
rests out of the way prior to assisting the movement of the of draw sheets and slide boards to safely move the patient.
patient. If you are fortunate enough to have an x-ray table With either method, the patient should be instructed to
that is adjustable in height, then it will need to be lowered place his or her arms across the chest to protect the arms
to match the height of the wheelchair. Have the patient and hands during the transfer.
356 Part VI: Patient Care

Draw Sheet Transfers the patient will not fall or attempt to climb off without
A single sheet is folded in half and placed under the assistance. Application of side rails during transport is an
patient between the shoulders and hips. When moving extremely important safety practice that must be followed
the patient the edges of the draw sheet are rolled up close without exception. Side rails must also be raised when
to the patient’s body. The rolled edges provide a handhold the patient is left unattended on a stretcher.
for lifting and pulling the patient. While using proper body
mechanics the patient is transferred to the cart or x-ray
table. Care must be taken to ensure that the patient’s head
and feet move safely with the trunk of the body. These
Chapter Summary
transfers require at least two people to move the patient Administration of medication follows the five
and possibly more depending upon the patient’s weight. rights: (1) right dose, (2) right patient, (3) right
medication, (4) right time, and (5) right route.
The technologist must be skilled in selecting the
Slide Board Transfers appropriate needle size and type for each patient.
Needles come in different gauge sizes from 26 to
A video for this topic can be viewed at 18 gauge. Most departments use 21 gauge or 22
http://thepoint.lww.com/FosbinderText gauge needles for contrast injections. The skin at
the injection site is properly prepared for a sterile
Slide board transfer is a variation of a draw sheet trans- technique. Syringes come in different sizes from
fer. The slide board is a strong, rigid sheet of plastic 5 to 100 mL. When injecting contrast into the
that is large enough to support the patient’s body. The vein, the technologist must observe for any con-
slide board has handholds along each side to assist trast reaction that can occur. Allergic reactions to
the technologists in moving the slide board. To place the contrast media can be minor, moderate, or severe.
slide board the patient is rolled onto one side, the slide board Vital signs included body temperature, pulse
is placed under the draw sheet and approximately halfway rate, respiratory rate, and blood pressure. The
under the patient. The remaining width of the board spans radiographer must understand vital signs and
the space between the cart and x-ray table or bed. Have their normal values. The radiographer also must
the patient cross his or her arms safely across the chest; two be able to perform them on a patient.
technologists will grip the rolled edge of the draw sheet and Body mechanics are the proper way to lift
slide the patient smoothly across the board. Slide boards and transfer the patient. Proper body mechanics
reduce the amount of effort required to move a patient help to avoid injury to the technologist such as
while protecting the technologists from back injury. a back injury. Patients are transferred by either
Due to the morbid obesity of many patients, it is not wheelchair or cart. When assisting the patient
safe to use a draw sheet or slide board to transfer the onto the x-ray table, care must be taken to assist
patient out of the patient’s hospital bed onto a cart. Many the patient to stand on a step stool and sit on
facilities have employed the use of mechanical lifts to the table. The proper use of a draw sheet, slide
safely transfer patients. The mechanical lifts have a har- board, or mechanical lift will ensure the patient
ness which is secured around the patient and with the aid is moved safely from the cart to the x-ray table.
of hydraulics the patient is lifted out of bed. The tech-
nologist will assist in guiding the patient from the bed to
the cart where the patient will be gently lowered. This
maneuver can cause anxiety for the patient; however the Case Study
technologist can ease the anxiety by providing the patient
Janice has been sent to bring Juanita Watson
with an explanation of the maneuver and by reassuring
to the radiography department for an exam.
the patient throughout the process.
Juanita has been in the hospital for a few days
When transporting patients on a cart the side rails must
remain in the elevated and locked position. This ensures
 Chapter 23: Patient Care, Medications, Vital Signs, and Body Mechanics 357

and is on complete bed rest orders. Juanita the transfer on her own. If Juanita is not able to
weighs 185 lb and is able to sit up in bed. Janice move at all then Janice will need to have at least
will need to bring Juanita down on a cart. one other person help her transfer Juanita. Due
to Juanita’s weight Janice determines the slide
board is the most appropriate moving aid to
Critical Thinking Questions use. To move Juanita safely, Janice will need to
perform the following steps:
How can Janice determine the type of transfer
that is appropriate? 1. Position the cart next to Juanita’s bed, lower
the side rails, and lock the wheels.
How many people will Janice need to assist in 2. If Juanita is self transferring, Janice will need
moving Juanita? to assist her in moving to the cart.
3. If Juanita is not able to move on her own then
Which moving aid is most appropriate; draw Janice will use the slide board method.
sheet, slide board, or mechanical lift? 4. An assistant will roll Juanita onto one side
using a draw sheet.
What steps must Janice take to safely transfer 5. The slide board will be placed half-way under
Juanita from her bed to the cart? Juanita with the other half on the cart.
6. Juanita will be rolled back onto the slide board
and will fold her arms across her chest.
Janice must first talk with Juanita to 7. Janice and her assistant will then use the draw
determine if she is able to move on her own. sheet to move Juanita across the slide board
If Juanita can move from one side to the other and onto the stretcher.
she will likely be able to perform a self transfer, 8. The side rails will be elevated during the
in which case Janice may be able to perform transport.
Review Questions

5. The normal breaths per minute for an average

Multiple Choice adult is
A. 5 to 10
B. 12 to 20
1. Skin preparation for the injection site should C. 35 to 65
include D. 65 to 85
A. alcohol 6. Medications can be administered by which of the
B. antiseptic solution following routes?
C. warm saline
D. no preparation is needed 1. Orally
E. A and B 2. Intravenously
F. B and C 3. Rectally
A. 1 and 2
2. The term anaphylaxis is used to describe
B. 2 and 3
A. an inflammatory reaction C. 1 and 3
B. chest pain D. 1, 2, and 3
C. allergic shock
D. asthma 7. Patients may be moved by which methods?
1. Ambulation
3. A blood pressure of 120/80 mm Hg or 120 over 80.
2. Wheelchair
What is the 120 called?
3. Cart
A. Diastolic
A. 1 and 2
B. Systolic
B. 1 and 3
C. Dyspnea
C. 2 only
D. Top blood pressure
D. 1, 2, and 3
4. When lifting or transferring a patient from a
8. Which of the following is the opacifying agent in
stretcher to the x-ray table, you should
nonionic contrast media?
A. push the patient
A. Meglumine salts
B. bend at your waist and shove the patient
B. Iodine
C. pull the patient
C. Carbon ions
D. do not transfer the patient
D. Hydrogen ions
 Chapter 23: Patient Care, Medications, Vital Signs, and Body Mechanics 359

9. Which of the following are necessary to assess vital 5. What is the solubility agent in ionic contrast
signs? media?

1. Shygmomanometer
2. Stethoscope
3. Thermometer
A. 1 and 2
B. 1 and 3 6. List the rights of drug administration.
C. 2 only
D. 1, 2, and 3

10. A person with a heart rate over 100 beats/min is

experiencing
A. tachycardia 7. List the moderate reactions a patient can
B. bradypnea experience after contrast media injection.
C. tachypnea
D. bradycardia

Short Answer 8. What is the purpose of a slide board for cart

transfers?
1. Which vessels can be used for venipuncture?

9. When assisting a patient with difficulty standing

off a x-ray table which leg moves down to the step
2 List the supplies needed to perform venipuncture.
stool first?

3. Syringes are marked in _____.

10. Which type of connection is used on needles and
syringes?

4. The needle with the smallest gauge number has

the _____ diameter.
 Glossary

absorbed dose quantity of radiation in rad or gray (Gy). automatic brightness control (ABC) a circuit that
absorption complete transfer of the x-ray photons’ maintains the fluoroscopic image at a constant brightness.
energy to an atom. autotransformer a transformer with a single winding
activator the chemical used in film developing to main- used to change the input voltage to a step-up or step-
tain the pH balance. down transformer.
activity describes the quantity of radioactive mate- base plus fog the density on the film at no exposure.
rial; expressed as the number of radioactive atoms that base the base material that the film or intensifying
undergo decay per unit time. screen is made from; it is usually polyester, tough, rigid,
actual focal spot the physical area on the focal track stable, and uniformly radiolucent.
that is impacted. beam quality the penetrating characteristics of the x-ray
air core transformer a simple transformer made with beam.
two coils of wire placed close to each other to facilitate beam quantity the amount or intensity of the photons
induction. in the x-ray beam.
air gap technique a technique that uses increased OID beta particle ionizing radiation with characteristics of
to reduce scatter radiation reaching the image receptor. an electron; emitted from the nucleus of radioactive
alpha particle ionizing radiation having two protons and materials; it is very light and negatively charged.
two neutrons emitted from the nucleus of a radioisotope. bipolar every magnet has two poles; a north pole and a
alternating current (AC) current that flows in a posi- south pole.
tive direction for half of the cycle and then in a negative bone mineral densitometry measures the density of
direction for the other half of the cycle. bone mineralization to assist the diagnosis of
ampere the unit of electric current; it is the number of osteoporosis.
electrons flowing in a conductor. bremsstrahlung interactions x-rays produced when
amplitude the maximum height of the peaks or valleys projectile electrons are stopped or slowed in the anode.
of a wave. Bucky factor the ratio of the mAs required with a grid
analog-to-digital converter (ADC) converts an analog to the mAs required without a grid to produce the same
signal to a digital signal for a computer to analyze. optical density. The amount of mAs increase required
angulation angle of the beam that creates a controlled when a grid is added.
or expected amount of shape distortion. Bucky grids moving grids designed to blur out the grid
anode angle the angle between the anode surface and lines and absorb scatter radiation.
the central ray of the x-ray beam. capacitors an electrical device used to temporarily store
anode the positive electrode of an x-ray tube that con- electrical charge.
tains the target that is struck by the projectile electrons. carriage the arm that supports the fluoroscopic equip-
atomic mass number (A) the number of nucleons ment suspended over the table.
(neutrons plus protons) in the nucleus. cathode ray tube television monitor used to display the
atomic number (Z) the number of protons in the fluoroscopic image.
nucleus. cathode the negative electrode of an x-ray tube, which
attenuation the removal of incident x-ray photons from contains the filament that emits electrons for x-ray
the beam by either absorption or scattering. production.

361
362 Glossary

characteristic cascade the process of electrons moving developing the step in film processing where exposed
into the holes created during a characteristic interaction silver halide crystals turn into metallic silver making the
until there is only a hole in the outer shell. latent image visible.
characteristic curve a graph of optical density and diamagnetic materials magnetic materials that are
relative exposure that is characteristic of a particular weakly repelled by a magnet.
type of x-ray film. differential absorption varying degrees of absorption in
characteristic interactions x-ray production that occurs different tissues that results in radiographic contrast and
when an orbital electron fills a vacancy in the shell of visualization of anatomy.
the atom. digital imaging and communications in medicine
cine cinefluorography is associated with rapid (DICOM) computer software standards that permit a
(30 frames per second or more) sequence filming. wide range of digital imaging programs to understand
clearing agent the primary agent, ammonium thiosul- each other.
fate, in fixer that removes undeveloped silver bromine digital-to-analog converter (DAC) converts a digital
from the emulsion. signal to an analog signal.
closed core transformer a transformer with two coils direct current (DC) current that flows in only one
of wire each with an iron placed close to each other to direction.
facilitate induction. distortion a misrepresentation of the size and shape of
coherent scattering low-energy scattering involving no the anatomic structures being imaged.
loss of photon energy, only a change in photon direction. Dmax the maximum density the film is able to record.
Compton scattering scattering of x-ray photons that drive system the mechanical system responsible for
results in ionization of an atom and loss of energy in the turning the rollers in the processor.
scattered photon. effective dose the dose to the whole body that would
conductor a material in which electrons can move freely. cause the same harm as the actual dose received from
contrast agent material added to the body to increase the examination; used to measure the radiation and
the subject contrast. Contrast media has densities and organ system damage in man.
atomic numbers very different from body tissues. effective focal spot the area of the focal spot that is
contrast the difference between adjacent densities that projected toward the object being imaged.
makes detail visible. electric field the force field surrounding an object,
conversion efficiency a measure of a screen’s efficiency resulting from the charges of the object.
in converting x-ray photon energy into light energy. electrification occurs when electrons are added to or
coulomb the standard unit of charge. subtracted from an object.
Coulomb’s law the electrostatic force between two electrodynamics the study of moving electric charges.
charges is directly proportional to the product of their electromagnet temporary magnet produced by moving
quantities and inversely proportional to the square of the electric current.
distance between them. electromagnetic induction production of a current in
crossed grids two linear grids placed on top of one a conductor by a changing magnetic field near the
another so that the lead strips form a crisscross pattern. conductor.
crossover effect blurring of the image caused by light electromagnetic spectrum describes the different
from one screen crossing into the light from another forms of electromagnetic radiation.
screen. electromagnetism deals with the relationship between
crossover network part of the automatic film proces- electricity and magnetism.
sor system designed to bend and turn the film when electromotive force (EMF) electrical potential that is
it reaches the top of the transport rack and must be measured in volts (V) or kilovolts (kV).
directed down into the next tank. electron binding energy the amount of energy needed
current the quantity or number of electrons flowing. to remove the electron from the atom.
densitometer a device used to measure the amount of electron volt measurement of the binding energy of an
light transmitted through the film, giving the numerical electron; the energy one electron will have when it is
value of its optical density. accelerated by an electrical potential of 1 V.
detail the degree of geometric sharpness or resolution electrostatics the study of stationary or resting electric
of an object recorded as an image. charges.
 Glossary 363

elongation projection of a structure making it appear generator a device that converts mechanical energy
longer than it actually is. into electrical energy.
emulsion layer a layer of gelatin containing the silver grid cutoff the interception of transmitted x-ray photons
halide crystals; thin coating that acts as a neutral lucent by the radiopaque strips of a grid, resulting in lighter
suspension for the silver halide crystals. density at one or both edges of the field.
ESE entrance skin exposure. grid frequency the number of lead strips per cm or
exit radiation the combination of transmitted and scat- per inch.
tered radiation that passes through the patient. grid ratio the ratio of the height of the lead strips to the
exposure angle the total distance the tube travels while distance between the lead strips in a grid.
the exposure is being made. grid scatter reduction device consisting of alternating
exposure quantity of radiation intensity (R or C/kg). strips of radiopaque and radiolucent material.
ferromagnetic materials materials that are easily Gurney Mott theory a theory of how the silver halide
magnetized. crystals are exposed to form a latent image and devel-
filament the source of electrons in the cathode. oped to form a visible radiographic image.
film contrast the difference in optical density between half-life the time it takes for a radioisotope to decay to
a region of interest and its surroundings. one half its activity.
film speed a measure of film sensitivity; faster films half-value layer (HVL) the thickness of an absorbing
require less exposure. material that will reduce the intensity of the primary
filtration the removal of low energy x-ray photons from beam by one half the original value.
the primary beam with aluminum or other metal. half-wave rectification rectification resulting from one
fixing the process where the reducing action of the half of the incoming alternating current being con-
developer is stopped and the undeveloped silver halide verted to pulsating direct current.
crystals are removed; makes the image permanent. hardener a chemical used to stiffen and shrink emul-
flat panel detector plates used in direct digital imaging. sion; prevents scratching and abrasions during
fluorescence the production of light in the intensifying processing.
screen phosphor by x-ray photons. heel effect decreased intensity from the cathode side of
fluoroscopy dynamic x-ray technique for viewing mov- the x-ray beam to the anode side. The lightest part of an
ing structures. image is at the anode side of the image.
flux gain a measurement of the increase in light hydroquinone a reducing agent in the developing solu-
photons due to the conversion efficiency of the output tion that slowly changes the silver halide crystals into
screen. metallic silver.
focal plane region of anatomy of interest in tomogra- image intensifier converts x-ray photons into a brighter
phy; also object plane. visible image.
focal spot blooming an increase in focal spot size with incident electron the electrons from the thermionic
an increase in mA caused by this electrostatic repulsion. cloud that bombard the anode target.
focal spot the area on the anode where the projectile insulator a material in which electrons are fixed and
electrons strike, the source of x-ray photons. cannot move freely.
focal track the area of the anode where the high-voltage intensifying screen increases the efficiency of x-ray
electrons will strike. absorption and decreases the dose to the patient by
focused grids grids whose radiopaque lead strips are converting x-ray photon energy into visible light
tilted to align, at a predetermined SID, with the diver- energy.
gent x-ray beam. inverse square law the Electrostatic Law that states the
focusing cup the shallow depression in the cathode force between two charges is directly proportional to the
that houses the filament or filaments. product of their quantities and inversely proportional to
foreshortening projection of a structure making it the square of the distance between them.
appear shorter than it actually is. involuntary motion movement that is not in the con-
frequency the number of cycles per second that are in trol of the patient.
a wave. ion an atom that has gained or lost an electron.
fulcrum pivot point between the tube and image receptor. ionization the process of adding or removing an
gauss (G) the SI unit for magnetism. electron from an atom.
364 Glossary

isotopes atoms of the same element whose nuclei open core transformer two coils of wire each having an
contain the same number of protons but a different iron core placed close to each other to facilitate
number of neutrons. induction.
keV kiloelectron volt. A measure of the energy of an optical densitometer a device to measure the blackness
x-ray photon or an electron. or optical density of a film.
kVp kilovoltage potential. A measure of the voltage optical density a measure of the degree of blackness of
applied to the x-ray tube. the film expressed on a logarithmic scale. The primary
latent image the unseen image stored in the exposed controlling factor is mAs.
silver halide emulsion; the image is made manifest dur- orthochromatic film sensitive to light from green-light
ing processing. emitting screens.
latitude range of exposures or densities over which a oscillating grid mechanism that moves the grid in a
radiographic image is acceptable. circular pattern above the image receptor.
leakage radiation radiation outside the primary x-ray pair production an interaction between x-ray photons
beam emitted through the tube housing. and the force field of the nucleus of an atom resulting
line focus principle used to reduce the effective area of in the x-ray photon energy being completely converted
the focal spot. into a positive and negative electron.
luminescence the ability of a material to emit light in panchromatic film sensitive to all wavelengths of
response to stimulation. visible light.
magnetic dipole a group of atoms with their dipoles parallel grids grids that have parallel lead strips.
aligned in the same direction. paramagnetic materials materials that are weakly
magnetic domain a group of atoms with their dipoles attracted to magnetic fields.
aligned in the same direction. penetrometer aluminum step wedge with increasingly
magnetic field the force fields that are created when thick absorbers; uses x-ray beam to produce step wedge
dipoles align in the same direction; also called lines of image for quality assurance.
force or lines of flux. period (of a wave) the time required for one complete
magnetic induction temporary alignment of dipoles cycle of a waveform.
when acted upon by a strong magnetic field. phenidone a reducing agent in the developing solution
magnetism the ability of a magnetic material to attract that rapidly changes the silver halide crystals into
iron, nickel, and cobalt. metallic silver.
magnification an increase in the image size of an phosphor layer a layer of material used in intensifying
object. screens that is capable of absorbing the energy from
matrix a group of numbers arranged in rows and incident x-ray photon and emitting light photons.
columns. phosphorescence the continuation of light emission
minification gain resulting from the electrons that from intensifying screens after the stimulation from the
were produced at the input phosphor being compressed x-ray photons ceases (afterglow).
into the area of the smaller output phosphor. photocathode converts light photons into photoelec-
motor an electrical device used to convert electrical trons in the image intensifier.
energy into mechanical energy. photodisintegration an interaction between an x-ray pho-
mutual induction the result of two coils being placed ton and the nucleus of an atom where the nucleus absorbs
in close proximity with a varying current supplied to the all the photons’ energy and emits a nuclear fragment.
first coil, which then induces a similar flow in the sec- photoelectric effect complete absorption of the inci-
ond coil. dent photon by the atom.
nonmagnetic materials materials that do not react to photoelectron an electron ejected from an atom fol-
magnetic fields. Examples: wood, glass, plastic. lowing a photoelectric interaction.
nucleons nuclear particles; either neutrons or protons. photon small bundles of energy used to produce
object plane region of anatomy of interest in tomogra- x-radiation; also called quantum.
phy; also focal plane. pixel a picture element of a matrix that contains infor-
off-focus radiation photons that were not produced at mation on its location and intensity.
the focal spot. positive beam limitation an automatic collimator that
ohm the unit of electrical resistance (W). adjusts to the size of the cassette.
 Glossary 365

potential difference the force or strength of electron rotor the central rotating component of an electric
flow; also known as electromotive force (EMF). motor, used to rotate the anode.
power the amount of energy used per second. Electric scattering the photon interaction with an atom result-
power is the current multiplied by the voltage and is ing in a change of direction and loss of energy.
measured in watts. section interval the distance between the fulcrum
preservative a chemical additive that maintains chemi- levels.
cal balance in the developer and fixer. section level the variable location of structures of inter-
protective coat a material used in an intensifying est, controlled by the fulcrum.
screen that is applied to the top of the phosphor layer to section thickness the width of the focal or object plane,
protect it from abrasions and trauma. controlled by tomographic angle.
quality assurance the activities that are performed to semiconductors a material that can act as a conductor
provide adequate confidence that high-quality images or insulator, depending on how it is made and its
will be consistently produced. environment.
quality control the measurement and evaluation of sensitivity speck an impurity added to the silver halide
equipment to maintain superior standards. crystals that attracts free silver ions during latent image
quantum mottle the random speckled appearance formation.
of an image, similar to the “snow” seen with poor TV sensitometer a device that uses light to produce a step
reception. Quantum mottle is greater when high-speed wedge image for processor quality assurance.
screens and low mAs techniques are used, because there sensitometry the measure of the characteristic
are fewer interactions. responses of film to exposure and processing.
radioactive decay the transformation of radioactive shell type transformer a central iron core with both the
nuclei into a different element followed by the emission primary and secondary wires wrapping around the iron
of particulate or electromagnetic radiation. core to facilitate induction.
radiographic contrast a combination of film and sub- shoulder region area of high exposure levels on a
ject contrast. characteristic curve.
radioisotopes an unstable isotope that spontaneously SID source to image receptor distance. The distance
transforms into a more stable isotope with the emission from the radiation source to the image receptor.
of radiation. signal-to-noise ratio (SNR) white noise that interferes
radiolucent low attenuating material or tissue that with the digital image.
appears dark on a radiographic image. single-phase circuits a circuit that allows the potential
radiopaque highly attenuating material or tissue that difference to build then drop to zero with each change
appears bright on a radiographic image. in direction of current flow.
rare earth screens rare earth phosphors employed in solvent chemicals suspended in water that are used in
intensifying screens such as gadolinium, lanthanum, developing film.
and yttrium. space charge effect with the buildup of electrons by the
reciprocity law the same mAs, regardless of the values filament, the electrons’ negative charges begin to oppose
of mA and seconds, should give the same image density. the emission of additional electrons.
recorded detail one of the geometric properties identi- spatial resolution the minimum separation at which
fied as the degree of sharpness in an image; also detail, two objects can be recognized as two separate objects.
sharpness, or spatial resolution. spin magnetic moment the magnetic effect created
rectifiers an electrical device that allows current to flow by orbital electrons spinning on their axes around the
only in one direction to convert AC into DC. nucleus of the atom.
reflective layer a layer of material used in an intensify- SSD source to skin distance.
ing screen to reflect light back toward the film. stator the fixed winding of an electric motor.
resistance the opposition to current flow. step-down transformer a transformer that has more
restrainer a chemical added to the developer to restrict turns in the primary winding than in the secondary
the reducing agent activity, acts as an antifogging agent. winding, which decreases the voltage.
ripple measures the amount of variation between maxi- step-up transformer a transformer that has more turns
mum and minimum voltage. in the secondary winding than in the primary winding,
rotating anode an anode that turns during an exposure. which increases the voltage.
366 Glossary

straight-line portion the useful range of densities on of tissue while structures above and below this plane
the characteristic curve. appear blurred.
subject contrast the difference in x-ray photon transformers electrical devices to change voltage from
transmission between different areas of the body. The low to high or vice versa.
primary controlling factor is kVp. transport racks part of the automatic processing trans-
superconductors a material in which electrons can port system consisting of three rollers located at the bot-
flow freely with no resistance when the material is tom of the processing tank that move the film through
cooled to an extremely low temperature. the tank.
tesla (T) the SI unit for magnetism. transport system part of the automatic processor
thermionic emission the emission of electrons by designed to move the film through developer, fixer,
heating of the filament in the cathode. wash, and dryer sections.
thin-film transistor (TFT) a photosensitive array, made vignetting the reduction of brightness at the periphery
up of small pixels, converts the light into electrical of an image.
charges. voltage a measure of electrical force or pressure.
three-phase circuit a full rectification circuit that volts the unit of potential difference.
produces a higher average voltage with less ripple. voluntary motion motion that can be controlled by the
toe region area of low exposure levels on a patient.
characteristic curve. wavelength the distance between adjacent peaks or
tomographic angle the total distance the tube moves adjacent valleys of a wave.
during a tomographic exposure; also tomographic x-ray beam quality a measurement of the penetrating
amplitude. ability of the x-ray beam.
tomography a radiographic imaging technique that x-ray beam quantity a measurement of the number of
uses motion to demonstrate structures lying in a plane x-ray photons in the useful beam.
 Index

Note: Page numbers followed by f indicate figure. Page numbers followed by “t” indicate table.

A Automatic exposure control (AEC) Body mechanics, 354, 354t, 355f

Absorbed dose, 3, 361 backup timer verification, 226 Bohr model, 4f
AEC. See Automatic exposure control circuit, 55–57, 56f Bone mineral densitometry (BMD),
Air gap technique, 179, 179f, 361 density 159–160, 361
Alternating current, 35, 35f, 46, 46f, 361 backup timer, 129 Bradycardia, 353
American Registry of Radiologic density controls, 129 Bradypnea, 353
Technologist (ARRT) Code of detectors, 128–129, 128f Breast imaging, 241
Ethics, 337–338 density variation control, 226 Bremsstrahlung interactions, 73–74,
Analog-to-digital converter (ADC), exposure reproducibility, 226 73f–74f
210–211, 213f, 361 ion chamber sensitivity, 226 Brightness gain
Anode mammography, 246–247, 247f automatic brightness control, 191
cooling curves/charts, 67–68, 67f response capability, 226 flux gain, 190
heat monitors, 68 Automatic film processing magnification tubes, 191–192,
materials, 63, 63f contamination, developer and fixer, 191f
rotating anode, 63–64, 63f 113 minification gain, 190
target area, 64, 64f developing, 111–112 total brightness gain, 190
As low as reasonably achievable drying, 113 Bucky factor, 173, 173t, 361
(ALARA), 322 fixing, 112, 112t Bucky grids, 361. See also Moving
Assault, 340 recirculation and replenishment, grids
Atomic mass unit (AMU), 7–8 113
Atomic models, 4, 4f washing, 112–113 C
Atomic number, 8 Autonomy, 339 Cancer, 302
Atomic structure Autotransformer, 49–50, 50f, 361 Capacitors, 40, 361
atomic nucleus, 5 Carcinogen, 302
electron binding energy, 6–7, 6f B Cart/stretcher patient transfers
electron shells, 5–6, 5f, 5t Backup timer, 57 draw sheet transfers, 355–356
ionization, 7, 7f Base of support, 354 slide board transfer, 356
matter, 4–5 Battery, 340 Cataracts, 301
Atoms Beam alignment, 309 Cathode, 361
alpha particle, 10 Beam angulation, 153–154 filament, 62, 62f
atomic mass, 7–8, 8t Beam hardening, 266 filament current, 62
atomic number, 8, 8t, 361 Beam quality and quantity focusing cup, 62, 63f
beta particle, 10 definition, 361 Cell damage, 291–292
half-life, 10, 10t x-ray interactions, 83 Center of gravity, 354
isotopes, 9–10 x-ray production, 75 Central nervous system syndrome,
periodic table, 8–9, 9f Beneficence, 339 300–301
radiations, radioactive decay, 10 Bergonie and Tribondeau law, 290 Characteristic curve, 107, 107f, 362
radioisotopes, 10 Bias focusing, 242 film contrast, 108, 108f
Automatic brightness control (ABC), Blood, urea, and nitrogen (BUN) film speed, 107–108, 108f
191, 233, 233t, 361 levels, 352 latitude, 108–109, 109f

367
368 Index

Circuits algorithm, 265 window level and width controls,

high-frequency circuits, 53–54, 54f exposure factors, 264 208–209, 210f–211f
ripple, 54, 55t field of view, 265 data compression, 217
single-phase circuits, 52–53, 53f section interval and thickness, 264 dry film processors, 216–217
three-phase circuits, 53, 53f, 54t scanning projections, 254, 254f film digitization, 216
Cloudiness. See Cataracts Conductors, 31 hard copy, 216
Coherent scattering, 84, 84f Cone vision, 185 image acquisition
Collimation, 261 Contrast. See also Image contrast; field of view (FOV), 206
Compton scattering, 86–87, 86f–87f, Optical density matrix and pixel size relationship,
362 image quality, 129 206, 208t
Computed radiography (CR) image/radiographic contrast picture elements/pixels, 205, 205f
benefit, 215 film contrast, 131–132 spatial resolution and pixel size,
dimensions and appearance, 211 subject contrast, 132–134 206, 207f
image formation and development, long- and short-scale contrast images, imaging system
214–215, 214f 129–130, 130f–131f, 131t ADC and DAC, 210–211, 213f
imaging plate, 212–213, 213f resolution, 235 components, 210, 212f
quality control, 231–232 technical factors affecting, 135 computed radiography, 215–216,
radiation dose, 213 Contrast media, 362 215f
resolution, 211 diagnosis, 350 direct radiography, 211–215,
Computed tomography (CT) ionic vs. nonionic, 351 213f–214f
artifacts precautions, 351–352 image acquisition, 210, 212f
beam hardening, 266 reactions, 352, 352t image sources, 211t
metal/star, 266, 266f Control panel components picture archiving and communica-
motion, 266 automatic exposure control circuits, tions system, 216
partial volume effect, 266–267 55–57, 56f Digital imaging and communications
ring, 267, 267f backup timer, 57 in medicine (DICOM), 216,
components kVp and mA selectors, 55 362
collimation, 261 timing circuits, 55 Digital mammography, 248f, 249
computer system, 262 X-ray circuit, 55, 56f Digital-to-analog converter (DAC),
CT number, 262–263, 263t Conventional fluoroscopy. See 210–211, 213f
display console, 262 Fluoroscopy Direct current (DC), 35, 35f, 46,
gantry, 258–259, 259f–260f Conversion efficiency, 95, 362 46f, 362
operator’s console, 262 Convolution, 265 Direct radiography, 215–216, 215f
patient support table, 261–262 Coulomb’s law, 25–26, 26f Distortion, 192–193, 362
radiation detectors, 259–261, Crossed grids, 171–172, 171f evaluation
260f–261f Crossover effect, 103, 362 shape distortion, 155, 157f
CT scanner generation size distortion, 155, 156f
fifth generation, 256 D size distortion/magnification
first generation, 255, 255f Darkroom, 116, 116f (see Magnification)
fourth generation, 256, 256f Data compression, 217 Doubling dose, 303
second generation, 255, 255f Daylight processing systems, 116–117, Dry film processors, 216–217
seventh generation, 257–258, 258f 117f Dry processing film, 117, 117f
sixth generation, 256–257, 257f Deconvolution, 265 Duplication film, 109–110, 110f
third generation, 255–256, 256f Densitometry, 105, 105f–106f Dyspnea, 353
historical perspective, 254 Density. See Optical density
image quality Deoxyribonucleic acid (DNA), 287–288, E
contrast resolution, 263–264, 287f Effective dose, 3, 321, 321t–322t
263f–264f Diagnostic mammography, 241 Electric currents and electricity
linearity, 264 Digital fluoroscopy. See Fluoroscopy capacitors, 40
noise, 264 Digital imaging direct and alternating currents,
spatial resolution, 263 data characteristics 35, 35f
image reconstruction, 265, 265f–266f contrast, 207–208 electric generators, 37–38, 38f
quality control, 234–235, 235t frequency, 206–207 electric motors, 38–40, 39f–40f
scanning parameters noise, 208 electric power, 35
 Index 369

electrical materials, 31, 31t law of movements, 26 drive system, 114

electrodynamics (see Electrodynamics) repulsion–attraction, 25, 26f extended processing, 115–116
electromagnetism unit, 25 processor quality assurance, 116
(see Electromagnetism) Elongation, 153, 363 rapid processing, 115
induction motors, 40 Entrance skin exposure (ESE), 200 transport racks, 114, 114f–115f
Ohm’s law, 34, 34f Epilation, 301 optical density, 105–107, 106f, 106t
Electrification Errors penetrometer, 105, 105f
contact, 24, 24f grid artifact, 178t sensitometry, 105, 105f
friction, 24 grid cutoff, 174–175 silver recovery, 116
induction, 24–25, 25f grid positioning, 174 types
negatively and positively charged off-center grid error, 175–176, duplication film, 109–110, 110f
object, 24, 24f 176f, 178 hard copy film and laser printer,
Electrodynamics, 362 off-focus grid error, 177f, 178 110
current, 32, 32f, 32t off-level grid error, 175, 176f mammographic film, 109, 109f
electric charge movement, 31 upside-down grid error, 178, 178f multiformat film, 110
resistance ESE. See Entrance skin exposure Film badge dosimeters, 315
conductive material, 32 Exposure, radiation, 3, 363 Film digitization, 216
conductor length, 32–33, 33f Extravasation, 350 Flat contact shields, 328
cross-sectional diameter, wire, Flat panel detectors, 215, 215f, 363
33, 33f F Fluorescence, 95
temperature, 33–34, 34f False imprisonment, 340 Fluoroscopy, 363
voltage, 32, 33f Fidelity, 339 brightness gain
Electromagnetic radiation Film and processing automatic brightness control, 191
characteristics automatic film processing flux gain, 190
amplitude, 19, 19f contamination, developer and magnification tubes, 191–192,
energy, 19 fixer, 113 191f
frequency and period, 17, 17f developing, 111–112 minification gain, 190
radiation intensity and the inverse drying, 113 total brightness gain, 190
square law, 20, 20f fixing, 112, 112t cone and rod vision, 185
velocity, 17 recirculation and replenishment, fluoroscopic displays
wavelength, 17, 18f 113 cathode ray tube, 197, 197f
types washing, 112–113 charge-coupled device, 196–197
electromagnetic spectrum, 15, 16 characteristic curve, 107, 107f output phosphor, 193, 193f
infrared radiation, 15–16 film contrast, 108, 108f target assembly, 193–194, 194f
microwaves and radar, 15 film speed, 107–108, 108f TV camera and monitor, 194
radio waves, 15 latitude, 108–109, 109f video camera tubes, 194–196,
visible and ultraviolet light, 16 darkroom, 116, 116f 194f–196f
x-rays and gamma rays, 16–17 daylight processing systems, 116–117, fluoroscopic rooms, 185, 186f
Electromagnetism, 362 117f historical perspective, 185
electromagnetic induction, 36–37, densitometry, 105, 105f–106f image archiving, 197
37f dry processing film, 117, 117f cine recording, 198
magnetic field, 36, 36f film construction digital recording, 198–199
mutual induction, 37, 38f double-emulsion film, 103, 103f spot filming, 198, 198f
production, electromagnet, 36 emulsion layer, 103–104, 104t videocassette recording, 198
Electron beam CT scanner (EBCT), latent image formation, 104, 104f image intensifier
256 polyester base, 103 anode, 189, 189f
Electrostatic lenses, 188, 188f, 191 standard cassette sizes, 103t electrostatic lenses, 188, 188f
Electrostatics, 362 film storage and handling, 110–111, input phosphor, 188
electric fields, 24 111f output phosphor, 189, 189f
electrification, 24–25 film transport system photocathode, 188
electrostatic laws concentration, time, and tempera- tower, 186, 187f
Coulomb’s law, 25–26, 26f ture effect, 115 image quality
law of concentration, 26, 27f crossover networks, 114, 115f contrast, 192
law of distribution, 26, 26f description, 113 distortion, 192–193
370 Index

Fluoroscopy (Continued ) occurrence, 169 transformers (see Transformers)

quantum mottle, 193 parallel grid, 169 High-voltage circuits, 54–55
resolution, 192 portable examination, 175 Human biology
mobile C-arm fluoroscopy, 199, 199f Grid ratio, 168–169, 363 DNA, 287–288, 287f
patient dose, 199–200 Grids RNA, 288
quality control collimation, 166–167, 167f
automatic brightness control, 233, construction I
233t grid frequency, 169 Image acquisition
exposure reproducibility, 233 grid ratio, 168–169, 168f field of view (FOV), 206
field size and beam alignment, materials, 167–168, 168f matrix and pixel size relationship,
233 errors 206, 208t
intensifier viewing system resolu- grid artifact, 178t picture elements/pixels, 205, 205f
tion, 233–234 grid cutoff, 174–175 spatial resolution and pixel size, 206,
monitors and recorders, 234 grid positioning, 174 207f
radiation output/exposure rate, 232 off-center error, 175–176, 176f, Image archiving, 197
spatial resolution, 232, 233f 178 cine recording, 198
spot film images, 233 off-focus error, 177f, 178 digital recording, 198–199
radiation regulation, 311–312, off-level error, 175, 176f spot filming, 198, 198f
311f–312f upside-down error, 178, 178f videocassette recording, 198
table, 186 exit radiation, 165, 165f Image contrast, 275, 275f. See also
technique, 185 moving grids Contrast
x-ray tubes, 186, 187f advantages, 172–173 film contrast, 131–132
Flux gain, 190 disadvantages, 172 subject contrast
Focal spot blooming, 66, 363 reciprocating and oscillating grids, contrast agent, 134
Focal spot sizes, 244 172 differential absorption, 132
Focused grids, 170–171, 170f–171f purpose, 165 influencing factors, 132t
Fogging, 232 scatter reduction techniques scatter, 135
Foreshortening, 153 air gap technique, 179, 179f tissue density, 133
Fringe field, 276 radiographic contrast improve- tissue thickness, 132
Full-wave rectification, 52, 53f ment, 167 tissue type and atomic number,
scattered radiation, 165–166, 166f 133, 133t
G selection x-ray energy, 134, 135f
Gantry Bucky factor, 173, 173t Image density. See Optical density
frame, 258 mAs, 173–174, 175f Image formation
radiation detectors (see Radiation types bone mineral densitometry, 159–160
detectors) crossed grids, 171–172, 171f density and contrast (see Contrast;
x-ray circuit, 258–259 focused grids, 170–171, 170f–171f Optical density)
x-ray tube, 259, 259f parallel grids, 169, 170f distortion
Gas-filled detectors, 260–261, 261f, stationary grids, 172 evaluation, 155, 156f–157f
314, 314f Grounding, 25, 25f size distortion/magnification,
Gastrointestinal syndrome, 300 Gurney Mott theory, 104, 363 150–155
Geiger-Muller counters, 314, 314f film and processing (see Film and
Generators, electric, 37–38, 38f H processing)
Genetically significant dose (GSD), Half-value layer (HVL), 83, 84f, 314, grids and scatter reduction (see
303 363 Grids)
Gradient coils, 278, 278f Half-wave rectification, 52, 52f intensifying screens (see Intensifying
Grid artifact, 178t. See also Grid cutoff Hard copy film, 110, 216 screens)
Grid conversion factor (GCF). See Heat blur, 232 recorded detail
Bucky factor Heat monitors, anode, 68 beam size, 145, 145f
Grid cutoff, 363 Heel effect, 64–65, 65f, 244, 363 distance, 145–146, 146f
crossed grid, 172 Hematologic syndrome, 299–300 focal spot size, 146–149, 148f
focused grid, 170–171 Hemostasis, 350 image receptor, 149, 149t
forms and causes, 178t High voltage components image sharpness, 144, 145f
grid positioning, 174 rectifiers, 52, 52f motion, 149–150
 Index 371

technical factors phosphor crystal x-ray photon inter- image contrast, 275, 275f
distance, 141–143, 142f action, 93, 93f magnetic resonance, 273–274,
exposure time, 140 phosphor materials, 94–95 273f–274f
kilovoltage, 141, 141f purpose, 93 paramagnetic contrast agents,
milliampere second, 140–141, quantum mottle, 97 275–276, 276t
141t radiographic noise, 97 proton density, 274
milliamperes, 140, 140f rare earth screens, 95–96, 96f T1 relaxation time, 274, 274f
optical density, 143–144, 144t screen speed T2 relaxation time, 274, 275f,
tomography K-shell absorption edge, 97 275t
description, 155–156 types, 96–97, 97t Magnetism, 364
exposure angle/amplitude, 157 spatial resolution, 97–98, 98f diamagnetic materials, 21
fulcrum, 156 spectral matching, 95, 95t, 96f ferromagnetic materials, 21, 21f
object/focal plane, 156, 158f Inverse square law, 20, 23, 363 laws of magnetism, 22–23, 23f
principles, 158, 160f Involuntary motion, 150 magnetic fields, 21–22, 22f
section interval, 158 Ion chambers, 314 magnetic induction, 23
section thickness, 157, 159f nonmagnetic materials, 21
tomographic angle/amplitude, J paramagnetic materials, 21
156–157, 158f Justice, 339 units, 23
types, 159 Magnification, 191–192, 191f, 364
Image intensifier, 363 L beam angulation, 153–154
anode, 189, 189f Larmor frequency, 272–273, 273t mammography, 248–249, 248f
electrostatic lenses, 188, 188f Laser localizer, 235 object-to-image receptor distance,
input phosphor, 188 Laser printer, 110 151, 151f
output phosphor, 189, 189f Latent image, 104, 104f, 364 shape distortion, 153, 154f
photocathode, 188 Lethal dose (LD50/30), 297 size distortion, 151–152, 152f
tower, 186, 187f Leukemia, 302 source-to-image receptor distance,
Image quality Libel, 340 151
contrast, 192 Light spots, 232 tube angle direction, 155, 155t
distortion, 192–193 Line focus principle, 64, 65f, 364 Malpractice, 341
magnetic resonance imaging, 280 Line of gravity, 354 Mammography
quantum mottle, 193 Linear energy transfer (LET), 290–291, ancillaries, 245f
resolution, 192 291f automatic exposure control,
Image reconstruction, 265, 265f–266f Linearity, 235 246–247, 247f
Image resolution, 192 Lodestones, 21 breast compression, 245–246, 246f
Imaging techniques Luminescence, 95, 364 cassettes, 247, 247f
computed tomography (see Com- film processing, 248
puted tomography) M film/screen combinations,
digital imaging (see Digital imaging) Magnetic field strength, 280 247–248
fluoroscopy (see Fluoroscopy) Magnetic resonance imaging grids, 246
magnetic resonance imaging (see equipment resolution, 248
Magnetic resonance imaging) computer, 279 screens, 247
mammography (see Mammography) display console, 279 breast imaging, 241
quality control (see Quality control) gradient coils, 278, 278f digital, 248f, 249
Indexing, 261 magnets, 276–277, 277f exposure factors, 244–245, 245f
Induction motors, 40 operating console, 279 film, 109, 109f
Infiltration, 350 patient support table, 278–279 historical perspective, 241
Insulators, 31 shim coils, 278 magnification, 248–249, 248f
Intensifying screens surface coils, 278, 279f quality control, 236, 236t
construction, 93–94, 94f–95f hazards, 281 x-ray tube, 242, 242f
CR cassette, 93, 93f image quality, 280 anode, 242–244, 243f
film/screen cassettes proton alignment, 272–273, cathode, 242, 242f
cassette care, 99 272f–273f filtration, 244, 244f
film/screen contact, 98, 98f RF shielding, 280 focal spot sizes, 244
standard sizes, 98, 98t signal production heel effect, 244
372 Index

Medical and professional ethics CT, 234, 364 pregnancy, 329

ethical judgments and conflicts, digital imaging, 208 radiation exposure to staff
338–339 radiographic, 97 basic principles, 322–324, 324f
ethical principles, 339 Nonmaleficence, 339 patient immobilization, 326–327
legal aspects protective apparel, 324–326,
malpractice prevention, 341 O 325f–326f, 325t
Tort law, 340–341 Occupancy factor, 313 proximity to radiation, 326
morals and ethics, 337 Occupationally exposed workers, 321 Patient care
patient records, charting, and Off-focus radiation, 65, 66f, 364 body mechanics, 354, 354t, 355f
medical history, 341–342 Ohm’s law, 34, 34f medical and professional ethics (see
patient rights and responsibilities, Opacity. See Cataracts Medical and professional ethics)
339–340 Optical density (OD), 105–107, 106f, medication (see Medication admin-
radiography 106t, 364. See also Contrast istration)
practice standards, 336–337 AEC (see Automatic exposure patient transfer
professional organizations, 336 control) cart/stretcher transfers, 355–356
professionalism, 336 formula, 123 wheelchair transfers, 355
training and education, 336 image formation, 143–144, 144t vital signs (see Vital signs)
standards, 337–338 influencing factors Patient radiation dose
Medical record, 342 beam restriction, 126 CT quality control, 235, 235t
Medication administration body part thickness, 126–127 pediatric considerations, 328–329
contrast media filtration, 126 radiation dose during diagnosis, 328
diagnosis, 350 grids, 127 radiographic techniques, 327
ionic vs. nonionic contrast media, image receptor, 128 repeat radiographs, 327
351 kVp, 125, 125f shielding devices, 327–328
precautions, 351–352 SID, 125–126, 127f Penetrometer, 105, 105f
reactions, 352, 352t optical densitometer, 123f Permanent magnets, 276
needle technical factors affecting, 124, 124f Personnel monitors
angiocath needle, 348, 348f Optically stimulated luminescence film badge dosimeters, 315
insertion, 348–349, 349f (OSL), 316 optically stimulated luminescence,
straight steel needle, 347–348, 348f Oxygen effect, 292 316
winged needles, 348, 348f Oxygen enhancement ratio (OER), 293 pocket dosimeters, 316
rights, 347 thermoluminescent dosimeters, 315,
syringes, 349, 349f P 315f
venipuncture (see Venipuncture) Pair production, 87, 87f, 364 variety, 314, 315f
Meiosis, 289, 289f Parallel grids, 169, 170f, 364 Phantom images, 232
Metal artifacts, 266, 266f Paramagnetic contrast agents, 275–276, Phosphor
Minification gain, 190, 364 276t CCD detector, 249
Mitosis, 288–289, 289f Partial body irradiation effects, 301, layer, 94
Mobile C-arm fluoroscopy, 199, 199f 301f materials, 94–95
Motion artifacts, 266, 280 Partial volume effect, 266–267 Phosphorescence, 95, 364
Motors, electric, 38–40, 39f–40f Patient and personnel exposure Photodisintegration, 87, 88f
Moving grids reduction Photoelectric effect, 84–85, 85f, 364
advantages, 172–173 ionizing radiation exposure atomic number, 85–86, 85f
disadvantages, 172 ALARA, 322 x-ray energy, 86, 86f
reciprocating and oscillating grids, 172 dose limit regulations, 322, 323t Photomultiplier (PM) tube, 260
Multiformat film, 110 effective dose, 321, 321t–322t Photon, 19
Multisection/multislice computed occupationally exposed workers, Photopic vision, 185
tomography (MSCT), 257–258, 321 Photostimulable storage phosphor
257f–258f patient radiation dose (PSP) imaging plate, 212
Mutual induction, 37, 38f pediatric considerations, 328–329 Picture archiving and communications
radiation dose during diagnosis, 328 system (PACS), 216
N radiographic techniques, 327 Pitch, 257
Negligence, 341 repeat radiographs, 327 Pocket dosimeters, 316
Noise shielding devices, 327–328 Power, electric, 35
 Index 373

Precession, 272, 272f–273f linear, quadratic dose-response equipment regulations

Pregnancy and radiation, 302–303 model, 296, 296f beam alignment, 309
10-day rule, 329 nonlinear dose-response model, collimator, 309, 309f
fetal dose, 329 296, 296f exposure reproducibility, 310
pregnant radiographer, 329 nonstochastic effects, 294 exposure switch, 310
Primary radiation, 312, 313f parts, 293–294, 294f fluoroscopic equipment, 311–312,
Processor quality control stochastic effects, 294 311f–312f
image artifacts genetic effects, 303 mA station linearity, 310
exposure artifact, 228–229, 229f high-dose radiation effects mobile radiography units, 310
handling artifacts, 229–230, 230f final stage, 299 positive beam limitation, 309,
processor artifacts, 230–231, 231f latent period, 298 310f
processor cleaning and maintenance, manifest stage, 298–299, 298f protective x-ray tube housing,
231 prodromal stage, 298 309
processor monitoring, 228, 228f human biology source-to-image receptor distance
quality assurance factors, 227t DNA, 287–288, 287f (SID) indicator, 309
Protective apparel RNA, 288 total filtration, 310
drapes and Bucky tray, 324 late somatic effects, 301–302 radiation detectors
lead aprons, 325–326, 325f–326f partial body irradiation effects, 301, gas-filled detectors, 314, 314f
types, 325t 301f monitoring period, 316
wrap around, 326 pregnancy, 302–303 personnel monitors, 314–316, 315f
Protective coat, 94, 95f tissues and organs scintillation detectors, 314
Proton alignment, 272–273, Bergonie and Tribondeau law, 290 room shielding
272f–273f cell damage, 291–292 half-value layer, 314
Proton density, 274 direct and indirect effects, 292 primary barriers, 312, 313f
linear energy transfer, 290–291, protective barrier thickness consid-
Q 291f erations, 313–314
Quality assurance, 365 radiation sensitivity, 290t secondary barriers, 312–313
Quality control, 365 radiation weighting factors, 291t Radiation units, 3, 4t
computed radiography, 231–232 radiolysis of water, 292–293, 293f Radioactivity, 3
computed tomography (see radiosensitivity factors, 292, 292f Radiofrequency (RF) pulse, 273, 273f
Computed tomography) relative biological effectiveness, Radiofrequency (RF) shielding, 280
fluoroscopy (see Fluoroscopy) 291, 291t Radiographic contrast. See Image
mammographic, 236, 236t target theory, 293 contrast
processor (see Processor quality whole body radiation exposures Radiographic noise, 97
control) central nervous system syndrome, Radiographic quality control
protective apparel, 234 300–301 angle accuracy, 225
radiographic (see Radiographic dose levels, biologic effects, 299t, automatic exposure control, 226
quality control) 300f cassette cleaning, 225–226
tomography (see Tomography) gastrointestinal syndrome, 300 collimation, 222–223
Quanta. See Photon hematologic syndrome, 299–300 exposure linearity, 225, 225t
Quantum mottle, 97, 193, 232, 365 Radiation detectors exposure reproducibility, 224, 224t
array, 259 exposure time, 224, 224f
R gas-filled ionization detectors, filtration, 223–224
Radiation biology 260–261, 261f focal spot/spatial resolution
cell proliferation rotating detector system, 259 measurement, 222, 223f
cell cycle phases, 288t scintillation detectors, 260, 260f intensifying screens, 225
meiosis, 289, 289f solid-state detectors, 261, 261f kVp accuracy, 223, 224f
mitosis, 288–289, 289f Radiation dose, 245. See also Patient periodic monitoring, 222, 223t
cell survival curve radiation dose; Staff radiation SID and centering accuracy, 225
dose-response models, 295 dose viewbox illumination testing, 225
gonadal effects, 297 Radiation protection and regulations. Radioisotopes, 10, 365
LD50/30, 297, 297t See also Patient and personnel Radiolucent, 83
linear dose-response model, exposure reduction; Radiation Radiolysis of water, 292–293, 293f
295–296, 295f biology Radiopaque, 83
374 Index

Radiosensitivity Star artifacts. See Metal artifacts U

age, gender, and metabolic rate, 292, Static electricity, 23 Use factor, 313–314
292f Stationary grids, 172
cells, tissues, and organs, 290t Step-down transformers, 51–52, 51f, 365 V
linear energy transfer, 290–291, 291f Step-up transformers, 50–51, 50f, 365 Venipuncture
relative biological effectiveness, 291, Superconducting magnets, 276–277, 277f injection, 350
291t Superconductors, 31, 366 sites, 349–350, 350f
Rare earth screens, 95–96, 96f Surface coils, 278, 279f skin preparation, 350, 351f
Reciprocity law, 140, 365 Veracity, 339
Rectifiers, 52, 52f T Videocassette recording (VCR), 198
Reflective screen, 94, 94f T1 relaxation time, 274, 274f Vital signs
Relative biological effectiveness (RBE), T2 relaxation time, 274, 275f, 275t blood pressure, 352–353, 353f
291, 291t Table increment accuracy, 235 body temperature, 354
Repulsion–attraction Tachycardia, 353 pulse rate, 353, 353f
electric charges, 25, 26f Tachypnea, 353 respiration rate, 353–354
magnets, 22, 23f Target theory, 293 Voluntary motion, 149
Ribonucleic acid (RNA), 288 Temporary hair loss. See Epilation Voxel, 259, 260f
Ring artifacts, 267, 267f 10-day rule, 329
Ripple, 54, 55t Tenth-value layer (TVL), 314
W
Rod vision, 185 Thermoluminescent dosimeters (TLD),
Wheelchair transfers, 355
315, 315f
Whole body radiation exposures,
S Thin-film transistor (TFT), 215, 366
299–301
Scatter reduction techniques. See also Threshold dose, 297
Workload, 313
Grids Timing circuits, 55
air gap technique, 179, 179f Tissue interactions, 82, 82f, 83
radiographic contrast improvement, Tomography, 366 X
167 description, 155–156 X-ray beam hardening, 77
Scintillation detectors, 260, 260f, 314 exposure angle/amplitude, 157 X-ray interactions
Scotopic vision, 185 fulcrum, 156 attenuation, 83–84, 83f, 84t
Screening mammography, 241 object/focal plane, 156, 158f half-value layer, 83, 84f
Secondary radiation, 312–313 principles, 158, 160f types
Selenium flat panel, 249 quality control coherent scattering, 84, 84f
Semiconductors, 31 resolution, 227 Compton scattering, 86–87,
Sensitivity speck, 104 section depth indicator, 227 86f–87f
Sensitometry, 105, 105f, 365 section thickness, 227 pair production, 87, 87f
Shadow shields, 328 uniformity and completeness, tube photodisintegration, 87, 88f
Shielding devices, 327–328 motion, 226–227, 227f photoelectric effect, 84–86,
Shim coils, 278 section interval, 158 85f–86f
Signal-to-noise ratio (SNR), 208. section thickness, 157, 159f X-ray photon energy, 82–83
See also Noise tomographic angle/amplitude, X-ray production
Skin entrance exposure, 328 156–157, 158f beam quality and quantity
Slander, 340 types, 159 filtration, 77, 77f
Slice thickness, 235 Tort law, 340–341 intensity and average energy, 75, 75f
Solid-state detectors, 261, 261f Transformers kVp, 76, 76f
Spatial resolution, 97–98, 98f, 144, 235 components, 47, 47f mA, 76, 77f
Spectral matching, 95, 95t, 96f formulas, 48 time, 76
Sphygmomanometer, 352, 353f transformer cores, 48–49, 49f x-ray circuit waveform, 77, 77f
Spot filming, 198, 198f transformer efficiency, 48 x-ray spectra, 76, 76t
Staff radiation dose transformer law, 47–48 bremsstrahlung interactions, 73–74,
basic principles, 322–324, 324f types 73f–74f
patient immobilization, 326–327 autotransformer, 49–50, 50f characteristic interactions, 74–75, 75f
protective apparel (see Protective step-down transformer, 51–52, 51f x-ray interactions (see X-ray
apparel) step-up transformers, 50–51, 50f interactions)
proximity to radiation, 326 Tube rating charts, 66, 66f x-ray tubes (see X-ray tubes)
 Index 375

X-ray spectra, 76, 76f cathode tube housing, 61, 61f

bremsstrahlung, 74 filament, 62, 62f tube life and warm-up procedures,
factors influencing, 76t filament current, 62 68–69, 68f
X-ray tubes, 186, 187f focusing cup, 62, 63f tube rating charts and cooling curves
anode focal spot blooming, 66 anode cooling curves/charts,
heat monitors, 68 glass envelope, 61–62 67–68, 67f
materials, 63, 63f heel effect, 64–65, 65f housing cooling charts, 68
rotating anode, 63–64, 63f line focus principle, 64, 65f radiographic tube rating charts,
target area, 64, 64f off-focus radiation, 65, 66f 66, 66f